Instruction: Generate impression based on medical findings.

Input: Check for stress fracture, tendonitis History of right leg and ankle pain Lower leg and ankle: TENDONS: No significant abnormality noted. Specifically tendons and muscle compartments are well visualized and intact.LIGAMENTS: No significant abnormality noted. Specific attention was placed in the region of the ankle without acute abnormalityARTICULAR SURFACES AND BONE: No significant abnormality noted. Marrow and cortical bone signal are unremarkable. Specifically no findings to suggest stress fracture or periosteal cortical abnormality.ADDITIONAL

Output: Normal examI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: 23 years Female (DOB:4/27/1993)Reason: s/p AVM resection and SRS, please evaluate for changes, 3T scanner History: yearly surveillance, seizuresPROVIDER/ATTENDING NAME: ISSAM A. AWAD SERVICES ANCILLARY MRI of the brainNo diffusion weighted abnormalities are appreciated.The patient is status post left-sided craniotomy for removal of an arteriovenous malformation. Some signal changes at the surgical bed likely represent gliotic changesThere is a small tangle of flow voids present in the right perimesencephalic cistern and in the right geniculate nucleus. There is associated enhancement at the right geniculate nucleus which has decreased compared to the prior exam. This focus of enhancement currently measures 9 x 4 mm axial dimensions and previously measured 13 x 6 mm axial dimensions on the 11th/2/15 exam. On susceptibility imaging there is signal loss at the area of contrast enhancement. Associated FLAIR signal hyperintensity is also regressedA punctate microhemorrhage is present in the left middle frontal gyrus. This is stable when compared to the prior examThe visualized portions of the paranasal sinuses demonstrate a small mucus retention cyst in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is a small tangle of vascular structures centered in the expected location of the right geniculate nucleus associated with mild enlargement of the the thalamogeniculate branches of the right posterior cerebral artery. These are less prominent than on the previous exams. The right medial atrial vein is asymmetrically larger than the left medial atrial vein.The anterior communicating artery is medium-sized. The posterior communicating arteries are small. The vertebral arteries are similar in size.

Output: 1.Status post removal of left temporal lobe arteriovenous malformation with expected post treatment change.2.A previously identified and treated arteriovenous malformation centered in the right geniculate nucleus continues to regress. Given some asymmetry in the size of the medial atrial veins this may represent indirect evidence that it hasn't resolved completely. Contrast enhancement and T2 to signal hyperintensity within the radiation bed continues to regress and is likely related to posttreatment change.


Instruction: Generate impression based on medical findings.

Input: 71 year old female with history of clear cell carcinoma of the uterus, status post chemotherapy. Metastatic uterine cancer with known enlarged retroperitoneal lymph nodes, presents with 3 weeks of progressive bilateral lower extremity edema. Evaluate for IVC clot/compression. CHEST:LUNGS AND PLEURA: Multiple small micronodules are unchanged.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter hypodense focus in the dome the liver is unchanged. There are no other focal lesions. Gallstones are unchanged, but the gallbladder is contracted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Double-J stent in the left kidney collecting system is unchanged. Mild left caliectasis is unchanged. On axial image 58/165 of series 3, a 1.8 x 2 cm left midpole renal cortical mass is found. In retrospect this was present on the prior examination, but the timing of contrast bolus was inadequate to delineate the mass. This mass may represent a metastasis or primary renal neoplasm.RETROPERITONEUM, LYMPH NODES: Left para-aortic mass invading the L4 lumbar vertebral body now measures 4.6 x 4.1 cm image number 83, series number 3. The mass encases the left ureter. Adjacent retroperitoneal adenopathy is also slightly smaller. Increasing distraction of the L4 vertebral segment with compression deformity. Increasing periaortic and left mesenteric adenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Destruction of the L4 vertebral body is increased.OTHER: No IVC obstruction was found. The IVC is narrowed at the inferior hepatic margin, without change from the prior examination.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Increasing periaortic and mesenteric lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is increasing edema within the dependent portion of the lower extremities on this scan which extends to the proximal thighs bilaterally.OTHER: Periaortic/psoas/L4 vertebral body mass with direct invasion of the psoas and vertebral body is approximately unchanged in size. New compression deformity of the L4 vertebral segment. The spinal canal is difficult to evaluate in MRI may be helpful for further evaluation, if cord compression is a concern.

Output: 2-cm diameter left midpole renal mass may be metastasis versus renal cell cancer.Slight increase in the size of the left psoas/L4 mass and retroperitoneal adenopathy. Increased destruction of L4 vertebral body with compression deformity. No other significant change from previous CT.


Instruction: Generate impression based on medical findings.

Input: 64 year old with proven right IDC grade 3 and high grade DCIS. MRI (10/13/14) demonstrated extensive non-mass enhancement in the right breast, suggesting extensive DCIS. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There has been significant interval decrease in right breast enhancement. At this point, only a few enhancing foci remain in the right breast. There are a few left breast foci which are stable to slightly less enhancing compared to the prior study. No abnormal enhancement is seen in the left breast. No abnormal lymph nodes are identified in either axillary region.A port-a-cath is present in the medial left chest wall superiorly.

Output: Nearly complete response to therapy on MRI since the prior study in October. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: Reason: Memory deterioration; evaluate for etiology. History of gastrointestinal stromal tumor. The CSF spaces are appropriate for the patient's stated age with no midline shift. There are punctate foci of signal loss present in the hippocampi, left thalamus, left and right cerebellar hemispheres, basal ganglia and the subcortical white matter.There is a moderate degree of periventricular and subcortical confluent hyperintense white matter lesions present identified on the FLAIR and T2 images. In addition, T2 and flair hyperintense lesions are present in the brain stem and internal capsules.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells demonstrate some scattered opacities. The visualized portions of the orbits demonstrate a left ocular prosthesis .

Output: 1.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related though they could be related to nonspecific leukoencephalopathy more be treatment related. Please correlate with the patient's clinical history.2.Lesions in the brainstem and internal capsules are also nonspecific but could be vascular related.3.There is a mild degree of microhemorrhages scattered along the cortex in both hemispheres as well as brainstem and basal ganglia. This is somewhat of a mixed pattern which can be seen with amyloid angiopathy or hypertension.4.There is no evidence for brain metastases.


Instruction: Generate impression based on medical findings.

Input: History of sarcomatoid prostate cancer. ABDOMEN:LUNG BASES: Trace bilateral pleural effusions, not significantly changed. No pericardial effusion.LIVER, BILIARY TRACT: The liver is normal in morphology, size, signal intensity and enhancement without a suspicious focal lesion. Segment IVb punctate focus, is too small to characterize, likely a small cyst (series 21, image 58). No intra or extrahepatic biliary ductal dilatation. Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Several bilateral simple cysts. Extrarenal pelvis bilaterally. No hydroureteronephrosis. No suspicious lesion.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes from ileal conduit formation with ostomy in the right lower quadrant. The bowel is unremarkable. No mesenteric lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: Status post cystoprostatectomy. Bowel loops have descend into the surgical bed. No specific evidence of soft tissue tumor recurrence in the surgical bed. Persistent partially loculated fluid in surgical bed extending towards the right hemipelvis, measuring approximately 3.6 x 2.7 cm (series 5/41).BLADDER: Status post cystoprostatectomy.LYMPH NODES: No enlarged pelvic lymphadenopathy.BOWEL, MESENTERY: Ileal conduit as above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable examination without evidence of disease recurrence or metastases. Stable postsurgical changes from cystoprostatectomy and ileal conduit.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: 66-year-old with history of HCV cirrhosis, evaluate for HCC. ABDOMEN:LIVER, BILIARY TRACT: The liver is cirrhotic in morphology with increased reticular T2 signal indicating fibrosis. In segment 5 of the liver (13/452) there is a subcentimeter nonenhancing T2 hyperintense lesion compatible with a simple cyst. No focal lesion or abnormal focus of enhancement is identified.The gallbladder appears normal. There is no intra or extrahepatic biliary ductal dilatation.The portal vein is patent.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic duct is nondilated. There is no focal parenchymal lesion.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis. No focal renal lesion.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Cirrhotic liver without suspicious focal hepatic lesion.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Patient was transferred from an outside institution for respiratory failure. Found down at trauma on paralytics and sedated at outside hospital. Now lie attending sedation and off paralytic agents. Still minimally responsive. Non-enhanced CT of brain:There is lower than expected hypoattenuation of the white matter of bilateral cerebral hemispheres. There is however no evidence of effacement of cortical sulci, mass effect midline shift or hydrocephalus. The density of cortex and basal ganglia and thalami remain within normal limits. Considering provided clinical date of possibly two underlying diffuse cerebral edema cannot be entirely ruled out and follow-up with an MRI is recommended. It is also possible that this appearance may be technique related. Images through posterior fossa are essentially unremarkable.

Output: Suspected cerebral edema of bihemispheric white matter as detailed. Considering patient's provided clinical date of follow-up with an MRI is recommended. There is no evidence of hemorrhage, mass-effect, midline shift or hydrocephalus. Please see above comments.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old, with new left sided headaches and eye pressure. A number of scattered punctate FLAIR hyperintense foci are seen in the cerebral white matter. The cerebral and cerebellar hemispheres and brainstem otherwise show normal signal intensity and morphology. No restricted diffusion is seen.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. On post-contrast images, no pathologic parenchymal or extra-axial enhancement is seen. Signal intensity of the bone marrow is unremarkable. Trace mucosal thickening is present in the sphenoid sinuses.

