Instruction: Generate impression based on medical findings.

Input: Contrast opacified the radiocarpal articulation in the expected fashion. Contrast extended into the midcarpal joint initially via a defect in the lunotriquetral ligament. With gentle manipulation of the wrist, communication of contrast between the radiocarpal and midcarpal joints was also noted via the scapholunate interval; however, I suspect that this communication is of limited significance, as the dorsal component of the scapholunate ligament appears intact on preliminary review of the MR images. No contrast extended into the distal radioulnar joint indicate a triangular fibrocartilage tear. Please refer to the subsequent MRI report for further information.Exposure time: Three minutes and 14 seconds

Output: Tears of the lunotriquetral and scapholunate ligaments as described above, of questionable clinical significance.


Instruction: Generate impression based on medical findings.

Input: Recent TIA with aphasia. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild patchy cerebral white matter T2 hyperintensity, which is nonspecific, but may represent chronic small vessel ischemic disease. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are bilateral lens implants.

Output: Probable mild chronic small vessel ischemic disease, but no evidence of acute infarction, intracranial hemorrhage, or mass.


Instruction: Generate impression based on medical findings.

Input: Wrist pain and contralateral Kienböck's malacia. LIGAMENTS: Limited view of the ligament complexes of the carpal bones are seen without intra-articular contrast. Within this limitations, no specific evidence of ligamentous injury.TRIANGULAR FIBROCARTILAGE COMPLEX: No significant abnormality noted.TENDONS: The tendons appear intact without signal change or significant edema.BONES: There is minimal negative ulnar variance. The lunate demonstrates tiny proximal degenerative cysts without edema or specific evidence of osteonecrosis. There is mild medial subluxation of the lunate.ADDITIONAL

Output: Minimal negative ulnar variance with degenerative lunate cysts yet no specific radiographic evidence of avascular necrosis.


Instruction: Generate impression based on medical findings.

Input: Reason: Alzheimer's disease No abnormal signal is seen on the T2, FLAIR or diffusion weighted images. There is no evidence of intracranial hemorrhage, mass or edema. Since the prior exam, there has been mild interval increase in symmetric dilatation of the occipital and temporal horns of the lateral ventricles bilaterally as well as the third ventricle. The cortical sulci of the medial temporal lobes appear more prominent, predominantly in the region of the sylvian fissure and hippocampus, consistent with some interval volume loss.

Output: Progressive symmetric bi-temporal lobe atrophy, consistent with reported history of Alzheimer's dementia.


Instruction: Generate impression based on medical findings.

Input: 20-year-old female with a history of a pelvic desmoid tumor, currently being treated with tamoxifen. PELVIS: Again seen is an ill-defined infiltrating mass in the left hemipelvis which has increased in size compared to the prior examination. The mass measures 9.6 x 7.3 cm (series 14, image 81), previously 9.5 x 6.6 cm. It continues to encase the left external iliac artery. The mass invades and occludes the left external iliac vein with collaterals again identified. Anteriorly, the mass invades largest left rectus muscle and adductor brevis. Laterally, the mass invades the left pelvic sidewall, iliacus muscle, psoas muscle, and abuts the left acetabular cortex. Posteriorly, the mass extends into the obturator internus muscle. Medially, the mass abuts the left lateral bladder wall and multiple loops of bowel. There is increased extension into the perirectal area and probable increased extension/invasion into the left psoas muscle. UTERUS, ADNEXA: No significant abnormality noted. BLADDER: The urinary bladder is displaced to the right. LYMPH NODES: No significant abnormality noted. BOWEL, MESENTERY: No significant abnormality noted. BONES, SOFT TISSUES: No significant abnormality noted.

Output: Increase in size and extent of the left pelvic desmoid tumor.


Instruction: Generate impression based on medical findings.

Input: 31-year-old male with L1 compression fracture There is normal lumbar lordosis. Multilevel superior and inferior endplate undulation with multiple Schmorl's nodes with sclerotic margins. Unusually large lucency of the L5 vertebral body with well defined margins extending from the intravertebral disk and associated with L5 superior endplate depression most likely representing a large Schmorl's node. Minimal anterior wedging of T12 and L1 vertebral bodies is noted. Otherwise the pedicles, lamina, facets, and posterior elements are intact without evidence of fracture or subluxation. At the level of the L5-S1 there degenerative disk disease with posterior disk bulge to the right of the midline causing moderate neuroforamina narrowing.Otherwise there is no significant neuroforaminal narrowing on the lumbar spine.The thecal sac and spinal cord are preserved with no evidence of spinal canal stenosis. The paraspinal and prevertebral soft tissues are unremarkable.

Output: 1.Findings compatible with Scheuermann's disease no acute fractures identified.2.L5-S1 degenerative disk disease with moderate right neuroforaminal narrowing.


Instruction: Generate impression based on medical findings.

Input: Squamous cell carcinoma of the left base of tongue, T1N2b, status post radiation and chemotherapy. There are recent postoperative findings in the left oropharynx, without evidence of gross residual tumor in the tongue base. There is decrease in size of the left level 2 lymphadenopathy, measuring up to 7 x 9 mm, previously 10 x 11 mm in axial cross-section. The right cervical lymph nodes are unchanged. There is herniation of the left sublingual gland through a mylohyoid defect. The other salivary glands are unremarkable. There is scattered paranasal sinus mucosal thickening. There is mild multilevel degenerative cervical spondylosis. The orbits and imaged intracranial structures are grossly unremarkable.

Output: 1. Postoperative findings in the left oropharynx, without evidence of gross residual tumor.2. Decreased left cervical lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: 63-year-old male, rule out rotator cuff tear ROTATOR CUFF: The patient is status post rotator cuff repair. There is full thickness near full width tearing of the distal supraspinatus with retraction of the undersurface fibers to the level of the glenoid. Some fibers of the supraspinatus remain attached to the greater tuberosity. The tear of the anterior aspect of the tendon measures approximately 1.2 cm in AP dimension and of the posterior aspect of the tendon measures 1.4 cm (images 19 and 17, series 8). There is mild to moderate supraspinatus muscle atrophy. Increased signal intensity within the supraspinatus and infraspinatus fibers within the supraspinatus outlet is compatible with tendinosis. There is mild infraspinatus muscle atrophy. The teres minor and subscapularis muscles and tendons are intact.SUPRASPINATUS OUTLET: An os acromiale is noted with mild to moderate AC joint osteoarthritis.GLENOHUMERAL JOINT AND GLENOID LABRUM: Evaluation of the labrum is limited, but there appears to be degeneration of the labrum with degenerative tearing anteriorly.BICEPS TENDON: Status post biceps tenodesis.ADDITIONAL

Output: 1. Full thickness, near full width tear of the supraspinatus tendon with retraction of the undersurface fibers to the level of the glenoid.2. Degeneration and tearing of the labrum as described above.3. Moderate distention of the subacromial subdeltoid bursa, containing debris.4. Os acromiale.


Instruction: Generate impression based on medical findings.

Input: 65 year old man with prior myocardial infarction referred to evaluate for ischemia and viability.MEDICATIONS: simvastatin, atenolol, aspirin, enalapril, omega 3 supplements. First Pass PerfusionDuring hyperemia, perfusion defects corresponding to the below described transmural myocardial infarctions were noted in the basal anterior and anteroseptal walls, mid anterior and anteroseptal walls, and the apical inferior, anterior, and septal walls (i.e LAD territory). Additionally, perfusion defects independent of scar representing mild residual ischemia were seen in the mid anterolateral walls and the apical lateral wall (i.e. LCx territory). Viability/ Myocardial ScarThere is a large transmural myocardial infarction (i.e. late gadolinium enhancement) with associated fatty replacement involving the basal anterior and anteroseptal walls, the mid anterior and anteroseptal walls, and the apical anterior, septal, and inferior walls). These segments (LAD territory) are unlikely to be viable. The remainder of the myocardium (i.e. LCx and RCA territory) is free of myocardial infarction and is likely to be viable. Left VentricleThe left ventricle is normal in size with normal systolic function with regional wall motion abnormalities as described below. The overall LV ejection fraction is 64%, the LV end diastolic volume index is 77 ml/m2 (normal range: 74+/-15), the LVEDV is 151 ml (normal range 142+/-34), the LV end systolic volume index is 28 ml/m2 (normal range 25+/-9), the LVESV is 55 ml (normal range 47+/-19), the LV mass index is 57 g/m2, and the LV mass is 110 g. There is hypokinesis of the entire anterior wall and the anteroseptal wall. There is also hypokinesis of the apical inferior wall.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 76%, the RV end diastolic volume index is 74 ml/m2 (normal range 82+/-16), the RVEDV is 143 ml (normal range 142+/-31), the RV end systolic volume index is 18 ml/m2 (normal range 31+/-9), and the RVESV is 34 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. There is a transmural infarction involving much of the LAD territory and it is unlikely to be viable.2. There is mild ischemia in the LCx territory and is likely to be viable.3. Normal LV size and systolic function (LVEF 64%). There is hypokinesis of the the entire anterior and anteroseptal walls and the apical inferior wall.4. Normal RV size and systolic function (RVEF 76%).5. Mild dilation of the left atrium.


