Instruction: Generate impression based on medical findings.

Input: Known left breast ADH underwent a recent MRI that showed areas of non-Mass enhancement in the left upper outer quadrant with sonographic correlate. Left ultrasound re-identified the target lesion for biopsy. The lesion to be targeted is a hypoechoic area measuring 28 x 10 mm at the 1 o’clock position with increased vascularity, 1 cm from the nipple. The lesion was readily visible.PROCEDURE: The procedure and its risks, including bleeding, infection, and failure to diagnose, and expected benefits of ultrasound-guided core biopsy with percutaneous placement of a marking clip and post-procedure unilateral mammogram were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time-out form was completed to confirm patient identity and side/type of procedure.The left breast was cleansed with chlorhexidine over the target area. Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially, with 1% lidocaine with 1:100,000 epinephrine at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a inferolateral to superomedial approach, eight 12-gauge core needle (Suros) specimens were obtained of the lesion. Targeting was judged very good. Specimens were radiographed with digital magnification technique. 5 cores showed calcifications, segregated into 10% formalin container #1, and labeled "left breast with calcifications." The remaining core specimens were placed into formalin container #2, "left breast without calcifications." They were sent to pathology for histologic evaluation with an accompanying history sheet.Specimens were sent to Pathology with an accompanying history sheet. Using continuous ultrasound-guidance a Hydromark clip was placed into the lesion in the usual manner. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. Post-procedure digital left CC and ML views revealed the percutaneously placed clip to be in the expected location at 1 o'clock position, 17 mm medial from the previous biopsy clip. No evidence of hematoma or other complication.Right unilateral mammogram CC and ML views were performed to locate the percutaneously placed clip from MRI guided biopsy which had been performed earlier. The clip is placed at 12 o'clock position with no evidence of any complications due to the procedure.A pressure dressing was positioned over the biopsy site and an ice pack positioned over the pressure dressing. Post-procedure instructions were reviewed with the patient both verbally and in writing. She tolerated the procedure well with no evident complications and left the Breast Imaging Department in stable condition.The procedure was performed by Dr. Abe.

Output: Successful ultrasound-guided core biopsy of the left breast lesion and clip placement. Pathology is pending at this time.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on medical findings.

Input: 78-year-old male with a history of hypertension, hyperlipidemia, paroxysmal nocturnal dyspnea, coronary artery disease with PCI of ostial right coronary artery, now with ostial left anterior descending disease. MRI evaluation prior to PCI of ostial LAD versus TECAB of LAD.MEDICATIONS: Aspirin, clopidogrel, isosorbide mononitrate, losartan, metoprolol, simvastatin. First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 73%, the LV end diastolic volume index is 57 ml/m2 (normal range: 74+/-15), the LVEDV is 100 ml (normal range 142+/-34), the LV end systolic volume index is 16 ml/m2 (normal range 25+/-9), the LVESV is 28 ml (normal range 47+/-19), the LV mass index is 33 g/m2, and the LV mass is 58 g. There are no regional wall motion abnormalities present. Stent artifact is noted in the mid right coronary artery.Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 56%, the RV end diastolic volume index is 64 ml/m2 (normal range 82+/-16), the RVEDV is 112 ml (normal range 142+/-31), the RV end systolic volume index is 28 ml/m2 (normal range 31+/-9), and the RVESV is 49 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. 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.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 FindingsHepatic cyst 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. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 73%).4. Normal RV size and systolic function (RVEF 56%).5. Mild mitral regurgitation6. Moderate left atrial dilation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: History of prostate cancer. 3+3 right mid medial, 3+3 right Apex medial dated 6/25/2013. PELVIS:PROSTATE:Prostate Size: 2.8 x 5.3 x 5.0 cmPeripheral Zone: No discrete T2-weighted hypointense or restricting lesion to suggest neoplasm. Non-specific linear foci of T2-weighted and ADC hypointensity.Central Gland: There is a large T2 hypointense lesion in the transition zone extending from the apex to the base with abnormal restricted diffusion and avid enhancement with washout. The lesion is best delineated on the restricted diffusion images were measures 2.0 x 2.6 cm (series 604/284). Using similar measurement technique the lesion previously measured 1.7 x 2.6 cm (series 902/324). The lesion appears to extend into a prominent median lobe.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: The lesion bulges the anterior margin of the prostate.BLADDER: No significant abnormality noted.LYMPH NODES: Small nonspecific external iliac lymph nodes measuring less than 1 cm in short axis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Large transition zone lesion has not demonstrated significant interval change. Carcinoma cannot be ruled out. This lesion would be amenable to MRI/TRUS fusion biopsy.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Memory loss. Evaluate for chronic vascular changes. Non-infused head CT:Images through posterior fossa again identify a right-sided cerebellopontine angle extra axial primarily fatty density mass measuring 14.7 x 11.6-mm in size. There is no appreciable interval change in the size or morphology of this lesion. Finding likely present a lipoma however an MRI examination is recommended for more precise evaluation. Images through posterior fossa are otherwise unremarkable.Anatomical variation of partially empty sella is also again identified with no change.Images supratentorial space demonstrate diffuse patchy areas of low attenuation in the subcortical and periventricular white matter of bilateral cerebral hemispheres. Although nonspecific these findings however are often result of small vessel ischemic strokes. These findings were present on prior exam and precise comparison is not possible.There is no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus. Calvarium is intact. Visualized orbits, mastoid air cells and middle ear cavities are unremarkable.Limited images of the paranasal sinuses again demonstrate complete opacification of right chamber of the sphenoid sinus with no change since prior examination from 2008.

Output: 1.Small vessel disease of indeterminate age.2.Revisualization of complete opacification of right chamber of sphenoid sinus.


Instruction: Generate impression based on medical findings.

Input: 51-year-old woman with biopsy-proven right upper-outer quadrant breast cancer presents for second look ultrasound for indeterminate right mass and left focus identified on staging MRI. A targeted right ultrasound was performed area of clinical concern. In the right breast 3:00 position 3 cm from the nipple, there is a mixed echogenicity mass with mild internal and apical vascularity, correlating to the mass seen on MRI. This mass measures 1.0 x 0.5 x 1.0 cm and is indeterminate. An ultrasound core biopsy is recommended.A targeted left ultrasound was performed for the area of the focus deep to the nipple. In the left breast periareolar region, unremarkable fibroglandular tissue is seen. No discrete solid or cystic masses are identified to correlate with the finding on MRI.

Output: (1) Indeterminate right breast 3:00 position mass measuring up to 1.0 cm, correlating to the area of clinical concern identified on MRI. An ultrasound-guided core biopsy is recommended. This will be performed today and reported under a different accession.(2) No sonographic correlate to enhancing focus identified in the left periareolar region on MRI.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.


Instruction: Generate impression based on medical findings.

Input: Rule out bleed or acute change. Signs and symptoms: Encephalopathy. No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Cortical sulci, ventricular system and all CSF cisterns remain within normal range for patient's stated age of 69. Large vessel intracranial vascular calcification. Calvarium, paranasal sinuses and mastoid air cells are unremarkable. If clinical concern persist an MRI is recommended.

Output: Negative CT of brain without infusion.


Instruction: Generate impression based on medical findings.

Input: 40 years, Female, increased headache, history of generalized epilepsy. Brain parenchyma appears within normal limits. No significant parenchymal T2/FLAIR signal abnormality. No evidence of cortical dysplasia, gray matter heterotopia, or other lesions to suggest seizure focus. Bilateral hippocampi are symmetric in size and signal characteristics with preserved internal architecture. Cerebellar tonsils are borderline low measuring up to 4 mm below the foramen magnum without evidence of Chiari malformation. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass effect, midline shift, or herniation. The ventricles are within normal limits in size and configuration. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. MRI brain is essentially unremarkable.2. Borderline low cerebellar tonsils without clear evidence of Chiari I malformation.


Instruction: Generate impression based on medical findings.

Input: Exam obtained for research purposes only. Research scanning of both breasts was performed with the research protocol. The images are stored for research analysis. Formal interpretation was not performed, existing data are not used for clinical purposes.

Output: This study was completed for research purposes only. Formal interpretation was not performed, existing data are not used for clinical purposes.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Abnormality of gait. Dizziness and giddinessClinical question: Episodes of imbalance, vertigo; evaluate cerebellum MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There are a couple punctate foci of signal hypointensity in the left periventricular white matter (one adjacent ot the occipital horn and one adjacent to the body of the lateral ventricle) on susceptibility imaging which most likely represent microhemorrhages.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mild mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is multilevel disk dessication present.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 . There is encroachment of the right exiting nerve roots due to right facet hypertrophy and uncovertebral osteophytes associated with disk material.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.There is a 13x8mm axial dimension T2 hyperintense and T1 hypointense well circumscribed lesion in the posterior and inferior aspect of the right parotid gland.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The right posterior communicating arteries is not readily identified. There is fetal origin of the left PCA. The right vertebral artery is larger than the left vertebral artery.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. The LVA originates from the aortic arch.

