Instruction: Generate impression based on medical findings.

Input: A 69 years old female with recent diagnosis of heart failure and no coronary artery disease. Echocardiography showed severe biventricular dysfunction. Referred to cardiac MRI to rule out infiltrative heart disease. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 16%, the LV end diastolic volume index is 155 ml/m2 (normal range: 65+/-11), the LVEDV is 330 ml (normal range 109+/-23), the LV end systolic volume index is 131 ml/m2 (normal range 18+/-5), the LVESV is 278 ml (normal range 31+/-10), the LV mass index is 69 g/m2, and the LV mass is 147 g. There is global hypokinesis with dyssynchrony. There is very small, atypical patch of late gadolinium enhancement in the mid inferior wall. The pattern is atypical for prior myocardial infarction and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process.T2-star sequence is negative for myocardial iron deposition. There is no intracardiac thrombus.Left AtriumThe left atrium is severely dilated Right VentricleThe right ventricle is severely dilated with severely reduced systolic function The overall RV ejection fraction is 18%, the RV end diastolic volume index is 148 ml/m2 (normal range 69+/-14), the RVEDV is 315 ml (normal range 110+/-24), the RV end systolic volume index is 121 ml/m2 (normal range 22+/-8), and the RVESV is 258 ml (normal range 35+/-13). Right AtriumThe right atrium is severely dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation visualized. Mitral ValveThe mitral valve opens widely and there is moderate mitral regurgitation visualized. Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation visualized. Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation visualized. AortaThe ascending thoracic aorta is normal in size. There is a left sided aortic arch.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 thickening or effusion.Extracardiac FindingsA small nodule in the right lower lung can not be excluded, suggest correlation with chest x-ray. Small bilateral pleural effusions are noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is severely dilated with severely reduced systolic function (LVEF 16%). There is global hypokinesis with dyssynchrony. 2. There is very small, atypical patch of late gadolinium enhancement in the mid inferior wall. The pattern is atypical for prior myocardial infarction and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process3. The right ventricle is severely dilated with severely reduced systolic function (RVEF 18%). 4. The left atrium is moderately dilated. 5. There is moderate mitral regurgitation. 6. Mild dilation of the main pulmonary artery. 7. See extra-cardiac findings.


Instruction: Generate impression based on medical findings.

Input: 20 years Female (DOB:7/21/1995)Reason: evaluating for underlying lesion. History: intermittent dizziness, also with weight loss \T\ increased thirst.PROVIDER/ATTENDING NAME: KRISTEN E LIPSTREUER KRISTEN E LIPSTREUER The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. The pituitary gland measures approximately 8 mm height.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: No underlying lesion is appreciated intracranially to explain the patient's dizziness and giddiness. MRI of the brain is within normal limits


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old, with right lower extremity weakness and spasticity. Postsurgical changes from a right temporal craniotomy are seen. There is a fluid-filled cavity involving the right inferior and middle temporal gyri with minimal surrounding T2 hyperintensity and no associated edema. A slitlike extension of this cavity extends upward into the external capsule. Nodular and streaky areas of susceptibility are seen within or around the cavity likely representing chronic hemosiderin staining.Elsewhere in the brain, no significant parenchymal signal abnormality is seen. Diffusion-weighted images are within normal limits. No evidence of edema or mass effect is detected. No findings to suggest acute intracranial hemorrhage are noted. The ventricular system is within normal limits allowing for some mild ex vacuo dilatation of the right atrium and temporal horn. There may be mild crowding of structures at the level of the foramen magnum, though this is equivocal and can be artifactual or exaggerated by positioning.Marrow signal characteristics are within normal limits except for postoperative changes as above. Mucosal thickening or a mucous retention cyst is seen within the right maxillary sinus.

Output: 1.Sequelae of right temporal craniotomy with a resection cavity and/or encephalomalacia involving the right middle and inferior temporal gyri.2.Elsewhere no significant brain parenchymal signal abnormality is seen. No acute intracranial process is suspected.


Instruction: Generate impression based on medical findings.

Input: Undiagnosed seizure disorder with possible temporal lobe epilepsy, presenting with aura followed by GTC. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. In particular, the hippocampi are unremarkable and there is no evidence of heterotopia. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There are small retention cysts in the maxillary sinuses. The skull, orbits, and scalp soft tissues are unremarkable.

Output: No discernible candidate seizure foci.


Instruction: Generate impression based on medical findings.

Input: History of prostate cancer. Evaluate extent of disease. Biopsy: Left mid Gleason 3+3 5%; Right mid, Gleason 3+4 38% PELVIS:PROSTATE:Prostate Size: 2.5 x 4.5 x 3.9 cmPeripheral Zone: A dominant lesion is noted in the paramedian posterior right mid gland measuring 1.3 x 0.8 x 0.9 cm (series 801/10). A small suspicious focus is present in the left apex.Central Gland: No focal suspicious lesion.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: The dominant posterior right mid-gland lesion abuts and slightly bulges the posterior fibromuscular stroma, possibly reflecting extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Dominant posterior right mid-gland lesion with possible extracapsular extension.


Instruction: Generate impression based on medical findings.

Input: Evaluate for structural abnormality, hydrocephalus: AM vomiting, abnormal movements, autism, and behavioral issues. There is a prominent cerebrospinal fluid intensity space overlying the anterior left frontal lobe that measures up to 8 mm in width, which is compatible with an arachnoid cyst. Otherwise, there is no evidence of intracranial hemorrhage, soft tissue mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is scattered paranasal sinus mucosal thickening.

Output: Small left frontal convexity arachnoid cyst, but no evidence of ventriculomegaly, acute intracranial hemorrhage, solid mass, or acute infarct.


Instruction: Generate impression based on medical findings.

Input: Recent Chiari re-decompression with dura graft. There are postoperative findings related to Chiari decompression surgery with minimal fluid overlying the dural graft. There appears to be robust CSF flow across the anterior aspect of the neo-foramen magnum. There also appears to be intact CSF flow across the posterior aspect of the neo-foramen magnum, although relatively attenuated. The cerebellar morphology appears to be grossly unchanged, accounting for differences in technique. There is surgical hardware in the anterior cervical spine, which produces extensive artifact that obscures surrounding anatomy. The vertebral column alignment appears to be unchanged and the portions of spinal cord that are not obscured by artifact appear unremarkable.

Output: Expected postoperative findings related to Chiari decompression surgery. Otherwise, assessment of the cervical spine is considerably limited due to artifacts from surgical hardware.


Instruction: Generate impression based on medical findings.

Input: Squamous cell lung cancer. There is a linear area of high T2 signal that extends from the posterior limb of the left internal capsule into the corona radiata without associated restricted diffusion. There are also mild scattered foci of T2 hyperintensity in the cerebral white matter elsewhere without restricted diffusion. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: Linear area of high T2 signal that extends from the posterior limb of the left internal capsule into the corona radiata without associated restricted diffusion may represent a prior lacunar infarct. Otherwise, no evidence of intracranial metastases, hemorrhage, or acute infarction.


Instruction: Generate impression based on medical findings.

Input: 78 years, Male, Reason: liver and adrenal lesions History: liver and adrenal lesions. ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Diffuse loss of signal on out of phase images indicates hepatic steatosis. Cholelithiasis. Multiple small simple cysts correspond to hypodensity seen on prior CT.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: 2-cm left adrenal lesion loses signal on out of phase images, compatible with an adenoma.KIDNEYS, URETERS: Multiple simple renal cysts on the left.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Left adrenal adenoma.2.Multiple simple hepatic cysts.


Instruction: Generate impression based on medical findings.

Input: Female, 37 years old, with headache, status post third ventriculocisternostomy, with pineal mass status post biopsy. Again seen are sequelae of right frontal burr hole access and endoscopic biopsy of a pineal region mass. A small amount of intracranial and intraventricular air is seen compatible with recent redo ventriculostomy. Without the benefit of IV contrast, the T2 hyperintense pineal mass shows no significant change in size or morphology relative to the prior MRI examination. As before, the lesion splays the thalami but otherwise exerts no significant generalized mass effect.High-resolution midline sagittal imaging does appear to show a small defect in the floor of the third ventricle just anterior to the mamillary bodies. Cine flow imaging demonstrates robust flow related signal along the ventral brainstem and basal cisterns which appears to cease abruptly at the floor of the third ventricle. Mild flow related signal is detected within the third ventricle, though it is difficult to ascertain if this arises from CSF pulsation through the foramina of Monro or through the third ventriculocisternostomy.The caliber of the ventricles has improved relative to recent prior CTs, and now appears equivalent to that seen on the postoperative MRI from 9/5/2015. Mild T2 hyperintense rimming of the ventricular system persists. No new areas of parenchymal signal abnormality are detected. No restricted diffusion is seen. Mucosal thickening is evident in the maxillary sinuses.

