Instruction: Generate impression based on medical findings.

Input: 4-year-old male status post chiari decompression January 2016 with syrinx. BRAIN: Postsurgical changes of the posterior suboccipital craniectomy compatible with a Chiari decompression and left cerebellar tonsillar resection. There is now ample CSF space in the neo-foramen magnum. There is now biphasic CSF flow across the ventral and dorsal aspect of the neo-foramen magnum, as well as along the dorsal upper cervical canal.There is no evidence of intracranial hemorrhage, mass, or acute infarct. Focus of asymmetric T2/FLAIR signal abnormality in the periventricular white matter along the posterior body the right lateral ventricle region of the right lateral ventricle, in the area of a terminal zone of myelination, may represent asymmetric variation of myelination versus more likely gliosis given the possible mild volume loss. 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.CERVICAL SPINE: A syrinx is noted at the C5-C7 levels slightly decreased craniocaudal extent now measuring 1.5 cm and measuring 3 mm in AP dimension, previously 8 mm AP. The cervical spine is in normal alignment, with a normal cervical lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the cervical spine. THORACIC SPINE: Trace residual prominence of the central spinal canal is noted at the T8 level measuring 1.0 mm in diameter, significantly improved since the prior exam, where the thoracic syringohydromyelia was only partially visualized.The thoracic spine is in normal alignment, with a normal thoracic kyphosis. The vertebral body and disk heights are well maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is otherwise of normal caliber and signal.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine.

Output: 1.Expected postoperative changes following Chiari decompression, with patent neoforamen magnum and restoration of dorsal biphasic CSF flow at this level.2.Interval decrease in size and craniocaudal extent of a cervical spine syrinx.3.Significant interval improvement of previously partially visualized lower thoracic syringohydromyelia, with trace prominence of the canal at the T8 level.


Instruction: Generate impression based on medical findings.

Input: History of ulcerative colitis with mild IBD symptoms. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Shotty retroperitoneal lymph nodes.BOWEL, MESENTERY: Shotty mesenteric lymph nodes. The stomach appears very distended during the course of the examination without an associated duodenal abnormality.The small bowel is adequately distended. It is normal in caliber. There is no abnormal wall thickening, enhancement, restricted diffusion or adjacent inflammatory changes. No fibrofatty proliferation. No focal fluid collection. The colon is also unremarkable in appearance.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. No evidence of acute or chronic inflammatory changes of the bowel.2. The stomach remains very distended during the course of the examination without an obstructive mass or stricture evident. This may reflect delayed transit. Clinical correlation and follow-up is recommended.


Instruction: Generate impression based on medical findings.

Input: TIA. Brain MRI: There are multiple small areas of encephalomalacia in the left coronal radiata, right frontal lobe centrum semiovale, right thalamus, and left cerebellar hemisphere. There is a background of diffuse patchy cerebral white matter T2 hyperintensity. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a small retention cyst in the right maxillary sinus.Brain MRA: There is no evidence of significant steno-occlusive lesions or aneurysms.Neck MRA: There appears to be mild narrowing of the origins of the bilateral vertebral arteries. There is no otherwise evidence of significant steno-occlusive lesions in the other neck arteries.

Output: 1. Multifocal chronic lacunar infarcts and probable chronic small vessel white matter ischemic disease, but no evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Apparent mild narrowing of the origins of the bilateral vertebral arteries, but no evidence of significant steno-occlusive lesions in the rest of the major head and neck arteries.


Instruction: Generate impression based on medical findings.

Input: Further evaluation of cerebellar lesion. History of medulloblastoma. Status post resection in April 2007 followed by chemotherapy and radiation treatment (which was reported). Presented with three-week history of worsening headache, nausea and vomiting. CT scan of the head from outside institution shows right cerebellar mass. BRAIN: A lobulated, septated mass has developed in the lateral aspect of the right cerebellar hemisphere, at the site of previous tumor resection. The mass measures axially 3.9 cm x 3.6 cm and craniocaudally 2.4 cm. The mass is partly solid and partly cystic, with the largest cystic component being in the superior medial aspect of the mass along its interface with the cerebellar parenchyma, measuring up to 2.4 cm. The solid component shows heterogeneous contrast enhancement and diffusion restriction, reflecting dense hypercellularity. There is vasogenic edema in the right cerebellar hemisphere extending along the right-sided cerebellar peduncles. In addition to deforming the right cerebellar hemisphere and causing downward herniation of the right cerebellar tonsil 8 mm below the level of the foramen magnum, the mass also deforms the brainstem and partially effaces the fourth ventricle and its outflow tracts without obstructive hydrocephalus. The mass, along its superior part, abuts the junction between the right transverse and sigmoid sinuses without definite invasion. There is mild dural thickening and enhancement subjacent to the right retrosigmoid craniotomy but this is nonspecific and can be postoperative.There is no other contrast-enhancing or space-occupying brain lesion. There is no acute infarct. There is no sizable intracranial hemorrhage. A few, tiny foci of susceptibility effect in the occipital and frontal lobes may reflect mineralizing angiography from previous radiation treatment. Supratentorially, the ventricles and other CSF-containing spaces are normal in size and there is no midline shift. The major intracranial vascular flow voids are preserved.There is mild mucosal thickening in the left sphenoid and right maxillary sinuses. There are small cystic lesions involving the left ear pinna without associated inflammatory change, which were not present on the previous examination. Please correlate with possible history of ear piercing and physical examination.WHOLE SPINE:Cervical: There is reversal of the normal cervical lordosis along with desiccation of the upper and mid cervical discs. There is also a mild leftward convex curvature. There is no significant spinal canal or neural foraminal stenosis. The cervical spinal cord is unremarkable. There is no abnormal intrathecal contrast enhancement. Thoracic: Alignment is anatomic. The vertebral bodies and discs are preserved in height. The spinal canal is preserved. The thoracic spinal cord is unremarkable. There is no abnormal intrathecal contrast enhancement.Lumbar: Off note, there are 6 lumbar-type vertebrae and the last well-formed disc is at S1-S2. Alignment is anatomic accounting for straightening which may relate to patient position. The vertebral bodies and discs are preserved in height. The spinal canal is preserved. The conus medullaris tip lies at L1-L2 level. The conus medullaris is unremarkable. There is no abnormal intrathecal contrast enhancement.

Output: 1.Large heterogenous lateral right cerebellar mass along the previous resection cavity margin, most likely represents medulloblastoma recurrence. This shows strong resemblance in composition and signal characteristics to the original tumor from the pretreatment examination from April 3, 2007.2.The associated mass-effect compresses the fourth ventricle and causes secondary Chiari malformation but there is no obstructive hydrocephalus. 3.There is no intracranial metastasis, otherwise. A few, tiny foci of susceptibility effect in the cerebrum may reflect mineralizing angiopathy from previous radiation treatment.4.No spinal drop metastasis. Please note transitional spinal anatomy as above, and if surgery is to be contemplated, correlation with imaging of the entire spine is recommended.