Output: Scattered punctate foci of FLAIR hyperintensity may represent sequelae of migraine headache, vasculitis, small vessel disease or gliosis from prior inflammation among other etiologies. No definite acute findings are seen.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o meniscus tear History: pain MENISCI: The medial meniscus appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: No full-thickness articular cartilage defects are identified. Foci of decreased signal abnormality within the lateral femoral condyle likely represent benign bone islands. Otherwise no bone marrow signal abnormality is identified.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact. There is minimal increased signal abnormality and fluid sensitive sequences within the distal quadriceps tendon which may reflect a very mild tendinosis.ADDITIONAL

Output: Minimal quadriceps tendon tendinosis. Otherwise normal-appearing right knee without evidence of a meniscal tear. Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: 72-year-old woman with history of urothelial cancer, new liver lesion on recent CT. ABDOMEN:LIVER, BILIARY TRACT: In segment 8 of the liver (1101/29) there is a 21 x 18 mm lobular, T2 hyperintense lesion which demonstrates nodular, progressive enhancement through the perfusion sequences. On the delayed phase (1205/254), this lesion is homogenous in appearance and isointense to the blood pool. The liver is otherwise normal in signal and morphology.The gallbladder appears normal. There is no intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Patient is status post left nephrectomy. Subcentimeter right renal cysts noted.RETROPERITONEUM, LYMPH NODES: Multiple enlarged retroperitoneal lymph nodes are noted (1205/169), characterized on recent CT. BOWEL, MESENTERY: Enhancing soft tissue is seen predominantly in the left upper quadrant mesentery. A previously described serosal T2 hyperintense lesion along the greater curvature of the stomach (1101/23) does not have definite imaging characteristics for metastasis. For reference purposes, peritoneal disease in the left lower abdomen (1204/48) measures 31 x 30 mm. Partially visualized small bowel and colon appear normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Mildly enlarged cardiophrenic lymph node noted.

Output: 1.Liver lesion compatible with hemangioma.2.Retroperitoneal lymphadenopathy and peritoneal carcinomatosis as seen on recent CT.


Instruction: Generate impression based on medical findings.

Input: T2 versus T3 glottic carcinoma. Neck CT:There is a mass at the larynx, involving the left vocal cord, extending superiorly to the false cord with partial infiltration of the left paraglottic fat, and inferiorly to the subglottic region. There is thickening of the anterior commissure and the right true cord, suggesting extension across midline to the right. There is sclerosis of the left arytenoid cartilage, which may be involved. There is minimal soft tissue thickening overlying the left lamina of the thyroid cartilage, which is also thinner compared to the right. Very early extralaryngeal extension therefore cannot be excluded; this can be further evaluated with MRI.There is slightly prominent lymph node at left level 2, measuring approximate 10-mm in short axis. A 11-mm node is seen at level 5B. These nodes may be involved.There is a 6-mm cystic lesion at the left tonsil.There is a 9-mm lytic lesion in the left scapular glenoid. It is well marginated, and is likely benign.Degenerative disease of cervical spine is noted.

Output: 1. Left laryngeal mass, with supraglottic and subglottic involvement, and extension across midline to the right. There is suggestion of involvement of the left arytenoid cartilage and left thyroid cartilage, and very early extralaryngeal extension. These findings can be further confirmed with MRI.2. Well marginated lytic lesion at the left scapular glenoid, likely benign given its imaging appearance.3. Small left tonsillar cyst.4. Borderline adenopathy at the left level IIA, and level 5B.


Instruction: Generate impression based on medical findings.

Input: There are multiple new foci of abnormal parenchymal enhancement suspicious for progression of metastatic disease. -Three foci of abnormal enhancement involving the posterior paramedian frontal lobes which appear new since 2/9/2015. There is a 6 mm enhancing nodule on the right and 4 and 5 mm nodules on the left. These are best seen on series 10 axial images 4-6. -There is also focus of enhancement involving the cortical surface of the right inferior parietal lobule adjacent to a vessel, axial image 11 which is also new.-Additional punctate foci of enhancement are seen in the right occipital lobe, sagittal series 11 image 13, and axial series 10 image 19, and right inferior frontal lobe sagittal image 6 and axial image 14. -Additional scattered foci of T2/FLAIR hyperintensity are seen including the bilateral anterior subcortical frontal white matter as well as lateral aspect of the left precentral gyrus without definite associated enhancement. Punctate focus of susceptibility is associated with the focus of FLAIR hyperintensity in the left precentral gyrus.There is mild edema without significant mass effect associated with these small lesions. No midline shift or herniation. No hydrocephalus. Small arachnoid cyst suspected in the posterior fossa on the left with mild effacement of the left cerebellar hemisphere.Two foci of susceptibility effect in the right frontal lobe and one in the right cerebellar hemisphere are unchanged and compatible with chronic microhemorrhages.Bone marrow signal and extracranial soft tissues are grossly unremarkable.

Output: 1. Compared to 2/9/2015, there has been development of at least six new subcentimeter foci of abnormal parenchymal enhancement consistent with progression of intracranial metastatic disease. There is mild associated edema without midline shift or herniation.2. Chronic microhemorrhages in the right frontal lobe and right cerebellar hemisphere are unchanged and may represent previously treated metastases. There is also a new focus of susceptibility effect with associated T2/FLAIR hyperintensity involving the left lateral aspect of the precentral gyrus without definite enhancement which may represent a new microhemorrhage. Although no definite associated enhancement is appreciated, underlying metastasis is not entirely excluded.


Instruction: Generate impression based on medical findings.

Input: 38-year-old female with BRCA mutation and family history of breast cancer. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally, symmetrically increased compared to prior studies.No unique or suspicious enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. To maximize the utility of breast MRI, please schedule future studies during the second week of the patient's menstrual cycle in order to minimize the effects of background enhancement. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on medical findings.

Input: History of hepatitis B and family history of pancreatic cancer. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, signal intensity and size. Normal postcontrast enhancement. Punctate hepatic cysts are present. No suspicious liver lesion or vascular abnormality. Contracted gallbladder without biliary ductal dilatation.SPLEEN: Normal size spleen without focal lesion.PANCREAS: Normal variant ductal anatomy. No focal suspicious lesion. In the distal pancreatic tail there is a 1.7 x 1.7 cm lesion which matches splenic intensity on some but not all imaging sequences.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts. No hydronephrosis or suspicious lesion.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No suspicious liver. 1.7 cm distal pancreatic tail hyperenhancing lesion matches splenic intensity on some but not all imaging sequences. Although this likely represents a intrapancreatic accessory spleen this is not confirmed. A nuclear medicine damaged RBC scan is recommended to confirm that this is splenic tissue.


Instruction: Generate impression based on medical findings.

Input: 37-year-old male with a salivary cancer. Status post 4 cycles of treatment. Compare and provide measurement. CT of soft tissues of the neck with infusion:Large destructive mass involving the left ethmoid air cells and with extension into the left orbit is again noted. In comparison with the prior exam there may be slight increase in the size of tumor in the retro-orbital space. Extensive tumor across the midline into the right ethmoid air cells with extensive bony erosion is also noted. This section of tumor demonstrates no definitive interval change. Erosion of the anterior wall of the sphenoid sinus with extension of tumor remains a stable. Increased soft tissue density on the lateral aspect of right orbit and right infratemporal fossa also remains a stable. Extensive posttherapy/surgical changes remains stable. No evidence of pathologic adenopathy in the neck. Limited images of the apices of the lungs are negative. Limited images of the mediastinum are negative on this study. Please review the dictated report of CT of chest that visualizes both these sections with more accuracy.CT of brain with infusion.No evidence of hemorrhage, edema, mass effect, midline shift or hydrocephalus. No evidence of abnormal enhancement of brain parenchyma or leptomeninges. To better evaluate patient's known tumor at the skull base in particular for epidural spread into the intracranial space an MRI is recommended.

Output: 1. With the exception of possible minimal increase in the left the retro-orbital tumor this is study remains a stable.2.Unremarkable CT of brain. Three see above comments.


Instruction: Generate impression based on medical findings.

Input: There are postoperative findings are redemonstrated related to right-sided L4-L5 microdiscectomy. There is persistent enhancement and effusion with a subcentimeter synovial cyst associated with the left L4-L5 facet joint. There is also enhancement along the right aspect of the L4-L5 intervertebral disc. There is a diffuse disc bulge at L4-5, with superimposed right foraminal component and associated facet arthropathy resulting in moderate bilateral neural foraminal stenosis at L4-L5 level and posterior epidural lipomatosis with mild-to-moderate spinal canal stenosis. There is a disc bulge at L5-S1, resulting in bilateral moderate neural foraminal stenosis. The vertebral body heights are preserved. There is endplate degenerative changes and Schmorl's node in the inferior endplate of L5 vertebra. The vertebral bone marrow signal is otherwise unremarkable. There is loss of disc height at L5-S1 and mild loss of disc height at L1-L2 and L4-L5 level. There is no abnormal signal within the imaged portion of the spinal cord. There is an unchanged perineural cyst in the sacral spinal canal.

