Instruction: Generate impression based on medical findings.

Input: There has been suboccipital craniectomy with resection of the posterior C1 arch. Fluid intensity material is noted within the operative site, and changes within the overlying subcutaneous tissues are consistent with the patient's postprocedural status. The cerebellar tonsils are elongated, extending pathologically below the level of the foramen magnum, demonstrating a pointed morphology. There is abnormal T2 hyperintensity within the cervical cord beginning at the cervicomedullary junction and extending inferiorly to the T1 level. Cephalad to the C5 level, this is subtle and patchy, whereas from C5/6 through T1, it is more discrete and results in cord expansion. The odontoid tip is retroflexed causing mild abutment of the anterior cervicomedullary junction. Sagittal CSF flow studies were acquired in 4 different acquisitions utilizing 3 different velocity encoding settings. None demonstrate significant biphasic CSF flow involvement at the level performed in magnum and herniated tonsils.There appears to be a partially imaged left pleural effusion.There is straightening the cervical spine which is most likely positional. There are no fractures or subluxations. The marrow signal is benign. There are no degenerative stenoses.

Output: 1.There has been suboccipital craniectomy with resection of the posterior C1 arch. The cerebellar tonsils are elongated, extending pathologically below the level of the foramen magnum, demonstrating a pointed morphology. 2.There is abnormal T2 hyperintensity within the cervical cord beginning at the cervicomedullary junction and extending inferiorly to the T1 level. Cephalad to the C5 level, this is subtle and patchy, whereas from C5/6 through T1, it is more discrete and results in cord expansion. Although this may represent a presyrinx state, the region of cord expansion can be followed for interval changes to assess for possible concurrent neoplasm.3.Sagittal CSF flow studies were acquired in 4 different acquisitions utilizing 3 different velocity encoding settings. None demonstrate significant biphasic CSF flow involvement at the level performed in magnum and herniated tonsils.4.There appears to be a partially imaged left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: History of cirrhosis and ascites. Evaluate for HCC. MRI ABDOMEN UPPER WWO; 7/11/2015 7:10 AMCLINICAL INFORMATION:Evaluate liver lesions, HCC screenTECHNIQUE: MRI abdomen performed with and without IV contrast. Approximately 9 mL of MultiHance administered for study.        COMPARISON: Outside MRI from April 12, 2013.

Output: 1. Cirrhotic liver morphology. Arterially enhancing hepatic dome focus measuring 1.1 x 0.8 cm with washout, suspicious for small hepatocellular carcinoma, attention on follow-up recommended. Additional arterially enhancing foci seen, indeterminate.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Male, 29 years old. Follow-up femoral neck stress fracture. Continued pain despite healed femoral neck fracture on x-ray and immobility. ACETABULAR LABRUM: Acetabular labrum is intact without evidence of tear.ARTICULAR CARTILAGE AND BONE: At the level of the lesser trochanter, there is decreased signal on T1 sequences which likely represents sclerosis with a punctate focus of increased signal (series 801, image 10) which may represent a nidus. Adjacent to the presumed sclerosis is bone marrow edema along the medial femoral neck. Alignment of the hip joint is anatomic. The articular cartilage is intact. SOFT TISSUES: The visualized soft tissues are unremarkable. ADDITIONAL

Output: Apparent sclerosis along the medial femoral neck with a possible small nidus and adjacent bone marrow edema. Given that the patient's symptoms do not correlate with activity and have not improved with rest, these findings are highly suspicious for an osteoid osteoma or less likely a persistent stress fracture of the femoral neck.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Multiple sclerosisClinical question: MS; f/u progressionSigns and Symptoms: ataxia MRI brain:There is a moderate degree of periventricular and subcortical white matter lesions some which are perpendicularly oriented to the lateral ventricles and some of which extend to the corpus callosum. There are T2 and FLAIR punctate signal hyperintensity is also present in the internal capsules, external capsules as well as within the brainstem. These were also present on the prior exam from 1/6/2015 and have not changed tremendously.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. There are patchy small signal hyperintensities present throughout the cervical spinal cord which were also present on the prior exam as well. More prominent lesions are present at C2, C3-4, C4-5-7 which can also be identified on the prior exam. There is reversal of the normal cervical curvature present.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a small central disc protrusion at this level.At C4-5 there is no significant compromise to the spinal canal. There is a small left paramedian disc protrusion at this level. There are bilateral uncovertebral osteophytes present this level which are associated with encroachment of exiting nerve roots. There is no significant change since prior exam.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a small left paramedian broad-based disc protrusion at this level. There is no significant change since prior exam.At C6-7 there is no significant compromise to the spinal canal. There is a left lateral disc protrusion present this level which encroaches on the left-sided exiting nerve roots within the neural foramen. There is no significant change since prior exam.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There are multiple lesions scattered throughout the periventricular and subcortical white matter as well as the brainstem and internal capsules which are compatible with patient's clinical diagnosis of multiple sclerosis and have not changed when compared to the previous exam.2.The multiple lesions within the cervical spinal cord which are compatible with patient's diagnosis of multiple sclerosis. These are stable since the prior exam.3.There are multilevel degenerative changes present cervical spine with reversal of the normal cervical curvature and neural foramen encroachment of exiting nerve roots at C4-5 and on the left side at C6-7


Instruction: Generate impression based on medical findings.

Input: Female 42 years old Reason: mvc, midline tenderness around t 10, low back pain, knee pain Thoracic spine: No acute fracture or malalignment. The vertebral body heights and disc spaces are maintained. Evaluation of T1 is somewhat limited secondary to overlying anatomy.Lumbar spine: Vertebral body heights maintained. Alignment is within normal limits. Mild to moderate degenerative disc disease at L5-S1, unchanged from MRI 8/3/2015. Right knee: Triangular appearing ossific density overlying the anterior tibial plateau, near the midline may represent a loose body or a fracture fragment, however no donor site or fracture line is identified. Fabella is present posterior to the knee and minimal osteoarthritis affects the right knee. Joint effusion is present.

Output: 1.Ossific density within the right knee joint space may represent a loose body, or fracture fragment, however no donor site or fracture line is identified. CT or MRI may be performed to determine acuity and/or origin of this fragment, if clinically warranted.2.Normal radiograph of the thoracic spine.3.Degenerative disc disease affects L5-S1.


Instruction: Generate impression based on medical findings.

Input: Right upper quadrant pain ABDOMEN:LUNG BASES: Cardiomegaly. No pleural effusions.LIVER, BILIARY TRACT: Prominent hepatic veins and intrahepatic IVC, likely representing a component of cardiac congestion. No focal hepatic lesions are seen. No biliary ductal dilation is present.Cholelithiasis without choledocholithiasis. A small amount of fluid about the gallbladder is nonspecific, though similar to prior CTs dating back to 3/12/2015 and is likely secondary to cardiac congestion.SPLEEN: No significant abnormality noted.PANCREAS: Punctate T2 hyperintensity in the inferior pancreatic head likely represents a very small side branch IPMN. Otherwise, no abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter renal cysts noted. No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Thoracic dextroscoliosis and lumbar levoscoliosis.OTHER: Small Tarlov cysts noted.

Output: 1.Cholelithiasis without specific evidence of cholecystitis.2.No specific findings otherwise to account for the patient's right upper quadrant abdominal pain.


Instruction: Generate impression based on medical findings.

Input: Mr. Brown is a 65 year old male with a history of Philadelphia chromosome positive CML on Gleevec, papillary thyroid cancer s/p partial thyroidectomy, OSA, with complaints of palpitations and irregular heart rate. Left VentricleThe left ventricle is moderately dilated with mild to moderately reduced systolic function. The overall LV ejection fraction is 43%, the LV end diastolic volume index is 130 ml/m2 (normal range: 74+/-15), the LVEDV is 306 ml (normal range 142+/-34), the LV end systolic volume index is 73 ml/m2 (normal range 25+/-9), the LVESV is 173 ml (normal range 47+/-19). LV dysfunction is global. There are several small non-contiguous patches of nontransmural late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process in the mid lateral, inferior and septal walls that is atypical for myocardial infarction. Native T1 time is approximately 1080 ms. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 60%, the RV end diastolic volume index is 86 ml/m2 (normal range 82+/-16), the RVEDV is 204 ml (normal range 142+/-31), the RV end systolic volume index is 34 ml/m2 (normal range 31+/-9), and the RVESV is 80 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.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 no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a common right innominate and left common carotid brachiocephalic branching pattern (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 moderately dilated (33 mm x 32 mm).Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is moderately dilated with mild to moderately reduced systolic function. There are LV dysfunction is global. There are several small non-contiguous patches of nontransmural late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process in the mid lateral, inferior and septal walls that is atypical for myocardial infarction. Native T1 time is approximately 1080 ms. 2. The right ventricle is normal in size and systolic function. The overall RV ejection fraction is 60%.3. Biatrial enlargement. 4. Dilated pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: 45-year-old female with bilateral leg paresthesias and weakness Alignment is anatomic. Vertebral body heights are intact. There is a well defined T1/T2 hypointense likely sclerotic lesion in the posterior T11 vertebral body which is unchanged from prior exam. Otherwise no abnormal marrow signal. Signal within the cord and cauda equina is grossly normal. There is no evidence of cord compression. Multi-level disk desiccation with mild disk space loss at T10-T11 and T11-T12. There is a posterior disk osteophyte complex at C4-C5 which is slightly less prominent with minimal effacement of ventral thecal sac. A diffuse disk bulge at C6-C7 is also unchanged. There is ligamentum flavum thickening at C5-C6 and C6-C7 which is unchanged.Mild diffuse disk bulge at T1-T2 slightly worse than the prior exam. Facet arthropathy and ligamentum flavum thickening at T10-T11 is unchanged.Diffuse disk bulge at T11-T12 appears slightly worse than the prior exam.There is a large lobulated soft tissue structure in the pelvis which was present on prior exams but appears slightly enlarged, however this is incompletely visualized. This extends cranially up to the L3 level, previously to the L4 level. There is partially exophytic rounded component anteriorly along the mass measuring at least 7.8 cm. There is additional less well-defined soft tissue extending into the lower pelvis. Multiple thyroid nodules and cysts are present.