Instruction: Generate impression based on medical findings.

Input: There is no evidence of acute infarct. There are multiple patchy foci of T2 hyperintensity within the supratentorial and infratentorial white matter that are most compatible with chronic small vessel ischemic disease. There are also a few small foci of T2 hyperintensity and enhancement with minimal associated susceptibility effect in the left cerebellar hemisphere.There is an ectatic distal intracranial right vertebral artery that makes a prominent impression upon the right aspect of the medulla of doubtful clinical significance. The major cerebral flow voids are intact. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation.

Output: 1.No evidence of acute infarct, however, a few patchy foci of signal abnormality and enhancement within the left cerebellar hemisphere are most compatible with subacute lacunar infarcts. A follow-up MRI in 8 weeks may be helpful to ensure resolution of enhancement as clinically indicated.2.Supratentorial and infratentorial chronic small vessel ischemic disease.


Instruction: Generate impression based on medical findings.

Input: 72 year old woman with history of coronary artery disease who presents with chest pain and shortness of breath. Patient presents for cardiac MRI to evaluate for myocardial ischemia.MEDICATIONS: carvedilol, furosemide, lisinopril, simvastatin First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. Left VentricleThe left ventricle is mildly dilated with moderately reduced systolic function. The overall LV ejection fraction is 43 %, the LV end diastolic volume index is 96 ml/m2 (normal range: 65+/-11), the LVEDV is 210 ml (normal range 109+/-23), the LV end systolic volume index is 54 ml/m2 (normal range 18+/-5), the LVESV is 118 ml (normal range 31+/-10), the LV mass index is 63 g/m2, and the LV mass is 139 g. There is global mild hypokinesis.No intracardiac thrombus.Left AtriumThe left atrium is moderately to severely dilated in size. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 42%, the RV end diastolic volume index is 89 ml/m2 (normal range 69+/-14), the RVEDV is 195 ml (normal range 110+/-24), the RV end systolic volume index is 52 ml/m2 (normal range 22+/-8), and the RVESV is 114 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no pericardial effusion.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. The left ventricle is mildly dilated with reduced systolic function (LVEF 43%).4. The right ventricle is normal in size with mildly reduced systolic function. (RVEF 42%).5. Left atrial enlargement.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: Other nontraumatic intracerebral hemorrhage [I61.8], Reason for Study: ^Reason: evaluate 2/2 cause of bleed History: hemorrhage There are 2 burr holes, one on the right frontal and another on the right temporal occipital area.Large right frontal intracerebral hematoma (45.3 mm x 55 and 5 mm x 63.6 mm) with surrounding edema, internal fluid fluid level and mass effect is seen. Midline shift towards left side is also seen, about 4 mm, at the level of foramen of Monro.Susceptibility lesions on surrounding sulci indicating associated subarachnoid hemorrhages.There is no evidence of contrast enhancement on the hematoma.There is no evidence of abnormal enhancement except thin, non nodular meningeal enhancement around the right frontal temporal parietal area which could be related to prior surgery or related to current hematoma related meningeal irritation.Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Large right frontal ICH, surrounding SAH with mass effects and midline shift toward left side as described above.2. No evidence of abnormal enhancement except right hemispheric meningeal enhancement.


Instruction: Generate impression based on medical findings.

Input: Metastatic breast cancer: Headaches. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild scattered paranasal sinus mucosal thickening.

Output: No evidence of intracranial metastases.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old, with multiple myeloma and new acute pain. New T1 hypointense and T2 hyperintense signal abnormality is seen within along the posterior right aspects of the T12-L1 endplates. There also appears to be a new right paracentral and foraminal disc protrusion at this level.No other areas of new marrow signal abnormality are seen. A moderate compression deformity of the T12 vertebral body is unchanged. Likewise, mild endplate cavity affecting the mid thoracic vertebral bodies, and t the L1-L5 vertebral bodies, is unchanged. Mild degenerative disc findings in the lumbar spine are unchanged. No significant spinal canal stenosis is seen. Mild left foraminal narrowing at L3-4 and L4-5 is unchanged. Facet arthropathy at lower lumbar levels is unchanged.The spinal cord itself demonstrates normal signal intensity and morphology. The conus cauda equina are within normal limits. No epidural abnormalities are suspected.

Output: 1.New signal abnormal is seen along the right posterior T12-L1 endplates. Given that this occurs in combination with possible new disc protrusion in the same location, the findings are favored to be degenerative in nature.2.No other definite new lesions are seen to suggest progressive myelomatous disease. No evidence of significant spinal canal stenosis is observed.3.Multiple compression deformities involving the T12-L5 vertebral bodies are unchanged. No new compressions are seen.


Instruction: Generate impression based on medical findings.

Input: 89-year-old female with osteomyelitis. TENDONS: The extensor and flexor tendons appear intact. The peroneal tendons appear intact.LIGAMENTS: The distal tibiofibular syndesmotic complex appears intact. The lateral collateral ligament complex appears intact.ARTICULAR SURFACES AND BONE: No bone marrow signal abnormality is identified to suggest osteomyelitis. There is a small amount of fluid within the tibiotalar joint.ADDITIONAL

Output: Findings suggestive of inflammation/subcutaneous edema along the posteromedial aspect of the ankle as described above without evidence of osteomyelitis or abscess formation.


Instruction: Generate impression based on medical findings.

Input: Toe ulcer The examination is limited by motion artifact.There is abnormal signal intensity within the distal phalanx of the great toe, particularly within the tuft, compatible with osteomyelitis. There is ulceration of the skin dorsal to the distal phalanx. The proximal phalanx and first metatarsal demonstrate normal marrow signal. The second ray is unremarkable.A bandlike focus of abnormal signal intensity traverses the middle and proximal phalanges of the third toe representing nondisplaced fractures. Edema within the distal phalanx of the third toe may represent an additional nondisplaced fracture.The fourth ray is unremarkable.Bandlike signal abnormality noted within the neck of the proximal phalanx of the fifth toe represents a nondisplaced fracture.The metatarsals demonstrate normal marrow signal. There is mild diffuse soft tissue edema of the foot.

Output: Limited exam demonstrates osteomyelitis of the distal phalanx of the great toe with multiple phalangeal fractures as detailed above.


Instruction: Generate impression based on medical findings.

Input: GH deficiency on insulin tolerance test: tiredness. There is no evidence of pituitary or parasellar lesions. The pituitary gland is not enlarged. The infundibulum is intact. There is no mass effect upon the optic apparatus or cavernous sinuses.

Output: No evidence of pituitary microadenoma.


Instruction: Generate impression based on medical findings.

Input: Reason: ICH noted on head CT History: history of head trauma MRI of the brainThere is T1 signal hyperintensity present within the left geniculated nucleus measuring approximate 7 mm in size. A similar lesion which is T1 hyperintense is present in the right superior colliculus measuring 4 mm. The margins of these two lesions are rather ill-defined. On the T2, FLAIR, SWI and DWI imaging these are not conspicuous. No diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There are a couple periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. These are of uncertain significance in isolation.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate arch opacification of the maxillary sinus is associated with blood products. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size. The left A1 segment is larger than the right A1 segment. There is extracranial origin of the left posterior inferior cerebellar artery. There is no convincing evidence for arteriovenous malformation on this exam.

Output: 1.Small lesions identified in the left geniculated nucleus and the right superior colliculus are present. It is suspected that this represents calcified lesions. Although the MR angiogram did not demonstrate that these are vascular lesions, the possibility cannot be excluded on the basis of this exam.2.No evidence for cerebrovascular occlusive disease.3.No evidence for intracranial aneurysm.


Instruction: Generate impression based on medical findings.

Input: Exam obtained for research purposes only. Research scanning of both breasts was performed with the research protocol. The images are stored for research analysis. Formal interpretation was not performed, existing data are not to be used for clinical purposes.

Output: This study was completed for research purposes only. Formal interpretation was not performed, existing data are not to be used for clinical purposes.


Instruction: Generate impression based on medical findings.

Input: Other alteration of consciousness [780.09], Reason for Study: ^Reason: r/o stroke History: right-sided weakness There is no evidence of acute ischemic or hemorrhagic lesion on the scan.Bihemispheric scattered several high signal intensities on FLAIR imaging indicate nonspecific small vessel ischemic disease, no change since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.

Output: 1. No change of nonspecific small vessel ischemic disease since prior scan.2. No evidence of acute ischemic or hemorrhagic lesion.3. Normal brain MRA.


Instruction: Generate impression based on medical findings.

