Instruction: Generate impression based on medical findings.

Input: Bariatric surgery history and AMS, high grade fevers, sepsis, and reported seizures. CSF with high WBCs, normal protein, and high glucose. Brain MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is mild fluid signal within the mastoid air cells. There is also fluid within the upper aerodigestive track associated with intubation.Brain MRA: There is no evidence of significant steno-occlusive lesions or aneurysms.Neck MRA: There is no evidence of significant steno-occlusive lesions.

Output: 1. No evidence of intracranial abscess or acute infarct.2. No evidence of significant steno-occlusive lesions in the head and neck.


Instruction: Generate impression based on medical findings.

Input: h/o spondylolysis. Examination demonstrates a spondylolysis of the left L4 pars interarticularis. The lumbar spine alignment and vertebral body height appear normal. No spinal stenosis or neuroforaminal compromise is identified.

Output: Spondylolysis of the left L4 pars interarticularis.


Instruction: Generate impression based on medical findings.

Input: There is redemonstration of postoperative findings from multiple prior craniotomies with areas of bilateral frontal and cerebellar hemisphere encephalomalacia. There is an unchanged meningioma along the planum sphenoidale. The partially cystic lesion in the left cerebellar hemisphere with surrounding edema appears to be unchanged in size. There is no evidence of acute ischemia. The shunted ventricular system appears to be unchanged. There is an unchanged enhancing intraconal lesion within the lateral left orbit. There is a partially-imaged upper cervical spinal cord ependymoma and upper cervical spinal canal schwannomas. There are unchanged enhancing left parietal and right occipital scalp lesions. There are postoperative findings related to bilateral retrosigmoid craniotomies. The residual components of the left vestibular schwannoma have not significantly changed in size. Likewise, the residual right vestibular schwannoma has not significantly changed in size. There is no significant interval change in the left facial nerve schwannoma involving the geniculate ganglion and internal auditory canal. There are also smaller facial nerve schwannomas centered in the right geniculate ganglion, as well as in the right mastoid segment, which are unchanged. A punctate left cerebellomedullary cistern schwannoma is unchanged. There are grossly unchanged bilateral trigeminal nerve schwannomas.

Output: 1. No significant interval change in the stigmata of neurofibromatosis type 2, including the planum sphenoidale meningioma, residual bilateral vestibular schwannomas and bilateral facial nerve and trigeminal nerve schwannomas, and left cerebellomedullary cistern schwannomas, left orbit and scalp schwannomas, left cerebellar lesion with surrounding edema, partially-imaged upper cervical spinal cord ependymoma and upper cervical spinal canal schwannomas. 2. The shunted ventricular system appears to be unchanged in size.


Instruction: Generate impression based on medical findings.

Input: Secondary malignant neoplasm of skin [C79.2], Reason for Study: ^Reason: leptomeningeal spread History: metastatic breast CA Re-demonstration of multiple extra axial enhancing metastatic lesions involving skull and leptomeninges. Overall the enhancing lesions show a bit smaller than prior scan. In particular, the left parietal and midline occipital adjacent to torcular show significant decrease in size since prior scan. Leptomeningeal enhancement is again demonstrated without any significant interval change since prior scan.Previously seen left parietal lobe lesion, does not show any significant interval changes since prior scan. There is no other intra axial lesion on this scan.There is no evidence of acute ischemic or hemorrhagic lesion. The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Overall decrease in size of multifocal extra-axial (skull and scalp) metastatic enhancing nodule since prior scan, especially significant decrease in size of left parietal and midline occipital lesions.2. No significant interval change of leptomeningeal and enhancement since prior scan.3. No MR evidence of intra-axial metastatic lesion.


Instruction: Generate impression based on medical findings.

Input: NECK: There are extensive postoperative findings related to right orbital and sinonasal exenteration with myocutaneous flap reconstruction. There marked interval decrease in size of the enhancing lesion in the roof of the left posterior nasopharynx along the surgical margin, now measuring up to approximately 5 mm, previously 15 mm. In addition, the previously demonstrated punctate right temporal scalp subcutaneous tissues nodule is no longer apparent. The right temporal fossa enhancing lesion with an adjacent underlying calvarial defect has decreased in size, measuring up to 5 mm, previously 9 mm. Likewise, the right squamosal temporal bone calvarial lesion with extension into the overlying scalp has decreased in size, now measuring up to approximately 4 mm, previously 6 mm. The right mandibular body lesion is also smaller, measuring 14 mm in the anteroposterior dimension, previously 16 mm, such that the lesion no longer protrudes through the anterior cortical defect. There is unchanged asymmetric enhancement in the right foramen rotundum. There are persistent obstructed secretions in the frontal and sphenoid sinuses with new mucosal thickening and fluid level in the left maxillary sinus. There is nonspecific high T2 signal in the right mastoid air cells. There is no evidence of significant lymphadenopathy in the neck. The thyroid and salivary glands appear unchanged.BRAIN: There is no abnormal intraparenchymal enhancement, acute infarct, mass, herniation, or midline shift. There are unchanged scattered T2 hyperintensities in the subcortical and periventricular white matter, which are nonspecific. The ventricles and sulci are unchanged.

Output: 1.Interval decrease in size of the metastases in the skull and mandible, left posterior nasopharynx along the surgical margin, and in the right scalp have decreased in size, consistent with response to therapy.2.Persistent mild asymmetric enhancement in the right foramen rotundum may be post-treatment in nature.3.No evidence of intraparenchymal brain metastases.4. Findings suggestive of acute left maxillary sinusitis with otherwise persistent obstructed secretions associated with the exenteration flap.


Instruction: Generate impression based on medical findings.

Input: Clinical question to be answered: Rule out bleed or hematoma. Signs and symptoms: Mental status change. Examination demonstrates a gyriform area of increased density in the high convex to the left parietal cortex (axial image 20). This finding is associated with an adjacent area of encephalomalacia . The finding is believed to represent calcific changes of an area of old stroke which was noted on prior MRI exam. Less likely possibility of a new small hemorrhagic cortical stroke cannot be entirely ruled out. Prominence of cortical sulci and folia of the cerebellum as well as prominence of the ventricular system is concerning for underlying parenchymal volume loss.

Output: See above comments.


Instruction: Generate impression based on medical findings.

Input: Right shoulder pain ROTATOR CUFF: There is no rotator cuff full thickness tear or significant tendinosis. Muscle bulk is appropriate for age without muscle edema.BICEPS TENDON: The long head of the biceps tendon is normal in caliber, signal, and positioned within the intertubercular sulcus.LABRUM: The glenoid labrum is intact for non-arthographic technique.OSSEOUS STRUCTURES: The osseous structures are normal in alignment and marrow signal.ADDITIONAL

Output: Placement of a marker at the right supraclavicular region at the region of interest and no abnormal enhancement at this area. Dedicated ultrasound could be performed for further evaluation if clinically indicated.


Instruction: Generate impression based on medical findings.

Input: 70 years, Male, Reason: H/o IVC sarcoma resected early this year. F/U CT Scan here on yesterday, new soft tissue lesion near IVC and hepatic lesion. Needs MRI for better charcterizattion History: none. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Left hepatic lesion which is hyperintense on T2 with peripheral nodular centripetal progressive enhancement likely represents a hemangioma it is unchanged in size measuring 1 cm (701/26). There is a punctate enhancing focus in segment 8 measuring 6 mm (1002/307) which is bright on T2 and nonspecific. A segment 5 T2 hyperintensity is new from the prior exam but does not demonstrate significant enhancement and may be postsurgical.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: There is been interval resection of IVC sarcoma. There is a small amount of enhancement along the left diaphragmatic crus measuring 1.9 x 1.2 cm (1004/199) with a focus of diffusion restriction in within a portion of the lesion (601/238), likely representing recurrent tumor.Low-density focus seen on prior CT is nonenhancing and is T2 hyperintense, likely a small fluid collection which measures 2.5 x 1.5 cm. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Postsurgical changes along the anterior abdominal wall.OTHER: No significant abnormality noted.

Output: 1.Postsurgical changes of IVC sarcoma resection. A small amount of enhancing tissue along the right diaphragmatic crus likely represents recurrent tumor.2.Hypodense collection identified in prior CT is nonenhancing and likely represents a small amount of postoperative edema.3.Segment 5 T2 hyperintensity does not demonstrate significant enhancement and likely postoperative.


Instruction: Generate impression based on medical findings.

