Instruction: Generate impression based on medical findings.

Input: 43 year old female with a VSD, ASD (secundum) and a PDA s/p surgical repair at age 2y, RV dysfunction, s/p supravalvular pulmonic plasty and coiling of an aorto-left pulmonary artery fistula (alternatively a residual PDA) 1/8/14. CMR today for pre-operative evaluation prior to shoulder surgery. Left VentricleThe left ventricle is normal in size with a normal systolic function. The overall LV ejection fraction is 58%, the LV end diastolic volume index is 66 ml/m2 (normal range: 65+/-11), the LVEDV is 122 ml (normal range 109+/-23), the LV end systolic volume index is 28 ml/m2 (normal range 18+/-5), the LVESV is 51 ml (normal range 31+/-10), the LV mass index is 41 g/m2 (normal range 67+/-11), and the LV mass is 75 g (normal range 114+/-24). Ventricular septal patch repair is noted. The presence of residual VSD can not be excluded (see below). There is systolic septal flattening consistent with RV pressure overload. There late gadolinium enhancement of the inferior right ventricular insertion point suggesting the presence of underlying myocardial fibrosis. This pattern is commonly seen in RV pressure overload states such as pulmonary hypertension and congenital heart disease. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is severely dilated with a mildly reduced systolic function. The overall RV ejection fraction is 43%, the RV end diastolic volume index is 129 ml/m2 (normal range 69+/-14), the RVEDV is 238 ml (normal range 110+/-24), the RV end systolic volume index is 74 ml/m2 (normal range 22+/-8), and the RVESV is 102 ml (normal range 35+/-13). There is no obstruction in the RVOT.Right AtriumThe right atrium is severely dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is likely moderate tricuspid regurgitation with an eccentric jet; however, the possibility that the jet represents a residual ventricular septal defect can not be completely excluded.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsThe right-sided pulmonary veins form a common antrum and join with the left atrium. The left sided pulmonary veins are not visible.Pulmonary ArteryThe main pulmonary artery is severely dilated (43x37mm). The proximal portion of the main pulmonary artery is narrowed (16mm) but without evidence of significant flow acceleration. The right pulmonary artery is normal in size (17mm). The left pulmonary vein is small in caliber (10mm). Venous AnatomyThe SVC is normal in size and drains normally into the right atrium. The IVC is massively dilated and drains normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere are diffusely increased interstitial markings in the left lung.This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal LV size and systolic function (LVEF 58%) with evidence of fibrosis along the right ventricular inferior insertion point, which is commonly seen in RV pressure overload states.2. Severe RV dilation with mildly reduced systolic function (RVEF 43%). There is systolic flattening of the interventricular septum suggesting that the RV systolic pressure is increased.3. The IVC is massively dilated.4. The left pulmonary artery is significantly diminished in caliber. The left-sided pulmonary veins are not well seen. The left lung is hypoperfused relative to the right lung. There are diffusely increased interstitial markings in the left lung.5. The main pulmonary artery is severely dilated.6. There is likely moderate tricuspid regurgitation with an eccentric jet; however, the possibility that the jet represents a residual ventricular septal defect can not be completely excluded.7. When compared to the prior study, there has been mild improvement in RV function.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: T4 breast cancer with lethargy and wight loss. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few scattered nonspecific cerebral white matter T2 hyperintense foci. 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. There is a 15 mm long T1 hyperintense lesion that losses signal with fat suppression in the occipital bone, which likely represents a hemangioma. The orbits, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of intracranial metastases.


Instruction: Generate impression based on medical findings.

Input: Left shoulder pain after fall ROTATOR CUFF: There is increased signal and thickening of the supraspinatus tendon reflecting moderate tendinosis. There is separation of the anterior fibers of the distal supraspinatus tendon at its insertion reflecting tear of the bursal surface fibers. The articular surface fibers may be intact. There is no evidence of retraction and the supraspinatus muscle is normal.There is mild tendinopathy of the distal infraspinatus tendon however there is no evidence of tear. The infraspinatus muscle is normal.The teres minor tendon and muscle are normal.There is mild insertional tendinosis of the subscapularis tendon without evidence of tear. The subscapularis muscle is normal.SUPRASPINATUS OUTLET: There is severe acromioclavicular arthrosis. Fluid is noted within the subdeltoid bursa anterior to the region of the supraspinatus tear. The glenohumeral joint demonstrates mild osteoarthritic changes.GLENOHUMERAL JOINT AND GLENOID LABRUM: The labrum appears normal for the patient's age. A small amount of joint fluid is present but there is no sizable effusion. Mild osteoarthritis affects the joint.BICEPS TENDON: There is mild tendinosis of the biceps tendon at the rotator interval without evidence of tear.

Output: Rotator cuff tendinosis with focal tearing of the anterior insertional fibers of the supraspinatus tendon. There is no retraction or atrophy of the supraspinatus muscle. There is no evidence of additional rotator cuff tendon tear; additional findings of the shoulder are described above.


Instruction: Generate impression based on medical findings.

Input: Ms. SHIRLEY KONRATH is a 69 years old female with a personal history of right lumpectomy in 1997 and radiation for breast cancer. She has no current breast related complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density (BiRads Density Category B), unchanged in pattern and distribution.A linear marker is placed on the scar overlying the right breast. There are stable post-lumpectomy changes present in the right breast, including decreased size of the right breast, architectural distortion, increased density, and dystrophic calcifications. Additional scattered benign calcifications are present. Mildly prominent left lower axillary lymph nodes appear not significantly changed compared to MRI 9/10/2014 where fatty hila were demonstrated.There are no new masses, suspicious microcalcifications or areas of architectural distortion identified in either breast.

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


Instruction: Generate impression based on medical findings.

Input: 66-year-old man status post heart transplant with right upper and left lower extremity neuropathic pain. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Loss of the normal cervical lordosis may be in part positional. Bone marrow signal is normal. The cervical spinal cord has normal signal characteristics and overall morphology. The cervical canal is congenitally narrow, particularly between C4 and C6.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: There is a disc osteophyte complex without spinal canal stenosis. There is mild to moderate right neural foraminal stenosis and mild left neural foraminal stenosis.C4-5: There is a disc osteophyte complex with mild spinal canal stenosis, particularly on the right. There is moderate bilateral neural foraminal stenosis.C5-6: There is a disc osteophyte complex with mild spinal canal stenosis, particularly on the left. There is moderate to severe bilateral neural foraminal stenosis.C6-7: There is a disc osteophyte complex without spinal canal stenosis. There is mild right and mild-to-moderate left neural foraminal stenosis. C7-T1: There is a disc osteophyte complex without significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. There is prominent fat in the subcutaneous and deeper soft tissues. The soft tissue structures are otherwise appear within normal limits.

Output: 1.Multilevel degenerative disease with spinal canal and neural foraminal stenoses. Overall this is worst at C5/C6, right greater than left. Please see additional details above.2.Please note that this examination only evaluates the cervical spine. If there is concern for brachial plexus abnormality, a dedicated brachial plexus MR can be obtained.


Instruction: Generate impression based on medical findings.

Input: History of recurrent cholangitis of unclear etiology, evaluate for biliary stricture. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions are identified. The hepatic vasculature is patent. The gallbladder is surgically absent. There is no intrahepatic biliary ductal dilatation. The common bile duct measures up to 7 mm in diameter. There is slight smooth narrowing of the distal common bile duct measuring down to approximately 2 to 3 mm which remains patent. There is no abnormal enhancement of the bile ducts or secondary evidence of cholangitis.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic parenchyma demonstrates normal signal intensity and enhancement. The pancreatic duct is not dilated. There are a few small cystic foci within the body of the pancreas measuring up to 4 mm (series 9, image 17). Though these do not definitively connect to the pancreatic duct, they likely represent side branch IPMNs. ADRENAL GLANDS: There is a 1.3 x 2.5 cm right adrenal nodule which demonstrates loss of signal on out of phase images and is compatible with a benign adrenal adenoma.KIDNEYS, URETERS: Status post right nephrectomy. Left renal cysts, some of which are too small to characterize.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.Smooth slight narrowing of the distal common bile duct without definite stricture, stone, or obstructing lesion. No specific imaging evidence of cholangitis currently.2.Benign right adrenal adenoma.


Instruction: Generate impression based on medical findings.