Instruction: Generate impression based on medical findings.

Input: There is a 3.6 cm AP x 3.1 cm transverse lesion centered in the left parietal lobe. It demonstrates peripheral, irregular enhancement with adjacent asymmetric edema mildly flattening the left occipital horn, as well as central necrosis. There are no other abnormal enhancing foci. Basilar cisterns are maintained. Expected vascular flow voids are demonstrated. The sinuses and mastoid air cells are clear.

Output: There is a 3.6 cm AP x 3.1 cm transverse enhancing, centrally necrotic lesion centered in the left parietal lobe.


Instruction: Generate impression based on medical findings.

Input: Evaluate for accumulation of MS lesions. There are numerous cerebral white matter lesions bilaterally, mainly in a periventricular distribution, but also in the right paracentral lobule subcortical white matter, as well as in the right cerebellar hemisphere. Some of the lesions demonstrate low signal on T1 weighted sequences, but there is no evidence of associated enhancement. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No appreciable change in the burden of demyelinating lesions related to multiple sclerosis and no evidence of acutely inflamed lesions.


Instruction: Generate impression based on medical findings.

Input: 33-year-old male with a history of meniscal repair failure status post surgery last year in 2014. Presents with medial joint line tenderness. MENISCI: Note is made of branching linear increased signal abnormality within a fragmented/deformed posterior horn of the medial meniscus which extends into the body of the meniscus and fills with intra-articular contrast, consistent with a complex re-tear. There is mild blunting of the anterior horn of the medial meniscus. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: Note is made of a partial thickness defect affecting the articular cartilage of the trochlea. No full thickness articular cartilage defects are identified.LIGAMENTS: The cruciate and collateral ligaments appear intact EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Complex re-tear of the medial meniscus as described above.


Instruction: Generate impression based on medical findings.

Input: 55-year-old female with lupus status post CVA x 2, hypotensive and unresponsive with distended abdomen. Concern for intracranial process and acute abdomen. There is no evidence of intracranial hemorrhage, mass or edema. No evidence of acute cortical stroke, however, if there is clinical concern for acute stroke an MRI may be considered. Increased density within the left globe may be due to hemorrhage.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: 1. No evidence of acute cortical stroke, however, if there is clinical concern for acute stroke an MRI may be considered.2. Increased density within the left globe may be due to hemorrhage.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, intractable, without status epilepticusClinical question: epilepsySigns and Symptoms: seizuresComments: Pre op laser fiber | Since the prior exam the patient has undergone depth electrode placement and right-sided burr hole placement. One probe extends to the right parietal bone the brain parenchyma with tip along the medial aspect of the right temporal lobe another three course through the right temporal lobe medially with the tips along the medial aspect of the right temporal lobe. There is associated scalp soft tissue swelling present.There is T2 hyperintense signal present along the posterior aspect of the right subcentral lobule. This was not present on the prior exam.There is intracranial air present on the current exam as well as more subdural fluid.No abnormal foci of enhancement are appreciated within the brain parenchymaThe visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.The patient status post recent multiple depth electrode placement with associated postoperative change. 2.Some new edema is present along the posterior aspect of the right subcentral lobule


Instruction: Generate impression based on medical findings.

Input: 55 years Female (DOB: 5/3/1960)Reason: myelopathy cord signal change? History: R hand numbness, neck painPROVIDER/ATTENDING NAME: JAMES M MOK JAMES M MOK The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is mild reversal of the normal cervical curvature. There is multilevel disc desiccation present. There is a 7 mm extra-axial and intradural nodule present adjacent to the spinal cord at the right lateral aspect of the spinal canal at the C2-3 level.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is a broad-based central disc protrusion which impresses on the ventral aspect of the thecal sac and partially effaces spinal fluid ventral to the spinal cord. Overall there is a mild degree of spinal stenosis resulting at this level. There is no compromise of the exiting nerve roots at this level.At C4-5 there is no significant compromise to the spinal canal. There are some uncovertebral osteophytes and disc material at the lateral recesses which mildly encroach on the exiting nerve roots.At C5-6 there is a disc bulge at this level associated with bilateral uncovertebral osteophytes resulting in effacement of spinal fluid ventral and posterior the spinal cord and overall a mild to moderate degree of spinal stenosis as well as encroachment of the exiting nerve roots.At C6-7 there is a central disc extrusion at this level associated with bilateral uncovertebral osteophytes resulting in effacement of spinal fluid ventral and posterior the spinal cord and overall a moderate degree of spinal stenosis. There is no significant compromise to the exiting nerve roots within the neural foramina at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There are multilevel degenerative changes present in the cervical spine worse at C5-6 and C6-7 where there is mild to moderate spinal stenosis at C5-6 and moderate spinal stenosis at C6-7 as well as encroachment of the exiting nerve roots within the neural foramina at C5-6. There are degenerative changes present at other levels as well with milder degrees of neural foraminal encroachment.2.There is an extra-axial and intradural well-circumscribed nodule present within the spinal cana at C2-3l. Differential considerations include a schwannoma and less likely meningioma as well as in the appropriate clinical setting metastatic disease. An MRI with contrast would help further evaluate this.3.An email was sent to Dr Mok regarding the above findings.


Instruction: Generate impression based on medical findings.

Input: Left inferior ramus lesion.IMAGE ACQUISITIONS: Noncontrast CT of the pelvis was performed with standard CT protocol. There is an irregular lucency measuring approximately 1.2 cm through the left inferior pubic ramus which demonstrates sclerotic margins and slight expansile remodeling however there is no associated soft tissue mass. There is no similar findings on the contralateral side. The remainder of the visualized osseous structures are within normal limits. The visualized lower lumbar spine and sacrum also are within normal limits. Sacroiliac joints are within normal limitsThe surrounding soft tissue structures including the musculature surrounding this lucency in the left inferior pubic ramus appears within normal limits. The edema seen on outside MRI study surrounding this lesion is not appreciated on CT examination which is expected.

Output: Irregular lucency with sclerotic margins in the left inferior pubic ramus with no associated soft tissue mass is most compatible with a benign lesion. The location and imaging appearance of this finding is highly suggestive of the ischiopubic synchondrosis which represents a normal ossification process however given the patient is symptomatic, it has been described to have stress reaction or swelling of the synchondrosis. Alternatively, this could be a fracture however it is an atypical place. Much less likely and still benign in etiology, this could represent an atypical appearing eosinophilic granuloma.Given the findings are most likely secondary to a swollen ischiopubic synchondrosis, short-term follow-up CT examination in 3 to 6 months is recommended to evaluate for change or resolution of findings.


Instruction: Generate impression based on medical findings.

