Instruction: Generate impression based on medical findings.

Input: 42 years Male (DOB:4/12/1974)Reason: history of L frontal brain tumor s/p resection and RT History: nonePROVIDER/ATTENDING NAME: STEVEN J. CHMURA STEVEN J. CHMURA The patient is status post left frontal craniotomy for left frontal lobe surgery. There is a small linear focus of enhancement present along the inferior medial aspect of the resection site which is stable compared to prior exam. There is also small focus of T1 signal hyperintensity adjacent to the frontal horn of left lateral ventricle. Perfusion imaging does not demonstrate any areas of increased microvascularity. The signal characteristics of the apparent fluid within the resection cavity are similar to spinal fluid.There is some leptomeningeal enhancement present in the left middle frontal gyrus which was also present on the prior exam and has not changed. This associated with some leptomeningeal FLAIR signal hyperintensity.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images predominantly located in the left hemisphere. This was also present on the prior exam.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.The patient is status post left frontal lobe surgery. The appearance of the resection site is stable compared to the prior exam. Small focus of enhancement at the surgical site remains stable. It is quite possible that it is related to postoperative effect.2.Leptomeningeal enhancement along the left middle frontal gyrus is stable compared to the prior exam. One possibility is that this represents collateralized venous flow.3.Left hemispheric periventricular white matter lesions present which are nonspecific but may be posttreatment related.


Instruction: Generate impression based on medical findings.

Input: Multiple sclerosis. Worsening gait. Evaluate for progression. Numerous juxtacortical and periventricular T2 hyperintense lesions are seen in both cerebral hemispheres becoming nearly confluent in the periatrial regions and along the temporal horns. Lesions are also evident within the pons, along the margins of the fourth ventricle, and in the cerebellum. There is questionable elevated T2 signal within the dorsal spinal cord at the C2 level, but this is equivocal and not adequately assessed on the present examination.The immediate prior examination was obtained with significantly different imaging technique which complicates precise comparison. However, given this caveat, no definite or significant interval changes are seen. When comparison is made to the older examination from 2013, most of the lesions show no significant interval change, but at least one lesion in the left centrum semiovale has become less conspicuous.No evidence of significant parenchymal edema or mass effect is seen. No abnormal extra-axial fluid collections are detected. The ventricular system remains within normal limits for size and morphology. Multiple nonspecific subcentimeter right parotid nodules are evident.

Output: A substantial burden of supratentorial and infratentorial white matter lesions is again demonstrated compatible with the history of multiple sclerosis. Although the immediate prior examination was obtained with different imaging technique which complicates precise comparison, no definite or significant interval changes are appreciated.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: Again demonstrated are posttreatment changes related to surgical resection of left occipital lobe mass with associated susceptibility effects related to blood products. There has been interval increase in heterogeneous contrast enhancement in the left occipital lobe with a more focal mass-like area involving the left paramedian occipital lobe with associated restricted diffusion, overall measuring 2.2 x 1.7 cm. Much of the surrounding enhancement is favored to represent radiation related changes as seen previously. Perfusion images demonstrates elevated cerebral blood volume within the medial aspect of the left occipital lobe. There is extensive T2 FLAIR hyperintensity surrounding the left occipital lesion extending into the left parietal lobe superiorly and the left posterior temporal lobe, mildly progressed since prior. There is slight interval enlargement of the lateral ventricles predominantly left occipital lobe. There is mild rightward midline shift.Additional new rounded, rim enhancing lesion with internal punctate heterogeneous enhancement measuring 1.4 x 1.3 cm is seen along the posterior aspect of the right medial orbital gyrus. There is mild surrounding T2 hyperintensity suggesting vasogenic edema. There is another enhancing lesion measuring 0.7 x 0.5 cm in the right post central gyrus with surrounding edema (image 38, series 15).

Output: 1.Extensive posttreatment changes in the left occipital lobe related to prior surgery and radiation. Compared to 3/2/2015, there is interval increase in more masslike area of enhancement in the left paramedian occipital lobe measuring approximately 2.2 x 1.7 cm with elevated CBV and suspicious for tumor recurrence. Much of the surrounding enhancement is likely reflective of radiation change as seen previously. Mild interval increase in surrounding edema.2. Two new enhancing lesions involving the right inferior frontal lobe and the right parietal lobe (post central gyrus) consistent with progression of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Renal mass seen on CT. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology and size without a focal lesion. Normally distended gallbladder. No biliary ductal dilatation. Mild steatosis.SPLEEN: The spleen is normal in size and morphology. Note is made of a 1.8 cm splenule adjacent to the inferior margin of the spleen.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: 2.7 x 2.0 cm lesion along the dorsomedial aspect of the right renal interpolar region demonstrates T2 weighted isointensity to the renal cortex (series 4/21) and intrinsic T1 weighted hyperintensity (series 12/57). It has intrinsic T1 weighted hyperintensity. The subtraction images appear well aligned and show that there is no definite post-contrast enhancement of the lesion. The wall of the lesion is relatively smooth without distinct mural nodularity.Additional subcentimeter renal cysts are noted.No hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: Infrarenal abdominal aortic aneurysm measuring 3.1 cm in AP dimension with extensive asymmetric atherosclerotic plaque.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.The right renal lesion is intrinsically T1 hyperintense without evidence of enhancement on subtraction imaging, compatible with a hemorrhagic or proteinaceous cyst without suspicious nodularity.2.Infrarenal abdominal aortic aneurysm measuring 3.1 cm in AP dimension.


Instruction: Generate impression based on medical findings.

Input: 77 years, Male, Reason: hx of large pseudocyst. CT 1/21/15 with disruption of PD where AXIOS stent placed. Please eval History: na. ABDOMEN:LUNG BASES: Right basilar opacity is unchanged.LIVER, BILIARY TRACT: Left hepatic subcentimeter cyst. Status post cholecystectomy.Common bile duct is mildly dilated to 8 mm with smooth tapering at its distal aspect. There is mild intrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: There is a peripancreatic collection measuring 1.7 x 1.1 cm which is decreased from 2.6 x 1.3 cm previously. AXIOS stent entering the pancreatic collection produces local artifact in this region of the pancreas. The pancreatic duct within the distal tail appears to communicate with the peripancreatic lesion (16/5 and 2001/48), indicating disruption of the duct. There is a long segment, subjacent to the stent, in which the pancreatic duct is not well visualized. The pancreatic duct within the head and neck appears normal.Diffusion restriction within the pancreatic tail suggests inflammation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple subcentimeter T2 hyperintensities likely represent cysts.RETROPERITONEUM, LYMPH NODES: IVC filter. Mild amount of mural thrombus in the aorta.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Peripancreatic fluid collection is decreased in size from the prior exam. The main pancreatic duct within the tail appears to communicate with this collection, indicating disruption. The pancreatic duct within the body subjacent to the stent is not well visualized, either due to artifact or disruption.2.Diffusion restriction within the tail of the pancreas suggests inflammation and is likely related to recent episode of pancreatitis.3.Right lower lobe pulmonary opacity may represent consolidation, however neoplasm is also considered, particularly given its persistence. Recommend either short term follow-up or PET-CT.


Instruction: Generate impression based on medical findings.

Input: 5 day old male with history of perinatal acidosis undergoing cooling protocol. Evaluate for HIE and extent of ischemic injury. Born at 40 1/7 weeks, C-section, low APGARs, suspect infection. There are no areas of restricted diffusion to suggest acute ischemic infarct. There is no evidence of acute intracranial hemorrhage. Myelination is age-appropriate. The ventricles and sulci are symmetric. Flow-voids are appreciated within the major intracranial vessels. The imaged paranasal sinuses, mastoid air cells, and orbits are within normal limits.

Output: Normal brain MRI without evidence of HIE or ischemia.


Instruction: Generate impression based on medical findings.

Input: Right leg tingling Conventional anatomy with 5 lumbar type vertebral bodies are presumed, with the most inferior well-defined disc space labeled L5-S1. Vertebral body heights are within normal limits. There is grade 1 anterolisthesis of L4 and L5 as well as minimal retrolisthesis of L5 on S1. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: Minimal disc bulge, ligamentum flavum thickening, and facet arthropathy. No spinal canal or neural foraminal stenosis.L2-L3: Minimal disc bulge, ligamentum flavum thickening, and facet arthropathy. No spinal canal or neural foraminal stenosis.L3-L4: Disc bulge eccentric to the left. There is moderate bilateral facet arthropathy. There is partial effacement of the left lateral recess as well as mild central canal narrowing. Neural foramina are patent.L4-L5: Grade 1 anterolisthesis and mild disc bulge with advanced bilateral facet arthropathy and ligamentum flavum thickening. There is moderate spinal canal stenosis including partial effacement of the bilateral lateral recesses. There is mild narrowing of the neural foramina, right worse than left. L5-S1: Minimal retrolisthesis and disc bulge. There is no significant spinal canal stenosis. Bilateral facet arthropathy. There is mild narrowing of the neural foramina, left relatively greater than right.Paraspinous soft tissues are within normal limits.