Input: A patient submitted outside study for review. Submitted for review are:1. Bilateral diagnostic mammogram dated 7/1/2016 and ultrasound dated 7/1/2016 performed at . For comparison,12/17/2015 incomplete tomo images are available. Bilateral diagnostic mammogram and ultrasound dated 7/1/2016:Heterogeneously dense breast parenchyma noted bilaterally. Surgical clips identified in the left breast 12:00 position posterior depth with area of postsurgical distortion. Benign calcifications seen in both breasts.Ultrasound demonstrated an indeterminate hypoechoic area slightly taller than wide with spiculated margins in the left breast 12:00 position 7 cm from the nipple that measures 6 x 4 x 7 mm. A second lesion is identified in the left breast 12:00 position 3 cm from the nipple that measures 7 x 5 x 4 mm in the anterior depth.No abnormal axillary lymph nodes identified in the axillary region. No suspicious masses, or calcifications identified in both breasts.Subsequent MRI guided biopsy of 2 sites in the left breast performed. Diagnostic MRI is not submitted.

Output: Mammographically occult, sonographically detected 2 indeterminate masses in the left breast 12:00 position. These lesions were subsequently biopsied under MRI guidance. Diagnostic MRI has not been submitted.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Stroke. Signs and symptoms: Stroke. Non-enhanced CT brain:Small left likely stroke is again identified. The corner infarct the left pons is again noted. Old likely hemorrhagic lacunar infarct of left basal ganglia is again identified. There is ex vacuo dilatation of left lateral ventricle secondary to this large stroke.There is no evidence of new hemorrhage, edema, mass-effect, midline shift or hydrocephalus. The study is essentially stable since prior exam. If concern for new strokes persist follow-up with an MRI is recommended.

Output: Multiple old strokes and no evidence of acute new intracranial findings. Stable exam.


Instruction: Generate impression based on medical findings.

Input: H/o cervical cancer. The lumbar lordosis is present. The lumbar spine alignment appears within normal limits. Abnormal hyperdensity is seen in the L2, L4, L5 and S1 vertebral bodies, in which there are 30% loss of height in the L2 vertebral body and depression of the right superior endplate of the L5 vertebral body. T12/L1: disc bulge and bilateral facet hypertrophy; no neuroforaminal compromise or spinal canal stenosis. L1/L2: disc bulge, vacuum phenomena and bilateral facet hypertrophy; no neuroforaminal compromise or spinal canal stenosis. L2/L3: disc bulge and bilateral facet hypertrophy; no neuroforaminal compromise or spinal canal stenosis. L3/L4: disc bulge and bilateral facet hypertrophy; no neuroforaminal compromise or spinal canal stenosis. L4/L5: disc bulge, vacuum phenomena and bilateral facet hypertrophy; left neuroforaminal compromise; no spinal canal stenosis. L5/S1: disc bulge, vacuum phenomena with small amount of air in the epidural space and bilateral facet hypertrophy; bilateral neuroforaminal compromise; no spinal canal stenosis. These findings have been stable since prior MRI.

Output: 1. Metastases likely involving the L2, L4, L5 and S1 vertebral bodies with the L2 and L5 compression or pathologic fractures. 2. Degenerative disease of the lumbar spine as detailed above.


Instruction: Generate impression based on medical findings.

Input: Female, 86 years old, with virtigo that woke the patient up from sleep, nystagmus, nausea and vomiting. Evaluate for brain stem stroke from posterior circulation No restricted diffusion is seen. There is, however, patchy and confluent periventricular T2 hyperintensity. Involvement of the subcortical white matter, basal ganglia, thalami, and the pons is also evident. No parenchymal mass effect or edema is seen. No intracranial hemorrhage or any other abnormal extra-axial fluid collection is seen. The ventricles and sulci are proportionately prominent compatible with volume loss.

Output: 1.No acute intracranial abnormality, and in particular, no evidence of acute ischemia.2.Moderately extensive chronic small vessel and lacunar ischemic disease.


Instruction: Generate impression based on medical findings.

Input: Limited sequences per demyelinating disease protocol. Again seen are multiple T2/FLAIR hyperintense lesions in the periventricular and subcortical supratentorial white matter with morphology and distribution consistent with known demyelinating disease. Multiple brainstem and cerebellar lesions are also again seen, which are predominately along the dorsal midbrain and pons similar to prior. No new lesions are identified. Mild to moderate burden of T1 hypointense lesions again seen similar to prior. Mild parenchymal volume loss including mild thinning of the corpus callosum similar to prior. No evidence of intracranial mass effect, midline shift, or herniation.

Output: Compared to 5/22/2015, there are no new lesions in the brain to suggest progression of demyelinating disease.


Instruction: Generate impression based on medical findings.

Input: Chronic HCV cirrhosis, evaluate liver lesion ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology. Moderately T2 hyperintense mass in segment 8 demonstrates central arterial enhancement and distorts the hepatic capsule measuring up to 3.0 x 3.1 cm (series 11, image 29). There is washout on the delayed postcontrast images. The anterior branch of the right portal vein courses towards this lesion and demonstrates internal signal abnormality on arterial and portal venous phase.Additional small arterial enhancing foci are scattered throughout the right hepatic lobe without washout. No intrahepatic biliary ductal dilation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.3 cm segment 8 hepatic mass, which meets the criteria for HCC.2.Signal abnormality within the anterior branch of the right portal vein; portal venous tumor invasion is suspected.


Instruction: Generate impression based on medical findings.

Input: History of right breast cancer status post lumpectomy in 2012 presents for screening MRI. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. Stable post operative change in the right outer breast. No abnormal lymph nodes are identified in either axillary region.Port-A-Cath in the left chest wall again noted.

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


Instruction: Generate impression based on medical findings.

Input: 70 year-old male presenting with transient alteration of awareness and ataxia, with likely TIA. Evaluate for bleed or other cause. There is no evidence of intracranial hemorrhage, mass or edema. Soft tissue mass extending from the sella is identified, incompletely evaluated without contrast administration, resulting in mass effect upon the suprasellar cistern. No internal calcifications or adjacent bone erosion is evident. Further evaluation with MRI is recommended. The ventricles are midline, and demonstrate normal volume and morphology.The calvaria and skull base are radiographically normal. Crescentic high density is noted in the subcutaneous tissues along the superior aspect of the left parietal lobe, which may represent hematoma. No underlying fracture is evident. Partial opacification of the maxillary and sphenoid sinuses and numerous ethmoid air cells is evident.

Output: 1. Subcutaneous hematoma overlying the postero-superior left parietal bone, with no underlying fractures or intracranial hemorrhage. 2. Sellar mass as described above. Differential considerations include pituitary macroadenoma, among others. Further evaluation with MRI is recommended. 3. Sinus disease as described above.


Instruction: Generate impression based on medical findings.

Input: History of renal cell carcinoma status post partial nephrectomy. Pathology/10/15 demonstrated a multilocular cystic renal cell carcinoma grade 2 measuring 2.5 cm. The study was somewhat suboptimal. The patient felt nauseous during the postcontrast image acquisition and no venous or delayed phase images were obtained.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Mild diffuse thickening of the adrenal glands bilaterally without a focal lesion, unchanged.KIDNEYS, URETERS: Postsurgical changes of a partial nephrectomy of the anterior left renal interpolar cortex. No evidence of residual or recurrent tumor.Unchanged subcentimeter right renal T2-weighted hyperintensities are too small to characterize, likely cysts.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: Postsurgical changes from a left partial nephrectomy without evidence of residual or recurrent tumor.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old. Reason: better evaluation of post-surgical site, rule out osteomyelitis History: as above The examination is somewhat motion degraded. There are postsurgical changes related to amputation of the great toe through the level of the metatarsal diaphysis. There is moderate edema in the surrounding soft tissues. There is increased STIR signal within the distal aspect of the remaining first metatarsal with decreased signal on T1-weighted images which is suspicious for osteomyelitis. Additional abnormal signal is noted within the second metatarsal head extending into the diaphysis, suspicious for an additional focal area of osteomyelitis. The remainder of the bones of the foot show normal marrow signal. There is no discrete fluid collection identified within the soft tissues.

Output: Postsurgical changes related to amputation through the first metatarsal. Abnormal marrow signal involving the remaining portion of the first metatarsal as well as the distal aspect of the second metatarsal, highly suspicious for osteomyelitis in these two areas.


Instruction: Generate impression based on medical findings.