Input: Reason: smoldering myeloma new diagnosis, baseline MRI r/o lesions History: none Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. Overall the marrow signal is somewhat mottledNo abnormal enhancing lesions are appreciated in the cervical spine.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 is a disk bulge present at this level.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a disk bulge present at this level.At C5-6 there is no significant compromise to the spinal canal. There is a disk bulge present at this level. There is some associated narrowing of the right neural foramen at this level due to disk materialAt C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. There is diffuse marrow replacement present.No abnormal enhancing lesions are appreciated in the throacic spine.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is diffuse marrow replacement present.No abnormal enhancing lesions are appreciated in the lumbar spine.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is diffuse disk bulge present associated bilateral facet ligamentum flavum hypertrophy and effacement of the fat of the lateral recesses bilaterally. Overall there is a mild to moderate degree of spinal stenosis at this level. There is mild narrowing of the neural foramina at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.Overall the marrow signal is diffusely low . This is a nonspecific finding can but can be seen with myeloproliferative disorders as per the patient's clinical history.2.There are degenerative changes present in the cervical spine worse at C5-6 where there is some encroachment of the right-sided exiting nerve roots due to disk material3.There are degenerative changes present in the lumbar spine worse at L4-5 where there is a mild to moderate degree of spinal stenosis


Instruction: Generate impression based on medical findings.

Input: Abdominal pain. Pancreatic ductal dilatation on recent CT. ABDOMEN:LUNG BASES: Minimal pleural effusions.LIVER, BILIARY TRACT: Normal liver morphology without focal suspicious lesion or vascular abnormality. The patient is status post cholecystectomy. The common bile duct measures 11 mm, increased and may be secondary to prior cholecystectomy or ampullary stenosis. It tapers smoothly to the ampulla without a discrete mass or gallstone. There is mild left intrahepatic biliary ductal dilatation without a discrete mass evident.SPLEEN: Minimal perisplenic fluid. The splenic vein is chronically occluded with perisplenic collateral vessels.PANCREAS: The distal pancreatic body and tail is decreased in T1 weighted signal and is slightly hypoenhancing relative to the remainder of the kidney compatible with parenchymal dysfunction. The pancreatic duct at this level is irregularly dilated, findings compatible with chronic pancreatitis, as seen on recent CT. There is pancreatic divisum.There is no significant peripancreatic inflammatory changes or fluid collection. The splenic vein is chronically occluded with perisplenic collateral vessels. No additional arterial or venous complication.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted. Single right and left subcentimeter renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic diverticulosis. Normal bowel caliber. Redundant folding in the proximal duodenum versus a duodenal diverticulum. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace pelvic free fluid.

Output: 1.Findings of chronic pancreatitis with possible mild superimposed acute pancreatitis. Chronic splenic vein occlusion with collateral vessels. No evidence of pancreatic parenchymal necrosis, fluid collections or additional vascular complication.2.The common bile duct measures 11 mm, increased and may be secondary to prior cholecystectomy or ampullary stenosis. It tapers smoothly to the ampulla without a discrete mass or gallstone.3.Pancreatic divisum.


Instruction: Generate impression based on medical findings.

Input: 16-year-old female with chest heaviness, new reduced EF Clinical TTE. Evaluate for signs of myocarditis. Left VentricleFrequent ectopy limits quantification of ejection fraction. Wall motion is suggestive of frequent premature ventricular contractions during the entire examination. The left ventricle is visually normal in size. The LV systolic function is globally, mildly reduced. The overall LV ejection fraction is approximately 42%.On the short-axis view, there is minimal high signal intensity of the mid myocardium at the mid chamber of the inferior wall compatible with enhancement. This is a focal, limited to the inferior wall. No other enhancement is identified, specifically no enhancement is identified at the interventricular septum.No intracardiac thrombus is present.Left AtriumThe left atrium is normal in sizeRight VentricleThe right ventricle is mildly dilated. The RV systolic function is moderately reduced. The overall RV ejection fraction is 35%.Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumNo significant pericardial effusion, pericardial enhancement or thickening.

Output: There is a linear mid myocardial high signal at the inferior wall at the mid chamber of the left ventricle. This is compatible with limited gadolinium enhancement. There is global, mildly reduced systolic function with an approximate left ventricular ejection fraction of 42%. Preventricular contractions are noted throughout the entire examination. The wall motion abnormality is disproportionate to the extent of enhancement.The right ventricle and atrium appear mildly dilated; no associated enhancement of the right ventricle is noted. The constellation of imaging findings, along with negative serology at the time of imaging, raises a question of a remote or subacute myocarditis with possible remodeling of the right ventricle. The ventricular ectopy may be related to prior inflammation.Dedicated imaging does not suggest pericardial inflammation at this time. The results were discussed with Dr. Arredondo.


Instruction: Generate impression based on medical findings.

Input: There are post treatment findings within the right neck including T2 hyperintensity within the right neck soft tissues. In particular, there is diffuse T2 hyperintensity and loss of muscle bulk in the right trapezius muscle. There is perhaps slightly increased T2 signal diffusely along the inferior portions of the right brachial plexus, although assessment is limited by various artifacts. Otherwise, there is no evidence of right cervical or axillary mass, or significant lymphadenopathy in the neck. The osseous structures are unremarkable.

Output: Post-treatment findings within the right neck with denervation injury of the right trapezius muscle and possibly inferior right brachial neuritis, although assessment is limited by various artifacts. Otherwise, no evidence of mass lesions in the region of the right brachial plexus.


Instruction: Generate impression based on medical findings.

Input: History of metastatic prostate cancer. Pathology demonstrated left base medial and left mid medial carcinoma. PELVIS:PROSTATE:Prostate Size: 3.3 x 5.1 x 4.3 cmPeripheral Zone: Dominant lesion in the posterior left apex measuring 1.3 x 1.0 cm (series 801/14) extending into the left mid gland demonstrating T2 weighted hypointensity, restricted diffusion and early arterial enhancement. The lesion abuts the posterior fibromuscular stroma without definite extracapsular extension.Central Gland: No significant abnormality.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: The dominant left apex to left mid gland lesion abuts the left posterolateral capsule without 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: 1.3 cm left lesion compatible with carcinoma extending into the left mid gland without definite extracapsular extension.


Instruction: Generate impression based on medical findings.

Input: Altered mental status, s/p PEA, difficult to extubate. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild periventricular white matter T2 hyperintensity diffusely, which is nonspecific. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the sphenoid sinuses. There is left intraocular silicone oil. There are subcentimeter T2 hyperintense nodules in the bilateral eyelids, which may represent hydradenitis. There is bilateral otomastoid fluid, which is likely related to intubation.

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


Instruction: Generate impression based on medical findings.

Input: Female, 85 years old, with low back pain. Thoracic:Spinal alignment is anatomic. Vertebral body heights are preserved. Scattered areas of marrow signal change, largely T1 isointense and T2 hyperintense, within the T9 and T10 vertebral bodies, and the T8 left lamina, were present on the prior examination and likely reflect benign hemangiomas. No worrisome marrow replacement is seen.The spinal cord demonstrates normal signal intensity throughout. No epidural lesions are suspected. Multilevel disc degeneration is seen, appearing similar to the prior examination. At T10-11, disc bulging with facet arthropathy and ligamentum flavum thickening produce a mild spinal canal stenosis and mild foraminal narrowing. At T11-12, disc bulging along with facet arthropathy, left greater than right, and ligamentum flavum thickening produce a moderate spinal canal stenosis with slight cord deformation and severe left foraminal narrowing.A hiatal hernia is noted incidentally. The thyroid contains multiple nonspecific nodules.Lumbar:An S-shaped scoliotic curvature of the lumbar spine is seen. Grade 1 anterolisthesis of L4 relative to L5, and L5 relative to S1 is seen. Evidence of posterior instrumented fusion from L4 to L5 is demonstrated. Alignment is grossly unchanged. A laminectomy defect is also redemonstrated at L4-5. Marrow signal characteristics are extremely heterogeneous. This likely reflects degenerative endplate signal alteration. Apart from some lateral wedging related to scoliosis, the vertebral body heights are preserved.The distal spinal cord and conus are within normal limits. No significant impingement of the cauda equina is seen. No epidural abnormalities are detected.General progression of degenerative findings is seen with further loss of disc height and endplate irregularity at most levels. Additional level specific findings are as follows:L1-2: Progressive facet arthropathy, particularly on the right. Slightly progressive disc bulging without significant spinal canal stenosis. Severe progressive right foraminal narrowing. L2-3: Facet arthropathy and ligamentum flavum thickening slightly progressed. Progressive disc bulging with greater effacement of the left lateral recess and a mild generalized canal stenosis. Moderate bilateral foraminal narrowing, progressed. L3-4: Postoperative changes. Facet arthropathy grossly similar to prior. Bulging disc and mild spinal canal narrowing, similar to prior. Severe left and mild right foraminal narrowing, unchanged. L4-5: Postoperative changes. Facet arthropathy grossly similar to prior. No significant spinal canal or foraminal stenosis. L5-S1: Facet arthropathy and ligamentum flavum thickening grossly similar to prior. Disc bulging, unchanged. No significant spinal canal stenosis. Mild bilateral foraminal narrowing, unchanged.