Output: 1.No evidence of cord compression.2.Multilevel spondylolyses which is slightly worse T1-T2 and T11-T12 and less prominent at C4-C53.Large pelvic soft tissue structure may represent uterine fibroids, but appears larger than the prior exam and is incompletely visualized. Pelvic ultrasound may be considered for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Patient with history of lung cancer with metastases to brain status post RT. Signs and symptoms: Doing well but no new disease evaluation compared to prior scans. Pre-and post-enhanced head CT:Examination demonstrates further decrease in the size of a single small metastatic focus in the dorsal aspect of the right cerebellum. It measures approximately 4 x 6-mm in size compared to prior measurements of 11 x 11.There is no detectable surrounding vasogenic edema.Unremarkable pre-and post enhanced head CT otherwise and in particular no evidence of any new additional metastatic lesions of brain parenchymal or leptomeninges.Calvarium is intact.Limited images through the orbits are unremarkable.Paranasal sinuses and mastoid air cells are unremarkable.

Output: Further decrease in the size of a single right posterior cerebellar metastatic focus to 4 x 6-mm in size compared to prior measurements of 11 x 11. No evidence of any new findings.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old, with thoracic pain with fractures of T4, T5 and T6. Severe comminuted fracturing of the T5 vertebral body is demonstrated. Fracture fragments have been displaced laterally on both sides. There is complete loss of height anteriorly, and approximately 40% loss of height posteriorly.There is a small fracture of the anterior/inferior aspect of the T4 vertebral body. There is also a severe comminuted compression fracture of the T6 vertebral body. A fracture line is seen traversing the spinous process of T4 and to some degree the lamina, but the fracture fragments are not significantly displaced. At T5, the pars interarticularis on the right is fractured. A lucency is also evident within the left T7 pedicle which does not appear to be traumatic in nature and may simply represent fatty deposition or perhaps a hemangioma. There is, however, lucency through the right T6, T7 and T8 transverse processes compatible with fractures. As a result, there is a focal kyphotic angulation of the thoracic spine centered at the T4 through T6 region. The fractured vertebral bodies show mild retropulsion of vertebral body material, mostly at T5 and T6. This does not appear to significantly compromise the spinal canal, though MRI would provide a better assessment.Elsewhere, the bony spinal canal does not appear to be significantly compromised, though CT is insensitive for soft tissue encroachment. Likewise, except at the fractured levels, the bony neural foramina are preserved. At the level of fracturing, there is narrowing of the T5-6 and T6-7 neural foramina.Numerous rib fractures are identified involving at least T1 through T8 on the right and T1 through T6 on the left. These are at variable stages of repair given the presence of callus formation at some fracture sites.Bilateral small pleural effusions are seen.

Output: 1. Vertebral body fractures involving T4, T5 and T6, most severely affecting T5, with mild retropulsion of vertebral body material.2. Posterior element and/or transverse process fractures involving T4 through T8 as discussed above.3. Numerous bilateral rib fractures.


Instruction: Generate impression based on medical findings.

Input: Male; 68 years old. Reason: 1.4 cm HCC pre liver transplant for reassessment History: cirrhosis. LIVER, BILIARY TRACT:Mild nodular liver contour, fissural prominence, and caudate hypertrophy are compatible with cirrhosis. Reference segment 8 lesion demonstrates high T2 signal as well as arterial enhancement and washout and now measures 2.5 x 2.2 cm, previously 1.4 x 1.3 cm (series 5, image 16). The hepatic vasculature is patent, although it should be noted that the segment 8 lesion is near a right anterior portal venous branch and right hepatic venous branch. No new suspicious enhancing lesions. No biliary ductal dilatation or intraductal filling defect on MRCP images. Previously described gallstone is not evident on today's exam. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Mildly atrophic kidneys bilaterally. No suspicious lesions or hydronephrosis. 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.Cirrhotic liver morphology with interval increase in size of solitary segment 8 lesion which meets criteria for HCC.2.No new suspicious lesions or biliary ductal dilatation.


Instruction: Generate impression based on medical findings.

Input: Altered mental status and acute onset of slurred speech, right facial droop, confusion and bilateral lower extremity weakness. Rule out stroke. The study is moderately limited by patient motion.Brain MRI:There is an area of diffusion restriction involving the right cerebellar hemisphere. In addition, there are numerous foci of diffusion restriction involving both cerebellar hemispheres and, to a lesser extent, both cerebral hemispheres. While many of the lesions are located within the white matter, some of them involve the overlying cortex. There is a tiny focus of susceptibility effect in the left occipital lobe which probably reflects the presence of blood products. Otherwise, there is no gross intracranial hemorrhage within the limitation of this motion-degraded examination. There is confluent periventricular cerebral white matter T2 hyperintensity without diffusion restriction, probably reflecting chronic microvascular ischemia. Given the small size of the diffusion restricted lesions, they are not associated with significant mass effect. There is no midline shift or herniation. The ventricles and other CSF-containing spaces are normal in size. The orbits are unremarkable. There is fluid in the mastoid air cells and there is mild anterior ethmoid mucosal thickening. The other included paranasal sinuses are clear. Head MRA:There is no large vessel significant stenosis or occlusion. There might be mild narrowing of the left internal carotid artery as it enters and within the cavernous sinus but this study lacks the quality needed for assessing for mild stenosis. There is no severe narrowing in the internal carotid arteries or the paired middle and anterior cerebral arteries. Of note, the left A1 segment is very small which is probably congenital given the large right A1 segment and anterior communicating artery. The flow in the more downstream anterior cerebral arteries is fairly symmetric. Similarly, the flow in the posterior cerebral arteries is preserved and symmetric. The basilar artery is also without significant narrowing. Visualization of most of the intracranial vertebral arteries is severely affected by motion.

Output: 1.The examination is moderately limited by patient motion.2.Right cerebellar and numerous other smaller foci of diffusion restriction throughout the brain are compatible with acute/subacute infarcts. Tiny focus of susceptibility effect in the left occipital lobe is probably related to microscopic blood products, likely chronic. Otherwise, there is no gross intracranial hemorrhage, within the limitation of the examination.3.Mild background chronic microvascular ischemia of the white matter.4.Within the limitation of the examination, there is no significant intracranial vessel narrowing or occlusion. Dr. Monther Qandeel discussed the above results with Dr. Matthew Burns over the phone on September 19, 2015 at 1730 hours.


Instruction: Generate impression based on medical findings.

Input: Knee pain following injury Evaluation is slightly limited secondary to motion artifact particularly on the sagittal PD sequence.MENISCI: There is attenuation and blunting of the body of the medial meniscus compatible with a radial tear. There is also undulation of the free edge fibers of the body of the medial meniscus that likely represent the sequela of additional tearing, although could in part be due to flounce. There is horizontal signal abnormality at the junction of the posterior horn and body which extends to the tibial articular surface with additional attenuation of the posterior horn itself which both likely reflect additional tearing. There is intermediate signal intensity replacing the much of the body of the meniscus suggestive of degeneration.The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is severe degeneration of the articular cartilage of the medial compartment with much of the weightbearing portions of the medial femoral condyle and medial tibial plateau devoid of articular cartilage. There is flattening of the weightbearing articular surface of the medial femoral condyle with underlying subchondral sclerosis and edema. Similar but less pronounced changes affect the medial tibial plateau. There is full-thickness loss of the articular cartilage along the lateral tibial spine with degenerative signal abnormality in the underlying subchondral bone. There is diffuse articular cartilage loss of the undersurface of the patella with foci of full thickness loss particularly along the medial facet. There is degeneration of the articular cartilage of the femoral trochlea inferiorly.LIGAMENTS: There is thickening and increased signal intensity of the ACL likely representing mucoid degeneration. There is perhaps mild mucoid degeneration of the PCL as well. There is mild edema along the superficial band of MCL and perhaps within the proximal substance of the ligament itself which could represent a sprain in the appropriate clinical context but may simply relate to the adjacent medial compartment pathology. The lateral collateral ligament is intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Complex tearing of the medial meniscus and severe osteoarthritic changes of the knee with other findings described above.


Instruction: Generate impression based on medical findings.