Input: 73-year-old female with mass in the liver. ABDOMEN:LIVER, BILIARY TRACT: In hepatic segment 2, there is a 3.6 x 2.5 cm cyst (series 7 image 30, series 10 image 78).In hepatic segment 4A, there is a 3.5 x 4.7 cm T2 hyperintense, T1 hypointense lesion demonstrating contiguous peripheral enhancement (series 10 image 284). The imaging features are not typical for a hemangioma. The lesion also demonstrates restricted diffusion (series 6 image 114). No intra or extrahepatic biliary ductal dilatation.Normal gallbladder.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Hepatic segment 4A lesion demonstrating contiguous peripheral enhancement does not have features of a typical hemangioma, and a neoplastic process (including malignancy) remains in the differential.2.Hepatic segment 2 cyst.


Instruction: Generate impression based on medical findings.

Input: There is continued evolution of postsurgical changes from T6 to T9 including left T7, T8 and T9 hemilaminectomies and left T8 pedicle resection for resection of aneurysmal bone cyst. There is no definite residual osseous tumor. Interval resolution of enhancement superior and inferior to the resection site which was reactive. There is mild dorsal epidural enhancement from the T9 to T11 levels which may represent postsurgical change. There is no evidence of abscess. There is interval resolution of the left pleural effusion.The vertebral column alignment is within normal limits. The vertebral body and disc space heights are otherwise preserved. The spinal cord displays normal signal and morphology with the conus terminating at L1.

Output: 1. Evolution of postsurgical changes from T6 to T9, including left T7, T8 and T9 hemilaminectomies and resection of the left T8 pedicle, without definite evidence of residual or recurrent tumor. 2. Decrease in previously seen epidural enhancement superior and inferior to the resection site which represented reactive change. Minimal residual epidural and soft tissue enhancement at the resection site may represent postsurgical change.


Instruction: Generate impression based on medical findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The right wrist was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge.Under fluoroscopic guidance, a 21-gauge spinal needle was advanced into the joint. Next, 5 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 56 seconds

Output: Successful right wrist arthrogram in preparation for MRI.


Instruction: Generate impression based on medical findings.

Input: A patient submitted outside study for review. Submitted for review are ultrasound images for both breasts and right axilla (6/9/15), images from ultrasound guided FNA of with axilla (6/9/15) performed at Aurora Grafton Medical Center. ULTRASOUND IMAGES FOR BOTH BREASTS AND RIGHT AXILLA (6/9/15):MR-directed ultrasound was performed for both breasts based on the outside reading of MRI study (6/3/2015). No abnormal findings are detected in either breast. In the right axilla, a small borderline lymph node with cortical thickness of 3 mm is detected.IMAGES FROM ULTRASOUND GUIDED FNA OF WITH AXILLA (6/9/15):Fine-needle aspiration was performed for the borderline right axillary lymph node with appropriate needle placement.Per outside radiology report, the cytology result was negative for malignant cells.

Output: Negative MR-directed ultrasound for both breasts. Negative FNA of the right axillary lymph node.BIRADS: 1 - Negative.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on medical findings.

Input: 40 years Male (DOB:11/21/1975)Reason: eval hemorrhagic mets, hydro, preop shunt History: headachePROVIDER/ATTENDING NAME: JEFFREY D. JACOBS JEFFREY D. JACOBS The patient status post left frontal craniotomy for left frontal lobe lesion.Since the prior examination the patient is developed new hemorrhagic lesions within the brain parenchyma and previous hemorrhagic lesions within the brain parenchyma have enlarged. There is a new hemorrhagic focus in the right frontal lobe which on T2 imaging measures approximately 7 mm in diameter. Another one in the right medial frontal lobe is approximately 3 mm in size. It was not previously present. A lesion located in the right thalamus was not clearly present on the prior exam and measures 34 x 14 mm axial dimensions. It protrudes into the right lateral ventricle. The lesion is present in the left cerebellar hemisphere which measures approximately 1 mm in size. Another lesion adjacent to the occipital horn of the right lateral ventricle was present on the prior exam and demonstrates a fluid fluid level. It measures 11 x 8 mm axial dimensions. Another one in the right occipital lobe in the cuneus measures 2 mm. Another one in the right occipital L adjacent to the temporal lobe measures 7 mm and was not clearly demonstrated on the prior exam. One in the right temporal lobe medially measures 13 mm on the current exam and previously was not readily visualized. One in the left temporal lobe could only be seen on susceptibility weighted imaging on the prior exam and now can be seen on rest of the pulse sequences and measures 7 x 4 mm. The enhancement pattern with these lesions is predominantly heterogeneous.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Since the previous examination, the patient has developed multiple new hemorrhagic lesions while previously noted hemorrhagic lesions have enlarged. This is compatible with metastatic disease throughout the brain.


Instruction: Generate impression based on medical findings.

Input: Male 71 years old Reason: history of left base prostate cancer History: history of left base prostate cancer PELVIS:PROSTATE:Prostate Size: The prostate gland measures 3.8 x 5.5 x 6.3 cm.Peripheral Zone: Three foci of abnormal T2 hypointense signal which demonstrate early enhancement and are dark on the ADC map are identified within the peripheral zone. The dominant focus of signal abnormality is in the right paracentral peripheral zone posteriorly in the base. This measures 1.1 x 0.9 cm. It abuts the posterior capsule but there is no definite extracapsular extension. A second smaller focus of signal abnormality in the left peripheral zone in the mid gland measures 0.6 x 0.6 cm. A third punctate focus measuring 0.4 x 0.4 cm is identified in the left peripheral zone base/mid gland.Central Gland: Enlarged and heterogeneous.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Three foci of signal abnormality within the peripheral zone which are suspicious for foci of prostatic carcinoma. There is no extracapsular extension or seminal vesicle invasion.


Instruction: Generate impression based on medical findings.

Input: 13-year-old female with right knee stiffness and pain after fall. MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: There is fraying and discontinuity of the anterior cruciate ligament. However, many fibers appear intact. The PCL and LCL appear intact. There is minimal irregularity of the junction of the medial meniscus and MCL inferiorly with a tiny amount of joint fluid seen dissecting superiorly (series #9, image 12).EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Partial tearing of the ACL with mild irregularity of the MCL/medial meniscal interface.


Instruction: Generate impression based on medical findings.

Input: 69-year-old male with a history of multiple sclerosis now with weakness, changes in speech and consciousness. Evaluate for an MS exacerbation. MRI Brain:Again seen are scattered hyperintense T2/FLAIR white matter abnormalities, which are grossly unchanged compared to the prior exam. There is a left parietal periventricular lesion suggestive of a chronic demyelinating lesion while most of the additional scattered foci demonstrate a more nonspecific appearance and may represent mild chronic small vessel ischemic changes. Apparent FLAIR hyperintense foci involving the middle cerebellar peduncles are likely artifactual.There is no evidence of intracranial hemorrhage, mass, or acute infarct. No evidence of intracranial mass effect, midline shift, or herniation. There is mild global parenchymal volume loss. There is a left lens implant. There is severe rightward nasal septal deviation. There is minimal paranasal sinus opacification. Bone marrow signal and remainder of the extracranial soft tissues are grossly unremarkable.MRI Cervical spine:There is no definite cervical cord signal abnormality with motion degradation slightly limiting evaluation.There is mild straightening of the cervical spinal curvature. The cervical vertebral bodies are appropriate in height. Bone marrow signal is benign. There are multilevel degenerative changes with disc height loss and disc osteophyte complexes throughout the cervical spine with up to moderate spinal canal stenosis at the C5-C6 level where there is mild impression on the left ventral aspect of the cord related to left paracentral disc osteophyte complex. There is also mild spinal canal stenosis at the C4-C5 and C6-C7 levels.There is prominent multilevel neural foraminal narrowing secondary to facet and uncovertebral hypertrophy throughout the spine with moderate to severe neural foraminal stenoses at the left greater than right C3-C4 level, bilaterally at C4-C5, bilaterally at C5-C6, right greater than left C6-C7, and to a milder degree at the left C7-T1 level. There is an ovoid posterior superficial subcutaneous lesion at the C4 level measuring 1.2 x 1.5 cm which may represent a sebaceous cyst and can be correlated with clinical exam.