Output: 1. Postoperative findings related to right L4-L5 microdiscectomy with residual eccentric right disc protrusion and what appears to be associated scar versus granulation tissue.2. Persistent enhancement and effusion associated with a subcentimeter synovial cyst involving the left L4-L5 facet joint may represent synovitis.3. Degenerative spondylosis at L5-S1 with bilateral moderate neural foraminal stenosis.


Instruction: Generate impression based on medical findings.

Input: 80 years, Female, Reason: further assess intra and extrahepatic biliary obstruction seen on US History: jaundice, weight loss, fatigue, pruritis. Limited exam due to lack of intravenous contrast.ABDOMEN:LUNG BASES: Small left pleural effusion.LIVER, BILIARY TRACT: There is lesion within the hepatic hilum at the Klatskin point, involving the proximal and mid common bile duct, which measures 3.2 x 4.4 cm (301/17). This lesion is diffusely infiltrative with additional lesions within the right hepatic lobe seen on T2/DWI (501/310 and 305), suspicious for metastases.The distal common bile duct is also dilated to 1.2 cm without a distal obstructing lesion evident.SPLEEN: No significant abnormality noted.PANCREAS: Prominent pancreatic duct. Pancreatic parenchymal appears normal.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple scattered renal cysts with a right upper pole hemorrhagic/proteinaceous cyst measuring 1.1 cm (801/17).RETROPERITONEUM, LYMPH NODES: Prominent portocaval lymph node measuring 1.2 x 0.9 cm (501/318). Enlarged left periaortic lymph node measuring 1.8 x 1.0 cm (501/312).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Mild abdominal ascites.

Output: 1.Evaluation is limited due to lack of intravenous contrast, however there is an obstructing mass within the liver causing severe intrahepatic biliary ductal dilatation which may represent either cholangiocarcinoma or metastases.2.Additional lesions within the right hepatic lobe are suspicious for metastases.3.Retroperitoneal lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old, with history of squamous cell lung cancer and known brain metastasis, admitted with altered mental status and hypoglycemia in the setting of vomiting, now extubated but persistently confused and altered. Subtle restricted diffusion is seen involving the splenium of the corpus callosum with no evidence of associated mass effect, blood product or enhancement and minimal if any corresponding T2 signal abnormality.Scattered patchy areas of T2 hyperintensity are redemonstrated in both cerebral hemispheres, largely periventricular and particularly prominent in the periatrial regions. The appearance and number of these lesions have not significantly changed allowing for technical differences between the scans.A focus of enhancement within the inferior right cerebellar hemisphere is redemonstrated with minimal associated T2 hyperintensity. This lesion measures approximately 6 x 5 mm on the current study compared to 8 x 7 mm on the prior exam. No new pathologic parenchymal or extra-axial enhancement is clearly seen.An enhancing mass centered in the sella is not as well seen on the present study due to motion artifact but probably not changed significantly in the interval.No evidence of significant mass effect is demonstrated. No intracranial hemorrhage or abnormal extra-axial fluid collection is suspected. Ventricular system is within normal limits for size and morphology.

Output: 1. Mild restricted diffusion involving the splenium of the corpus callosum is seen. This finding carries a broad differential diagnosis including sequelae of metabolic or electrolyte derangements including hypoglycemia, ischemic injury, sequelae of seizure, a medication related phenomenon, and some viral infectious agents. Given the history, it is quite possible that this finding reflects injury related to hypoglycemia.2. Scattered additional areas of white matter signal abnormality, particularly prominent in the periatrial regions, are again seen. There has been no significant interval change in the size or number of these lesions. These may be related to chronic ischemic injury, though other etiologies including demyelination and treatment related effects may be contributing.3. An enhancing lesion in the right cerebellar hemisphere compatible with metastasis remains visible but has decreased in size relative to the prior examination. No new intracranial metastases are suspected.4. A sellar mass is redemonstrated showing no significant interval change.


Instruction: Generate impression based on medical findings.

Input: Clinical question: rule out. Signs and symptoms: Astrocytoma with increased weakness. Unenhanced CT of brain:Examination demonstrates no evidence of hemorrhage.Lesion isointense with cortex involving the left basal ganglia and periventricular white matter of left hemisphere measures approximately 33 x 22.5-mm in transaxial dimensions. There is no evidence of surrounding edema or any associated mass effect with this finding. Considering provided clinical date out of astrocytoma this finding could represent tumor. There are no old studies and follow-up with an MRI is recommended. There is no evidence of hemorrhage, edema, significant mass effect or midline shift or hydrocephalus. Calvarium, paranasal sinuses and mastoid air cells are unremarkable.

Output: 1.No evidence of acute intracranial findings.2.Isodense mass in the left hemispheric white matter which may represent patient's known astrocytoma. Follow-up with an MRI is recommended.


Instruction: Generate impression based on medical findings.

Input: Paresthesias, evaluate for progression of demyelinating disease. Brain: Again seen are scattered foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter not appreciably changed compared to 6/12/2015. No new lesions. There is subtle focus of enhancement in the right posterior frontal lobe, series 4 image 12 with enhancement not present on the 3-D SPGR sequences likely related to differences in technique and contrast timing. There is corresponding T2 FLAIR hyperintensity which was present on prior study from 6/12/2015 but did not demonstrate enhancement. As such this may represent new enhancement within pre-existing lesion versus chronic enhancement which was not appreciable previously due to technique. Subtle focus of enhancement is also suspected in the right ventral pons, series 3 image 130 also not appreciated on prior.Brain parenchymal volume is preserved. No evidence of intracranial mass or mass effect. No hydrocephalus or extra-axial collections. Evidence of prior left parietal burr hole placement for biopsy with gliosis involving the adjacent cortex again seen. Visualized extracranial soft tissues are unremarkable.Cervical spine: There is minimal patchy T2 signal abnormality throughout the cervical cord without findings to suggest a new discrete lesion. No discrete/large lesion with enhancement is appreciated. There are subtle foci of enhancement which are again questioned in the cervical cord, such as at the C1 level sagittal series 9 image 8 and at the left C4 level, sagittal series 9 image 9. Previously described foci of enhancement at the C2 level and right lateral C6 level are no longer appreciated.Spinal alignment is anatomic. Vertebral body height and morphology are normal. No concerning marrow signal abnormality or enhancement is seen. No significant spinal canal or neural foraminal stenosis. Paraspinous soft tissues are unremarkable.

Output: Compared to 6/12/2015, there are small scattered T2/FLAIR hyperintense lesions in the white matter which are not appreciably changed since 6/12/2015. There are tiny foci of enhancement, such as in the right posterior frontal lobe and right ventral pons which were not appreciated on prior. Similarly in the cervical cord, there are tiny T2 hyperintense lesions which overall are not appreciably changed. There are subtle foci of enhancement in the cervical cord which appear new, while subtle enhancing foci present on prior study which are no longer appreciated on the current study. Overall, these tiny areas of enhancement in the brain and cervical cord suggest ongoing inflammation/demyelination. Given their small size (1-3 mm) it is possible that they represent chronic subtle enhancing foci with apparent fluctuation possibly related to differences in technique/contrast timing.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o metastatic dz History: h/o lymphoma in remission, night pain The bone marrow signal intensity is within normal limits. No acute fracture or malalignment is evident. The image musculature of the pelvis is normal in appearance there is no evidence of lymphadenopathy. No enhancing mass lesions are identified on postcontrast sequences. Minimal degenerative disc disease affects image lower lumbar spine including intervertebral disc desiccation. Please see the patient's dedicated MRI of lumbar spine examination report for additional details. There is a 2 cm cystic lesion within the right adnexa, likely physiologic in a patient of this age. There is a small amount of peritrochanteric inflammation, right greater than left, which is not necessarily of any clinical significance. There is a small amount of fluid identified within the hips also not necessarily of any clinical significance. The sacroiliac joints are normal in appearance.

Output: No findings to account for the patient's pain. No evidence of lymphadenopathy or enhancing mass lesion.


Instruction: Generate impression based on medical findings.

