Instruction: Generate impression based on medical findings.

Input: 75 years, Female, multiple myeloma and breast cancer, carries diagnosis of vasovagal syncope, presenting today after spell concerning for epileptic seizure. There is no intracranial mass or abnormal parenchymal or meningeal enhancement to suggest metastatic disease. There are multiple foci of T2/FLAIR hyperintensity in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild-to-moderate chronic small ischemic disease. Small probable chronic lacunar infarct involving the right right frontal corona radiata and anterior aspect of the caudate body; prominent perivascular space remains an alternative possibility. No hydrocephalus. No extra-axial collections. No evidence of acute ischemia or hemorrhage. Bilateral hippocampi are symmetric in size and signal characteristics with grossly preserved internal architecture; no findings to suggest mesial temporal sclerosis. Major flow-voids are preserved. Pituitary gland is slightly prominent in size for age which is nonspecific. There is heterogeneous marrow signal which may be related to known multiple myeloma. There are however no discrete destructive osseous lesions demonstrated.

Output: 1. No evidence of intracranial metastatic disease. No findings to suggest seizure focus are appreciated.2. Mild to moderate chronic small vessel ischemic disease.


Instruction: Generate impression based on medical findings.

Input: 60 year-old female with pain and bloating. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: 11-mm lesion in the medial aspect of the right upper pole with peripheral, eccentric enhancement is suspicious for a small renal cell carcinoma. Further evaluation with a dedicated renal protocol CT or MRI is recommended.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Large pelvic mass with solid and cystic components measuring 17 x 11 cm on image number 105, series number 3. This lesion likely arises from the left ovary. Right ovary cannot be differentiated from the large mass but is likely seen on image number 122 of series number 3 and slightly enlarged. Ovarian torsion cannot the exclude by imaging.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Large pelvic mass likely arising from the left ovary suspicious for a malignant ovarian neoplasm. Superimposed torsion cannot be excluded.Small right renal lesion with eccentric enhancement suspicious for renal cell carcinoma. Further evaluation with dedicated kidney protocol CT or MRI is recommended.


Instruction: Generate impression based on medical findings.

Input: Evaluate for abnormality/metastatic disease; history ovarian cancer. Brain: There is a peripherally enhancing mass in the medial left occipital lobe that measures up to 24 mm, with extensive surrounding vasogenic edema. There is also a heterogeneously enhancing mass in the right cerebellar hemisphere, which measures up to 15 mm, also with extensive surrounding vasogenic edema. There cerebellar tonsils extend up to 6 mm inferior to the foramen magnum. There is no evidence of intracranial hemorrhage or acute infarct. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Complete Spine: There is fatty bone marrow signal in the lumbosacral spine related to radiation effects. There is also irregular linear low T1 signal and enhancement that traverses the right sacral ala. There are prominent sacral perineural cysts with remodelling of the sacrum. Otherwise, there is no evidence of mass lesions in the spine. There are mild degenerative changes in the lower cervical spine and at L5-S1 without significant spinal canal stenosis. The vertebral body heights are preserved. There is no significant spondylolisthesis. The spinal cord signal and morphology is normal. There is a right pleural effusion.

Output: 1. Metastases in the right cerebellar hemisphere and left occipital lobe with associated vasogenic edema.2. Radiation effects in the lumbosacral spine bone marrow with probable right sacral insufficiency fracture versus less likely an infiltrative metastasis.3. Low-lying cerebellar tonsils may represent Chiari 1 malformation.4. Right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 20 years old, with worsening migraine frequency, right-sided. Assess for mass lesion. Also with lower extremity numbness. Brain:No evidence of signal abnormality, edema or mass effect is seen. No pathologic parenchymal or extra-axial enhancement is detected. A small right frontal developmental venous anomaly is noted incidentally.There is no evidence of intracranial hemorrhage or any abnormal extra axial fluid collection. Ventricles are normal in size and morphology.Spine:Alignment is anatomic. Vertebral body morphology and signal characteristics are normal. No evidence of marrow edema is seen.The visualized spinal cord shows normal signal intensity and morphology.Very small central disk protrusions are seen at C5-6 and C6-7. These do not contact the spinal cord and results in no significant spinal canal stenosis. The neural foramina are patent throughout.

Output: 1. Unremarkable evaluation of the brain with no specific findings to account for the patient's worsening migraines.2. Minimal degenerative disk disease in the cervical spine which, again, would not explain the patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: 19-year-old female patient with history of progressive pelvic desmoid tumor, currently being treated with tamoxifen. PELVIS: The ill-defined infiltrating mass in the left hemipelvis is mildly increased in size and currently measures 9.5 x 6.6 cm (series 8 image 43), previously 9.5 x 5.7 cm when measured similarly. The mass encases the left external iliac artery. The mass invades and occludes the left external iliac vein, with numerous collateral vessels identified. Anteriorly, the mass further invades and enlarges the left rectus muscle and adductor brevis. Laterally, the mass invades the left pelvic side wall, iliacus muscle, psoas muscle, and abuts the left acetabular cortex, similar to prior. Posteriorly, the mass extends into obturator internus muscle. Medially, the mass abuts left lateral bladder wall and adjacent loops of small intestine. The rectum appears uninvolved. UTERUS, ADNEXA: T1 and T2 hypointense probable pessary device in place in the vagina.BLADDER: The urinary bladder is displaced to the right.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mildly increased left thigh soft tissue edema, reflecting venous congestion of the aforementioned left external iliac vein occlusion.

Output: 1.Approximately 1 cm increase in size in the mediolateral plane with other dimensions and degree of invasion of pelvic musculature remaining stable.2.Persistent occlusion of the left iliac vein with venous collateral formation.


Instruction: Generate impression based on medical findings.

Input: 61-year-old male with history of prostate cancer. PELVIS:PROSTATE:Prostate Size: 5.8 x 3.2 x 4.5 cmPeripheral Zone: Anterior mid gland lesion measuring 14 x 8 mm with decreased T2 signal and restricted diffusion (image 88 of series 401).Diffuse linear decreased T2 signal abnormality in the peripheral zone without corresponding restricted diffusion likely benign.Central Gland: Small hyperplastic nodules compatible with BPH.Seminal Vesicles: NormalExtracapsular Extension: The anterior mid gland lesion abuts the capsule but does not invade.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Anterior midgland lesion as above which is highly suspicious for adenocarcinoma.


Instruction: Generate impression based on medical findings.

Input: The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.

Output: No mass, signal abnormality, or structural anomaly. Specifically, there are no MRI findings to explain the patient's chronic headaches.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Surgical planning for craniotomy. Signs and symptoms: Weakness. Pre and post enhanced Stealth brain MRI:Examination is performed utilizing surgical planning protocol and is not a complete diagnostic study.There is a large necrotic and rim enhancing mass in the right mid temporal lobe and extending superiorly into the right basal ganglia. The largest transaxial dimensions of tumor measures approximately at 41 x 33 mm. The mass applies mass effect on the right temporal horn of lateral ventricle and inseparable from the ventricle or the right choroid plexus in the trigone of right lateral ventricle. There is however no detectable ependymoma enhancement of the ventricular wall.Mass effect results in leftward deviation of midline of approximately 7 mm and without evidence of ventriculomegaly. There is no detectable additional foci parenchymal or leptomeningeal enhancement. There is also no detectable calvarial or retro-orbital enhancement.

Output: Necrotic rim enhancing tumor (41 x 33 mm) suspected of GBM in the right temporal lobe with surrounding vasogenic edema and 7 mm leftward midline shift.


Instruction: Generate impression based on medical findings.

Input: Aphasia [R47.01], Reason for Study: ^Reason: eval for pathology, s/p crani for R MCA and L ICA aneurysms. History: aphasia Due to metallic artifact, precise evaluation with diffusion-weighted imaging and gradient-echo imaging are limited.However, there is no evidence of acute ischemic lesion on the scan.There are localized and somewhat gyral pattern FLAIR/T2 high signal intensity lesions at the left anterior temporal lobe surface area (series 6, image 12,13,14). There are also associated FLAIR/T2 high signal intensity lesions at the left anterior and mesial temporal area. This lesion is likely to be intra axial and indicate possible hemorrhagic lesions as well as associated parenchymal edema likely related to prior operation.There is also extra dural fluid collection extending from the left frontal lobe 2 to temporal lobe and the maximum diameter was measured about 11 mm on axial T2 images with subtle effacement of underlying brain parenchyme. The maximum diameter measured on prior CT scan was about 10.1 mm, thus, considering different imaging modality, there is no significant interval change of extradural fluid collections.There is also scalp fluid collections with air signal intensities which are related to prior operation, unchanged since prior scan.Minimal (about 1-2mm) midline shift toward right side is again seen but unchanged since prior scan.The ventricles, sulci and cisterns are symmetric.There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Left temporal lobe likely hemorrhagic lesion and edematous lesions, likely represent prior surgery related lesions as described above (series 6, image 12,13,14).2. No evidence of acute ischemic lesion.3. Unchanged extra dural fluid and air collections since prior scan with subtle effacement of underlying brain parenchyme since prior scan.4. Unchanged subgaleal fluid and air collection since prior CT scan.