Input: 46 years Male (DOB:7/20/1969)Reason: lumbar radiculopathy vsl infiltration History: severe length-dependent axonal neuropathyReferring Attending: ANTHONY T REDER Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. No abnormal enhancing lesions are appreciated in the lumbar spine. There is a T2 hyperintense 9 mm round focus within the L2 vertebral body which is slightly hyperintense on T1 and demonstrates some contrast uptake on the postcontrast imaging. There is a 11 mm T1 hyperintense lesion within the L3 vertebral bodyAt L5-S1 there is no significant compromise to spinal canal or neural foramina. There are some endplate reactive changes present this level. There is a broad-based right lateral disc protrusion present which extends into the right neural foramen and mildly encroaches on the right-sided exiting nerve roots. There are some chronic type endplate reactive changes associated with this.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.No compromise to lumbar spinal canal . There is a right far lateral disc protrusion at L5-S1 which mildly encroaches on the right-sided exiting nerve roots within the right L5-S1 neural foramen.2.There is an enhancing lesion within the L2 vertebral body. It is suspected most likely represents an atypical hemangioma. Follow-up exam or CT of the lumbar spine may help confirm this.


Instruction: Generate impression based on medical findings.

Input: 64-year-old female with proximal muscle weakness. Evaluate for inflammatory myopathy. Moderate to severe degenerative changes affect both hips, right greater than left. There is associated increased bone marrow signal abnormality within the femoral heads and acetabuli, likely reflecting degenerative signal abnormality. There is osteophyte formation, subchondral cysts, and joint space narrowing. There is no increased signal abnormality within the imaged musculature of the left thigh to suggest myositis, as clinically questioned. There is no abnormal enhancement on postcontrast sequences. There is nonspecific subcutaneous edema along the lateral aspect of the vastus lateralis muscle.

Output: Degenerative osteoarthritic changes of both hips without evidence of inflammatory myopathy as clinically questioned.


Instruction: Generate impression based on medical findings.

Input: 56-year-old male with recent prostate biopsy undergoing a heart transplant workup. Postbiopsy pathology results 5/3/2016 - Gleason score 6 at right apex lateral. PELVIS:PROSTATE:Prostate Size: 4.0 x 5.8 x 3.7 cmPeripheral Zone: There is increased T1 signal throughout the prostate compatible with hemorrhage from recent biopsy. The right apex lesion is not conspicuous by MRI. There is a T2 hypointense lesion with corresponding low signal in the left apex measuring 7 x 5 mm.Central Gland: Heterogeneous central gland compatible with benign prostatic hypertrophy.Seminal Vesicles: No evidence of invasion of the seminal vesicles.Extracapsular Extension: No extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Limited examination given recent biopsy. Within this limitation, there is a suspicious subcentimeter left apex lesion. No suspicious right apex lesion.2.No evidence of metastatic disease in visualized pelvis.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old, with history of metastatic lung adenocarcinoma, surveillance scan. Two subcentimeter foci of enhancement seen previously within the right postcentral gyrus, and a third within the left superior frontal gyrus, are no longer evident. Mild associated T2 hyperintensity has also resolved in these locations.No evidence of any new enhancing or nonenhancing intracranial lesion is seen. Ill-defined periventricular T2 hyperintensity is again seen compatible with prior therapy. No evidence of parenchymal edema or mass effect is seen. No restricted diffusion is detected.There is no evidence of any significant intracranial hemorrhage or abnormal extra axial fluid. The ventricular system is normal in size.

Output: 1.Interval resolution of subcentimeter lesions seen in the right post central gyrus and left superior frontal gyrus.2.No new intracranial lesions are evident.


Instruction: Generate impression based on medical findings.

Input: Male 55 years old Reason: colorectal staging History: occasional brbpr Overall image quality: Satisfactory.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted. LYMPH NODES: Lymph nodes in the perirectal space, within the mesorectal fascia: At least 6 tiny nodes seen (see key images)Lymph nodes outside the mesorectal fascia: Tiny pelvic sidewall nodes, at least 2 (see key images)BOWEL, MESENTERY: Rectal Tumor:Size: 1.6 (axial) x 5 (CC) x 2.9 (AP) cm, image 29 series 1101Tumor appearance on T2-weighted images: IsointenseTumor location: Rectosigmoid colon (For lower rectal tumors):Distance of the lower edge of the tumor to the anal verge (lower edge of the anal canal): n/a Distance of the lower edge of the tumor to the pelvic floor (relationship of the tumor to the anal sphincter complex): n/aCircumference of the colon involved: At least 180 degrees, see image 29 series 1101Relationship and proximity of the tumor to adjacent structures (prostate, seminal vesicles): RemoteMRI T-stage: Tumor Distance to Mesorectal Fascia: 1.7 cm, image 57 series 701BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Adjacent serosal surface slightly indistinct with fat stranding seen, suspicious for tumor involvement.

Output: 1. Rectosigmoid mass with extension to level of serosa and tiny adjacent lymph nodes as above.


Instruction: Generate impression based on medical findings.

Input: Female 78 years old Reason: Evaluate for cause of knee pain History: knee pain MENISCI: There is marked loss of the posterior horn of the medial meniscus. The anterior and posterior horns of the lateral meniscus are grossly intact.ARTICULAR CARTILAGE AND BONE: There is marked loss of cartilage in the medial and lateral compartments with areas of full-thickness cartilage loss on the posterior lateral femoral condyle. Marked thickness cartilage loss is seen along the medial patellar facet and medium patellar eminence. The cartilage in the femoral trochlea is thinned and irregular with a full-thickness defect along the lateral aspect of the femoral trochlea.There is reactive bone marrow edema in the medial and lateral compartments and there are tricompartmental osteophytes.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Degeneration and tearing of the posterior horn of the medial meniscus.2.Marked loss of cartilage and osteoarthritic changes in all 3 compartments.


Instruction: Generate impression based on medical findings.

Input: Grade 2 astrocytoma diagnosed in 2009, status post RT/TMZ Again seen are postsurgical changes of prior left parietal craniotomy with biopsy tract extending into the left superior frontal gyrus. There is no significant change in appearance of masslike FLAIR hyperintensity involving the posterior aspect of the left superior frontal gyrus with additional also unchanged FLAIR hyperintensity involving the left precentral gyrus and extending deeper into the left hemispheric periventricular white matter. There is no significant enhancement. Multiple foci of susceptibility effect in the left frontal lobe remain unchanged.Again seen is a right posterior falcine dural based mass compatible with a meningioma and measures 16 x 14 x 17 mm in the AP by TR by CC dimensions and unchanged allowing for sampling error. The mass appears to encroach on the superior sagittal sinus. Additional nonspecific focus of FLAIR hyperintensity in the right superior frontal gyrus is unchanged. No significant intracranial mass effect, midline shift, or herniation. No hydrocephalus or extra-axial collections. Benign-appearing focus of enhancement involving the right frontal calvarium also remains unchanged. No suspicious calvarial lesions are appreciated.

Output: 1. Compared to 6/11/2014, there is unchanged appearance of the nonenhancing, expansile mass centered at the posterior aspect of the left superior frontal gyrus consistent with known low-grade glioma. No evidence of tumor progression.2. Stable right posterior falcine meningioma.


Instruction: Generate impression based on medical findings.

Input: Headache [R51] / Disorientation, unspecified [R41.0], Reason for Study: ^Reason: Evaluate for possible recurrence of seizures with new headache and intermittent LUE/LLE weakness History: pls see above No evidence of acute ischemic or hemorrhagic lesion on the scan.No evidence of abnormal enhancement.There are scattered high signal intensity foci on bilateral frontal lobe white matter on FLAIR images which are nonspecific.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement.


Instruction: Generate impression based on medical findings.

Input: 49-year-old female with right shoulder pain. Rule out rotator cuff tear. ROTATOR CUFF: There is a partial thickness undersurface tearing of the anterior fibers of the supraspinatus tendon at the level of its insertion on the greater tuberosity, involving greater than 50% of the tendon width, measuring approximately 15 mm in the AP dimension, without significant retraction. There is interstitial tearing of the infraspinatus tendon proximal to its insertion on the greater tuberosity. There is thickening and intermediate signal abnormality of the supraspinatus suggestive of mild to moderate tendinosis. The subscapularis and teres minor muscles and tendons appear intact. SUPRASPINATUS OUTLET: Mild degenerative changes affect the acromioclavicular joint. No significant fluid is identified within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Moderate degenerative changes affect the glenohumeral joint with subchondral cyst formation. There is heterogeneity and increased intermediate signal abnormality within the anterior glenoid labrum suggestive of degenerative tearing. Note is made of subchondral cyst formation within the humeral head. No large glenohumeral joint effusion is evident.BICEPS TENDON: There is circumferential fluid within the tendon sheath of the long head of the biceps which may reflect fluid extension from the glenohumeral joint versus a very mild tenosynovitis. ADDITIONAL

Output: Rotator cuff tearing involving the supraspinatus and infraspinatus tendons as described above. Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Male 28 years old with PSC with elevated LFTs and AP. Concerned for a new stricture vs DILI. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in size and smooth in contour. No enhancing liver lesion is identified. The hepatic vasculature appears patent.There is a long segment of stricturing in the distal common duct similar to the previous exam. A short segment stricture is seen in the right hepatic duct and there are scattered short segment intrahepatic strictures, unchanged. There is mild wall thickening in the proximal common duct. No dominant stricture or mass.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: There is thickening, loss of haustration, restricted effusion and mild enhancement throughout the visualized colon compatible with the history of ulcerative colitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Scattered intra and extrahepatic biliary ductal strictures are compatible with the history of primary sclerosing cholangitis and not significantly changed since the previous exam.2.No dominant stricture or hepatic lesion.3.Inflammatory changes within the visualized colon compatible with the history of ulcerative colitis.