Output: 1.Expected immediate postoperative findings compatible with recent redo ventriculocisternostomy.2.A small defect appears to be present within the floor of the third ventricle just anterior to the mammillary bodies. On cine flow imaging, however, no large jet of CSF flow is seen to freely communicate between the basal cistern and third ventricle. Mild flow related signal in the third ventricle could reflect a small communication, or it could simply represent CSF pulsatility through the foramina of Monro.3.Nevertheless, the caliber of the ventricles has improved relative to recent prior CTs and appears similar to that seen on the immediate postoperative MRI.4.No significant interval change is identified in the size or morphology of the pineal lesion.


Instruction: Generate impression based on medical findings.

Input: Female 9 years old Reason: follow up study recurrent pain. ?TB ?osteoid osteoma History: pain right sided lower back/pelvis BONE MARROW: Interval resolution of abnormal foci in the right acetabular roof and left acetabular anterior column. No abnormal contrast enhancement. No infiltrative bone marrow signal.SOFT TISSUES: Normal soft tissue signal intensity with no abnormal enhancement.JOINTS: No joint effusions.ADDITIONAL

Output: Interval resolution of abnormal foci in the right acetabular roof and left acetabular anterior column.


Instruction: Generate impression based on medical findings.

Input: Reason: Eval shoulder - please include pec major tendon History: pec major - possible partial tear The pectoralis muscles and tendons appear intact. This examination was not protocoled for detailed evaluation of the rotator cuff or the glenohumeral joint, however, there is perhaps a small amount of fluid within the glenohumeral joint without evidence of a large effusion. The imaged musculature of the left shoulder and chest is otherwise unremarkable. No bone marrow signal abnormality is seen.

Output: The pectoralis muscles and tendons appear intact.


Instruction: Generate impression based on medical findings.

Input: 13-day-old male with low Apgars at birth, evidence of ischemic damage to the liver. Concern for hypoxic ischemic encephalopathy. Plan to wean off iNO overnight. Per chart review, patient is an ex-37 2/7 infant male patient born via emergent c-section to a 31-yo G2P2 mother secondary to placental abruption. He remains in stable condition as his LFTs and ammonia levels have been decreasing, but continues to require aggressive NICU management given likely multiorgan involvement from mixed acute on chronic hypoxic-ischemic injury. Today there is plan to wean NO and hydrocortisone and going up on feeds. There are foci of restricted diffusion in the periventricular white matter along the trigone of the lateral ventricles, left greater than right, which demonstrates increased T1 and T2/FLAIR hyperintensity. Otherwise the remaining brain parenchyma is unremarkable; specifically there is no cortical or deep gray matter signal abnormality.. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Findings compatible with focal ischemic infarcts within the periventricular white matter adjacent to the trigone of the lateral ventricles, left greater than right. Otherwise the cortical and deep gray matter signal is within normal limits. No acute hemorrhage.


Instruction: Generate impression based on medical findings.

Input: Reason: rule out cerebellar process or lesions History: bilateral lower extremity paresthesias and balance issues. The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal. There is no diffusion abnormality. There is no pathological enhancement. 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. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: MRI of the brain is within normal limits.


Instruction: Generate impression based on medical findings.

Input: dementia, visuospatial poor but attention fairly preserved. No evidence of acute ischemic or hemorrhagic lesion on this scan.Minimal patchy high signal intensities on bilateral periventricular white matter indicate non specific small vessel ischemic disease.Prominent sulci may indicate mild brain atrophy.The ventricles, sulci and cisterns are symmetric and unremarkable.There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.The left maxillary sinus shows fluid collection.

Output: No evidence of acute ischemic or hemorrhagic lesion on this scan.Minimal brain atrophy.Otherwise unremarkable brain MRI.


Instruction: Generate impression based on medical findings.

Input: Stated history of anal fistula with bleeding. PELVIS:UTERUS, ADNEXA: The uterus is normal in morphology and size. The uterus measures 6.8 x 2.9 cm in sagittal plane. The endometrial cavity/fluid is normal in signal intensity and thickness. The inner myometrium/junctional zone is normal in thickness measuring 6 mm. No discrete uterine mass. The parametrial soft tissues and vaginal canal are unremarkable.There are numerous predominantly peripheral ovarian follicles which are mildly prominent.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is a very thin fluid tract extending from approximately the 3:00 of the lower anal canal extending inferiorly in the intersphincteric space and terminating along the left gluteal cleft. This is associated with mild restricted diffusion and postcontrast enhancement. No associated fluid collection. There are small adjacent vessels.There is suggestion of mild hyperenhancement of the visualized rectosigmoid colon.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Intersphincteric low perianal fistula terminating along the left gluteal cleft without associated fluid collection.2. Suggestion of colitis involving the visualized rectosigmoid colon; correlate for potential inflammatory bowel disease. 3. Numerous predominantly peripheral ovarian follicles which are mildly prominent; correlate for clinical signs and symptoms of polycystic ovarian syndrome.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old, with nausea and headache. Evaluate for PRES, venous thrombosis. MRI brain:Numerous scattered foci of predominant periventricular T2 hyperintensity are seen, progressed from the prior examination. No diffusion restriction is seen. No evidence of edema or mass effect is detected. No intracranial hemorrhage or any abnormal extra axial fluid collection is seen. The ventricles are normal in size and morphology. Partially empty sella is noted incidentally. A fluid level is present in the maxillary sinuses.MRI orbits:The globes are round and symmetric. The extraocular muscles demonstrate normal caliber and morphology. The optic nerves are of normal caliber and free of pathologic signal abnormally. The intraorbital fat is clean. No masses are detected.MRA brain:Image quality is slightly degraded by motion artifact. Within this limitation, no high-grade stenosis or occlusion is detected. No aneurysm or vascular malformation is seen. The left A1 segment is hypoplastic. The ACOM artery is prominent. A moderately sized right PCOM artery and a small left PCOM artery are evident. Please note that the venous sinuses are not assessed with MRA technique.

Output: 1.Numerous foci of periventricular T2 hyperintensity are seen, progressed from the prior MRI and most compatible with chronic microvascular ischemic disease.2.No evidence of any acute intracranial abnormality is seen. No findings are detected which would be consistent with PRES. 3.Evaluation the orbits is within normal limits.4.No abnormalities of the intracranial arteries are detected.


Instruction: Generate impression based on medical findings.

Input: Pulmonary fibrosis. History of syncope. Headache x 1 month. Question bleed or midline shift. There is no evidence of intracranial hemorrhage, mass or midline shift. Patchy areas of subcortical and periventricular white matter hypodensity likely represent mild small vessel ischemic disease, age indeterminate by CT. There is a left high convexity cortical stroke of indeterminate age. If the patient is symptomatic, an MRI may be considered for further evaluation. Vascular calcifications are noted within the cavernous carotid and vertebral arteries. Calcification within the parotid glands bilaterally may be from prior infection and appears unchanged.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Small vessel ischemic disease. Left high convexity cortical stroke of indeterminate age. If the patient is symptomatic, an MRI may be considered for further evaluation. No evidence of intracranial hemorrhage.


Instruction: Generate impression based on medical findings.

Input: Right knee pain MENISCI: There is truncation and blunting of the posterior horn and body of the medial meniscus suggesting the presence of a radial tear. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is moderate diffuse articular cartilage loss of the medial compartment with areas of full-thickness loss along the medial femoral condyle and medial tibial plateau (Series 4 image 23/38). The articular cartilage of the lateral meniscus is diffusely thin but relatively preserved otherwise. There is severe articular cartilage loss of the patellofemoral compartment with full-thickness loss along both the medial and lateral patellar facets. There is loss of the articular cartilage of the femoral trochlea as well.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Radial tear of the medial meniscus.2. Marked articular cartilage loss of the patellofemoral compartment with additional areas of full-thickness loss of the medial compartment.3. Large joint effusion.


Instruction: Generate impression based on medical findings.

Input: Parkinson's disease [G20] / Concussion without loss of consciousness, initial encounter [S06.0X0A], Reason for Study: ^Reason: please check for chronic subdural, s/p head injury 1/16, still with headache, please eval SAH, SDH History: headache, c/w prior There is no evidence of acute ischemic or hemorrhagic lesion.Scattered FLAIR high signal intensity lesions on periventricular white matter are again seen, unchanged.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, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Unchanged minimal nonspecific small vessel ischemic disease.No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on medical findings.