Instruction: Generate impression based on medical findings.

Input: 77-year-old male with history of prostate cancer. Evaluate for disease. Fusion biopsy to follow. Biopsy with Gleason 3+3 in right base lateral, Gleason 3+3 in left mid medial, Gleason 3+3 in left mid lateral. PELVIS:PROSTATE:Prostate Size: The prostate measures 7.7 cm in transverse, 6.1 cm in AP, and 7.4 cm in craniocaudal length.Peripheral Zone: Thin rim of peripheral zone parenchyma. In the right lateral mid gland, there is a 0.6 cm focus of T2 and ADC hypointense signal (series 301 image 80, series 508 image 24) touching the prostate capsule.In the right paramedian mid gland, there is a 0.8 cm ADC hypointense focus (series 508 image 344). However, correlation on the T2 sequence is nonspecific.Central Gland: Marked multinodular appearance of BPH. On the ADC sequence, there are multiple central gland hypointense foci that are difficult to confirm on the T2 sequence and remain indeterminate.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: None.BLADDER: Trabeculated bladder related to chronic bladder outlet obstruction.LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Dominant lesion in the peripheral right mid gland measuring up to 0.6 cm.2.Trabeculated bladder related to chronic bladder outlet obstruction from severe BPH.


Instruction: Generate impression based on medical findings.

Input: 79 years Female (DOB:3/12/1936)Reason: stroke evaluation History: L sided clumsiness/weaknessPROVIDER/ATTENDING NAME: MURRAY J KEENE MURRAY J KEENE The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a focus of encephalomalacia involving the medial aspect of the left occipital lobe which involves left lingual gyrus and left cuneus and part of the left fusiform gyrus. It is associated with ex vacuo effect along the left lateral ventricle.There is no evidence for diffusion restriction on the current exam.A punctate hypointense focus is present along the inferior aspect and posterior aspect of the right thalamus. There are punctate foci of signal hyperintensity on T2 imaging in the right thalamus and the basal ganglia bilaterallyThere is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate minor opacities. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.

Output: 1.There is no evidence for acute cerebral ischemic infarction.2.There is encephalomalacia involving much of the left occipital lobe which is probably related to prior vascular event.3.Small lesions in the basal ganglia and right thalamus are likely related to prior lacunar infarcts.4.Findings suggest a microhemorrhage in the right thalamus which in isolation is of unknown clinical significance.5.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on medical findings.

Input: Reason: Evaluate right shoulder labral tear for worsening since 2009 History: Right shoulder pain ROTATOR CUFF: The supraspinatus and infraspinatus muscles and tendons appear intact. The infraspinatus and subscapularis muscles and tendons appear intact.SUPRASPINATUS OUTLET: No significant fluid or intra-articular gadolinium is identified within the subacromial subdeltoid bursa. The acromioclavicular joint is normal in appearance.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. Again seen is intra-articular gadolinium extending into the anterior labrum in a branching pattern indicating a tear. There is also extension of this tear to involve the articular cartilage of the glenoid indicating a GLAD lesion appearing similar to the prior study. There is heterogeneity and irregularity of the anterior inferior glenoid which likely represents a combination of degeneration and postsurgical change.BICEPS TENDON: The tendon of the long head of the biceps appears intact. ADDITIONAL

Output: Tearing of the anterior glenoid labrum as described with extension of the tear to involve the articular cartilage of the glenoid, appearing similar to the prior study.


Instruction: Generate impression based on medical findings.

Input: Check for SLAP tear. Pain and clicking. Exam is limited in the absence of augmentation and an existing effusion.ROTATOR CUFF: Mild undersurface fraying of the supraspinatus with otherwise intact fibers. The remainder of the rotator cuff is otherwise intactSUPRASPINATUS OUTLET: Moderate osteoarthritic changes of the AC joint with more mild to moderate changes of the shoulder. This includes minimal narrowing, more pronounced osteophytes and subchondral cysts.GLENOHUMERAL JOINT AND GLENOID LABRUM: Specifically the labrum is grossly intact, however small diminished, specifically along the anterior aspect. Additionally abnormal signal underlying the superior component suggesting detachment is observed, however free fluid is not seen it could be absent given the lack of augmentation.Marrow signal is intact throughoutBICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Mild tendinosis of the supraspinatus with undersurface fraying as well as changes of the superior labrum suggesting probable SLAP tear difficult to confirm in the absence of an augmented exam.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: 64-year-old female with pancreatic lesion noted on abdominal ultrasound, abdominal pain ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis without specific evidence of cholecystitis. There are subcentimeter T2 hypointensities within the left and right lobe of the liver most compatible with cysts. Trace amount of perihepatic fluid.There is a focus of susceptibility artifact in the inferior right lobe of the liver that is nonspecific.SPLEEN: Trace amount of perisplenic fluid.PANCREAS: There is loss of the intrinsic T1 signal of the pancreatic parenchyma. There is a hypoenhancing, intrinsic T1 and T2 isointense enhancing mass within the body of the pancreas measuring up to 5.1 x 4.0 x 4.7 cm (series 1103, image 35). There is dilation of the distal pancreatic duct measuring up to 8 mm. There is at least 180 degree encasement of the proximal SMA and common hepatic artery. There is encasement of the SMV with marked mass effect without evidence of occlusion. The splenic vein is chronically occluded with gastric varices present. The portal vein is patent.Pancreatic divisum anatomy is noted. ADRENAL GLANDS: Nodularity/thickening of the left adrenal gland is nonspecific.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Moderately prominent left para-aortic lymph nodes measuring up to 8 mm in short axis.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Pancreatic mass in the body of the pancreas as described above is suspicious for cancer. Focal pancreatitis may result in these findings as well. An endoscopic ultrasound is recommended for further evaluation.


Instruction: Generate impression based on medical findings.

Input: 58-year-old male with enteritis/small bowel wall thickening noted on CT. ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis is is present.SPLEEN: No significant abnormality noted.PANCREAS: Previously noted cystic focus in the tail of the pancreas is not well seen on the current study. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Hydronephrosis or perinephric inflammation. Punctate T2 hyperintensities likely reflect small cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is no evidence of small bowel obstruction. There is no focus of abnormal enhancement. Previously noted segment of small bowel wall thickening is not appreciated on the current study. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Previously noted segment of small bowel wall thickening is not appreciated on the current study. No additional sites of abnormal bowel enhancement.2.Previously noted cystic focus in the tail of the pancreas is not well seen on the current study. Consider dedicated MRCP for further evaluation.


Instruction: Generate impression based on medical findings.

Input: 68-year-old male. HCC, cirrhosis, HCV. Status post TACE/RFA. Evaluate liver lesions. ABDOMEN:LIVER, BILIARY TRACT: Ablation defect in the right hepatic lobe measures 1.8 x 3.6 cm (series 9, image 136). There is a anterior and superior peripheral nodule of arterial enhancement in the cavity measuring 1.1 x 0.9 cm (series 9, image 40), concerning for residual tumor. New 1.2 x 1.3 cm arterial focus of enhancement in segment 6 (series 9, image 55) that becomes isointense to liver parenchyma on later phases and does not have associated T2 signal abnormality; does meet criteria for HCC, special attention on follow-up scans.No biliary ductal dilatation. Patent hepatic artery, hepatic vein, and portal vein. Cirrhotic liver morphology.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Mildly atrophic kidneys.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small hiatal hernia.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Interval ablation of segment 8 lesion with a small nodular focus of arterial enhancement in the ablation cavity concerning for residual tumor. 2. New 1.2 cm arterially enhancing focus in segment 6 that does meet criteria for HCC; special attention on follow-up scans.


Instruction: Generate impression based on medical findings.

Input: 53-year-old female with history of cholangiocarcinoma. ABDOMEN:LIVER, BILIARY TRACT: Surgical changes from a partial right hepatectomy. Increased size of the known fluid-filled cavity (axial series 4 image 8) measuring 9.4 x 5.6 cm (prior 7.5 x 4.5 cm). Nodular focus of T2 hyperintense signal measuring 3.6 x 1.9 cm (axial series 4 image 13) again demonstrates contrast enhancement and has increased in size (prior 1.9 x 1.4 cm). The nodule encases the middle hepatic vein. The left portal vein is patent. The segment 8 ablation cavity has decreased in size in the interval. Similar appearing portacaval lymph nodes.SPLEEN: Unchanged T2 hyperintense nonenhancing splenic lesion, probable cyst.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Similar appearing portacaval lymph nodes.BOWEL, MESENTERY: No evidence of peritoneal disease.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Interval resolution of the small right pleural effusion.