Instruction: Generate impression based on medical findings.

Input: 45-year-old male with history of prostate cancer status post focal laser ablation. PROSTATE:Prostate Size: 4.6 x 3.1 x 2.6 cm, TR x AP x CCPeripheral Zone: There is a focal enhancing lesion in the left apex which demonstrates low T2 and ADC signal and measures 1.3 x 0.6 cm (series 703, image 144). T2 hyperintense post-ablation changes are noted within the right base and mid gland.Central Gland: Prostatic hypertrophy without focal lesion. Please see measurements above.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: Enhancing lesion in the left apex abuts and appears to extend past the prostatic capsule, most pronounced on post-contrast images. BLADDER: No significant abnormality noted.LYMPH NODES: No suspicious pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Enhancing, T2 hypointense lesion in the left apex that appears to abut/extend across the capsule. Findings are suspicious for neoplasm at this site. 2.Post-ablation changes in the right base as described above.


Instruction: Generate impression based on medical findings.

Input: 75-year-old man with history of pancreatic cyst. ABDOMEN:LIVER, BILIARY TRACT: The liver appears normal. There is no intrahepatic biliary duct dilatation. The gallbladder is normal.SPLEEN: Spleen appears normal.PANCREAS: A 12 x 12 T2 hyperintense lesion in the ventral body of the pancreas (series 701, image 23) is seen, does not enhance, and does not communicate with the pancreatic duct. Of note, this lesion is minimally increased in size from the CT in 1/2011. Additional, very small T2 hyperintense lesions are seen in the pancreatic neck and communicated with the pancreatic duct.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Simple cyst in the pancreatic body which does not communicate with the pancreatic duct but has minimally increased in size over 4 year interval.2.Small sidebranch IMPNs in the pancreatic neck.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old, with right-sided weakness and right hand tingling, history of multiple sclerosis. Please note that the patient declined to complete all postcontrast views. Complete postcontrast imaging of the cervical spine was performed, but only sagittal views of the thoracic spine were obtained, and no postcontrast images of the brain were obtained.Brain:Scattered foci of predominantly periventricular T2 hyperintensity are redemonstrated without significant interval change in size or number. The brainstem and cerebellum are preserved. Cerebral morphology is otherwise unremarkable. Brain parenchymal volume is preserved. No evidence of any edema or mass effect is seen. No abnormal extra axial fluid collections are detected. A small focus of susceptibility at the pontomedullary junction is unchanged and probably represents a benign vascular anomaly.Cervical spine:The previously seen signal abnormality within the right lateral cord at C2-3 has become less conspicuous. Whereas the cord in this area was slightly edematous on the prior examination, there is now slight volume loss. Scattered smaller questionable focus of signal abnormality are seen elsewhere in the cervical cord without significant interval change. No pathologic cord enhancement is seen.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or edema is seen. Minimal posterior disc-osteophyte complex formation is seen at C4-5, C5-6 and C6-7 without significant spinal canal compromise. Moderate narrowing of the left neural foramen at C5-6 is demonstrated.At least one T2 hyperintense nodule is evident within the right thyroid lobe, non-specific but probably unchanged and likely benign.Thoracic spine:The previously demonstrated T2 hyperintense lesions within the thoracic spinal cord are not as clearly seen on the present examination. However, there does appear to be some minimal residual signal abnormality within the spinal cord at T5-6, potentially at T8, and also at T9. No new lesions are seen. Only sagittal postcontrast images could be obtained, but within this limitation, no pathologic spinal cord enhancement is seen.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or edema is observed. A small right paracentral disc extrusion is evident at T12-L1, similar to prior. No significant compromise of the spinal canal or neural foramina is detected.

Output: 1.Stable scattered lesions in the brain compatible with demyelinating disease.2.Scattered spinal cord lesions as noted on the prior examination are either stable or less conspicuous. No new spinal cord lesions are seen.3.Scattered mild degenerative findings are noted without significant compromise of the spinal canal.


Instruction: Generate impression based on medical findings.

Input: Clinical question to be answered coned rule out intracranial process. Signs and symptoms: Newborn with apnea. Poor quality exam secondary to extensive motion artifact. No definitive abnormalities detected. However poor quality of examination can obscure subtle findings. Repeat exam or an MRI is recommended. No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. No definitive calvarial abnormality.

Output: No gross abnormality in this limited examination of brain due to extensive motion.


Instruction: Generate impression based on medical findings.

Input: Ms. Sherri Downs is a 58 years old female with MRI detected enhancing mass in the right breast presents for MRI directed ultrasound. A targeted right ultrasound was performed for the MRI area of concern. There is no solid or cystic mass identified to definitively correlate with the MRI.

Output: No sonographic correlate for the enhancing right breast lesion detected on the MRI breast. MRI guided biopsy of this right breast breast mass is recommended. Results and recommendations were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.


Instruction: Generate impression based on medical findings.

Input: 44-year-old female with heavy bleeding. Evaluate uterine fibroids. PELVIS:UTERUS, ADNEXA: The uterus is retroverted. Note is made of thickening of the endometrium, most pronounced along the anterior wall of the body and fundus of the uterus, measuring approximately 26 mm in diameter. There are punctate foci of fluid signal intensity in the aforementioned area. These findings are suspicious for adenomyosis. Additionally, note is made of multiple subcentimeter masses in the uterus with associated decreased T2 signal abnormality and enhancement consistent with intramural uterine firboids. The largest measures 8 mm in diameter. Multiple nabothian cysts are identified. Left ovarian cystic lesion measures 2.6 cm in diameter and may represent a physiologic cyst. BLADDER: No significant abnormality noted.LYMPH NODES: No evidence of lymphadenopathy. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Findings which appear most consistent with adenomyosis, as detailed above.2.Multiple subcentimeter uterine fibroids, as detailed above.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old, with visual field defect, status post tumor resection. Evidence of recent resection of the previously demonstrated left occipital lobe tumor is seen. The resection cavity contains air and mixed fluid and blood product as expected.On comparison with the preoperative examination, a majority of the dominant enhancing component of the lesion has been resected. There is, however, enhancement along the posterior margin of the resection cavity extending to the ependymal surface of the atrium and occipital horn which likely represents residual tumor. In addition, there are patchy areas of very ill-defined parenchymal enhancement above the level of the resection which were evident on the preoperative examination and which likely reflect additional sites of tumor.Patchy ill-defined and gyriform T2 hyperintensity is seen within the parenchyma surrounding the resection cavity, similar to the prior examination, which may represent a combination of edema and nonenhancing tumor. Regional mass effect is seen in the form of sulcal and ventricular effacement. However, no significant generalized mass effect or brain herniation is identified. The ventricular system is stable in size and morphology.

Output: Expected findings are seen status post resection of a left occipital lobe tumor. A majority of the dominant enhancing portion has been resected, though there is residual enhancing tumor along the deep aspect of the resection cavity, and in the parenchyma above the resection cavity. There may also be scattered areas of nonenhancing tumor in the surrounding parenchyma as well.


Instruction: Generate impression based on medical findings.

Input: There is a CSF intensity structure within the right hemisphere with white matter borders demonstrating mild gliosis, contiguous with the adjacent right lateral ventricle.The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Fluid is present within both mastoid air cells and middle ear cavities. There is no abnormal enhancement within the brain.

Output: There is a CSF intensity structure within the right hemisphere with white matter borders demonstrating mild gliosis, contiguous with the adjacent right lateral ventricle. These findings provide MRI evidence for a porencephalic cyst with associated ex vacuo dilatation of the adjacent right lateral ventricle.


Instruction: Generate impression based on medical findings.

Input: Pituitary microadenoma. Assess for changes. As discussed previously, the pituitary gland is elongated craniocaudally, measuring up to 12 mm, but is narrow in the transverse dimension. It also shows homogeneous normal signal on T1 and T2 sequences as well as appropriate homogenous contrast enhancement. The cavernous internal carotid arteries are medialized impinging on the sella, which is probably causing or at least contributing to the craniocaudal elongation of the pituitary gland. The pituitary infundibulum is midline and not thickened. There is no hypothalamic abnormality and the optic chiasm is unremarkable. There is no intrasellar acute infarct or hemorrhage nor in the included part of the brain.Included part of the brain shows nonspecific T2-hyperintense white-matter lesions which are unchanged and may reflect chronic microvascular ischemia.