Input: 36-year-old male with history of metastatic renal cell cancer with back pain.EXAM: CT of the thoracic and lumbar spine was performed without IV contrast. Thoracic spine: Alignment of thoracic spine is normal. Mild degenerative changes are seen throughout the thoracic spine. No lesions suspicious for metastases are identified. Nodular opacities at the right lung base are likely due to previously identified consolidation.Lumbar spine:3.3 x 2.9 cm lucent lesion in the L3 vertebral body, with a sclerotic rim, is not significantly changed compared to CT pelvis study from 2/18/08. There is a suggestion of posterior extension of this lesion into the central canal, however, this is equivocal. Additionally, another lucent lesion measuring 1.5 x 0.8 cm in the L1 vertebral body with sclerotic borders is identified. Although these lesions have a benign appearance the etiology of these lesions is unknown, and further evaluation by infused MRI is recommended.

Output: Two lucent lesions in the lumbar vertebral bodies as described above. Extension of the L3 lesion posteriorly into the central canal cannot be excluded. Although they have a benign appearance, the etiology of these lesions is unknown. Further evaluation by contrast-enhanced MRI is recommended.


Instruction: Generate impression based on medical findings.

Input: 27 years Male (DOB:12/11/1988)Reason: MS, f/u progression History: paresthesiasPROVIDER/ATTENDING NAME: ADIL JAVED ADIL JAVED There is redemonstration of multiple T2 and FLAIR hyperintense lesions in the corpus callosum, some periventricular white matter especially adjacent to the trigones of the lateral ventricles, the right internal capsule the right posterior lateral cervical cord at the C1 level, cerebellum, cervical medullary junction, brainstem as well as subcortical white matter in the frontal lobes. This appears stable compared to the previous exam.There is a hyperintense appearance along the optic nerves is present. It is suspected that this is artifactual.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There are multiple lesions scattered throughout the brain which are stable compared to prior exam and compatible with patient's diagnosis of multiple sclerosis.2.Signal hyperintensity on T2 and FLAIR imaging on the optic nerves is suspected to be artifactual. Please correlate with patient's clinical symptoms related to the optic nerves to confirm.


Instruction: Generate impression based on medical findings.

Input: There is irregular thickened peripheral enhancement of the 2.6 x 2.2 cm lesion in the right temporoparietal region white matter. The rim of the lesion is T2 isointense and the central portion of this lesion demonstrates restricted diffusion. There is marked surrounding vasogenic edema with mass effect causing effacement of the right lateral and third ventricle with 9 mm leftward midline shift. The temporal horn of the right lateral ventricle is mildly dilated, suggesting early entrapment. Mild mass effect is present upon the right dorsal lateral aspect of the midbrain. No abnormal susceptibility artifact is present. No additional lesions are identified. No extra-axial fluid collection is evident.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.

Output: 1. 2.6 cm right temporoparietal region lesion with a constellation of imaging features most likely representing abscess or neoplasia. Marked associated vasogenic edema and mass effect with stable 9 mm leftward midline shift.2. Limited additional sequences performed for STEALTH protocol.


Instruction: Generate impression based on medical findings.

Input: 33-year-old female with Gitelman's Syndrome, hypomagnesemia, sinus tachycardia, palpitations, and PVC's s/p ablation 4/2014 (RVOT focus). MRI for further evaluation of possible RV dilation on TTE. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 58%. The LVEDV is 111 ml (normal range 109+/-23), LV end diastolic volume index is 56 ml/m2 (normal range: 65+/-11), LVESV is 46 ml (normal range 31+/-10), and LV end systolic volume index is 23 ml/m2 (normal range 18+/-5). The LV mass is 88 g (normal range 114+/-24) and the LV mass index is 44 g/m2 (normal range 67+/-11). 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.Left AtriumThe left atrium is normal in size.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 50%, the RVEDV is 148 ml (normal range 110+/-24), the RV end diastolic volume index is 74 ml/m2 (normal range 69+/-14), the RVESV is 74 ml (normal range 35+/-13), and the RV end systolic volume index is 37 ml/m2 (normal range 22+/-8). No focal right ventricular wall motion abnormalities or aneurysms. No evidence of fatty or fibrous infiltration into the RV.Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal-sized left ventricle with normal systolic function (LVEF 58%).2. Normal-sized right ventricle with normal systolic function (RVEF 50%) without any cardiac MRI features of arrhythmogenic right ventricular dysplasia.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: Pt with know h/o Pancreatic Divisum and multiple bouts of pancreatitis requiring several ERCPS with stents. Need SECRETIN Stimulating MRCP to evaluate. History: Chronic abdominal pain ABDOMEN:LIVER, BILIARY TRACT: The liver parenchyma demonstrates normal signal intensity. There is a subcentimeter T2 hyperintense focus within segment 6 (series 4, image 16) which demonstrates persistent enhancement and is compatible with a hemangioma. There are several additional peripheral wedge-shaped areas of arterial enhancement without washout which are compatible with transient hepatic intensity differences. No suspicious focal hepatic lesions are identified. The gallbladder is surgically absent. There is no intra or extrahepatic biliary ductal dilatation. The hepatic vasculature appears patent.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas demonstrates diffusely decreased T1 signal as well as diffuse mild atrophy compatible with chronic pancreatitis. The pancreatic duct is mildly irregular with scattered strictures and is mildly prominent in caliber measuring up to 5 mm at the level of the pancreatic head. The main pancreatic duct empties into the minor papilla compatible with pancreatic divisum. There appear to be several small connections between the main pancreatic duct and the distal common bile duct. No pancreatic duct stones are identified. Post secretin images demonstrate a blunted/poor response to secretin possibly due to pancreatic duct stricturing.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Pancreas divisum. 2.Findings compatible with chronic pancreatitis including mild prominence, irregularity, and stricturing of the main pancreatic duct. No evidence of acute pancreatitis.3.Blunted/poor response to secretin possibly due to pancreatic duct stricturing.


Instruction: Generate impression based on medical findings.

Input: Increased confusion. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. However, there is bilateral tympanomastoid fluid. There are also secretions in the nasal cavity.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. Bilateral tympanomastoid fluid may represent otomastoiditis.


Instruction: Generate impression based on medical findings.

Input: 66-year-old female with significant ecchymosis and hemarthrosis. Evaluate MCL, ACL, MPFL, patellofemoral articulation. Due to patient's body habitus, the high-definition coil could not be utilized resulting in slightly suboptimal image quality. MENISCI: There is globular signal abnormality within the body and posterior horn of the medial meniscus that appears to extend to the free edge, indicating intrasubstance degeneration with degenerative tearing. The anterior horn appears spared. There is globular signal abnormality within the body of the lateral meniscus, which extends to the free edge, indicating intrasubstance degeneration and degenerative tearing. There is intrasubstance degeneration affecting the posterior horn of the lateral meniscus.ARTICULAR CARTILAGE AND BONE: There is focal discontinuity of the cortex along the medial aspect of the patella which we suspect represents an avulsion fracture at the site of attachment of the medial patellofemoral ligament. There is mild edema within the underlying medial aspect of the patella as well as mild edema within the anterior aspect of the lateral femoral condyle likely reflecting prior transient patellar dislocation. There is full-thickness cartilage loss along portions of the lateral facet of the patella. The medial facet of the femoral trochlea appears abnormally small relative to the lateral facet, likely representing dysplasia. The trochlear depth appears shallow. There is focal depression of the articular surface of the medial femoral condyle just above the posterior horn of the medial meniscus that may represent an old impaction injury, but this is not associated with edema on this examination. There are small tricompartmental osteophytes.LIGAMENTS: The ACL, PCL, and LCL appear intact. There is a small amount of edema along the medial collateral ligament which may represent a mild sprain, but the ligament itself appears intact. EXTENSOR MECHANISM: The quadriceps tendon appears intact. There is mild increased signal intensity within the medial fibers of the patellar tendon at its patellar attachment, suggesting a sprain injury. The medial retinacular structures are ill-defined with adjacent edema indicating injury. As stated previously, we suspect there is an avulsion fracture of the medial aspect of the patella at the attachment of the medial patellofemoral ligament. The ligament, including its femoral attachment, is not well visualized. There is also slight thickening and edema along the lateral retinacular structures, although we see no gross disruption.ADDITIONAL

Output: 1. Findings indicating prior transient lateral dislocation of the patella, including disruption of the medial patellofemoral ligament and probable medial patellofemoral ligament avulsion fracture at the medial aspect of the patella. There are also findings of femoral trochlear dysplasia.2. Possible mild sprain of the MCL which otherwise appears intact. The ACL appears intact.3. Full-thickness cartilage loss along the lateral facet of the patella.4. Degeneration and degenerative tearing of the menisci.5. Joint effusion and Baker's cyst.