Output: 1. Multilevel degenerative changes in the lumbar spine, worst at the L4-L5 level, where there is moderate moderate spinal canal stenosis and evidence of degenerative grade 1 anterolisthesis. There is mild neural foraminal stenosis at this level, right relatively greater than left.2. Multilevel facet arthropathy, worst at L4-L5 and L3-L4 and to a lesser degree at additional levels.


Instruction: Generate impression based on medical findings.

Input: Cognitive deficits, hypertension, and diabetes. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is susceptibility effect and high T2 signal in the bilateral globi pallidi. There is minimal diffuse cerebral volume loss. There is minimal nonspecific periventricular T2 hyperintensity. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and paranasal sinuses are grossly unremarkable. There is a 12 mm thick right occipital scalp lipoma.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. minimal nonspecific periventricular T2 hyperintensity, which may be related to chronic small vessel ischemia.3. Nonspecific mineralization of the globi pallidi.4. Minimal diffuse cerebral volume loss.


Instruction: Generate impression based on medical findings.

Input: 53-year-old male, evaluate for acute ischemia, history of complex partial seizure with left weakness and neglect. There has been marked progression of encephalomalacia and gliosis centered in the right inferior parietal lobule extending into the superior parietal lobule and posterior superior temporal lobe as well as involving the right centrum semiovale and right corona radiata corresponding to the regions of previously identified infarction. Associated susceptibility artifact likely represents chronic blood product. There is mild ex vacuo dilatation of the posterior horn of the right lateral ventricle. Note is made of T2 signal abnormality compatible with Wallerian degeneration in the right brain stem. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic changes. Major flow-voids are preservedSella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. No evidence of acute infarction, acute hemorrhage or mass effect.2. Encephalomalacia and gliosis with chronic blood product is centered in the right inferior parietal lobule extending into adjacent superior temporal gyrus and superior parietal lobule. The territory involved has progressed significantly since the prior MRI at the time of acute cerebral ischemia in this territory. There is associated wallerian degeneration.


Instruction: Generate impression based on medical findings.

Input: Reason: Please evaluate large intramuscular plexiform neurofibroma in left thigh; is it attached to a major nerve? History: young woman with NF1 who has developed a rapidly growing mass in left thigh Within the semitendinosus muscle of the left thigh, is a lobulated mass which demonstrates homogeneously low T1 signal and heterogeneously high T2 signal with intermediate T2 signal internally, consistent with an atypical peripheral nerve sheath tumor. The mass measures approximately 3.6 x 2.3 x 4.7 cm (transverse by AP by CC) and demonstrates heterogeneous enhancement. The lesion does not appear to originate from the major neurovascular bundle in the posterior thigh.A second presumed peripheral nerve sheath tumor is present adjacent to the right gluteal muscles, seen only on the AP coronal view, but is incompletely evaluated.

Output: Peripheral nerve sheath tumor within the left semitendinosus muscle, which does not appear to originate from the major neurovascular bundle in the posterior thigh. However, atypical appearance on T2 and post gadolinium imaging raises concern for the possibility of a malignant nerve sheath tumor, and clinical correlation is advised.


Instruction: Generate impression based on medical findings.

Input: 65 years Male (DOB: 10/3/1950)Reason: evaluate for causes of right paresthesia and weakness History: right paresthesia and weaknessPROVIDER NAME: PELEG M HOROWITZ EDWIN RAMOS MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion. The right vertebral artery is larger than on the left vertebral artery.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is a small disc bulge associated with uncovertebral osteophytes bilaterally at this level and some mild narrowing of the neural foramina. There is partial effacement of spinal fluid ventral and posterior the spinal cord at this level. There is narrowing of the neural foramina bilaterally with some mild encroachment of the exiting nerve roots bilaterally. This encroachment appears to be worse on the right when compared to the left side at this level. Overall there is a mild to moderate degree of spinal stenosis at this level.At C5-6 there is loss of disc space height, disc desiccation, disc bulge and endplate and uncovertebral osteophytes associated with effacement of spinal fluid ventral and posterior the spinal cord and mild to moderate degree of spinal stenosis. There is narrowing of the neural foramina bilaterally due to uncovertebral osteophytes at this level associated with encroachment of the left-sided exiting nerve roots.At C6-7 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge present at this level associated with the small uncovertebral osteophytes and mild narrowing of the neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. No abnormal lesions are identified in the thoracic spine.

Output: 1.There are degenerative changes present in the cervical spine worse at C4-5 and C5-6 where there is encroachment of right-sided exiting nerve roots at C4-5 and left-sided exiting nerve roots at C5-6 and mild to moderate spinal stenosis at these levels.2.There is no compromise to the thoracic spinal canal.3.No spinal cord lesions are identified.4.There is no evidence for intracranial cerebrovascular occlusive disease.


Instruction: Generate impression based on medical findings.

Input: 7-year-old with breast cancer and confusion with hallucinations rule out brain metastases Noncontrast CT scan brain demonstrates no evidence of hemorrhage, mass or edema.There is evidence of periventricular hypodensities which given the patient's age most likely represent small vessel ischemic disease.Please note the lack of intravenous contrast limits the sensitivity in evaluating for metastatic disease. If this is of clinical concern repeat study with contrast or preferably MRI with contrast is recommended as a more sensitive means of islet for metastatic disease.

Output: No evidence of acute intracranial process sensitivity for metastatic disease is limited by the lack of intravenous contrast material


Instruction: Generate impression based on medical findings.

Input: 2-year-old male with history of syncope and falls. Please amount of The density and morphology brain parenchyma remains within normal limits. No evidence of hemorrhage, edema, mass effect, midline shift or hydrocephalus.Prominence of lateral ventricles (left greater than right) is noted. Further evaluation with an MRI examination is recommended to evaluate the cause of this discrepancy in the size of lateral ventricles which CT may not be able to determine.Calvarial, mastoid air cells and limited view of paranasal sinuses are unremarkable.

Output: 1.No evidence of acute intracranial process.2.Expansion of left lateral ventricle although may be anatomical variation it is concerning for underlying parenchymal volume loss of left hemisphere and should be further evaluated with an MRI examination.


Instruction: Generate impression based on medical findings.

Input: 49 year old female with a personal history of right simple skin sparing mastectomy with immediate implant based reconstruction in 10/2012 for IDC/DCIS and a benign right axillary lymph node biopsy in 2015. RIGHT RECONSTRUCTED BREAST:Status post skin sparing mastectomy with implant based reconstruction. The retropectoral silicone implant appears unchanged in contour and appearance. No abnormal enhancement is seen.LEFT BREAST:There is scattered fibroglandular tissue in the left breast.Minimal parenchymal enhancement is noted in the left breast.No abnormal enhancement is seen in left breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old, with low back pain, worsening over the past 9-10 months. Alignment is anatomic. Vertebral body heights are preserved. Marrow signal characteristics are mildly heterogeneous but no concerning marrow replacement or marrow edema is seen.The visualized distal spinal cord and conus are unremarkable. The spinal canal is congenitally slender. The discs show loss of height. Additional level specific findings are as follows:Low thoracic spine: Mild disc bulging, only assessed on sagittal images.L1-2: Mild facet arthropathy. Mild bulging disc. Prominence of the epidural fat. Mild spinal canal narrowing. No significant foraminal narrowing. L2-3: Facet arthropathy and ligamentum flavum thickening. Mild bulging disc. Prominence of the dorsal epidural fat. Mild to moderate generalized spinal canal narrowing with borderline crowding of the cauda equina. No significant foraminal narrowing. L3-4: Facet arthropathy and ligamentum flavum thickening. Bulging disc. Prominence of the dorsal epidural fat. Moderate generalized spinal canal narrowing with exclusion of CSF and crowding of the cauda equina. Mild bilateral foraminal narrowing. L4-5: Facet arthropathy and ligamentum flavum thickening. Bulging disc. Prominence of the dorsal epidural fat. Mild to moderate generalized spinal canal stenosis with some crowding of the cauda equina. Moderate right and mild left foraminal narrowing. L5-S1: Facet arthropathy and ligamentum flavum thickening. Bulging disc. No significant spinal canal stenosis. Severe right and moderate to severe left foraminal narrowing.

Output: Spinal canal narrowing is seen at L3-4, L4-5, and to a lesser degree at L2-3, due to a combination of disc degeneration, posterior element hypertrophy, prominence of the dorsal epidural fat and a congenitally slender spinal canal. Significant foraminal narrowing is also evident bilaterally at L5-S1.


Instruction: Generate impression based on medical findings.

Input: Please evaluate for signs of remote hemorrhage or contusion: neonatal seizures. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a linear flow void that traverses the left posterior cingulate region. The brain parenchyma otherwise appears unremarkable, without evidence of heterotopia or hamartomas. There is an expected degree of myelination. There is a subcentimeter left choroid fissure cyst. The ventricles and basal cisterns are otherwise normal in size and configuration and the extra-axial cerebrospinal fluid spaces are not enlarged. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Probable developmental venous anomaly in the left posterior cingulate region. Otherwise, no evidence of potential seizure foci.