Output: The pituitary gland is elongated craniocaudally but is compressed in transverse by the cavernous internal carotid arteries. The gland continues to be homogeneous on all pre and post contrast sequences. Therefore, the increase in the craniocaudal dimension of the gland may reflect mere distortion of the gland by the mass-effect rather than the presence of a primary lesion such as an adenoma.


Instruction: Generate impression based on medical findings.

Input: Elevated PSA. Negative prostate biopsy 12/14/2009 PELVIS:PROSTATE:Prostate Size: 4.1 x 6.8 x 6.5 cmPeripheral Zone: The peripheral zone is homogeneously T2 hyperintense with an ovoid T2 hypointense lesion in the lateral base (series 501/70) measuring 7 x 6 mm associated with mild decreased ADC signal (series 704/324). There is mild T1-weighted hyperintensity in this region however on pre- and post-contrast images there is early nodular enhancement (series 1401/2011).Central Gland: Moderate changes of benign prostatic hyperplasia without a suspicious lesion.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: The lesion abuts the prostatic margin which appears mildly retracted without specific evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 7 x 6 mm lesion in the left lateral mid gland is suspicious for prostatic adenocarcinoma. No specific evidence of extraprostatic tumor extension.


Instruction: Generate impression based on medical findings.

Input: 76-year-old female with a history of breast cancer, presenting with dizziness, lightheadedness and near-syncope for one week. No evidence of acute intracranial hemorrhage or infarction. No evidence of edema or mass. Scattered hypoattenuating regions in the cerebral white matter roughly correlate with hyperintensities seen on prior MRI form 2003.The ventricles and basal cisterns are unremarkable in size and configuration.The calvaria and skull base are radiographically unremarkable. Scattered lucent lesions in the calvarium are nonspecific, but do not appear aggressive. Visualized paranasal sinuses and mastoid air cells are normally pneumatized. Bilateral internal carotic artery calcifications are noted.

Output: No acute intracranial abnormality.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Persistent nausea without clear etiology. Rule out mass/neural cause. Signs and symptoms: Nausea Nonenhanced head CT:Examination demonstrates several periventricular and subcortical nonspecific foci of low attenuation of white matter. As was noted on prior MRI examination these findings are suggestive of demyelinating disease. There is no evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus.The cortical sulci and ventricular system remain normal for patient stated age.Calvarium is intact. Visualized paranasal sinuses, mastoid air cells and middle ear cavities are unremarkable.

Output: 1.Periventricular and subcortical white matter low-attenuation and white matter consistent with patient's known multiple sclerosis.2.No evidence of acute intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.


Instruction: Generate impression based on medical findings.

Input: 17-year-old male with right shoulder instability, evaluate for intra-articular pathology ROTATOR CUFF: The rotator cuff appears normal.SUPRASPINATUS OUTLET: The acromioclavicular joint is normal. We see no fluid in the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is normal. There is a linear band of increased signal intensity between the anterior inferior labrum and underlying glenoid suggesting a tear. There is a bandlike low signal intensity extending from the anterior inferior labrum to the medial aspect of the glenoid that may represent thickened periosteum. These findings are suggestive of a Perthes lesion. The anterior superior labrum also appears detached from the underlying glenoid but this may simply represent a normal variant sublabral foramen. There is gadolinium between the superior labrum and underlying glenoid which may also represent a normal variant sublabral sulcus. The posterior labrum is intact. BICEPS TENDON: The tendon of the long head of the biceps muscle appears normal.ADDITIONAL

Output: Findings compatible with a Perthes lesion of the anterior inferior labrum.


Instruction: Generate impression based on medical findings.

Input: History of rectal cancer. Also history of gallbladder adenocarcinoma on cholecystectomy pathology.Rectal tumor demonstrated invasive moderately differentiated adenocarcinoma. No regional lymphadenopathy on pathology report. PELVIS:PROSTATE/SEMINAL VESICLES: Heterogeneous mildly enlarged prostate.BLADDER: No significant abnormality noted.LYMPH NODES: The perirectal space lymph nodes remain markedly decreased in size from the initial study without measurable lymph node enlargement, unchanged.The referenced lymph node at the level of the rectosigmoid junction on the left measures 6 x 3 mm (series 4/5), compared to 8 x 5 mm previously.BOWEL, MESENTERY: In the location of the original solid rectal lesion again seen is a predominantly markedly low T2 weighted focus affecting the left posterolateral aspect of the rectum (series 4/25) measuring up to 1.6 x 0.9 cm (series 4/25), not significantly changed accounting for differences in measurement technique. There is no evidence of extramural extension. No significant restricted diffusion or appreciable postcontrast enhancement is evident.Sigmoid diverticulosis is noted.BONES, SOFT TISSUES: Minimal presacral soft tissue stranding and minimal fluid is likely treatment related.OTHER: No significant abnormality noted.

Output: Stable post-treatment appearance of the rectal mass with imaging characteristics suggestive of post-radiation scar tissue without residual restricted diffusion or appreciable post-contrast enhancement. Interval mild decrease in reference pelvic lymph node. No measurable perirectal lymphadenopathy, similar to the prior and markedly improved from the initial staging examination.


Instruction: Generate impression based on medical findings.

Input: 60-year-old male status post OLT for HCC/HCV. Evaluate for lesions and assess hepatic vessel patency. ABDOMEN:LIVER, BILIARY TRACT: No suspicious focal hepatic lesions. Mild wedge-shaped T2 signal abnormality in segment 8 is likely related to perfusional change due to thrombosed portal vein (see below). No intra-or extrahepatic biliary ductal dilatation. Mild pneumobilia, similar to prior CT on 2/10/2015.The proper hepatic artery and its branches are patent. Limited evaluation of the common hepatic artery due to artifact from surgical clips. Main portal vein, left portal vein, and most of the right portal vein are patent. A segment 8 branch of the portal vein is thrombosed, similar to prior CT on 11/18/2014 (series 103/43). Hepatic veins are patent.SPLEEN: Splenomegaly with the spleen measuring 15.2 cm in length.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Multiple peri-splenic and gastroesophageal varices are again noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Complex collection within the anterior abdominal wall seen on prior CT on 2/10/2015 is decreased in size with small residual collection measuring up to 2.6 x 1 cm (series 8/13).OTHER: No significant abnormality noted.

Output: 1. Postsurgical changes from liver transplantation. No suspicious focal hepatic lesions. Stable appearance of the hepatic vasculature as detailed above.2. Complex collection within the anterior abdominal wall seen on prior CT has decreased in size.


Instruction: Generate impression based on medical findings.

Input: T4aN1 squamous cell carcinoma of the left base of the tongue status post induction chemotherapy. There has been interval decrease in size of the infiltrative mass arising from the tongue base, measures up to approximately 30 mm. There is no evidence of significant cervical lymphadenopathy. The thyroid and salivary glands are unremarkable. The osseous structures are grossly intact. The imaged intracranial structures are unremarkable. There is staphylomatous deformity of the globes.

Output: Interval decrease in size of the tongue base squamous cell carcinoma and no significant cervical lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: History of lung cancer metastatic to the brain, the, weakness, ataxia. Rule out cord compression. Examination is obtained per screening cord compression protocol. No significant stenosis in the cervical, thoracic, or lumbar spine is seen. There is no evidence of cord compression. Sagittal STIR sequence demonstrates abnormal T2 hyperintensity at the C6-C7 level and the T2-T3 level.The vertebral bodies are appropriate in the overall alignment and height. Mild degenerative changes are seen with small disk bulge at the C3-C4 and C4-C5 levels as well as at the L5-S1 level without significant stenosis.

Output: 1. This is a limited exam specific for the exclusion of cord compression only and details are not as evident as dedicated protocols of the spine. No cord compression is identified.2. Abnormal T2 hyperintense lesions in the spinal cord at C6-7 and T2-3 levels, which given history and brain MRI findings, are suspicious for intramedullary metastases. Recommend dedicated cervical and thoracic MRI study with gadolinium.Dr. Ali discussed findings with Dr. Wang at 10 am on 3/13/2015.


Instruction: Generate impression based on medical findings.

Input: 60-year-old female with hyperglycemia and noninsulin-dependent diabetes mellitus, pancreatic body neuroendocrine tumor less than 2 cm. Patient needs repeat imaging in 3 months to evaluate any change in the lesion. ABDOMEN:LIVER, BILIARY TRACT: Mild fissural prominence suggesting chronic liver disease. The no focal lesion or biliary ductal dilatation.SPLEEN: Status post splenectomy.PANCREAS: Subtle T2 hyperintense focus of the proximal pancreatic body (axial series 7 image 34). Focal enhancement is noted on the postcontrast subtraction series (axial series 102 image 66) Similar appearing prominent peripancreatic and periportal lymph nodes. No pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Stable nonspecific right cardiophrenic lymph node. Prominent right periportal lymph node adjacent to the caudate lobe measuring 1.9 x 1 cm (axial series 5 image 25) is again noted. Other prominent periportal lymph nodes are also unchanged (axial series 7 images 24, 31, 34).BOWEL, MESENTERY: Small hiatal hernia.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Subtle T2 hyperintense focus of the proximal pancreatic body with corresponding focal enhancement on the postcontrast subtraction series. This hyperintense focus corresponds to the location of a subtle enhancing lesion seen in retrospect on the 5/2/2016 CT exam (CT series 804 image 51).