Output: 1.No evidence of progression of demyelinating disease in the brain. No evidence of acute infarct or intracranial mass effect.2.No definite evidence of demyelinating disease in the cervical cord within the limits of mild motion degradation.3. Moderate degree of multilevel degenerative changes throughout the cervical spine with up to moderate spinal canal stenosis at the left C5-C6 level and moderate to severe neural foraminal stenoses at multiple levels as described 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: Bilateral lower extremity pain. History of metastatic lung cancer. Thoracic Spine: There is no evidence of fracture. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable. There are partially imaged postoperative findings related to right lower lobectomy.Lumbar Spine: There is an enhancing mass in the right aspect of the thecal sac at the L5 level, which measures up to 12 mm in length. There may also be a small amount of enhancing tumor on the left side of the thecal sac at this level. There appears to be engorgement of the surrounding venous structures at this level as well. In conjunction with mild disc bulging, facet hypertrophy, and ligamentum flavum thickening, there is severe spinal canal stenosis at L4-5. There is also mild bilateral neural foraminal narrowing at L4-5 and L5-S1. There is no significant spinal canal or neural foraminal stenosis at the other levels of the lumbar spine. A punctate focus of enhancement in the left posterolateral spinal canal at the level of L3-4 along the length of a vessel may represent focal dilatation of the vessel. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved, aside from multilevel small intravertebral disc herniations. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: Enhancing tumor in the right aspect of the thecal sac, and perhaps also in the left aspect of the thecal sac at the L5 level may represent metastatic disease or peripheral nerve sheath tumor for example. In conjunction with mild disc bulging, facet hypertrophy, and ligamentum flavum thickening, there is severe spinal canal stenosis at L4-5.


Instruction: Generate impression based on medical findings.

Input: 32-year-old woman, 34 weeks gestation, with prior C-section, low-lying placenta, and concern for placenta accreta. PELVIS:UTERUS, ADNEXA: Gravid uterus. Low-lying placenta noted with placental tissue seen within 2.5 cm of the cervical os (801, image 24), consistent with grade I placenta previa. Additionally, the placental-myometrial junction is poorly seen anteriorly, appearance compatible with placenta increta. Intraplacental heterogeneous T2 signal and T2 hypointense bands are seen (series 801, image 29). The placenta closely abuts the ventral abdominal musculature particularly the right rectus abdominis muscle with obscuration of the expected intervening plane, appearance suspicious for placenta percreta. Prior C-section scar is noted.BLADDER: The bladder appears normal.LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: The partially visualized small bowel and colon are normal.BONES, SOFT TISSUES: No significant abnormality noted.FETUS: No significant abnormality noted within the brain, spinal canal, kidneys, alimentary tract, or heart of the fetus.OTHER: No significant abnormality noted.

Output: 1.Findings of abnormal placentation/increta with possible placenta percreta of involving the ventral abdominal musculature as above. 2.Inferior edge of placenta located approximately 2.5 cm from the internal cervical os, consistent with placenta previa, grade I.


Instruction: Generate impression based on medical findings.

Input: 15-year-old male with laceration to toe. Cannot move toe after injury. TENDONS: There is increased STIR signal in the dorsal soft tissues overlying the third toe. Abnormal STIR signal surrounds the third extensor tendon, and focal thinning of the tendon is noted on T1-weighted images in this area of swelling/edema (series 12, image 15). Findings may represent a partial tear or trapping of the 3rd extensor tendon. LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: No significant abnormality noted. ADDITIONAL

Output: Findings suggestive of partial tear or trapping of the third extensor tendon with surrounding edema as described above.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Baseline scan prior to new treatment start following disease progression. Signs and symptoms: History of stage IV metastatic melanoma. Enhanced CT of soft tissues of neck:60 cc of Omnipaque 350 is administered for this exam.Limited view of intracranial space demonstrate a large area of vasogenic edema in the right mid and posterior temporal lobe. There is a partially visualized enhancing mass in the right posterior temporal lobe measuring 13 x 14.2-mm in size.This finding was reported on prior MRI examination of brain from 6 -- 28 -- 11.Images through the skull base including cavernous sinuses are unremarkable.A right-sided nasopharyngeal mass is again identified. In comparison to prior study from 5 -- 16 -- 11 there is interval decrease in the size of the tumor. This mass extends along the posterior wall of the nasopharynx across the midline to the left paramedian left side of nasopharynx. The largest AP axis of this tumor is 18.6 and the largest transverse axis is 32.6-mm. These measurements are smaller since prior study. On the prior exam note was also made of extension of this tumor into the right posterior choana of the right nasal cavity which is no longer present on current study.A small subcutaneous metastatic nodule or on the left at C4 level demonstrate interval increase in its size to 18.6 x 20.6-mm in size while it measured only 9 x 6-mm on prior study.A small necrotic node in the left submandibular region remains identical to prior study and measures approximately 6.5 mm.No additional foci of metastatic lesions are identified.There is no definitive evidence of any osseous metastatic lesions. Please review dedicated studies for detection of osseous metastases.

Output: 1.Interval decrease in the size of right-sided nasopharyngeal mass since prior study. The largest dimensions of this mass are 18.6 x 32.6 millimeter.2.Interval increase in the size of a left posterior upper neck subcutaneous metastases lesion from 9 x 6-mm to 18.6 x 20.6-mm on current exam. 3.No evidence of neoplastic lesions.4.Large area of vasogenic edema in the right mid to posterior temporal lobe surrounding an enhancing tumor measuring 13 x 14.2-mm in size.


Instruction: Generate impression based on medical findings.

Input: Right upper quadrant pain. Rising conjugated bilirubin/LFTs. Evaluate cholelithiasis, cholecystitis. ABDOMEN:LUNG BASES: Trace bilateral pleural effusions are present.LIVER, BILIARY TRACT: Sludge is present within the gallbladder with gallbladder wall thickening and small amount of pericholecystic fluid, suggestive of cholecystitis. Trace ascites is also noted. No evidence of intra or extrahepatic biliary ductal dilatation. Multiple lobulated T2 hyperintense bilobar hepatic lesions are incompletely evaluated without intravenous contrast, though likely represent cysts.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Limited exam by lack images postcontrast.2.Findings suggestive of cholecystitis.


Instruction: Generate impression based on medical findings.

Input: Female, 17 days old, status post ALTE, with abnormal EEG. Assess for structural abnormality or brain lesions. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen.The pituitary gland and region of the sella are within normal limits. The brainstem, cerebellar vermis and cerebellar hemispheres are normally formed and unremarkable.The corpus callosum is fully formed and intact. The pattern of white matter myelination is appropriate for the stated age.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology.

Output: Unremarkable evaluation of the brain without specific findings to account for the patient's presentation.


Instruction: Generate impression based on medical findings.

Input: Prostate cancer, evaluate disease extent PELVIS:PROSTATE:Prostate Size: 7 cm in transverse dimension x 6.9 cm in craniocaudal dimension x 7.4 cm in AP dimension.Peripheral Zone: Ovoid focus of T2 hypointense signal in right-sided mid peripheral zone posteriorly measuring 9 x 7 mm. Corresponding marked low ADC signal visualized, image 184 series 704. Early arterial enhancement suggested.Central Gland: Marked BPH with median lobe hypertrophy extending into bladder.Seminal Vesicles: Symmetric signal seen.Extracapsular Extension: Right-sided 9 mm peripheral zone T2 hypointense lesion does not demonstrate extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: Right greater than left small fat-containing inguinal hernias.OTHER: Increased T1 signal seen in bilateral transition zones posteriorly, suspicious for underlying hemorrhage. To a lesser degree similar signal seen in bilateral peripheral zones. Atherosclerotic abdominal aorta, mildly aneurysmal.

Output: 1. Right-sided 9 mm mid peripheral zone lesion suspicious for prostatic adenocarcinoma given decreased T2 signal and marked low ADC signal.2. Mildly aneurysmal abdominal aorta partially imaged, measuring up to 3 cm.


Instruction: Generate impression based on medical findings.

Input: 61-year-old male with cirrhosis and abdominal pain. Please screen for HCC and possible source of generalized abdominal pain. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology. Status post cholecystectomy with stable mild prominence of the common bile duct measuring 5.8 mm in diameter. No suspicious lesions are identified. No evidence for washout. Patent vasculature.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable right upper pole renal cyst. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Stable mildly enlarged periportal lymph nodes.BOWEL, MESENTERY: Small esophageal varices.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cirrhotic morphology. No suspicious hepatic lesions.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: AphasiaClinical question: TIA strokeSigns and Symptoms: Left sided sensory deficits and resolved slurred speech MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. 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.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 small. The posterior communicating arteries are small. The left vertebral artery is slightly larger than the right 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. There is mild narrowing of the vertebral arteries at their origins but no significant stenosis..