Output: 1.Severe disc and posterior element degeneration is again seen in the lumbar spine with progression at most levels. No high-grade spinal canal stenosis is seen. However, scattered severe foraminal narrowing is noted as above. Postoperative findings are redemonstrated compatible with posterior instrumented fusion and laminectomy at L4-5.2.Moderate degenerative findings are seen in the thoracic spine without significant interval change. There is narrowing of the spinal canal at T10-11 and T11-12. No acute lesions are seen.


Instruction: Generate impression based on medical findings.

Input: 69 years, Male, status post craniotomy for GBM resection. Weakness. Evaluate for new infarct or another new lesion. Again seen are postsurgical changes of left parietal craniotomy for tumor resection. Again seen is nodular enhancement involving the anterior medial and anterior inferior aspects of the resection cavity including the left parietal and posterior frontal lobes which appears more prominent than on prior. There is restricted diffusion surrounding the postoperative resection cavity compatible with cytotoxic edema/infarct which shows mild evolution. There is no new infarct elsewhere in the brain. There is also interval increase in FLAIR hyperintensity surrounding the resection cavity which has increased since postoperative study from 9/29/2015. Small extra-axial collection beneath the left parietal craniotomy is again seen with evolution in signal intensity of the blood products. There is no midline shift or herniation. No hydrocephalus.

Output: Compared to postoperative MRI from 9/29/2015, there has been evolution of postoperative changes including of the small areas of cytotoxic edema/infarct surrounding the left parietal resection cavity. There is interval increase in nodular enhancement surrounding the resection cavity, particularly in its anterior medial and anterior inferior aspects, as well as increase in FLAIR hyperintensity surrounding the resection cavity. These changes may represent evolution of postsurgical changes and mildly worsened edema but early tumor progression cannot be excluded. Suggest close follow-up evaluation.


Instruction: Generate impression based on medical findings.

Input: Please note that evaluation is slightly limited by motion artifact.  The lateral and third ventricles are moderately enlarged with abnormal contour and mild surrounding white matter T2 hyperintensities, compatible with periventricular leukomalacia. The 4th ventricle is normal in size. There is prominence of the CSF space adjacent to the right operculum, insula, and inferior frontal lobe, which may represent encephalomalacia from prior injury versus an arachnoid cyst. The sulci are otherwise unremarkable in morphology. The corpus callosum is thin, though fully formed. There is prominence of the CSF spaces anterior to the temporal tips and prominence of the suprasellar and prepontine cisterns. The brainstem is slender, though otherwise unremarkable. Bilateral choroid plexus cysts are noted. The cerebellar vermis is hypoplastic. The cerebellar tonsils are in normal position. There is prominence of the supravermian and retrocerebellar cisterns. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem, or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain. SPINE

Output: 1. Findings compatible with periventricular leukomalacia. Prominence of the CSF space about the right frontal lobe and operculum may represent encephalomalacia from prior insult versus an arachnoid cyst. 2. Posterior fossa abnormalities, which probably largely reflect congenital developmental abnormalities. 3. No acute intracranial abnormality.4. Normal appearing spine and spinal cord. No evidence of tethered cord.


Instruction: Generate impression based on medical findings.

Input: There is a rudimentary disk at S1-S2. The lumbar spine is in normal alignment, with a normal lumbar lordosis. Redemonstrated is multilevel disk narrowing and desiccation, most prominent at L5-S1 where there is moderate narrowing. The vertebral body heights are well-maintained. The distal spinal cord and conus are within normal limits with the conus terminating at the mid L2 level. No worrisome focal marrow signal abnormality is appreciated. There are endplate degenerative changes on the right at T10-T11. There is narrowing of the distal lumbar spinal canal predominantly due to shortened pedicles. There is thickening and slight redundancy of the cauda equina nerve root relating to spinal stenosis to be detailed below.New T2 signal is seen within the right paraspinal musculature at the level of S1 through S3 (best seen series 5, images 2/17 through 7/17).At T10-T11 and T11-T12, sagittal images suggest a mild diffuse disk bulge with right sided moderate foraminal narrowing. There may be mild central spinal canal stenosis. These findings are unchanged.At T12-L1, there is a mild diffuse disk bulge without stenosis, unchanged.At L1-L2, there is a mild diffuse disk bulge resulting in mild-moderate right and moderate left foraminal narrowing, unchanged.At L2-L3, there is a shallow right foraminal disk protrusion without stenosis, unchanged.At L3-L4, there is a trace diffuse disk bulge with mild left facet arthropathy. There is mild developmental narrowing of the lumbar spinal canal with overall moderate central spinal canal stenosis. There is also mild bilateral lateral recess stenosis as well as minimal right and moderate left foraminal narrowing. These findings are unchanged.At L4-L5, there is a mild diffuse disk bulge with left paracentral prominence. There is also prominent facet arthropathy and ligamentum flavum thickening. Superimposed upon the developmental narrowing, there is moderate-severe central spinal canal stenosis, moderate bilateral lateral recess stenosis as well as moderate left and mild-moderate right foraminal narrowing. These findings are unchanged.At L5-S1, there is a diffuse disk bulge with bilateral facet arthropathy and ligamentum flavum thickening. There is mild-moderate central spinal canal stenosis, although there is moderate-severe bilateral foraminal narrowing. These findings are unchanged.

Output: 1.New T2 signal is seen within the right paraspinal musculature at the level of S1 through S3. This appearance is most suggestive of muscle strain or other soft tissue injury.2.Multilevel degenerative disease with stenoses, stable in appearance, as described in detail above on a level by level basis.


Instruction: Generate impression based on medical findings.

Input: Female 43 years old Reason: increasing pain in L shoulder and neck after car accident ROTATOR CUFF: Thickening of the distal fibers of the tendon of the supraspinatus as well as mildly increased T2 signal indicates tendinosis of the distal supraspinatus without discrete tearing. The remainder of the rotator cuff is intact. No fluid is present within the subdeltoid bursa.SUPRASPINATUS OUTLET: There is a type II acromion.GLENOHUMERAL JOINT AND GLENOID LABRUM: The humeral head is well-seated glenoid. The glenoid labrum is intact. T2 hyperintensity and T1 hypointensity within the proximal diaphysis of the humerus likely indicates a bone contusion (series 901, image 10; series 1201, image 9).BICEPS TENDON: Biceps tendon is intact and situated within the bicipital groove.ADDITIONAL

Output: Supraspinatus tendinosis and bone contusion in the proximal humeral diaphysis.


Instruction: Generate impression based on medical findings.

Input: 62-year-old male with left adrenal mass. ABDOMEN:LIVER, BILIARY TRACT: No suspicious hepatic lesions. Redemonstration of small, peripheral portal hepatic venous shunt is noted in the right hepatic lobe.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: There is redemonstration of a 5 x 3.1 x 5.6 cm part cystic and part solid left adrenal mass. Again, the cystic components demonstrate thin-walled enhancement, and the solid component demonstrates homogeneous enhancement. On in-and-out of phase images, there is a equivocal loss of signal to indicate microscopic fat within the soft tissue component. As a result, the lesion remains indeterminate, and malignancy cannot be excluded.KIDNEYS, URETERS: Small bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Compression deformities of T12 and L1 vertebral bodies, as detailed on MRI lumbar spine from 6/5/2015.BONES, SOFT TISSUES: Body wall anasarca.OTHER: Mild abdominal ascites.

Output: Part cystic and part solid left adrenal mass is overall indeterminate. Malignancy cannot be excluded. Biopsy versus short interval follow-up imaging can be performed as clinically indicated.Findings discussed with Dr. Wang at 10:00 AM on 6/10/2015.


Instruction: Generate impression based on medical findings.

Input: Biopsy proven invasive carcinoma in the left upper outer breast. Additionally, a stereotactic biopsy of the left breast at a central site showed ADH. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.At the site of known malignancy in the left upper outer breast, the Hydromark biopsy clip is well seen with mild surrounding enhancement measuring up to 8 mm. This probably represents a combination of the residua of the small mass and post biopsy change.In the left central breast at the location of the stereotactic biopsy with pathology resulting in focal ADH, there is focal enhancement with a few foci of enhancement projecting anterior to the biopsy site in a linear distribution. Overall AP extent is about 4 cm. There is also an area of lateral to medial enhancement corresponding to the biopsy track near this site. No abnormal enhancement is seen in the right breast. There are a few scattered enhancing foci in the right breast that appear similar to scattered enhancing foci on the left that are not at the areas described above.No abnormal enlarged lymph nodes are identified in either axillary region. Symmetric small nodes are present. Incidental note of a lipoma within the right serratus anterior is made.