Input: Back pain, episode of bowel incontinence Vertebral body heights are maintained. Alignment is grossly maintained. Mild degenerative changes are present in the cervical, thoracic, and lumbar spine including small disc bulges in the cervical, thoracic, and lumbar spine. There is no significant compromise to the spinal canal or evidence of acute cord compression. Spinal cord signal is grossly unremarkable.

Output: This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No evidence of spinal cord or cauda equina compression. Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine.


Instruction: Generate impression based on medical findings.

Input: Again seen is a syrinx extending from superior C6 to the inferior T1 level and measuring up to 5 mm in maximal diameter, unchanged from prior exam. The spinal cord is otherwise normal in caliber and signal without evidence of pathological enhancement. Cervical spine alignment is anatomic, with a normal cervical lordosis. The vertebral body and disk heights are preserved. No worrisome focal marrow signal abnormality is appreciated. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the cervical spine. THORACIC SPINE

Output: Cervical and thoracic cord syrinxes appear stable from prior exam.


Instruction: Generate impression based on medical findings.

Input: Reason: intracranial stenosis? History: imbalance MRI of the brainThere is a 5 mm thick by 22-mm wide extra-axial lesion which is bright on flair and T1 weighted imaging.Small focus of encephalomalacia present along the right orbital gyrus which is associated with some susceptibility effect and superficial siderosis .There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is small in. The posterior communicating arteries are identified. The left posterior communicating artery is fairly large whereas the right posterior communicating artery is a very small. The vertebral arteries are similar in size.

Output: 1.A small extra-axial lesion is present adjacent to the left frontal lobe. There is no associated mass effect. Differential considerations include a small subacute hematoma.2.Small focus of encephalomalacia and he right orbital gyrus is present. This specific location and is often associated with posttraumatic injury.3.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on medical findings.

Input: 17 year-old female status post fall with double vision and headache, loss of consciousness and blood from left ear canal. There is no evidence of intracranial mass or edema. A small focus of high density presumably represents an extra-axial fluid collection adjacent to the frontoparietal cortex, (images 12 and 13). Focus of soft tissue density overlying the left parietal occiput likely represents a hematoma without underlying fracture.These focal findings suspicious for a small subdural hematoma would be better evaluated with an MRI.Low-density focal widening of the right lateral sylvian fissure may represent an arachnoid cyst (image 7).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: 1. Small focus of hyperdensity, as described above, may represent a subdural hematoma which would be better evaluated with MRI.2. Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Other specified counseling. Neoplasm of unspecified behavior of unspecified siteClinical question: Patient has MRI compatible pacemaker. Will see Device Clinic. Preop planning for brain biopsy. Signs and Symptoms: preop planning The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a 73 x 53 mm axial dimension mass involving right basal ganglia and adjacent right frontal lobe which extends to involve gray and white matter of the insular cortex and right orbital gyrus and right inferior frontal gyrus does not display any contrast enhancement.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a mucous retention cyst in the right maxillary sinus and mucosal thickening elsewhere in the paranasal sinuses. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There is a mass involving right frontal lobe, insular cortex and basal ganglia. Most likely this represents a primary brain tumor such as an oligodendroglioma. Please note this examination is a limited exam for the purposes of stereotactic guidance.


Instruction: Generate impression based on medical findings.

Input: Multiple hepatic lesions. History of hepatic steatosis. ABDOMEN:LIVER, BILIARY TRACT: Diffuse decrease in signal intensity on the out of phase images is consistent with hepatic steatosis/fatty infiltration. The liver is enlarged measuring 23 cm in craniocaudal dimension.Demonstrated again are multiple hepatic lesions which are not significantly changed in size or number. The reference largest lesion measures 4.7 x 3.5 cm (series 11 image 15), compared to 4.5 x 3.7 cm previously.The lesions are relatively hyperintense on the T1-weighted fat-suppressed precontrast imaging sequences likely secondary to the background fatty liver and relatively homogeneously hypointense on the nonfat suppressed T2 weighted images. Again, the larger lesions demonstrate some heterogeneity on the fat-suppressed T2-weighted images and peripheral restricted diffusion. On the multi hour delayed images the lesions are iso to slightly hyperintense to the background liver parenchyma.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal inferior pole simple cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stable size and number of the multiple hepatic lesions. Although a few of the lesions demonstrate somewhat atypical characteristics these likely represent multiple focal nodular hyperplasias.2.Hepatomegaly and steatosis.


Instruction: Generate impression based on medical findings.

Input: Prostate cancer PELVIS:PROSTATE:Prostate Size: 4.7 x 2.3 x 3.8 cmPeripheral Zone: Punctate T2-weighted hypointensities in the right apex may reflect sites of disease.Central Gland: In the anterior mid-gland there is a 9 x 5 mm T2-weighted hypointensity with restricted diffusion and equivocal early enhancement, suspicious for carcinoma. It abuts and mildly bulges the adjacent anterior capsule, extracapsular extension cannot be excluded.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: See discussion above.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Suspicious T2-weighted punctate hypointensities in the right peripheral zone apex.2. Anterior mid-gland 9 x 5 mm focus is suspicious for carcinoma. It abuts and mildly bulges the adjacent anterior capsule, therefore extracapsular extension cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: Reason: Left hip pain for several months, evaluate for labral tear, PLEASE INJECT WITH KENALOG 40MG AT TIME OF ARTHROGRAM History: LEFT HIP PAIN Metallic susceptibility artifact from the patient's right total hip arthroplasty device limits evaluation of the right hip and right hemipelvis on the large field-of-view images.ACETABULAR LABRUM: There is linear increased signal abnormality traversing the anterior superior acetabular labrum at the 2 o'clock position indicating a tear, best seen on the direct sagittal sequence series 801 image 20.ARTICULAR CARTILAGE AND BONE: Heterogeneous bone marrow signal abnormality likely residual islands of red marrow. There is articular cartilage degeneration along the superior aspect of the acetabulum with underlying subchondral cysts formation and subchondral signal abnormality. No CAM deformity is identified. The alpha angle measures 53 degrees, within normal limits. There is no evidence of cranial acetabular retroversion.SOFT TISSUES: The imaged musculature of the left hip is normal in appearance ADDITIONAL

Output: Osteoarthritis of the left hip and tearing of the anterior superior acetabular labrum as described above.


Instruction: Generate impression based on medical findings.

Input: 48-year-old male patient with history of HCV and cirrhosis. Evaluate for HCC. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. Mild iron deposition noted. No arterial enhancing foci with washout to suggest hepatocellular carcinoma.SPLEEN: Splenomegaly, measuring up to 16 cm in craniocaudal dimension. Stable 2 cm T1 and T2 hyperintense lesion in the anterior spleen may represent a sclerosed hemangioma.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts appear unchanged compared to prior examination. 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: Cirrhosis and splenomegaly without suspicious appearing hepatic lesions.