Instruction: Generate impression based on medical findings.

Input: Left hip pain, assess for labral tear or stress fracture. ACETABULAR LABRUM: There is an increased signal in the anterior superior labrum, suspicious for anterior superior labral tear. No other labral abnormalities.ARTICULAR CARTILAGE AND BONE: There is marked decrease in the bone marrow edema in the medial aspect of the left distal femoral neck/proximal diaphysis adjacent to the lesser trochanter as compared to the prior study, consistent with resolving stress reaction. No discrete fractures.SOFT TISSUES: No significant abnormalities present in the soft tissues.ADDITIONAL

Output: 1.Anterior superior labral tear.2. Marked interval decrease in the stress reaction in the proximal diaphysis of the femur.


Instruction: Generate impression based on medical findings.

Input: There is reversal of normal cervical lordosis with smooth kyphosis with apex at C5. There are no fractures or subluxations. Vertebral body heights are maintained. Degenerative changes are noted from C2-C3 through C6-C7. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: There is mild bilateral neural foraminal narrowing. There is no significant spinal canal stenosis.C3/4: There is mild bilateral neural foraminal narrowing. There is a small posterior disk osteophyte complex without significant spinal canal stenosis.C4/5: There is mild bilateral neural foraminal narrowing and posterior disk osteophyte complex. There is no significant spinal canal narrowing.C5/6: There is moderate bilateral neural foraminal narrowing relatively worse on the left related to uncovertebral hypertrophy. Small posterior disk osteophyte complex with mild spinal canal narrowing.C6/7: There is severe bilateral neural foraminal narrowing related to uncovertebral hypertrophy. There is a small posterior disk osteophyte complex with mild spinal canal narrowing.C7/T1: There is mild bilateral neural foraminal narrowing. No significant spinal canal narrowing.

Output: Bilateral neural foraminal narrowing most significant at the C5-6 and C6-C7 levels as detailed above.Mild spinal canal narrowing at C5-C6 and C6-C7 related to kyphotic angulation and small disc osteophyte complexes. No spinal cord signal abnormality.


Instruction: Generate impression based on medical findings.

Input: Status post femoral access attempts. Rule out retroperitoneal bleeding. ABDOMEN: Bilateral small pleural effusions. Cardiomegaly. Independent atelectasis lung bases.LIVER, BILIARY TRACT: Liver is nodular in contour with hypertrophic left lobe suggestive of chronic liver disease. Cholelithiasis without evidence of cholecystitis. No biliary dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Pancreas is atrophic. Lack of IV contrast severely limits evaluation of the pancreas. If there is any clinical concern for pancreatic pathology MRI is recommended.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Both kidneys demonstrate retained contrast likely from previous contrast enhanced study. Bilateral large stones mostly in the lower pole of the collecting system of the kidneys are again noted. Large left-sided renal cyst and small bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small left-sided inguinal hematoma. No extension to the retroperitoneum.OTHER: Right-sided femoral venous catheter extends to the right ventricle.

Output: No evidence of retroperitoneal hemorrhage. Cholelithiasis and bilateral nephrolithiasis unchanged.Cardiomegaly bilateral small pleural effusions. Possible chronic liver disease. If there is a clinical concern for pancreatic pathology MR of the liver is recommended. This study is extremely limited for evaluation of the pancreas.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Hepatic encephalopathy, now with acute mental status change, only responsive to pain. Signs and symptoms: Altered mental status. Very minimal blood adjacent to right frontal pressure monitor is again identified with no interval change. No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus since prior study. No definitive evidence of edema or parenchymal air is detected. Cortical sulci, ventricular system and all CSF cisterns are stable since prior study. Extensive opacification of all paranasal sinuses with interval worsening since prior exam. The above findings could be related to instrumentation.Further evaluation with an MRI is recommended.

Output: No definitive evidence of any new finding since prior exam. Please see above comments.


Instruction: Generate impression based on medical findings.

Input: There is bilateral cystic encephalomalacia, white matter loss, gliosis, and ex vacuo dilatation of the left lateral ventricle atrium and occipital horn. Bilaterally this involves frontal, parietal, and occipital lobes, with the left hemisphere more predominantly affected. There is also associated thinning of the body and splenium of the corpus callosum.There are no findings of hydrocephalus. The more normal-appearing white matter anteriorly appears to have an appropriate myelination pattern. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The mastoid air cells are clear.

Output: Bilateral periventricular leukomalacia, left greater than right, with associated thinning of the corpus callosum.


Instruction: Generate impression based on medical findings.

Input: concern for lupus cerebritis, headache No evidence of acute ischemic or hemorrhagic lesion.Re demonstration of the partial right temporal lobectomy (middle and inferior temporal lobe anterior aspect), no change since prior exam.Scattered high signal intensity lesions on bilateral hemisphere on FLAIR images indicating non specific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. No change of right temporal partial lobectomy since prior exam.3. Non specific small vessel ischemic lesions.


Instruction: Generate impression based on medical findings.

Input: Paresthesias. Prior history of L5 NHL. Brain:No intracranial mass or mass-effect. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. There is mild parenchymal volume loss. The ventricles are within normal limits in size and configuration. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. No destructive lesions within the calvarium. Cervical:Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate height. Alignment is maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Minimal degenerative changes are seen in the cervical spine with tiny disc protrusions at C4-5 and C5-6. No significant spinal canal or neural foraminal stenosis at any level in the cervical spine. Tiny perineural cysts are incidentally noted at multiple levels.Lumbar:There is a disc bulge at T11-T12 which is partially imaged and mildly effaces the ventral thecal sac. There is mild compression deformity involving the L5 vertebral body with Schmorl nodes at the endplates. There is lesion involving the L5 vertebral body with heterogenous signal including STIR hyperintensity. There is T1 shortening involving the L4, L5 and sacrum which may be related to prior radiation. Remainder of the vertebral body heights and alignment are unremarkable.There is no significant disc herniation. No spinal canal or neural foraminal stenosis at any level in the lumbar spine. Tiny perineural cysts incidentally noted. Mild lumbar facet arthropathy.Distended urinary bladder noted as well as a partially visualized 3 cm cystic structure possibly adnexal or bladder diverticulum but incompletely evaluated.

Output: 1. No evidence of intracranial mass or mass effect. No evidence of infarct. 2. Minimal degenerative changes in the cervical spine. No cord signal abnormality. No spinal canal or neural foraminal stenosis.3. No spinal canal or neural foraminal stenosis in the lumbar spine.4. Heterogeneous lesion at the L5 vertebral body with mild compression deformity of L5. Findings are compatible with history of treated lymphoma but consider comparison with prior studies if available.5. Partially imaged distended urinary bladder and adjacent 3 cm cystic structure posterolaterally on the left. Ultrasound can be considered for better visualization if clinically indicated.


Instruction: Generate impression based on medical findings.

Input: MRI Brain:Examination is motion degraded. There is however no evidence of acute infarct, mass, or mass effect. There is moderate degree of periventricular and subcortical white matter T2/FLAIR hyperintensity, which is nonspecific but likely related to chronic small vessel ischemic disease, similar to prior. There is moderate degree of global parenchymal volume loss. Chronic lacunar infarct involving the right cerebellum again seen. No hydrocephalus. No extra-axial collections. There is no midline shift or herniation. The major cerebral flow voids are intact. Bone marrow signal and extra cranial soft tissues are grossly unremarkable.MRA Brain: The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. No evidence of aneurysms within the limits of motion degradation.

Output: 1. No evidence of acute infarct, edema, or intracranial mass effect. 2. Mild to moderate chronic small vessel ischemic disease which appears similar to prior study.3. No significant stenosis in the intracranial vasculature.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: 67-year-old man with history of prostate cancer. PELVIS:PROSTATE:Prostate Size: 52 x 32 mm.Peripheral Zone: Two foci of signal abnormality are noted in the right apical peripheral zone. The first (series 901, image 12) measures 4 x 4 x 3 mm and the second (series 901, image 14) measures 4 x 3 x 3 mm. These foci are hypointense on T2 images, demonstrate diffusion restriction, and subtly enhance.Central Gland: No significant abnormality noted.Seminal Vesicles: Seminal vesicles are normal without evidence of tumor invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: The bladder is normal.LYMPH NODES: No significant lymphadenopathy noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Two foci of signal abnormality in the right apical peripheral zone which may represent adenocarcinoma.


Instruction: Generate impression based on medical findings.

Input: Progressive metastatic melanoma after Ipilimumab. The clivus appears heterogeneous and there is an enhancing lesion within in the partially imaged right aspect of C1. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is a nonspecific non-enhancing subcentimeter nodule in the posterior upper neck subcutaneous tissues. There is scattered paranasal sinus mucosal thickening.