Input: 75-year-old female with drop attacks, subsequent nausea; rule out posterior circulation hemorrhage, TIA There are increasing periventricular and subcortical hypoattenuating lesions which is nonspecific but may represent increased small vessel disease of indeterminate age. Recommend MRI if high clinical concern for ischemic CVA. Again seen is an evolving right basal ganglia lacunar infarct. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and sulci are prominent which is consistent with mild parenchymal volume loss. The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Increased small vessel disease of indeterminate age. No evidence of acute intracranial hemorrhage. Recommend MRI if high clinical concern for ischemic CVA.Mild parenchymal volume loss and evolving lacunar infarct as described above.


Instruction: Generate impression based on medical findings.

Input: There are unchanged postoperative findings related to left parietal craniotomy for resection of a left frontal lobe mass with associated susceptibility effect in and adjacent to the resection cavity compatible with chronic blood products. There is an unchanged 11-mm thick CSF signal intensity extra-axial fluid collection subjacent to the craniotomy flap. There is unchanged T2 hyperintensity without associated mass effect within the left frontal white matter. There is no thick, nodular, or measurable enhancement near the resection cavity. There is no significantly elevated relative cerebral blood volume adjacent to the resection cavity. There is no evidence of acute 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 paranasal sinuses are unremarkable.

Output: Unchanged postoperative findings without evidence of tumor progression. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Female, 18 years old, with simple partial seizures. A single punctate non-specific focus of T2 hyperintensity is seen in the white matter just anterior to the left insula. The cerebral and cerebellar hemispheres and brainstem otherwise show normal signal intensity and morphology. No restricted diffusion is seen. The medial temporal lobe structures are symmetric and free of focal lesions.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. Signal intensity of the bone marrow is unremarkable. No significant abnormalities of the paranasal sinuses are detected.

Output: No specific findings to account for the patient's seizures.


Instruction: Generate impression based on medical findings.

Input: 70-year-old man with history of Gleason 6 prostate cancer in the right mid gland found on single core in August 2015. Subsequent MRI and biopsy identified Gleason 7 cancer in the right mid gland and right apex. PELVIS:PROSTATE:Prostate Size: 40 x 30 mmPeripheral Zone: Within the lateral right mid gland (1001/14), there is a 7 x 5 mm area of T2 hypointense signal and slight diffusion restriction which abuts the capsule.Central Gland: Enlargement with impression on the bladder base.Seminal Vesicles: Normal in appearance.Extracapsular Extension: NoneBLADDER: No significant abnormality noted.LYMPH NODES: No significant lymphadenopathy noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Focus of signal abnormality in the right lateral mid gland suspicious for adenocarcinoma.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Smoldering versus symptomatic symptomatic multiple myeloma, follow up on prior vertebral lesions. Signs and symptoms: No focal pain in these area. Pre-and enhanced cervical MRI:There is a well demarcated round mildly enhancing focus in the vertebral body of C6 measuring approximately 6 mm in size. The lesion demonstrate no appreciable change since prior exam in its signal intensity, size or pattern of enhancement.There is no evidence of an additional foci of marrow signal replacement or enhancement. This is a similar observations prior study. Moderate disk disease at C5 -- C6 and mild disk disease at other levels similar to prior exam. No spinal stenosis at any level. Degenerative changes however results in mild left neural foraminal compromise at C3-C4, mild bilateral neural foraminal compromise at C4 -- C5 and moderate right and mild left C5 -- C6 levels without significant change.There is normal signal intensity and caliber of cervical cord and without abnormal enhancement.Pre-and post-enhanced thoracic MRI:There is normal anatomical alignment of the vertebral column.There is normal signal intensity of which column.There is no detectable abnormal enhancement of vertebral column.There is no evidence of spinal canal or neural foraminal compromise at any level.There is normal signal intensity and caliber of cord and without evidence of enhancement.Pre-and post-enhanced lumbar MRI:Examination demonstrates an approximately 9 mm focus of T2 stir hyperintensity in the vertebral body of L1 with mild uniform enhancement without appreciable interval change since prior exam. There is no detectable additional foci of marrow signal change or abnormal enhancement of the vertebral column. This is a similar observations as the prior MRI exam.There is normal signal intensity and alignment the vertebral column.There is no evidence of spinal canal or neural foraminal compromise at any level.

Output: 1.MRI examination of cervical spine demonstrate stable 6-mm focus of marrow signal change and enhancement in C6 vertebral body without change since prior exam. No additional suspected lesions. No evidence of central spinal stenosis. Mild multilevel neural foraminal compromise as detailed per level. Normal signal intensity and caliber of cervical cord without abnormal enhancement.2.Pre-and post-enhanced MRI of thoracic spine is unremarkable and stable since prior study.3.Pre-and post-enhanced lumbar MRI demonstrates a single stable 8mm focus of marrow signal change with enhancement in the vertebral body of L1. Unremarkable and stable pre-and post enhanced lumbar MRI exam otherwise.


Instruction: Generate impression based on medical findings.

Input: Congenital anomaly of cerebrovascular system [747.81] / Hereditary hemorrhagic telangiectasia [448.0], Reason for Study: ^Reason: AVM, prior hemorrhage in 2014, please evaluate, HHT History: HHT, motor, cognitive, speech deficits from previous stroke Brain MRI:There is extensive left parieto-occipital encephalomalacia.There is evidence of left fronto-temporo-parietal craniotomy.Within the encephalomalacia, there are multiple somewhat punctate and tubular restricted diffusion lesions indicating acute ischemic infarctions at remained brain parenchyme.There are enlarged left PCA and its branches converging into the left posterior aspect of the temporal lobe middle temporal gyrus area nidus. The size of the nidus was measured about 23mm(R to L) x 18mm (AP) x 17mm (Craniocaudal). There is large draining vein on the posterior temporo-occipital cortex and reaching into the left transverse sinus.The left lateral ventricle shows ex vacuo changes.There is no evidence of acute hemorrhagic lesion.Multiple susceptibility lesions on the left frontal, parietal and temporal lobes may be related to prior hemorrhagic stroke.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.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate enlarged left ICA with fetal left PCA which is also enlarged.There is no identifiable arterial aneurysm.Right ICA, bilateral ACA, bilateral MCA and vertebrobasilar system appear to be normal.

Output: 1. Acute ischemic infarctions without hemorrhagic transformation on the left hemisphere especially on the remained brain parenchyme within encephalomalacia as described above. 2. Left temporooccipital brain AVM mainly supplied by the left PCA.3. Left hemispheric extensive encephalomalacia.


Instruction: Generate impression based on medical findings.

Input: 40 year old 5 month pregnant female with history of heroine use and cocaine use with two days of left-sided weakness/numbness. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No acute intracranial abnormalities.


Instruction: Generate impression based on medical findings.

Input: 30-year-old with history of gunshot wound to the left side of the head with increased tone in spasticity with question of previous stroke and question of new seizure. A bullet or structural abnormality left in the brain. There is no evidence of intracranial hemorrhage, mass or edema. Large left-sided encephalomalacia throughout the frontal parietal and temporal lobes with ex vacuo dilatation of the adjacent ventricles. Patient appears to be status post craniotomy. No acute cortical stroke identified. If there is clinical concern for acute ischemia, an MRI may be considered.The basal cisterns are normal in size and configuration.With exception of postsurgical craniotomy the calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.No evidence of retained intracranial metallic fragments.

Output: 1. Left frontoparietal and temporal extensive encephalomalacia without evidence of acute ischemia. If there is clinical concern for acute ischemia, an MRI may be considered.2. No evidence of retained intracranial metallic fragments.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Assess for epidural hematoma after epidural steroid injection last week. Signs and symptoms: Subjective right leg weakness and increased urinary frequency. Pre- and post enhanced lumbar MRI:Examination demonstrates a posterior epidural collection with mixed T2 and T1 signal intensity along the dorsal aspect of the spinal canal at L4-L5 disc level. It measures approximately 25 mm in cranial cephalad axis and 7 x 12 mm in transaxial dimensions. Finding is highly suspected of a small epidural hemorrhage. It results in subtle mass effect on the thecal sac posteriorly. On prior MRI exam from 3-20 2-15 from St. Alexius Medical Center there is also a central disc protrusion at this level with mass effect on the thecal sac which in combination with the epidural collection results in significant central spinal stenosis at this level. There is no significant neural foraminal compromise.Advanced degenerative disc disease at L4-L5 and moderate bilateral facet and ligamentum flavum hypertrophy is also noted at this level.Examination at L3-L4 demonstrate moderate disc disease, broad base bulging disc and moderate hypertrophic changes of posterior elements with resultant significant central spinal stenosis. There is no significant change of this finding since prior outside institution lumbar MRI. A tiny central disc extrusion at this level is also noted.Moderate disc disease and hypertrophic changes of posterior elements at L5-S1 as well as a small left paramedian disc protrusion without central spinal stenosis or significant neural foraminal compromise is noted. Mild degenerative changes at other levels however without central spinal stenosis.

Output: 1.At L4-L5 there is a small posterior epidural hemorrhage which in combination with a large central disc protrusion results in significant central spinal stenosis.2.At L3-L4 extensive degenerative changes also results in significant central spinal stenosis. No change since prior outside institute exam.3.At L5-S1 degenerative changes and including a left paramedian disc protrusion without spinal stenosis is present.


Instruction: Generate impression based on medical findings.