Input: History of cervical cancer. Evaluate tumor burden. History of invasive moderately differentiated squamous cell carcinoma. PELVIS:UTERUS, ADNEXA: The uterus is markedly distorted in its mural contour with numerous T2-weighted very hypointense masses and T2-weighted intermediate signal intensity masses which are submucosal, intramural and subserosal in distribution. The uterus is approximately 20.5 x 8.9 cm in sagittal cross section (series 901/45). Many of these masses demonstrate peripheral heterogeneous enhancement with central non-enhancement, suspicious for extensive tumor involvement. The endometrial cavity is abnormally dilated measuring up to 2 cm with an ill-defined endometrial/inner myometrial junction.There is suspected tumor invasion into the bilateral adnexa. Tumor extends to the right lateral pelvic side wall (series 701/41). Tumor invades the proximal vagina. BLADDER: Foley catheter within a partially collapsed urinary bladder. The fat plane between the cervix and inferior dorsal bladder wall is obliterated with suspected tumor invasion into the base of the bladder (series 1002/49).LYMPH NODES: There is extensive periaortic lymphadenopathy best seen on the coronal series #401, image 21 and 19 as well as common iliac lymphadenopathy (series 401 image 24). The right periaortic lymph node measures approximately 3.7 x 2.4 cm in the coronal plane.BOWEL, MESENTERY: There is a moderate volume of pelvic ascites with nodular peritoneal thickening with enhancement suspicious for carcinomatosis (series 1604/64).Peripheral enhancing nodule at the umbilicus suspicious for tumoral deposit measuring 1.8 x 1.5 cm (series 1604/image 121). Additional tumoral deposits are suspected but are incompletely evaluated in the lower abdomen/upper pelvis. Tumor involves the right ureter with moderate hydroureter. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Extensive tumoral involvement of an enlarged and distorted uterus, proximal vagina and bilateral adnexa. Probable tumoral invasion into the base of the bladder. 2.Extensive pelvic and lower abdominal retroperitoneal lymphadenopathy.3.Right ureteral involvement resulting in hydroureter.4. Pelvic ascites and additional findings as described above.


Instruction: Generate impression based on medical findings.

Input: Pain with locking up. ROTATOR CUFF: There is mild thickening and increased signal intensity within the distal fibers of the infraspinatus tendon compatible with mild tendinosis. Additionally, there is a small partial thickness insertional tear of the anterior fibers of the infraspinatus tendon. There is no supraspinatus or infraspinatus muscle atrophy. The teres minor and subscapularis muscles and tendons are intact.SUPRASPINATUS OUTLET: Moderate osteoarthritis affects the acromioclavicular joint. There is no significant fluid in the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a hypoplastic osseous posterior glenoid with fragmentation of the cartilage labrum. There is thinning of the glenoid cartilage posteriorly. There is a small to moderate joint effusion.BICEPS TENDON: The biceps tendon is intact. ADDITIONAL

Output: 1. Partial thickness insertional tear and mild tendinosis of the infraspinatus tendon.2. Hypoplastic glenoid.


Instruction: Generate impression based on medical findings.

Input: Pain. Follow-up DJD left hip. Two views of the left hip are provided. There is narrowing of the left hip joint with near bone-on-bone apposition superomedially, as well as subchondral cyst formation and small femoral head osteophytes. These findings indicate moderate to severe osteoarthritis. Lack of joint fluid on the MRI examination from earlier today argues against an acute inflammatory process.Two views of the right hip are provided. There is coxa profunda, which is not necessarily of any clinical significance. The right hip is otherwise unremarkable.The AP view the pelvis shows the aforementioned arthritic changes on the left. The remainder of the pelvis is unremarkable.

Output: Osteoarthritis of the left hip as described above.


Instruction: Generate impression based on medical findings.

Input: Reason: Dx of smoldering multiple myeloma. History: Dx of smoldering multiple myeloma w/ back pain Note is made of heterogeneous bone marrow signal abnormality likely representing residual islands of red marrow. There is a punctate focus of enhancing signal abnormality along the posterior aspect of the medial wall of the right acetabulum likely representing a subchondral cyst. Otherwise no discrete enhancing myelomatous deposit is identified. The imaged musculature of the pelvis unremarkable. Mild osteoarthritis affects the hips.

Output: Diffuse heterogeneous bone marrow signal abnormality likely represents residual islands of red marrow, although diffuse myelomatous involvement is considered a less likely differential consideration. No discrete enhancing myelomatous deposit is identified.


Instruction: Generate impression based on medical findings.

Input: 71 year old male with history of fall with neck pain. Please evaluate. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.There is grade I retrolisthesis of C5 on C6 of approximately 5 mm that appears unchanged from the prior MRI 3/3/2009. In addition, there are destructive changes of the endplates at C5-C6 that is also unchanged; these findings are compatible with a chronic, non-progressive destructive process.Disk bulge noted at C3-C4; unchanged from previous MRI.No acute fracture. The remainder of the spine is in normal alignment.

Output: 1. Stable destructive process at C5-C6; there are no findings to suggest acute or progressive process.2. No acute intracranial abnormality.


Instruction: Generate impression based on medical findings.

Input: 83 year old with history of coronary artery disease requiring multiple percutaneous coronary interventions and three vessel coronary artery bypass grafting (LIMA to LAD, SVG to RCA and SVG to OM) and valvular heart disease s/p recent repeat aortic valve replacement and mitral valve repairMEDICATIONS: Amiodarone, aspirin, clopidogrel, triamterene-hydrochlorothiazide First Pass PerfusionDuring hyperemia, extensive perfusion defects involving the entire basal left ventricle, all but the inferolateral wall of the mid left ventricle, and all but the anterior wall of the apical left ventricle. Viability/ Myocardial ScarThere is a small transmural late gadolinium enhancement noted in the mid inferior wall that is consistent with transmural myocardial infarction. This small area (<5% of the myocardium) is unlikely to be viable. The basal septum has a mid-ventricular stripe pattern of late gadolinium enhancement, which is atypical for prior myocardial infarction and suggests the presence of myocardial fibrosis due to a non-ischemic etiology. This segment has an indeterminate probability of viability. The remaining myocardium does not show evidence of myocardial infarction, fibrosis, inflammation, or infiltration and is likely to be viable. Left VentricleThe left ventricle is normal in size and with severely reduced systolic function. The overall LV ejection fraction is 23%, the LV end diastolic volume index is 102 ml/m2 (normal range: 74+/-15), the LVEDV is 205 ml (normal range 142+/-34), the LV end systolic volume index is 78 ml/m2 (normal range 25+/-9), the LVESV is 158 ml (normal range 47+/-19), the LV mass index is 66 g/m2, and the LV mass is 132 g. There is global hypokinesis with additional severe akinesis of the entire inferior wall.. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with severely reduced systolic function. The overall RV ejection fraction is 28%, the RV end diastolic volume index is 108 ml/m2 (normal range 82+/-16), the RVEDV is 217 ml (normal range 142+/-31), the RV end systolic volume index is 78 ml/m2 (normal range 31+/-9), and the RVESV is 156 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThere is a bioprosthetic aortic valve presentMitral ValveThe mitral valve has posterior leaflet restriction with severe mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere are small bilateral pleural effusions. 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 a large burden of ischemia, as described above, in a multivessel coronary distribution. 2. There is a small transmural myocardial infarction in the mid inferior wall. This small area (<5% of the myocardium) is unlikely to be viable. The basal septum has a mid-ventricular stripe pattern of late gadolinium enhancement, which is atypical for prior myocardial infarction and suggests the presence of myocardial fibrosis due to an additional non-ischemic etiology. This segment has an indeterminate probability of viability. The remaining myocardium does not show evidence of myocardial infarction or fibrosis and is likely to be viable. 3. Normal LV size with severely reduced systolic function (LVEF 23%). There is global hypokinesis but the entire inferior wall is clearly worse.4. Normal RV size with severely reduced systolic function (RVEF 28%).5. Mild biatrial dilation.6. Severe mitral regurgitation, likely due to an "ischemic" etiology causing tethering of the posterior leaflet. 7. Small bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: 64-year-old man with history of Gleason 7 prostate adenocarcinoma at the left mid gland and left apex. PELVIS:PROSTATE:Prostate Size: 42 x 38 mm.Peripheral Zone: There is a vague, approximately 6 x 5 mm focus of T2 hypointensity and diffusion restriction in the left anterolateral apex (501/19).Central Gland: Normal in appearance.Seminal Vesicles: Seminal vesicles appear normal.Extracapsular Extension: No evidence of extraprostatic extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant lymphadenopathy noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Small area of left apical prostatic signal abnormality suspicious for tumor.


Instruction: Generate impression based on medical findings.

Input: 37 years Female (DOB:12/4/1979)Reason: multifocal GBM with incontinence History: incontinencePROVIDER/ATTENDING NAME: JAMES A. MASTRIANNI 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.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, disc desiccation and a mild disc bulge at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, disc desiccation and a mild disc bulge 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: There is some degenerative disc disease present but no compromise to lumbar spinal canal or neural foramina.


Instruction: Generate impression based on medical findings.

Input: 67 year-old female with confusion. There is no evidence of intracranial hemorrhage, mass or edema. Confluent periventricular and subcortical areas of hypoattenuation are consistent with chronic small vessel ischemic disease, which was present on 2010 MRI.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.Atherosclerotic calcifications in both internal carotid arteries.

Output: 1.No acute intracranial abnormality. However, CT is not sensitive in detecting acute ischemic change and MRI is recommended if clinical suspicion for nonhemorrhagic stroke persists.2.Chronic small vessel ischemic disease.


Instruction: Generate impression based on medical findings.