Output: 1.Status post right partial hepatectomy and segment 8 radiofrequency ablation. Residual enhancing tumor nodule at the hepatectomy margin has increased in size. No evidence of peritoneal disease.


Instruction: Generate impression based on medical findings.

Input: There are postoperative changes at L4 and L5. There is disc desiccation at all levels. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. With the exception of endplate degenerative change, the vertebral bone marrow signal is unremarkable. The imaged spinal cord displays normal signal and morphology and the conus terminates at L1-L2. The paravertebral soft tissues are unremarkable.L1-L2: There is an unchanged minimal disc bulge as well as bilateral facet arthropathy and ligamentum flavum thickening. There is no significant spinal canal or neural foramen stenosis.L2-L3: There is an unchanged mild disc bulge asymmetric to the left as well as bilateral facet arthropathy and ligamentum flavum thickening that is mildly progressed as well as ligamentum flavum thickening. These findings result in minimally worsened mild spinal canal stenosis and impingement upon the right subarticular zone.L3-L4: There is unchanged loss of disc height, modic type 2 endplate degenerative changes, and a slightly enlarged moderately sized disc bulge as well as bilateral facet arthropathy and ligamentum flavum thickening. Findings result in unchanged moderate spinal canal stenosis and unchanged severe right and moderate left neural foramen stenosis.L4-L5: There is unchanged loss of disc height, modic type 2 endplate degenerative changes and a moderately sized disc bulge as well as a small unchanged annular fissure. There is severe bilateral facet arthropathy that is mildly progressed as well as ligamentum flavum thickening. These findings result in mildly progressed severe spinal canal stenosis as well as severe right and moderate left neural foramen stenosis.L5-S1: There is an unchanged mild disc bulge as well as bilateral facet arthropathy. Findings result in unchanged severe left and moderate right neural foramen stenosis and no significant spinal canal stenosis.

Output: Slightly progressed multilevel severe degenerative changes including up to severe spinal canal stenosis at L4-L5, multilevel moderate and severe neural foramen stenosis, and severe multilevel facet arthropathy.


Instruction: Generate impression based on medical findings.

Input: Disorientation, unspecified [R41.0], Reason for Study: ^Reason: CT head with acute versus subacute infarct in the right occipital lobe History: see above Brain MRIRestricted diffusion lesions on bilateral frontal and parietal lobes as well as the right occipital lobe. Especially the right occipital lobe lesion show susceptibility artifacts indicating hemorrhagic conversion.There are scattered FLAIR/T2 high signal intensity lesions on periventricular white matter indicating non specific small vessel ischemic disease.The ventricles, sulci and cisterns are unremarkable. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. The right distal PCA is not clearly visualized. Otherwise basilar artery and the left PCA appear to be normal.

Output: 1. Right occipital, bilateral frontal and bilateral parietal subacute ischemic infarction with evidence of hemorrhagic conversion on the right occipital lobe lesion.2. Non visualization of the distal right PCA which corresponding to the right occipital ischemic infarction.3. Minimal non specific small vessel ischemic disease.


Instruction: Generate impression based on medical findings.

Input: 55-year-old female with low back pain and left hip pain The density and the alignment the vertebral column remains within normal limits. No significant degenerative disk disease is identified. There is however mild degree of degenerative disease at L5 -- S1 level. No evidence of spinal stenosis at any level.No evidence of central spinal stenosis or neural foramina compromise from T12 -- L1 through L3 -- L4 level.L4 -- L5.Minimal degenerative disk disease and hypertrophic changes of posterior elements are noted. Minimal bulge of disk material is present. Laterally within the neural foramina and far laterally there is broad-based bulge of disk material and a more focal area of disk protrusion. This is highly suspected of a large herniated disk. This finding is best appreciated on axial image 57 and 58. Lateral to the disk a prominent soft tissue density (axial image 55) is identified. This finding may represent inflamed and swollen nerve root or a migrated disk fragment laterally. I recommend further evaluation with an MRI examination or a post infusion study to exclude possibility of a mass. There is only minimal compromise of the left neuroforamina secondary to above findings. The right neuroforamina is patent and no central spinal stenosis is detected.L5 -- S1.Moderate degree of degenerative disk disease with a sclerotic changes of endplates are noted. No central spinal stenosis or neural foramina compromise. Mild bulge of disk material is also present.

Output: 1.Suspected large herniated disk at L4 -- L5 laterally and far laterally as detailed.2.Prominent soft tissue density adjacent to the disk at this same location may be represent a swollen nerve root or a mass. Further evaluation with a dedicated post infused MRI or a post infusion CT to exclude presence of the mass is recommended.3.No evidence of central spinal stenosis or neural foramina compromise at any other level.


Instruction: Generate impression based on medical findings.

Input: MRI brain: Again seen is a stable pineal gland cyst which measures 12 x 10 mm, previously 12 x 10 mm. There are a few punctate foci of susceptibility effect in the cerebral hemispheres, unchanged. There is a single very small focus of T2 signal abnormality in the right frontal white matter, unchanged and nonspecific. There is no diffusion abnormality. There are no areas of abnormal signal or pathological enhancement.The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. MRA brain: The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. Bilateral posterior communicating arteries are seen. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.

Output: 1. Stable pineal gland cyst. No new findings on brain MRI to account for patient's symptoms.2. No evidence of cerebrovascular occlusion or aneurysm.


Instruction: Generate impression based on medical findings.

Input: Redemonstrated are prominent subarachnoid CSF spaces, more prominently noted over the frontal lobes and the anterior falx in the supine position.The ventricles and sulci are normal in size. 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. No diffusion-weighted abnormalities are identified. Myelination is appropriate. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Fluid is present within both middle ear cavities and mastoid air cells. There is no abnormal enhancement within the brain.Coronal images of the temporal lobes demonstrate the temporal horns, hippocampal formations and parahippocampal gyri to be normal in size and symmetric bilaterally without signal abnormalities, masses, or abnormal enhancement identified within the medial temporal lobes on either side. There is no evidence of mesial temporal sclerosis and there are no foci of heterotopic gray matter.

Output: 1.Redemonstrated is benign enlargement of the subarachnoid spaces which usually resolves by two years of age.2.Fluid is present within both middle ear cavities and mastoid air cells.3.There are no MRI findings to explain the patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: 99 years Female (DOB:2/17/1917)Reason: Stroke location History: R side weakness and aphasiaPROVIDER/ATTENDING NAME: DAVID G BEISER KOUROSH X REZANIA MRI of the brainFoci of diffusion restriction are present along the left insular cortex extending to the inferior aspect of the left precentral gyrus. Some punctate foci of diffusion restriction are present in the left centrum semiovale.. A 5 mm focus of diffusion restriction is present in the left temporal lobe.There are patchy foci of encephalomalacia present along the inferior aspects of the cerebellar hemispheres bilaterally.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Some patchy lesions which are T2 and FLAIR hyperintense are present in the brainstem. Small T2 and FLAIR hyperintense foci are present in the basal ganglia.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain: Exam is degraded by patient motion artifact.Flow within the basilar artery and the distal left vertebral artery is not readily identified. The right vertebral artery and the left vertebral artery both appear relatively small. The posterior communicating arteries appear to supply the posterior cerebral arteries bilaterally.. There is opacification of the distal basilar artery including the superior cerebellar arteries.The left A1 segment is small. Findings suggest an azygos A2 segment. The left middle cerebral artery vasculature is not as readily visualized is the right middle cerebral artery vasculature. There appears to be divisional occlusion along the left middle cerebral artery territory most likely the inferior division. Is partly obscured by patient motion.

Output: 1.Occlusion of the proximal and mid portions of the basilar artery and possibly distal left vertebral artery. The distal basilar artery and the superior cerebellar arteries appear to be supplied from the anterior circulation through the circle of Willis. Please note that the MRA exam is somewhat degraded due to motion artifact. As a result details are less conspicuous. If clinically appropriate and further detail is necessary for clinical management a CT angiogram may be helpful to further evaluate this.2.Findings suggest left middle cerebral artery occlusion at the inferior division. Please note that the MRA exam is somewhat degraded due to motion artifact. As a result details are less conspicuous. If clinically appropriate and further detail is necessary for clinical management a CT angiogram may be helpful to further evaluate this.3.Findings are compatible with acute infarction involving left insular cortex and adjacent aspects of the left centrum semiovale and frontal lobe as well as a small lesion in the left temporal lobe. These are located in the left middle cerebral artery territory.4.Foci of encephalomalacia present along the inferior aspect of the cerebellar hemispheres which are most likely related to prior cerebrovascular event.5.Periventricular and subcortical white matter lesions of a mild degree as well as patchy lesions in the brainstem are nonspecific. At this age they are most likely vascular related. 6.The MRI of the brain exam is limited due to patient inability to cooperate. No susceptibility weighted imaging was performed. No T2 axial or imaging was performed. No axial T1 imaging was performed.


Instruction: Generate impression based on medical findings.