Input: 44 years, Female, headache, facial numbness and tingling. Evaluate for jugular foramen tumor. There is a 9.5 x 5.5 mm enhancing, T2 hyperintense, T1 isointense, fairly well-demarcated lesion medial and inferior to the right carotid canal, without mass effect. The surrounding bone is unremarkable. There is no restricted diffusion. The mastoid air cells are well pneumatized. The internal auditory canal and inner ears are normal in morphology and signal intensity. There is no abnormal enhancement of the facial nerve. There is a dominant right sigmoid sinus. There is no evidence of acute infarction or hemorrhage. The ventricles are within normal limits in size and configuration. Brain parenchyma is unremarkable for age. Major flow-voids are preserved

Output: Enhancing T2 hyperintense, well-demarcated lesion within the right petrous temporal bone, medial and inferior to the right carotid canal, probable cholesterol granuloma or cholesteatoma. CT of the skull base is recommended for further characterization.


Instruction: Generate impression based on medical findings.

Input: Age : 4 years Gender: Female Indication: Leg length discrepancy Please note that there may be a margin of air due to the fact that the the tibia are not parallel.Measurements are defined as follows: FEMUR -- from the top of the femoral head to the median femoral condyle, TIBIA -- from the median femoral condyle to the tibial plafond, LOWER EXTREMITY -- from the top of the femoral head to the tibial plafond.Measurements are as follows, in centimeters (cm):Left femur: 22.0 cm right femur: 21.5 cmLeft tibia: 16.0 cm right tibia: 17.0 cm Left lower extremity: 38.0 cmRight lower extremity:38.5 cmLeg length discrepancy: 0.5 cm The pelvis is normal in appearance without fracture.

Output: Please note that there may be a margin of air due to the fact that the the tibia are not parallel. Within this limitation, there is a 0.5 cm leg length discrepancy as detailed above.


Instruction: Generate impression based on medical findings.

Input: Reason: osteo? History: foot pain, h/o osteo, dm, stepped on glass Right foot: Increased erosion and deformity of the head of the first metatarsal and the base of the proximal phalanx of the great toe compatible with progression of osteomyelitis. There is adjacent soft tissue swelling and hallux valgus deformity. Second toe is amputated. Mild deformity of the second metatarsal head appears similar to prior study, and we see no progression of osteomyelitis at this location.Left foot: Laceration at the ball of the foot, but we see no underlying radiopaque foreign body. There is mild soft tissue swelling without evidence of osteomyelitis.

Output: Increased erosion and deformity of the right first metatarsal head and base of the proximal phalanx compared to prior study, indicating progression of osteomyelitis.


Instruction: Generate impression based on medical findings.

Input: 42-year-old male with headaches. Question of sigmoid sinus thrombosis. CTV of intracranial venous sinuses:65 cc of Omnipaque 350 is administered for this exam.3-D reformatted images were acquired utilizing in the dependent workstation.Axial source images, axial, coronal and sagittal 0.9 mm MIP images as well as 3-D reformatted images were obtained and utilized for interpretation of the exam.Examination demonstrates an intraluminal defect seen the left transverse sinus highly suspected of a thrombosed as was suspected on prior MRI examination. There is no definitive extension of this defect into the sigmoid sinus. The lumen of the sinus however remains patent. There is also no detectable abnormality of the left jugular bulb and visualized proximal left internal jugular vein.The confluence of sinuses, right transverse and sigmoid sinus as well as right jugular bulb and proximal dominant right internal jugular remains within normal limits. The superior sagittal sinus, inferior sagittal sinus, straight sinus, vein of Galen, bilateral internal cerebral veins and bilateral thalamostriate veins remain patent and unremarkable.Nonenhanced head CT:Examination demonstrates no evidence of intracranial edema, hemorrhage, mass-effect, midline shift or hydrocephalus.The cortical sulci, ventricular system, CSF cisterns and greater white matter differentiation remains within normal.

Output: 1.Intraluminal defect in the left nondominant transverse sinus likely result of thrombus as described. The left transverse sinus lumen is compromised however remains patent and there is no definitive evidence of thrombus within the left sigmoid sinus or the jugular bulb.2.Patent all other intracranial venous sinuses as well as visualized deep venous structures.


Instruction: Generate impression based on medical findings.

Input: 23 year old woman with double inlet left ventricle s/p Fontan, s/p coiling of innominate vein to pulmonary vein collateral vessel, and s/p SVT ablation referred for evaluation of hypoxia. Overall AnatomyDoublet inlet left ventricle s/p bidirectional Glenn shunt and Fontan procedure. There are side-by-side, malposed great vessels. The interatrial septum has been resected. The tricuspid and mitral valves both drain into the left ventricle. There is a hypoplastic right ventricle which communicates with the left ventricle via a large ventricular septal defect. The main pulmonary artery is ligated and forms a blind pouch. Systemic Venous Return (Fontan)A Glenn shunt connects the SVC to the right pulmonary artery. There is a lateral tunnel conduit connecting the IVC to the right pulmonary artery. There are no obstructions or stenoses in either the SVC or IVC. The IVC is dilated. The presence of a communication between the lateral tunnel conduit and right atrial appendage can not be excluded. The communication is suggested on the non-contrast MRA and first pass contrast imaging, but not on cine CMR or contrast enhanced MRA. Systemic Ventricle (i.e. Left Ventricle)The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 54%, the LV end diastolic volume index is 76 ml/m2 (normal range: 65+/-11), the LVEDV is 125 ml (normal range 109+/-23), the LV end systolic volume index is 35 ml/m2 (normal range 18+/-5), and the LVESV is 58 ml (normal range 31+/-10). Pulmonary Venous ReturnThere are four pulmonary veins which drain into the common atrium. There are no obvious obstructions of the pulmonary veins.Right VentricleThe right ventricle is hypoplastic.Common AtriumThe interatrial septum has been resected resulting in a common atrium. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely into the left ventricle and there is no significant mitral regurgitation.Tricuspid ValveThe tricuspid valve opens widely into the left ventricle and there is mild tricuspid regurgitation. Great VesselsThere are side-by-side, malposed great vessels. There is a left sided aortic arch with a normal brachiocephalic branching pattern. There is no thoracic aortic aneurysm or thoracic aortic dissection. The main pulmonary artery is ligated and forms a blind pouch emptying into the right ventricle. There are no proximal stenoses of the left and right pulmonary arteries. The left pulmonary artery diameter is 11mm. The right pulmonary artery diameter is 16mm.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Double inlet left ventricle with hypoplastic right ventricle s/p tunneled Fontan2. No Fontan/ Glenn obstruction. Can not rule out small communication between intra-cardiac tunnel and right atrial appendage. 3. Normal left ventricular size and systolic function (LVEF 54%). 4. Main pulmonary artery is ligated and forms blind pouch.5. Dilated inferior vena cava.6. Left pulmonary artery is 2/3 of the size of right pulmonary artery. 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: Reason: Evaluate bone metastasis in pelvis and femoral necks, concern for impending fracture History: bone metastasis in pelvis and femoral necks. BONE MARROW: Innumerable foci of signal abnormality throughout the pelvis and visualized femora compatible with extensive osseous metastases.SOFT TISSUES: No significant abnormality noted. JOINTS: No significant abnormality noted.ADDITIONAL

Output: Extensive osseous metastases involving the visualized axial and appendicular skeleton, including the femoral necks, which places the patient at risk for pathologic fractures. No evidence of pathologic fracture currently.


Instruction: Generate impression based on medical findings.

Input: Reason: RULE OUT OSTEMOMYLITITS History: BACTEREMIA AND FEVER There is no bone marrow signal abnormality to suggest osteomyelitis. There is no frank osteolysis to suggest osteomyelitis. There is peritrochanteric edema bilaterally, left greater than right. Some of this edema becomes confluent along the lateral aspect of the gluteal musculature which may represent a bursitis. No organized fluid collection is identified to suggest abscess formation. There is enhancing increased signal abnormality within the gluteal musculature bilaterally which is nonspecific but appear to correspond with foci of hypermetabolic activity on recent PET/CT examination. Note is made of enhancing lymphadenopathy in the left internal iliac region measuring 2.9 x 2.7 cm suspicious for metastatic disease. There is also right iliac lymphadenopathy measuring approximately 2.5 cm in its greatest dimension. There is associated enhancement in the surrounding area which extends to the level of the anterior aspect of the L5/S1 disc space appearing similar to the prior studies.

Output: 1. Nonspecific edema and foci of enhancement within the gluteal musculature bilaterally which appear to correspond with foci of hypermetabolic activity on recent PET/CT examination. These could represent inflammatory changes related to an infectious etiology in the correct clinical context versus metastatic disease. No drainable fluid collection is identified. No evidence of osteomyelitis. 2. Pelvic lymphadenopathy consistent with the patient's known history of metastatic disease. 3. Findings suggestive of a peritrochanteric bursitis, left greater than right. Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old, with left facial droop and memory loss. No restricted diffusion is seen. No evidence of edema or mass effect is observed. There are no large cortical defects. A small focus of apparent encephalomalacia in the right caudate head is similar to findings seen on prior CT. Numerous scattered foci of T2 hyperintensity are demonstrated within the cerebral hemispheres and pons. No findings are seen to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collections. Brain volume is relatively well-preserved. Ventricular size and morphology are also within normal limits.