Output: 1.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related and likely of little clinical significance.2.A couple microhemorrhages in the periventricular white matter in isolation are likely of little clinical significance.3.There is encroachment of the right sided exiting nerve roots at C4-5 due to degenerative changes.4.There is no evidence for carotid or vertebral dissection.5.There is not evidence for intracranial or extracranial cerebrovascular occlusive disease.6.A right parotid gland lesion is present which has a relatively benign appearance. Please correlate with clinical exam. If appropriate follow-up imaging may be helpful. This is an incidental finding.


Instruction: Generate impression based on medical findings.

Input: 30 years Female (DOB: 10/14/1985)Reason: MS; f/u progression History: paresthesiasPROVIDER NAME: ADIL JAVED ADIL JAVED MRI brain:There is redemonstration of multiple periventricular and subcortical white matter lesions as well as scattered in the cerebellum and brainstem. Some of the lesions are perpendicularly oriented to the lateral ventricles some extend into the corpus callosum. Compared to the prior exam from March these do not appear to have changed substantially. Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate an air-fluid level in the right maxillary sinus and a minor opacity in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:There are patchy foci of signal hyperintensity throughout the cervical spinal cord compared to 3/7/2016 exam these have not changed substantially in extent. Differences in the magnet used for differences conspicuity of lesions.The cervical vertebral bodies are appropriate in overall alignment and height. No abnormal enhancing lesions are identified in the cervical spine. There is a noted enhancing punctate focus in the spinal cord at the C2 level is not identified on the current exam.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.Periventricular and subcortical white matter lesions as well as lesions in the brainstem and corpus callosum appear to be stable compared to the prior exam.2.Accounting for differences in MRI technique lesions identified in the cervical spinal cord also appear to be stable. A previously noted punctate focus of enhancement within the upper cervical spinal cord does not enhance on the current exam.3.Please note that because this is not an MRI of the orbits previously noted prechiasmatic left optic nerve enhancement would not be readily detected.


Instruction: Generate impression based on medical findings.

Input: 27 years Female (DOB:8/26/1988)Reason: evaluate for lumbar pathology - please view full SI joints History: refractory lower back painReferring Attending: REEM H JAN Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. No abnormal enhancing lesions are appreciated in the lumbar spine.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: No compromise to lumbar spinal canal or neural foramina.


Instruction: Generate impression based on medical findings.

Input: 87-year-old female status post fall with an elevated INR. Please evaluate for acute intracranial hemorrhage. There is no evidence of intracranial hemorrhage. As a parafalcine high attenuation mass with a broad based dural connection measuring 2.9 x 2.0 cm transaxial at the posterior superior aspect of the right lateral ventricle consistent with a meningioma.Scattered areas of periventricular and subcortical low attenuation consistent with small vessel ischemic disease of indeterminate age.There is asymmetry in the size and configuration of the lateral ventricles, larger on the left. The possibility of a arachnoid cyst at the level of the left foramen of Monroe is a consideration further evaluation with MRI is recommendedThe calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Right posterior parafalcine meningioma as detailed above.2. Possible intraventricular arachnoid cyst at the level of the left foramen of Monroe. Further evaluation with MRI is recommended.2. Small vessel ischemic disease of indeterminate age.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old, with history of prostate cancer and progressive right upper extremity weakness. Mild reversal of the cervical lordosis is seen. Trace retrolisthesis of C5 relative to C6 is evident. Spinal alignment is otherwise unremarkable.Vertebral body heights are preserved. Endplate degeneration with associated signal abnormality is evident from C5 through T1. Mild degenerative endplate edema is seen at C7 and T1. No other concerning marrow edema or marrow replacement is detected.The visualized spinal cord is free of pathologic signal and mildly. Additional details are as follows by level:C2-3: Left greater than right facet hypertrophy. No significant spinal canal or neuroforaminal stenosis. C3-4: Facet hypertrophy. Mild posterior disc-osteophyte complex formation. Minimal generalized spinal canal stenosis. Moderate right and mild left foraminal narrowing. C4-5: Left facet hypertrophy. No significant spinal canal or neuroforaminal stenosis. C5-6: Facet hypertrophy. Spondylolisthesis and posterior disc-osteophyte complex formation. Mild generalized spinal canal stenosis. Severe bilateral foraminal narrowing. C6-7: Posterior disc-osteophyte complex formation with mild to moderate generalized spinal canal stenosis and mild cord flattening. Severe left and mild right foraminal narrowing. C7-T1: Facet hypertrophy. Posterior disc-osteophyte complex formation. Severe bilateral foraminal narrowing. The paraspinal soft tissues are unremarkable. Incidental note is made of a mildly prominent submental lymph nodes.

Output: Multilevel cervical spondylosis is seen, most severely affecting the C5-C6 through C7-T1 levels. No high-grade spinal canal stenosis is suspected.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Epilepsy, unspecified, not intractable, without status epilepticusClinical question: seizure; evaluate for structural abnormalitySigns and Symptoms: seizure The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.A couple punctate periventricular white matter lesions present which are high signal on T2 and FLAIR MRI and not changed since the prior exam.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some scattered opacities which are unchanged since prior exam. The visualized portions of the mastoid air cells are partially opacified The visualized portions of the orbits are intact. There is somewhat more opacification of the mastoid air cells on the current exam when compared to the previous exam.Incidental note is made of partial empty sella finding which was previously present as well.

Output: 1.No abnormal mass lesions or other lesions are identified intracranially to explain the patient's seizures. MRI of the brain is age-appropriate.2.Opacification of mastoid air cells is nonspecific but could be related to retained secretions. It is somewhat more evident on the current exam when compared to the prior


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Muscle weakness (generalized)Clinical question: cervical disc diseaseSigns and Symptoms: hyperreflexia on the left and weakness on the right The cervical vertebral bodies are appropriate in overall alignment and height. There is reversal of the normal cervical curvature present. There is multilevel disk dessication present. Findings raise the question of a punctate signal hyperintensity in the spinal cord at the C3-4 level (image #7 sequence 4) which cannot be confirmed on axial imaging due to motion artifact.The exam is partly compromised due to patient motion.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is a disk bulge at this level.At C3-4 there is a diffuse disk bulge present associated with effacement oof spinal fluid ventral and posterior to the spinal cord and mild flattening of the spinal cord. There is some narrowing of the neural foramina at this level.At C4-5 there is a diffuse disk bulge present associated with effacement oof spinal fluid ventral and posterior to the spinal cord and mild flattening of the spinal cord.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a disk bulge present at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. The left vertebral artery is very small.

Output: 1.The exam is partly compromised due to patient motion which may obscure more subtle abnormalities.2.There are disk bulges at C3-4 and C4-5 with moderate spinal stenosis (worse at C3-4). A punctate focus of signal change in the cord at C3-4 is of unclear significance due to patient motion.


Instruction: Generate impression based on medical findings.

Input: H/o unknown primary with widely metastasis. Examination demonstrates diffuse bony destruction in the thoracic and lumbar spine as well as sacrum with loss of vertebral body height in T2, T12, L1 and L2. It appears that the spinal canal narrows at Levels T2 and L1. Please refer to spine MRI for details of cord compression. Specifically, there is bony destruction in the C7, T1-7, T9-L3, and L5 vertebral bodies and sacrum, in which posterior element destruction is seen in the C7-T3, T12-L3 and L5, and rib destruction is seen at levels T1-T3 and T7. Bilateral effusion is also noted.

Output: Diffuse metastatic disease in the thoracic and lumbar spine as detailed above. spinal canal stenosis at levels T2 and L1, please refer to spine MRI for details of cord compression.


Instruction: Generate impression based on medical findings.

Input: 51 years, Female, memory loss, evaluate for structural lesion No intracranial mass or mass-effect. Scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Brain parenchyma is otherwise unremarkable for age. No abnormal parenchymal or meningeal enhancement. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. The ventricles are within normal limits in size and configuration. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are grossly clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: MRI of the brain is within normal limits for age.


Instruction: Generate impression based on medical findings.