Instruction: Generate impression based on medical findings.

Input: Recent surgery on left hip. Pain in the right hip. Rule out fracture. Components of a left total hip arthroplasty device are situated in near-anatomic alignment, although the distal extent of the prosthesis is not included on the field-of-view of this study.I see no fracture.The bones appear demineralized, suggesting osteopenia. The lateral margin of the right femoral head is slightly indistinct, which I suspect simply reflects the patient's underlying osteopenia/osteoporosis; however if the patient has a known primary malignancy, then I would recommend CT or MRI for further evaluation to exclude an unusual metastatic focus.Mild degenerative arthritis affects the pubic symphysis. Degenerative arthritic changes also affect the visualized lower lumbar spine.

Output: I see no fracture. The bones are demineralized, suggesting osteopenia. The lateral margin of the right femoral head is slightly indistinct which I suspect simply reflects the patient's underlying osteopenia; however, if the patient has a known primary malignancy, then I would recommend CT or MRI for further evaluation to exclude an unusual metastatic focus.


Instruction: Generate impression based on medical findings.

Input: 64 year old female s/p heart and kidney transplant referred to evaluate for function and ischemia. Her irsk factors include diabetes.MEDICATIONS: tacrolimus, celcept, prednisone, synthroid, azithromycin, folic acid, lantus. First Pass PerfusionDuring hyperemia, no perfusion defects were present. Dark rim artifacts were noted.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 69%, the LV end diastolic volume index is 38 ml/m2 (normal range: 65+/-11), the LVEDV is 96 ml (normal range 109+/-23), the LV end systolic volume index is 12 ml/m2 (normal range 18+/-5), the LVESV is 29 ml (normal range 31+/-10), the LV mass index is 55 g/m2, and the LV mass is 139 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 56%, the RV end diastolic volume index is 40 ml/m2 (normal range 69+/-14), the RVEDV is 99 ml (normal range 110+/-24), the RV end systolic volume index is 18 ml/m2 (normal range 22+/-8), and the RVESV is 44 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is moderately dilated (MPA = 35mm).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. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 69%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.4. Normal RV size and systolic function (RVEF 56%).5. Moderate dilation of the main pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluation soft tissue and muscle inflammation around R hip and upper thigh. History: pain, swelling, inflammation There are foci of signal void within the soft tissues of the right hip likely reflecting metallic susceptibility artifact from prior surgery. There is mild deformity of the anterior femoral head/neck junction likely reflecting prior osteoplasty. There is a small amount of edema and enhancement within the lateral aspect of the femoral head which is nonspecific but not clearly evident on the prior study. There is a small amount of fluid within the right hip joint, but we see no frank synovitis. Please note that this study was not protocoled for detailed evaluation of the acetabular labrum. There is enhancement of the soft tissues along the lateral margin of the greater trochanter as well as within the soft tissues anterior and superior to the femoral neck as well as a small amount of enhancement within the direct head of the rectus femoris, at its origin There are also linear foci of enhancement within the tensor fascia lata muscle that we presume reflect postoperative scarring. There is moderate atrophy of the right gluteus minimus muscle. Portions of the gluteus minimus tendon are indistinct at the insertion on the anterior facet of the greater trochanter indicating at least partial thickness tearing. The remaining musculature of the right hip is unremarkable. The remaining musculature of the pelvis is unremarkable. There is avascular necrosis of the left femoral head without evidence of subchondral fracture or collapse. There is minimal peritrochanteric enhancement on the left, which is not necessarily of any clinical significance. There is a small amount of fluid within the left hip joint with no evidence of a synovitis. The sacroiliac joints are within normal limits. Mild degenerative disc disease affects the imaged lower lumbar spine.

Output: Surgical changes involving the right hip, as described above, with enhancement of the adjacent soft tissues likely reflecting a combination of scarring and mild inflammation. There is also atrophy of the right gluteus minimus muscle and at least partial-thickness tearing of the gluteus minimus tendon at its insertion on the anterior facet of the greater trochanter. Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: History of CFTR mutation with hypertriglyceridemia and severe pancreatitis now with worsening pain. Evaluate for pancreatic duct stricture and new fluid collection. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology and size measuring 19.4 cm in craniocaudal dimension. Loss of signal intensity on out of phase imaging compatible with diffuse fatty infiltration. No suspicious liver lesion. No significant intra or extrahepatic biliary ductal dilatation with the common bile duct measuring 7 mm. The patient is status post cholecystectomy.SPLEEN: Status post splenectomy.PANCREAS: Status post distal pancreatectomy. The pancreas is mildly atrophic. It demonstrates decreased intrinsic T1 weighted signal intensity and overall postcontrast enhancement. No evidence of parenchymal necrosis or hemorrhage. No significant parenchymal edema or peripancreatic fluid/fat stranding.Along the anterior pararenal fashion dorsal to the pancreatic tail is a 3.3 x 2.1 cm fluid collection along the lesser curvature of the stomach demonstrating thin wall enhancement compatible with a pseudocyst given the patient's history. There is minimal fluid surrounding the duodenal sweepNo evidence of arterial pseudoaneurysm or venous thrombosis.There is mild irregular narrowing, dilatation and mural contour of the main pancreatic duct (series 3 image 85 and 96) which is improved from the prior and is patent throughout, compatible with stigmata of chronic/prior pancreatitis. 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: Mild irregular dilatation, narrowing and mural contour of the main pancreatic duct, improved in caliber from the prior, compatible with stigmata of chronic/prior pancreatitis. 3.3 cm air and fluid collection anterior to the left adrenal gland abutting the lesser curvature of the stomach. This likely represents a pseudocyst when comparing to prior studies and much less likely a gastric diverticulum. It is mildly increased from the prior study.Fatty infiltration of liver.


Instruction: Generate impression based on medical findings.

Input: Sacral decubitus ulcer There is decubitus ulceration overlying the sacrum with a small area of low T1/high T2 signal involving the distal coccyx consistent with a small focus of osteomyelitis. This is best appreciated on sagittal image 33/65 of series 9 and image 29/34 of series 3. There is soft tissue edema overlying the sacrum/coccyx but no discrete fluid collection identified. Scattered areas of heterogeneous marrow signal within the remaining sacrum may be reactive in nature.There is irregularity of the tendon of the left gluteus maximus with a large amount of increased signal surrounding the muscle suggestive of partial tear of the tendon and muscle. There is diffuse muscle atrophy. Deformity of the right hip/pelvis relates to Paget's as seen on prior CT.

Output: 1. Small focus of osteomyelitis involving the distal coccyx. This finding represents a discrepancy with initial preliminary report and was conveyed to Dr. P. Mehta of the admitting service at the time of dictation.2. Partial tear of the left gluteus maximus tendon/muscle.


Instruction: Generate impression based on medical findings.