Instruction: Generate impression based on medical findings.

Input: 41 year old female patient with recurrent PSC after LDLT, screen for cholangiocarcinoma. Fevers, chills, tenderness to palpation in the right upper quadrant, and epigastrium; also concern for cholangitis. ABDOMEN:LIVER, BILIARY TRACT: There are post-surgical changes of a liver transplant with hepaticojejunostomy. There is a continued mottled appearance of the liver with nodular areas of T1 hyperintensity which demonstrate variable degrees of enhancement without washout on more delaying images. There is no associated restricted diffusion or delayed enhancement. No definite suspicious hepatic mass is identified. The caudate lobe has hypertrophied and compresses the adjacent IVC. There is scattered intrahepatic biliary ductal dilatation, appearing similar to the prior study.The posterior branch of the right portal vein no longer opacifies with contrast and is likely occluded. Furthermore, the peripheral right hepatic vein is filling with contrast, however, centrally there is attenuation of signal which may represent a partial or complete occlusion. The anterior branch of the right portal vein and main portal vein appear patent. The hepatic artery/anastomosis appears patent.There is mild intrahepatic biliary ductal dilatation. No dominant obstructing lesion.SPLEEN: The spleen is enlarged measuring up to 19 cm in length. The splenic vein is prominent in size and patent. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No evidence of hydronephrosis. There is a 8 mm lesion within the right upper pole with T2 hyperintensity and the appearance of enhancing septa. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is marked wall thickening of the ascending and proximal transverse colon with surrounding edema within the abdomen.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small to moderate right pleural effusion. The azygous vein has increased in size compared to the prior study.

Output: 1. Mottled appearance of the liver with caudate lobe hypertrophy and central attenuation of signal of the hepatic venous vasculature is concerning for partial or complete central right hepatic venous obstruction. Furthermore, increase in size of the azygous vein also suggests some degree of central venous stenosis.2. Interval occlusion of the posterior branch of the right portal vein. 3. Right colonic wall thickening and surrounding inflammatory changes compatible with a colitis, possibly from an infectious or inflammatory etiology.4. 8 mm right upper pole complex cyst can be followed on subsequent imaging. 5. Scattered intrahepatic mild biliary ductal dilatation without focal dominant obstructing lesion.Findings communicated to K. Davey via telephone at 1159 hrs on 8/5/2016.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for superior labral tear History: worker comp injury. Prior mri in pacs. Has continued pain. ROTATOR CUFF: The supraspinatus and infraspinatus muscles and tendons appear intact. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: There is a small amount of fluid within the subacromial subdeltoid bursa which could reflect a mild bursitis. The acromioclavicular joint appears normal.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is intermediate signal intensity directed superomedially along the base of the anterior superior labrum likely representing a normal variant sublabral recess. We see no gadolinium entering the substance of the labrum to indicate a tear.BICEPS TENDON: The tendon of the long head of the biceps appears intact. ADDITIONAL

Output: 1. There is a small amount of fluid within the subacromial bursa which may reflect a mild bursitis.2. Small focus of edema within the greater tuberosity is nonspecific.


Instruction: Generate impression based on medical findings.

Input: VP shunt, evaluate ventricles: yearly follow up. Paralytic strabismus, sixth or abducens nerve palsy. There is no appreciable change in the size of mildly dilated supratentorial ventricular system with a right transparietal ventricular catheter in position, which projects into the right anterior corpus callosum. There is partial absence of the septum pellucidum. There is also persistent dilatation of the fourth ventricle with a catheter in position that indents the posterior aspect of the right pons. There is unchanged T2 hyperintensity along the catheter tracts, periventricular white matter, and right cerebellar hemisphere. There is no evidence of intracranial hemorrhage, mass, or acute infarct, although reservoir artifact obscures the right posterior brain. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. No appreciable change in the size of mildly dilated supratentorial ventricular system with a right transparietal ventricular catheter in position.2. Persistent dilatation of the fourth ventricle with a catheter in position that indents the posterior aspect of the right pons. 3. Areas of gliosis and/or encephalomalacia along the catheter tracts, periventricular white matter, and right cerebellar hemisphere.4. No evidence of acute intracranial hemorrhage, mass, or acute infarct, although reservoir artifact obscures the right posterior brain.


Instruction: Generate impression based on medical findings.

Input: History of multiple sclerosis; presenting with paresthesias. Again seen are numerous T2 hyperintense supratentorial and infratentorial lesions. There are areas which appear confluent, with perpendicular orientation with respect to the lateral ventricles. There is a new T2 hyperintense lesion in the left corona radiata, which partially enhances. The previously seen area of enhancement in the left subinsular cortex has resolved. The remainder of the lesions are stable, including brainstem involvement, and possibly along the left brachium pontis. There is no evidence of intracranial hemorrhage or acute infarction. The pituitary gland is unremarkable. The ventricles and basal cisterns are unchanged. There is no midline shift or herniation. The major cerebral flow voids are intact. Cosmetic fillers again noted in the bilateral nasolabial folds.

Output: Multiple supratentorial and infratentorial demyelinating lesions consistent with history of multiple sclerosis, including a new T2 hyperintense lesion which partially enhances in the left corona radiata, compatible with an acute/active lesion. Previous enhancement associated with a left subinsular region lesion has resolved. There is mild to moderate T1 burden and moderate to severe T2 burden of disease.


Instruction: Generate impression based on medical findings.

Input: Redemonstrated is a small area of susceptibility, blooming artifact, heterogeneous T1 signal and hypointense T2 signal just inferior to the optic chiasm within the left hypothalamus. It is unchanged in size and morphology with mild localized mass effect upon the inferior third ventricle and splaying of the upper aspect of the infundibulum. No other foci of susceptibility are appreciated.The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or significant mass effect. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures, including the pituitary gland, and craniocervical junction are within normal limits.

Output: Unchanged likely small cavernoma within the left hypothalamus with mild localized mass effect upon the inferior third ventricle and splaying of the upper aspect of infundibulum. No other foci of susceptibility identified.


Instruction: Generate impression based on medical findings.

Input: 58-year-old female presents with hand numbness and pain, evaluate for stroke. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are scattered punctate foci of abnormal T2 hyperintensity within the periventricular and subcortical white matter. There are also apparent scattered areas of cerebral sulcal FLAIR hyperintensity bilaterally. The pituitary gland appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is degenerative spondylosis in the imaged upper cervical spine.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. Nonspecific scattered punctate periventricular and subcortical white matter lesions may represent mild chronic small vessel ischemic changes. 3. Apparent scattered areas of sulcal FLAIR hyperintensity may represent artifact or less likely meningitis, given the lack of corresponding clinical findings.The above findings were discussed via telephone with Dr. Mastrianni at 11:15 AM on 1/06/2016.


Instruction: Generate impression based on medical findings.

Input: 28-year-old female with BRCA mutation and family history of breast cancer. History of benign MR guided biopsy of left breast. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.An enhancing focus, which is a proven benign lesion, is again seen at 2 o'clock position in the left breast. It is significantly smaller measuring 3 mm in maximum diameter, compared to the previous measurement of 7 mm. A marker clip is identified immediately medial to the focus.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on medical findings.

Input: Following a discussion of the procedure with the patient and/or family, including its risks, benefits, alternatives and steps to prevent infection, informed written consent was obtained and documented in the patient's chart. The time-out form was completed to confirm patient identity and side/type of procedure. All operators present for the case performed standard preprocedural prep including hand washing, sterile gloves, mask and cap. The patient was prepped and draped in the usual aseptic fashion. Local anesthesia over the target area was obtained by 1% lidocaine. Midazolam and fentanyl were administered IV by the nurses during continuous hemodynamic monitoring. Targeted CT examination demonstrates a 3 cm soft tissue pelvic mass along the anterior aspect of the left ilium which may reside within the left iliacus muscle, corresponding to the findings on recent MRI and PET/CT examinations. Using CT guidance, a 14-gauge Achieve core biopsy needle was advanced into the lesion. 3 14-gauge core needle biopsy specimens were obtained and placed in formalin. Touch preparations were performed and handed to cytopathology to confirm specimen adequacy. 2 biopsy specimens sunk, 1 biopsy specimen floated.The core biopsy specimens were hand carried to the Surgical Pathology lab.The patient tolerated the procedure well without immediate complication. Routine post procedure instructions were communicated to the patient.ESTIMATED BLOOD LOSS: Less than 5cc. An adhesive bandage was placed on the patient’s skin.

Output: CT guided biopsy of left pelvic/iliacus muscle lesion.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old, history of lung adenocarcinoma with decreased appetite and dysphagia, assess for metastases. No evidence of parenchymal edema or mass effect is seen. Moderately extensive scattered foci of FLAIR hyperintensity are demonstrated in the subcortical and periventricular tissues. On postcontrast images, no pathologic parenchymal or leptomeningeal enhancement is seen. Faint gyriform susceptibility effect is noted scattered along the cerebral hemispheres, particularly the bilateral parietal and occipital lobes. No acute intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricles are normal in size.The pituitary gland is enlarged and somewhat heterogeneously enhancing measuring up to 11 mm in craniocaudal dimension. Bone marrow signal characteristics are within normal limits.