Input: 80-year-old female patient with pancreatic adenocarcinoma and liver lesion seen on outside CT. ABDOMEN:LIVER, BILIARY TRACT: There are two T2 hyperintense, arterially enhancing foci in the right lobe of the liver corresponding to the lesions seen on prior CT. A lesion in the dome of the liver measures 7 x 7 mm and contains minimal enhancement on venous phase imaging. The peripheral, mildly wedge shaped focus in segment seven measures 10 x 7 mm and does not enhance on venous or delayed phase imaging. There is mild perihepatic fluid.SPLEEN: There is mild perisplenic fluid.PANCREAS: Corresponding to the prior CT findings, again seen is an ill-defined soft tissue lesion in the body of the pancreas with soft tissue encasement of the celiac axis and the superior mesenteric artery. The superior mesenteric vein was attenuated on the prior CT and is not well seen on the current study, likely representing occlusion. There are at least five peripancreatic fluid and hemorrhage containing collections about the tail of the pancreas. The largest collection anteriorly is mildly increased in size compared to prior CT and measures 8 x 4.4 cm (series 601 image 186), previously 7.6 x 3.6 cm.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: 1.Lesion in the dome of the liver most likely represents a hemangioma, while the posterior peripheral focus in the liver most likely represents a perfusional anomaly. No metastatic hepatic lesions are seen.2.Soft tissue mass in the body of the pancreas compatible with known adenocarcinoma. 3.There is peripancreatic soft tissue encasement of the celiac axis and superior mesenteric artery as well as likely interval focal occlusion of the superior mesenteric vein.4.Multiple fluid and hemorrhage containing collections about the distal pancreas, the largest of which has slightly increased in size compared to prior CT.


Instruction: Generate impression based on medical findings.

Input: There has been significant interval reduction in size of a pineal region mass now measuring 17 mm AP x 14 mm transverse x 14 mm craniocaudal (previously 36 x 28 x 26). There has also been associated decrease in regional mass effect, and previously demonstrated ventricular dilatation is now nearly normalized. Findings of transependymal CSF resorption have decreased. Compared to the recent head CT, again noted is a shunt tract of the right frontal lobe which demonstrates persistent T2 hyperintensity and enhancement, the latter of which is uncertain clinical significance.There is no evidence of intracranial acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. The nasal sinuses and mastoid air cells are clear.

Output: 1.There has been significant interval reduction in size of a pineal region mas2.There has also been associated decrease in regional mass effect, and previously demonstrated ventricular dilatation is now nearly normalized. Findings of transependymal CSF resorption have decreased. 3.Again noted is a shunt tract of the right frontal lobe which demonstrates persistent T2 hyperintensity and enhancement, the latter of which is uncertain clinical significance.


Instruction: Generate impression based on medical findings.

Input: Other malaise [R53.81] / Other fatigue [R53.83], Reason for Study: ^Reason: rule out neoplastic, paraneoplastic process, or CO poisoning History: AMS, fatigue, LOC No evidence of acute ischemic or hemorrhagic lesion on the scan. There is no evidence of abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Normal brain MRI


Instruction: Generate impression based on medical findings.

Input: 55-year-old male with history of chronic pancreatitis and abdominal pain. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, signal intensity and enhancement without biliary ductal dilatation focal suspicious lesion or vascular abnormality. The posterior right hepatic bile duct inserts directly onto the common hepatic duct distal inferior to the junction of the anterior right hepatic bile duct and left hepatic bile duct, a normal variant.SPLEEN: No significant abnormality noted.PANCREAS: Pancreas divisum. Mildly decreased intrinsic T1 weighted signal intensity of the pancreas may reflect parenchymal dysfunction possibly from chronic pancreatitis. The pancreatic parenchyma enhances homogeneously. No peripancreatic inflammatory changes or fluid collections. No arterial or venous complication.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: 1.Pancreas divisum. Mildly decreased intrinsic T1 weighted signal intensity in the pancreas may reflect parenchymal dysfunction possibly from chronic pancreatitis. No evidence of acute inflammation or complication.2.The secretin portion of the examination was not performed.


Instruction: Generate impression based on medical findings.

Input: Liver lesions. Stated history of hepatocellular carcinoma status post TACE/RFA of segment 5 and segment 7/8 (8/11/2014 at OSH). Per EPIC note: Segment 7/8 was HCC; Segment 5 CCA. History of Wilms tumor status post radical right nephrectomy. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology with nodular contour and areas of fibrosis.Segment 5 ablation cavity measuring 2.0 x 1.9 cm (series 11/124) with internal blood products/hemorrhage. Along the anteroinferior margin of the ablation cavity there is arterial enhancement measuring 1.9 x 1.5 cm. This does not appear to progress on delayed imaging or wash-out but rather persists or is iso-intense to the liver parenchyma. There is no definite associated DWI or T2WI signal abnormality. Segment 7/8 radiofrequency ablation cavity measures 2.2 x 1.3 cm (series 11/24). No evidence of residual or recurrent tumor.Several peripheral punctate foci of arterial enhancement without associated washout or other signal abnormality are unchanged and are likely perfusional abnormalities.No new suspicious lesion. The vessels are patent.Normally distended gallbladder. Stable minimal peripheral biliary ductal dilatation of the inferior medial segment of the left hepatic lobe. SPLEEN: The spleen measures 10 cm in length without a focal lesion.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Minimal adrenal nodularity measuring less than 1 cm, unchanged.KIDNEYS, URETERS: Status post right nephrectomy without evidence of residual or recurrent disease in the surgical bed. Subcentimeter left inferior pole simple appearing cyst is unchanged. No hydroureteronephrosis or suspicious lesion.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.Arterial enhancement along the anteroinferior margin of the segment V RFA cavity does not appear to progress on delayed imaging or wash-out but rather persist or is iso-intense. There is no definite associated DWI or T2WI signal abnormality. Given that this lesion was reportedly a cholangiocarcinoma residual/marginal recurrent disease cannot be excluded although a perfusional abnormality is a possibility. Short interval follow-up is recommended if definitive evaluation (biopsy) or treatment is not pursued at this time. 2.Segment 7/8 ablation cavity without evidence of residual or recurrent tumor.3.Cirrhosis with mild fibrotic changes.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old, with history of neurofibromatosis type II, with worsening gait and ataxia. MRI brain and IACs:Findings are redemonstrated compatible with right parietal and bilateral occipital craniotomy. The dura remains diffusely thickened. Superimposed on this are numerous dural based enhancing tumors compatible with meningiomas scattered throughout the intracranial space. These show no significant interval change in size from the prior examination. Some of these lesions are associated with mild parenchymal edema, particularly at the vertex.Enhancing lesions involving both IACs are also redemonstrated compatible with schwannomas. A bulky lesion on the right measures 36 x 26 x 25 mm, previously of similar size when measured in the same manner. This lesion significantly encroaches upon the CP angle cistern and exerts mass effect on the brainstem and pons similar to prior. A much smaller lesion involving the left IAC measures 15 x 6 x 7 mm, unchanged from prior.A small mildly hemosiderin stained surgical cavity or area of encephalomalacia is unchanged along the right middle frontal gyrus. No new intracranial lesions are detected. No new abnormal fluid collections are seen. The ventricles are stable in size and morphology.MRI cervical spine:Numerous small intramedullary enhancing lesions are seen within the cervical spinal cord which appear unchanged in size and number compared to prior exams. A small lesion along the left dorsal surface of the cord at C3 is unchanged as well. A bulky intramedullary tumor at T1 also appears unchanged from the prior exam.At C7-T1, a large extramedullary tumor which may be both intradural and extradural, spanning the right neural foramen, is unchanged in size. This lesion slightly flattens the right ventral spinal cord similar to prior. A bulky left dorsal dural based tumor at T4 is partially visualized.Spinal alignment is anatomic. Vertebral body morphology and signal characteristics are within normal limits. Mild cervical spondylosis is seen with no areas of significant associated spinal canal or foraminal stenosis.A bulky soft tissue mass is partially visualized along the right brachial plexus, as well as another more posteriorly along the right levator scapulae.

Output: 1.No significant interval change in the size of multiple intracranial meningiomas, nor of the bilateral IAC schwannomas. No new intracranial masses are identified.2.Numerous intramedullary lesions are redemonstrated in the visualized spinal cord compatible with primary cord tumors, statistically most likely ependymomas. The lesions show no significant interval change in size or number. Multiple extra-medullary tumors representing a combination of schwannomas and meningiomas are also unchanged.


Instruction: Generate impression based on medical findings.