Output: 1.There is no evidence for acute ischemic cerebral infarction.2.No evidence for intracranial cerebrovascular occlusive disease.3.No evidence for extracranial cerebrovascular occlusive disease


Instruction: Generate impression based on medical findings.

Input: Assess hepatic vessel patency. Status post orthotopic liver transplant in 1990. Recurrent cirrhosis. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology with regions of confluent fibrosis with no suspicious focal lesion. Two small hepatic cysts.Dilated patent portal vein. TIPS catheter in expected position was better opacified on the prior study with poor opacification near its middle hepatic vein landing site on today's examination.Diffuse iron deposition.SPLEEN: Splenomegaly measuring 17 cm in length without a focal lesion. Perisplenic collateral vessels.PANCREAS: 9 mm pancreatic head cystic lesion appears to communicate with the normal caliber main pancreatic duct, compatible with a side branch IPMN without suspicious imaging features, unchanged.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.The TIPS catheter is poorly opacified at the level of the middle hepatic vein landing site, especially when compared to the prior. Consider ultrasound evaluation if there is concern for TIPS thrombosis/stenosis. No ascites.2.Cirrhosis and stigmata of portal hypertension (splenomegaly and perisplenic collateral vessel formation). No suspicious liver lesion.3.Stable pancreatic head subcentimeter sidebranch IPMN without suspicious imaging features.


Instruction: Generate impression based on medical findings.

Input: 30 years Male (DOB:5/20/1986)Reason: epilepsy History: seizuresPROVIDER/ATTENDING NAME: PETER C. WARNKE PETER C. WARNKE There is a heterogeneous appearance of the medial aspect of the left temporal lobe which appears similar to the prior exam.The patient status post left temporal burr hole placement. Patient's also status post left occipital burr hole placement. 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 a mucous retention cyst in the left side. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Examination was performed for stereotactic guidance. There are postoperative changes present related to left medial temporal lobe stereotactic surgery.


Instruction: Generate impression based on medical findings.

Input: 4-year-old male with lethargy and altered mental status. There is a well-defined focus of hypodensity in the right centrum semiovale, which was seen on 2010 MRI of brain; this is consistent with a prominent perivascular space. There is no evidence of intracranial hemorrhage, mass, edema, hydrocephalus, or midline shift. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. Sphenoid sinuses and ethmoid air cells are opacified. The mastoid air cells are normal in appearance.

Output: 1.No acute intracranial abnormality. 2.Sinus opacification.


Instruction: Generate impression based on medical findings.

Input: Reason: Brachytherapy planning History: Brachytherapy planning. PELVIS:UTERUS, ADNEXA: Interval placement of tandem and ovoid apparatus. Cervical mass compatible with patient's history cervical cancer has significantly decreased in size with no detectable disease on T2 sequences. Small focus of enhancement measures 2.5 x 1.7 cm (series 1101 image 279), previously 2.9 x 2 cm and may represent inflammatory reaction or small residual disease. The mass remains in close proximity to the rectum. Previously noted loss of fat plane between the mass and the left pelvic side wall is again appreciated. Uterine fibroids and nabothian cysts have not significantly changed.BLADDER: No significant abnormality noted.LYMPH NODES: Reference right pelvic sidewall lymph node measures 1.5 x 0.6 cm (series 801 image 83), previously 1.6 x 0.8 cm. Previously referenced left pelvic sidewall rounded lymph node has also slightly decreased in size (series 801 image 34).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Partially visualized large left renal cyst extending into the pelvis is again noted.

Output: Cervical mass and bilateral pelvic sidewall lymphadenopathy have decreased in size compared to prior.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Other malaise and fatigue. Other malaise and fatigueClinical question: Is there stenosis?Signs and Symptoms: back pain and weakness MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Exam is mildly degraded due to patient motionMRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There are bilateral uncovertebral osteophytes present this level which are more on the left versus the right side where there is encroachment of the nerve roots of the left-sided exiting nerve root and encroachment on the left hemicord. This has progressed since the 2009 examAt C4-5 there are endplate and uncovertebral osteophytes present associated with some mild narrowing of the neural foramina bilaterally more on the left versus the right side. There is encroachment of the exiting nerve roots within the left neural foramen at this this was also present on the prior exam from 2009. It has not changed substantially since.At C5-6 there are endplate and uncovertebral osteophytes present with encroachment of the neural foramina bilaterally but more on the right and the left side where there is encroachment of the right-sided exiting nerve roots. This was also present on the prior exam and has not changed substantially.At C6-7 there are endplate and uncovertebral osteophytes present associated with disc material and mild narrowing of the neural foramina bilaterally. This was also present on the 2009 exam and not substantially changed.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.There are multilevel degenerative changes present in the cervical spine with multilevel encroachment of exiting nerve roots on the left side at C3-4, and the left side at C4-5 and the right-sided C5-6. These are largely stable since the prior exam except that the encroachment of the left exiting nerve roots at C3-4 has progressed2.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 3.Examination is mildly degraded due to patient motion which may obscure more subtle abnormalities.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Memory loss. Assess for vascular/other etiology.Signs and Symptoms: As above The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There no evidence for acute ischemic cerebral infarction.2.MRI of the brain is appropriate in appearance for the patient's stated age.


Instruction: Generate impression based on medical findings.

Input: History of Whipple in 2013 for IPMN with subsequent recurrent acute and chronic pancreatitis. Patient has a history of CREST syndrome, autoimmune thyroiditis and Sjogren's syndrome. ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes from hepaticojejunostomy. The central biliary tree demonstrates short segment smooth narrowing at the level of the right and left hepatic bile ducts. No focal lesion is evident, however evaluation is limited by lack of intravenous contrast. No significant intrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Postsurgical changes from a Whipple procedure. The residual pancreatic body demonstrates normal T1-weighted signal intensity. However, the residual pancreatic tail demonstrates bulbous enlargement, decreased T1-weighted signal intensity and associated restricted diffusion. The main pancreatic duct in the tail demonstrated beaded dilatation measuring up to 4 mm with side branch ectasia. There are small unilocular cystic lesions in the pancreatic tail with the largest measuring 1.2 x 1.0 cm (series 3/20). Following secretin administration there is no significant dilatation in the residual pancreatic duct but there appears to be some excretory function of the parenchyma.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. Bulbous enlargement, restricted diffusion and ectatic dilation of the pancreatic tail suspicious for an inflammatory process. The constellation of findings and the patient's history raises suspicion for auto-immune hepatopancreatitis. An underlying mass lesion cannot be excluded. EUS and tissue sampling is suggested. 2. Abnormal narrowing of the central biliary tree without a focal lesion seen on this limited non-enhanced study; also may be related to auto-immune hepatopancreatitis. 3. Small cystic foci in the pancreatic tail may represent side branch type IPMNs with the largest measuring 1.2 cm without suspicious features, within the limitations of a nonenhanced study.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Rule out cord compression. Signs and symptoms: Urinary/bowel incontinence. Nonenhanced lumbar MRI:Examination demonstrates a large destructive enhancing mass involving vertebral bodies of S1-S3 and their posterior elements. There is extraosseous spread of tumor into the spinal canal at these levels which is completely occupied by the mass. There is significant extension of mass into bilateral neural foraminal There is significant extraosseous spread of mass into the left pelvis and left presacral space, extensive extension into the sacral canal which is nearly completely occupied by tumor as well as bilateral neural foraminal of the sacral region.Additionally exam demonstrates fairly extensive lymphadenopathy on the left anterior to the spine.The left presacral mass measures at least at 52 x 55 mm in transaxial dimensions. The largest transaxial dimensions of partially visualized nodes measures at 50 x 36 mm in transaxial dimensions. This cluster of nodes measures approximately at 140 mm in cranial cephalad access and extending from T12-L1 inferiorly to the pelvis.There is significant expansion of the bladder.Nonenhanced total spine MRI:Examination is performed utilizing cord compression protocol without axial series.Examination demonstrates extensive tiny foci of marrow signal replacement with hypointense T1 and hyperintense T2 and T2 STIR signal pattern highly suspicious for metastatic disease. The findings are present throughout the cervical and thoracolumbar spine. On sagittal post enhanced images of the dedicated lumbar MRI the lesions demonstrate enhancement and all highly suspected of diffuse metastatic lesions.