Instruction: Generate impression based on medical findings.

Input: History of optic neuritis: visual decline. Orbits: There is diffuse high T2 signal involving the intraorbital, canalicular, and cisternal segments of the left optic nerve. There is also enlacement along the cisternal segment of the left optic nerve. The right optic nerve is intact. There are bilateral lens implants. The bilateral globes and ocular adnexa are otherwise unremarkable. There is no evidence of intraorbital mass lesions.Brain: There is no evidence of intracranial hemorrhage or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is a 10 mm diameter pineal gland cyst. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, mastoid air cells, and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the bilateral frontal and ethmoid sinuses.

Output: 1. Findings compatible with left optic neuritis.2. No evidence of acute intracranial hemorrhage or acute infarct.


Instruction: Generate impression based on medical findings.

Input: Multiple myeloma with a large lesion on PET impinging on T6/T7: No pain or neurologic deficits. There is an infiltrative, enhancing left posterior chest wall mass with left neural foraminal and epidural extension at theT6-7 level with mild narrowing of the thecal sac, but no spinal cord compression. The vertebral column alignment is within normal limits. There are multilevel small intravertebral disc herniations. The vertebral body are otherwise preserved. There is a small focus of left ligamentum flavum calcification that projects into the spinal canal at T10-11, without spinal cord impingement. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. There is a small right renal cyst.

Output: Left posterior chest wall multiple myeloma extends into left neural foramen and epidural space at theT6-7 level with mild narrowing of the thecal sac, but no spinal cord compression.


Instruction: Generate impression based on medical findings.

Input: 85-year-old female with bilateral apparently non-functional adrenal masses. Evaluate for change in adrenal masses. ABDOMEN:LIVER, BILIARY TRACT: Stable cyst of the left hepatic lobe (series 1101 image 26). The 1 x 0.9 cm T2 hyperintense focus of hepatic segment 2 (series 1101 image 27) is stable in size, and the prior exam demonstrated post contrast imaging characteristics compatible with a benign hemangioma. Contrast was not given the current exam. No intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Right adrenal nodule measuring 2.1 x 1.5 cm (series 501 image 17) is stable in size. The left adrenal nodule measuring 1.6 x 1.2 cm (series 501 image 18) is stable in size. Both adrenal nodules demonstrate loss of signal on the out of phase sequences compatible with benign adenomas.KIDNEYS, URETERS: Stable bilateral renal cysts. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stable size of the bilateral benign lipid-rich adrenal adenomas; based on imaging no additional surveillance imaging needed.2.Stable hepatic and renal cysts.3.Previously characterized hepatic hemangioma is stable in size.


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 radiocarpal joint was localized fluoroscopically, and a spot radiograph was obtained. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge needle.Under fluoroscopic guidance, a 22-gauge needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 8 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. Multiple spot radiographs were 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: 3 minutes, 6 seconds

Output: Successful arthrogram injection of the right radiocarpal joint. Please refer to the subsequent MRI report for further information.


Instruction: Generate impression based on medical findings.

Input: Metastatic lung cancer to brain status post right frontal tumor resection: evaluation of cavity and presence of additional lesions, referred for radiosurgery planning. There are postoperative findings related to right frontal lobe tumor with diffuse presumed marginal enhancement that is more nodular along the anterior and inferior aspects of the surgical cavity. There is susceptibility effect within the resection cavity, which likely represents blood products. There is also circumferential confluent high T2 signal surrounding the surgical cavity, which may represent vasogenic edema, and mild mass effect upon the anterior portions of the lateral ventricles. There are a few scattered punctate foci of cerebral white matter T2 hyperintensity. There is a 10 mm diameter cystic pineal gland. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is fluid and mucosal thickening in the left maxillary sinus.

Output: 1. Postoperative findings related to right frontal lobe tumor with diffuse presumed enhancement that is more nodular along the anterior and inferior aspects of the surgical cavity, which may represent residual tumor. However, assessment is limited due to the lack of non-contrast T1-weighted sequences for comparison.2. Findings suggestive of acute left maxillary sinusitis.


Instruction: Generate impression based on medical findings.

Input: Pain over scapholunate ligament. Evaluate for scapholunate ligament tear. LIGAMENTS: No contrast is identified within the radiocarpal joint. The lunotriquetral and scapholunate ligaments appear intact. TRIANGULAR FIBROCARTILAGE COMPLEX: The triangular fibrocartilage complex is grossly intact.TENDONS: The tendons are intact. BONES: There is increased T2 signal within the inferior and ulnar aspect of the lunate bone. Additionally, there is positive ulnar variance. These findings are compatible with ulnar abutment of the lunate. Bone marrow signal is otherwise within normal limits. ADDITIONAL

Output: 1. No evidence of scapholunate ligamentous disruption.2. Findings compatible with ulnar abutment of the lunate.


Instruction: Generate impression based on medical findings.

Input: Ms. Prendergast is a 49-year-old female with a strong family history of breast cancer in three sisters (diagnosed at the ages of 35, 42, and 55) and a paternal great aunt. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. Benign bilateral subcentimeter cysts are noted on T2 weighted imaging. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on medical findings.

Input: Dizziness and giddiness [R42], Reason for Study: ^Reason: r/o acute ischemia History: vertigo, nystagmus Linear restricted diffusion lesion on the left frontal lobe deep white matter indicating acute/subacute ischemic infarct. Subtle high signal intensities on DWI on the right thalamus are more likely represent T2 shine through.There is no evidence of acute hemorrhagic lesion on the scan.There are FLAIR/T2 high signal intensity lesions involving bilateral centrum semiovale and periventricular white matter indicating non specific small vessel ischemic disease, unchanged.Multifocal tissue losses involving bilateral basal ganglia, thalamus, right side corpus callosum genu and left external capsule indicating chronic lacunar infarctions, unchanged. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Linear ischemic infarction on the left frontal lobe deep white matter as described above.2. Unchanged non specific small vessel ischemic disease and multiple lacunar infarctions since prior scan.


Instruction: Generate impression based on medical findings.

Input: 67-year-old with strong family history of breast cancer, maternal grandmother, 2 aunts and sister. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Stable benign enhancing foci in the left breast at the 3 o'clock position. Stable dark T2 signal lesion in the medial right breast with mammographic correlate is consistent with an oil cyst. No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old, with history of breast cancer, triple negative, with possible brain metastases on head CT. Corresponding to the abnormality detected on CT, a 5 mm enhancing lesion is evident within the mid vermis with mild local edema.Although postcontrast imaging is somewhat limited due to motion, up to five additional small enhancing lesions are also suspected within the cerebellum, and a small enhancing focus is also seen within the right frontal lobe. These small lesions are associated with no significant parenchymal edema.A developmental venous anomaly is present in the right operculum. Patchy periventricular and brainstem T2 hyperintensity is seen in the background, a nonspecific finding which likely reflects chronic microvascular ischemic disease. No convincing evidence of restricted diffusion is evident. No acute intracranial hemorrhage or any abnormal extra-axial fluid collection is observed. The ventricles are normal in size and morphology.

Output: Up to seven small enhancing lesions are evident, primarily within the posterior fossa, suspicious for metastatic disease. The largest lesion is in the cerebellar vermis and is associated with mild local edema.


Instruction: Generate impression based on medical findings.

Input: Reason: 86 yo female with history of pancreas divisum s/p minor sphincterotomy and stent placement as well as major papilla sphincterotomy and balloon dilation in November 2014, now with recurring pancreatic type pain. MRI/MRCP w/ secretin to rule out sphincter re stenosis, also rule out pancreatic mass. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions are identified. The gallbladder is surgically absent. There is mild central intrahepatic ductal dilatation. There is also extrahepatic ductal dilatation up to 16 mm in diameter with dilation nearly up to level of the ampulla.SPLEEN: No significant abnormality noted.PANCREAS: The main pancreatic duct is not dilated and measures up to 4 mm in diameter. There appears to be mild stricturing of the main pancreatic duct at the level of the pancreatic head. The major duct courses inferiorly at the level of the common bile duct and then ascends and empties into the minor papilla. The minor duct is nondilated and drains into the ampulla. These findings are consistent with pancreatic divisum. There is a 5 mm cystic focus in the pancreatic body which appears in continuity with the main pancreatic duct (series 4, image 17) and which may reflect a dilated side branch or a side branch IPMN. There is an additional similar lesion in the pancreatic tail also in continuity with the main duct (4, image 16) measuring 5 x 10 mm. There are additional similar smaller lesions within the uncinate process.Post-secretin images demonstrate reduced compliance of the pancreatic duct with satisfactory exocrine function.The pancreatic parenchyma appears atrophic with decreased T1 signal suggesting chronic pancreatitis. No discrete pancreatic masses are identified.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal cyst with thin septations, not significantly changed. Additional renal cysts are present bilaterally.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Extensive diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Pancreas divisum and findings consistent with chronic pancreatitis. Diminished pancreatic duct compliance. Satisfactory pancreatic exocrine function.2.Mild stricturing of the main pancreatic duct at the level of the pancreatic head without significant dilation of the main pancreatic duct.3.Several new small cystic lesions along the pancreatic ducts which may reflect dilated side branches or IPMNs. 4.Persistent dilation of the common bile duct up until the level of the ampulla.