Input: The cervical and upper thoracic cord are normal in caliber and signal. The cervicomedullary junction is normal. Vertebral body heights and alignment are preserved. There is no evidence of fractures or subluxations. The bone marrow signal is benign. The visualized paraspinal structures are normal.C1/2: The atlantoaxial articulation appears normal.C2/3: There is no significant spinal canal or neural foraminal stenosis.C3/4: There is no significant spinal canal or neural foraminal stenosis.C4/5: There is mild disc bulge with minimal effacement of the anterior subarachnoid space. There is mild right uncovertebral hypertrophy with mild right neural foraminal narrowing.C5/6: There is a right paramedian disc protrusion with moderate narrowing of the spinal canal and severe narrowing of bilateral neural foramina.C6/7: There is a mild disc bulge with mild narrowing of the spinal canal. There is also mild bilateral uncovertebral and facet hypertrophy causing mild narrowing of the bilateral neural foramina.C7/T1: There is no significant spinal canal or neural foraminal stenosis.

Output: 1.Normal signal of the cervical cord without foci of demyelinating disease.2.Degenerative disease as described above with multilevel neural foraminal stenosis and moderate spinal canal stenosis, worst at C5/C6.


Instruction: Generate impression based on medical findings.

Input: Metastatic cancer. There is an enhancing mass that measures up to 15 mm in the right temporal bone squamosal portion. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is nonspecific mild scattered cerebral white matter T2 hyperintensity. There are small chronic lacunar infarcts in the bilateral cerebellar hemispheres. 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, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Right temporal bone metastasis, but no evidence of brain metastases.


Instruction: Generate impression based on medical findings.

Input: Right arm radicular pain with extension of to the neck, assess for cervical spinal instability Cervical vertebral body heights are normal. There is exaggerated cervical lordosis as seen previously. There is mild osseous irregularity involving the cranial aspect of the odontoid process which is minimally progressed since prior study from 2009. There is small amount of fluid at the anterior atlantoaxial joint which is similar to prior. No evidence of cranial settling. Alignment of the craniocervical junction is preserved.Motion degradation slightly limits evaluation. No cord signal abnormality is appreciated. There are moderate multilevel degenerative changes throughout the cervical spine. There is mild progression of endplate degenerative changes at the C6-C7 level compared to 2009.Individual levels as described below:C2-3: No significant compromise to the spinal canal or neural foramina. Left-sided facet arthropathy.C3-4: Small disc bulge and mild bilateral facet arthropathy. No significant compromise to the spinal canal or neural foramina.C4-5: Small disc bulge and bilateral facet arthropathy, relatively worse on the left. No significant compromise to the spinal canal or neural foramina.C5-6: There is a disc osteophyte complex with ligamentum flavum thickening contributing to mild spinal canal stenosis at this level. There is facet arthropathy on the left with which contributes to moderate left and minimal right neural foraminal narrowing C6-7: There is a disc osteophyte complex, ligamentum flavum thickening, and facet arthropathy. There is mild to moderate spinal canal stenosis. There is a moderate to severe right and moderate left neural foraminal stenosis.C7-T1: No significant compromise to the spinal canal. Mild bilateral neural foraminal narrowing. Mild bilateral facet arthropathy.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Multilevel degenerative changes in the cervical spine which have slightly progressed since prior study from 5/18/2009. There is moderate to severe right C6-C7 neural foraminal stenosis which may be contributing to patient's described arm symptoms. Additional levels as above. No high-grade spinal canal stenosis.2. Mild osseous irregularity involving the odontoid process with mild fluid involving the anterior C1-C2 joint. These findings may be related to degenerative disease or history of rheumatoid arthritis and minimally worse since 2009. Craniocervical junction alignment is preserved on the supine MRI. Flexion-extension radiographs however may be helpful to assess for instability.


Instruction: Generate impression based on medical findings.

Input: Stage IV lung cancer now with increasing right lower back pain. Evaluate extent of bone metastases. Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The bone marrow is diffusely heterogeneous which may be secondary to treatment change. In addition, there are multiple T2 hyperintense foci throughout the visualized thoracolumbar spine are compatible with osseous metastases. The largest lesion is incompletely visualized within the posterior T11 vertebral body which extends to partially involve the right pedicle. There are also additional lesion suspicious for metastasis in the posterior superior endplate of the L3 vertebral body, the posterior S1 vertebral body and S3 vertebral body. There is no extraosseous spread of tumor, pathologic fracture or central spinal canal compromise. The conus medullaris on sagittal imaging is grossly intact.T12-L1 through L2-L3: There is no significant compromise to spinal canal or neural foramina.L3-L4: Mild disc disease is noted with evidence of a small midline posterior annular fissure. There is minimal grade 1 retrolisthesis of L3 on L4 which causes mild to moderate right and mild left neural foraminal stenosis as well as mild central canal stenosis.L4-5: Mild disc disease is noted with a tiny linear T2 hyperintense signal within the posterior annulus of the disc compatible with a fissure. There is mild bilateral facet hypertrophy with small facet joint effusions as well as moderate bilateral ligamentum flavum thickening. This causes mild central canal stenosis. There is also moderate bilateral right greater than left neural foraminal stenosis as well as bilateral lateral recess compromise which may impinge the L5 nerve root. A degenerative Schmorl's node is noted in the inferior endplate of L4.L5-S1: No significant disc disease and mild bilateral facet hypertrophy. No neuroforaminal or central spinal canal stenosis.Two enhancing lesions are noted within the left iliac wing compatible with metastases.

Output: 1.Metastatic osseous lesions involving several lower thoracic and lumbosacral vertebral levels as well as the left iliac wing.2.Multilevel degenerative changes as described above, most severe at the L3-4 and L4-5 levels.


Instruction: Generate impression based on medical findings.

Input: Surveillance scan for cancer. History of squamous of carcinoma of the scalp with cervical nodal metastasis. Status post surgery and chemoradiation. Developed recurrence in left cervical lymph nodes. Currently on induction chemotherapy. There are findings related to previous left neck dissection and flap reconstruction. The multilobulated tumor recurrence deep to the flap seen on the previous MRI has regressed in size and is more difficult to discern from the overlying flap. Transaxially, it now measures 28 mm x 9 mm compared to 42 mm x 19 mm previously. Additionally, the metastatic soft tissue nodule superficial to the flap at the level of C6 has also regressed, now measuring up to 15 mm, previously measured 21 mm. There is a smaller soft tissue nodule more superiorly just deep to the posterior edge of the flap, which is also smaller, now measuring up to 9 mm compared to 18 mm previously. Otherwise, there is underlying posttreatment soft tissue thickening but no new mass lesions. There is no new cervical lymph node enlargement.Vascular dilatation at the left carotid bifurcation/bulb is unchanged. The airway is patent. Asymmetry at the level of the larynx remains and is probably in part due to prior medialization laryngoplasty.Well-circumscribed focus of T2-hyperintensity in the left mandibular body has not changed and may represent posttreatment change.Multilevel degenerative cervical spondylosis present is unchanged and results in only mild spinal canal stenosis but left more than right lower cervical neural foraminal stenoses.Included brain shows unchanged right frontal encephalomalacia and brain volume loss. Small retention cysts are present in the right maxillary sinus.

Output: 1.Since the previous MRI from March 2016, there has been further regression of multiple left cervical soft tissue masses, most probably representing lymph node metastases.2.Other posttreatment findings remain unchanged since the prior examination.


Instruction: Generate impression based on medical findings.

Input: 18 year old male with a small mass for 9 months also seen on recent ultrasound examination. A marker was placed along the volar and medial aspect of the mid to distal forearm at the site of the palpable abnormality. We suspect that there is a small subcutaneous fatty mass deep to the marker that measures no more than 8 mm in the greatest transverse dimension and approximately 1.5 cm in the longitudinal dimension, however, accurate measurement is difficult to obtain due to lack of inherent contrast with the surrounding subcutaneous fat. There is no enhancement of this mass or the surrounding area. We see no additional masses. The signal intensity of the musculature of the forearm is normal. The bone marrow signal intensity is normal.