Output: 1. Mild enhancement surrounding the biopsy clip of the known invasive cancer in the left upper outer breast measures up to 8 mm, and could relate to the residua of the mass and post biopsy change. 2. At the site of focal ADH from stereotactic biopsy, there is enhancement with a few linear distribution enhancing foci extending anteriorly. Excisional biopsy should be considered given this appearance and the ADH known from prior biopsy. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: Reason: Optic disc swelling - rule out intracranial process History: central visual blurrying MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated within the brain parenchyma. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses and demonstrate small mucus retention cysts. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI orbits:The eyeballs are intact. No intraconal or extraconal space mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. There is no optic nerve enhancement appreciated. The suprasellar cistern is intact .

Output: MRI of the brain and orbits is within normal limits.


Instruction: Generate impression based on medical findings.

Input: 56-year-old male patient with pain. Evaluate for meniscal tear. MENISCI: Again seen is a complex tear of the posterior horn of the medial meniscus and blunting of the free edge of the posterior horn, similar to prior.Complex meniscal tearing including horizontal and vertical components, predominantly affecting the posterior horn and body, as well as blunting of the free edge appears similar to prior.ARTICULAR CARTILAGE AND BONE: Tricompartmental osteophytes are noted. There is a full-thickness chondral defect in the weightbearing portion of the medial femoral condyle, progressed compared to prior MRI. This defect measures up to 2.3 cm in AP dimension and 1.3 cm in mediolateral dimension. There is also a large area of full-thickness chondral loss in the weightbearing portion of the medial tibial plateau with subtle subchondral reactive marrow changes. There are numerous chondral defects in the posterior weightbearing portions of the lateral compartment, similar to prior. There is thinning and partial-thickness fissuring of the patellar cartilage.LIGAMENTS: The anterior cruciate ligament is not visualized, unchanged compared prior examination and compatible with a chronic full-thickness tear. The posterior collateral ligament, medial collateral ligament, lateral collateral ligament complex, and patellar retinacula are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Tricompartmental chondromalacia with progression of full-thickness chondral defects in the medial compartment.2.No significant interval change in medial and lateral meniscal complex tearing.3.Baker's cyst containing at least one loose body.4.Chronic anterior cruciate ligament tear.


Instruction: Generate impression based on medical findings.

Input: 25-year-old male with history of neurofibromatosis type I status post excision of right upper arm lesion. A vitamin E marker was placed on the medial skin surface of the arm approximately 10 cm above the elbow joint. There is band-like low signal intensity and foci of signal void in the underlying soft tissues indicating scarring and metallic susceptibility artifact from prior surgery at this site. An enhancing nerve sheath tumor along the ulnar nerve just above the medial epicondyle seen on the prior study has been intervally resected.There is enlargement of the ulnar nerve along its course associated with multiple nerve sheath tumors. The enlarged ulnar nerve is perched upon the posterior margin of the medial epicondyle, which may reflect interval release. In the area of the surgical resection, there is now an elongated subcutaneous mass that is inseparable from the ulnar nerve. This particular mass measures approximately 2.5 x 1.5 cm in transverse dimension and 4.5 cm in craniocaudal dimension. The mass is mostly isointense to skeletal muscle on T1-weighted images, but heterogeneous on T2-weighted images with areas of both low and high signal intensity. There is minimal enhancement of this mass after gadolinium administration. Nerve sheath tumors are also noted along the courses of the medial and radial nerves with additional innumerable cutaneous, subcutaneous, and intramuscular nerve sheath tumors.Bone marrow signal intensity is normal.

Output: 1. Innumerable nerve sheath tumors compatible with stated diagnosis of neurofibromatosis type I.2. Postsurgical changes of a nerve sheath tumor resection along the course of the ulnar nerve above the medial epicondyle of the distal humerus.3. New mass in the area of the resection that is inseparable from the enlarged ulnar nerve. Its signal characteristics are atypical for a nerve sheath tumor with relatively low signal intensity on T2-weighted images suggesting the possibility of a postsurgical neuroma.


Instruction: Generate impression based on medical findings.

Input: MRI brain:The patient is status post Chiari I decompression surgery with resection of the C1 arch and posterior fossa craniectomy. CSF flow at the level of foramen magnum is appropriate and stable.There is patchy T2 and FLAIR signal hyperintensity within the pons. This is unchanged since the prior exam.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.MRI 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.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. There is redemonstration of a small right paramedian disc protrusion at the T11-T12 level which is stable compared to prior exam. There is a Schmorl's node present at T11-T12.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is a well-circumscribed lesion present within the L3 vertebral body which is bright on T1 and suppresses on the inversion recovery images which most likely represents a vertebral body hemangioma. It is stable compared to the prior exam.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.The patient is status post Chiari I decompression.2.There is no evidence for syrinx or ventriculomegaly.3.There are mild degenerative changes present in the lower thoracic spine. These are stable compared to the prior exam.


Instruction: Generate impression based on medical findings.

Input: 45 year old female with biopsy-proven cancer in the right inferior breast. She underwent a lumpectomy on 10/08/2014 with positive medial margin. She underwent re-excision for the medial margin and right mastectomy in November 2014. Three standard views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. Spot compression CC and MLO views of the left breast were also obtained. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. There is a lobulated mass in the medial left breast, lower inner quadrant. This was seen on prior mammograms and persists on spot compression views. On comparison to prior MRI 9/23/2014, this mass is consistent with a cyst. No additional mass, suspicious microcalcifications or areas of architectural distortion in the left breast. No abnormalities in the left axilla.

Output: Stable left lower inner quadrant cyst. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, left unilateral 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: Trouble swallowing and neck pain. There is no evidence of mass lesions or significant cervical lymphadenopathy. The thyroid and major salivary glands are unremarkable. There is minimal anterolisthesis of C4 upon C5. The vertebral and carotid artery flow voids appear to be intact. The imaged intracranial structures are unremarkable.

Output: No evidence of mass lesions in the neck.


Instruction: Generate impression based on medical findings.

Input: 72 years Female (DOB:9/22/1943)Reason: evaluate for lumbar spine pathology History: low back and LLE painPROVIDER/ATTENDING NAME: MICHAEL J LEE MICHAEL J LEE Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact. There is a scoliotic curvature to the lumbar spine. With a levocurvature to the upper lumbar spine. There is left lateral translation of L3 on L4 and a rotatory component.At L5-S1 there is no significant compromise to the neural foramina. There is bilateral facet hypertrophy at this level. There is a left lateral recess disc protrusion at this level associated with endplate osteophytes which encroaches on the nerve roots at the left lateral recess. There is loss of disc space height at this level as well as left-sided endplate reactive change. The endplate reactive changes bright on T1.At L4-5 there is loss of disc space height, disc desiccation and a left lateral broad-based disc extrusion. Disc material extends behind the left lateral superior aspect of the L4 vertebral body and also extends into the left neural foramen. It is associated with encroachment of the nerve roots at the left lateral recess and the left neural foramen at this level. There is moderate bilateral facet hypertrophy at this level. The facet hypertrophy appears to be worse on the left compared to the right side.At L3-4 there is left lateral translation of L3 on L4 with mild rotation of L3 on L4. There is moderate bilateral facet hypertrophy at this level. There is some narrowing of the spinal canal at this level. There is mild encroachment of the left-sided exiting nerve roots.At L2-3 there is a moderate disc bulge at this level associated with moderate bilateral facet and ligamentum flavum hypertrophy. This results in narrowing of the thecal sac with effacement of spinal fluid surrounding the nerve roots within the thecal sac. Overall there is moderate spinal stenosis at this level. Within the neural foramina the exiting nerve roots are surrounded by fat.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is a large left parapelvic cyst present measuring 26 x 13 mm axial dimensions.