Input: Male 21 years old; Reason: Is there an injury to the UCL? History: Medial elbow pain and felt a pop after a throw as a baseball catcher LIGAMENTS: The posterior fibers of the ulnar collateral ligament are indistinct, with associated high T2 signal, compatible with tearing. The anterior fibers of the ulnar collateral ligament are intact. The remaining ligaments of the elbow are unremarkable.TENDONS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: No significant abnormality noted. SURROUNDING STRUCTURES: No significant abnormality noted.

Output: Partial full-thickness tear of the posterior fibers of the ulnar collateral ligament.


Instruction: Generate impression based on medical findings.

Input: 61 year old male presents with left knee pain and swelling. There is clinical concern for a septic knee. There is a fluid collection in the soft tissues of the knee anterior to the patella and the patellar tendon. This collection measures 2 x 1 cm in transverse dimension. The collection has irregular margins which enhance and there is enhancing reticulation of the surrounding soft tissues indicating inflammation. This is compatible with an abscess though could represent bursitis with extensive surrounding inflammation.Bone marrow signal is normal.The extensor mechanism is intact.There is a full thickness defect of the articular cartilage of the medial femoral condyle just above the posterior horn of the medial meniscus measuring approximately 1cm in diameter. There are additional full thickness clefts in the articular cartilage of the femoral trochlea.The cruciate and collateral ligaments are intact.There is a small amount of fluid in the joint but no effusion. There are no other findings that suggest septic arthritis.

Output: Fluid collection in the prepatellar soft tissues with surrounding inflammation suggestive of an abscess or bursitis. Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Evaluate presumed meningioma reported on an MRI from another institution, please compare to uploaded outside MRI: vision and hearing loss. There is no evidence of mass lesions within the left middle cranial fossa. There are bilateral lens implants. The bilateral orbital contents are otherwise unremarkable, without evidence of tumor or abnormal enhancement. The imaged portions of the skull appears unremarkable as well.

Output: No evidence of middle cranial fossa or orbital mass.


Instruction: Generate impression based on medical findings.

Input: The left frontal sinus is completely opacified with a peripheral rind of T1 isointensity to brain which enhances, with central T1 hyperintensity, likely representing obstructive inspissated secretions.There is a T1 isointense to brain and T2 hyperintense lesion in the left frontoethmoidal recess and the left anterior ethmoid, which is diffusely enhancing. There is dehiscence of the lateral wall of the frontoethmoidal recess at this level and there is an extraconal enhancing component along the medial aspect of the left orbit. There is mass effect on the extraconal left orbit, although the muscles remain discrete. There is also dehiscence of the left ethmoid roof. There is adjacent dural thickening of the left inferior frontal lobe.There is mucosal thickening of both maxillary sinuses, left more than the right.There are extensive paranasal sinus post-operative changes, including bilateral antrostomies which are patent.

Output: 1. There is a stable enhancing mass in the left frontoethmoidal recess, extending into the left anterior ethmoid sinus. Extra conal left orbital component with dehiscence of the lateral wall of the frontoethmoidal recess and left ethmoid roof. This mass is likely to represent recurrence of squamous cell carcinoma. MRI of the brain is recommended to assess for brain parenchymal involvement.2. Probable mucosal thickening of the left frontal sinus with associated obstructive inspissated secretions.3. Mucosal thickening of the maxillary sinuses bilaterally, left greater than right.


Instruction: Generate impression based on medical findings.

Input: Chronic low back pain radiating to left buttock. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: No evidence of lumbar disc herniation.


Instruction: Generate impression based on medical findings.

Input: Sudden hearing loss in left ear, history of chemoradiation for esophageal cancer. The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. There is mild fluid signal in the bilateral mastoid air cells, left more than right. The bilateral middle ears also appear unremarkable. There are bilateral lens implants. There is scattered cerebral white matter T2 hyperintensity in the imaged portions of the brain.

Output: 1. No evidence of retrocochlear or inner ear lesions.2. Mild nonspecific fluid signal in the bilateral mastoid air cells, left more than right, which may represent effusions.


Instruction: Generate impression based on medical findings.

Input: 36 year old with known right breast cancer and metastatic right axillary lymph node presents for research MRI of I-SPY protocol (3rd time point). There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.A known cancer is again identified at posterior depth in the right breast, 11 o'clock position, measuring in total extent 13 x 8 x 9 mm (AP x LR x CC) and previously 18 x 16 x 19 mm. The primary mass now measures 8 x 8 x 9 mm with a small focus of enhancement anterior to the mass which is included in the total extent given above. There has been resolution of the linear non mass enhancement extending inferior and anterior from the known cancer which previously measured 31 x 6 x 8 mm.  An enlarges lymph node is again seen in the right axilla, with maximum diameter of 9 mm (previously 15 mm) . No abnormal enhancement is seen in left breast. No abnormal axillary lymph nodes are identified in left axillary region.

Output: Decrease in size of known cancer in the right breast and metastatic right axillary lymph node as described above.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on medical findings.

Input: There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There are no restriction or diffusion abnormalities. Ventricular size is normal. There is no evidence of hemorrhage, mass effect, or edema.Paranasal sinuses and mastoid cells are clear.Vascular flow voids are normal.There is bilateral lens prosthesis.

Output: 1. No evidence of hemorrhage, mass effect, or edema. No evidence for acute ischemic cerebral infarction.2. Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on medical findings.

Input: 36 years Male (DOB:9/18/1980)Reason: 3t scanner, ccm protocol, qsm permeability, History: surveillancePROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD There is some mass associated with peripheral signal hypointensity and susceptibility artifact which has a more popcorn-like appearance on T1 and T2 imaging located in the left periventricular white matter and extending to the left lateral ventricle. On T1 imaging it measures 23 x 16 mm in axial dimensions.On susceptibility imaging there is a ringlike focus located in the right temporal lobe inferiorly which is very subtle on the FLAIR and T2 imaging. It is not readily visible on noncontrast T1 imaging.Incidental note is made of cavum septum pellucidum and cavum vergae.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 right vertebral artery appears to be hypoplasticThe 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.Findings compatible with the cerebral cavernous malformation located in the left periventricular white matter which extends into the left lateral ventricle.2.There is a small lesion in the right temporal lobe along the fusiform gyrus best visible on the susceptibility weighted imaging which is suspicious for a cerebral cavernous malformation. It is punctate on in size on the FLAIR and T2 images and likely a millimeter or less in size.


Instruction: Generate impression based on medical findings.