Output: Small subcutaneous lipoma of the left forearm.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old, with right-sided hyperreflexia and weakness. Assess for cord compression versus nerve root compression. Brain:Diffusion-weighted images are within normal limits. A small linear focus of T2 hyperintensity is evident within the brainstem at the pontomedullary junction, actually best appreciated on sagittal spine views. No evidence of edema or mass effect is seen. No acute intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. The ventricles are normal in size and morphology.C-spine:Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or edema is seen.The visualized spinal cord shows normal signal intensity throughout. No epidural abnormalities are suspected.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Facet arthropathy is evident on the right. A small expansile cystic lesion noted on prior CT within the C4 superior articulating process is T2 hyperintense. Minimal posterior disc-osteophyte complex formation is seen. No significant spinal canal stenosis. Severe right foraminal narrowing with possible nerve root impingement. C4-5: Posterior disc-osteophyte complex formation asymmetric to the right paracentral zone which impinges upon and mildly deforms the spinal cord. No cord signal abnormality. Mild left foraminal narrowing. C5-6: Posterior disc-osteophyte complex formation with central focality which mildly impinges upon the spinal cord. No cord signal abnormality. Mild left foraminal narrowing. C6-7: Minimal posterior disc-osteophyte complex formation. No significant spinal canal or foraminal stenosis. C7-T1: Facet arthropathy. No significant spinal canal or foraminal stenosis.

Output: 1.No acute lesions are evident in the brain. Note is made of a small T2 hyperintense focus within the brainstem at the pontomedullary junction for which there is no correlation on prior CTA. This finding is nonspecific and could reflect a small chronic ischemic lesion or gliosis from prior inflammation or injury.2.Multilevel cervical spondylosis is demonstrated in the cervical spine. This is most notable at C4-5 and C5-6 where disc osteophyte complexes also impinge upon the spinal cord. At C3-4, significant facet arthropathy is evident on the right with probable degenerative cyst formation. This results in a severe stenosis of the neural foramen and possible nerve root impingement.


Instruction: Generate impression based on medical findings.

Input: 57-year-old male with headache. Evaluate for stroke. Foci of hypoattenuation in the left cerebellar hemisphere compatible with known infarcts seen on MRI. Periventricular hypoattenuating foci are consistent with minimal ischemic small vessel disease, age indeterminate. The cerebral and cerebellar hemispheres and the brain stem are otherwise normal morphologically and have normal CT attenuation. The ventricles are normal volume.No abnormal extra axial fluid collections, mass, intracranial hemorrhage. The calvaria and skull base are radiographically normal. Bilateral opacification of the maxillary sinuses. The mastoid air cells are normally pneumatized.There is no evidence of intracranial hemorrhage, mass or edema. 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: No acute intracranial abnormality. If there is clinical concern for an acute stroke, an MRI may be obtained.


Instruction: Generate impression based on medical findings.

Input: Reason: RUQ pain; hemangioma on CT History: RUQ pain; hemangioma on CT ABDOMEN:LIVER, BILIARY TRACT: Simple cyst in the right hepatic dome as well as in the inferior right hepatic lobe. Segment 7 lesion with peripheral nodular enhancement measures 2.9 x 2.9 cm (3/13), consistent with a hemangioma. No adjacent lesion is present to correspond to hypoattenuation as seen on prior CT.Status post cholecystectomy.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: Postsurgical changes of right hemicolectomy.BONES, SOFT TISSUES: Midline incisional and postsurgical changes.OTHER: No significant abnormality noted.

Output: 1.Right hepatic lesion is consistent with a hemangioma.2.No new findings to account for patient's right upper quadrant pain.


Instruction: Generate impression based on medical findings.

Input: known brainstem lesion interval change, projectile vomiting. No evidence of acute ischemic or hemorrhagic lesion.Multifocal scattered high signal intensities on FLAIR images on bilateral periventricular white matter and centrum semiovale indicate non specific small vessel ischemic disease.There is ovoid shaped lesion on the left dorsal medulla (6mm x 5mm x 5mm) with subtle enhancement on Gad infusion. There is no evidence of surrounding edema. Possible diagnosis of the lesion is likely low grade glioma.There is no other abnormal enhancement on this scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Ovoid subtle enhancing left dorsal medullar lesion without surrounding edema, comparing to out side MR scan on Nov 18 2014, the size and MR characteristics do not show any significant interval change.2. Underlying non specific small vessel ischemic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old, with left arm weakness and right leg decreased pin prick, left arm and left leg weakness with hypotonia/hyperreflexia in the left arm. Brain:One or two scattered foci of T2 hyperintensity are evident within the cerebral hemispheres. No parenchymal edema or mass effect is detected. No restricted diffusion is seen. No pathologic parenchymal or extra-axial enhancement is observed. No evidence of intracranial hemorrhage or abnormal extra-axial fluid collection is seen. The ventricles are normal in size and morphology. A 4 mm focus of enhancement within the left aspect of the occipital bone is nonspecific. Elsewhere, signal characteristics of the marrow are unremarkable. A mucous retention cyst is present in the right maxillary sinus.Cervical spine:A T2 heterogeneous, homogeneously enhancing extra medullary mass is present within the left aspect of the spinal canal centered at C5. This lesion occupies approximately two thirds of the spinal canal and causes significant is compression of the adjacent spinal cord. Edema tracks within the spinal cord from the C3 level down to C7.The tumor itself extends craniocaudally within the spinal canal spanning from the mid C4 to the upper C6 levels. The inferior most margin of this lesion is T2 hypointense which may reflect mineralization or blood product. The lesion extends through the left C4-5 neural foramen, and even tracks for some distance laterally into the paraspinal musculature, likely following the course of the exiting nerve roots. The left vertebral artery abuts this lesion as it passes adjacent to the foramen and may be narrowed but the flow void does seem to be preserved.A small deposit of abnormal enhancing tissue is also seen within the left aspect of the thecal sac at the C4 level. This lesion is perhaps contiguous with minimal suspected tumor within the adjacent left C3-4 neural foramen.The cervical vertebral bodies demonstrate mildly heterogeneous marrow signal characteristics with scattered small areas of nonspecific marrow enhancement. Some or all of this may reflect degenerative disk disease prominently affecting the C4, C5 and C6 disk spaces and endplates.The cervical lordosis is reversed. Vertebral body heights are preserved. Vertebral morphology, accounting for degenerative disease, is otherwise unremarkable.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Left paracentral disk osteophyte or perhaps thickened PLL causing mild mass effect on the ventral spinal cord. No significant generalized spinal canal stenosis. Cord signal is abnormal at this level due to tracking edema from below. The neural foramina are not significantly narrowed, allowing for the suspected tumor involvement of the left C3-4 foramen. C4-5: Right paracentral disk osteophyte or thickened PLL. In combination with intracanalicular tumor, there is a severe spinal canal stenosis with marked cord compression and cord edema. Mild bilateral foraminal narrowing is seen along with tumor infiltration of the left C4-5 foramen.C5-6: Central disk osteophyte or thickened PLL. In combination with intracanalicular tumor, there is a severe spinal canal stenosis with cord compression and edema. Moderate right and mild left neuroforaminal narrowing. C6-7: Central disk osteophyte or thickened PLL. No significant spinal canal or neuroforaminal stenosis.C7-T1: Unremarkable. Thoracic spine:A marrow replacing, homogeneously enhancing lesion is evident within the T1 vertebral body without evidence of epidural or extraosseous extension. Similar appearing smaller lesions are also seen within the left T4 vertebral body and pedicle, the left T7 pedicle and minimally scattered through the T5, T8, T9 and T10 vertebral bodies.At T11, significant marrow replacement and enhancement is seen within the left aspect of the vertebral body, pedicle and facet complex. The vertebral body is compressed centrally with at least 60% loss of height. Significant epidural disease extension is noted with encroachment upon the left lateral and ventral epidural space. This results in mild displacement of the spinal cord but no definite evidence of spinal cord compression or edema.A large lesion is also demonstrated within the T12 vertebral body without extraosseous spread or loss of vertebral body height. The partially visualized L1 vertebral body is also diffusely infiltrated and compressed. There is likely some epidural disease extension at this level as well, but it is only partially visualized.Except as discussed above, the thoracic spinal canal is patent. The spinal cord itself demonstrates normal morphology and signal characteristics. No pathologic intramedullary or leptomeningeal enhancement is clearly seen. No significant degenerative disk disease is identified. The left T10-11 and T11-12 neural foramina are mildly narrowed due to the epidural encroachment from T11.Tumor deposits are seen within the right supraclavicular fossa and right axilla. A tumor deposit is also evident within the left paraspinal musculature at the L1 level. This lesion protrudes into the abdominal cavity perhaps exerting slight mass effect on the adjacent left kidney.