Output: 1.No evidence of acute ischemia or any other definite acute intracranial abnormality.2.Findings are seen compatible with chronic microvascular and lacunar ischemic disease.


Instruction: Generate impression based on medical findings.

Input: Concern for seizure activity. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma, brainstem, cerebellum, and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift. The cerebellar tonsils extend up to 5 mm inferior to the foramen magnum. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Mildly low-lying cerebellar tonsils, but display rounded contours.


Instruction: Generate impression based on medical findings.

Input: 39-year-old female with right shoulder pain and impaired movement, history of myeloma ROTATOR CUFF: The supraspinatus appears normal. There is perhaps mild insertional tendinosis of the infraspinatus with associated cysts within the humeral head, but no discrete tear. There is also mild edema type signal along the myotendinous junction of the infraspinatus which may indicate a mild strain. Teres minor tendon is intact. There is mild intermediate signal intensity within the subscapularis tendon which may indicate a mild tendinosis, however we see no discrete tear or abnormality within the musculature.SUPRASPINATUS OUTLET: There is perhaps mild acromioclavicular joint osteoarthritis. A small amount of fluid is present within the subacromial bursa which is of questionable significance.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral alignment is within normal limits. There is a small amount of fluid within the glenohumeral joint, but no frank effusion. Evaluation of the articular cartilage is limited due to motion and a non-arthrographic study, however there appears to be degeneration of the articular cartilage along the anterior aspect of the glenoid. Given the limitations of a non-arthrographic study, the glenoid labrum appears normal.BICEPS TENDON: The biceps tendon is intact. ADDITIONAL

Output: 1.Heterogeneous bone marrow from multiple myeloma2.Mild rotator cuff tendinosis and strain of the infraspinatus, but no full-thickness rotator cuff tear is evident.3.Mild degeneration of the articular cartilage of the glenohumeral joint.4.A small amount of fluid in the subacromial bursa is of questionable significance.


Instruction: Generate impression based on medical findings.

Input: 52-year-old with a strong family history of breast cancer. The patient has a family history of breast cancer in two sisters and a maternal cousin. Minimal parenchymal enhancement is noted bilaterally. Scattered fibroglandular elements are present. Stable enhancing right retroareolar foci. No suspicious enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. Annual mammography is also due this month. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on medical findings.

Input: 61 year old with history of congestive heart failure and valvular heart disease requiring mitral and tricuspid valve surgery, COPD, CKD and coronary artery disease presenting for cardiac evaluation prior to implantable cardioverter defibrillator. Left VentricleThe left ventricle is moderately dilated with moderate-severely reduced systolic function. The overall LV ejection fraction is 36%, the LV end diastolic volume index is 108 ml/m2 (normal range: 65+/-11), the LVEDV is 188 ml (normal range 109+/-23), the LV end systolic volume index is 69 ml/m2 (normal range 18+/-5), the LVESV is 120 ml (normal range 31+/-10), the LV mass index is 81 g/m2 (normal range 67+/-11), and the LV mass is 140 g (normal range 114+/-24). The systolic dysfunction is global with regional variation. There is an apical inferior subendocardial late gadolinium enhancement (LGE) (60-80% thickness) and basal-mid anterolateral LGE (40-50% thickness) consistent with myocardial infarction. No left ventricular thrombus. Left AtriumThe left atrium is severely dilated.Right VentricleThe right ventricle is severely dilated with severely reduced systolic function. The overall RV ejection fraction is 30%, the RV end diastolic volume index is 133 ml/m2 (normal range 69+/-14), the RVEDV is 231 ml (normal range 110+/-24), the RV end systolic volume index is 93 ml/m2 (normal range 22+/-8), and the RVESV is 161 ml (normal range 35+/-13). Right AtriumThe right atrium is severely dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve is consistent with previous surgery. There is evidence of mitral regurgitation that appears valvular.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a common trunk with right innominate and left common carotid (normal variant). The aortic root is normal in size, the ascending aorta is ectatic (40 x 42 at ascending aorta, not orthogonal dimension).Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is severely dilated (40 mm). Venous AnatomyThe SVC and IVC drain normally into the right atrium. The coronary sinus is dilated. PericardiumThere is no pericardial effusion.Extracardiac FindingsThere is a stable right adrenal nodule and right hepatic calcified cyst (better characterized on previous cross-sectional imaging)

Output: 1. The left ventricle is moderately dilated with moderate-severely reduced systolic function (LVEF 36%). There is an apical inferior subendocardial and basal-mid anterolateral LGE consistent with myocardial infarction.2. The right ventricle is severely dilated with severely reduced systolic function (RVEF 30%)3. Severe Biatrial enlargement4. Dilated pulmonary artery5. Ectatic ascending aorta.


Instruction: Generate impression based on medical findings.

Input: 50-year-old male patient with left shoulder pain after breaking up a fight three days ago. Evaluate for cause of left shoulder pain. ROTATOR CUFF: There is increased signal intensity within the superior aspect of the subscapularis muscle along the myotendinous junction likely representing a muscle strain. Also, there is increased signal intensity within the superior tendons of the subscapularis which may represent interstitial tearing, but we see no discrete full-thickness rotator cuff injury. The muscles and tendons of the supraspinatus, infraspinatus, and teres minor are intact.SUPRASPINATUS OUTLET: There is prominence of the distal end of the clavicle. Trace fluid within the subacromial bursa is not necessarily of any current clinical significance.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral alignment is within normal limits. There is apparent detachment of the anterior/superior labrum from the underlying glenoid which may represent a normal variant foramen. We otherwise see no evidence of a labral tear given this nonarthrogram evaluation.BICEPS TENDON: The long head of the biceps tendon is intact and positioned normally within the bicipital groove. ADDITIONAL

Output: Strain injury of the subscapularis tendon with interstitial tearing, but no full-thickness rotator cuff tear.


Instruction: Generate impression based on medical findings.

Input: 20 year old female with severe preeclampsia status post C-section 4/16/2009. Chronic hypertension. Now complaining of visual changes in left eye. There is no evidence of intracranial hemorrhage or edema. Gray white differentiation is preserved and no midline shift or herniation is present. The pituitary is prominent (series 2 image 5). This may be a physiologic finding related to the patient's postpartum state. However, given the presence of visual symptoms, the pituitary could be more accurately imaged with MRI if clinically warranted.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.The orbits are incompletely visualized.

Output: Prominent pituitary as detailed above. If clinically appropriate, this finding could be further evaluated with pituitary protocol MRI.This finding was discussed with Dr. Rosalyn Porter at 12:00 p.m. April 20, 2009.


Instruction: Generate impression based on medical findings.

Input: History of pineal abnormality, comparison. The pineal contains cystic component that measures up to 13 mm is unchanged. This lesion again causes slight flattening of the tectal plate; however, the cerebral aqueduct remains patent. The brain parenchyma is otherwise unremarkable. The ventricles are normal in size and configuration. The skull and imaged extracranial structures are unchanged.

Output: The cystic pineal gland appears unchanged dating back to 3/2/2012.


Instruction: Generate impression based on medical findings.

Input: The patient is a 5-year-old female with history of teratoid rhabdoid tumor status post radiation. Status post VPS revision. Stable from the previous exam are craniotomy and parenchymal defects, the approximately 17 mm hyperattenuating left CP angle mass and calcification in the dentate nuclei and pons.Ventricular volumes are mildly enlarged, similar to the prior study. Right frontal shunt catheter tip terminates near midline in the right lateral ventricle. Hypoattenuation of the white matter adjacent to the ventricles could be due to transependymal edema or white matter disease secondary to treatment. A vague hyper-attenuation in the left cerebellar tonsil could be residual of the known second lesion seen on MRI. No evidence of intracranial hemorrhage. Extra-axial fluid along the posterior calvarium is unchanged.The calvaria and skull base are radiographically normal except for postsurgical changes. There is abnormal opacity in the right ethmoid and maxillary sinuses, but otherwise the visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Stable hydrocephalus and postoperative changes as described above with no evidence of intracranial hemorrhage.


Instruction: Generate impression based on medical findings.

Input: Moyamoya disease [I67.5] / Neurofibromatosis, unspecified [Q85.00], Reason for Study: ^Reason: is there any evidence of ischemia History: girl with NF1 and moyamoya and renal artery stenosis Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion.Previously recognized multifocal small, somewhat nodular and somewhat patchy high signal intensity lesions on FLAIR/T2 at bilateral internal capsules, thalami, cerebral peduncle, left inferomesial cerebellar hemisphere and right internal capsule genu appear to be stable since prior scan. There is no new abnormal signal intensity lesion seen on today's scan.The ventricles, sulci and cisterns are symmetric and unremarkable.There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. Small left parietal scalp nodule, no change in size and MR characteristics since prior scan.The midline structures and cranial-cervical junction are normal. The mastoid air cells are clear.No change of right maxillary sinus retention cyst.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate non visualization of the distal ICA beyond the level of the right ophthalmic artery origin. The right MCA appears to be reconstituted via collateral vessels but the luminal diameter of the reconstituted right MCA is very small, unchanged since prior scan. The left ICA, MCA and bilateral ACAs appear to be normal without showing any evidence of luminal irregularity.Vertebrobasilar system shows hypoplastic left distal vertebral artery, otherwise unremarkable.There is no evidence of intracranial arterial aneurysm.Bilateral Pcom arteries and Acom artery are patent.