Input: 20-year-old female with pain. Evaluate for stress fracture. Right tibia/fibula: The distal tibial diaphysis demonstrates abnormal bone marrow signal intensity with hyperintense signal to skeletal muscle on T2/STIR sequences and hypointense signal on T1-weighted sequences however not as hypointense as the adjacent skeletal muscle. This is compatible with marked bone marrow edema. There is mild surrounding periosteal edema as well. This is compatible with a stress reaction. We cannot identify a discrete fracture. There is associated edema in the surrounding soft tissues.Left tibia/fibula: There is bone marrow edema within the distal tibial diaphysis however to a lesser degree when compared to the right tibia. This is also compatible with a stress reaction with no discrete fracture identified. There is mild periosteal edema and edema within the surrounding soft tissues.

Output: Bilateral tibial stress fractures as described above.


Instruction: Generate impression based on medical findings.

Input: 39-year-old female with left knee pain and swelling. Evaluate meniscus tear versus ligamentous injury Motion artifact limits examination. The high definition coil could not be utilized secondary to patient's body habitus resulting in slightly suboptimal image quality.MENISCI: The lateral meniscus appears intact. There is globular increased signal abnormality within the posterior horn of the medial meniscus consistent with intrasubstance degeneration. There are foci of increased signal abnormality which extend to the tibial articular surface consistent with undersurface fraying. There is no linear signal abnormality which extends to either articular surface or fluid filled defects to suggest an unstable tear.ARTICULAR CARTILAGE AND BONE: Suboptimal evaluation of the articular cartilage of the patellofemoral joint articular cartilage secondary to the aforementioned limitations. No overt full-thickness or near full-thickness articular cartilage defects are identified. Heterogeneous bone marrow signal abnormality likely represents residual islands of red marrow. There is increased signal abnormality within the posterior aspect of the tibial plateau with a subcentimeter focus of fluid signal intensity at the insertion site of the PCL which may reflect degenerative signal abnormality.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact. There is mild increased signal abnormality within the distal fibers of the patellar tendon just proximal to its insertion on the tibial tubercle which may reflect a very mild tendinosis.ADDITIONAL

Output: 1. Undersurface fraying and degeneration of the medial meniscus as described above.2. Small joint effusion.


Instruction: Generate impression based on medical findings.

Input: 71-year-old male with acute altered mental status. Evaluate for intracranial hemorrhage. There is no evidence of intracranial hemorrhage, mass or edema. No evidence of acute cortical ischemia. Multifocal regions of patchy low attenuation throughout the periventricular and subcortical deep white matter, nonspecific, however most likely secondary to small vessel ischemic disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.Focal region of encephalomalacia along the left temporoparietal region, not grossly changed compared with the previous examination of 4/23/2005.The ventricles and basal cisterns are mildly enlarged secondary to volume loss.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. No evidence of acute cortical infarction. Left temporoparietal encephalomalacia secondary to previous infarction. Diffuse white matter change most likely secondary to small vessel ischemic disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.3. No evidence of intracranial hemorrhage.


Instruction: Generate impression based on medical findings.

Input: Reason: Evaluate for loose body, calculate TT/TG History: Pain, lateral patella dislocation MENISCI: There is intermediate signal intensity within the free edge of the posterior horn of the lateral meniscus extending along its tibial articular surface suggesting an undersurface tear. The anterior horn appears intact. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is asymmetry of the trochlear facets with a relatively small medial facet suggesting mild dysplasia. The bone marrow signal intensity is within normal limits. There is a slight lateral patellar tilt.LIGAMENTS: The cruciate and collateral ligaments appear intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Borderline tibial tubercle to trochlear groove distance and other findings as described above that may be associated with patellofemoral instability.2. Small undersurface tear/fraying of the lateral meniscus.


Instruction: Generate impression based on medical findings.

Input: 87-year-old female with basal ganglia lesion seen on recent head CT. Please further evaluate. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are subcentimeter areas of high T2 signal in the bilateral basal ganglia and right thalamus distinct from accompanying prominent perivascular spaces (etat crible). There is mild scattered T2 hyperintensity in the periventricular and subcortical white matter. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. There are bilateral lens implants. The right periorbital contusion has resolved.

Output: 1. FIndings suggestive of chronic infarcts in the bilateral basal ganglia and right thalamus superimposed upon mild probable chronic small vessel ischemic white matter disease. 2. No evidence of acute intracranial hemorrhage, mass, or acute infarct.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Female, 38 years old, with cranial pharyngioma, receiving radiotherapy, evaluate cystic lesions. Again seen is a primarily cystic, rim-enhancing lesion centered in the suprasellar cistern and third ventricle. Since the prior examination, there has been a slight decrease in size of the inferior aspect of the cystic lesion now measuring approximately 34 mm in the AP dimension, previously 40 mm. More superiorly, the lesion projects through the left foramen of Monro and into the left frontal horn to a similar degree as seen on the prior examination. The left lateral ventricle remains dilated, similar to prior with evidence of transependymal CSF flow. Subfalcine herniation and a midline shift to the right of up to 14 mm are unchanged. Evidence of left frontal approach biopsies again seen.

Output: 1.Slight interval decrease in the size of the inferior aspect of the cystic craniopharyngioma. Elsewhere, the lesion is not significantly changed.2.The lesion continues to obstruct the left foramen of Monro with stable left lateral ventricular dilatation.


Instruction: Generate impression based on medical findings.

Input: There is a 10 mm AP x 12 mm transverse x 14 mm lesion within the anteromedial right temporal lobe which is heterogeneously yet primarily T2 hyperintense surrounded by a rim of multisequence hypointensity. This is associated with elevated susceptibility hypointensity, yet does not exhibit perilesional edema. Additionally, along its anteromedial aspect there is an associated developmental venous anomaly. There are no other lesions identified on susceptibility imaging.A large developmental venous anomaly is noted involving the right cerebellar hemisphere. There is no associated lesion demonstrating susceptibility abnormality.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There is no mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for acute intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: 1.MRI findings consistent with a right temporal lobe cavernous malformation with associated developmental venous anomaly. There is no perilesional edema.2.A large developmental venous anomaly is noted involving the right cerebellar hemisphere. There is no associated lesion demonstrating susceptibility abnormality.


Instruction: Generate impression based on medical findings.

Input: Asymmetrical right sensorineural hearing loss with tinnitus. The bilateral labyrinthine structures, internal auditory canals, and cranial nerve 7 and 8 complexes appear unremarkable. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is minimal nonspecific cerebral white matter T2 hyperintensity. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, orbits, and scalp soft tissues are unremarkable. There is mild scattered paranasal sinus mucosal thickening.

Output: No evidence of retrocochlear or inner ear lesions.


Instruction: Generate impression based on medical findings.

Input: Head and neck cancer, right frontal meningioma. IMPRESSION:Report Electronically Signed: 2/21/2008 2:23 PM Vivek Sehgal, MD

Output: No significant change. No evidence of tumor. Follow-up is suggested. TECHNIQUE:


Instruction: Generate impression based on medical findings.