Output: An extramedullary, intracanalicular tumor is present centered at C5 spanning from C4 to C6. This lesion causes a severe cord compression with evidence of tracking cord edema.The above lesion extends in infiltrative fashion through the left C4-5 neural foramen into the adjacent paraspinal soft tissues. A small deposit of tumor is also suspected within the left lateral aspect of the spinal canal and left neural foramen at C3-4.Numerous tumor deposits are evident within the thoracic spine. At the T11 level, this is associated with significant epidural extension which causes spinal canal narrowing and a mild rightward displacement of the spinal cord but no frank cord impingement. A compression fracture of T11 is seen, as well as at L1.Soft tissue tumor deposits are evident in the right supraclavicular fossa, the right axilla and within the deep left paraspinal musculature at L1.No evidence of intracranial metastatic disease is seen.All the above lesions most likely represent metastatic disease from either the known breast or endometrial cancers. This constellation of findings would be a very atypical presentation for the patient's multiple myeloma, and this is therefore considered less likely.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Other symptoms and signs involving the musculoskeletal systemClinical question: Evaluate for venous sinus thrombosisSigns and Symptoms: Acute onset L sided weakness, headache MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.At the clinoidal segment of the right internal carotid artery there is a medially directed 3 mm broad-based aneurysm.There is no evidence for intracranial cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.MRV brain:The dural venous sinuses are patent. Straight sinus, internal cerebral veins and basal veins are identified and appear patent. The left transverse sinus and left sigmoid sinus are larger than the right-sided counterparts.

Output: 1.No evidence for cerebrovascular occlusive disease.2.There is a right internal carotid artery clinoid segment 3 mm aneurysm present3.MR venogram of the brain is within normal limits.4.There is no evidence for acute ischemic cerebral infarction.5.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on medical findings.

Input: Pain and swelling, history of MVA. MENISCI: There is a radial tear of the body of the lateral meniscus. The tear itself does not appear to extend through the entire width of the meniscus; however, it may communicate with an intrameniscal cyst within the body and anterior horn of the meniscus, which in turn communicates with a large para-meniscal cyst that extends along the entire anterior horn and body of the meniscus, deep to the iliotibial band and lateral collateral ligament proper. This para-meniscal cyst measures approximately 6 cm in oblique AP dimension and is approximately 1 cm in width at the joint line adjacent to the meniscal body. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage appears intact. I see no bone marrow abnormalities.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Incomplete radial tear of the body of the lateral meniscus, which may communicate with an intrameniscal cyst that in turn communicates with a large para-meniscal cyst, as described above.


Instruction: Generate impression based on medical findings.

Input: A patient submitted outside study for review. Submitted for review are digital mammographic images (8/4/15, 8/6/15, 9/1/15), ultrasound images of left breast (8/4/15, 8/6/15, 9/1/15), images from ultrasound guided biopsy of left breast and postprocedural left mammographic images (9/1/2015), breast MRI (9/9/15) performed at Adventist Hinsdale Hospital. For comparison, digital mammographic images (4/9/14, 12/11/12), ultrasound images (4/9/14, 12/11/12) are available. DIGITAL MAMMOGRAPHIC IMAGES (8/4/15, 8/6/15, 9/1/15):The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. A triangular marker is placed at upper outer quadrant of left breast, denoting the area of palpable lump. There is a developing focal asymmetry with architectural distortions at the site of palpable lump, at the upper outer quadrant in the left breast, measuring approximately 4 cm.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in right breast. 'ULTRASOUND IMAGES OF LEFT BREAST (8/4/15, 8/6/15, 9/1/15):An irregularly shaped hypoechoic mass is visualized at 1:30 position in the left breast measuring 17 x 10 mm. The lesion is unchanged in one month follow-up.A normal appearing lymph node is visualized in the left axilla.IMAGES FROM ULTRASOUND GUIDED BIOPSY OF LEFT BREAST AND POSTPROCEDURAL LEFT MAMMOGRAPHIC IMAGES (9/1/2015):Ultrasound guided biopsy was performed for the mass at 1:30 position in the left breast, with an appropriate needle placement. A marker clip is placed at anterior-medial aspect of the focal asymmetry with distortion at upper outer quadrant. Per outside radiology report, the biopsy result was malignant; invasive lobular carcinoma.BREAST MRI (9/9/15):Imaging protocol is outlined in the outside radiology report.There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.In the left breast, there is a large irregularly shaped mass at upper outer quadrant measuring 47 x 43 x 44 mm (AP x LR x CC). This enhancing lesion corresponds to the proven carcinoma, but the size of the lesion appears larger in the MRI. No abnormal enhancing lesions in the right breast.No abnormal lymph nodes are identified in either axillary region.

Output: Biopsy proven invasive lobular carcinoma in the left breast. Size of the tumor is larger on the MRI than on the conventional imaging.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on medical findings.

Input: Clinical question: 45 year-old with metastatic lung cancer. Assess for acuity of compression fracture of L2. Has prior L4 vertebroplasty. Signs and symptoms: Low back pain. Pre and post enhanced Thoracic MRI:Examination demonstrates a fairly extensive osseous metastatic lesions involving vertebral bodies and the posterior elements of the thoracic spine. There is no evidence of fracture or malalignment. There is however progression of disease since prior MRI study from January of 2015. There is mild expansion of tumor into the ventral epidural space at T11 and T12 levels with resultant mild central spinal stenosis. Epidural spread of tumor at T12 also extends laterally to the left and partially into the left T11 -- T12 neural foramina. There is also mild epidural spread of tumor at T6, T7 and T9 levels and posteriorly at T3 level. There is however no appreciable compromise of the spinal canal secondary to this finding.The signal intensity and caliber of thoracic cord remains within normal without detectable abnormal in enhancement.Pre-and post enhanced lumbar MRI:Examination demonstrates very extensive marrow signal changes of the tubercle consistent with diffuse osseous metastatic lesions. There is no evidence of malalignment. There is compression deformity of the superior and inferior endplates of L2 vertebrae however without evidence of marrow space edema to suggest an acute compression. The height of L2 vertebrae at their maximum level of compression measures 14.6-mm and it 27.6-mm height along the dorsal aspect of L2 vertebrae.There is ventral epidural spread of tumor from this tube into the spinal canal and resultant spinal stenosis. No evidence of spinal stenosis at any other level.No detectable signal abnormality or abnormal enhancement of the cauda equina.

Output: 1.Pre-and post enhanced MRI of thoracic spine demonstrate extensive osseous metastatic lesions involving the vertebral bodies / posterior elements and with evidence of interval progression since prior exam 1-12-14. No fracture or malalignment. There are multiple foci of epidural spread of tumor noticeably at T11 and T12 with resultant mild central spinal stenosis as detailed above.2.Pre-and post enhanced MRI of the lumbar spine demonstrate extensive osseous metastatic lesions from patient's known lung cancer. There is mild less than 50% compression fracture of the superior and inferior endplates of L2 without detectable marrow space hyperintense signal to suggest edema and likely representing a chronic change. Epidural spread of tumor at the S2 results in central spinal stenosis.


Instruction: Generate impression based on medical findings.

Input: Male 36 years old assess left hip AVN. ACETABULAR LABRUM: There is linear increased T2 signal within the anterior superior acetabular labrum (series 501, image 16 and series 1401, image 4) likely representing a labral tear.ARTICULAR CARTILAGE AND BONE: There is low T1 and heterogeneously high T2 signal within the anterior superior aspect of the humeral head. These areas are outlined with a band of low T1 signal consistent with avascular necrosis. There is associated irregularity of the cortex along the anterior superior femoral head with increased T2 signal most likely due to subchondral fracture. Small round, well-circumscribed areas of high T2 signal likely represent cystic changes from secondary osteoarthritis. The left acetabulum is preserved.Outside of the left humeral head marrow signal is within normal limits, no evidence for avascular necrosis elsewhere. There is one small subchondral cyst in the right femoral head possibly degenerative in etiology.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: 1.Avascular necrosis of the left femoral head with subchondral fracturing along the anterior superior femoral head.2.Probable tear of the anterior superior acetabular labrum.


Instruction: Generate impression based on medical findings.

Input: There are postsurgical findings related to right-sided craniotomy and tumor resection with cavities in the right anterior temporal lobe and the inferior right frontal lobe. There is evidence of prior stereotactic biopsy in this region as well. Since the prior examination from 8/25/2016, there has been an increase in the confluent T2 hyperintensity in the anterior right frontal lobe and extending along the anterior genu of the corpus callosum, further into the left frontal lobe. There is an associated increase in marginal enhancement in the right anterior frontal portion and there is extensive confluent restricted diffusion in this region. These areas do not demonstrate increased cerebral blood volume, which may be related to Avastin therapy. There is also a slight increase in T2 intensity posterior to the resection cavity. There is unchanged mild midline shift to the right and mild ex vacuo dilatation of the right lateral ventricle due to volume loss. There is redemonstration of susceptibility in the right frontal region and multiple additional foci of susceptibility consistent with blood products surrounding the resection cavity. The brainstem and cerebellum are intact. The orbits are unremarkable.