Output: 1.No definite evidence of intracranial metastases or any other specific findings which would account for the patient's symptoms. Scattered small lesions likely reflect chronic microvascular ischemia. Faint susceptibility effect is of uncertain etiology and may represent the sequelae of a prior hemorrhagic event.2.The pituitary gland is enlarged for age and somewhat heterogeneously enhancing. Metastases to the pituitary gland are quite rare and as such this is favored to represent an unrelated and incidental pituitary lesion such as an adenoma or a cyst. Dedicated pituitary imaging can be considered for further evaluation as clinically warranted.


Instruction: Generate impression based on medical findings.

Input: metastatic breast cancer to brain, post SRS follow up. Again there is a focal enhancing nodular lesion on the left frontal lobe middle frontal gyrus likely located on the subcortical gyrus subcortical white matter. Comparing to prior scan, the size of the enhancement appears to be slightly smaller (3.5mm to 3mm).The right pre central gyrus around the paracentral lobule lesion (about 2mm) does not show any interval change since prior exam.There is no associated perilesional edema. There is no other enhancing lesion on this scan.There is no evidence of acute ischemic or hemorrhagic lesion on this scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No change of right pre-central gyrus close to paracentral lobule lesion since prior exam.Slightly decreased in size of the left frontal middle frontal gyrus lesion since prior exam.


Instruction: Generate impression based on medical findings.

Input: Unspecified disturbances of skin sensation [R20.9], Reason for Study: ^Reason: evaluate for stroke History: R face, arm, leg Brain MRIThere is focal restricted diffusion on the left thalamus without evidence of susceptibility artifact indicating acute/subacute ischemic stroke without hemorrhagic conversion.Underlying brain shows scattered high signal intensity on T2/FLAIR images indicating nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate about 4 x 3 mm sized right MCA distal M1 segment aneurysm.There is also about 2.8mm x 3.8mm sized left pcom arterial bulge which appears to be connected with a small patent left pcom artery. This lesion could represent infundibulum. However, the size and configuration are suggesting possibility of associated pcom aneurysm.Bilateral P-comm arteries are patent.Luminal irregularities without significant luminal stenosis are seen on intracranial arterial system indicating atherosclerotic changes.There is no other intracranial arterial aneurysm.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate about 5 mm sized aneurysmal bulge on the right ICA distal aspect of petrous segment.Left vertebral artery ostium arises very proximal to the left subclavian artery thus difficult to evaluate on this imaging due to artifact.Otherwise bilateral common carotid arteries, bilateral carotid bifurcation as well as right vertebral artery appears to be unremarkable.

Output: 1. Acute/subacute ischemic infarction on the left thalamus without evidence of hemorrhagic conversion.2. Right MCA distal M1 aneurysm and left Pcom possible aneurysm as described above. 3. Right distal petrous segment ICA aneurysm.


Instruction: Generate impression based on medical findings.

Input: Reason: concern for meniscal tear, please evaluate History: see above MENISCI: There is a horizontal tear through the body and posterior horn of the medial meniscus. There is a small parameniscal cyst along the medial aspect of the body of the medial meniscus. The lateral meniscus is normal in appearance.ARTICULAR CARTILAGE AND BONE: There is thinning of the articular cartilage along the medial facet of the patella. There is no bone marrow edema. LIGAMENTS: There is mild increased signal within the MCL, consistent with a sprain. There is a full thickness tear of the ACL, with no fibers completing their attachment upon the femur. The PCL and LCL complex appear intact. EXTENSOR MECHANISM: The quadriceps and patellar tendons appear intact.ADDITIONAL

Output: 1. Complete ACL tear and findings consistent with MCL sprain.2. Horizontal tear through the body and posterior horn of the medial meniscus.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old, with right occipital hemorrhage, evaluate for source of bleeding. Image quality is degraded by motion artifact. Within this limitation, the following observations are made. A rim-enhancing mass is present in the right occipital lobe measuring 4 x 3 x 2.5 cm. Hemorrhage is evident adjacent to and within the tumor. Moderate edema is seen in the surrounding parenchyma and there is regional mass effect in the form of right lateral ventricular effacement and sulcal effacement. No definite brain herniation is observed. No definite additional enhancing lesions are seen. The ventricular system is otherwise unremarkable.

Output: A hemorrhagic rim-enhancing mass is present in the right occipital lobe. Given the history of cancer, a metastatic lesion is favored. However, a primary brain tumor could present with similar features.


Instruction: Generate impression based on medical findings.

Input: There is mild motion artifact degrading image quality. There is no suspicious intracranial enhancement, acute infarct, mass effect, or cerebral edema. There is minimal nonspecific T2 signal abnormality at in the periventricular white matter, likely vascular related. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is trace bilateral maxillary, and scattered ethmoid mucosal thickening. The skull and extracranial soft tissues are unremarkable.

Output: No intracranial mass or mass effect.


Instruction: Generate impression based on medical findings.

Input: Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: Evaluate for ischemia and vessel wall History: L BG infarct on prior MRI, RUE distal weakness There are eccentric intracranial arterial wall thickenings including right distal cervical ICA and petrous ICA junction, right distal ICA, right MCA, left ICA cavernous sinus segment, left MCA proximal M2 segment indicating atherosclerotic changes.These lesions show relatively homogenous enhancement of wall thickening except left ICA cavernous sinus segment lesion. The lesion shows enhancement of intimal and adventitia side but not core of the wall thickening. Thus, this lesion can be regarded as a vulnerable plaque.The leftThe left basal ganglia ischemic lesion shows enhancement indicating luxury perfusion status.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, midline shift, intra or extra-axial fluid collection/hemorrhage. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Multifocal intracranial arterial eccentric wall thickening involving left ICA cavernous sinus segment, left MCA proximal M2 segment, right distal ICA, right MCA indicating possibility of atherosclerotic changes. 2. Differential diagnosis include vasculitis, vasospasm, or focal dissection with underlying atherosclerosis.


Instruction: Generate impression based on medical findings.

Input: 27-year-old female with lateral left ankle pain. Evaluate for peroneal tendinitis. TENDONS: There is focal signal abnormality within the subcutaneous fat superficial to the peroneus longus tendon as it courses along the body of the calcaneus. This finding is nonspecific but suggestive of mild inflammation. The peroneal tendons themselves appear normal and we see no tenosynovitis. The Achilles tendon, extensor tendons, and remaining flexor tendons are unremarkable.LIGAMENTS: The lateral collateral ligament complex and distal tibiofibular syndesmotic complex are within normal limits. The visualized components of the deltoid ligament appear intact.ARTICULAR SURFACES AND BONE: The bone marrow signal and articular cartilage are within normal limits. No osteochondral defect is identified.ADDITIONAL

Output: Mild nonspecific inflammation of the subcutaneous fat superficial to the peroneus longus tendon as it courses along the body of the calcaneus. The tendons themselves appear normal.


Instruction: Generate impression based on medical findings.

Input: 42-year-old man with right shoulder pain, weakness in abduction and external rotation. ROTATOR CUFF: There is a full thickness tear of the supraspinatus. There is no retraction of the muscle belly. The infraspinatus, teres minor and subscapularis appear normal. SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Full-thickness tear of the supraspinatus.


Instruction: Generate impression based on medical findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.he patient was placed supine on the fluoroscopy table. The left hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 11 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 23 seconds

Output: Successful gadolinium injection of the left hip.


Instruction: Generate impression based on medical findings.

Input: 67-year-old female with endometrial cancer. Compared to last MRI and measure vaginal cuff mass, left inguinal lymph node, and right common iliac node. Status post immunotherapy 4 cycles. PELVIS:UTERUS, ADNEXA: The known vaginal cuff mass has slightly decreased in size with reference measurements listed below. Extension through the parametrial fat is again noted. The mass is associated with satellite nodules and peritoneal extension, and there are persistent areas of the peritoneal implants compatible with carcinomatosis. Large volume ascites is again partially visualized. Tumor is present along the peritoneal reflection of the bladder. The posterior aspect of the tumor abuts the rectosigmoid colon. Enhancing tumor is again identified along the anterior surgical scar.BLADDER: As above.LYMPH NODES: Decreased size of the right common iliac lymph node. Stable size of the left inguinal lymph node. Reference measurements listed below.BOWEL, MESENTERY: As above.BONES, SOFT TISSUES: Mild anasarca.OTHER: No significant abnormality noted.INDEX LESION MEASUREMENTS (Current exam date/time: 11/2/2016 14:15:00)LEFT INGUINAL LYMPH NODE: 0.9 x 0.4 cm (Image 30, Series 401); 0.9 x 0.5 cm on prior (8/10/2016) (Image 23, Series 1301).RIGHT COMMON ILIAC LYMPH NODE: 0.7 x 0.7 cm (Image 55, Series 401); 1.2 x 1.0 cm on prior (8/10/2016) (Image 48, Series 1301).VAGINAL CUFF MASS: 6.4 x 3.8 cm (Image 43, Series 401); 7.9 x 4.6 cm on prior (8/10/2016) (Image 38, Series 1301).