Input: History of surgery for pituitary tumor, yearly follow up for change. There is a T2 hyperintense, enhancing lesion within the right anterolateral aspect of the sella, which displaces and compresses the normal pituitary tissue posteriorly, and measures up to 12 x 11 x 9 mm in the AP, transverse, and craniocaudal dimensions. There is no significant change in size allowing for differences in technique. The lesion bulges slightly into the medial aspect of the right cavernous sinuses and abuts the supraclinoid portion of the right internal carotid artery, without clear evidence of cavernous sinus invasion. There is no mass effect upon the optic apparatus. The pituitary infundibulum is intact, but displaced to the left, as before. The posterior pituitary bright spot is diminished but present. Limited evaluation of the brain again demonstrates scattered foci of T2 hyperintensity in the white matter which are nonspecific but compatible with mild small vessel ischemic disease.

Output: Enhancing pituitary mass involving the right anterior lateral aspect of the sella demonstrates no significant change in size since 1/21/2015 and is compatible with residual macroadenoma. There is interval increased enhancement evident within this lesion, which is favored to be related to differences in contrast dose and timing.


Instruction: Generate impression based on medical findings.

Input: Reason: S/P uterine artery embolization History: uterine fibroids, s/p uterine artery embolization. PELVIS:UTERUS, ADNEXA: Enlarged uterus with innumerable heterogeneous T2 hypointense enhancing masses compatible with fibroids has decreased compared to prior. Previous reference largest left subserosal mass measures 11.7 x 7.7 x 12.9 cm (series 1001 image 44, series 1201 image 12), previously 14.6 x 8.7 x 15.9 cm. Previous referenced largest right subserosal mass measures 7.5 x 6.4 x 7.1 cm, previously 8.8 x 8.0 x 9.8 cm. The largest fibroids, which previously enhanced homogeneously, no longer demonstrate enhancement. Some of the smaller fibroids continue to demonstrate enhancement.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval decrease in size and enhancement of uterine fibroids compatible with some treatment response.


Instruction: Generate impression based on medical findings.

Input: Examination is motion degraded. The cervical spine is in normal alignment. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the cervical spine although motion degradation slightly limits evaluation. No abnormal enhancement. No evidence of epidural tumor. THORACIC SPINE

Output: 1. Examination is somewhat motion degraded. No suspicious osseous lesions however are appreciated to suggest metastatic disease in the spine. No compression fractures. No evidence of epidural tumor. 2. Degenerative changes in the lumbar spine without high grade spinal canal or neural foraminal stenosis at any level. There is mild right L4-5 neural foraminal narrowing questionably contributing to right leg pain; correlate with signs of right L4 radiculopathy. There is facet arthropathy in the lower lumbar spine which may be contributing to low back pain.3. Extraspinal findings include left lower lobe mass and atelectasis,16x23 mm right thyroid lobe nodule, and left adrenal mass, better assessed on prior CT.


Instruction: Generate impression based on medical findings.

Input: Low back pain and leg numbness. Leukocytosis. Rule out epidural abscess. There are 5 lumbar-type, ribless vertebrae. The last well-formed disc is at L5-S1.Alignment is anatomic. The vertebral bodies are preserved in height. The intervertebral discs are preserved in height and T2 signal. There is no significant marrow signal abnormality. The spinal canal is preserved. The tip of the conus medullaris lies at mid L1 vertebral level. The conus medullaris shows normal shape and signal characteristics. Following contrast injection, there is no abnormal spinal cord, leptomeningeal, epidural or osseous contrast enhancement. Stranding, T2-hyperintensity and contrast enhancement in the subcutaneous fat at L3 and L4 levels is very nonspecific and may reflect dependent edema.The paraspinal soft tissues are notable for a 6 mm, well-circumscribed, T2-hyperintense, T1-hypointense, noncontrast enhancing lesion arising from the inferior pole of the right kidney which is probably a cyst.

Output: 1.No sign of lumbar spinal infection.2.No significant degenerative disease of the lumbar spine.


Instruction: Generate impression based on medical findings.

Input: Neuralgia and neuritis, unspecified [M79.2], Reason for Study: ^Reason: Patient with tingling/pain in distribution of V1 v. Facial nerve, MRI to evaluate soft tissue for inflammation with concern for tri-geminal neuralgia History: see above The globes, optic nerves, extraocular muscles and retroglobal spaces are symmetric and normal. The lacrimal glands are normal. There is no evidence of signal abnormality, mass, or abnormal contrast enhancement.  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: Normal brain and orbit MRI.


Instruction: Generate impression based on medical findings.

Input: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a small developmental venous anomaly along the inferior and anterior aspect of the right thalamus. The brain parenchyma and pituitary gland otherwise 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 and scalp soft tissues are grossly unremarkable. There are small mucous retention cysts in the right maxillary sinus and in the right nasopharyngeal mucosal space.

Output: No evidence of intracranial metastatic disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: 59-year-old male for evaluation for prostate cancer, elevated PSA. PELVIS:PROSTATE:Prostate Size: 6.4 x 5.8 x 4.5 cm.Peripheral Zone: There is a 8 x 4 mm ill-defined, wedge-shaped T2 hypointense lesion with corresponding restricted diffusion and no early focal enhancement in the right mid gland peripheral zone (series 801, image 15)Central Gland: Severe degree of prostatic hypertrophy.Seminal Vesicles: No significant abnormality.Extracapsular Extension: Not present.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Ill-defined wedge-shaped T2 hypointense lesion in the right mid gland peripheral zone as described above is indeterminate.2.Severe degree benign prostatic hypertrophy.


Instruction: Generate impression based on medical findings.

Input: Strong family history of breast cancer and history of benign right breast biopsy in 2013. Tyrer Cusick model shows her lifetime risk to be 31%. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.There are multiple bilateral enhancing foci in the breasts, none of which are uniquely enhancing.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on medical findings.

Input: Low back pain with sports for months. There is facet arthropathy and ligamentum flavum thickening affecting L3 through S1, including mild trace effusions and a subcentimeter right L4-5 synovial cyst. In addition, there is a partial disc dessication and a disc bulge at L5-S1 with mild left and mild to moderate right neural foraminal stenosis. There is also slight disc bulging at L4-5 with minimal bilateral neural foraminal narrowing, The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology and the cauda equina nerve roots are unremarkable. The paravertebral soft tissues are unremarkable.

Output: 1. No discernible evidence of spondylolysis or spondylolisthesis.2. Degenerative spondylosis in the lower lumbar spine including facet arthropathy and ligamentum flavum thickening affecting L3 through S1, a partial disc dessication and a disc bulge at L5-S1 with mild left and mild to moderate right neural foraminal stenosis, and slight disc bulging at L4-5 with minimal bilateral neural foraminal narrowing,


Instruction: Generate impression based on medical findings.