Input: Lung cancer with metastasis. Status post radiation for cord compression. Presented with urinary retention. The vertebral column alignment is near-anatomic, aside from mild straightening of the cervical and lumbar lordosis. There are postoperative findings related to T4 and T5 partial corpectomy and posterior fixation hardware from T2 through T8, which created artifact that largely obscures the spinal canal from T2 through T3 and from T4 through T8. Otherwise, there are relatively small ventral and dorsal indentations of the thecal sac by degenerative disc-osteophyte complexes and ligamentum flavum thickening at C5-C6 and C6-C7. There is no abnormal spinal cord signal at these levels, as well as inferior to T8. There is interval increase in size of the T1 hypointense and T2 hyperintense sacral mass that markedly narrows the spinal canal and compresses the S1-S2 and S2-3 sacral foramina, especially on the left side. There is also increase in size of a T1 hypointense and T2 hyperintense lesion in the anterosuperior portion of the L3 vertebral body. There is an incompletely-imaged left thoracic soft tissue mass abutting the aortic arch.

Output: 1. Postoperative findings related to T4 and T5 partial corpectomy and posterior fixation hardware from T2 through T8, which created artifact that largely obscures the spinal canal from T2 through T3 and from T4 through T8. 2. Mild indentation of the cervical spinal cord by disc-osteophyte complexes and thickened ligamentum flavum at multilevel level. Otherwise, assessment of the spinal canal in the mid thoracic region is limited by the artifact from the posterior fixation hardware. 3. Interval increase in size of the sacral metastasis with increased spinal canal and sacral foramina narrowing, especially on the left side. Please refer to the separate pelvis MRI report for additional details.4. Interval increase in size of a metastatic lesion in the anterosuperior L3 vertebral body. 5. The left thoracic soft tissue mass abutting the aortic arch is incompletely imaged.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Past pituitary adenoma. Evaluate for or regrowth of adenoma. Signs and symptoms: Worsening memory for a year. Pre-and post-enhanced pituitary MRI:Examination demonstrate stable post surgical changes of prior removal of pituitary adenoma. There is no convincing evidence of residual tumor which is a similar observation as prior study. There is revisualization of pituitary stalk with rightward course and termination to residual pituitary gland on the right similar to prior exam. Heart remarkable bilateral cavernous sinuses and similar to prior study. Unremarkable suprasellar visual complex.Pre-and post-enhanced brain MRI:Negative diffusion weighted images.T2 flair images demonstrate minimal punctate foci of hyperintensity in the periventricular white matter of cerebral hemispheres which are nonspecific however often represent microvascular ischemic changes. There are no prior dedicated brain MRI in particular of flair sequence which makes precise comparison difficult. However comparison with prior axial T2 weighted images demonstrate no convincing evidence of progression of findings.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and myelination are brain otherwise. Post-enhanced images fail to demonstrate any abnormal parenchymal, leptomeningeal, calvarial or orbital enhancement.The signal void of major intracranial arterial branches are identified. The signal intensity of the intracranial venous sinuses is within normal and with normal pattern of enhancement.

Output: 1.Stable post surgical changes of pituitary adenoma resection since prior exam and without evidence of residual tumor.2.Negative diffusion weighted images.3.Minute periventricular flair hyperintensity although nonspecific it could represent chronic microvascular ischemic changes of minimal degree.4.No detectable abnormal enhancement and unremarkable brain MRI otherwise.


Instruction: Generate impression based on medical findings.

Input: 69-year-old female with history of small bowel obstruction 10 years prior, now with pain in the midabdomen and weight loss. Evaluate for small bowel narrowing or inflammation. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted. No focal liver lesions identified. No biliary ductal dilation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted. No lymphadenopathy noted.BOWEL, MESENTERY: Normal appearing loops of bowel without abnormal enhancement, wall thickening, stricturing, fistulization, or associated fluid collections. No fibrofatty proliferation of the mesentery.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Not well visualized.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Large amount of rectal stool noted. Otherwise normal appearing loops of bowel without abnormal enhancement, wall thickening, stricturing, fistulization, or associated fluid collections. No fibrofatty proliferation of the mesentery.BONES, SOFT TISSUES: Susceptibility artifact noted, likely secondary to spinal hardware.

Output: Large amount of rectal stool noted. Otherwise normal appearing loops of bowel without abnormal enhancement, wall thickening, stricturing, fistulization, or associated fluid collections.


Instruction: Generate impression based on medical findings.

Input: Male, 27 years old. Left shoulder instability ROTATOR CUFF: The supraspinatus, infraspinatus, subscapularis, and teres minor muscles and tendons are normal in appearance. Contrast remains within the joint space.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a defect in the anterior labrum at approximately the 3:00 position. This likely represents a normal variant (sublabral foramen), but we cannot completely exclude a tear in this location.BICEPS TENDON: The tendon of the long head of the biceps appears normal. ADDITIONAL

Output: A defect in the anterior labrum likely represents a normal variant, but we cannot completely exclude a tear in this location. Otherwise normal MR appearance of the shoulder.


Instruction: Generate impression based on medical findings.

Input: A 76 year old male with history of hypertension, hyperlipidemia and coronary artery disease: in a recent hospitalization a left cath showed chronic total occlusion of the left circumflex and 95% of the right coronary artery, a stent was implanted to the RCA. The echocardiography showed normal left ventricular function. Now referred to stress cardiac MRI for further evaluation due to fatigue.MEDICATIONS: aspirin, ticagrelor, metoprolol, ramipril, atorvastatin, tamsulosin. First Pass PerfusionDuring hyperemia, a moderate perfusion defects was present at the base and mid level of the lateral, inferolateral and inferior walls and within the apical lateral wall. The ischemia score is 4/32 (12.5%). Viability/ Myocardial ScarThere was late gadolinium enhancement at the base and mid level of the inferolateral walls, suggesting a prior myocardial infarction. This finding affects more than 50% of the thickness of the myocardium suggesting that is a transmural defect. The rest of the myocardium is viable.Left VentricleThe left ventricle is normal size with normal systolic function. The overall LV ejection fraction is 67%, the LV end diastolic volume index is 59 ml/m2 (normal range: 74+/-15), the LVEDV is 129 ml (normal range 142+/-34), the LV end systolic volume index is 20 ml/m2 (normal range 25+/-9), the LVESV is 43 ml (normal range 47+/-19), the LV mass index is 52 g/m2, and the LV mass is 112 g. There is mild hypokinesis of the basal and mid segments of the inferolateral wall. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal size with normal systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 74 ml/m2 (normal range 82+/-16), the RVEDV is 162 ml (normal range 142+/-31), the RV end systolic volume index is 34 ml/m2 (normal range 31+/-9), and the RVESV is 73 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. During hyperemia, a moderate perfusion defects was present at the base and mid level of the lateral, inferolateral and inferior walls and within the apical lateral wall. The ischemia score is 4/32 (12.5%). 2. There was late gadolinium enhancement at the base and mid level of the inferolateral wall, suggesting a prior myocardial infarction. This finding affects more than 50% of the thickness of the myocardium suggesting that is a transmural defect. The rest of the myocardium is viable.3. Normal LV size and systolic function (LVEF 67%).4. Normal RV size and systolic function (RVEF 55%).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: 65-year-old woman with history of nodular HCV cirrhosis. ABDOMEN:LIVER, BILIARY TRACT: The liver is cirrhotic in morphology with nodular contour. Additionally, there is diffusely decreased T2 signal with areas of reticular increased T2 signal. Scattered T2 hyperintense hepatic cysts are seen in both lobes. Additionally, there are innumerable punctate/subcentimeter T2 hyperintense foci without enhancement compatible with biliary hamartomas/von Meyenburg complexes.The gallbladder appears normal. There is no intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Prominent periportal lymph nodes noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Bilateral axillary lymphadenopathy noted, seen on prior mammograms.OTHER: No significant abnormality noted.

Output: 1.Cirrhotic, fibrotic liver with cysts and biliary hamartomas but no suspicious focal lesion.2.Prominent axillary lymph nodes as seen on prior mammograms.


Instruction: Generate impression based on medical findings.

Input: 62 years Female (DOB:3/9/1953)Reason: lumbar radiculopathy spondylolisthesis History: buttock and leg 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 levocurvature to the lumbar spine associated with right lateral translation of L1 on L2. This was not conspicuous on the prior exam. There is multilevel disc desiccation present. There is a left-sided Tarlov cyst in the sacral spinal canal. This appears to have also been present on the priorAt L5-S1 there is no significant compromise to spinal canal. There is a left lateral disc protrusion present at this level which extends into the left neural foramen and effaces the fat surrounding the left-sided exiting nerve root. This is new since the prior exam. Since the prior exam associated endplate reactive changes developed along the left half of the disc space.At L4-5 there is mild anterior subluxation of L4 and L5 associated with diffuse disc bulge. The subluxation is new since the prior exam. There is associated bilateral facet hypertrophy. There is also associated narrowing of the neural foramina bilaterally at this level with some mild encroachment of the right-sided exiting nerve roots.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is a mild disc bulge at this level. There are some facet hypertrophic changes present at this level which were also present on the prior exam.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge present at this level which extends into the neural foramina bilaterally. The exiting nerve roots are surrounded by fat within the neural foramina. There are new facet hypertrophic changes present at this levelAt L1-2 there is no significant compromise to spinal canal or neural foramina. There is mild right lateral translation of L1 and L2 associated with a broad-based disc protrusion extending along the left anterior lateral aspect of the disc space.