Output: 1. Re-demonstration of multifocal parenchymal high signal intensity lesions on FLAIR/T2 images, no change since prior scan.2. No evidence of acute ischemic or hemorrhagic lesion. No new abnormal signal intensity.3. Complete occlusion of the distal right ICA with reconstitution of the right MCA via collateral vessels, no change since prior scan. Unremarkable left ICA, bilateral ACAs, left MCA and vertebrobasilar system.


Instruction: Generate impression based on medical findings.

Input: Headache. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear 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, and scalp soft tissues are grossly unremarkable. There is moderate right sphenoid and posterior ethmoid sinus, as well as left maxillary and anterior ethmoid sinus mucosal thickening.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Inflammatory mucosal disease involving the right sphenoid and posterior ethmoid sinuses, as well as left maxillary and anterior ethmoid sinuses.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Multiple sclerosis. Please perform dedicated multiple sclerosis protocol (Dr.Javed). Signs and symptoms: Tremor, fatigue and paresthesia. Pre and post enhanced brain MRI:There are no prior exams for comparison.Examination demonstrates normal anatomical development, morphology and signal intensity of brain parenchyma on all acquired MRI sequences. There is no finding to suggest demyelinating disease. Post contrast images demonstrate no detectable abnormal parenchymal or leptomeningeal enhancement.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells.

Output: Negative pre and post enhanced brain MRI utilizing dedicated multiple sclerosis protocol.


Instruction: Generate impression based on medical findings.

Input: History of craniotomy for Chiari malformation. There are postsurgical changes of a suboccipital craniectomy and C1 laminectomy for decompression. The CSF spaces at the ventral and dorsal foramen magnum remain widely patent. Again seen is a retrocerebellar CSF intensity collection, not significant changed in size. CSF flow sequence demonstrates biphasic flow at the foramen magnum as well as some continuity of flow at the dorsal foramen magnum into the retrocerebellar CSF space. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few punctate foci of increased T2/FLAIR signal within the periventricular white matter which are nonspecific but not significantly changed when accounting for differences in technique. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is minimal patchy mucosal thickening within the paranasal sinuses. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: 1. Post-surgical changes of suboccipital craniectomy and C1 laminectomy for Chiari decompression .2. Biophysical CSF flow at the foramen magnum which appears to communicate with the prominent retrocerebellar CSF space, not significantly changed in appearance.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Rule out CVA. Signs and symptoms: Slurred speech and facial tube. Nonenhanced CT of brain:Findings consistent with extensive small vessel disease of indeterminate age is noted. There is no evidence of acute intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus. No evidence of acute cortical stroke is detected. Prominence of cortical sulci and ventricular system is concerning for underlying volume loss. Follow-up with an MRI is recommended.Calvarium, visualized paranasal sinuses, mastoid air cells and middle cavities are unremarkable.

Output: 1.Small vessel disease of indeterminate age.2.No evidence of acute cortical stroke or hemorrhage.3.Calvarium, paranasal sinuses and mastoid air cells are pneumatized and unremarkable.


Instruction: Generate impression based on medical findings.

Input: Hemangioma of intracranial structures [D18.02], Reason for Study: ^Reason: 3T scanner, qsm/permeability History: Known CCM disease w prior bleeding, intermittent vision changes "upside down", vertigo There are multifocal various sized susceptibility lesions on bilateral cerebral hemispheres, bilateral cerebellar hemispheres and brainstem.There is no MR evidence of surrounding edema of those lesions. There is no evidence of abnormal contrast enhancement. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Multifocal bihemispheric, supra and infratentorial scattered various sized susceptibility artifacts indicating multiple cavernous malformations.2. There is no evidence of surrounding edema, no mass effects.3. There is no evidence of abnormal enhancement.


Instruction: Generate impression based on medical findings.

Input: 68-year-old male with pain since 2008, occasional trigger. Evaluate for tenosynovitis or mass of the left thumb There is a multilobulated collection of near fluid signal intensity at the level of the base of the first and second metacarpals, deep to the first dorsal interosseous muscle, either within or along the dorsal surface of the adductor pollicis, adjacent to the dorsal carpal branch of the radial artery, measuring 8 x 5 mm in the transverse dimension and 14 mm in the craniocaudal dimension. We suspect that this represents a ganglion. Proximally, the mass abuts the base of the first metacarpal and tapers distally. The signal intensity of the bone itself is normal. The tendons, including that of the flexor pollicis longus appear normal. We see no findings to suggest a pulley tear.

Output: Small multilobulated mass adjacent to the radial aspect of the base of the second metacarpal likely representing a ganglion. The tendons appear normal.


Instruction: Generate impression based on medical findings.

Input: Male 16 years old Reason: f/u OCD lesion s/p microfracture History: pain MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: There are postsurgical changes related to prior microfracture within the articular cartilage of the lateral femoral condyle, above the anterior horn of the lateral meniscus, with associated new cartilage formation.LIGAMENTS: The posterior and anterior cruciate ligaments are intact. The medial collateral ligament and lateral collateral ligament complex are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Postoperative findings related to prior microfracture for an osteochondral defect in the lateral femoral condyle as detailed above.


Instruction: Generate impression based on medical findings.

Input: 45-year-old female with stage IV ovarian cancer. Evaluate for clinical trial. Is there measurable disease? Is there sites of disease that can be safely biopsied twice?Per outside report, clinical history ofPET avid area to left iliopsoas. Patient with history of recurrent ovarian cancer. ABDOMEN:LIVER, BILIARY TRACT: Within the left lobe of the liver, there is a peripheral enhancing lesion measuring 1.8 x 1.5 cm (series 17 image 27) that demonstrates restricted diffusion and FDG avidity on outside PET. Additional peripheral enhancing lesion lesion along the gallbladder fossa measures 1.1 x 1.1 centimeters (series 17 image 42) also demonstrates restricted diffusion FDG avidity on outside PET. Focus of arterial enhancement in segment 3 likely represents a flash filling hemangioma.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Omental and mesenteric nodules in the left abdomen compatible with carcinomatosis. Nodule that demonstrated FDG avidity on outside PET measures 1.4 x 0.8 cm (series 19 image 45).BONES, SOFT TISSUES: Enhancing nodule adjacent to the left iliopsoas muscle measures 1.2 x 1.1 cm (series 23 image 47) and is PET avid on outside PET. Additional enhancing nodule lateral to the left iliopsoas muscle (series 23 image 38). OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Postsurgical changes of hysterectomy and bilateral salpingo-oophorectomy. BLADDER: No significant abnormality noted.LYMPH NODES: Ill defined soft tissue nodularity anterior to the rectum compatible with carcinomatosis. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Hepatic lesions suspicious for metastases.2.Omental and mesenteric nodularity in the abdomen and pelvis suspicious for carcinomatosis.


Instruction: Generate impression based on medical findings.

Input: MRI BRAIN: This exam is mildly degraded by motion artifact. Regions of cortical, subcortical, and deep white matter diffusion restriction within the bilateral cerebral hemisphere watershed zones, right more than left, have decreased in size as has the associated T2 hyperintensity. Patchy gyriform enhancement in these areas persists but with developing intrinsic gyriform T1 hyperintensity suggesting laminar necrosis. The dominant region of abnormality within the right occipital, inferior parietal lobule, and posterior temporal regions demonstrates mildly improved diffusion cortical and subcortical restriction and minimally worsened associated T2 hyperintensity that extends to involve the right forceps major. T2 hyperintensity within the posterior medial right thalamus is unchanged. There is increased patchy gyriform enhancement in the regions of signal abnormality compared to the prior exam. The contrast bolus was not of optimal quality, and therefore, the perfusion data may not be entirely reliable. Evidence of largely sulcal elevated rCBV is seen which may reflect vasodilatation and luxury perfusion.There is no evidence of intracranial hemorrhage. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is unchanged fluid within the bilateral mastoid air cells. MR SPECTROSCOPY: The dominant right occipital lesion was interrogated with single voxel spectroscopy performed at multiple TEs. These show a marked lactate peak, significantly decreased NAA, and mildly increased choline relative to the contralateral lobe.

Output: Continued evolution of subacute, possibly watershed, infarcts involving the cerebral hemispheres, right side more than left.Evolving parenchymal abnormality within the right occipital and posterior temporal lobes which is highly likely to represent ischemic injury. This is supported by the distribution which conforms to the PCA territory (including posterior thalamic involvement), as well as MR spectroscopy showing a pronounced lactate presence indicating anaerobic respiration. No findings are seen to suggest an aggressive or highly proliferative process.The underlying etiology for these suspected ischemic lesions is not entirely clear. As above, the high cerebral lesions seem to show a watershed pattern while the right temporo-ccipital lesion appears to be territorial. These could reflect a combination of hypoperfusion and thromboembolic disease. Vasculitis or a PRES-like phenomenon can also be considered. An underlying inflammatory process is felt to be less likely.


Instruction: Generate impression based on medical findings.

Input: Patient with known left shoulder mass. There is destruction of the scapula and a subglenoid lucency, consistent with destructive involvement by patient's known soft tissue tumor. Please refer to the MRI from 2/29/2016 for further characterization. Patient bones appear demineralized. There are degenerative changes at the AC joint.