Instruction: Generate impression based on medical findings.

Input: Planning for stereotactic brain biopsy. Brain lesion. Enhanced head CT:75 cc of Omnipaque 350 was administered for this study.Enhanced axial 1 mm CT images of the entire brain were obtained for presurgical planning brain biopsy.Examination demonstrates diffuse lower density of bihemispheric white matter likely result of prior therapy. Multiple periventricular irregularly-shaped highly suspected calcific lesions similar to prior MRI examination from 8 -- 5 -- 11. There is suggestion of subtle enhancement of these lesions as well. There are no non-infused CT images for confirmation of calcification however the very high density of these lesions is highly suspected of calcification. Review of prior head CT from 5 -- 12 -- 08 demonstrated no calcification. Findings could represent posttreatment changes of patient's known lymphoma. Recommend non-infused head CT for further evaluation. When compared with prior recent MRI there is no appreciable change.

Output: Multiple irregularly-shaped and highly suspected calcific lesions similar to prior MRI. Subtle enhancement of these lesions is present in. Please see above comments.


Instruction: Generate impression based on medical findings.

Input: History of left breast excisional biopsy in October 2013 with final pathology report indicating focal atypia with a fragment of pseudo-angiomatous stromal hyperplasia (originally read as ADH on MR biopsy of 7/9/2013). Known BRCA2 mutation carrier. Biopsy proven left breast fibroadenoma in 2004. History of mother with breast cancer at age 39, and maternal grandmother at age 43. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Stable appearance of round slowly enhancing benign morphology mass in the left breast 2:00 position corresponds to biopsy-proven fibroadenoma.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on medical findings.

Input: Prostate cancer staging. Biopsy dated 1/26/2016 demonstrated left base lateral 3+3 1.5 mm 10%. PELVIS:PROSTATE:Prostate Size: 4.1 x 6.7 x 6.2 cmPeripheral Zone: Minimal hemorrhage/proteinaceous signal intensity. Mild wedge shaped T2 weighted hypointensity of the right mid gland/base peripheral zone without a discrete measurable lesion. Central Gland: Changes of BPH without a suspicious lesion.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No enlarged pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.Contrast extravasation description:Supervising radiologist: Dr. O'BrienMinor or major extravasation: MinorContrast type:16 cc of Multihance were administered. Amount extravasated: 8 ccLocation of extravasation: Right AC fossaSigns and symptoms: Patient reports mild swelling but no pain. Intact neurovascular function.Treatment given: Warm compress and elevation. No pain at discharge. Discharge instructions given: Yes

Output: Mild signal abnormality in the right mid-gland/base without a discrete dominant lesion. No evidence of extraprostatic extension or enlarged pelvic lymphadenopathy. Please note that this was a nonenhanced MR due to contrast extravasation.


Instruction: Generate impression based on medical findings.

Input: Female, 29 years old, with history of nasopharyngeal carcinoma status post treatment with chemotherapy and radiation. Asymmetry of the nasopharyngeal mucosa is again seen appearing similar to the prior examination and perhaps related to therapy. Likewise, a thin layer of T2 hyperintense material along the left aspect of the nasopharynx is also similar to prior and may simply represent adherent secretions. No evidence of any recurrent aerodigestive tumor is seen. No pathologic adenopathy is detected in the neck by size criteria. The glandular tissues are unremarkable. The bone marrow signal characteristics are within normal limits. A new focus of susceptibility is evident within the brainstem at the level of the obex (see image 17 series 8) which is present on all sequences and not likely to be artifactual. There does not appear to be any associated parenchymal edema or mass effect.

Output: 1.Treatment related findings in the neck with no evidence to suggest recurrent nasopharyngeal tumor or pathologic adenopathy.2.A small focus of susceptibility within the brainstem at the level of the obex is new when compared to prior examinations. This could represent chronic microhemorrhage of uncertain etiology. If clinical concern warrants, dedicated brain imaging can be obtained to better assess this lesion and to evaluate for the presence of additional lesions.


Instruction: Generate impression based on medical findings.

Input: Seizures and falls and possible breakthrough seizures. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is nonspecific mild patchy cerebral white matter T2 hyperintensity. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are bilateral lens implants.

Output: Mild patchy cerebral white matter T2 hyperintensity, but no discernible seizure foci otherwise.


Instruction: Generate impression based on medical findings.

Input: There is no acute cord compression. Degenerative changes are noted of the cervical spine at C5/6 and of the lower lumbar spine. Posterior surgical changes from T10 through T12 are consistent with the provided history of plasmacytoma, presumably status post resection.

Output: No acute cord compression.


Instruction: Generate impression based on medical findings.

Input: 13-year-old female who is 7 months status post left hip arthroscopy with labral repair. Patient has continued left hip pain. Evaluate healing of labrum and new labral tear. ACETABULAR LABRUM: No abnormalities are noted in the labrum, specifically no evidence of labral tear.ARTICULAR CARTILAGE AND BONE: There is no bone marrow edema. The articular cartilage appears intact.SOFT TISSUES: There are mildly prominent left inguinal lymph nodes. There is contrast within the anterior soft tissues which is likely iatrogenic in etiology. The remainder of the soft tissues are unremarkable. ADDITIONAL

Output: No evidence of labral tear.


Instruction: Generate impression based on medical findings.

Input: 65 year-old male with unclear cardiomyopathy status-post dual chamber ICD with recent ICD discharges for ventricular tachycardia who is referred for cardiac MRI for further evaluation. The risks of cardiac MRI were discussed with the patient and consent was obtained to proceed. Left VentricleThe left ventricle is severely dilated and qualitatively appears to have severely reduced systolic function (LVEF 20-25%). Quantitative measurements are not possible due to artifact from ICD. There is global hypokinesis with regional variation There are two distinct areas of late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The first is mid-wall and involves the basal anterior wall. The second is epicardial and involves the basal to mid inferior wall (near the right ventricular insertion point). Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size and function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 62 ml/m2 (normal range 82+/-16), the RVEDV is 153 ml (normal range 142+/-31), the RV end systolic volume index is 29 ml/m2 (normal range 31+/-9), and the RVESV is 73 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveDue to ICD artifact, unable to accurately assess the valve. Mitral ValveDue to ICD artifact, unable to accurately assess the valve.Pulmonic ValveDue to ICD artifact, unable to accurately assess the valve.Tricuspid ValveDue to ICD artifact, unable to accurately assess the valve.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is severely dilated with severely reduced systolic function (LVEF 20-25%).2. The right ventricle is normal in size and function. 3. There are two distinct areas of late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The first is mid-wall and involves the basal anterior wall. The second is epicardial and involves the basal to mid inferior wall (near the right ventricular insertion point). 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: 13-year-old male with pain, muscle wasting, evaluate for progression of lesions Foci of T2 signal abnormality affecting bilateral iliac crests are less intense than on the prior exam. Extension into the adjacent gluteus musculature is no longer noted. Additional foci T2 signal abnormality adjacent to the left and right SI joints, and ischia are also decreased compared with the prior exam. There is mild associated enhancement of these lesions. No new foci of signal abnormality are identified. Both hip joints appear normal for the patient's age. The soft tissues and musculature are normal.

Output: Interval improvement in multifocal marrow signal abnormality as described above. No new lesions.


Instruction: Generate impression based on medical findings.