Output: 1.Nonenhanced total spine (cord compression protocol) MRI exam demonstrate numerous tiny foci of marrow signal replacement involving extensively the vertebral column highly suggestive of metastatic lesions.2.Dedicated pre and postcontrast enhanced lumbar MRI demonstrate a large destructive enhancing mass involving S1, S2 and S3 vertebral bodies, extensively occupying the sacral canal at these levels, large extraosseous component in the left pelvis and extensively of the sacral neural foraminal as detailed. There is extensive loculated lymph nodes within the abdomen on the left paraspinal tissues extending from T12-L1 to the pelvis as detailed/measured above.3.Significant expansion of the bladder.


Instruction: Generate impression based on medical findings.

Input: There is stable mild grade 1 retrolisthesis of L4 on L5. The spine is in otherwise normal alignment. The vertebral body heights are well-maintained. There is mild scattered disc narrowing throughout the cervical spine, with redemonstration of moderate-severe disc narrowing at L4-L5 with vacuum phenomenon.Prominent endplate degenerative marrow changes are seen again at L4-L5. Multiple areas of abnormal marrow signal are again visualized, with increased size and conspicuity of rounded areas and punctate foci of T1 and T2 hypointensity consistent with sclerosis. The largest lesion in the lumbar spine is now located at L1 along its superior endplate, increased in size since the prior MRI. There is slight associated convexity of the superior endplate due to the metastasis. A prominent area of T1 and T2 hypointensity corresponding to a sclerotic lesion is seen in the T8 vertebral body, similar to prior CT. Some of the lesions demonstrate mild peripheral STIR hyperintensity. Heterogeneous STIR hyperintensity is noted in the T1 vertebral body.The spinal cord is grossly of normal caliber and signal. There is at most mild central spinal canal stenosis at C4-C5 and C5-C6 with a focal central disc protrusion at C5-C6. Along the thoracic spine, there is a minimal shallow central disc protrusion at T9-T10 which indents the sac and may abut the ventral cord. Along the lumbar spine, there is redemonstration of focal spondylotic changes from L2-L3 through L4-L5 resulting in moderate-severe central spinal canal stenosis at these levels as previously seen. Grossly on sagittal images, the degree of narrowing appears similar. Scattered moderate foraminal narrowing is again noted along the lumbar spine.Mild STIR hyperintensity is noted along the left paraspinal musculature at the lumbosacral junction which may relate to postprocedural changes following recent steroid injection. There is no focal fluid collection identified.

Output: 1.No evidence of overt cord compression or evidence of acute pathologic compression deformity. Grossly similar degree of high-grade central spinal canal stenosis at L3-L4 and L4-L5 as previously seen, with significant crowding of cauda equina nerve roots. This is in part relating to grade 1 retrolisthesis of L4 on L5, which is stable.2.Compared to prior remote MRI of the lumbar spine, progressed size and conspicuity of sclerotic appearing osseous metastatic lesions within the spine. Findings do appear slightly progressed since more recent prior CT.3.Minimal signal changes along left lumbosacral paraspinal musculature which may relate to recent procedure. Please correlate clinically.


Instruction: Generate impression based on medical findings.

Input: 26-year-old female. Hepatic mass with chronic right upper quadrant pain ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Patient's known mass near the caudate lobe cannot be well seen on this single phase CT but remains grossly unchanged compared to previous MRI. No evidence of a complication related to this mass such as hemorrhage.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: 7 x 4.3 cm cystic mass arising from the right ovary. Further evaluation with pelvic ultrasound is recommended.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No significant change in the patient's known, most likely benign hepatic lesion. This lesion cannot be well seen or measured on this single phase CT.Right ovarian cystic lesion. Further evaluation with pelvic ultrasound is recommended to exclude a cystic ovarian neoplasm.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for malignancy History: NMDA encephalitis, R ala lesion on PET, neg TVUS No bone marrow signal abnormality is identified. No enhancing mass lesions are seen. The imaged musculature of the pelvis is unremarkable. There is a small amount of fluid within the vaginal cuff of uncertain significance. There is a small amount of fluid within the hips which is likely of no current clinical significance. No acute fracture or malalignment.

Output: No bone marrow signal abnormality or enhancing mass lesion to correspond to the findings seen on recent PET examination. Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Redemonstrated is a mixed signal T1 and T2 intensity lesion within the medial rolandic brain involving both sensory and motor cortices, measuring 17 mm AP by 13 mm transverse dimensions (as measured on axial T2 technique), unchanged in size or morphology. This is associated with susceptibility hypointense abnormality, however without perilesional edema. Postcontrast images demonstrate an associated developmental venous anomaly which drains posteriorly, superiorly, and medially. There are no other foci of susceptibility abnormality.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no other masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for acute intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear.

Output: Stable cerebral cavernous malformation involving left medial rolandic brain involving both sensory and motor cortices with an associated developmental venous anomaly.


Instruction: Generate impression based on medical findings.

Input: Parkinson's disease [G20], Reason for Study: ^Reason: parkinsons History: tremor There is very prominent enhancing tubular structure on the posterior aspect of the distal basilar artery (series 401, image 80) and located at the interpeduncular fossa. Superior aspect of this structure is following the right PCA and it appears to be connected to the left posterior cavernous sinus. Possibility of this structure is prominent interpeduncular vein.However, since the vein is too prominent than usual on MRI, the possibility of arteriovenous shunting or duplicated right PCA cannot be completely excluded. For further imaging evaluation, CTA and CTV can be considered. However, if those imaging studies are not conclusive, diagnostic catheter angiography can be the next resort if clinically indicated.Scattered T2 high signal intensity lesions on periventricular white matter and centrum semiovale are seen which are nonspecific.There is no evidence of acute hemorrhagic lesion on the scan.There is no evidence of abnormal enhancement on the scan. The ventricles, sulci and cisterns are symmetric and unremarkable. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Non specific T2 high signal intensity lesions on periventricular white matter.2. No abnormal enhancing parenchymal lesion.3. Likely vascular structure seen on the posterior aspect of the distal basilar artery. Differential diagnosis include prominent interpeduncular vein, possible arteriovenous shunt or duplicated right PCA.CTA and CTV of head can be considered for further imaging investigation if clinically indicated.


Instruction: Generate impression based on medical findings.

Input: 24 year old woman with history of syncope, abnormal RV wall motion on TTE referred for cardiac MRI to evaluate for ARVD. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 60%, the LV end diastolic volume index is 76 ml/m2 (normal range: 65+/-11), the LVEDV is 150 ml (normal range 109+/-23), the LV end systolic volume index is 30 ml/m2 (normal range 18+/-5), the LVESV is 60 ml (normal range 31+/-10). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Left AtriumThe left atrium is normalRight VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 89 ml/m2 (normal range 69+/-14), the RVEDV is 177 ml (normal range 110+/-24), the RV end systolic volume index is 43 ml/m2 (normal range 22+/-8), and the RVESV is 85 ml (normal range 35+/-13). There is a focal wall motion abnormality in the distal RV free wall.Right AtriumThe right atrium is normalAortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation, but the severity of aortic regurgitation can be underestimated by the MRI pulse sequence used in this study.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation, but the severity of mitral regurgitation can be underestimated by the MRI pulse sequence used in this study.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation, but the severity of pulmonic regurgitation can be underestimated by the MRI pulse sequence used in this study.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation, but the severity of tricuspid regurgitation can be underestimated by the MRI pulse sequence used in this study.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 FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function (EF 60%).2. There is no late gadolinium enhancement to suggest the presence of an underlying inflammatory, infiltrative, fibrotic process in the myocardium.3. The right ventricle is normal in size with normal overall systolic function (EF 52%). However there is a focal wall motion abnormality present in the distal RV free wall.


Instruction: Generate impression based on medical findings.

Input: 55 year old female with metastatic breast cancer who presents with left-sided blurry vision. Rule out metastases disease to the eye or brain. Expansile lytic destructive changes of calvarium consistent with metastatic lesions are again identified. There is significant interval increase in the size of lesions since prior study. There is no apparent epidural spread of tumor into the spinal canal. This can be significantly better visualized on MRI exam. The brain parenchyma remains normal in density and demonstrates no abnormal enhancement of the right parenchymal or the meninges. There is also suggestion of new additional metastatic lesions to the calvarium.Expansile mixed density left frontal bone lesion with significant extension into the right orbit is consistent with fibrous dysplasia is again identified with no interval change.CT of maxillofacial. Significant expansion of right frontal bone in all of its segments and in particular along the floor of the right anterior cranial fossa is noted. The changes extends medially and involves the fovea ethmoidalis and the left frontal bone and is contiguous with fibrous dysplasia changes of sphenoid bone. Significant expansion of the right frontal bone causes elevation of right frontal lobe. Expansile changes of right frontal bone reduces the carinal cephalad axis of the right orbit and applies mass effect on the external ocular musculature and globe. Coronal reformatted images demonstrate these findings with better advantage. There is fibrous dysplasia of left frontal bone along the floor of the anterior cranial fossa. There is mild compromise of the left optic nerve canal and likely the right optic nerve canal secondary to fibrous dysplasia changes at the level of planum sphenoidale. The retro-orbital fat, extraocular musculature and globe remains normal on the left.