Input: 73-year-old male with back pain that is better with getting up and walking. Alignment is anatomic. Vertebral body heights are within normal limits. Scattered areas of T1 hyperintensity in the vertebral bodies likely represent focal fat or hemangiomas. The conus medullaris is normal in position. Left renal cysts are also noted. The paraspinous soft tissues are otherwise within normal limits. Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No significant spinal canal or neural foraminal stenosis. L2-L3: Mild facet arthropathy. Reduced T2 signal of the disc without loss of disc height or disc bulge. No significant spinal canal or neural foraminal stenosis.L3-L4: Moderate facet arthropathy. Reduced T2 signal of the disc with mild loss of disc height. In addition to a mild, predominantly lateral disc bulge, this results in mild bilateral neural foraminal stenosis. No significant spinal canal stenosis.L4-L5: Moderate facet arthropathy and ligamentum flavum thickening. Reduced T2 signal of the disc without significant loss of disc height. In addition to a mild disc bulge, this results in moderate left and mild right neural foraminal stenosis. The left lateral recess is effaced, greater than the right, with crowding of the descending L5 nerve roots. No significant spinal canal stenosis.L5-S1: Moderate facet arthropathy. Reduced T2 signal of the disc without significant loss of disc height. In addition to a mild disc bulge, this results in mild bilateral neural foraminal stenosis. No significant spinal canal stenosis. Right subarticular annular fissure is also noted.

Output: Relatively mild degenerative changes of the lumbar spine without high-grade spinal canal or neural foraminal stenosis. At worst, there is moderate left neural foraminal stenosis at the L4-5 level.


Instruction: Generate impression based on medical findings.

Input: Persistent N/V. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a small areas of apparent encephalomalacia and gliosis in the white matter adjacent to the frontal horn of the left lateral ventricle. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is streaky high T2 signal material in the bilateral cheek subcutaneous tissues. The orbits, skull, mastoid air cells, and scalp soft tissues are grossly unremarkable. There is a small right maxillary sinus retention cyst.

Output: 1. Small areas of periventricular leukomalacia adjacent to the frontal horn of the left lateral ventricle.2. No evidence of intracranial hemorrhage, mass, or acute infarct. 3. Probable cosmetic filler material in the bilateral cheeks.


Instruction: Generate impression based on medical findings.

Input: Clinical question: History of recent head and neck cancer, post surgery, pre-chemotherapy/RT. Signs and symptoms: Baseline chemo/RT CT of soft tissues of neck with contrast:70 cc of Omnipaque 350 was utilized for the above study.Images through the skull base, cavernous sinuses, paranasal sinuses and mastoid air cells are unremarkable. There is evidence of thrombosed right internal jugular vein that appears to extend into the right jugular bulb. This is a new finding since prior study. There is expansion of thrombosed right internal jugular from the skull base to approximately the level of the right carotid bifurcation.Examination demonstrates extensive postoperative changes of right neck with a large flap which extends from the right submandibular level inferiorly to the level of the right thyroid cartilage. There is evidence of partial right mandibulectomy. There is fixating screws and rod extending from anterior aspect of remaining right body of mandible posteriorly to the ramus of mandible.Postoperative changes in the including multiple surgical clips near right submandibular region are noted. This is also believed to be related to surgical changes of the lack placement.There is no definite differential mass or pathologic adenopathy by CT size criteria is identified. There is a small cyst within the right lobe of thyroid measuring approximately 10.5 mm times 7-mm on coronal reformatted image 39.Limited images of the apices of the lungs and mediastinum are negative. Please review dedicated report of CT of chest which visualizes both of these regions would better advantage.The osseous structures of the area of exam other than what was noted in the mandible are unremarkable. No evidence of cartilaginous erosion. The carotid system is intact.CT of brain with contrast:Examination demonstrates an enhancing mass measuring approximately 8 mm times 5 mm in transaxial dimension in the body of the left lateral ventricle. The mass is well demarcated and demonstrates uniform intense enhancement. No definitive calcification is detected. There is no associated edema of the adjacent brain parenchyma. Considering patient's history of malignancy metastatic lesion should be considered. Other differentials for this mass includes intraventricular meningioma, great plexus papilloma, ependymoma and other lesions. Follow up with a dedicated MRI may help in differentiating the etiology of this finding.There is no evidence of any additional area of abnormal enhancement. No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Gray/white matter differentiation is well preserved.Calvarium is intact. Limited view of paranasal sinuses and mastoid air cells are unremarkable.There is redemonstration of thrombosed and expanded right jugular vein in upper cervical with apparent extension into the right jugular bulb.

Output: 1.Extensive postoperative changes of the neck on the right with no detectable tumor or pathologic adenopathy.2.Well demarcated a small mass within the body of left lateral ventricle (5-mm times 8mm) as detailed. Differential includes metastatic lesion, meningioma, ependymoma and choroid plexus papilloma. Considering the history of malignancy metastatic disease should be considered and follow-up with an MRI is recommended.3.CT examination of brain and calvarium is otherwise unremarkable for malignancy.4.Thrombosed right jugular vein in upper cervical region and with apparent extension into the right jugular bulb.


Instruction: Generate impression based on medical findings.

Input: Right knee pain. Evaluate meniscal tear. MENISCI: There is extensive degenerative tearing of the lateral meniscus. This includes attenuation, deformity and extrusion of the body of the lateral meniscus, attenuation and abnormal signal intensity of the anterior horn, and horizontally oriented signal abnormality within the posterior horn that extends to the tibial articular surface. There is increased signal intensity within the posterior horn of the medial meniscus indicating intrasubstance degeneration, which extends to the tibial articular surface suggesting a degenerative undersurface tear.ARTICULAR CARTILAGE AND BONE: There is full-thickness cartilage loss along the lateral femoral condyle and medial tibial plateau with cyst formation and degenerative signal abnormality in the underlying subchondral bone. There is more focal near-full-thickness to full-thickness degeneration of the articular cartilage along the lateral aspect of the medial femoral condyle. There is edema-type signal within the posterior aspect of the medial femoral condyle as well as a cyst in the anterior aspect of the medial tibial plateau which I suspect are degenerative etiology as well. Moderate cartilage degeneration affects the patellofemoral joint. There are tricompartmental osteophytes.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Osteoarthritis as described above most severely affecting the lateral tibiofemoral compartment with extensive tearing of the lateral meniscus.2.Intrasubstance degeneration and degenerative undersurface tearing of the medial meniscus as above.


Instruction: Generate impression based on medical findings.