Output: 1. No evidence of intracranial metastases or hypophysitis.2. Findings suggestive of bone metastases involving the upper cervical spine and perhaps the skull base. Dedicated cervical spine imaging may be useful for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Female with history of ovarian tumor. ABDOMEN:LIVER, BILIARY TRACT: Several images are degraded by artifact. The liver is normal in morphology, signal intensity and enhancement. No biliary ductal dilatation. No vascular abnormality.There are at least 3 lesions identified demonstrating mild T2 weighted hyperintensity and peripheral rim enhancement on postcontrast imaging, suspicious for metastatic disease. The segment 7/8 lesion measures 1.1 cm (series 12 image 11). The segment 5 peripheral lesion measures approximately 8 mm (series 12 image 30). The segment 2 peripheral lesion measures approximately 9 mm (series 12/28). Additional very small peripheral segment 7/8 T2-weighted hyperintensity. These lesions are decreased in size when compared to the 4/9/2015 CT.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Outside exam read:Several enhancing lesions in the liver are compatible with metastatic disease and are decreased in size compared to the 4/9/2015 outside hospital CT.


Instruction: Generate impression based on medical findings.

Input: Flexion contracture status post trigger release. Evaluate A2 pulley of right index and long fingers. The A2 pulley of the index finger appears intact. The flexor tendon apparatus of the index finger appears normal. The extensor tendon is difficult to visualize dorsal to the middle phalanx; however, its insertion on the middle and distal phalanges appear intact. Mild osteoarthritis affects the second metacarpophalangeal joint. Bone marrow signal intensity is normal.The A2 pulley of the middle finger appears intact. There is mild edema-type signal along the volar margin of the flexor tendon apparatus at the level of the third metacarpal head, which may reflect surgical changes of trigger finger release. The flexor digitorum superior superficialis and profundus tendons appear slightly thickened as they course of volar to the proximal phalanx suggesting tendinosis and perhaps mild interstitial tearing, but I see no frank tendon rupture. A small amount of fluid in the tendon sheath at this same location suggests a mild tenosynovitis. There is also a small amount of fluid in the soft tissues along the volar aspect of the A2 pulley, but again, the underlying pulley itself appears intact. The extensor tendon is difficult to visualize dorsal to the middle phalanx; however, its insertion on the bases of the distal and middle phalanges appear intact. Moderate osteoarthritis affects the third metacarpophalangeal joint with small cysts in the third metacarpal head and base of the third proximal phalanx. Bone marrow signal intensity is otherwise unremarkable.

Output: 1.Normal-appearing A2 pulleys of the index and middle fingers.2.Mild tendinosis and tenosynovitis of the flexor tendon apparatus of the middle finger.3.Osteoarthritis of the second and third MCP joints - a pattern that can be seen in patients with CPPD arthropathy.


Instruction: Generate impression based on medical findings.

Input: Low back pain The sacroiliac joints appear normal for the patient's age with no findings to account for the patient's low back pain.

Output: Normal appearance of the sacroiliac joints with no findings to account for the patient's pain.


Instruction: Generate impression based on medical findings.

Input: Female 43 years old Reason: lateral meniscus injury History: pain MENISCI: The medial meniscus is intact. There is a horizontal tear involving the anterior horn body junction of lateral meniscus. There is a multilobulated cystic structure extending anteriorly between the iliotibial band and patellar tendon. It measures 4.0 x 0.6 cm. It has a neck closely associated with a meniscal tear.ARTICULAR CARTILAGE AND BONE: The cartilage of the medial and lateral compartments are normal.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: Linear low signal band along the medial aspect of the patella extending superiorly represents a suprapatellar synovial plica. No underlying cartilage abnormality.ADDITIONAL

Output: Tear of the lateral meniscus at the anterior horn body junction with a multilocular para meniscal cyst that extends adjacent to the iliotibial band extending into the anterior soft tissues lateral to the patellar tendon.


Instruction: Generate impression based on medical findings.

Input: Ms. Pistorio is a 31-year-old female with known history of triple negative left breast cancer and metastatic left axillary lymphadenopathy. She presents for MRI evaluation to assess for response during neoadjuvant chemotherapy. There is extreme amount of fibroglandular tissue in both breasts. Marked background parenchymal enhancement is noted bilaterally, limiting the sensitivity of this examination.LEFT BREAST:In the left upper outer breast, there is revisualization of the index malignancy, now measuring 2.6 x 2.0 x 4.3 cm, previously measuring 3.2 x 2.5 x 5.1 cm (AP x ML x SI). Susceptibility artifact from biopsy marker clip is seen within this lesion, compatible with index malignancy.Extending antero-inferiorly from this index malignancy are multiple additional enhancing masses, the inferior-most one of which is biopsy-proven to be malignant. Total span of enhancement of the additional satellite lesions now measures approximately 2.1 x 2.3 x 2.6 cm, previously measuring 3.3 x 2.9 x 2.7 cm. The total span of enhancement (index lesion + additional satellite lesions) in the AP oblique dimension measures approximately 8.3 cm, previously measuring 8.8 cm. The two biopsy marker clips (index + satellite) are separated by approximately 8.1 cm in the AP dimension. In the left axilla, the biopsy proven lymph node with biopsy marker clip now measures 1.6 cm, previously measuring 2.2 cm. RIGHT BREAST:Stable enhancing benign-appearing masses in the right breast. There is no new abnormal enhancement seen in the right breast. No abnormal lymph nodes are identified in either axillary or internal mammary region.

Output: (1) Interval decrease in size of known multicentric left breast cancer. Detailed measurements as above.(2) No MRI evidence of malignancy in the right breast.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: 51-year-old female, please evaluate mass on superolateral patella. MENISCI: The menisci appear intact without significant tearing.ARTICULAR CARTILAGE AND BONE: Tiny osteophytes affect the lateral and medial tibiofemoral compartments. A large osteophyte is seen off the superior aspect of the patella. There is a small amount of patellar edema with general thinning of the patellar cartilage.LIGAMENTS: The ACL, PCL, MCL, and LCL complex appears intact. EXTENSOR MECHANISM: Extensor mechanism appears intact.ADDITIONAL

Output: 3 cm lesion anterior to the patella as outlined above. These findings are nonspecific. The lesion is favored to be inflammatory in etiology, soft tissue mass is not excluded, especially on only noncontrast examination. Biopsy is recommended if clinically warranted for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Again seen is an infiltrating mass involving the hypothalamus extending into the optic chiasm, left greater than right. Mass measures approximately 17 x 20 x 13 mm and unchanged allowing for differences in measurement technique. Posteriorly mass abuts the mamillary bodies. Pituitary gland and infundibulum which are more inferior appear grossly unremarkable. Again noted is focal enlargement of the left prechiasmatic optic nerve likely reflecting tumor involvement, coronal STIR series 1201 images, and is adjacent to/contiguous with the larger mass more posterior superiorly. No findings to suggest interval enlargement or new enhancement.Images of the remainder of the brain again demonstrate patchy foci of T2 hyperintensity within the basal ganglia, thalami, cerebral peduncles, brainstem, cerebellum as well as within the left amygdala/medial temporal lobe where there is also mild expansion without enhancement. Again seen is a tiny linear focus of enhancement within the right precentral gyrus with susceptibility most likely representing an incidental small developmental venous anomaly or capillary telangiectasia. There is no evidence of acute infarct or hemorrhage. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.Compared to 5/22/2015, there is no significant change in size of glioma involving the hypothalamus/optic chiasm and extending mildly to involve the left prechiasmatic optic nerve.2.Additional stigmata of NF 1 including numerous supratentorial and infratentorial foci of T2/FLAIR signal abnormality" are unchanged.3.The left medial temporal lobe/amygdala focus of signal abnormality with mild expansion also remains unchanged. Suggest attention on follow-up for possibility of an additional focus of glial neoplasm.


Instruction: Generate impression based on medical findings.

Input: 65 years Male (DOB:12/15/1950)Reason: lumbar radiculopathy History: lumbar radiculopathyPROVIDER/ATTENDING NAME: RICHARD W KANG RICHARD W KANG Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height and some endplate reactive changes as well as disc desiccation at this level associated with a diffuse disc bulge and mild facet hypertrophy. Although the neural foraminal are narrowed, within the neural foramina the exiting nerve roots are surrounded by fat.At L4-5 there is a diffuse disc bulge and a superimposed left paramedian disc extrusion which disc extrusion impresses on the thecal sac and effaces the spinal fluid within the thecal sac at this level. Some disc material extends behind the adjacent endplates. Overall there is moderate to marked spinal stenosis at this level. There is effacement of the fat at the left lateral recess at this level. There are some mild facet and ligamentum flavum hypertrophy at this level. Although the neural foraminal are narrowed, within the neural foramina the exiting nerve roots are surrounded by fat.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, disc desiccation and a diffuse disc bulge at this level. There are endplate reactive changes at this level which are high signal on T1 and T2 and suppresses on the inversion recovery images. These are chronic endplate reactive changes.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height and a disc bulge as well as some endplate reactive changes which are high signal on T1 and suppresses on the STIR images indicating they are chronic.At L1-2 there is no significant compromise to spinal canal or neural foramina. There are Schmorl's nodes present at this level.