Output: 1.Since the prior exam patient has developed more degenerative changes. There is now a levocurvature to the lumbar spine centered at L1-L2 and mild anterior subluxation of L4 on L5 is not present in 2006. There is more disc disease and facet disease on the current exam relative to the prior exam.2.There are degenerative changes present in the lumbar spine with new mild to moderate encroachment of left-sided exiting nerve roots at L5-S1 within the left neural foramen and mild encroachment of the right-sided exiting nerve roots within the right neural foramen at L4-5.


Instruction: Generate impression based on medical findings.

Input: 47-year-old female with history of trauma, thumb pain and swelling about the flexor tendon. The visualized portion of the flexor pollicis longus tendon is intact as traced from the level of the the first metacarpal to its insertion on the distal phalanx. There is abnormal signal intensity replacing the subcutaneous fat between the volar margin of the flexor pollicis longus and the overlying skin at the crease of the interphalangeal joint. This is of intermediate signal intensity on T1 and T2 weighted sequences and slightly increased signal intensity on fat suppressed T2-weighted images. While this is nonspecific, this may represent focal edema or possibly scar tissue. The volar plate deep to the tendon appears sightly prominent, but we see no evidence to suggest a volar plate injury and this may simply reflect mild osteoarthritis and slight flexion at the interphalangeal joint. There is mild thickening and increased signal intensity of the radial collateral ligament of the interphalangeal joint which we suspect is chronic in etiology. There is also small bony excrescence arising from the metacarpal head which likely reflects old trauma. We see no fluid within the interphalangeal joint, however there is an elongated collection of fluid signal intensity dorsal to the extensor pollicis tendon along the proximal phalanx which likely represents a ganglion cyst which measures approximately 1 cm in the longest dimension.

Output: 1.Abnormal signal intensity volar to the flexor pollicis longus tendon volar to the interphalangeal joint. This is nonspecific and may represent edema or scar tissue. The possibility of an A2 pulley injury is also a consideration. The flexor pollicis longus tendon appears normal.2.Degenerative arthritic and possible old posttraumatic changes as above.3.Ganglion cyst dorsal to the proximal phalanx as above.


Instruction: Generate impression based on medical findings.

Input: 57-year-old male with a history of multiple skin cancers presents with a vocal cord paralysis. There are postoperative findings related to left left lateral temporal bone resection with myocutaneous graft reconstruction. There has been interval increase in the degree of a peripherally enhancing area with scattered foci of susceptibility effect and surrounding edema in the left temporal lobe with effacement of the third and left lateral ventricles, but dilatation of the right lateral ventricle. The defect in the left tegmen with mild herniation of the inferior temporal lobe is unchanged. There is minimal residual fluid extra-axial fluid along the floor of the left middle cranial fossa. There is no evidence of acute territorial infarction. There is a nonspecific punctate focus of susceptibility effect in the right anterior cingulate gyrus. There are denervation changes in the left masticator and facial expression muscles. Low T1 and T2 bone marrow signal in the irregular left mandibular condyle may be attributed to degenerative changes with subchondral sclerosis. There has been interval resolution of the enhancement in the left cochlea and cranial nerves in the left internal auditory canal, but new T1 hyperintensity in the left vestibule and semicircular canal,

Output: 1. Continued evolution of what likely radiation necrosis in the left temporal lobe with increase in localized mass effect and incipient obstructive hydrocephalus of the right lateral ventricle.2. Persistent defect in the left tegmen with mild herniation of the inferior temporal lobe and minimal residual extra-axial fluid collection along the floor of the left middle cranial fossa.3. Resolved enhancement of the left cochlea and cranial nerves in the left internal auditory canal, but new T1 hyperintensity in the left vestibule and semicircular canal, which may be related to proteinaceous debris or hemorrhage.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: Macroadenoma without history of surgery. There is redemonstration of T1 hypointense and T2 hyperintense tissue within the enlarged sella consistent with macroadenoma. This is located in the interim left lateral aspects of the sella, with relative hypoenhancement as compared to adjacent normal enhancing glandular tissue tissue. The lesion again invades the clivus along the inferior and posterior margins of the sella. The medial aspect of the left cavernous sinus is likely involved. The mass again measures 13 x 10 mm on 3/7, not significantly changed even dating back to 2003.The native pituitary gland is displaced to the right superior aspect of the sella where it enhances normally and appears stable compared to multiple prior exams. The pituitary stalk demonstrates normal enhancement and is very minimally deviated to the right. The optic chiasm and visualized portions of the optic nerves bilaterally are unremarkable. Flow-voids are visualized in the cavernous carotid arteries without significant narrowing.Incidental note is made of fluid within a degenerated right temporomandibular joint.

Output: Continued stable appearance of macroadenoma with invasion of the clivus and the left cavernous sinus.


Instruction: Generate impression based on medical findings.

Input: 75-year-old female with severe right hip pain status post fall from couch. History of renal, anal and lung cancer. There is a 3.8 x 3.0 x 7.3 cm focus of nonenhancing increased signal abnormality within the intertrochanteric and subtrochanteric region of the right femur with associated cortical destruction and soft tissue extension resulting in anterior displacement of the vastus musculature, consistent with osseous metastatic disease. Note is made of innumerable additional foci of increased signal abnormality within the bones of the pelvis including the acetabulum bilaterally, inferior pubic rami, superior pubic rami, sacrum, and iliac bones, bilaterally. There is also signal abnormality within the intertrochanteric region of the left femur, distal left femoral metadiaphysis, left femoral head and L5 vertebral body suspicious for osseous metastatic disease. Foley catheter in place. There is increased signal abnormality and fluid sensitive sequences within the right gluteus minimus muscle, anteriorly, as well as along the vastus musculature, which is nonspecific, but does not demonstrate enhancement on postcontrast sequences. There is mild diffuse fatty infiltration of the imaged musculature of the right hip. There is a small collection with fluid signal intensity and fluid fluid level within the soft tissues along the left perineum which may represent a Bartholin's cyst.

Output: Multiple foci of osseous metastatic disease involving the imaged bones of the pelvis and proximal appendicular skeleton as described above. The largest lesion is situated within the intertrochanteric/subtrochanteric region of the right femur and is associated with cortical destruction, soft tissue extension, and involvement of nearly the entire medullary space of the femur. Evaluation for the possibility of an impending pathologic fracture is recommended. Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Multiple sequences are degraded by motion artifact. As on the previous exams the left aspect of the sella is empty. The pituitary stalk leads to a homogeneously enhancing tissue within the right aspect of the sella which likely represent pituitary gland unchanged in size and appearance. No new or enlarging mass within the sella.MRA HEAD

Output: 1.Motion degraded current and prior MRA studies demonstrate a 2-3 mm right supraclinoid ICA aneurysm which is not significantly changed dating back to 8/15/2012. 2.Motion degraded current and prior pituitary studies demonstrate no new or enlarging mass within the sella.


Instruction: Generate impression based on medical findings.

Input: 48 year old female patient with pain after 9 foot fall off ladder Evaluate for rotator cuff tear and biceps tear. There is a mildly displaced avulsion type fracture of the greater tuberosity with the fracture fragment measuring approximately 1.3 x 0.5 cm. The fragment is uplifted slightly by 7 mm by the supraspinatus tendon, separated by underlying bone with heterogeneous signal intensity which presumably represents fluid and blood products. There is edema within the underlying humeral head. We see no additional fracture.ROTATOR CUFF: The supraspinatus tendon can be followed to its insertion on the mildly displaced greater tuberosity fracture fragment. It appears thickened which is likely due to slight retraction and edema but we see no discrete full-thickness tear. The supraspinatus muscle is within normal limits. There is longitudinally oriented increased signal intensity along the undersurface fibers of the infraspinatus tendon near the posterior margin of the fracture fragment, which perhaps represents a shallow posttraumatic undersurface tear, but we see no full-thickness tear of the tendon. Thickening and increased signal intensity of the subscapularis tendon likely represents a combination of tendinosis and internal rotation of the humerus. The subscapularis muscle is within normal limits. The teres minor muscle and tendon are intact.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. There is a small amount of fluid within the subacromial/subdeltoid bursa, which may be due to the aforementioned greater tuberosity fracture.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a small glenohumeral joint effusion. Mild osteoarthritis affects the glenohumeral joint. There is also increased signal intensity within the superior and anterior labrum which likely represents degeneration/degenerative tearing. BICEPS TENDON: Thickening and intermediate signal intensity in the biceps tendon within the intra-articular portion and transition to the intertubercular groove indicates moderate tendinosis, but we see no discrete tear. Small amount of fluid in the biceps tendon sheath may reflect extension of fluid from the glenohumeral joint.ADDITIONAL