Output: 1.Subglenoid lucency, consistent with scapular destruction, suggestive of involvement by patient's known soft tissue tumor.2.Degenerative changes at the AC joint.


Instruction: Generate impression based on medical findings.

Input: Slit ventricle syndrome: headaches. There is a right transparietal shunt catheter that terminates in the posterior third ventricle. Artifact related to the catheter reservoir obscures surrounding anatomy. There is also a right transfrontal catheter that terminates in the right frontal lobe. The third and lateral ventricles are diminutive, with relative prominence of the bilateral temporal horns, but unchanged in size. The fourth ventricle is unremarkable. There are minimal nonspecific punctate foci of T2 hyperintensity in the cerebral white matter. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. There is microcephaly. The orbits, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Unchanged diminutive appearance of the shunted supratentorial ventricular system, with relative prominence of the bilateral temporal horns, which can be a manifestation of slit ventricle syndrome.2. No evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on medical findings.

Input: Reason: Rule out internal derangement History: left knee swelling, popping, buckling MENISCI: There is a horizontal cleavage tear through the posterior horn of the lateral meniscus. The medial meniscus appears grossly intact.ARTICULAR CARTILAGE AND BONE: There are focal full-thickness defects of the articular cartilage of the medial facet of the trochlea with underlying increased T2 signal, consistent with a degenerative subchondral cyst. There are similar changes along the articular surface of the lateral tibial plateau. There is T1 hypointense signal throughout the distal femoral and proximal tibial metaphysis, consistent with residual red marrow.LIGAMENTS: The ACL, MCL, PCL, and LCL are intact. EXTENSOR MECHANISM: The quadriceps and patellar tendons are intact.ADDITIONAL

Output: Horizontal cleavage tear of the posterior horn of the lateral meniscus and degenerative changes as described above.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Recent seizure activity. Signs and symptoms: Left head/neck colonic/thymic movement. Pre and post enhanced brain MRI:Negative diffusion weighted series.Examination demonstrates diffuse periventricular and to a lesser degree subcortical foci of FLAIR and T2 hyperintensity in bilateral cerebral hemispheres. Similar signal changes are also noted in bilateral basal ganglia and thalami. Although nonspecific considering patient's stated age of 77 findings also are present microvascular ischemic changes. There is no evidence of hemorrhagic changes with the findings. Small foci of chronic left cerebellar ischemic stroke in the distribution of left superior cerebellar artery is also noted.There is mild prominence of cortical sulci and the ventricular system which likely represent mild underlying parenchymal volume loss considering patient's stated age.No convincing evidence of cortical signal abnormality. No evidence of mass effect, midline shift or hydrocephalus.The signal void of major intracranial arterial branches are identified.Post contrast images demonstrate no detectable abnormal enhancement of brain parenchyma or the leptomeninges and no enhancement of the calvarium or the retro-orbital spaces.There is exuberant pneumatization of paranasal sinuses and including extensive pneumatization of frontal bones/frontal sinuses with multiple patchy foci of mucosal thickening and retention cysts.

Output: 1.No acute intracranial process.2.Findings suggestive of chronic nonhemorrhagic small vessel ischemic strokes of moderate degree and a small chronic left cerebellar ischemic stroke as detailed.3.No detectable abnormal parenchymal, leptomeningeal, calvarial or orbital enhancement.4.Exuberant pneumatization of paranasal sinuses with extensive pneumatization of frontal bones with multiple foci of mucosal thickening and retention cysts.


Instruction: Generate impression based on medical findings.

Input: 32 year old male with history of asymptomatic left ventricular dysfunction thought to be secondary to chemotherapy for Stage IV neuroblastoma at the age of 4 (treated with chemotherapy, radiation and BMT). Left VentricleThe left ventricle is normal in size with mildly reduced left ventricular systolic function. The overall LV ejection fraction is 51%, the LV end diastolic volume index is 63 ml/m2 (normal range: 74+/-15), the LVEDV is 107 ml (normal range 142+/-34), the LV end systolic volume index is 31 ml/m2 (normal range 25+/-9), the LVESV is 53 ml (normal range 47+/-19), the LV mass index is 34 g/m2 (normal range 85+/-15), and the LV mass is 58 g (normal range 164+/-36). The left ventricular dysfunction is global with regional variation. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 60%, the RV end diastolic volume index is 62 ml/m2 (normal range 82+/-16), the RVEDV is 104 ml (normal range 142+/-31), the RV end systolic volume index is 24 ml/m2 (normal range 31+/-9), and the RVESV is 42 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 trace significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal left ventricular size with mildly reduced systolic function (LVEF 51%). The systolic dysfunction is global and there is no evidence of late gadolinium enhancement to suggest scar or fibrosis. 2. Normal right ventricular size with normal systolic function (RVEF 60%).


Instruction: Generate impression based on medical findings.

Input: 60-year-old female patient with multiple vertebral fractures and focal pain in lumbar and thoracic spine. History of multiple myeloma. Thoracic Spine: Note that the patient has 11 thoracic type vertebrae and a transitional S1 vertebra. There is high T2 and T1 hyperintense lesion in T12 with peripheral enhancement and at least 50% compression deformity with slight focal kyphosis, but no significant retropulsion or neural foramen stenosis. There is diffusely abnormal signal within the bone marrow of the rest of the thoracic vertebral column and with multiple small foci of enhancement, but no evidence of associated pathological fractures elsewhere in the thoracic spine. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. There is a septated left renal cyst. Lumbar Spine: There is an unchanged compression fracture of the L1 vertebral body with circumferential cortical step offs and cleft without significant spinal stenosis or neural foraminal compromise. There is unchanged compression fracture of L2 vertebrae with considerable loss of height and approximately 5 mm of retropulsion of the posterior vertebral body as well as contiguous disc material into the spinal canal with focal kyphotic angulation, but no significant spinal stenosis or neural foraminal compromise. The other lumbar vertebrae display heterogeneous signal characteristics, but no evidence of pathologic fracture. There is mild multilevel degenerative spondylosis in the lower lumbar spine and mild lumbosacral epidural lipomatosis without significant spinal stenosis or neural foraminal compromise.

Output: Diffuse involvement of the imaged axial skeleton by multiple myeloma with no significant change in the pathological fractures involving the T12, L1, and L2 vertebrae, but no evidence of spinal cord or cauda equina compression.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old, with a hamartoma with meningothelial elements in the right frontoparietal scalp. Evaluate for underlying meningioma with extracranial extension. An area of subcutaneous thickening is seen in the high right parietal scalp which appears to be composed of both fatty and scarlike tissue. The lesion enhances on postcontrast images and demonstrates restricted diffusion. The bone immediately deep to the scalp lesion is mildly thickened with irregular margins and is somewhat heterogeneously low in signal intensity. There may be very mild marrow enhancement, best appreciated on sagittal T1 postcontrast images (image 9 series 12). The extracranial periosteum is slightly thickened and enhancing as well.No evidence of any intracranial mass or pathologic enhancement is seen including in the high right parietal area. No edema or mass effect is detected. A few scattered small foci of T2 hyperintensity in the cerebral hemispheres are nonspecific. No findings are seen to indicate intracranial hemorrhage or any abnormal extra-axial fluid. Ventricular size and morphology are within normal limits.

Output: An area of subcutaneous scalp thickening is seen in the high right parietal region likely indicating the site of the biopsied/excised lesion. The bone immediately deep to the lesion is thickened with irregular margins and perhaps minimal marrow enhancement. While these findings are by no means specific, they can be seen in the context of intraosseous meningioma, which could potentially account for the meningothelial elements on histology. If further evaluation is warranted, a CT examination can be considered to better evaluate the bony features. No evidence of any intracranial meningioma is seen.


Instruction: Generate impression based on medical findings.

Input: Reason: 54 yo M hx of IPMN, last viewed on EUS in July 2015. 1 year follow up MRI/MRCP. Also eval pancreatic parenchyma and PD as there has been atrophy in past on imaging History: ipmn ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter hepatic cysts are unchanged.SPLEEN: No significant abnormality noted.PANCREAS: T2 hyperintense lesion within the pancreatic body which communicates with the main pancreatic duct measures 6 mm, similar in size and appearance to the exam from 12/17/2014. No abnormal enhancement.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable right renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Cystic lesion in the pancreatic body is stable and likely represents a side branch IPMN.


Instruction: Generate impression based on medical findings.

Input: 31-year-old female with biopsy proven right breast fibroadenoma (4/21/15), underwent a research MRI that demonstrated 15-mm mass in the right breast 8 o'clock position and 9-mm mass in the left breast 10 o'clock position for which a second look ultrasound is recommended. A targeted bilateral breast ultrasound was performed. Right breast 8 o'clock position and there is an oval parallel oriented hypoechoic mass with lobulations, very similar in morphology to the previously biopsied fibroadenoma in the right breast 12 o'clock position. This mass measures 1.4 x 0.7 x 1.3 cm and most likely corresponds to the finding seen on MRI.In the left breast 10 o'clock position, there is an oval parallel oriented hypoechoic mass measuring 7 x 4 x 8 mm, most likely corresponding to the finding seen on MRI. Both these lesions most likely represent benign fibroadenomas.