Output: 1.There are multilevel degenerative changes present in the lumbar spine which are worse at L4-5 where there is moderate to severe spinal stenosis as a result of a left paramedian disc extrusion .


Instruction: Generate impression based on medical findings.

Input: Female, 24 years old, with migraine headache and normal neuro exam. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. Signal intensity of the bone marrow is unremarkable. A mucous retention cyst is evident in the right maxillary sinus.

Output: Unremarkable evaluation with no specific findings to account for the patient's headaches.


Instruction: Generate impression based on medical findings.

Input: 55-year-old woman with ER positive IDC of the right breast. I-Spy 2 research MRI performed. There is relatively extensive non-mass enhancement, new since the 8/31/2016 comparison examination, presumably related to the biopsy performed on 9/8/2016. Within the limitation created by this enhancement, the following observations can be made:There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Within the right outer breast, the patient's biopsy-proven malignancy is seen as an enhancing mass measuring up to 220 mm. The biopsy clip is again noted within this mass. Immediately anterolateral to the index mass is 6 mm mm satellite mass. Medial to the index lesion there are 3 additional small enhancing masses, 2 of which are immediately anterior to and abut the pectoralis major muscle. An enhancing mass is again noted within the anterior chest wall musculature, posteromedial to the index lesion and presumed satellites. The other areas of chest wall muscular enhancement are less prominent on today's examination, which may relate to differences in technique.The previously described 9 mm area of non-mass enhancement is not definitively seen on today's examination, also possibly due to technique and effect of yesterday's biopsy.The overall extent of masses, inclusive of the mass suspicious for pectoralis involvement is up to 6.2 cm. The nonspecific focus of increased T2 signal within a midthoracic vertebral body has been evaluated using other imaging modalities and is of doubtful clinical significance given those results.There are scattered foci of increased T2 signal within the liver, likely representing cysts or hemangiomas, without corresponding hypermetabolic activity on the PET scan dated 9/9/2016.No abnormal enhancement is seen in the left breast. A few scattered foci and areas of edge parenchymal enhancement are not suspicious. No abnormal axillary lymph nodes are identified in either axillary region.

Output: Biopsy proven right breast cancer with multiple additional enhancing masses within the right breast and the right anterior chest wall musculature. The overall extent of masses, inclusive of the mass suspicious for pectoralis involvement is up to 6.2 cm. Presumed biopsy related non-mass enhancement is a limitation of this study compared to the recent MRI exam. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: Ms. Einsele is a 64 year old female with a personal history of right breast lumpectomy in 2002 for DCIS treated with radiation and hormonal therapy. Family history of breast cancer in mother, maternal aunt, maternal first cousin, and paternal aunt. Patient is BRCA2 mutation carrier. There is scattered fibroglandular tissue in both breasts. Mild background parenchymal enhancement is noted bilaterally.Stable post-lumpectomy changes are present in the right inferior breast. No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.Bilateral small pleural effusions noted.

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


Instruction: Generate impression based on medical findings.

Input: Status post motor vehicle collision. Evaluate for stroke, acute pathology or intracranial hemorrhage. The patient experienced loss of sensation and neck pain. Evaluate for cervical instability. MRI brain:Redemonstrated is a minimally enhancing lobular mass involving the right frontal periventricular region which measures 10 x 11 mm (series 7, image 21). This demonstrates susceptibility abnormality with an accompanying prominent venous structure. There is no surrounding edema and the lesion has not changed in size compared to the previous CT. No other lesions are detected elsewhere. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRI C-spine:The cervical spine alignment is maintained. The vertebral bodies are appropriate in height. The bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: There is a mild disc osteophyte complex but no significant compromise to the spinal canal or neural foramina.C3-4: There is a mild disc osteophyte complex and mild uncovertebral and facet hypertrophy, which causes mild bilateral neural foraminal stenosis but no central canal stenosis.C4-5: There is a mild disc osteophyte complex and mild facet and uncovertebral hypertrophy, which cause mild bilateral neuroforaminal stenosis. No central spinal canal stenosis. C5-6: There is a mild disc osteophyte complex and mild to moderate uncovertebral and facet hypertrophy, which causes mild bilateral neuroforaminal stenosis. No central spinal canal stenosis.C6-7: There is mild uncovertebral and mild to moderate facet hypertrophy which causes mild left neural foraminal stenosis. No right neural foraminal or central canal stenosis.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. The paraspinous soft tissue structures appear within normal limits.

Output: 1.Findings compatible with a 10 x 11 mm cavernous malformation in the right frontal periventricular region which is unchanged compared to the previous exam.2.Mild degenerative changes involving the cervical spine without evidence of significant spinal canal or neural foraminal compromise.


Instruction: Generate impression based on medical findings.

Input: Hemiplegia, unspecified, affecting unspecified side [342.90], Reason for Study: ^Reason: r/o stroke History: right-sided weakness and dysarthria No evidence of acute ischemic or hemorrhagic lesion on this scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on medical findings.

Input: New horizontal double vision and headache. There is mild scattered cerebral white matter T2 hyperintensity. There also appears to be a punctate focus of restricted diffusion in the left posterior cingulate gyrus without correlate on the other sequences. There is no evidence of intracranial hemorrhage or mass. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Mild scattered cerebral white matter T2 hyperintensity is nonspecific, but likely represents chronic small vessel ischemic disease. An apparent punctate focus of restricted diffusion in the left posterior cingulate gyrus without correlate on the other sequences is likely artifactual, although an acute infarct is a potential consideration.


Instruction: Generate impression based on medical findings.

Input: History of acute pancreatitis and gallstones. ABDOMEN:LUNG BASES: Post-sternotomy changes.LIVER, BILIARY TRACT: Normal liver morphology. No focal hepatic lesion, biliary ductal dilatation or vascular abnormality. Normally distended gallbladder containing large gallstones without gallbladder wall thickening, pericholecystic fluid or other inflammatory changes.The common bile duct is normal in caliber.SPLEEN: No significant abnormality noted.PANCREAS: There is mild decrease in T1 weighted pancreatic parenchymal signal suggesting parenchymal dysfunction. The pancreas enhances homogeneously following contrast administration. No peripancreatic fluid collection. No arterial or venous complication. 8 x 8 mm cystic lesion in the pancreatic body (series 501/27), likely a sidebranch IPMN.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: A left anterolateral bladder diverticulum is noted.

Output: 1. Large gallstones within a normally distended gallbladder without evidence of acute cholecystitis. No choledocholithiasis.2. Decreased T1-weighted pancreatic parenchymal signal suggesting parenchymal dysfunction compatible with stated history of acute pancreatitis without evidence of complication.


Instruction: Generate impression based on medical findings.

Input: Female 38 years old status post sigmoid resection, cholecystectomy and appendectomy. History of stage IV endometriosis with right lower quadrant pain recurrent endometrioma on the right from outside imaging. PELVIS:UTERUS, ADNEXA: The right adnexa is not well defined. The left adnexa contains 3 lesions which are intermediate intensity on T1 and dark on T2-weighted images consistent with endometriomas. The largest measures 1.5 x 1.1 cm (image 23 of series 6). There is an additional 9 x 8 mm lesion in the right upper pelvis lateral to the sigmoid colon also consistent with endometrioma (series 12, image 42).BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: There is and thickening of the sigmoid colon wall (series 14, image 19) causing focal narrowing at this level and mild proximal sigmoid colonic dilatation.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Endometriosis involving the right upper pelvis lateral to the sigmoid colon as well as the left adnexa.2.Thickening of the sigmoid colon wall results in narrowing at this level and mild proximal bowel dilatation. These findings may be secondary to endometriosis or postoperative change.


Instruction: Generate impression based on medical findings.

Input: Fever, leukocytosis, and headache; concern for meningitis. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal enhancement within the brain parenchyma or meninges. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of intracranial abscess or abnormal meningeal enhancement.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: 59-year-old male with newly diagnosed oral cancer, evaluate for lung metastases LUNGS AND PLEURA: Mild right basilar pleural parenchymal scarring is redemonstrated without interval change. No new pulmonary, pleural nodules or masses. No pleural effusion identified.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy is identified. Cardiac size is normal. Small pericardial effusion is stable however, is new from the exam dated 6/17/10.Central venous catheter with its tip in the RA.CHEST WALL: Extensive postsurgical changes in the thoracic spine. See recent MRI of the thoracic spine.UPPER ABDOMEN: Status post cholecystectomy.

Output: No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Tender subcutaneous nodule right postauricular scalp. There is a well-defined enhancing nodular lesion in the right post-auricular scalp that measures 5 x 15 mm in cross-section. The underlying mastoid bone appears to be intact. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are mild scattered foci of nonspecific cerebral 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.

Output: A well-defined lesion in the right post-auricular scalp that measures up to 15 mm may represent a peripheral nerve sheath tumor or "traumatic neuroma", for example.