Input: 45-year-old woman with history of pancreatic pseudocyst status post drainage. ABDOMEN:LIVER, BILIARY TRACT: The liver and gallbladder appear normal. There is no intra or extra hepatic biliary duct dilatation.SPLEEN: The spleen appears normal.PANCREAS: The cystgastrostomy tube has been removed. The pancreatic parenchyma is atrophic. The parenchyma and pancreatic tail has decreased T1 signal and enhances poorly. Additionally, there is mild pancreatic tail duct dilatation. No pseudocyst or abnormal fluid collection is identified. No focal pancreatic lesion is identified.The duodenum distends normally on the secretin augmented images suggesting normal exocrine function.ADRENAL GLANDS: The adrenal glands appear normal.KIDNEYS, URETERS: The kidneys appear normal and enhance symmetrically.RETROPERITONEUM, LYMPH NODES: Small peripancreatic lymph nodes are noted, however there is no significant lymphadenopathy.BOWEL, MESENTERY: Loops of small bowel and colon are partially visualized.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Resolved pancreatic pseudocyst and cystgastrostomy removed.2.Findings suggestive of chronic tail pancreatitis with mild ductal dilatation, likely due to stricture or chronic ductal injury.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old, history of NF2, history spinal schwannoma resection, meningioma, one year follow-up Brain: Redemonstrated is a mildly hemosiderin stained area of encephalomalacia involving the left pons appearing similar to the prior examination. Tract like T2 hyperintensity is seen coursing through the left frontal lobe, also unchanged compatible with prior instrumentation. No evidence of mass effect is seen. No abnormal fluid collections are detected. Ventricles are normal in size and morphology.Multiple areas of dural thickening and enhancement are again demonstrated including a plaque like region along the anterior right frontal convexity, as well as more nodular areas along the high right convexity, the anterior interhemispheric falx, along the right transverse sinus, and the left tentorial leaf. There is stable to minimal enlargement compared to prior. For example a left tentorial lesion measures 8 x 14 mm, previously 6 x 12 mm.A nodular enhancing lesion within the right IAC measures 10 x 5 mm, previously 8 x 5 mm. An enhancing nodule in the left IAC measures 14 x 8 mm previously 12 x 6 mm.A small enhancing nodule in the right parietal scalp measuring 8 x 5 mm, previously also 8 x 5 mm.Cervical Spine: Spinal lesions are as follows:1. Extramedullary intradural lesion within the left posterolateral thecal sac at C1 measuring 9 x 5 mm, previously 8 x 5 mm.2. Right C2-3 foraminal lesion measuring 16 x 8 mm, previously 13 x 10 mm. Minimal extension into the right lateral aspect of the epidural space without mass effect on the cord. 3. Left C3-4 foraminal lesion measuring 26 x 10 mm, previously 25 x 10 mm. The more medial intraspinal component measures 10 mm in the oblique dimension, previously 7 mm. The enlargement involving the medial intraspinal component results in mass affect on the cord which is stable to minimally worse.As above, the spinal cord is impinged at the C3-4 level, but at no point is there any evidence of increased cord T2 signal to suggest edema.The cervical lordosis is mildly reversed. Vertebral body heights are preserved. Marrow signal characteristics are unremarkable.There remains a disk osteophyte complex asymmetric towards the right at the C5-6 level which results in at least mild spinal canal stenosis and impression on the ventral cord; there is also mild right greater than left neural foraminal stenosis. Minimal T2 hyperintensity within the right ventral aspect of the cord at this level is suspected and possibly also present previously; finding may represent myelomalacia.Numerous small nodular lesions within the soft tissues of the neck which may reflect lymph nodes or nerve sheath tumors appear similar to prior.Thoracic Spine:Redemonstrated is evidence of posterior approach surgery with changes spanning from T3 to T7 for resection of a previously noted schwannoma at the T6 level. No evidence of residual tumor is seen in the operative region. Subtle foci of nodular enhancement are seen along the ventral aspect of the thoracic cord at the T6-T7 level on the sagittal images and not well appreciated on the axial images. These are not seen on the prior study. T2 hyperintensity within the cord is noted at T6 compatible with myelomalacia and present previously.At the T12 level, an enhancing extramedullary intradural mass is redemonstrated in the right lateral aspect of the thecal sac measuring 6 x 4 x 8 mm, previously 5 x 5 x 7 mm.Alignment is anatomic. Vertebral body heights are preserved. No concerning marrow replacement is seen. No significant spinal canal or neuroforaminal stenosis is detected.Lumbar Spine:Intradural lesion within the posterior left aspect of the distal cord surface at L1 measures approximately 5 x 4 mm, previously 5 x 4 mm. Intradural enhancing lesion nearly filling the thecal sac at the L3-4 level measures 10 x 12 x 13 mm, previously 10 x 11 x 12 mm. This lesion displaces the adjacent nerve roots of the cauda equina posteriorly and laterally.The lumbar lordosis is slightly straightened. Alignment is otherwise unremarkable. Vertebral body heights are normal. No concerning marrow signal alteration is demonstrated.Mild degenerative disk disease seen at L3-4 without significant degenerative spinal canal or foraminal narrowing. Moderate degenerative disease is seen at L4-5 and L5-S1 with disk bulging and facet hypertrophy resulting in mild thecal sac narrowing and at most mild foraminal narrowing, not significantly changed.

Output: 1. Multiple areas of nodular or plaque-like dural thickening are redemonstrated compatible with meningiomas and stable to minimally larger than prior from 6/23/2014.2. Encephalomalacia in the left pons is unchanged.3. Bilateral vestibular schwannomas are reidentified and are minimally larger than prior.4. A mass within the right C2-3 neural foramen is not significantly changed. Minimal epidural extension without mass effect on the cord again seen.5. A mass centered in the left C3-4 neural foramen with intraspinal extension has slightly increased in size with stable to slight worsening in mass effect on the adjacent cervical cord. No associated cord signal abnormality. 6. Disc osteophyte complex at C5-C6 with mild impression on the right ventral aspect of the cord and small focus of associated cord signal abnormality which may represent myelomalacia. No significant change since prior.7. Redemonstration of surgical sequelae following resection of a previously seen posterior intradural lesion at T6. No evidence of recurrent tumor is seen at this site. There remains some abnormal T2 signal in the cord at this level which likely reflects myelomalacia and which is unchanged. There is however nodular enhancement at the T6-T7 level along the ventral aspect of the cord seen only on the sagittal images which may be related to a new lesion and can be assessed on follow-up studies.8. Remaining lesions in the thoracic and lumber spine are stable to minimally larger as above. Largest of these is at the L3-L4 level and fills the thecal sac.


Instruction: Generate impression based on medical findings.

Input: Reason: 61-year-old female with lower extremity weakness and numbness with upgoing babinski for several months, history of ALL. There continues to be no nodular enhancement involving the conus or cauda equina nerve roots. An isolated right-sided linear enhancing structure represents a congenital radicular vein. There remains minimal enhancement of cauda equina nerve roots which again are enhancing less so compared to the previous exam. These findings are nonspecific but may represent an inflammatory process. The conus medullaris shows normal signal. Alignment is notable for unchanged minimal retrolisthesis of L1 relative to L2 which is associated with desiccation and mild disc height loss. The other intervertebral discs are preserved in height. The vertebral bodies are preserved in height. There is no significant neuroforaminal or spinal canal stenosis. The bone marrow signal is preserved. There are changes of presumed bone marrow biopsies in the posterior iliac bones. These findings are unchanged.

Output: There continues to be no nodular enhancement involving the conus or cauda equina nerve roots. An isolated right-sided linear enhancing structure represents a congenital radicular vein. There remains minimal enhancement of cauda equina nerve roots which again are enhancing less so compared to the previous exam.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old, history of stage IV lung adenocarcinoma, in need of brain MRI to complete staging. Fairly extensive patchy periventricular T2 hyperintensity seen. Notable T2 hyperintensity is also evident within the pons.Diffusion weighted images are normal. No evidence of parenchymal edema or mass effect is detected. On postcontrast images, a punctate, submillimeter focus of enhancement is seen within the right parietal white matter (image 254 series 12). Otherwise, no pathologic parenchymal or extra-axial enhancement is detected.Numerous scattered foci of susceptibility are seen, prominently clustered within the basal ganglia and thalami, but with a few scattered elsewhere including the left cerebellum. No evidence acute intracranial hemorrhage is seen. No pathologic extra-axial fluid collections are detected. The size and shape of the ventricles are within normal limits.Mucosal thickening and layering of secretions are evident in the right maxillary sinus and at the level of the right ethmoid air cells.

Output: 1.Extensive periventricular white matter signal abnormality, with scattered corresponding foci of susceptibility, likely reflect sequelae of chronic microvascular ischemic disease.2.No definite evidence of intracranial metastatic disease is seen. A punctate submillimeter focus of enhancement within the right parietal white matter is nonspecific, but given the appearance of the background parenchyma, it may reflect a resolving or subacute microvascular event. A follow up examination should be considered to verify resolution.


Instruction: Generate impression based on medical findings.

Input: 19-year-old female with wrist pain. LIGAMENTS: Intra-articular contrast is identified in the radiocarpal joint indicating ligamentous disruption. Intra-articular contrast is identified traversing the scapholunate ligament consistent with a tear. The lunotriquetral ligament appears intact.TRIANGULAR FIBROCARTILAGE COMPLEX: The triangular fibrocartilage complex appears intact.TENDONS: The flexor and extensor tendons appear intact. BONES: There is a small amount of increased signal abnormality was in the ulnar styloid which is nonspecific but may represent a direct bone contusion. No additional bone marrow signal abnormality is identified.ADDITIONAL

Output: Findings consistent with disruption of the scapholunate ligament as described above. Nonspecific bone marrow signal abnormality within the ulnar styloid may represent a direct bone contusion.


Instruction: Generate impression based on medical findings.

Input: Ovarian cancer. Rising CA-125. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left pelvicaliectasis, unchanged. RETROPERITONEUM, LYMPH NODES: Right retrocrural lymphadenopathy extending above the diaphragm into the lower chest, measures 2.5 x 1.8 cm (series 901, image 32), previously 2.5 x 1.9 cm.Multiple other prominent retroperitoneal and porta hepatis lymph nodes best seen on DWI sequences, not significantly changed.BOWEL, MESENTERY: Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Fatty marrow infiltration in the lumbar spine, likely due to post-radiation effect.OTHER: No significant abnormality noted.

Output: Stable right retrocrural and retroperitoneal lymphadenopathy with no new sites of disease.


Instruction: Generate impression based on medical findings.

Input: Right-sided weakness. Acute CVA. Non-enhanced CT of brain:There is evidence of a nonhemorrhagic acute left MCA cortical stroke in the left frontal lobe. There is subtle associated mass effect and effacement of adjacent cortical sulci. No evidence of midline shift.Patchy periventricular foci of low-attenuation is concerning for small vessel ischemic disease of indeterminate age. Follow-up with an MRI is recommended. Ventricular system is within normal range of size for patient's stated age of 70. No abnormalities of basal ganglia, thalami, pons or the cerebellum is detected. Mild vascular calcification of bilateral cavernous carotid are noted. Limited view of orbits, paranasal sinuses and mastoid air cells are unremarkable. Old healed fracture of posterior lateral wall of right maxillary sinus in this limited view is identified.