Output: 1.There are multilevel degenerative changes present in the lumbar spine with the left lateral translation of L3 and L4 associated with the rotatory scoliosis and a levocurvature to the upper lumbar spine.2.There is moderate spinal stenosis present at L2-3.3.There is encroachment of the left-sided exiting nerve roots within the neural foramen at L4-5 associated with encroachment of the nerve roots at the left lateral recess at this level.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Patient with worsening sciatica and radiculopathy with lower extremity weakness. Signs and symptoms: As above. Nonenhanced lumbar MRI:T11-T12 is unremarkable.T12-L1 is unremarkable.L1-L2 is unremarkable. Incidental note is 12 x 12 mm focus of T1 and T2 hyperintense and the L2 vertebral body posteriorly consistent with a benign skeletal capillary hemangioma.L2-L3 demonstrate mild disc desiccation and loss of disc height, shallow broad-based disc protrusion laterally and far laterally on the left is noted. There is also mild to moderate bilateral ligamentum flavum hypertrophy and mild facet disease. Mild left neural foraminal compromise and mild central spinal stenosis is present.L3-L4 demonstrate moderate disc disease and loss of disc height, moderate bilateral ligamentum flavum hypertrophy and mild facet hypertrophy changes (right greater than left). There is also mild grade 1 anterolisthesis at this level secondary to degenerative disease. There is resultant moderate central spinal stenosis with significant right and mild left neural foraminal compromise.L4-L5 demonstrate moderate disc disease with mild loss of disc height, moderate (left greater than right) ligamentum flavum hypertrophy and moderate right and mild left facet hypertrophic changes. Degenerative changes at this level also includes mild grade 1 anterolisthesis. There is no central spinal stenosis however moderate right neural foraminal compromise and mild on the left is noted. There is also slight compromise of the left lateral recess present.L5-S1 demonstrate mild disc disease and loss of disc height, moderate bilateral ligamentum flavum hypertrophy is present. Moderate right facet disease and including facet effusion is noted. There is no central spinal stenosis however moderate left neural foraminal compromise is noted.Perispinal soft tissues are unremarkable.

Output: 1.Mild to moderate degenerative changes of the lumbar spine with resultant central spinal stenosis only at L3-L4 level of moderate degree as detailed.2.Multilevel mild-to-moderate neural foraminal compromise as detailed per level above.3.Unremarkable lower most visualized thoracic spine and thoracic cord.


Instruction: Generate impression based on medical findings.

Input: History of virilization. Evaluate for adrenal pathology. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: There is minimal left adrenal nodularity without a discrete characterizable lesion.KIDNEYS, URETERS: Small simple appearing renal cysts.RETROPERITONEUM, LYMPH NODES: There is a prominent distal thoracic peri-aortic lymph node measuring 1.3 cm in short-axis with a fatty hilum (series 3/10). Several additional prominent retroperitoneal lymph nodes are noted. On the coronal image only there is a prominent left common iliac lymph node as well (series 14/35).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: ]1. Minimal left adrenal nodularity without a discrete characterizable lesion.2. Non-specific prominent perio-aortic and retroperitoneal lymph nodes.


Instruction: Generate impression based on medical findings.

Input: Metastatic head and neck cancer with new brain lesion. There is a presumably ring-enhancing mass that measures up to 12 mm in the left superior frontal gyrus with associated vasogenic edema. There is a defect in the left caudate head, which may represent a chronic lacunar infarct. There are also a few punctate foci of nonspecific T2 hyperintensity in the cerebral white matter. There is no midline shift or herniation. There is no evidence of hydrocephalus. The skull, orbits, and scalp soft tissues are unremarkable.

Output: Limited treatment planning MRI demonstrates a mass that measures up to 12 mm with associated vasogenic edema in the left superior frontal gyrus, which is compatible with metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Patient with history of benign left breast biopsy with pathology demonstrating ALH and PASH. Patient with strong family history of breast cancer. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate to marked parenchymal enhancement is noted bilaterally.There are a few scattered subcentimeter cysts bilaterally. Additionally, there are scattered enhancing foci without suspicious enhancement in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. Routine high risk screening follow-up is recommended.BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on medical findings.

Input: Change in size of pituitary macroadenoma: Chronic left eye visual loss. There are postoperative findings related to prior frontal craniotomy with a large area of encephalomalacia of the anterior left frontal lobe and ex vacuo dilatation of left lateral ventricle. There appears to be slight interval increase in size of the heterogeneous sellar mass with extension into the cavernous sinuses, mass effect upon the optic chiasm, and invasion of the sphenoid sinuses. The tumor measures up to 45 mm in width, 34 mm in height, and 38 mm in length. There is encasement and narrowing of the left cavernous carotid and a small left cavernous carotid aneurysm.

Output: 1. Postoperative findings related to prior frontal craniotomy with a large area of encephalomalacia of the anterior left frontal lobe2. Apparent slight interval increase in size of the heterogeneous sellar mass with extension into the cavernous sinuses, mass effect upon the optic chiasm, and invasion of the sphenoid sinuses. 3. Encasement and narrowing of the left cavernous carotid and a small left cavernous carotid aneurysm.


Instruction: Generate impression based on medical findings.

Input: There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration. No abnormal extra-axial fluid collection is identified. There is no midline shift. The midline structures and craniocervical junction are within normal limits. Note is made of a cavum septum pellucidum, a normal variant. There are a few punctate foci of T2 hyperintensity within the periventricular and subcortical white matter bilaterally which are nonspecific. There is no diffusion abnormality or susceptibility artifact. Normal flow-voids are demonstrated in the major intracranial vascular structures.A mucosal retention cyst is present within the right maxillary sinus. There is mucosal thickening within the bilateral ethmoid air cells. The visualized mastoid air cells are clear. The orbits are unremarkable.

Output: 1.No evidence of intracranial mass, hemorrhage or acute.2.Mild paranasal sinus disease.


Instruction: Generate impression based on medical findings.

Input: Preterm newborn; born at gestational age 31 weeks via emergent C-section for cord prolapse. Sepsis and neonatal depression. For the calculated gestational age, myelination is age-appropriate. There is no acute infarct or intracranial hemorrhage. There is no sign of malformation of cortical development. There is no mass-effect, midline shift or brain herniation. The major intracranial vascular flow voids are grossly preserved. The ventricles and CSF-containing spaces are normal in size. The skull, orbits and scalp are grossly unremarkable.

Output: Unremarkable evaluation. No acute infarct or intracranial hemorrhage. Myelination is appropriate for calculated gestational age.


Instruction: Generate impression based on medical findings.

Input: There is a subcentimeter focus of high T2 signal in the midline of the splenium of the corpus callosum. The rest of the brain parenchyma appears unremarkable. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: A subcentimeter focus of high T2 signal in the midline of the splenium of the corpus callosum may represent a transient splenial lesion, which can be a manifestation of viral encephalitis, epilepsy, and drug reaction, for example. Otherwise, no evidence of acute intracranial hemorrhage, mass, or acute infarct. Nevertheless, a follow up brain MRI may be useful.


Instruction: Generate impression based on medical findings.

Input: 31 year old male with incidental hyperechoic liver lesion detected on recent ultrasound and history of inflammatory bowel disease. ABDOMEN:LIVER, BILIARY TRACT: The lesion in the left hepatic lobe seen on prior ultrasound is not visualized, and no other suspicious hepatic lesions are seen. Mild nonspecific arterial hyperenhancement involving the biliary tree normalizes on later postcontrast sequences. Mild intrahepatic ductal dilatation, as well as mild dilatation of the CBD to 10 mm are noted. No dominant stricture. Patent hepatic vasculature. 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: Several prominent periportal lymph nodes. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No suspicious focal hepatic lesions. Specifically, the lesion seen in the left hepatic lobe on prior ultrasound is not visualized. 2.Mild biliary ductal dilatation and nonspecific arterial enhancement involving the biliary tree that normalizes on subsequent postcontrast sequences. Given the imaging findings and patient's history of inflammatory bowel disease, primary sclerosing cholangitis (PSC) is a differential consideration.


Instruction: Generate impression based on medical findings.

Input: 50 year old man with history of head and neck SCC with recent follow up chest CT which was suggestive of possible coronary sinus thrombosis. He was referred for cardiac MRI with contrast for further evaluation. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 66%, the LV end diastolic volume index is 57 ml/m2 (normal range: 74+/-15), the LVEDV is 120 ml (normal range 142+/-34), the LV end systolic volume index is 20 ml/m2 (normal range 25+/-9), the LVESV is 41 ml (normal range 47+/-19), the LV mass index is 42 g/m2 (normal range 85+/-15), and the LV mass is 90 g (normal range 164+/-36). 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 normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 60%, the RV end diastolic volume index is 60 ml/m2 (normal range 82+/-16), the RVEDV is 125 ml (normal range 142+/-31), the RV end systolic volume index is 24 ml/m2 (normal range 31+/-9), and the RVESV is 50 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. There is no obvious thrombus in the coronary sinus. Perhaps the CT finding represents a motion artifact or the thrombus has migrated.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSee recent CT for lung findings. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. There is no obvious thrombus in the coronary sinus. Perhaps the CT finding represents a motion artifact or the thrombus has migrated.2. Normal LV size and systolic function (LVEF 66%) without evidence of underlying fibrosis, inflammation, or infiltration. 3. Normal RV size and systolic function (RVEF 60%).4. Normal biatrial dilation.


Instruction: Generate impression based on medical findings.

Input: 56-year-old male. Rule out stroke. Images through posterior fossa are unremarkableimages through the supratentorial brain parenchyma demonstrates no definitive evidence of any hemorrhage, mass-effect, edema, midline shift or hydrocephalus. Focal area of low-attenuation in the periventricular white matter with ex vacuo dilatation of the right lateral ventricle is noted. This has the appearance of an old finding and further evaluation with an MRI is recommended.