Output: 1. Avulsion type fracture of the greater tuberosity as described above.2. Rotator cuff tendinosis and possible shallow undersurface tear of the infraspinatus, but no full-thickness rotator cuff tear.3. Tendinosis of the proximal tendon of the long head of the biceps without evidence of tear. The most distal portion of the biceps tendon is not included in the field-of-view; if there is concern for insertional injury, the patient may return for additional imaging.4. Mild osteoarthritis of the shoulder and degenerative labral tearing.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old, with right-sided back pain radiating down leg, positive straight leg test, history of herniated disc status post discectomy now with recurring pain on the right side. Innumerable foci of marrow replacement are identified involving every level of the spine as well as the visualized sacrum and iliac bones. At several levels, significant tumor extension is seen into the epidural and/or extraosseous spaces with details as follows:At T2, extraosseous or epidural tumor extension causes effacement of the left aspect of the spinal canal, completely excluding CSF, deforming and displacing the cord to the right. Tumor extends into the left T1-2 and T2-3 neural foramina.At T5, extraosseous or epidural tumor extension is seen on the left causing effacement of the left spinal canal, with deformity and rightward displacement of the spinal cord. The left C5-6 neural foramen is invaded.At T6, ventral epidural tumor extension is seen bilaterally with narrowing of the spinal canal and bilateral deformity of the spinal cord. The left T6-7 neural foramen is invaded as well.At L3, tumor within the right lateral and posterior epidural space causes significant effacement of the spinal canal, exclusion of CSF, deformity and displacement of the cauda equina towards the left. A smaller quantity of epidural tumor is also seen on the right at L1 and L2. The right L1-2, L2-3 and L3-4 neural foramina are all invaded by tumor.Numerous additional areas of epidural invasion are seen throughout the spine, though with less severe compromise of the spinal canal and neural foramina. At no point is there any definite evidence of spinal cord edema. No pathologic spinal cord or leptomeningeal enhancement is identified.Spinal alignment is grossly anatomic. Vertebral body heights are preserved. In the cervical spine, disc osteophyte formation is seen from C4-5 through C7-T1 but without significant spinal canal compromise. The neural foramina at these levels are mildly to moderately narrowed. In the lumbar spine, disc bulging and osteophytic ridging is seen at L4-5 and L5-S1, again without significant spinal canal compromise. Moderate bilateral foraminal narrowing seen at L5-S1.

Output: Diffuse osseous metastatic disease is seen involving every level of the spine and the visualized sacrum and iliac bones. At multiple levels, epidural tumor extension is seen causing severe spinal canal compromise and impingement or displacement of the spinal cord or cauda equina with details as above. At no level is there any definite evidence of cord edema.After initial attempts to contact by page, these findings were communicated to Drs. Campbell and Meza by email at 8:15 PM on 11/11/16.


Instruction: Generate impression based on medical findings.

Input: 68 year old woman with dyspnea, referred for evaluation of underlying ischemia.MEDICATIONS: Tricor, lovastatin, Toprol XL First Pass PerfusionDuring hyperemia, no perfusion defects were present.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 59%, the LV end diastolic volume index is 82 ml/m2 (normal range: 65+/-11), the LVEDV is 149 ml (normal range 109+/-23), the LV end systolic volume index is 33 ml/m2 (normal range 18+/-5), the LVESV is 61 ml (normal range 31+/-10), the LV mass index is 40 g/m2, and the LV mass is 73 g. There are no regional wall motion abnormalities present. The native myocardial T1 relaxation time is 1006ms, which is within the normal range.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 51%, the RV end diastolic volume index is 89 ml/m2 (normal range 69+/-14), the RVEDV is 164 ml (normal range 110+/-24), the RV end systolic volume index is 44 ml/m2 (normal range 22+/-8), and the RVESV is 80 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is trace mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is trace pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsA large hiatal hernia is noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 59%).4. Normal RV size and systolic function (RVEF 51%).5. See extra cardiac findings.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: Female, 81 years old, with non-Hodgkin's lymphoma. Surveillance scan. On comparison with the prior examination, continued interval regression is seen of the infiltrative pathologic enhancement and thickening involving the right orbital structures including the superior and lateral recti, the lacrimal gland, and the orbital fat. Minimal residual stranding persists, but there is no longer any definite or significant mass effect on the orbital structures.No additional pathologic enhancement is identified in the orbits or intracranially. Scattered punctate foci of T2 hyperintensity within the bilateral cerebral white matter have not significantly changed from prior and are nonspecific. No evidence of parenchymal edema or mass effect is seen. No intracranial hemorrhage or abnormal extra-axial fluid is seen. The ventricular system is stable and within normal limits for size.

Output: 1.Continued interval regression of an infiltrative lesion involving the structures of the right orbit. There is only minimal residual stranding in the orbit with no evidence of significant mass effect.2.No findings to suggest intracranial disease involvement.


Instruction: Generate impression based on medical findings.

Input: History of retroperitoneal fibrosis, evaluate for disease recurrence PELVIS:UTERUS, ADNEXA: Fibroid uterus, leiomyomas measure up to approximately 1.3 cm, endometrial complex normal in size.BLADDER: No significant abnormality noted.LYMPH NODES: Small subcentimeter bilateral external iliac lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Mild circumferential mildly enhancing soft tissue signal in region of distal abdominal aorta, beyond level of origin of inferior mesenteric artery and extending to level of common iliac bifurcation, associated restricted diffusion present (image 101 series 9). In distal abdominal aortic area, signal abnormality appears to encircle aorta approximately 180 degrees or less. This area described was not imaged in its entirety on prior 4/10/14 exam but demonstrates significant improvement since earlier 12/28/12 outside MRI, for example, portion of thickening previously measuring up to 6 mm now measures 3 mm.

Output: 1. Circumferential soft tissue signal in aortobiiliac area as described, corresponding to patient's history of retroperitoneal fibrosis.


Instruction: Generate impression based on medical findings.

Input: 67 years Male (DOB:7/26/1948)Reason: history of lumbar fracture compare to previous MRI History: low back painReferring Attending: JAVAD HEKMATPANAH Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment. The conus medullaris on sagittal imaging is grossly intact. There is a well formed disc at S1-S2.There is a compression fracture present at L5 with approximately 30% loss of vertebral body height. It is unchanged since prior examAt L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a diffuse disc bulge at this level as well as disc desiccation. There is moderate facet hypertrophy at this level. There is narrowing of the neural foramina bilaterally with mild encroachment of the exiting nerve roots within the neural foramina.At L4-5 there is a disc bulge at this associated with mild facet hypertrophy. The left neural foramen is mild encroachment of the left recess and partial effacement of fat at the left lateral recess. There is encroachment of the nerve roots of the left lateral recess at this level. There is narrowing of neural foramina bilaterally at this level. The exiting nerve roots are surrounded by fat within the 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. There is a Schmorl's node present at this level associated with endplate reactive changes which are bright on T1.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There is a well formed disc at S1-S2. We assume L5 to be the compressed vertebral body.2.There is a stable compression fracture 5 which has generally a benign appearance.3.There are degenerative changes present in the lumbar spine with encroachment of nerve roots at the left lateral recess at L4-5.


Instruction: Generate impression based on medical findings.

Input: 75 years Female (DOB:3/24/1941)Reason: Alzheimer's vs Frontotemporal Dementia History: cognitive changesPROVIDER/ATTENDING NAME: JAMES A MASTRIANNI JAMES A MASTRIANNI 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.There is a punctate focus of susceptibility effect in the right middle frontal gyrus subcortical white matter. This is not present on the prior exam from 2012. In isolation this is of unknown clinical significance.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Exam is mildly degraded due to patient motion.

Output: No intracranial mass lesions are appreciated. An isolated microhemorrhage in the right frontal lobe is of little clinical significance.


Instruction: Generate impression based on medical findings.

Input: Pain. Question of cuff tear. ROTATOR CUFF: The supraspinatus, infraspinatus, teres minor, and subscapularis muscles and tendons appear normal, other than minimal enthesopathic changes along the humerus at the supraspinatus/infraspinatus insertionSUPRASPINATUS OUTLET: Moderate osteoarthritis affects the acromioclavicular joint. No fluid is seen within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is mild osteoarthritis of the glenohumeral joint with loss of articular cartilage along the superolateral aspect of the humeral head. Also, signal abnormality is seen within the superior labrum extending into the anterior labrum which likely represents tearing. The inferior labrum appears intact. A small amount of fluid is noted in the glenohumeral joint but no frank effusion.BICEPS TENDON: The long head of the biceps tendon is intact.

Output: 1. No evidence of rotator cuff tear.2. Osteoarthritis of the acromioclavicular joint.3. Osteoarthritis of the glenohumeral joint with labral tearing as described above.


Instruction: Generate impression based on medical findings.

Input: Status post craniotomy for epidural abscess evacuation, view for residual epidural abscess or subdural abscess Metallic artifact from the patient's braces limits the anterior and inferior aspect of the diffusion-weighted and susceptibility weighted images.Status post frontal craniotomy. New rim-enhancing, diffusion restricting fluid collections along the right posterior falx and superolateral to the right frontal lobe are compatible with subdural abscesses. The largest collection adjacent to the posterior falx just anterior and superior to the torcula measures 1.7 cm in thickness (image 14, series 1301). The extra-axial collection overlying the right frontal lobe measures 1.1 cm in thickness (image 11, series 1401). These collections causes local mass effect on the adjacent brain parenchyma and increased T2/FLAIR signal within the right superior frontal and right occipital white matter, compatible with edema/cerebritis. There is no ventricular extension of these collections and the ventricles are normal in size.Minimal enhancement anterior to the right frontal lobe is likely postsurgical and no residual abscess is seen in this area. Enhancing material within the frontal sinuses likely represents granulation tissue.No intraparenchymal mass lesion is seen. No intraparenchymal areas of diffusion restriction are seen to suggest acute infarction. Major intracranial artery and dural venous sinus flow voids are present without evidence of thrombosis.