Output: 1.The known infiltrative soft tissue mass at the vaginal cuff with extension into the parametrial soft tissue, along the peritoneum, and abutment above the bladder and rectum and sigmoid colon has decreased in size. Reference measurements listed above.2.Decreased size of the right common iliac lymph node and stable size of the subcentimeter left inguinal lymph node. Reference measurements listed above.


Instruction: Generate impression based on medical findings.

Input: 52-year-old female with history of schwannoma status post resection in 2014. PELVIS:UTERUS, ADNEXA: Status post hysterectomy and bilateral salpingo-oophorectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is a wide mouth ventral hernia in the lower abdomen containing small bowel without evidence of complication.OTHER: No evidence of tumor recurrence.

Output: 1. No evidence of tumor recurrence.2. New lower abdominal ventral wall hernia containing small bowel without evidence of complication.


Instruction: Generate impression based on medical findings.

Input: 61-year-old female patient with history of BCRA mutation. Evaluate for pancreatic mass. ABDOMEN:LIVER, BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation. No suspicious hepatic lesions.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic divisum noted. No suspicious pancreatic lesions seen. No pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter T2 hyperintense, nonenhancing lesions in the left kidney are too small to characterize and likely represent cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No suspicious pancreatic lesions or secondary signs of the lesion.2.Pancreatic divisum.


Instruction: Generate impression based on medical findings.

Input: S/P OHT - evaluate for constriction Left VentricleThe left ventricle is normal. The overall LV ejection fraction is 62%, the LV end diastolic volume index is 76 ml/m2 (normal range: 74+/-15), the LVEDV is 144 ml (normal range 142+/-34), the LV end systolic volume index is 28 ml/m2 (normal range 25+/-9), the LVESV is 54 ml (normal range 47+/-19). No regional wall motion abnormalities. Mild concentric LVH.Left AtriumThe left atrium is c/w post transplant. Right VentricleThe right ventricle is normal. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 74 ml/m2 (normal range 82+/-16), the RVEDV is 140 ml (normal range 142+/-31), the RV end systolic volume index is 34 ml/m2 (normal range 31+/-9), and the RVESV is 65 ml (normal range 54+/-17).Right AtriumThe right atrium is c/w post transplant.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation, but the severity of aortic regurgitation can be underestimated by the MRI pulse sequence used in this study.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation, but the severity of mitral regurgitation can be underestimated by the MRI pulse sequence used in this study.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation, but the severity of pulmonic regurgitation can be underestimated by the MRI pulse sequence used in this study.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation, but the severity of tricuspid regurgitation can be underestimated by the MRI pulse sequence used in this study.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size (25 mm).Venous AnatomyThe SVC and IVC drain normally into the right atrium. IVC is dilated (3 cm).PericardiumThere is no obvious pericardial effusion. Pericardial fat is noted. Pericardium does not appear thickened. Myocardial tags and real-time imaging do not demonstrate cardiac motion consistent with constriction.Extracardiac FindingsSmall BL pleural effusions R>L. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal LV systolic function2 Normal RV systolic function3. Nothing on MRI suggestive of pericardial constriction. RHC and/or TTE would provide complementary physiologic evaluation.


Instruction: Generate impression based on medical findings.

Input: Female 56 years old Reason: asses for pancreatic mass History: family hx of pancreatic cancer LUNG BASES: Bilateral breast prostheses in situ.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted. No intra-or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Unremarkable appearance of the pancreas with no evidence of pancreatic mass. No pancreatic duct dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Mild right pelvic caliectasis. Unremarkable appearance of the left kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Unremarkable appearance of the pancreas and pancreatic duct.


Instruction: Generate impression based on medical findings.

Input: 42-year-old male with colon cancer with metastases to the liver ABDOMEN:LIVER, BILIARY TRACT: There is a large hypoenhancing lesion in the left lobe of liver measuring 6.2 x 6.1 cm (series 11, image 170). Segment six lesion measuring 4.5 x 3.2 cm (series 11, image 117). Additional smaller lesions are also present in hepatic segment 7/8 and segment 6.Common bile duct is normal in caliber. Cholelithiasis.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: Mildly prominent gastrohepatic ligament lymph node.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Metastatic disease to the L4 vertebral bodyOTHER: No significant abnormality noted.

Output: 1.Masses in the liver compatible with metastatic disease.2.Osseous metastasis the L4 vertebral body.3.Cholelithiasis.


Instruction: Generate impression based on medical findings.

Input: 39-year-old female with history of right pre-auricular area mass. Please evaluate. Examination demonstrates no definitive evidence of any masses or pathologic adenopathy of the the soft tissues of the neck. The parotid glands appear prominent bilaterally however may be minimally larger on the right side. The density and morphology of the parotid glands however remain within normal limits. No definite evidence of any masses is detected. This area is somewhat obscured by artifact from the mandible. If clinical concern for tumor exist an MRI examination is highly recommended.The bony density of the area of the exam remains essentially unremarkable for any pathology.

Output: 1.No definitive evidence of any masses or pathologic adenopathy in the neck.2.If clinical concern persist an MRI examination is highly recommended.3.4.


Instruction: Generate impression based on medical findings.

Input: Ms. Vondriska is a 60 year old female with a personal history of occult primary adenocarcinoma status post complete axillary lymph node dissection in 2006 treated with chemotherapy and radiation therapy. Personal history of benign left breast biopsy in 2006 for fibroadenoma. Family history of breast cancer in sister, diagnosed at the age of 39. She has no current breast related complaints. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. Stable postoperative changes are present along the left axilla. No abnormal lymph nodes are identified in either axillary or internal mammary region.

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


Instruction: Generate impression based on medical findings.

Input: Esophageal cancer. There is interval decrease in size and enhancement of the heterogeneous mass in the left temporo-occipital region, now measuring up to 25 mm, previously 34 mm. Likewise, there is interval decrease in size and enhancement of the heterogeneous mass in the left frontal lobe, now measuring up to 17 mm, previously 28 mm. In addition, the right frontal lobe lesion has also decreased in size, now measuring up to 5 mm, previously 12 mm, and no longer enhances. There is no evidence of intracranial hemorrhage or acute territorial infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, orbits, and scalp soft tissues are unremarkable. However, there is fluid within the bilateral middle ears and mastoid air cells and mild scattered paranasal sinus mucosal thickening.

Output: Interval decrease in size of the brain metastases.


Instruction: Generate impression based on medical findings.

Input: 42-year-old female with multifocal left breast cancer and left nipple discharge. Patient reports left breast lumps have decreased in size and nipple discharge has resolved. LEFT BREAST:There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Previously seen biopsy proven posterior left axillary tail mass with clip susceptibility artifact has significant decreased in size, measuring 6 x 4 x 5 mm (AP x TR x CC), previously 10 x 8 x 9 mm. Area of non-mass enhancement immediately anterior and slightly superior has also decreased in size, measuring 11 x 3 x 3 mm, previously 16 x 7 x 10 mm (AP x TR x CC).No new enhancement. Previously noted left nipple enhancement has resolved. No abnormal lymph nodes are identified in the left axilla.RIGHT BREAST:No abnormal enhancement is seen in the right breast. No abnormal lymph nodes are identified in the right axilla.

Output: 1.Interval decrease in size of left axillary tail mass with clip compatible with patient's biopsy proven malignancy. 2.Interval decrease in size of non-mass enhancement immediately anterior to this mass. 3.Resolution of left nipple enhancement.4.No new enhancing lesion.5.No abnormal lymph nodes bilaterally.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: The cervical spinal canal is small on a congenital basis. The overall alignment is straightened. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.There are mild multilevel degenerative changes throughout the mid to lower cervical spine without significant resultant spinal canal or neural foraminal stenosis.

Output: 1. No evidence of cord compression or abnormal cord signal.2. Mild multilevel degenerative changes without high-grade spinal canal or neural foraminal stenoses, as detailed above.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Structural lesion causing headache. Signs and symptoms: Diffuse sharp headache with left sharp trigeminal distribution pain. Pre-and enhanced brain MRI:Negative diffusion weighted images.Examination demonstrates a few punctate foci of nonspecific flair hyperintensity in the subcortical and periventricular white matter bilateral seen hemispheres. Although nonspecific in proper clinical setting these findings could represent mild chronic small vessel ischemic strokes.The anatomical morphology as well as the signal intensity of brain parenchyma is otherwise entirely within normal on all MRI sequences. Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.There is no detectable abnormal parenchymal or leptomeningeal enhancement. The signal 80 the major intracranial arterial branches are identified.The signal intensity intracranial venous sinuses are within normal and with normal pattern of enhancement. Calvarium and soft tissues of the scalp are unremarkable and without abnormal enhancement.Unremarkable images through the orbits and including axial fat sat post enhanced series.Paranasal sinuses and bilateral mastoid air cells/middle ear cavities demonstrate normal pneumatization signal.