Output: No evidence of acute findings. Follow-up with an MRI is recommended.


Instruction: Generate impression based on medical findings.

Input: There is thick pial enhancement as well as possibly a dura/arachnoid component within the right frontal lobe centered within the precentral sulcus. There is some probable subtle contrast leakage within the adjacent brain parenchyma as well as surrounding T2 hyperintensity compatible with edema that does involve the right precentral gyrus. There is also associated parenchymal susceptibility effect compatible with blood products. There is no evidence of acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: Focal meningeal thickening and enhancement centered within the right precentral gyrus with associated adjacent parenchymal involvement. These findings are most compatible with metastasis but infection could have a similar appearance.


Instruction: Generate impression based on medical findings.

Input: Cholangitis. Evaluate for stricture/suspicious lesion. History of primary sclerosing cholangitis. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology of the liver. No suspicious hepatic lesion identified. Mild intrahepatic stricturing, with no dominant stricture identified. The gallbladder is normal in appearance.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. Status post colectomy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Mild intrahepatic stricturing. No dominant stricture or suspicious hepatic lesion.


Instruction: Generate impression based on medical findings.

Input: History of atypical meningioma prior resection and radiation therapy. Follow-up examination. The MRI exam was a scheduled to have pre and post gadolinium enhancement. However, due to patient's left-sided severe pain, the patient wanted to abort the exam prior to gadolinium enhancement. There is no evidence of acute ischemic lesion on the scan.Again there is evidence of tissue loss on right frontal lobe and left frontal lobe with frontal craniotomy and overlying extra axial fluid collections. Encephalomalacia on bifrontal lobes are also shown.Above findings do not show any significant interval change since April 17, 2014.There is no evidence of postoperative unusual signal intensity on the scan. There is no evidence of recurrence of the tumor on this limited scan.The ventricles, sulci and cisterns are symmetric and unremarkable. No change since prior scan. There is no mass, mass effect, edema, midline shift, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. Retention cyst on the left maxillary sinus.

Output: No evidence of acute ischemic lesion.Post surgical resection status of bi-frontal atypical meningioma, no interval change since prior study and no evidence of recurrence on this limited scan.Postgadolinium enhancement study was not performed due to patient pain.


Instruction: Generate impression based on medical findings.

Input: Occipital headaches. Chiari malformation. Assess for syrinx or cord tethering. The odontoid process is retroflexed. There is cervical spinal sagittal straightening. Please refer to the previous cervical spine MRI report for other details.Thoracic alignment is anatomic. The vertebral bodies are preserved in height. There is no suspicious focal marrow lesion. There is disc desiccation at T7-T8 and T8-T9 with mild height loss. The other discs are relatively preserved in height. The spinal canal is notable for mild narrowing at T10-T11 caused by facet arthropathy and right greater than left ligamenta flavum thickening which minimally indents the right posterolateral aspect of the thecal sac and abuts the spinal cord. There is also narrowing of the left T10-T11 neural foramen by facet arthropathy and a cyst, which may represent a perineural cyst or less likely a synovial cyst related to the facet. The cyst measures axially 0.7 cm x 0.4 cm. Cervical spinal cord is notable for diffuse mild dilatation of the central canal (from T4 level through lower T12 level but most pronounced at mid T7 level measuring axially 3 mm x 3 mm). The conus medullaris has normal shape and its tip is located at the L1-L2 level.Right ventrolateral to spine at the level of T5-T6 disc, there is a 10 mm x 6 mm well-circumscribed, homogeneously T2-hyperintense, T1-hypointense structure which probably reflects focal dilatation of the thoracic duct. Alternatively but less likely, this may represent a small focal foregut duplication cyst or even lymphatic malformation.

Output: 1.Mild thoracic syrinx, measuring up to 3 mm at mid T7 level.2.Mild spinal canal stenosis at T10-T11 cause by facet arthropathy and ligamenta flava thickening. A small left T10-T11 neural foramen cyst may represent either a perineural or less likely synovial cyst.3.Small right ventral paraspinal cyst at T5-T6 level may represent focal dilatation of the thoracic duct, a small focal foregut duplication cyst or lymphatic malformation.4.Normal position of the conus medullaris tip.5.Please refer to the report of the brain MRI from the same day for more details regarding the Chiari malformation.


Instruction: Generate impression based on medical findings.

Input: Ms. Casey submitted outside studies for review.Submitted for review are:-Bilateral breast MRI dated 7/12/2016 performed at Silver Cross Hospital-Bilateral mammogram dated 7/12/2016 performed at Silver Cross Hospital-Images from stereotactic core biopsy of the right breast including specimen radiograph and postprocedure right breast mammogram performed at Silver Cross HospitalFor comparison, bilateral mammogram dated 8/15/2014, left breast ultrasound dated 2/6/2015, bilateral breast MRI dated 2/9/2015, and images from a left breast ultrasound-guided biopsy dated 2/17/2015 are available. Older exams from this institution are also available. BILATERAL BREAST MRI:Multiple enhanced MR sequences are submitted per outside institution's protocol.There is scattered fibroglandular tissue bilaterally. There is minimal background parenchymal enhancement.No abnormal enhancement in either breast. There are postsurgical changes in the upper outer posterior left breast with stable mild enhancement near the surgical site. Biopsy clip artifact is seen within the area of postsurgical changes. No abnormal enhancement in either breast. No axillary or internal mammary lymphadenopathy. Post surgical changes noted in the left axilla. BILATERAL MAMMOGRAM:Bilateral CC and MLO views and spot magnification views of the right breast are submitted.The breast parenchyma is composed of scattered fibroglandular density (BiRads Density Category B).There is a suspicious 11 mm cluster of pleomorphic calcifications in the upper outer quadrant of the right breast at posterior depth. There is a smaller 3 mm cluster of calcifications 6 mm posterosuperior to this cluster. When measured together, the calcifications span approximately 1.2 x 1 x 1 cm (AP x TV x CC).There are expected postsurgical changes in the upper outer quadrant of the left breast at posterior depth. Biopsy clip is seen in the upper left breast at posterior depth on the MLO view. Scattered benign calcifications are present in the left breast. No new mass, suspicious microcalcifications, or nonsurgical architectural distortion in the left breast.STEREOTACTIC CORE BIOPSY, RIGHT BREAST:Images from stereotactic core biopsy of the right breast including specimen radiograph and postprocedure CC and ML view mammograms of the right breast are submitted.A suspicious cluster of pleomorphic calcifications in the upper outer quadrant of the right breast are targeted for biopsy. Targeting appears appropriate. Specimen radiograph demonstrates calcifications within one of the cores. Postprocedure mammograms demonstrate a dumbbell-shaped clip in the upper outer quadrant of the right breast that is displaced inferiorly by 1.3 cm. There are residual calcifications 8 mm posterosuperior to the biopsy site.OUTSIDE PATHOLOGY (per report):The core specimens samples of the 10 o'clock RIGHT breast demonstrate ductal carcinoma in situ, cribriform type with necrosis and microcalcifications, nuclear grade 2.

Output: 1. Biopsy proven right breast DCIS. The biopsy clip is displaced 1.3 cm inferiorly. There are residual calcifications posterosuperior to the biopsy site. Continued surgical management is recommended.2. Expected postsurgical changes of the left breast are not changed. No mammographic or MR evidence of malignancy in the left breast.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Ms. Linksman is a 63-year-old female with personal history of right breast lumpectomy in June 2009 for multifocal IDC followed by radiation and hormonal therapy. Family history of breast cancer in mother and paternal grandmother. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Postsurgical changes are identified in the right breast, at site of prior lumpectomy. There is no new abnormal enhancement seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region. Normal size intramammary lymph node in the left upper outer breast is stable.

Output: Stable postsurgical changes of the right breast. No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on medical findings.

Input: Abnormal results of other function studies of central nervous system [R94.09], Reason for Study: ^Reason: 6 month repeat MRI looking for hyperintensities to compare History: as above There is no evidence of acute ischemic or hemorrhagic lesion on this scan.There is no evidence new high signal intensity lesion on FLAIR/T2 images.Previously found multifocal high signal intensity lesions on FLAIR/T2 images including the right middle cerebellar peduncle, left posterior temporal lobe periventricular white matter (just underneath of the left lateral ventricle occipital horn), and right parietal lobe (right parietal operculum) appear to be stable or slightly not as conspicuous as it was.About 4.5mm downward herniation of cerebellar tonsils through the foramen magnum, no change since prior scan. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. Minimal mucosal thickening on ethmoid sinuses and sphenoid sinus.