Output: 1.Acute left MCA frontal lobe nonhemorrhagic cortical stroke.2.Small vessel disease of indeterminate age.


Instruction: Generate impression based on medical findings.

Input: 58 year old female with a suspicious lesion seen on mammogram and ultrasound at right 12:30 position. Additional suspicious lesion was seen on the breast MRI performed earlier today at right 12 o'clock position. Right ultrasound re-identified the target lesion (lesion #1) for biopsy. This is a hypoechoic mass measuring 10 x 8 mm at the 12:30 position with slightly vascularity, 5 cm from the nipple. The lesion was somewhat subtle.MR directed ultrasound was performed for the additional suspicious lesion seen on the MRI. Detected is an elongated intraductal lesion with increased vascularity measuring 14 x 3 mm at 12 o'clock position, 1 cm from the nipple (lesion #2). This lesion corresponds to the additional enhancing lesion on MRI.PROCEDURE: The procedure and its risks, including bleeding, infection, and failure to diagnose, and expected benefits of ultrasound-guided core biopsy with percutaneous placement of a marking clip and post-procedure unilateral mammogram were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time-out form was completed to confirm patient identity and side/type of procedure.The right breast was cleansed with chlorhexidine. Transducer was sterilely sheathed. Biopsy for lesion #1 (12:30 position, 5-cm from nipple):Local anesthesia was obtained using 2% lidocaine superficially, with 1% lidocaine with 1:100,000 epinephrine at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a mediolateral approach, three 14-gauge core needle (Inrad) specimens were obtained of the lesion. Targeting was judged very good. One specimen sank to the bottom of the prefilled container of 10% formalin. Two specimens partially sank. Specimen quality was judged very good. Using continuous ultrasound-guidance a Hydromark clip was placed into the lesion in the usual manner. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. Biopsy for lesion #2 (12:00 position, 1-cm from nipple):Local anesthesia was obtained using 2% lidocaine superficially, with 1% lidocaine with 1:100,000 epinephrine at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a mediolateral approach, three 14-gauge core needle (Inrad) specimens were obtained of the lesion. Targeting was judged very good. All specimens sank to the bottom of the prefilled container of 10% formalin. Specimen quality was judged very good. Using continuous ultrasound-guidance a Bard ribbon clip was placed into the lesion in the usual manner. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. Specimens were sent to Pathology with an accompanying history sheet. Post-procedure digital right CC and ML views revealed the percutaneously placed Hydromark clip to be at the peripheral superior aspect of the lesion and the ribbon clip to be at expected location at anterior 12 o'clock position. No evidence of hematoma or other complication.A pressure dressing was positioned over the biopsy site and an ice pack positioned over the pressure dressing. Post-procedure instructions were reviewed with the patient both verbally and in writing. She tolerated the procedure well with no evident complications and left the Breast Imaging Department in stable condition.The procedure was performed by Dr. Abe.

Output: Successful ultrasound-guided core biopsy of the right breast lesion (2 sites) and clip placement. Pathology is pending at this time.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on medical findings.

Input: Left parotid fullness, hx of tongue cancer. PER EPIC note: revision left partial glossectomy on 1/28/2016 for microinvasive SCC/severe dysplasia with positive margins from surgery on 12/22/2015 in an outside hospital. Wife notes left parotid fullness today, states that the fullness was present prior to surgery. The left parotid tail is longer than on the right side, but there is no discernible tumor or associated inflammatory changes. The masticator spaces are unremarkable. The submandibular glands are also unremarkable. There are postoperative findings related to left partial glossectomy, but there is no evidence of measurable mass lesions or significant cervical lymphadenopathy based on size criteria. The thyroid is unremarkable. There is multilevel degenerative cervical spondylosis. The airways are patent. The imaged intracranial structures are unremarkable.

Output: 1. The left parotid tail is longer than on the right side, but there is no discernible tumor or associated inflammatory changes. This may represent an anatomic variant versus much less likely neoplasm. 2. No evidence of measurable oral tongue tumor.


Instruction: Generate impression based on medical findings.

Input: 23-year-old male with a history of Crohn's disease. Unable to scope proximal to the ileocolonic anastomosis. Evaluate for active inflammation in neoterminal ileum. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postoperative changes of small bowel resection with patent anastomosis. There is no bowel wall thickening or signal abnormality to suggest active disease/inflammation. No focal fluid collection to suggest abscess formation. No fistula is identifed.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Postoperative changes without evidence of active inflammatory bowel disease.


Instruction: Generate impression based on medical findings.

Input: Left-sided weakness There is no evidence of acute ischemic or hemorrhagic lesion on this scan.Multifocal patch periventricular white matter lesions on FLAIR imaging indicating mild to moderate nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, 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.3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate irregularity of right proximal extracranial internal carotid artery about 1 cm above the bifurcation. The degree of stenosis of the right extracranial proximal internal carotid artery is about 50%.The left extracranial internal carotid artery at the level of carotid bulb also shows about 30% luminal stenosis.Normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Mild to moderate nonspecific small vessel ischemic disease.3. Normal intracranial MR angiogram. 4. About 50% of luminal stenosis and irregularity on the right extracranial internal carotid artery just above the bifurcation and 30 % luminal stenosis on the left extracranial internal carotid artery at the level of the carotid bulb. Precise evaluation of luminal stenosis with and NASCET criteria can be performed with CT angiogram of head and neck.


Instruction: Generate impression based on medical findings.

Input: Unspecified fracture of unspecified lumbar vertebra, initial encounter for closed fracture [S32.009A], Reason for Study: ^Reason: lumbar fracture 3 month follow up History: lumbar fracture 3 month follow up For the purpose of this dictation, and to be continuous with the prior MR scan, the fractured vertebral body was numbered as L5. Comparing to prior scan, the vertical fracture line of the L5 vertebral body traversing from the superior endplate to inferior endplate is more conspicuous on the scan. Regarding the bone marrow edema of L5 vertebral body, the extent this is significantly decreased than prior scan are still remained especially on the anterior aspect of the L5 vertebral body. In addition, the degree of compression fracture of L5 vertebral body appears to be slightly aggravated since prior scan.Schmorl's node on the inferior endplate of L2 vertebral body does not show any significant interval change.The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The conus medullaris terminates at the L1-L2 level. Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: Diffuse bulging of disc, no neuroforaminal narrowing or spinal stenosis. L3-L4: Diffuse bulging of disc, no neuroforaminal narrowing or spinal stenosis. L4-L5: Broad-based disc protrusion central to left which extends toward left lateral recess creating mild left neuroforaminal narrowing. No change since prior scan. L5-S1: Diffuse bulging of disc, minimal anterolisthesis of L5S1, mild to minimal right lateral recess stenosis, no change since prior scan.

Output: 1. More conspicuous visualization of cortical fracture line of L5 vertebral body and slightly progressed the degree of compression fracture since prior scan.2. Interval decrease of bone marrow edema of L5 vertebral body.3. No change of Schmorl's node.4. No change of left lateral recess stenosis at the level of L45 and right lateral recess stenosis of L5S1.


Instruction: Generate impression based on medical findings.

Input: Reason: right shoulder pain, s/p labral repair, assess healing/re-tear History: right shoulder pain, s/p labral repair, assess healing/re-tear ROTATOR CUFF: The supraspinatus and infraspinatus muscles and tendons appear intact. There may be mild undersurface fraying of the supraspinatus at the level of the myotendinous junction. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: No significant fluid is identified within the subacromial subdeltoid bursa. The acromioclavicular joint is normal in appearance.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is minimal posterior translation of the humeral head relative to the glenoid.There is heterogeneity and branching linear increased signal abnormality traversing the superior and posterior superior labrum which fills with intra-articular gadolinium indicating a tear. There is additional linear signal abnormality traversing the articular cartilage of the posterior glenoid which extends through the posterior labrum and fills with intra-articular gadolinium. This likely represents a combination of post surgical change, degeneration and re-tearing. There is a tiny subcentimeter paralabral cyst along the posterior aspect of the glenoid. There is heterogeneity and increased signal abnormality within the anterior glenoid labrum likely representing a combination of postsurgical change and degeneration. No fluid-filled tear is evident.BICEPS TENDON: The tendon of the long head of the biceps appears intact. There is intermediate signal intensity within the intra-articular portion of long head of the biceps indicate mild tendinosis.

Output: Postsurgical and degenerative changes of the glenoid labrum with new tears involving the superior and posterior labrum as described above.


Instruction: Generate impression based on medical findings.