Output: Compared to examinations on 8/25/2016 and 4/7/2016, increase in T2 signal abnormality, enlargement of the area of restricted diffusion, and enhancement of the lesion centered in the right anterior and inferior frontal lobe are suspicious for tumor progression, although at least some of the findings, such as "persistent diffusion-restricted lesions" may be attributable to superimposed effects of Avastin therapy. 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: Hip pain, evaluate for labral tear. ACETABULAR LABRUM: The labrum appears intact.ARTICULAR CARTILAGE AND BONE: The visualized bone marrow is within normal limits. The cartilage of the left hip is grossly intact.SOFT TISSUES: The musculature and other soft tissues appear unremarkable. ADDITIONAL

Output: 1.No evidence for labral tear.2.Please see CT 6/25/2015 for details regarding acetabular over coverage and exaggerated acetabular anteversion.


Instruction: Generate impression based on medical findings.

Input: Limited MRI of the brain for pre-op planning demonstrates no intracranial mass. There are unchanged scattered punctate foci of high T2 foci in the cerebral white matter that likely represent chronic small vessel ischemic change. There is no abnormal intracranial enhancement. 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. There is minimal mucosal thickening of the bilateral frontal, ethmoid and sphenoid sinuses. There are scattered subcentimeter T2 hyperintense foci within the bilateral parotid glands, left greater than right.

Output: 1. Limited MRI of the brain for pre-surgical planning.2. Scattered incompletely characterized T2 hyperintense lesions within the bilateral parotid glands, left greater than right, which may represent benign lymphoepithelial lesions in the setting of HIV, Sjogren's disease or Warthin's tumor. Please correlate clinically.


Instruction: Generate impression based on medical findings.

Input: Right foot mass Tendons and ligaments: The visualized extensor tendons are intact. The visualized flexor tendons are intact. The peroneal tendons are intact. The Lisfranc ligament is intact. There is no subluxation or dislocation in the tarsometatarsal articulations.Bones: There is increased signal within the medial aspect of the navicular without a discrete fracture line identified. There is mildly increased signal within the soft tissue surrounding the navicular as well. Following contrast there is mild diffuse enhancement of the soft tissues surrounding the navicular however no discrete mass or fluid collection is identified. The remaining bone marrow signal is normal. There is no joint effusion. There are no osteochondral lesions identified.Alignment: There is normal alignment of the metatarsals. There is no hallux valgus deformity.Muscles: The plantar musculature is unremarkable.

Output: Mild edema within the navicular which may represent a stress injury. There is surrounding edema and inflammation which is likely reactive but there is no discrete fluid collection, mass, or fracture line evident.


Instruction: Generate impression based on medical findings.

Input: Dysequilibrium, evaluate for posterior circulation infarct. There is no evidence of acute infarction, intracranial hemorrhage, or mass. There is mild scattered periventricular and subcortical T2 hyperintensity. There is also a subcentimeter focus of encephalomalacia in the left thalamus. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are bilateral staphylomas. There is a subcentimeter Thornwaldt cyst.

Output: No evidence of acute intracranial hemorrhage, mass, or acute infarct. Mild scattered periventricular and subcortical T2 hyperintensity is suggestive of chronic small vessel ischemic disease and a subcentimeter focus of encephalomalacia in the left thalamus is suggestive of a chronic lacunar infarct.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: There are dental braces which result in artifact, especially in DWI and SWI sequences.There are no T2/FLAIR abnormalities. Ventricular size is normal. There is no midline shift. No abnormalities are seen in the mesial temporal lobe. Basal cisterns are patent. There is no extra-axial fluid. There are no diffusion abnormalities within the visualized structures. There are no structural abnormalities. Visualized vascular flow voids are normal.

Output: Unremarkable MRI of the brain, within limitations of artifact from dental hardware.


Instruction: Generate impression based on medical findings.

Input: 61 years, Male, left optic atrophy and vision changes. Additional provided history includes Chiari I malformation without spina bifida or hydrocephalus. MRI BRAIN: No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Minimal foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic changes. No other abnormal T2 signal is evident in the brain. There is been suboccipital craniectomy and resection of the posterior arch of C1 related to Chiari decompression surgery. The posterior fossa contents including the cerebellar tonsils are well decompressed. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Mild mucosal thickening is demonstrated in the frontal sinuses, posterior and anterior anterior ethmoid air cells, and bilateral maxillary sinuses. The mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits. MRI ORBITS: No abnormal mass or abnormal enhancement is seen. The left optic nerve appears to be mildly asymmetrically diminutive compared to the right. There is no abnormal signal in the optic nerves. No retrobulbar mass, chiasmatic mass, or parasellar abnormality is seen. Extraocular muscles are unremarkable.

Output: 1. Postoperative changes related to prior posterior fossa decompression. Posterior fossa structures are well compressed. Remainder of the brain parenchyma is otherwise within normal limits for age.2. No abnormal signal within the optic nerves is definitively appreciated. The left optic nerve is mildly asymmetrically smaller than the right, which is of uncertain significance. Orbital MRI appear otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Low back pain [M54.5], Reason for Study: ^Reason: Back pain and h/o multiple myeloma and pathologic fracture History: Low back pain For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There are multi-level vertebral body compression fractures including L2, L3 and L4.The L2 shows about 50% and L3 shows about 30% of height loss with minimum retropulsion of fractured fragment. The L3 vertebral body shows signal void area which corresponds to injected PMMA.The L4 shows focal 20% (mainly posterior fragment) height loss with high signal intensity on STIR images, minimal or no retropulsion is seen.The signal of the visualized cord is normal. The conus medullaris terminates at the T12-L1 level. T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: diffuse bulging of disc, no neuroforaminal narrowing or spinal stenosis. L2-L3: diffuse bulging of disc, minimal bilateral neuroforaminal narrowing is seen. no evidence of spinal stenosis. L3-L4: diffuse bulging of disc with bilateral ligamentum flavum thickening results moderate spinal canal stenosis. L4-L5: diffuse bulging of disc with bilateral ligamentum flavum thickening results moderate spinal canal stenosis.. L5-S1: no neuroforaminal narrowing or spinal stenosis.

Output: 1. Multi-level compression fractures including L2, L3 and L4 as described above.2. Post PMMA injection status of L3.3. Multi-level various degree degenerative changes of lumbar spine as described above.


Instruction: Generate impression based on medical findings.

Input: 49 years old female with a history of architectural distortion in the right central breast identified on screening mammogram dated 11/20/15. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate nodular parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. Annual surveillance with breast MRI is recommended as per the research protocol.Annual screening mammogram is also recommended. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old, with metastatic melanoma to the brain status post stereotactic radiosurgery. A hemorrhagic mass within the left inferior cerebellum and cerebellar tonsil is redemonstrated showing no significant interval change in size. The lesion induces strong susceptibility effect and contains pockets of internal T1 hyperintensity. Apart from this intrinsic T1 signal, little if any superimposed enhancement is seen internally. A thin uniform rim of enhancement has developed along the superior margin of the lesion. The degree of edema surrounding this lesion has slightly decreased.Chronic areas of hemosiderin staining and encephalomalacia are redemonstrated in the right parietal lobe, left occipital lobe, and within the left superior frontal gyrus showing no significant interval change. No new lesions are identified. No abnormal extra axial fluid collections are seen. A small focus of susceptibility is unchanged in the right cerebellum. Ventricular size and morphology are stable.

Output: 1.No significant change is seen in the size of a left cerebellar hemorrhagic lesion, though the associated edema has slightly improved. A thin rim of enhancement has developed along the superior margin of the lesion which is favored to be posttreatment in nature.2.Multiple additional areas of hemosiderin stained encephalomalacia are unchanged. No new intracranial lesions are detected.


Instruction: Generate impression based on medical findings.