Output: 1. Stable or slightly decreased signal intensity of previously noted lesions on FLAIR/T2 images including right middle cerebellar peduncle, left periventricular white matter especially inferior aspect of the lateral lateral ventricle occipital horn and the right parietal operculum since prior scan.2. No evidence of acute ischemic or hemorrhagic lesion on this scan.


Instruction: Generate impression based on medical findings.

Input: Right lower extremity radiculopathy Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal in the lumbar spine is benign. Sagittal images demonstrate a round lesion with low T1 and T2 signal involving the T11 vertebral body, which is not incompletely evaluated. The conus medullaris is normal in position.Individual levels as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis.L5-S1: There is a small posterior annular fissure with small central disc protrusion. No significant spinal canal or neural foraminal stenosis.Multiple small perineural cysts are incidentally noted. Paraspinous soft tissues are within normal limits.

Output: 1. There is no significant spinal canal or neural foraminal stenosis at any level in the lumbar spine. 2. Small central disc protrusion at L5-S1, which was present on prior MRI hip study from 7/30/2015.3. Partially imaged approximately 1 cm T11 vertebral body lesion is nonspecific.


Instruction: Generate impression based on medical findings.

Input: 79 year-old female history of HCC status post TACE/RFA x2. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. Low signal intensity peripheral segment 3 lesion without enhancement. No suspicious masses or enhancement is seen.The intraluminal portion of the distal TIPS is not well assessed due to artifact, however the remaining portions of the shunt appear patent. The main portal vein is open. The intrahepatic portal veins are not well opacified, appearing similar to prior.Cholelithiasis.SPLEEN: SplenomegalyPANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral nonenhancing subcentimeter simple/hemorrhagic cyst.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: Unchanged segment 3 ablation zone with no evidence of disease recurrence. Non-opacification of the intrahepatic portal veins appearing similar to prior.


Instruction: Generate impression based on medical findings.

Input: Somnolence [R40.0], Reason for Study: ^Reason: New onset seizure, concern for organic process History: New onset seizure No evidence of acute ischemic or hemorrhagic lesion.Myelination pattern appears to be normal.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Normal brain MRI


Instruction: Generate impression based on medical findings.

Input: Suprasellar meningioma, follow up MRI No evidence of acute ischemic or hemorrhagic lesion.There is about 9mm x 10mm sized left high frontal extra axial enhancing lesion which does not show any significant interval change since prior exam in terms of size, configuration and enhancement patter. This lesion is likely to be a benign lesion such as meningioma.Previously described encephalomalacia on the right anterior and inferior frontal, right anterior temporal lobes do not show any significant interval changes since prior exam.About 9mm length tubular signal void lesion within the left transverse sinus indicate possible arachnoid granulation or fibrous nodular septae, no change since prior exam. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.There is a retention cyst on the right maxillary sinus.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion on this scan.2. No change of left high frontal extra axial mass since prior exam.3. No change of right frontal and temporal encephalomalacia since prior exam.


Instruction: Generate impression based on medical findings.

Input: Male, 19 years old, status post re-resection of a cerebellar ganglioglioma, with swelling and drainage at the incision site. Again seen are findings related to right occipital craniotomy for tumor resection. A small epidural fluid collection beneath the craniotomy site is similar to or at most slightly increased from the prior examination. However, an extracranial fluid collection which appears to follow CSF signal has developed within the soft tissues of the neck overlying the craniotomy and extending inferiorly in the neck fascial planes to the C3 level. The collection measures up to 78 mm in craniocaudal extent, and measures 62 x 25 mm in maximal transaxial dimension.Lack of contrast limits assessment for residual tumor. However, the degree of T2 hyperintensity and restricted diffusion surrounding the cerebellar resection site has improved. The right cerebellum remains smaller than the left likely reflecting the effects of prior surgery and/or treatment. The quantity of postoperative intracranial air and intraventricular blood have also decreased. No new parenchymal lesions are seen. Again noted is prominence of the CSF space involving the right aspect of the pineal cistern. The supratentorial ventricular system is normal and similar in caliber to the prior exam.

Output: 1.Demonstration of postoperative findings compatible with recent re-resection of a cerebellar ganglioglioma. Lack of contrast prevents accurate assessment for residual tumor.2.Since the prior examination, an extracranial fluid collection has developed at the operative site compatible with a pseudomeningocele.


Instruction: Generate impression based on medical findings.

Input: 69-year-old male with history of high-volume Gleason 7 disease on the left. Pretreatment evaluation. PELVIS:PROSTATE:Prostate Size: The prostate measures 4.6 x 5.2 x 3.9 cm (cc by transverse by AP).Peripheral Zone: Within the midportion of the left posterior peripheral zone and extending towards but not reaching the apex is a area of confluent low T2 signal and restricted diffusion measuring 1.5 x 1.1 cm in the axial plane and 1.1 cm craniocaudal dimension. On the postcontrast images, the area of enhancement extends slightly beyond the abnormal T2 signal and there appears to be extension through the posterior lateral aspect of the capsule.Central Gland: Heterogeneous hyperplasia compatible with benign prostatic hypertrophy.Seminal Vesicles: Unremarkable.Extracapsular Extension: Suspicion for extracapsular extension on the posterolateral aspectBLADDER: No significant abnormality noted.LYMPH NODES: Scattered inguinal lymph nodes are within normal limits. No pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There is an unchanged simple cystic structure in the posterior aspect of the prostate posterior to the prostatic urethra, likely a utricle cyst.

Output: 1.Findings compatible with prostatic adenocarcinoma involving the posterior left peripheral zone with findings suspicious for extracapsular extension posterolaterally.


Instruction: Generate impression based on medical findings.

Input: Rule out PCL tear in a patient with posterior knee pain/tearing sensation. MENISCI: There is intrasubstance degeneration and degeneration of the root of the medial meniscus.ARTICULAR CARTILAGE AND BONE: Lateral patellar and lateral femoral trochlear chondromalacia with bone on bone apposition and adjacent bony contusions. Adjacent to the degenerative changes of the root of the medial meniscus is a bony contusion of the tibial plateau.LIGAMENTS: The ACL, PCL, MCL, and LCL complex appear intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Severe patellofemoral osteoarthritis and degenerative changes of the medial meniscus described above.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Possible sacroiliitis. Signs and symptoms: New right low back pain. Nonenhanced lumbar MRI:T12 -- L1 demonstrate mild disk desiccation and mild hypertrophic changes of posterior elements without spinal stenosis or neural foraminal compromise. A tiny right lateral disk protrusion noted on prior exam is significantly less conspicuous on current study and likely representing improvement.L1 -- L2 is unremarkable with the exception of mild degenerative changes. Stable since prior study.L2 -- L3 demonstrate mild disk desiccation and loss of disk height, mild to moderate ligamentum flavum hypertrophy and mild facet disease. There is decrease in transverse diameter of thecal sac secondary to hypertrophic ligamentum flavum similar to prior exam. No central spinal stenosis and AP axis and no neural foraminal compromise.L3 -- L4 demonstrate moderate disk desiccation and loss of disk height, moderate to severe right facet and ligamentum flavum hypertrophy and including right facet effusion, mild left facet and ligamentum flavum hypertrophy. Degenerative changes demonstrate no significant interval change however a previously noted centrally located disk protrusion at this level demonstrate interval increased size and with resultant significant left lateral recess and left neural foraminal compromise, mild mass effect on the ventral aspect of the thecal sac and mild central spinal stenosis.L4 -- L5 demonstrate mild disk desiccation and loss of disk height, moderate bilateral (right greater than left) facet and ligamentum flavum hypertrophy. There is a tiny centrally located disk protrusion without interval change since prior exam and with very subtle indentation on thecal sac. No central spinal stenosis. There is no moderate right and mild left neural foraminal compromise without significant change since prior study.L5 -- S1 demonstrate mild degenerative disk disease and no significant degenerative changes of posterior elements. No central spinal stenosis or neural foraminal compromise.Additional MRI sequences were acquired for assessment of the SI joints which demonstrate no detectable signal abnormality of the joints or the adjacent bony structures.

Output: 1.New since prior exam is interval increased size of central and leftward broad-based disk protrusion at L3 -- L4 with resultant significant left lateral recess and left neural foraminal compromise and mild central spinal stenosis. Extensive degenerative changes at this level and including mild grade 1 anterolisthesis otherwise remain stable.2.Degenerative changes at other levels as detailed however without central spinal stenosis.3.Neuroforaminal compromise as detailed per level above.4.Dictated images for SI joint evaluation were also acquired and demonstrate no abnormality.


Instruction: Generate impression based on medical findings.