Input: History of prostate cancer. Pathology dated 1/13/2016 showed 3+4 in right base lateral 1 mm 5%, right base lateral 2.5 mm 15%, right mid lateral 7 mm 50%, right Apex lateral 5 mm 30%. PELVIS:PROSTATE:Prostate Size: 2.9 x 5.3 x 6.0 cmPeripheral Zone: Dominant lesion in the medial aspect of the mid gland extending to the apex measuring up to 1.1 x 0.8 cm in maximal cross section demonstrating T2 weighted hypointensity (series 401 image 11 through 13) and restricted diffusion (series 603 image 244 through 164)Central Gland: Mild changes of benign prostatic hyperplasia.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: The right mid gland to apex lesion has a broad base of abutment with the prostate margin with suspected focal extension posteromedially (series 401/11).BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: Along the course of the right obturator nerve between the pectineus muscle and adductor brevis muscle there is a well-defined oval mass measuring up to 2.9 x 1.8 x 4.5 cm. The lesion is isointense to the musculature on T1-weighted imaging and heterogeneously hyperintense on T2-weighted imaging, demonstrating heterogeneous postcontrast enhancement. Punctate focus of T1-hyperintensity and low signal intensity suggests blood product and/or calcifications.OTHER: No significant abnormality noted.

Output: 1.1.1 cm right peripheral zone mid gland to apex lesion with broad-based abutment of the prostate margin with suspected extraprostatic extension posteromedially. No enlarged pelvic lymphadenopathy.2.Incidental 2.9 cm oval enhancing well-defined mass along the course of the right obturator nerve extending into the medial thigh. Differential considerations include a peripheral nerve sheath tumor or hemangioma, amongst others. Referral to orthopedic oncology is recommended for further evaluation, including dedicated imaging, including radiographs to evaluate for calcifications. (Discussed with urology service Dr. Eggener/Karens (sp?) at 1539 on 03/09/2016.)


Instruction: Generate impression based on medical findings.

Input: 55-year-old male with worsening bilateral upper and lower neuropathy Many noncontrast sequences are degraded secondary to patient motion. Given this caveat:Cervical:Spinal alignment is anatomic. Vertebral body height and morphology are normal. No concerning areas of marrow replacement or marrow edema are seen. There is no gross abnormal marrow enhancement.The visualized spinal cord shows normal signal intensity and caliber without gross abnormal enhancement. Mild degenerative changes in the cervical spine are again seen and are unchanged. Individual levels as below.C2-3: Minimal posterior disk osteophyte formation. No significant spinal canal or neuroforaminal stenosis. Facet hypertrophy. These findings are unchanged.C3-4: Minimal posterior disk osteophyte formation. No significant spinal canal or neuroforaminal stenosis. Mild facet arthropathy. These findings are unchanged.C4-5: No significant disk degeneration, spinal canal stenosis or neuroforaminal narrowing. Mild facet arthropathy. These findings are unchanged.C5-6: Mild disk height loss and osteophyte formation. No significant spinal canal or neuroforaminal stenosis. Mild facet arthropathy. These findings are unchanged.C6-7: There is loss of disk height, disk osteophyte complex and uncovertebral hypertrophy on the left with mild to moderate narrowing of the left neural foramen. There is partial effacement of the ventral thecal sac and minimal spinal canal stenosis. No significant right neural foraminal narrowing. There is mild facet arthropathy. These findings are unchanged.C7-T1: No significant disk degeneration, spinal canal or neuroforaminal stenosis. Mild facet arthropathy. These findings are unchanged.Thoracic:The thoracic spine is in normal alignment with a normal thoracic kyphosis. There are minimal degenerative changes; the vertebral body and disk heights are otherwise well maintained. No worrisome focal marrow signal abnormality is appreciated. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine. Paraspinous soft tissue structures in the thoracic spine are unremarkable.Cord signal is grossly unremarkable given motion degradation and there is no gross abnormal enhancement.

Output: 1.Due to claustrophobia, the study was terminated at the patient's request before acquisition of all contrast enhanced imaging could be performed. Because of this, only motion degraded sagittal postcontrast images were obtained.2.Many noncontrast sequences are degraded secondary to patient motion.3.No gross abnormal signal in the spinal cord or gross abnormal enhancement.4.No high-grade spinal canal or neural foramina stenosis in the cervical spine. There are mild degenerative changes with minimal spinal canal narrowing and mild to moderate left neural foraminal narrowing at the C6-C7 level. These findings are unchanged.5.No significant spinal canal or neural foraminal stenosis in the thoracic spine.


Instruction: Generate impression based on medical findings.

Input: Male 58 years old Reason: prostate cancer History: prostate cancer PELVIS:PROSTATE:Prostate Size: 3.7 x 4.1 x 4.0 cm.Peripheral Zone: Diffuse intrinsic T1 hyperintense signal throughout the prostate, particularly the peripheral zone suggestive of hemorrhage. Multiple foci of abnormal T2 hyperintense signal within the peripheral zone. A dominant focus of signal abnormality measures 0.7 x 1.2 cm in the right posterior basal/mid gland. A second dominant focus measures 0.6 x 1.1 cm in the left posterolateral base/mid gland. Central Gland: Heterogeneous.Seminal Vesicles: No significant abnormality, in particular no evidence of seminal vesicle invasion. Extracapsular Extension: There is suspicion for bilateral extracapsular extension. This is in the region of the expected location of the neurovascular bundles.BLADDER: No significant abnormality noted.LYMPH NODES: Mildly prominent external iliac chain lymph nodes are nonspecific.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Two dominant foci of signal abnormality in the peripheral zone suspicious for prostatic carcinoma. There is suspicion for bilateral extracapsular extension.


Instruction: Generate impression based on medical findings.

Input: Female; 32 years old. Reason: history of stage 1B1 cervical cancer, rule out recurrence. s/p trachylectomy. History: history of 1B1 cervical cancer PELVIS:UTERUS, ADNEXA: Post surgical changes from cervical trachylectomy. No evidence of residual or recurrent disease.Foley catheter tip within vagina. High T2 signal material within the vagina due to ultrasound gel.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace pelvic free fluid, likely physiologic.

Output: Status post cervical trachylectomy without evidence of residual or recurrent disease.


Instruction: Generate impression based on medical findings.

Input: 82 years, Female, vertigo and ataxia, stroke workup. No restricted diffusion to suggest acute ischemia. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. There is mild global parenchymal volume loss, which is appropriate for age.Patchy foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild to moderate chronic small vessel ischemic disease. There are a scattered foci of susceptibility effect consistent with chronic microhemorrhages involving the right thalamus, posterior left putamen, as well as the right anterior temporal subcortical white matter. Brain parenchyma is otherwise unremarkable for age. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. There is mild opacification of the bilateral ethmoid air cells. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. No evidence of acute infarct.2. Mild to moderate chronic small vessel ischemic disease.3. Few scattered foci of chronic microhemorrhage which may be related to chronic hypertension.


Instruction: Generate impression based on medical findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The right wrist was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 4 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 40 seconds

Output: Successful fluoroscopic guided right wrist arthrogram.


Instruction: Generate impression based on medical findings.

Input: 57 year old male with ICM s/p orthotopic heart transplant in 2003, new CHF, no significant coronary occlusion on cath. Referred for cardiac MRI to assess regional hypoperfusion. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 66%. The LVEDV is 205 ml (normal range 142+/-34), the LV end diastolic volume index is 86 ml/m2 (normal range: 74+/-15), the LVESV is 70 ml (normal range 47+/-19) and the LV end systolic volume index is 29 ml/m2 (normal range 25+/-9). The LV mass is 161 g (normal range 164+/-36) and the LV mass index is 68 g/m2 (normal range 85+/-15). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.There is a moderate elevation in the native myocardial T1-relaxation time at the basal inferior wall. There is, additionally, increased T2-signal, increased native T1-relaxation time, and early gadolinium enhancement of the RV free wall. This area, however, does not have evidence of late gadolinium enhancement. These findings could suggest the presence of an early inflammatory process. There is no myocardial iron overload.Left AtriumThe left atrium shows changes consistent with cardiac transplant. Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 61%. The RVEDV is 211 ml (normal range 142+/-31), RV end diastolic volume index is 89 ml/m2 (normal range 82+/-16), the RVESV is 83 ml (normal range 54+/-17), and the RV end systolic volume index is 35 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve is trileaflet, 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 a mild, eccentric jet of tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium. Left upper pulmonary veins form a common confluence with left lower pulmonary veins before draining into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is a mass (4.5cm x 3.3cm) around the first sternal wire of unclear etiology. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1.The left ventricle is normal in size with normal systolic function (LVEF 66%). There is a moderate increase in native myocardial T1-relaxation time along the basal inferior wall, which could be due to subtle inflammation, fibrosis or infiltration. The T1 time throughout the rest of the myocardium is within normal limits. There is additionally no late gadolinium enhancement in the left ventricle. 2.The right ventricle is mildly dilated with normal systolic function (RVEF 61%). The free wall of the RV has evidence of increased T2-signal, increased T1-times, and early gadolinium enhancement. There is no late gadolinium enhancement in the RV free wall. These findings might be seen during the early phases of inflammation. 3.There is a mass (4.5cm x 3.3cm) around the first sternal wire of unclear etiology. Consider dedicated imaging if finding not explained by physical exam. 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: Posteromedial knee pain MENISCI: There is abnormal signal intensity and morphology the posterior horn of the medial meniscus representing a large complex tear. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage of the lateral femoral condyles is thinned but otherwise there are no full-thickness defect. There is signal heterogeneity of the articular cartilage of the medial patellar facet representing degeneration but again, no full-thickness defect is appreciated.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Complex tear of the posterior horn of the medial meniscus.