Input: Worsening cardiac function, evaluate for infiltrative disease. Left VentricleThe left ventricle is dilated with globally decreased function. The overall LV ejection fraction is 21%, the LV end diastolic volume index is 170 ml/m2 (normal range: 74+/-15), the LVEDV is 358 ml (normal range 142+/-34), the LV end systolic volume index is 135 ml/m2 (normal range 25+/-9), the LVESV is 283 ml (normal range 47+/-19), the LV mass index is 89 g/m2 (normal range 85+/-15), and the LV mass is 186 g (normal range 164+/-36). . There is noted late gadolinium enhancement in the basal and mid inferior portion of the myocardium to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.The native T1 myocardial relaxation time is not calculated in setting of underlying arrhythmia. There is [ no ]myocardial iron overload. There is [no noted ]LV thrombus. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is borderline dilated. The overall RV ejection fraction is 15%, the RV end diastolic volume index is 96 ml/m2 (normal range 82+/-16), the RVEDV is 195 ml (normal range 142+/-31), the RV end systolic volume index is 79 ml/m2 (normal range 31+/-9), and the RVESV is 166 ml (normal range 54+/-17).Right AtriumThe right atrium is dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is moderate 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 with no noted pulmonary vein stenosis.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 FindingsPatchy pulmonary findings, right lung greater than left, which may be consistent with resolving pulmonary edema vs pneumonia/infection/pulmonary hemorrhage - clinical correlation recommended. 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. Severely decreased LV EF with global LV dysfunction. There is a focus of delayed gadolinium hyperenhancement in the basal to mid inferoseptal portion of the left ventricle which may represent right-sided volume or pressure overload. Localized scar, inflammation, or an infiltrative process is less likely.2. Decreased RV function. 3. Severely dilated left atrium and dilated right atrium.4. Moderate mitral regurgitation5. Pulmonary findings as above. 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: There are no masses, mass effect or midline shift. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. The pituitary gland is normal in size. Flow voids are present within the major vessels indicating patency. The paranasal sinuses are clear. Endotracheal tube is present. Moderate opacification of the mastoid air cells bilaterally which may be related to intubation.

Output: 1.No intracranial abnormality as clinically questioned. No specific findings to suggest PRES. 2.Moderate mastoid air cell opacification bilaterally may be related to intubation.


Instruction: Generate impression based on medical findings.

Input: 25-year-old female with FAI, evaluate for labral tear ACETABULAR LABRUM: Increased signal is seen within the anterior superior labrum at the 2:00 position, consistent with a tear.ARTICULAR CARTILAGE AND BONE: Articular cartilage is intact. No abnormal marrow signal. Alpha angle measures 48 degreesSOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Anterior superior labral tear at the 2:00 position.


Instruction: Generate impression based on medical findings.

Input: Male, 27 years old, with hand numbness, history of basilar invagination, Chiari malformation. Evaluate for worsening stenosis or cord edema. Suboccipital craniectomy and resection of the C1 posterior arch are redemonstrated. The thecal sac becomes tight at the C1 level with effacement of the CSF and some cord deformation, but this is similar to the prior postoperative exam. Above and below this level, the thecal sac is more capacious. The cerebellar tonsils are not crowded.The clivus is dysmorphic and the odontoid process projects through the foramen magnum. The odontoid process impresses upon the brainstem which has assumed a kinked morphology. T2 signal abnormality and slight volume loss affect the left lateral cord at C1. Faint signal abnormality is also detected in the left lateral cord throughout the cervical region. Findings are unchanged.Spinal alignment is otherwise anatomic. Vertebral body heights are preserved. Marrow signal characteristics are within normal limits. No disc herniations are seen. The spinal canal and neural foramina are otherwise patent.

Output: 1.Findings are redemonstrated compatible with Chiari decompressive surgery. At the C1 level, the thecal sac is tight with effacement of the CSF and cord deformation, but this appearance is unchanged. Above and below this level, the thecal sac is of adequate caliber. 2.Basilar impression is redemonstrated. The odontoid process impinges upon the brainstem which is kinked. Findings are unchanged. 3.Cord signal abnormality suggestive of myelomalacia is seen in the left lateral cord at C1, and faintly through the remainder of the left lateral cord. These findings are also unchaged.4.No definite new findings or significant interval changes are seen to account for the patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: 61-year-old with history of left breast ILC status post partial mastectomy and complete axillary lymph node dissection. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally. There are a few high T2 signal cysts in the right breast. No suspicious enhancement is seen in either breast. Postsurgical changes in the left upper inner breast are stable. Enhancing foci in both breast are stable to less prominent today. Area of enhancement in the right lower outer breast, posterior depth, is also stable to less enhancing. No abnormal lymph nodes are identified in either axillary region. Postsurgical changes in the left axilla are stable.

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


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old, history of metastatic melanoma with brain metastases, now with recent seizure and left-sided weakness. Assess for new brain metastases. Two new rim-enhancing lesions are evident within the right post-central gyrus, each containing blood fluid levels, measuring 13 and 10 mm in diameter. These lesions induce moderate local edema which tracks into the underlying white matter.A lesion within the left inferior parietal lobule has significantly increased in size now measuring up to 17 mm, previously 4 mm. A lesion along the left superior frontal sulcus has increased in size now measuring 7 mm, previously punctate. A new 10 mm lesion is evident within the paramedian right occipital lobe, and a new 16 mm lesion is evident more laterally in the right occipital lobe. The above lesions induce mild local edema. A 2 mm focus of enhancement is new within the left inferior frontal lobe.A lesion in the paramedian right parietal lobe is unchanged. The right frontal lobe resection cavity has collapsed with no significant change in the amount of enhancement and decreasing edema. The left superior frontal resection cavity is stable and free of enhancement.

Output: Multiple new and/or growing lesions compatible with progression of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: 58-year-old male with history of gastric cancer status post gastrectomy. Recent CT scan indicative of pancreatic ductal dilatation to 5 mm. Evaluate pancreatic duct and portal mass. ABDOMEN:LIVER, BILIARY TRACT: No suspicious hepatic lesions. No evidence of intra or extra hepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Normal T1 intrinsic hyperintensity without evidence of a pancreatic lesion or edema. There is mild dilatation of the pancreatic duct near the head measuring up to 5 mm with a normal common bile duct; there is possibly mild narrowing at the ampulla. Portion of the main pancreatic duct drains via the minor papilla.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Kidneys enhance symmetrically without evidence of hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postoperative changes of gastrectomy again noted. No bowel dilatation is present.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Mild dilatation of the pancreatic duct near the head without evidence of pancreatic mass as above.2.Common bile duct is normal.


Instruction: Generate impression based on medical findings.

Input: Male 49 years old Reason: 3 cm dysplastic nodule in liver, followup, R flank pain History: HCV cirrhosis, 3 cm nodule. ABDOMEN:LIVER, BILIARY TRACT: The liver demonstrates cirrhotic morphology with widening of the hepatic fissures and nodularity of the hepatic contour. There is no intra or extrahepatic biliary ductal dilatation. Patent hepatic vasculature.Again seen is an intrinsically T1 hyperintense 2.9 x 2.1 cm lesion in segment 8, previously measuring 3.2 x 2.4 cm. There is no arterial enhancement or washout. There is no diffusion restriction. The appearance is not significantly changed compared to prior study and likely represents a dysplastic or regenerative nodule.SPLEEN: Splenomegaly measuring 16.4 cm. Multiple prominent vessels centrally within the spleen which may represent a vascular malformation. The appearance is not significantly changed compared to prior study.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Scattered prominent portacaval lymph nodes which can be seen in the setting of cirrhosis.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Cirrhotic liver morphology with stable splenomegaly.2.Stable appearance of a segment 8 liver lesion which likely represents a dysplastic or regenerative nodule. Continued follow-up is recommended.


Instruction: Generate impression based on medical findings.

Input: Reason: 1 yr s/p sarcoma removal History: previous thigh surgery There is a scar traversing the anterior subcutaneous fat of the thigh. There is mild edema type signal and enhancement of the remaining vastus lateralis musculature which extends superiorly along the anterior margin of the proximal femur that we suspect reflects post therapeutic changes rather than tumor recurrence. We see no focal nodular masslike enhancement to confirm tumor recurrence. There is similar edema and enhancement noted affecting the short head of the biceps femoris as well as the adductor musculature of the hip. There is a small amount of fluid within the right hip as well as a mild synovitis. There is mild edema of the subcutaneous fat of the thigh as well. There is a small knee joint effusion.

Output: Edema and enhancement of the thigh musculature as described above which likely reflects post therapy changes. We see no focal nodules or masses to confirm tumor recurrence.


Instruction: Generate impression based on medical findings.

Input: 15-year-old male with knee injury MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: There is an avulsed 1.3 cm fracture fragment of the posterior tibial plateau at the attachment of the PCL. Edema extends within the medial and lateral tibial plateau. The patellofemoral cartilage is intact. The tibiofemoral cartilage is intact.LIGAMENTS: The ACL is intact. The fibers of the PCL are intact with an avulsion fracture of the tibial attachment as described above. The MCL and LCL are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. Avulsion fracture at the tibial insertion of the PCL. 2. Large hemarthrosis. 3. Intact menisci and collateral ligaments.