Output: 1.Increase in the size of lytic destructive metastatic lesions of the calvarium with no apparent extension into the intracranial space.2.No evidence of edema brain parenchyma or abnormal enhancement of the brain or leptomeninges.3.Large fibrous dysplasia of right and to a lesser degree left frontal bones with associated changes of the orbit as detailed above.


Instruction: Generate impression based on medical findings.

Input: Brain: Examination is limited to axial T2 sequences. Increased dilatation of the lateral, third, and fourth ventricle when compared to the prior study. For example, the third ventricle previously measured 16 mm, currently 20 mm in diameter. The fourth ventricle is particularly expanded when compared to prior study, currently measuring 30 mm in transverse dimension, previously 24 mm, with dilatation extending caudally to the level of the obex. There is increased effacement of the prepontine cistern and increased dorsal scalloping of the brainstem. There is no midline shift or uncal herniation. There is evidence of transependymal flow. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. There is minimal scattered mucosal thickening in the right maxillary sinus and anterior ethmoid air cells. There are postoperative findings related to Chiari decompression.Cervical Spine: Limited sagittal T2 images were acquired. Patient is status post Chiari decompression. The septated cervicothoracic syringohydromyelia now extends cranially to the obex. At the C1 level, the syrinx currently measures 11 x 13 mm in the axial plane, previously 3 x 4 mm. Based on sagittal imaging, there is increase in dimension of the syrinx, particularly within the upper cervical spine, with associated increase in expansion of the cervical cord. However, there is slight decrease in size of the syrinx within the upper thoracic cord. There is focal severely diminished CSF flow ventrally and dorsally at the foramen magnum. Straightening of the normal cervical lordosis. No worrisome focal marrow signal abnormality is appreciated. There is no significant spinal canal stenosis.

Output: 1.Interval increase in dilatation of the lateral, third, and fourth ventricles compared to MRI from 9/2/2015.2.Increase in caliber of the syrinx particularly at the upper cervical cord level and obex. Syrinx involving the partially imaged upper thoracic cord appears decreased since 9/2/2015 based on the sagittal images.3.Examinations of the brain and cervical cord were abbreviated due to patient's condition.


Instruction: Generate impression based on medical findings.

Input: Fall status post head trauma. Patchy hypodensity within the periventricular and subcortical white matter represent small vessel disease of indeterminate age. There is hypodensity of the right thalamus, possibly representing subacute ischemia.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 paranasal sinuses and mastoid air cells are normally aerated.

Output: Small vessel ischemic disease of indeterminate age. Possible acute/subacute ischemia of the right thalamus. MRI can be obtained for further evaluation if clinically indicated.


Instruction: Generate impression based on medical findings.

Input: Wrist pain The exam is limited by motion artifact as well as inability of the patient to complete all sequences.LIGAMENTS: No significant abnormality noted.TRIANGULAR FIBROCARTILAGE COMPLEX: No significant abnormality noted.TENDONS: No significant abnormality noted. BONES: There are degenerative cystic changes within the proximal carpal row specifically within the lunate. There is no evidence of fracture or malalignment. Positive ulnar variance is again noted.ADDITIONAL

Output: Positive ulnar variance with degenerative changes in the proximal carpal row (particularly the lunate), suggesting ulnar abutment syndrome.


Instruction: Generate impression based on medical findings.

Input: Elevated prolactin with pituitary microadenoma treated with cabergoline. There is no evidence of a residual pituitary lesion. The adenohypophysis is not enlarged. There is an intact posterior pituitary bright spot. The pituitary stalk is intact. The optic apparatus and cavernous sinuses are unremarkable.

Output: No evidence of residual pituitary adenoma.


Instruction: Generate impression based on medical findings.

Input: 47 years, Male, questionable focus of increased activity in the right thalamus on PET. Newly diagnosed tonsil cancer. Multiple sequences are motion degraded. There is however no evidence of intracranial metastatic disease or signal abnormality in the thalamus. 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. Few scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with minimal chronic small vessel ischemic changes. Brain parenchyma is otherwise unremarkable for age. 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 is within normal limits. Right tonsillar mass and right cervical lymphadenopathy is partially imaged.

Output: Brain parenchyma appears within normal limits for age. Specifically, no evidence of intracranial metastatic disease or signal abnormality in the right thalamus.


Instruction: Generate impression based on medical findings.

Input: Male 85 years old Reason: 85 yo M with chondrocalcinosis with worsening pain in R ankle/foot; evaluate for ligament/tendon tear/inflammation, soft tissue swelling History: pain, difficulty with ambulation needing wheelchair. TENDONS: A small amount of fluid within the sheaths of the posterior tibial and flexor digitorum tendons is within normal limits. There is fluid within the flexor hallucis longus tendon sheath just proximal to the knot of Henry which may represent mild tenosynovitis. A small amount of fluid in the peroneal tendon sheaths is within normal limits. Increased signal intensity within the peroneus brevis tendon as it courses beneath the fibular tip likely represents mild tendinosis. The Achilles' tendon appears normal.LIGAMENTS: The lateral collateral ligament complex is intact. The distal tibiofibular syndesmotic complex is intact. The deep fibers of the deltoid ligament have lost their normal striations and there is an ossicle distal to the medial malleolus. These findings suggest old trauma. The superficial components of the deltoid ligament appear unusually thickened which may likewise reflect old injury.ARTICULAR SURFACES AND BONE: There is edema within the distal tibia that extends from the epiphysis into the distal diaphysis, off the field of view of this study. The signal abnormality is most concentrated along the anterolateral aspect of the distal tibial epiphysis and appears associated with a thin band of horizontally oriented low signal intensity immediately adjacent to the physeal scar. We suspect that this constellation of findings represents a stress fracture with edema extending into the distal tibial diaphysis. Additional foci of signal abnormality within the foot are likely degenerative in etiology reflecting mild osteoarthritis. Metallic artifact within the head and neck of the first metatarsophalangeal joint represents arthroplasty which is incompletely imaged on this study. The ankle joint itself appears normal with no joint effusion. We see no osteochondral defects.ADDITIONAL

Output: 1. Bone marrow edema in the distal tibia as described above. This appears most concentrated along the lateral aspect of the distal tibial epiphysis and is associated with a small linear focus of low signal intensity that we suspect represents a stress fracture.2. Fluid within the flexor hallucis longus tendon sheath proximal to the knot of Henry may represent tenosynovitis.3. Generalized soft tissue swelling.4. Other findings as described above.Findings discussed by myself Dr. Ward with Dr Siddiqui 5:35 p.m.. 04/17/15.


Instruction: Generate impression based on medical findings.

Input: 9 month old female with history of fall from mother's arms onto concrete floor with scalp hematoma. Limited views of the orbits appear normal.Small right occipital subgaleal hematoma with underlying, minimally overriding occipital fracture with slight depression that is no thicker than the thickness of the bone itself.There is a subcutaneous lesion immediate above the anterior fontanelle that contains soft tissue and a small amount of fat. Suspect this may represent a hemangioma. No associated fat stranding is identified. No boney change is noted underneath the lesion to suggest a meningocele. Suspect hemangioma; correlate with physical examination. If it is not known what this lesion represents; consider an MRI with contrast for further evaluation.There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Small right occipital subgaleal hematoma with underlying, minimally overriding occipital fracture with slight depression that is no thicker than the thickness of the bone itself.2. Findings suggestive of anterior subcutaneous hemangioma. If it is not known what this lesion represents; consider an MRI with contrast for further evaluation.


Instruction: Generate impression based on medical findings.