Input: Reason: pain with flexion/extension, eval for tendonitis History: pain A marker was placed along the dorsum of the hand between the distal diaphysis of the second and third metacarpals. We see no abnormalities of the extensor tendon deep to this marker. The flexor tendons likewise are normal in appearance. There is minimal enhancement of the tendon sheath of the flexor pollicis longus as it courses along the proximal phalanx of the thumb. While this may represent a very mild tenosynovitis, this is of uncertain clinical significance. There is mild enhancement of the distal radioulnar joint. There is mild enhancement of the compartments of the wrist suggesting a mild synovitis. There are small foci of nonenhancing signal abnormality within several carpal bones which may represent small cysts but are of doubtful clinical significance. The imaged musculature of the wrist and hand appears normal.

Output: Minimal enhancement of the sheath of the flexor hallucis longus tendon which may represent a tenosynovitis, but is of questionable significance. Mild wrist synovitis. We otherwise see no findings to account for the patient's pain.


Instruction: Generate impression based on medical findings.

Input: History of testicular cancer. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Mild splenomegaly measuring 15 cm in craniocaudal dimension.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Reference left periaortic lymph node measures 7 mm in short axis (series 401/8). No new or additional retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Small hiatal hernia with small nonspecific gastroesophageal lymph nodes, unchanged dating back to 2013.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable left para-aortic lymph node.


Instruction: Generate impression based on medical findings.

Input: Grade II meningioma, s/p surgery and SRS. There are post-treatment findings related to right parietal craniotomy and radiation therapy. There is no significant interval change in size of an enhancing dural based lesion deep to the craniotomy, with extension to the superior sagittal sinus. There is also no significant interval change in size of the enhancing dural-based lesion along the right lateral parietal convexity with infiltration of the craniotomy flap margin. There are also small tumors along the posterior and lateral occipital convexities. There is persistent high T2 signal and scattered areas of gyriform enhancement in the posterior parietal lobes near the midline. There is no evidence of acute cerebral infarction. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. There is a partially-empty sella. The skull and extracranial soft tissues are unchanged.

Output: 1. No significant interval change in size of the residual tumor in the right parasagittal surgical bed and lateral right parietal convexity. There are also small tumors along the posterior and lateral occipital convexities. 2. Persistent treatment effects in the bilateral posterior cerebral hemispheres, likely related to radiation necrosis.


Instruction: Generate impression based on medical findings.

Input: History of renal cancer status post left nephrectomy, evaluate nodules in renal bed and left lower quadrant. Motion artifact on several of the sequences makes assessment suboptimal.ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size and signal intensity without a focal lesion or biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post left nephrectomy. In the adjacent dorsolateral retroperitoneal space there are several soft tissue nodules that demonstrate postcontrast enhancement, the largest conglomeration of which measures 2.5 x 1.4 cm (series 21, image 255), not significantly changed in size compared to 9/3/2015 where it measured 2.5 x 1.4 cm but slightly increased in size from 5/27/2015 outside MRI where it measured 2.2 x 1.1 cm (series 12 image 31). Another discrete nodule more inferiorly measures 8 mm (series 21, image 59), unchanged from 8 mm previously. There is a discrete parasplenic implant on the left lateral transversalis fascia (series 29, image 131), not significantly changed.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: In the lower left lateral abdominal wall musculature there is a 1.8 x 1.0 cm enhancing nodule (series 21, image 191), not significantly changed.OTHER: No significant abnormality noted.

Output: 1.Status post left nephrectomy with enhancing soft tissue nodularity in left retroperitoneal compartment suspicious for residual or locally recurrent disease, not significantly changed compared to 9/3/2015 but slightly increased in size from 5/27/2015 outside MRI. 2.Additional nonspecific enhancing soft tissue nodule in the left lateral abdominal wall musculature may also represent a site of metastatic disease, not significantly changed. 3.Additional nonspecific signal abnormality and enhancement in the insertion of the left gluteus maximus muscle which could represent inflammation or an additional site of metastatic disease, and continued attention to this area on follow-up imaging is recommended.


Instruction: Generate impression based on medical findings.

Input: Ms. Lange is a 47-year-old female with BRCA1 mutation presenting for high-risk breast cancer screening. She has a personal history of right lumpectomy for IDC with medullary features in 2003. She is status post radiation and chemotherapy. She has a family history of breast cancer in her sister diagnosed at age of 28 and ovarian cancer in a paternal aunt. There is scattered fibroglandular tissue in both breasts. Minimal parenchymal enhancement is noted bilaterally.Stable postsurgical changes are identified in the right upper outer breast and right axillary region. There is no abnormal enhancement seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on medical findings.

Input: Urinary incontinence, decreased bladder capacity, thick-walled bladder. Evaluate for tethered cord. Five lumbar type vertebral bodies are presumed to be present. The conus medullaris is normal in appearance and terminates at the L1-2 level. There is no T1 hyperintensity along the filum. There is no evidence of intraspinal tumors. The lumbar spine is in normal alignment, with a normal lumbar lordosis. There is no significant spinal canal or neural foraminal stenosis at T12-L1 through L5-S1. The vertebral body and disk heights are well-maintained. The vertebral marrow signal is unremarkable. The paravertebral soft tissues are unremarkable.

Output: No evidence of low-lying conus medullaris, fibrofatty filum, or other developmental anomalies in the lumbar spine.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: Pregnant with seizures. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma, including the hippocampi, appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is a small amount of fluid in the right mastoid air cells.

Output: 1. No evidence of gross seizure foci.2. A small amount of fluid in the right mastoid air cells could be a manifestation of mastoiditis.


Instruction: Generate impression based on medical findings.

Input: Kyphoplasty 2 weeks ago, now with bilateral leg numbness and worsening weakness There is trace prominence of the central canal in the mid to lower cervical cord, as seen on prior cervical spine study from 2/22/2016. Vertebral body heights in the cervical spine are normal. Again seen is partial fusion of the C3 and C4 vertebral bodies. There is mild reversal of cervical lordosis with apex at the C3-C4 level. There is also mild anterolisthesis of C5 on C6. Alignment is otherwise grossly maintained in the cervical spine. There is mild spinal canal stenosis at the C3-C4 and C4-C5 levels similar to prior. No high-grade spinal canal stenosis in the cervical spine. Again seen is a C6 vertebral body lesion with T1 hyperintensity, which is compatible with a hemangioma.Thoracic vertebral body heights and alignment are maintained. No significant spinal canal stenosis is evident. Trace central canal prominence in the upper and mid thoracic cord also appears grossly similar to prior but can be better assessed on dedicated thoracic study. Intraspinal catheter is again noted.In the lumbar spine, again seen is a severe compression fracture involving the L3 vertebral body with bone marrow edema similar to prior. Interval changes of kyphoplasty are noted. There is moderate to severe spinal canal stenosis at the L2-L3 level similar to prior, and can be better compared with dedicated lumbar spine images. Low-lying conus/distal neural tissue again noted to terminate near the L5 level. There are diminished posterior osseous elements from L3-L4 to the sacrum reflecting combination of prior laminectomies and dysplasia.

Output: 1. Examination limited to sequences per cord compression protocol. Again seen is moderate to severe spinal canal stenosis at the L2-L3 level which is better assessed on dedicated lumbar spine study. Severe L3 compression fracture again seen, grossly similar to prior, with interval changes of kyphoplasty. Please see separate lumbar spine report.2. No high-grade spinal canal stenosis in the cervical or thoracic spine. Mild spinal canal stenosis at C4-C5 again seen. There is also trace prominence of the central canal/tiny syrinx in the cervical and thoracic cord, better assessed on recent MRI spine study from 2/22/2016. Unchanged appearance of the low-lying conus which extends to the L5 level.


Instruction: Generate impression based on medical findings.

Input: There is no acute infarct, mass, or mass effect. There is mild diffuse global parenchymal volume loss including mild volume loss involving the cerebellum. There are moderate periventricular and subcortical white matter T2 hyperintensities which are nonspecific, but likely representing moderate chronic microvascular ischemic changes. There is no hydrocephalus. Brain parenchyma is otherwise unremarkable. Sella and orbits are grossly unremarkable. Paranasal sinuses and mastoid air cells are clear. Major flow-voids are preserved. Calvarium is intact.

Output: Mild age-related volume loss and moderate chronic small vessel ischemic disease. No evidence of acute infarct. No focal lesions in the cerebellum or disproportionate cerebellar atrophy as questioned.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: 22-year-old with paresthesias. Concern for multiple sclerosis. Brain:No abnormal signal is seen on the T2 or FLAIR images. There is no abnormal enhancement. There is no evidence of mass or edema. The cerebral volume is preserved.The ventricles and basal cisterns are normal in size and configuration. The expected intracranial vascular flow voids are present. The paranasal sinuses are clear. The visualized mastoid air cells are clear. The orbits are unremarkable.Cervical spine:Marked motion artifact limits evaluation of the cervical spine.Straightening of the cervical lordosis likely related to positioning. Vertebral body and intervertebral heights are maintained. No significant neural foraminal or spinal canal stenosis. The spinal cord is normal in signal and morphology throughout. No abnormal enhancement is present on the postcontrast images.