Output: Two benign morphology masses, in the right breast 8 o'clock position, and left breast 10 o'clock position, corresponding to the finding seen on MRI. Both these lesions most likely represent benign fibroadenomas. Follow-up right breast ultrasound and bilateral breast research MRI is recommended in 6 months to confirm stability.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months).


Instruction: Generate impression based on medical findings.

Input: Evaluate for lesions in hypothalamus: Progressively worsening cataplexy and sleep paralysis x 6 months. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is susceptibility effect in the bilateral globi pallidi. There is encephalomalacia in the anterior right frontal lobe. Thre is minimal periventricular white matter T2 hyperintensity. 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 are grossly unremarkable. There are secretions within the right frontal sinus.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. In particular, the hypothalami appear unremarkable. 2. Encephalomalacia in the anterior right frontal lobe may be related to prior trauma.3. Nonspecific mineralization in the bilateral globi pallidi.4. Secretions within the right frontal sinus may represent acute sinusitis.


Instruction: Generate impression based on medical findings.

Input: History of GBM status post RT and TMZ. Left parieto-occipital craniotomy changes related to prior resection of tumor are redemonstrated. Overall, there is further contraction of the resection cavity. Multifocal peripherally enhancing left parieto-occipital lobe lesions are again seen as well as small enhancing nodules. A more inferolaterally located cystic ovoid component with peripheral enhancement demonstrates interval resolution of internal T1 signal, likely related to resolved blood products within the lesion. There appears to be overall decreased nodular enhancement involving the lesions, particularly involving the most inferior lesion. There is increased enhancement extending along the ependyma of the posterior horn of the left lateral ventricle (series 1403, image 81). There is overall slightly increased craniocaudal extent of T2/FLAIR signal as well as new signal extending along the splenium of the corpus callosum towards the midline. Perfusion images demonstrated slightly increased vascularity involving the largest component of the lesion. No new intra or extra-axial fluid collections are visualized. No midline shift is appreciated. There is no evidence for acute ischemia.

Output: 1. Multifocal left parietal occipital peripherally enhancing lesions overall demonstrate slight decreased central enhancement and nodularity with further contraction of the resection cavity.2. There is slight increased anterior extension of ependymal enhancement involving the posterior horn of the left lateral ventricle.3. Slight increased extent of FLAIR hyperintensity in the left cerebral white matter, which may be post-treatment related given relative hypoperfusion.3. Evolved blood products in small oval cystic cavity.


Instruction: Generate impression based on medical findings.

Input: 44 years, Female, follow-up of a left retrocerebellar arachnoid cyst. Again seen is a left posterior fossa CSF signal lesion measuring approximately 7.0 x 3.3 x 5.5 cm (TV x AP x CC), which is unchanged when measured with a similar technique. Mild associated mass effect on the adjacent cerebellum. Mild scalloping of the occipital calvarium is also again noted. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. Unchanged 4 mm pineal cyst. No suspicious intracranial mass. The ventricles are within normal limits in size and configuration. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: Compared to outside MRI from 12/2/2013, left retrocerebellar arachnoid cyst is unchanged.


Instruction: Generate impression based on medical findings.

Input: Female 65 years old Reason: chronic abdominal pain, r/o biliary etiology ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. Dilated common bile duct measuring 1.5 cm in maximum transaxial dimension (series 9, image 36). At least two filling defects identified within the distal common duct. The largest measures 1.0 x 0.9 cm (series 9, image 29).SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: T2 hyperintensities within the kidney consistent with simple cysts.RETROPERITONEUM, LYMPH NODES: Plaque within the abdominal aorta is poorly evaluated on this study.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Status post cholecystectomy. Choledocholithiasis with dilatation of the upstream common duct.


Instruction: Generate impression based on medical findings.

Input: 64 year-old female history of left hepatectomy for multiple hepatic adenoma now with elevated alkaline phosphatase and fever. The study is limited due to patient motion.ABDOMEN:LIVER, BILIARY TRACT: Status post recent extended left hepatectomy and segment 6 segmentectomy with adjacent surgical drain present. Small amount of perihepatic ascites. No drainable fluid collections. No intra or extra hepatic biliary ductal dilatation.Scattered, smaller, presumed hepatic adenomas, are grossly unchanged compared to the prior CT.Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: 8 mm cystic lesion at the body/head junction likely represents an IPMN. Additional similar appearing cystic focus present near the inferior aspect of the uncinate process measuring 6 mm.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small right pleural effusion with associated basilar atelectasis/consolidation. Mild subsegmental atelectasis left lower lobe. Anasarca.

Output: 1. Postoperative changes in the liver as above with no evidence of drainable fluid collections. Small volume ascites.2. No intra or extrahepatic biliary ductal dilation.3. Small right pleural effusion and basilar atelectasis/consolidation.4. Small hepatic lesions presumably representing adenomas are unchanged from prior CT.5. Two small cystic lesions in the pancreas as above likely representing IPMNs.


Instruction: Generate impression based on medical findings.

Input: Female 87 years old with a 22mm x 14mm mass in pancreatic head biopsy with EUS 5/25/16. Needle aspiration indicated high-grade neuroendocrine tumor. Evaluate for pancreatic mass. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in size and morphology. There is no suspicious, enhancing hepatic lesion. The hepatic vasculature is patent. Please note that the right hepatic artery arises from the SMA.The gallbladder is collapsed. There is no intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: The tail of the pancreas is atrophic. There is a 20 x 19 mm round, T2 hyperintense, avidly arterially enhancing lesion at the junction of the pancreatic head and uncinate process (series 12, image 134). The pancreatic duct is not dilated. The pancreatic duct crosses the common bile duct suggesting pancreas divisum.ADRENAL GLANDS: Mild nodular thickening of the left adrenal gland is nonspecific.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: There is a prominent right retrocrural lymph node within normal appearing fatty hilum. No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.29 x 19 mm enhancing lesion in the uncinate process of the pancreas is consistent with history of a pancreatic neuroendocrine tumor. 2.No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: There is no suspicious intracranial enhancement, acute infarct, mass, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: No MRI findings to explain the patient's severe headaches.


Instruction: Generate impression based on medical findings.

Input: 61-year-old female with left knee pain for one year, pain is medial. History of breast cancer. Evaluate for meniscal tear versus chondral injury. MENISCI: There is linear increased signal abnormality within the posterior horn of the medial meniscus which extends to the tibial and femoral articular surfaces consistent with a complex tear, with a horizontal component, that extends into the body of the meniscus. The anterior horn appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is full-thickness articular cartilage degeneration along the medial femoral condyle, posteriorly, with a small amount of degenerative underlying subchondral signal abnormality. There is subjective thinning of the articular cartilage the medial and lateral tibiofemoral compartments. There is partial-thickness articular cartilage degeneration along the medial facet of the patella. There are tiny tricompartmental osteophytes.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Tearing of the medial meniscus as described above.2. Small joint effusion and Baker's cyst.3. Articular cartilage degeneration as described above. Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Limited images the brain were acquired per the Stealth protocol. There is no evidence of intracranial mass. There are no areas of abnormal parenchyma signal or enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The sella is again partially empty. There is protrusion of the bilateral optic nerve discs as well as mild posterior flattening of the globes. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: Examination for treatment planning. No intracranial mass or abnormal lesions along the expected tract of the ventriculostomy catheter. Findings suggestive of pseudotumor cerebri.


Instruction: Generate impression based on medical findings.

Input: Again seen are postsurgical changes of prior posterior fossa and upper cervical decompression for Chiari malformation with low-lying cerebellar tonsils again noted. Again seen is extensive T2 signal abnormality involving the right central and dorsal cervical cord from C2 to the C7 level. There is also a associated prominence of the central canal which extends to the lower T1 level on the axial T2 sequence. Overall appearance of the signal abnormality is unchanged since 4/27/2009.Cervical spine alignment is unchanged with reversal of cervical lordosis and mild retrolisthesis of C4 on C5. Bone marrow signal is benign. The vertebral body heights are preserved. No abnormal enhancement. Degenerative changes are specified by the intervertebral level as follows: C2-C3: Minimal disc osteophyte complex without spinal canal stenosis or neural foraminal compromise is identified. C3-C4: Small disk osteophyte complex with mild narrowing of the spinal canal and effacement of the ventral thecal sac.C4-C5: Small disk osteophyte complex with effacement of the ventral thecal sac. There is also ligamentum flavum buckling narrowing the dorsal thecal sac which appears slightly worse than prior. Minimal right foraminal narrowing, otherwise no significant neural foramina stenosis. C5-C6: Disk-osteophyte complex without significant spinal canal or neural foramina stenosis.C6-C7: Small disk osteophyte complex without significant spinal canal or neural foramina stenosis.C7-T1: No central canal stenosis or neural foraminal compromise.

Output: 1.No significant change in extensive right cervical cord myelomalacia with small adjacent syrinx.2.Multilevel degenerative changes as detailed above with mild spinal canal stenosis at C3-C4 and C4-C5 which is minimally worse at the C4-C5 level compared to 4/27/2009. No high-grade spinal canal or neural foramina stenosis.3.Postoperative changes of suboccipital and upper cervical decompression for Chiari malformation.