Instruction: Generate impression based on medical findings.

Input: Evaluate for rotator cuff tear ROTATOR CUFF: There is a full-thickness tear of the supraspinatus from its insertion. There is a large amount of fluid in the subdeltoid and subacromial bursae. The supraspinatus muscle is severely atrophiedThe infraspinatus is unremarkable. The subscapularis is unremarkable.SUPRASPINATUS OUTLET: Note is made of degenerative changes at the acromioclavicular joint..GLENOHUMERAL JOINT AND GLENOID LABRUM: There is marked irregularity of the inferior labrum consistent with generations.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Marked atrophy of the supraspinatus with a large full-thickness tear. Large amount of fluid within the subdeltoid and subacromial bursae


Instruction: Generate impression based on medical findings.

Input: 34-year-old female with history of brain trauma and double vision, ear fullness, and tinnitus. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. Partially empty sella is again noted. Redemonstrated is mild distention of the optic nerve sheaths with fluid. On available thinner section imaging, there is minimal bilateral optic nerve head elevation, also appreciated on axial T2-weighted images. No diffusion restriction or abnormal enhancement is noted along the optic nerve head within the limitations of this study which was not protocoled for evaluation of orbits.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.

Output: Redemonstration of partially empty sella and mild fluid distention of the optic nerve sheaths with bilateral optic nerve head elevation. Findings are again compatible with pseudotumor cerebri.


Instruction: Generate impression based on medical findings.

Input: 47-year-old male with history of neuroendocrine carcinoid now experiencing flushing and hot flashes. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions. Loss of signal on opposed phased images diffusely, compatible with hepatic steatosis. No biliary ductal dilation.SPLEEN: Small splenules redemonstrated. Occlusion of the splenic vein is redemonstrated.PANCREAS: 13 x 18 mm T2 hyperintense lesion at the posterior aspect of the pancreatic tail demonstrating restricted diffusion and enhancement, suspicious for neuroendocrine tumor given the provided history (series 901/223 and 701/343). ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No pathologically enlarged lymph nodes by size criteria.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 13 x 18 mm lesion in the pancreatic tail as described, suspicious for neuroendocrine tumor given the provided history.


Instruction: Generate impression based on medical findings.

Input: 80 year old woman with history of exertional angina, peripheral and carotid arterial disease, hypertension and atrial fibrillation who presents for evaluation of worsening of her chronic angina.MEDICATIONS: aspirin, felodipine, metoprolol, losartan, niacin, lasix, labetalol, omega 3 fatty acid First Pass PerfusionDuring hyperemia, there was a mild perfusion defect noted in the basal to mid inferoseptum and inferior wall. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. Left VentricleThe left ventricle is normal in size with low-normal systolic function. The overall LV ejection fraction is 52%, the LV end diastolic volume index is 80 ml/m2 (normal range: 65+/-11), the LVEDV is 136 ml (normal range 109+/-23), the LV end systolic volume index is 39 ml/m2 (normal range 18+/-5), the LVESV is 66 ml (normal range 31+/-10), the LV mass index is 71 g/m2, and the LV mass is 121 g. There are no regional wall motion abnormalities present. The native myocardial relaxation T1 time using endocardial mapping is 1110ms, which is mildly elevated and suggestive of a diffuse underlying fibrotic or infiltrative process. Left AtriumThe left atrium is moderately enlarged. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 57%, the RV end diastolic volume index is 67 ml/m2 (normal range 69+/-14), the RVEDV is 114 ml (normal range 110+/-24), the RV end systolic volume index is 29 ml/m2 (normal range 22+/-8), and the RVESV is 49 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly enlarged. Aortic ValveThe aortic valve opens widely and there is trivial aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Mild perfusion defect in the basal to mid inferior wall and inferoseptum.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and low-normal systolic function (LVEF 52%).4. Normal RV size and systolic function (RVEF 57%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Reason: 69 y/o female with DLCBL and lucency right femur head and neck on XRAy and PET. Is NOT FDG avid on PET. Looks like fatty deposit per radiology, Need MRI to characterize History: right femur lucency Note is made of heterogeneous bone marrow signal abnormality which may represent residual islands of red marrow. Note is made of heterogeneous marrow signal abnormality corresponding to findings seen on recent CT examination and hip radiographs which is iso to hyperintense to skeletal muscle on T1-weighted images, slightly hyperintense on fluid sensitive sequences and demonstrates no definite enhancement on postcontrast sequences. There is a subcentimeter focus of increased bone marrow signal abnormality within the left sacral wing which is nonspecific and too small to characterize. There is nonspecific subcutaneous edema along the lateral aspect of the right hip. There is a small amount of fluid within the hip joints bilaterally which is not necessarily of any clinical significance. Mild osteoarthritis affects the hips.

Output: Lesion within the right femoral head/neck corresponding to the findings seen on recent PET/CT examination and radiographs without definite enhancement. These findings appear most consistent with a benign fibrous lesion including fibrous dysplasia or perhaps a liposclerosing myxofibrous tumor, with an intraosseous lipoma also is a differential consideration. A lymphomatous deposit is considered exceedingly unlikely given the imaging characteristics, lack of definite enhancement, and lack of hypermetabolic activity on the recent PET/CT examination.


Instruction: Generate impression based on medical findings.

Input: Medically intractable epilepsy, abnormal CT head. Left temporal seizure, right hemisphere atrophy on CT. There is marked diffuse right cerebral volume loss with ex vacuo dilatation of the right lateral and third ventricles. There is a lesser degree of diffuse left cerebral volume loss. There are mild scattered patchy cerebral white matter T2 hyperintense lesions. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The infratentorial structures are unremarkable, aside from perhaps mild asymmetric left cerebellar volume loss, which maybe due to crosses-cerebellar diaschisis. There is no evidence of intracranial hemorrhage, abnormal intracranial enhancement, or mass. There is no midline shift or herniation. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a right maxillary sinus retention cyst and the bilateral frontal sinuses are mildly prominent, right greater than left. There is marked anterior nasal septal deviation.

Output: Right greater than left cerebral atrophy may represent adult-onset Rasmussen encephalitis or sequela of periventricular leukomalacia, perhaps with superimposed volume loss.


Instruction: Generate impression based on medical findings.

Input: A 74 year old female with personal history of systemic hypertension, deep vein thrombosis, GERD, pancreatitis, gallstones and systemic sarcoidosis (skin and lung). Recently had a syncope, the ECG showed sinus rhythm RBBB, the echocardiography showed normal left and right ventricular function. Referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 80 ml/m2 (normal range: 65+/-11), the LVEDV is 133 ml (normal range 109+/-23), the LV end systolic volume index is 36 ml/m2 (normal range 18+/-5), the LVESV is 60 ml (normal range 31+/-10), the LV mass index is 40 g/m2 (normal range 67+/-11), and the LV mass is 67 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is a focal high signal at the mid-myocardium at the insertion point of the right ventricle. This finding has been described in the setting of pulmonary arterial hypertension. In the context of this patient with sarcoidosis, we cannot exclude a focus of granuloma.No accelerated flow was seen in the LVOT. There is no thrombus. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 82 ml/m2 (normal range 69+/-14), the RVEDV is 135 ml (normal range 110+/-24), the RV end systolic volume index is 39 ml/m2 (normal range 22+/-8), and the RVESV is 65 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 trace pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no pericardial effusion.Extracardiac FindingsThere is rounded atelectasis of the right lower lobe. Mild splenomegaly. There is a low signal focus in the area of the gallbladder; this finding was better characterized on previous CT studies.

Output: 1. The left ventricle is normal in size and systolic function, the LVEF is 55%. There are no regional wall motion abnormalities present. 2. There is a focal high signal at the mid-myocardium at the insertion point of the right ventricle into the interventricular septum. This finding has been described in the setting of pulmonary arterial hypertension. In the context of this patient with sarcoidosis, we cannot exclude a focus of granuloma. 3. The right ventricle is normal in size and systolic function, the RVEF is 52%. 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: 16-year-old male with transverse myelitis. Evaluate for cord compression. There is increased T2 signal intensity within the ventral spinal cord from C3 to C6, which appears similar in distribution when compared to the prior outside examination from 9/17/2015. The spine is otherwise unremarkable. Alignment is within normal limits. Vertebral body heights and intervertebral disc spaces are preserved. No evidence of cord compression or significant spinal canal stenosis in the cervical, thoracic and lumbar spine.

Output: 1. No evidence of acute cord compression.2. Redemonstration of ventral spinal cord signal abnormality from C3 to C6, appearing similar in distribution when compared to the prior outside examination.