Output: 1.Negative diffusion weighted images.2.Few nonspecific punctate foci of flair hyperintensity the the subcortical and periventricular white matter which in proper clinical setting clips are present minimal chronic small vessel ischemic strokes.3.Unremarkable pre-and post enhanced brain MRI otherwise.4.Unremarkable images through the orbits, paranasal sinuses and well pneumatized mastoid air cells and middle ear cavities.


Instruction: Generate impression based on medical findings.

Input: Status post liver transplant, elevated bilirubin, evaluate for stricture ABDOMEN:Suboptimal evaluation secondary to absence of IV contrast.LIVER, BILIARY TRACT: No intrahepatic or extrahepatic biliary duct dilatation or focal stricture evident. Mild periportal edema. Dark flow voids maintained on T2-weighted imaging. Right-sided drainage catheters. Small to moderate perihepatic/subcapsular hematoma.SPLEEN: No significant abnormality noted.PANCREAS: Intrinsic T1 signal of pancreas somewhat decreased at level of neck/proximal body, nonspecific. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Small nonspecific retroperitoneal lymph nodes.BOWEL, MESENTERY: Small to moderate mesenteric edema and ascites. BONES, SOFT TISSUES: Right abdominal postsurgical sequela including soft tissue hematoma related to surgery. Ventral abdominal soft tissue defect. Diffuse anasarca. OTHER: Trace pleural effusions.

Output: No biliary duct dilatation or focal stricture evident.Intrinsic T1 signal of pancreas somewhat decreased at level of neck/proximal body, nonspecific, correlation with patient's clinical history and laboratory values recommended to exclude acute pancreatitis. Postsurgical sequela as above.Please refer to concomitant ultrasound exam from same day for additional findings.


Instruction: Generate impression based on medical findings.

Input: 61 year old with history of ischemic cardiomyopathy admitted with worsening heart failure being worked up for advanced options. Left VentricleThe left ventricle is massively dilated with severely reduced systolic function. The overall LV ejection fraction is 10%, the LV end diastolic volume index is 403 ml/m2 (normal range: 74+/-15), the LVEDV is 678 ml (normal range 142+/-34), the LV end systolic volume index is 363 ml/m2 (normal range 25+/-9), the LVESV is 611 ml (normal range 47+/-19), the LV mass index is 163 g/m2 (normal range 85+/-15), and the LV mass is 275 g (normal range 164+/-36). The left ventricular dysfunction is global with regional variation. There is thinning with dyskinesis of the mid to apical inferior wall and severe hypokinesis of the basal to mid anterior, anteroseptal, and inferoseptal walls. There are two distinct late gadolinium enhancement patterns. The first is transmural late gadolinium enhancement in the mid to apical inferior walls. This finding is most likely due to myocardial infarction and suggests that these segments are not viable. The second is a mid-wall stripe pattern in the interventricular septum. This finding is a non-infarction pattern and suggests a second non-ischemic etiology of the LV dysfunction, in addition to the ischemic etiology. Given the fact that there is also a significant non-ischemic component to the LV dysfunction, it is difficult to predict whether the other myocardial segments are viable. Left AtriumThe left atrium is severely enlarged. Right VentricleThe right ventricle is moderately dilated with mild-moderately reduced systolic function. The overall RV ejection fraction is 40%, the RV end diastolic volume index is 143 ml/m2 (normal range 82+/-16), the RVEDV is 241 ml (normal range 142+/-31), the RV end systolic volume index is 86 ml/m2 (normal range 31+/-9), and the RVESV is 145 ml (normal range 54+/-17).Right AtriumThe right atrium is mild-moderately dilated.Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is moderate-severe mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is moderate to severe tricuspid regurgitation.AortaThere is a left sided aortic arch with a "pseudo-bovine" brachiocephalic branching pattern with common origin of right innominate and left common carotid (normal variant). The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated. Venous AnatomyThe SVC is normal in size and drains normally into the right atrium. The IVC is dilated. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsRenal cyst is noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Severe LV dilation with severely reduced systolic function (LVEF 10%) with both ischemic and non-ischemic etiologies.2. There is a transmural myocardial infarction involving the mid to apical inferior wall. These segments are not viable.3. There is mid-wall fibrosis involving much of the basal to mid anterior wall and septum. It is unclear whether these segments are viable given the fibrosis is non-ischemic in etiology.4. Moderate RV dilation with mild to moderate RV systolic dysfunction (RVEF 40%.5. Severe left atrial dilation.6. Moderate to severe mitral and tricuspid valve regurgitation. 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: 6-year-old male with history of epilepsy, ADHD, behavioral issues with intense headache in afternoon and waking the patient in the middle of the night. Evaluate for abnormalities. There is no evidence of intracranial hemorrhage, mass or edema. No abnormal enhancement in the brain or leptomeninges.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Normal brain CT.


Instruction: Generate impression based on medical findings.

Input: 22-year-old female with left hip pain, limited motion, evaluate for stress fracture versus avascular necrosis versus loose body. ACETABULAR LABRUM: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: Linear T1 hypointensity along the medial cortex of the left femoral neck is compatible with an incomplete basicervical femoral neck fracture. The lateral cortex of the left femoral neck remains intact. There is high T2 signal surrounding the fracture line compatible with edema. The remainder of the bony pelvis and right hip appear within normal limits.SOFT TISSUES: The musculature of the left hip and pelvis appear within normal limits.ADDITIONAL

Output: Incomplete basicervical femoral neck fracture as described above.These findings were discussed with Barbara Engel by phone on 6/16/15 at 0920.


Instruction: Generate impression based on medical findings.

Input: White spot in left cerebellum: headaches. There is interval increase in size of a patchy T2 hyperintense lesion, now measuring up to 9 x 12 mm, previously 7 x 10 mm. There is no longer associated enhancement. There is no evidence of intracranial hemorrhage or acute infarct. There is a right cerebellar hemisphere developmental venous anomaly. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Slight interval increase in size of the left cerebellar hemisphere lesion, but no residual enhancement.


Instruction: Generate impression based on medical findings.

Input: cT4N1Mx left tongue squamous cell carcinoma, status post treatment. There is interval decrease in size of the infiltrative mass centered in the left tongue with extension across the midline, into the tongue base, left tonsillar fossa, and soft palate that measures up to approximately 30 mm, previously 55 mm. There also appears to be slight invasion of the left pterygoid musculature. There is interval decrease in size of the left level 2A lymph node, which now measures 10 x 11 mm, previously 13 x 17 mm. The thyroid and major salivary glands are unremarkable. The osseous structures and paranasal sinuses are unremarkable. The imaged intracranial structures are unremarkable.

Output: Interval decrease in size of the treated squamous cell carcinoma centered in the left tongue and left suprahyoid lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: There is mild to moderate motion degradation limiting evaluation. There is no acute infarct, mass effect, or cerebral edema. There is mild periventricular and subcortical white matter T2 signal abnormality, likely representing chronic microvascular ischemic changes. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is mild bilateral maxillary, sphenoid and ethmoid sinus mucosal thickening. The skull and extracranial soft tissues are unremarkable.

Output: Motion degraded exam with no acute infarct. Mild chronic microvascular ischemic changes.


Instruction: Generate impression based on medical findings.

Input: Newly diagnosed bilateral optic disc edema, mild headaches. Brain MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles are mildly prominent diffusely. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Orbit MRI: The bilateral globes, optic nerves, orbital fat, extraocular muscles, and superior ophthalmic veins are unremarkable. There is Brain MRV: There is narrowing of portions of the bilateral transverse sinuses, but no evidence of thrombosis.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. No evidence of orbital lesions.3. Narrowing of portions of the bilateral transverse sinuses may represent a normal variant or a manifestation of pseudotumor cerebri.4. Mild nonspecific diffuse prominent of the ventricles.


Instruction: Generate impression based on medical findings.

Input: Breast cancer and brain metastases treated with surgery and CyberKnife treatments. There are postoperative findings related to right frontal lesionectomy. There is confluent high T2 signal and susceptibility effect surrounding the resection cavity, but no evidence of associated abnormal enhancement. However, there is an irregularly enhancing lesion in the left cerebellar hemisphere that measures up to 20 mm with extensive surrounding vasogenic edema. There is also an irregularly enhancing lesion in the left cerebellar hemisphere that measures up to 10 mm with mild surrounding vasogenic edema and a punctate focus of enhancement in the superior right cerebellar hemisphere. In addition, there is an enhancing lesion in the right occipital lobe that measures up to 5 mm. There are a few punctate foci of nonspecific cerebral white matter T2 hyperintensity without associated enhancement. There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact.