Output: 1. Normal contrast enhanced MRI of brain. No evidence of demyelinating disease or findings to account for the patient's symptoms.2. Normal contrast enhanced MRI cervical spine within the limitations of extensive motion artifact. No evidence of demyelinating disease.


Instruction: Generate impression based on medical findings.

Input: 87-year-old female status post fall with an elevated INR. Please evaluate for acute intracranial hemorrhage. There is no evidence of intracranial hemorrhage. As a parafalcine high attenuation mass with a broad based dural connection measuring 2.9 x 2.0 cm transaxial at the posterior superior aspect of the right lateral ventricle consistent with a meningioma.Scattered areas of periventricular and subcortical low attenuation consistent with small vessel ischemic disease of indeterminate age.There is asymmetry in the size and configuration of the lateral ventricles, larger on the left. The possibility of a arachnoid cyst at the level of the left foramen of Monroe is a consideration further evaluation with MRI is recommendedThe calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Right posterior parafalcine meningioma as detailed above.2. Possible intraventricular arachnoid cyst at the level of the left foramen of Monroe. Further evaluation with MRI is recommended.2. Small vessel ischemic disease of indeterminate age.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old, with seizures. Evaluate for limbic encephalitis. T2 hyperintensity involving the mesial temporal lobe structures persists but has improved relative to the prior examination. The amygdala and hippocampi appear less swollen. The hippocampal cortex remains slightly hyperintense on DWI similar to prior. No associated pathologic enhancement is seen.No new parenchymal signal abnormality is seen. No evidence of significant generalized mass effect is detected. Previously demonstrated mild thickening and enhancement of the dura has resolved. No acute intracranial hemorrhage or any abnormal extra axial fluid collections are detected. The ventricular system is normal in size and morphology.

Output: 1.Interval improvement in signal abnormality and edema affecting the mesial temporal lobe structures. As before, the differential would include infection, limiting encephalitis or sequelae of seizure activity.2.Interval resolution of dural thickening and enhancement. No new intracranial lesions are seen.


Instruction: Generate impression based on medical findings.

Input: Elevated alkaline phosphatase. Concern for biliary stricture. History of AML. Status post transplant. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in size and morphology. There is abnormal periportal signal diffusely without definite enhancement.The previously seen segment 4A/B lesion has increased in size, see measurements below. It demonstrates T2 weighted moderate hyperintensity, is isointense on T1-weighted imaging and demonstrates arterial enhancement but no washout. There is a more peripheral satellite lesion adjacent to the dominant lesion with similar imaging characteristics.No intra or extrahepatic biliary ductal dilatation. Normally distended gallbladder without gallstones.SPLEEN: The spleen is normal morphology and size. Suspected iron deposition.PANCREAS: 1.3 cm pancreatic tail cystic lesion without suspicious enhancement. This does not clearly communicate with the pancreatic duct. There is also mild atrophy and pancreatic ductal dilatation distal to this lesion. Stable atrophy of the distal pancreatic body/proximal tail without a focal lesion.The remainder of the pancreatic parenchyma is unremarkable. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. There is diffuse abnormal periportal signal intensity which does not definitively show dropout on out of phase imaging. Although this may still represent nodular fatty infiltration an infectious or infiltrative process cannot be excluded. There is no discrete associated enhancement.2. Nonspecific enhancing segment 4A/B lesion is increased in size from the prior with a new satellite lesion. It does not demonstrate washout or other specific imaging characteristics. Differential considerations include focal nodular hypertrophy or a regenerative nodule amongst other possibilities. A malignant etiology is considered less likely as the lesion does not wash-out.3. New cystic pancreatic tail lesion does not clearly communicate with the main pancreatic duct and may represent a mucinous neoplasm, a small intrapancreatic pseudocyst or cystic islet cell neoplasm.


Instruction: Generate impression based on medical findings.

Input: 62-year-old man with thyroid nodule requiring further assessment. RIGHT LOBE MEASUREMENTS: 4.7 x 1.9 x 2.0 cmLEFT LOBE MEASUREMENTS: 4.8 x 1.7 x 2.4 cmISTHMUS MEASUREMENTS: 0.5 cmRIGHT LOBE: 2 nodules are noted in the right lobe of the thyroid. Both measure 7 x 8 mm. The medial and anterior nodule which is predominantly hypoechoic and slightly nodular in contour corresponds to the abnormality documented on recent PET/CT.LEFT LOBE: 7 mm complex nodule noted in the left lobe.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multiple thyroid nodules. The anterior-medial nodule in the right lobe of thyroid measuring 7 x 8 mm corresponds to the PET CT abnormality. FNA of this nodule could be attempted however given relatively small size, a nondiagnostic result is a distinct possibility.


Instruction: Generate impression based on medical findings.

Input: 31-year-old male with perianal Crohn's disease with recent perianal abscess. Evaluate for perianal fistula or abscess. PELVIS:PROSTATE/SEMINAL VESICLES: Suspected tiny fistula between the anterior rectum and the prostate noted on the diffusion weighted sequence (series 10 image 95).BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Trace free fluid in the dependent pelvis. BONES, SOFT TISSUES: Complex linear tract of fluid signal intensity extending from the left perineum extending anteriorly towards the scrotum, superiorly along the perianal soft tissues, connecting with irregular T2 fluid signal intensity in the presacral region with a thin fistulous connection to the posterior/6:00 position of the lower rectum (series 5 image 46). A separate left/5:00 position fistulous connection is also identified (series 8 image 48). The fluid tract measures 7 cm in craniocaudal length (series 6 image 40). OTHER: No significant abnormality noted.

Output: 1.Complex perianal fistula with connection at the left/5:00 position and possibly at the posterior/6:00 position. This fistula is a transsphincteric type. The fluid tract extends along the left perianal soft tissues, extends anteriorly towards the scrotum, and connects to irregular presacral fluid signal.2.There is a suspected fluid connection between the anterior rectum and the prostate.


Instruction: Generate impression based on medical findings.

Input: Chronic diarrhea. Evaluate for chronic pancreatitis. Status post orthotopic liver transplant. ABDOMEN:LIVER, BILIARY TRACT: The patient is status post liver transplant. No focal hepatic lesions are seen. No biliary ductal dilation is present. SPLEEN: No significant abnormality noted.PANCREAS: The pancreas is normal in signal and enhancement. There is no focal pancreatic lesion evident. The pancreatic duct is normal in caliber. No peripancreatic fluid collections are present.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Normal appearing bowel loops in the imaged upper abdomen.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No intra-abdominal fluid collections.

Output: 1. Normal MR appearance of the pancreas.2. No specific findings to account for the patient's chronic diarrhea.


Instruction: Generate impression based on medical findings.

Input: Intraosseous meningioma post resection: 3 month follow up. There are postoperative findings related to left parietal cranioplasty. There is no evidence of gross tumor in the surgical bed or adjacent calvarium. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few punctate foci of susceptibility effect in the bilateral parietal lobes. There is minimal scattered nonspecific cerebral white matter T2 hyperintensity. 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 are bilateral lens implants. There is fluid within the left sphenoid sinus.

Output: 1. Postoperative findings related to left parietal cranioplasty without evidence of gross tumor in the surgical bed or adjacent calvarium.2. A few punctate foci of susceptibility effect in the bilateral parietal lobes may represent chronic microhemorrhages. 3. Possible acute sinusitis.


Instruction: Generate impression based on medical findings.

Input: High risk breast cancer screening. History of breast cancer in mother, maternal second cousin and maternal aunt. There is heterogeneous amount of fibroglandular tissue in both breasts. Bilateral cysts are again seen.Mild parenchymal enhancement is noted bilaterally.No suspicious enhancement is seen in either breast. Bilateral enhancing foci are not significantly changed.No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on medical findings.