Output: New subdural abscesses along the right posterior falx cerebri and overlying the right frontal lobe.


Instruction: Generate impression based on medical findings.

Input: There is no acute infarct, mass effect, or cerebral edema. There are minimal foci of T2 hyperintensity in the cerebral white matter, which likely represent perivascular spaces. There is small area of encephalomalacia in the right superior frontal gyrus. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is mild bilateral maxillary sinus mucosal thickening. The orbits, skull, and extracranial soft tissues are otherwise unremarkable.

Output: No evidence of acute infarct.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Multiple sclerosis follow-up progression. Signs and symptoms: Facial numbness. Nonenhanced multiple sclerosis brain MRI:Examination demonstrates few scattered foci of FLAIR hyperintensity only in the subcortical and periventricular white matter of bilateral cerebral hemispheres which are nonspecific. Compared to prior exam there is suggestion of minimal interval increased number of lesions which are entirety in supratentorial brain parenchyma.Note however should be made that prior exam was performed utilizing routine brain MRI protocol with 5 mm slices and current exam with dedicated multiple sclerosis protocol with 2 mm slices which could account results in detection of more number of lesions.The cortical sulci and ventricular system as well as the CSF spaces are within normal for patient of stated age

Output: 1.Mild periventricular and subcortical foci of FLAIR hyperintensity only in the supratentorial brain parenchyma which are nonspecific and demonstrate minimal interval increased numbers since prior study from 2010 as detailed. Please see above comments.2.Unremarkable nonenhanced brain MRI otherwise.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old, nontraumatic intracranial hemorrhage and history of breast carcinoma. HCT done 10/27 showed an interval slight increase in ICH. MRI done the same day demonstrated 4.5x3x4.6 cm ICH with 5 mm left to right shift with no clear underlying mass. The previously demonstrated large intraparenchymal hemorrhage in the left occipital lobe has decreased in size since the prior examination and now measures up to 3.9 x 3.4 x 4.1 cm (TV by AP by CC). There has been interval evolution of the signal of the blood products with peripheral hemosiderin staining and central high T2 and T1 signal indicating late subacute blood. Mild peripheral enhancement is present, which can be seen with hematoma. No definite masslike enhancement is identified. Mild residual surrounding edema is seen, improved from prior. The atrium of the left lateral ventricle has reexpanded, and there has been interval resolution of previously demonstrated midline shift. Several punctate foci of susceptibility are seen in the tissues surrounding the hematoma but separate from the main collection. Elsewhere in the brain, however, no definite additional hemosiderin staining is demonstrated.There is no diffusion abnormality to suggest acute infarct. No new intracranial mass or mass effect. Numerous scattered foci of T2 hyperintensity are seen within the cerebral white matter, nonspecific and unchanged. The ventricles and sulci are within normal limits for age. No new abnormal extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. A small developmental venous anomaly is noted incidentally in the right cerebellum. The midline structures and craniocervical junction are within normal limits.MRA HEAD

Output: Interval evolution and improvement in size of the intraparenchymal hemorrhage in the left occipital lobe. Improved associated edema and mass effect. No definite underlying enhancing mass or vascular malformation is identified. 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: Male, 36 years old, history of grade 2 astrocytoma status post biopsy and third ventriculostomy. Surveillance scan. A T2 hyperintense, well-circumscribed mass is demonstrated involving the tegmentum of the midbrain, slightly asymmetric to the right. This lesion is predominantly nonenhancing with the exception of one or two very small vessels which seem to penetrate it. There has been no significant change in size or morphology with the lesion continuing to measure approximately 19 x 18 mm in the axial plane. Mass effect upon the cerebral aqueduct is unchanged.Again seen is a tract running through the right frontal lobe to the level of the right lateral ventricle likely related to prior instrumentation. No new intracranial lesions are seen. Ventricle size and morphology are unchanged and normal.

Output: Stable midbrain mass.


Instruction: Generate impression based on medical findings.

Input: Female 62 years old Reason: r/o obstruction History: conjugated hyperbilirubinemia ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. There are 2 cystic-appearing lesions involving the left hepatic lobe. The more lateral lesion has layering hemorrhage or debris within it and measures 3.9 x 3.1 cm. No definite solid hepatic lesions.There are few scattered other smaller lesions are too small to characterize.Hepatic and portal veins are patent. Gallbladder is distended with sludge and some debris. There is no intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small focal nonenhancing areas in the kidneys bilaterally which are wedge-shaped. Differential considerations include focal pyelonephritis vs. infarctions. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Scattered mesenteric ascites.BONES, SOFT TISSUES: Body wall anasarca.OTHER: Probable uterine fibroids.There is bibasal atelectasis and pleural effusions, right greater than left.INDEX LESION MEASUREMENTS (Current exam date/time: 2/12/2016 21:00:00)LEFT HEPATIC LOBE LESION: 3.9 x 3.1 cm (Image 85, Series 13).

Output: 1.No evidence of biliary ductal dilatation.2.Mild gallbladder distention with sludge.3.Lesion in the left hepatic lobe with layering debris or hemorrhage. Differential considerations include complex cyst, biliary cystadenoma, biliary hamartoma.4.Focal areas of nonenhancement in the kidneys differential considerations include focal pyelonephritis or infarctions. No hydronephrosis.


Instruction: Generate impression based on medical findings.

Input: 78-year-old male with HCC status post transarterial radioembolization. Please evaluate for interval change. ABDOMEN:LIVER, BILIARY TRACT: Multiple foci of the T2 hyperintense, T1 hypointense, nonenhancing lesions are seen throughout the right hepatic lobe, several of which are new in the interval particularly at the hepatic dome. Small foci of T1 hyperintensity along the periphery of hepatic segment 5 (series 1002 image 253) is unchanged and favored to represent small hemorrhage. No arterially enhancing lesions are identified. The portal vein is patent.SPLEEN: No significant abnormality noted.PANCREAS: No pancreatic ductal dilatation. No focal parenchymal lesion.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral simple renal cysts.RETROPERITONEUM, LYMPH NODES: Interval enlargement of portacaval lymph nodes measuring 5.6 x 3.7 cm (series 904 image 312) (prior 2.4 x 1.9 cm) and new enlarged retroperitoneal lymph nodes (series 904 images 48, 192, 240) are also noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Interval development of new T2 hyperintense lesions of the right hepatic lobe anteriorly at the dome without evidence of arterial enhancement, however enlargement of portacaval and new retroperitoneal lymph nodes are concerning for disease progression.


Instruction: Generate impression based on medical findings.

Input: Foot and ankle swelling There is diffuse subcutaneous edema of the foot particularly along the dorsal aspect of the metatarsals. Overlying the base of the third through fifth metatarsals is lobulated, ill-defined collection of fluid signal intensity. Following contrast administration, there is irregular peripheral enhancement of this collection. There are small areas of low signal intensity within the collection which could represent foci of gas. Additional small collections are noted between bases of the second and third metatarsals (ankle MRI series 10 image 33/42) as well as in the region of the sinus tarsi (ankle MRI series 10 image 28/42). There are erosions of the midfoot and tarsometatarsal articulation particularly involving the base of the first, third, and fourth metatarsals. Additionally, there is erosion of the head of the first metatarsal with a large associated soft tissue component. There are scattered areas of increased T2 marrow signal particularly in the bases of the metatarsalshowever there is no corresponding low signal on T1 to suggest osteomyelitis. There is no abnormal joint fluid within the foot.The visualized extensor tendons are intact. The visualized flexor tendons are intact. The peroneal tendons are intact. There is no subluxation or dislocation in the tarsometatarsal articulationsThere is normal alignment of the metatarsals.

Output: 1. Findings concerning for early abscess within the dorsal and lateral soft tissues of the foot. Additional small collections and phlegmonous changes are noted in the plantar soft tissues of the midfoot and near the sinus tarsi detailed above. There is no evidence of osteomyelitis.2. Changes of gouty arthropathy similar to the prior exam.


Instruction: Generate impression based on medical findings.

Input: Weakness [R53.1], Reason for Study: ^Reason: Eval stroke vs MS flare - please use MS protocol in addition to cuts History: L face/arm/leg weakness There is focal restricted diffusion on the right side posterior aspect of basal ganglia extends toward periventricular white matter and external capsule without evidence of hemorrhagic transformation indicating acute ischemic infarct.Underlying brain shows multifocal scattered periventricular and deep white matter FLAIR/T2 high signal intensity lesions on bilateral hemisphere as well as brain stem which is consistent with the patient's known demyelinating disease such as multiple sclerosis. Comparing to prior scan performed at outside hospital, there is no significant interval change of FLAIR/T2 high signal intensity lesions.There is no evidence of abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Acute ischemic infarct involving right posterior aspect of basal ganglia as described above without evidence of hemorrhagic transformation.2. Unchanged scattered multifocal bihemispheric, supra and infratentorial FLAIR/T2 high signal intensity lesions consistent with multiple sclerosis.