Output: 1. Postoperative findings related to right frontal lesionectomy, without evidence of recurrent tumor in this area. 2. Multiple enhancing intracranial lesions are compatible with metastases, the largest of which is located in the left cerebellar hemisphere with extensive vasogenic edema, but no herniation.


Instruction: Generate impression based on medical findings.

Input: 50 year-old woman with right hemiparesis. Status post recent aneurysm coiling, remote history of intracranial hemorrhage. Evaluate for ICH / stroke. There is no evidence of acute intracranial hemorrhage, mass or edema. There are midline metallic densities consistent patient's known history of aneurysm coiling. There are periventricular hypodensities which are more pronounced on the left as well as focal regions of hypodensity in the subcortical regions and basal ganglia bilaterally. These findings are consistent with age-indeterminate small vessel ischemic disease and lacunar strokes, respectively. Areas of encephalomalacia are present in the distribution of the bilateral anterior cerebral arteries (series 5 image 24) consistent with prior stroke. There are no definite CT findings of acute stroke. However, if acute stroke remains clinical concern recommend MRI.The left lateral ventricle is larger than the right. There is a shunt which enters through the frontal bone to the right of the midline and terminates in the region of the third ventricle. There is a region of encephalomalacia adjacent to the shunt.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. No CT findings of acute intracranial hemorrhage.2. No definite CT findings of acute stroke. If stroke remains clinical concern, recommend further evaluation with MRI.3. Metallic densities consistent with prior aneurysm coiling and ventricular shunt with adjacent encephalomalacia.4. Age-indeterminate findings of small vessel ischemic disease.5. Midline frontal and parietal regions of encephalomalacia consistent with prior stroke in bilateral ACA distribution.


Instruction: Generate impression based on medical findings.

Input: 70-year-old woman with history of bilateral renal masses. Please note that the subtraction images are limited due to misregistration.ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in signal and morphology. The gallbladder is normal.SPLEEN: A multiloculated cyst is noted in the spleen.PANCREAS: There is mild prominence of the pancreatic duct but no focal lesion.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: There is a 21 x 17 mm, lobulated lesion in the inferior pole of the left kidney (series 1301, image 106) which is hyperintense on T1 and mildly hyperintense on fat-saturated T2 images.Multiple additional renal cysts are noted bilaterally.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The partially visualized small bowel and colon are normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Slightly limited examination with a probable hemorrhagic/complex cyst in the inferior pole of the left kidney. This can be confirmed with follow-up examination in 6 months.2.Multiple additional renal cysts and a splenic cyst.


Instruction: Generate impression based on medical findings.

Input: Male 66 years old with small cell neuroendocrine tumor metastatic to transplanted liver s/p partial hepatectomy July 2016. PET suggested possible new lesion. Evaluate on MRI. History: PET positive lesion ABDOMEN:LIVER, BILIARY TRACT: Status post resection of the right lobe of the transplant liver. At the posterior resection margin there is a 2.3 x 1.4 cm lesion which is T1 hypointense, mildly T2 hyperintense with restricted diffusion and enhancement. This corresponds to the FDG avid lesion seen on recent PET/CT. This lesion abuts the right adrenal gland which demonstrates nodular thickening. Although we don't see evidence of such, direct invasion into the right adrenal gland is not excluded.There is no biliary ductal dilatation. The hepatic vasculature appears patent.SPLEEN: No significant abnormality noted.PANCREAS: A 2.8 x 2.2 cm T1 hypointense, T2 hypointense lesion in the body of the pancreas unchanged since 2014 and may represent a small mucinous neoplasm. No pancreatic ductal dilatation.ADRENAL GLANDS: Nodular thickening of the right adrenal gland. The hepatic lesion abuts the right adrenal gland as described above. The left adrenal gland is unremarkable.KIDNEYS, URETERS: No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Above average fecal burden.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Moderate right pleural effusion with associated compressive atelectasis. Trace left pleural fluid.

Output: 1.2.3 x 1.4 cm liver lesion at the posterior resection margin is highly suspicious for residual tumor2.A cystic lesion pancreatic body is stable since 2014, it may represent a mucinous neoplasm.


Instruction: Generate impression based on medical findings.

Input: Gait disorder with right upgoing toe and left leg paresthesia. There appears to be patchy T2 hyperintensity and mild volume loss at the T6-7 level. There is also apparent T2 hyperintensity in the spinal cord at the T1-2 and T4 levels. There are small posterior disc-osteophytes in the mid thoracic spine, but the spinal canal is not significantly narrowed. There are subcentimeter neural foraminal perineural cysts at multiple levels. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no evidence of mass lesions or abnormal enhancement in the thoracic spine. The paravertebral soft tissues are unremarkable.

Output: Apparent myelomalacia at multiple levels of the thoracic spinal cord. These may be secondary to a prior demyelinating or infectious process, for example.


Instruction: Generate impression based on medical findings.

Input: 10-month-old female with left lower extremities edema, cellulitis, abscess, concern for osteomyelitis. Diffuse subcutaneous edema extends from the knee to the forefoot. No bone marrow edema in the tibia-fibula or in the bones of the foot to suggest osteomyelitis. No abnormal enhancement is present. An area of increased signal intensity on T2 weighted images within the subcutaneous tissues superior to the left lateral malleolus may represent an empty abscess cavity. The visualized ligaments of the ankle are intact without evidence of infection.

Output: Diffuse cellulitis extending from the knee to the forefoot. No osteomyelitis.


Instruction: Generate impression based on medical findings.

Input: 52 year old male with history of stage IV CLL with suspected transformation to B-cell lymphoma who presents for stress cardiac MRI for further evaluation of newly identified heart failureMEDICATIONS: Carvedilol, Lisinopril, Lasix IV, Acyclovir, Levaquin, Decadron, Diflucan, Zoloft First Pass PerfusionDuring hyperemia, there is no definitive evidence of perfusion defect. A prominent dark rim artifact is present, reducing the diagnostic sensitivity of the test.Viability/ Myocardial ScarThere was no obvious 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 severely reduced in systolic function and severely increased in size . The overall LV ejection fraction is 28%, the LV end diastolic volume index is 145 ml/m2 (normal range: 74+/-15), the LVEDV is 225 ml (normal range 142+/-34), the LV end systolic volume index is 103 ml/m2 (normal range 25+/-9), the LVESV is 161 ml (normal range 47+/-19), the LV mass index is 91 g/m2, and the LV mass is 142 g. There is global hypokinesis with regional variation.Left AtriumThe left atrium is moderately increased. Right VentricleThe right ventricle is moderately reduced in systolic function and normal in size . The overall RV ejection fraction is 35%, the RV end diastolic volume index is 64 ml/m2 (normal range 82+/-16), the RVEDV is 99 ml (normal range 142+/-31), the RV end systolic volume index is 42 ml/m2 (normal range 31+/-9), and the RVESV is 65 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild 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 a small pericardial effusion.Extracardiac FindingsThere is a large burden of mediastinal lymphadenopathy. Moderate 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. No obvious perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Severely increased LV size and severely reduced systolic function (LVEF 28%) without evidence of obvious myocardial fibrosis, inflammation, or infiltration.4. Normal RV size and moderately reduced systolic function (RVEF 35%).5. Moderate left atrial dilation.6. See extra-cardiac findings.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Migraine, unspecified, without mention of intractable migraine without mention of status migrainosusClinical question: evaluating for underlying cause of change in pattern of headaches.Signs and Symptoms: Pt with migraines since elementary school, has had increased frequency of migraines over past 6 months, now 8 per month. The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is no evidence for intracranial mass lesion. MRI of the brain is within normal limits.2.Mucosal thickening in the paranasal sinuses is most likely inflammatory in nature but is a common finding. Please correlate with clinical symptoms for potential sinusitis.


Instruction: Generate impression based on medical findings.

Input: Breast cancer screening, IRB 13073B, strong family history of breast cancer and BRCA2 mutation. History of breast cancer in mother diagnosed at the age of 44 and maternal grandmother diagnosed at the age of 63. There is scattered fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on medical findings.

Input: Reason: Recent gross hematuria with hx kidney transplant and low GFR. request MR Urogram History: As above ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral atrophic native kidneys with small cysts. Additional subcentimeter lesions within the native kidneys are too small to characterize.Right iliac fossa transplant. There is a cyst within the transplant kidney measuring up to 2.8 cm with small septations, similar to the prior CT. No hydronephrosis. Delayed images show normal opacification of the transplant pelvis and ureter. No associated fluid collections.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.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.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: Right iliac fossa transplant with a minimally complex cyst which is unchanged in size. Otherwise, no hydronephrosis or other findings to account for patient's hematuria.


Instruction: Generate impression based on medical findings.

Input: Unspecified convulsions [R56.9], Reason for Study: ^Reason: concern for seizure-like activity, neurology service recommendation. Brain parenchyma appears within normal limits. No intracranial mass or mass effect. No evidence of cortical dysplasia, gray matter heterotopia, or other findings to suggest seizure focus are appreciated. No evidence of acute ischemia or hemorrhage. The ventricles and basal cisterns are normal in size and configuration. No abnormal enhancement. There is redemonstration of a prominent focus of T1 shortening in the posterior pituitary gland measuring up to 8 mm, which may represent a prominent neurohypophysis or Rathke's cleft cyst but not significantly changed since 2013. There is mild thickening and T1 hypointensity involving the calvarium compatible with history of sickle cell disease.