Input: Status post fourth ventricular choroid plexus tumor resection. There are postoperative findings related to suboccipital craniotomy with diffuse areas of scalp swelling. There is a residual lobular enhancing mass in the inferior fourth ventricle that measures up to 15 mm. There are patchy areas of high T2 signal and restricted diffusion within the bilateral cerebellar hemispheres. There is a right transfrontal ventricular catheter that terminates in the left lateral ventricle. The ventricles continue to decrease in size, along with the associated periventricular T2 hyperintensity. There is mild high T2 signal in the parenchyma surrounding the catheter. There is no evidence of acute cerebral infarction or intracranial hemorrhage. There is a 6 mm wide arachnoid cyst anterior to the anterior temporal pole. There is a retention cyst in the left maxillary sinus. Scalp fiducial markers are present.

Output: Postoperative findings related to partial resection of a fourth ventricular choroid plexus tumor with patchy areas of acute infarction involving the bilateral cerebellar hemispheres, but essentially resolved ventricular dilatation persistent obstructive hydrocephalus and transependymal edema, with a right transfrontal ventricular shunt catheter in position.


Instruction: Generate impression based on medical findings.

Input: 70 year old with silicone implant presents for implant evaluation. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Bilateral retro-glandular silicone implants appear intact. No evidence of intra-/extra-implant rupture, or implant herniation.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for implant rupture or malignancy. BIRADS: 1 - Negative.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on medical findings.

Input: Reason: 43 yo male with hx of right nephrectomy and cholecystectomy for renal cell carcinoma; pt has a stable hemangiomata within the liver; please evaluate for changes and or recurrence. ABDOMEN:LIVER, BILIARY TRACT: There is a diffuse decrease in hepatic parenchymal signal intensity on out of phase images consistent with fatty infiltration. There is a lobulated, well-circumscribed lesion within the right hepatic lobe (series 8, image 23) measuring 10.4 x 10.7 cm, previously 9.8 x 10.0 cm. The lesion demonstrates mild T1 hypointensity peripherally with more pronounced T1 hypointensity centrally as well as mild T2 hyperintensity peripherally and more pronounced T2 hyperintensity centrally. The lesion demonstrates discontinuous, peripheral, nodular enhancement on arterial phase images with some centripetal fill-in on delayed images compatible with a benign giant hemangioma. A well-circumscribed lesion within segment 2 of the liver (series 8, image 11) measures 2.5 x 2.9 cm, previously 2.1 x 2.4 cm. The lesion is homogeneously T2 hyperintense and T1 hypointense. The lesion demonstrates discontinuous peripheral nodular enhancement with progressive filling in on more delayed images and is compatible with a benign hemangioma. An additional lesion, also in segment 2 (series 8, image 9) measures 1.6 x 2.2 cm, previously 1.4 x 2.3 cm. The lesion is mildly T2 hyperintense and T1 hypointense, demonstrates peripheral nodular enhancement with fill-in on 1 hour delayed images, and is compatible with a benign hemangioma.Gallbladder is surgically absent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post right nephrectomy. No evidence of residual or recurrent disease in the surgical bed.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.Benign hepatic hemangiomas stable to minimally increased in size. No new hepatic lesions.2.No evidence of recurrent or residual malignancy.3.Hepatic steatosis.


Instruction: Generate impression based on medical findings.

Input: BRAIN: There is no suspicious intracranial enhancement, acute infarct, mass, or cerebral edema. There are no definite cortical dysplasias, heterotopic gray matter or evidence of mesial temporal sclerosis. There are few nonspecific periventricular and subcortical T2 hyperintensities in the supratentorial brain. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. LUMBAR: There is a large bulky structure in the pelvis which is incompletely imaged showing heterogeneous enhancement, likely representing a large fibroid uterus. There is apparent displacement of the fluid filled endometrial canal to the right of midline. In addition, there is partial visualization of a T2 hyperintense structures within the right upper pelvis which may be the location of the right ovary or may represent loops of bowel.The exam is mildly limited due to motion degradation on axial postcontrast images. The last well formed disk space is referred to as L5-S1. There is normal lumbar alignment and vertebral body heights. The disk heights are preserved. The osseous marrow signal is within normal limits for patient age. The conus terminates at mid L2 level. The conus shows normal signal intensity. There is mild developmental narrowing of the lumbar central spinal canal due to short pedicles and prominent dorsal epidural fat.There is subcutaneous edema in the deep posterior soft tissues lumbar region with enhancement, nonspecific, likely due to dependent edema although etiologies such as cellulitis are not excluded. There is no suspicious enhancement in the lumbar spine elsewhere.T12-L1: No disk herniation or spinal stenosis.L1-2: No disk herniation or spinal stenosis.L2-3: No disk herniation or spinal stenosis.L3-4: No disk herniation or spinal stenosis.L4-5: Mild disk bulge and facet arthropathy with no spinal stenosis.L5-S1: Mild disk bulge and moderate bilateral facet arthropathy causing no significant stenosis.

Output: 1.Essentially unremarkable MRI of the brain.2.Minimal lower lumbar spondylosis with no significant spinal stenosis.3.Nonspecific mild deep subcutaneous soft tissue edema of the posterior lower back with enhancement, likely representing dependent edema although etiologies such as cellulitis need to be excluded clinically.4.Extremely large bulky structure in the pelvis which is incompletely imaged showing heterogeneous enhancement likely represents a large fibroid uterus with presumed rightward displacement of the fluid-filled endometrial canal. However, this needs to be confirmed with ultrasound.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: Diagnosis: Chronic tension-type headache, not intractableClinical question: mass lesion causing new onset headaches and left arm weaknessSigns and Symptoms: HA, left arm weakness MRI brain: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 demonstrate a small mucous retention cyst in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is multilevel disc desiccation present.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a small central disc protrusion present at this level.At C4-5 there is no significant compromise to the spinal canal. There is a disc bulge present this level associated with some uncovertebral osteophytes with mild encroachment ofAt C5-6 there is no significant compromise to the spinal canal or neural foramina. There is loss of disc space height, disc desiccation and a mild disc bulge present at this level. There is mild ligamentum flavum hypertrophy at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is loss of disc space height, disc desiccation and a mild disc bulge present at this level. There is mild ligamentum flavum hypertrophy at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.There is a hyperintense T1 focus present in the T2 vertebral body measuring 8 mm in diameter most likely representing a vertebral body hemangioma.

Output: 1.There are degenerative changes present in the cervical spine without significant compromise to the spinal canal or exiting nerve roots.2.There is no evidence for intracranial mass lesion or cerebral infarction.


Instruction: Generate impression based on medical findings.

Input: Reason: please evaluate schwannoma in right brachial plexus and see if there is also a tumor on the left History: man with NF2 who is said to have tumor of both right and left brachial plexi. Limited images of the brain show bilateral enhancing lesions centered in the CP angles and IACs, right greater than left, likely vestibular schwannomas. There are additional enhancing lesions, anterior to the cerebellum as seen on coronal views as well as a lesion posteriorly within the foramen magnum which measures 1.6 x 1.5 cm (5/14). There are bilateral enhancing lesions around the C1-C2 thecal sac, right greater than left, causing no significant thecal sac compromise.There is minimal anterolisthesis of C4 on C5 and retrolisthesis of C6 on C7. Vertebral body heights are maintained. Multilevel disc desiccation without significant disc space loss. No abnormal marrow signal. Two small enhancing lesions are seen within the cord at C1-C2 which are suspicious for tumor.C2-C3: Enhancing left nerve root with mild expansion of the neural foramina likely represents a schwannoma. No spinal canal narrowing.C3-C4: No enhancing lesions. No spinal or neuroforaminal stenosis. C4-C5: Large enhancing lesion originating within the spinal canal causing expansion of the right neural foramina measuring 1.5 cm in width, similar to the prior exam. Small left extraforaminal lesion is unchanged. Lesion causes severe narrowing of the canal and deformity of the cord. C5-C6: Large, predominantly extraforaminal lesion on the right measuring up to 1.5 cm a second thickness, unchanged. Small enhancing extra foraminal lesion on the left is likely unchanged. No spinal canal stenosis.C6-C7: Small, predominantly extraforaminal enhancing lesions bilaterally without expansion of the foramina are likely unchanged. No spinal canal stenosis.C7-T1: Small predominantly enhancing extraforaminal enhancing bilaterally lesions without expansion of the foramina, likely unchanged. No spinal canal stenosis.Additional smaller schwannomas partially visualized within the thoracic spine.

Output: 1.Multiple schwannomas bilaterally throughout the cervical spine, the largest lesions on the right at C4-C5 and C5-C6, are overall unchanged from the prior exam. The lesion at C4-C5 causes severe spinal canal narrowing and deformity of the cord, similar to the prior exam.2.Two small enhancing lesions within the cord at C1-C2 are unchanged from the prior exam and likely represent a primary cord neoplasm.3.Multiple additional intracranial schwannomas partially visualized, including bilateral acoustic schwannomas.