Input: Clinical question: History of brain metastases with RT, please evaluate stability. Signs and symptoms: Brain metastases. Pre-and post enhanced brain MRI: Examination demonstrate very significant interval increased size of multiple previously known metastatic lesions and with significant interval increased peritumoral vasogenic edema and associated mass effect.A left high convexity paramedian enhancing/necrotic metastatic lesion abutting the falx measures at 18 x 15 x 18 transaxial dimensions compared to prior study measurement of approximately 8.5 x 10.5 x 10 -mm. Significant interval increased surrounding edema.A tiny study patient bone in the intrahemispheric aspect of right anterior frontal lobe measures approximately 4 mm in size compared to prior study measurement of approximately 2.5 mm.A necrotic rim enhancing metastatic lesion in the left thalamus measures at 6 x 7-mm compared to prior study measurement of 5 x 5 mm.a superficially located large necrotic enhancing tumor in the left posterior temporal lobe measures at 20.7 x 24 x 20-mm compared to prior study measurement of 14 x 12 x 12-mm. This lesion also demonstrates fairly significant interval increased surrounding vasogenic edema.An enhancing and centrally necrotic metastatic lesion in the pons is again identified and measuring at 5 x 10-mm without surrounding edema or significant change since prior study.Any right inferior cerebellar paramedian metastatic tumor measuring 7 times 6-mm and without interval change since prior study or any significant surrounding edema/mass effect.There is no evidence of any new metastatic lesions.Increased mass effect from a large left posterior temporal metastatic lesion results in only trace deviation of midline to the right which is new since prior exam.Flair hyperintensity of right hemispheric white matter likely representing post treatment/radiation. The white matter of left hemisphere is widely hyperintense secondary to increased peritumoral edema.Calvarium and orbits are unremarkable and without evidence of metastatic lesions.Paranasal sinuses and mastoid air cells are unremarkable.

Output: 1.Significant interval increase in size and surrounding vasogenic edema of several of the metastatic brain lesions since prior study.2.View of the smaller metastatic lesions demonstrate no significant change.3.Increased peritumoral edema in particular on the left results in trace deviation of midline to the right which is new since prior exam.


Instruction: Generate impression based on medical findings.

Input: Male, 32 years old, with bilateral lower extremity and low back pain. Grade 1 retrolisthesis of L5 relative to S1 is seen. Spinal alignment is otherwise unremarkable.Vertebral body morphology is unremarkable. No concerning marrow replacement is seen. Endplate edema is demonstrated at L5-S1.The visualized distal spinal cord, conus and cauda equina nerve roots are within normal limits. No epidural abnormality is seen.L1-2: Unremarkable. L2-3: Unremarkable. L3-4: Unremarkable. L4-5: Mild facet arthropathy. Loss of disc height and T2 signal. Disc bulging with a right paracentral annular fissure. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. L5-S1: Mild facet arthropathy. Loss of disc height and T2 signal. Disc bulging with a superimposed central/right paracentral protrusion. No significant spinal canal stenosis or clear nerve root impingement is seen. The neural foramina are moderately narrowed.

Output: 1.Disc degeneration at L4-5 is seen with mild bilateral foraminal narrowing but no significant spinal canal stenosis.2.Spondylolisthesis and disc degeneration is seen at L5-S1. The neural foramina are moderately narrowed at this level, but again, no significant generalized spinal canal stenosis is seen.


Instruction: Generate impression based on medical findings.

Input: 34 year old female with face, arm and foot numbness. Evaluate for demyelinating disease. Brain MRI: There are no significant T2 foci within the periventricular and subcortical white matter. There is also no significant burden of T1 hypointense lesions. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is mild bilateral maxillary mucosal sinus and ethmoid air cell thickening.Cervical Spine MRI: The craniovertebral junction appears within normal limits. The cervical spine alignment is maintained and the cervical vertebral bodies and disc spaces are appropriate in height. The bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology. The vertebral artery flow voids appear to be intact. The paraspinous soft tissue structures appear within normal limits.

Output: No intracranial or cervical spine lesions to suggest a demyelinating process.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: 42-year-old female with inguinal mass. Compared to the previous exam. PELVIS:UTERUS, ADNEXA: Again noted are multiple uterine fibroids. The largest subserosal fibroid extends anteroinferiorly from the uterus and measures 2.7 x 2.2 cm (series 301, image 24).BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Ill-defined enhancing soft tissue mass in the left inguinal area which measures 2.7 x 2.9 cm (series 1/1/2001, image 114), previously measuring 3.3 x 2.8 cm.OTHER: No significant abnormality noted.

Output: 1.No significant interval change in the ill-defined enhancing mass in left inguinal region. Given patient history of cyclical pain corresponding to her menstrual cycle, this most likely represents endometriosis.2.Leiomyomatous uterus.


Instruction: Generate impression based on medical findings.

Input: Female 56 years old Reason: Eval for intra-articular pathology History: Left knee pain MENISCI: Menisci are intact.ARTICULAR CARTILAGE AND BONE: Bone marrow is normal in appearance. There is no focal articular cartilage defect.LIGAMENTS: The ligaments including the ACL, PCL, MCL, and lateral collateral complex are intact. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: Small joint effusion and minimal Baker's cyst. Otherwise unremarkable MRI of the knee.


Instruction: Generate impression based on medical findings.

Input: Reason: Eval for abscess vs fistula History: History of perirectal abscess with fistula PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant lymphadenopathy.BOWEL, MESENTERY: No evidence of bowel obstruction, abnormal mucosal enhancement, or bowel wall thickening.BONES, SOFT TISSUES: Approximately 20 x 12 mm rim-enhancing collection in the right posterior buttock in the subcutaneous tissue (series 1201 and image 41). Underlying muscle appears normal without sinus tract or fistulization. There are faint linear enhancement along the medial left thigh extending from the anus (series 1201 and image 43-48) at the previous site of perirectal abscess. OTHER: Bilateral hydrocele.

Output: 1. Rim-Enhancing collection in the posterior right buttock subcutaneous tissue without fistulization.2. Faint linear enhancement along the medial left thigh at the previous site of perirectal abscess. This is not typical of abscess but cannot rule out developing inflammation. Please correlate with physical exam.


Instruction: Generate impression based on medical findings.

Input: 63-year-old male with history of cirrhosis. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. Mild perihepatic ascites. No intra or extra hepatic biliary ductal dilatation. Cholelithiasis. Patent vasculature.Segment 7 intrinsic T1 hyperintense/T2 hyperintense lesion with postcontrast enhancement with washout measures 3.3 x 3.3 cm (image 68 of series 1100).Right hepatic dome lesion is not well-visualized on today's study.Additional T2 hypointense nodules are present scattered diffusely throughout the liver parenchyma.SPLEEN: Splenomegaly.PANCREAS: Pancreatic body cystic lesion without enhancement measuring 1.7 x 1.4 cm (image 23 of series 4). ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace right pleural effusion.

Output: 1. Cirrhosis with extensive fibrosis. Small volume perihepatic ascites.2. Enhancing segment 7 lesion with probable washout concerning for HCC has not significantly changed in size.3. Stable pancreatic body cystic lesion, likely an IPMN.


Instruction: Generate impression based on medical findings.

Input: Reason: syrinx History: abd pain Thoracic spine:Alignment is anatomic. Vertebral body heights and discs are intact. No abnormal marrow signal. No abnormal signal within the cord. No abnormal enhancement. No significant spinal or neural foraminal narrowing.Lumbar spine:Please note that there are 4 lumbar vertebrae identified, counting from C2 down.Alignment is anatomic. No abnormal marrow signal. Disc desiccation is noted at L2-L3, L3-L4 and L4 S1. No abnormal signal in the distal cord or conus which ends at T12-L1. Mild mid endplate depression along inferior aspect of L4.T12-L1: No significant disc disease. No spinal canal or neural foraminal stenosis.L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-S1: Mild diffuse disc bulge with a small right paracentral protrusion and small annular fissure. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: Minimal disc degeneration at L4-S1 without evidence of syrinx or significant spinal or neuroforaminal narrowing.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Status post tumor resection. Signs and symptoms: Status post craniotomy. Pre-and post-enhanced brain MRI:Examination demonstrates extensive postoperative changes of a right frontal/parietal craniotomy for removal of tumor. A small surgical cavity measuring approximately 9 x 14 mm in transaxial dimension with extensive surrounding residual vasogenic edema is present. Post-enhanced images demonstrate no convincing evidence of residual enhancement within or surrounding the surgical cavity to suggest residual tumor. Further follow-up however is needed. Constellation of findings results in regional mass-effect and without evidence of mass effect on the lateral ventricle or midline shift.The ventricular system remain within normal size similar to prior exam.Previously noted small enhancing metastatic lesions in the left hemisphere are again identified and without change. A tiny left frontal lobe developmental venous anomaly is again identified.

Output: 1.Post operative changes of right hemispheric tumor resection without detectable residual tumor on this initial study.2.Demonstration of tiny additional metastatic lesions and a small left frontal developmental venous anomaly.3.Stable normal size of ventricular system and with maintained midline.4.