Output: Brain parenchyma appears within normal limits. No findings to suggest seizure focus.


Instruction: Generate impression based on medical findings.

Input: 75 years old, Female, Reason: 75 yo female with thyroid nodule on CT. History: thyroid nodule RIGHT LOBE MEASUREMENTS: 5.0 x 1.2 x 1.4 cmLEFT LOBE MEASUREMENTS: 5.8 x 1.2 x 2.1 cmISTHMUS MEASUREMENTS: 0.5 cmRIGHT LOBE: Subcentimeter isoechoic heterogeneous thyroid nodule with internal vascularity measuring 0.4 x 0.4 by 0.5 cm.LEFT LOBE: At least two nodules are present in the left thyroid lobe. The more superior nodule is solid and heterogeneous in appearance with internal vascularity measuring 1.3 x 1.2 x 0.8 cm. The inferior left thyroid nodule measures 1.2 x 0.8 x 1.1 cm and is spongiform appearance.ISTHMUS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.

Output: 1.Left mid pole heterogeneous solid nodule with internal vascularity measuring up to 1.3 cm is amenable to biopsy if clinically warranted.2.Left inferior pole spongiform nodule.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Evaluate for stroke. Signs and symptoms: LUE pain/numbness, slurring of speech. Nonenhanced brain MRI:Examination demonstrates small foci of restricted diffusion involving the cortex of the right post central gyrus and adjacent subcortical white matter consistent with acute to late acute nonhemorrhagic ischemic stroke. This finding was noted on the prior head CTs. There is no associated mass effect with this finding.Additionally examination demonstrate several tiny foci of flair hyperintensity in the subcortical and periventricular white matter of cerebral hemispheres. Tiny similar finding in the right external capsule is also noted. Findings highly suggestive of chronic small vessel ischemic stroke of mild degree.The signal intensity of brain parenchyma remains within normal otherwise. There is a slight prominence of cortical sulci for patient's stated age in a generalized pattern. Ventricular system are within normal size and morphology and maintained midline.There is revisualization of a small arachnoid cyst in the anterior aspect of right middle cranial fossa with subtle mass effect on the right temporal tip similar to prior head CT.Signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses are within normal.Calvarium, orbits, paranasal sinuses and mastoid air cells are unremarkable there

Output: 1.Tiny foci of cortical and subcortical restricted diffusion involving right post central gyrus as was seen on prior head CTs.2.Findings of mild chronic small vessel ischemic strokes as detailed.3.Mild generalized prominence of cerebral cortical sulci for age and unremarkable exam otherwise.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Ankylosing spondylitis of unspecified sites in spineClinical question: myelopathySigns and Symptoms: pain and decreased motion Cervical spine:The cervical vertebral bodies are appropriate in overall height. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is no significant compromise to the spinal canal. There is some fusion of the facet joints at this level as well as some facet hypertrophy.At C3-4 there is no significant compromise to the spinal canal . There is bilateral facet hypertrophy at this level. There is some encroachment of the exiting nerve roots within the neural foramina at this level.At C4-5 there is no significant compromise to the spinal canal . Findings suggest some fusion at the facet joints with facet hypertrophy. There is some encroachment of the exiting nerve roots within the neural foramina at this level.At C5-6 there is some loss of disc space height, disc desiccation and endplate and uncovertebral osteophytes. There is bilateral facet hypertrophy at this level. There is a diffuse disc bulge at this level. There is hypertrophy of the ligamentum flavum at this level. There is mild posterior subluxation of a C5 on C6. There is effacement of spinal fluid ventral and posterior to the spinal cord with minimal flattening of the spinal cord. There is encroachment of the exiting nerve roots within the neural foramina bilaterally at this level.At C6-7 there is no significant compromise to the spinal canal. There is a disc bulge at this level associated with endplate and uncovertebral osteophytes as well as some mild facet hypertrophy. There is narrowing of the neural foramina and encroachment of the exiting nerve roots bilaterally at this level. The encroachment of exiting nerve roots is worse on the left compared to the right side. Also some encroachment of the nerve roots at the left lateral recess at this level. Overall there is a mild degree of spinal stenosis at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina. There is mild posterior ligamentum flavum hypertrophy at this level.The right vertebral artery flow-void is not identified and in fact there is T2 signal hyperintensity within the right vertebral artery.Lumbar spine: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. Marrow signal is of high signal on T1 indicating fatty replacement. On the prior exam marrow signal is more heterogeneous. There is loss of vertebral body height due to inferior endplate compression at L5 and due to superior endplate compression at L4, L3, L2 and L1 as well as T12.The anterior longitudinal ligament does appear thick. This is not appear to be any convincing evidence for enthesitis, though contrast enhanced imaging was not performed.At L5-S1 there is no significant compromise to spinal canal. There is some facet hypertrophy at this level with narrowing of the neural foramina. There is mild disc bulge at this level. The fat surrounding the exiting nerve roots within the neural foramina is not effaced at this level.At L4-5 there is moderate bilateral facet hypertrophy associated with a diffuse disc bulge and some epidural lipomatosis. There is narrowing of the thecal sac with effacement of the spinal fluid surrounding the nerve roots. There is narrowing of the neural foramina with effacement of the fat surrounding the exiting nerve roots within the neural foramina bilaterally. Overall there is a moderate to severe degree of spinal stenosis at this level associated with encroachment of the exiting nerve roots within the neural foramina bilaterally.At L3-4 there is no significant compromise to spinal canal or neural foramina. The fat surrounding the exiting nerve roots within the neural foramina is mildly effaced at this level. There is mild to moderate facet hypertrophy at this level. The fat at the lateral recesses is not effaced at this level.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.There are multiple cystic lesions in the kidneys and the kidneys appear to be relatively small.

Output: 1.There is fusion across the facet joints in the upper cervical spine. There is a CT of the maxillofacial bones which demonstrate cyst in greater detail and also demonstrates some anterior osseous bridging at the C1-2 and C2-3. A CT of the cervical spine would be of further benefit in assessing extent of facet joint and vertebral ankylosis.2.There are multilevel degenerative changes in the cervical spine with findings compatible with a moderate degree of spinal stenosis with mild subluxation at C5-6 and neural foraminal encroachment of exiting nerve roots bilaterally at C3-4, C4-5, C5-6 and C6-7.3.Occlusion of the right vertebral artery.4.There are multilevel degenerative changes present in the lumbar spine with moderate to severe spinal stenosis at L4-5 where there is also encroachment of the exiting nerve roots within the neural foramina. This was also present on 11/7/2014 and has not changed.5.There is multilevel loss of vertebral body height in the lumbar spine.6.There is no convincing evidence for any active Romanus lesion. Please note that examination the sacroiliac joints was not performed7.Multiple cystic type lesions are present in the kidneys which have also been present on prior abdomen CTs8.In general the marrow signal in the lumbar spine appears somewhat more hyperintense. This raises the possibility of prior radiation treatment. Please correlate with patient's clinical history.


Instruction: Generate impression based on medical findings.

Input: History of neuroendocrine tumor in head of pancreas. ABDOMEN:LIVER, BILIARY TRACT: A simple cyst in segment 6/7 measures up to 3 cm. Additional scattered subcentimeter cysts are also present. The previously described tiny focus of arterial enhancement in the inferior right hepatic lobe is not well seen on this examination. No suspicious hepatic lesions are identified. The common bile duct measures up to 9 mm and tapers smoothly distally without obstructing stone or lesion identified. The hepatic vasculature appears patent.SPLEEN: There is a lesion within the spleen (series 14, image 31) measuring 2.3 x 2.8 cm which demonstrates isointense T1 and T2 signal as well as heterogeneous early enhancement with filling in on delayed imaging. The lesion appears grossly similar to the outside 12/19/2013 examination allowing for differences in technique.PANCREAS: There is significant pancreatic ductal dilation measuring up to 7 mm which abruptly tapers at the level of the pancreatic neck, and is again mildly prominent near the ampulla. At the level of the narrowing, there is a tiny hyperenhancing intraductal lesion (series 13, image 48) measuring up to 5 mm. There is moderate-severe atrophy of the pancreatic body and tail appearing similar to prior with sparing of the pancreatic head.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: A small duodenal diverticulum is present in the third portion of duodenum.BONES, SOFT TISSUES: Degenerative changes of the spine.OTHER: No significant abnormality noted.

Output: 1.5 mm hyperenhancing intraductal lesion at the pancreatic head/neck with resultant ductal dilation compatible with patient's known history of intraductal neuroendocrine tumor, not significantly changed. 2.A 2.8 cm enhancing splenic lesion which is nonspecific but similar to 2013 exam and thus most likely benign.