Input: 67-year-old male with history of prostate cancer. PELVIS:PROSTATE:Prostate Size: The prostate measures 5.3 x 2.9 x 6.0 cm.Peripheral Zone: Right peripheral apical T2 hypointense lesion with associated decreased ADC measuring 11 x 8 mm. No appreciable enhancement.There is an additional similar-appearing focus in the left mid gland measuring 6 x 5 mm. No appreciable enhancement.Mild bilateral peripheral increased T1 signal compatible with hemorrhage.Central Gland: BPHSeminal Vesicles: No significant abnormality noted.Extracapsular Extension: No definite extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Highly suspicious peripheral lesion in the right apex without definite extracapsular extension.2. Smaller lesion in the left mid gland also suspicious for multifocal disease.3. Scattered areas of hemorrhage.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Stroke. Signs and symptoms: Stroke. Nonenhanced CT of brain:The examination demonstrates fairly extensive supratentorial periventricular and subcortical low-attenuation with no associated mass effect. There is also suspected low-attenuation of corpus callosum. Although the above findings are nonspecific they could represent very advanced to small vessel disease of indeterminate age. Findings remain identical to prior study from 6 -- 2 -- 2010. Follow-up with an MRI examination is recommended to exclude other possibilities. Multiple prior studies and including patient MRI examination from 2009 demonstrated similar findings.An old right posterior temporal -- parietal cortical stroke is again identified and no change.Images through posterior fossa demonstrate suspected low-attenuation in the pons consistent with old lacunar strokes.There is no evidence of hemorrhage or acute cortical stroke. The ventricular system remains within normal range of size.

Output: 1.Stable exam since prior study.2.Extensive White matter findings likely secondary to advanced to small vessel disease of indeterminate age.3.Old right posterior parietal -- temporal cortical stroke. Local nor strokes of pons.


Instruction: Generate impression based on medical findings.

Input: Prostate cancer.PSA 6 months ago: 7 ng/mL.PSA May 20, 2015: 14.5 ng/mL.Prostate biopsy June 5, 2015, Gleason 8 prostate cancer and left mid, right mid, and right lateral apex. Greatest volume in right mid gland. Gleason 7 cancer at left apex, right lateral base, right base, right lateral mid gland. PELVIS:PROSTATE:Prostate Size: 5.0 x 3.2 cm.Peripheral Zone: There are several suspicious lesions in the peripheral zone demonstrating hypointense ADC and T2 signal abnormality. The largest, dominant lesion is located in the right mid gland extending to the apex, series 701, image 18. This demonstrates pathologic enhancement and suggestion of washout. The adjacent capsule is indistinct, suggesting extracapsular extension. Additional suspicious lesion in the left base is seen on series 701, image 21. There is bulbous appearance of the left mid gland as well, without definite T2 or ADC signal abnormality; this lesion is indeterminate.Central Gland: Nodular central gland. No nodules demonstrate suspicious signal characteristics.Seminal Vesicles: No evidence of seminal vesicle involvement.Extracapsular Extension: Extracapsular extension from the dominant right mid gland lesion is suspected, as above.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Lesions in the peripheral gland suspicious for known prostate adenocarcinoma. Dominant lesion in the right mid gland with appearance suspicious for associated extracapsular extension.


Instruction: Generate impression based on medical findings.

Input: 33 year old male with buttock abscess and tenderness to palpation. Evaluate for perirectal abscess. ABDOMEN:This examination is limited by absence of IV contrast. LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: There is extensive diffuse soft tissue thickening subcutaneously in the right medial buttock that extends to the anus. The enteric contrast has not reached the distal colon and rectum. Without IV and enteric contrast, it is difficult to define an abscess or fistula. No definite abscess was found. No intrapelvic extension. If this condition persists or further evaluation is required, a non-contrast MRI scan may be most helpful.There is diffuse vascular calcifications in the pelvis.

Output: Right buttock subcutaneous inflammatory changes, but no definite abscess. Sensitivity is limited without enteric or IV contrast. Consider MRI if further evaluation is required.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate for osteomyelitis of left thumb History: infection of thumb- herpetic whitlow with secondary infection, now s/p debridement with plastic surgery There are signal changes within the distal phalanx of the thumb, T1 hypointensity and T2 hyperintensity, along with marked enhancement of the bone and surrounding soft tissues, compatible with osteomyelitis. There is surrounding soft tissue edema. The rest of the hand is within normal limits.

Output: Acute osteomyelitis of the distal phalanx of the thumb.


Instruction: Generate impression based on medical findings.

Input: Male, 34 years old, with history of neurofibromatosis type I. Assess for any paraspinal neurofibromas. Does flank mass extend to spine. The left-sided paraspinal musculature and flank soft tissues are diffusely infiltrated by T2 hyperintensity which is largely ill-defined but in some areas rather nodular. Given the history, this is compatible with neurofibromas. These lesions begin at approximately the L1-2 level and continue down to the L5-S1 level. The disease is centered within the paraspinal and subcutaneous tissues at L4. Although these lesions extend towards the spinal canal they do not frankly invade it. Numerous additional scattered nodular hyperintense lesions are identified bilaterally in the paraspinal and prevertebral soft tissues. Numerous cutaneous nodules are also demonstrated.The sacral and lower lumbar nerve roots are diffusely nodular and T2 hyperintense compatible with the presence of neurofibromas. These lesions affect both the foraminal and extraforaminal portions of the nerves, but do not extend intracanalicularly. More superiorly, there are small neurofibromas associated with the exiting lumbar spinal nerve roots, particularly at L1-2 on the left.No large intraspinal lesions are detected. The visualized conus and cauda equina nerve roots are unremarkable.L1-2 through L3-4: No significant spinal canal or neuroforaminal stenosis.L4-5: Facet hypertrophy with small facet effusions. Mild bulging disk. No significant spinal canal or neuroforaminal stenosis.L5-S1: Facet hypertrophy. Bulging disk with a superimposed small right paracentral protrusion. The right ventral aspect of the thecal sac is mildly effaced, but no significant generalized spinal canal stenosis is seen. The neural foramina are mildly narrowed.

Output: 1.Large infiltrative left paraspinal and flank neurofibroma. This lesion extends towards the spinal canal but does not frankly invade it. 2.Innumerable neurofibromas are evident affecting the foraminal and extraforaminal sacral and lower lumbar nerve roots. Scattered smaller neurofibromas are also seen along the remaining lumbar neural foramina, and within the paraspinal and prevertebral soft tissues.3.No intracanalicular lesions are detected at this time. No areas of spinal canal stenosis are seen. There is a small disk herniation at L5-S1.


Instruction: Generate impression based on medical findings.

Input: An extra-axial homogenously enhancing mass lesion located in the left cerebellum along the tentorium has minimally increased in size, currently measuring 1.8cm (AP) x 1.8 cm (ML) x 2.0cm (CC), previously 1.6 x 1.7 x 2.0 cm with MRI 7/30/2015, respectively. There is no significant adjacent parenchymal edema. This lesion is adjacent to the left transverse sinus which is focally narrowed but patent proximally and distally, similar to the prior exam. There is an additional extra-axial enhancing lesion in the left frontal high convexity which is calcified on prior CTs measuring 7 mm in thickness and is also unchanged in size. No new enhancing lesions are present. There is no evidence of intracranial hemorrhage.There is a new T2/FLAIR hyperintense focus at the right temporoparietal occipital junction, which is nonspecific and may relate to ischemia or other injury. Otherwise scattered punctate foci of T2 and FLAIR hyperintensity within the white matter are nonspecific and may reflect minimal small vessel ischemic changes similar to prior. Ventricles are normal in size. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.Minimal gradual increase in size of a left posterior fossa meningioma compared to prior studies from 7/30/2015 and 8/7/2014.2.Stable appearance of a subcentimeter enhancing extra-axial lesion along the left high convexity, consistent with an additional meningioma.3.Again seen are minimal scattered foci of T2/FLAIR hyperintensity which are nonspecific but compatible with mild chronic small vessel ischemic changes. There is however a new focus at the right temporo-occipital junction, which is nonspecific and may relate to interval ischemia, inflammation, or other injury. No evidence of acute 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: headache, memory loss and cognitive problems. No evidence of acute ischemic or hemorrhagic lesion on this 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: No evidence of acute ischemic or hemorrhagic lesion on this scan.No evidence of abnormal enhancement.


Instruction: Generate impression based on medical findings.

Input: Reason: please do Dr javed MS prtocol on 3 tesla History: MS, gait disorder The CSF spaces are appropriate for the patient's stated age with no midline shift. Multiple periventricular and subcortical white matter lesions present asymmetrically located to the left hemisphere some of which are perpendicularly oriented to the lateral ventricles. There total of approximately 10 or 15 lesions present. No associated enhancement following gadolinium administration is appreciated in association with these lesions.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Periventricular and subcortical white matter lesions are suspicious for demyelination.