Input: Headache and dizziness. MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA: There is no evidence of significant steno-occlusive lesions in the head and neck arteries. There is no evidence of cerebral saccular aneurysms. The left vertebral artery arises directly from the aortic arch, which is an anatomic variant.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. No evidence of significant steno-occlusive lesions in the head and neck arteries.


Instruction: Generate impression based on medical findings.

Input: 20-year-old male with history of syrinx and tethered spinal cord, now experiencing new worsening back pain Cervical spine:Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable. There are no degenerative changes, disc herniations, or stenoses.Lumbar spine:Redemonstrated is a low-lying conus near the lumbosacral junction with postoperative changes related to prior cord untetherings. The distal thecal sac is ectatic and demonstrates septations. As before, the distal spinal cord abuts and may be adherent to the posterior thecal sac. Cauda equina nerve roots are also peripherally located as seen before which may also be reflective of adhesion. Prone images demonstrate no appreciable ventral motion of the distal cord. As before, a syrinx is present extending from the L1 to the L3-L4 levels and measuring up to 2 x 4 mm in the axial plane. These findings are unchanged.Alignment is anatomic. Vertebral body heights and intervertebral disc spaces are unchanged in morphology. The bone marrow demonstrates normal signal. No spinal canal or neural foraminal stenosis is present.

Output: 1.Negative noncontrast cervical spine MRI.2.No significant change in the appearance of lumbar spine including a small distal cord syrinx.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Patient with acute liver injury, altered mental status. Signs and symptoms: Acute liver injury and altered mental status. Non-infused CT of brain:No evidence of hemorrhage, edema, mass effect or midline shift or hydrocephalus. The gray/white matter differentiation is preserved. The ventricular system are within normal limits and no evidence of compression or midline shift. The basal cisterns remain patent. There is slight paucity of cortical sulci which may be well within normal range for patient's stated age of 28. Calvarium, paranasal sinuses and mastoid air cells are unremarkable. If clinical concern persist follow-up with a CT or an MRI is recommended.

Output: Unremarkable non-infused CT of brain.


Instruction: Generate impression based on medical findings.

Input: 26 years, Male, Reason: H/o PSC, elevated alk phos, eval for disease progression History: see above. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Peripheral regions arterial enhancement which do not persist on subsequent phases likely represent transient hepatic intensity differences. No suspicious hepatic lesions are evident.The common bile duct is dilated to 1 cm, proximal to an approximately 2 cm segment of narrowing and irregularity of the distal common bile duct, new from the prior exam. There are multiple regions of narrowing and dilatation involving the intrahepatic bile ducts giving a beaded appearance, increased from the prior exam. The right common bile duct is particularly narrowed at its confluence.SPLEEN: Multiple splenic cysts are overall similar in appearance to the prior exam. A large T2 hyperintense complex cystic lesion in the anterior spleen with multiple enhancing septations and progressive centripetal enhancement is unchanged in size measuring 3.5 x 2.8 cm (501/34), previously 3.4 x 2.8 cm.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is mild diffusion restriction, thickening and minimal enhancement within the relatively ahaustral colon and terminal ileum.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Multiple foci of intrahepatic and extrahepatic stricturing, increased from the prior exam, suggestive of primary sclerosing cholangitis.2.Diffusion restriction, enhancement and ahaustral colon is suggestive of inflammatory bowel disease with terminal ileitis.3.Multiple splenic cysts, including a larger nonspecific enhancing complex cystic lesion, are stable.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old, history of melanoma with a left occipital lobe mass identified on prior imaging. An intrinsically T1 hyperintense, hemosiderin stained lesion is redemonstrated within the left occipital lobe showing no significant interval change from the prior examination. As before, this lesion measures up to 10 mm in diameter. There is no significant associated parenchymal edema.No new intracranial lesions are seen. Scattered small foci of white matter T2 hyperintensity are unchanged and nonspecific. No evidence of mass effect is seen. The ventricles are normal in size and morphology. Findings likely related to prior surgery are evident in the left calvarial scalp.

Output: 1.Stable appearing left occipital lobe lesion.2.No new intracranial lesions are seen.3.Please note that the patient experienced a mild contrast reaction following administration of gadolinium with details as above.


Instruction: Generate impression based on medical findings.

Input: There is no abnormal parenchymal or meningeal enhancement. No intracranial mass or mass effect. Again seen is extensive confluent T2/FLAIR hyperintensity in the bilateral frontoparietal and to a lesser degree temporal and occipital white matter most compatible with treatment related leukoencephalopathy. There are multiple scattered foci of susceptibility effect including the bilateral temporal lobes and cerebellar hemispheres which are grossly similar to prior. There is focus of susceptibility in the left posterior frontal lobe which is not definitely seen on prior and may be due to differences in technique and the small size of the lesion. No restricted diffusion to suggest acute ischemia. The ventricles are within normal limits in size and configuration. Major flow-voids are preserved. There is aneurysm involving the right supraclinoid internal carotid artery which measures approximately 9 mm in diameter and 11 mm in the craniocaudal dimension, similar to prior. Left maxillary mucous retention cyst again seen. The enhancing lesions that were seen in the previous study involving the left frontal calvarium at the vertex and the right parietal calvarium are grossly unchanged.

Output: 1. No evidence of intraparenchymal or leptomeningeal metastatic disease.2. Enhancing foci in the right parietal and left frontal calvarium which were seen on prior study from 5/15/2015 but not on more remote prior studies are not significantly changed. 3. No significant change in extensive supratentorial white matter abnormality most compatible with treatment-related leukoencephalopathy.4. No significant change in scattered punctate foci of chronic microhemorrhages which are nonspecific and can be seen with entities such as chronic hypertension as well as sequela of radiation treatment. 5. Right supraclinoid internal carotid artery aneurysm again seen and grossly similar in size to priors but can be better evaluated with dedicated MR or CT angiogram.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: Right foot ulcer There is subcutaneous ulceration overlying the head of the fifth metatarsal. There is abnormal low T1 marrow signal and increased T2 marrow signal within the head of the fifth metatarsal consistent with osteomyelitis. There is overlying subcutaneous edema throughout the foot. There is no discrete focal fluid collection identified. There is moderate degenerative changes of the midfoot. The remaining marrow signal is otherwise normal.

Output: Findings consistent with osteomyelitis of the head of the fifth metatarsal.


Instruction: Generate impression based on medical findings.

Input: 63-year-old female with severe shoulder pain and bacteremia. Evaluate for septic arthritis of the shoulder. ROTATOR CUFF: There is increased signal abnormality within the supraspinatus, infraspinatus, and teres minor muscles as well as within the subscapularis muscle, suspicious for pyomyositis given the stated history of bacteremia. There is thickening and increased signal abnormality of the supraspinatus tendon consistent with moderate tendinosis. Note is made of a full-thickness tear of the supraspinatus tendon approximately 7 mm of retraction. There is also partial thickness tearing of the anterior fibers of the infraspinatus tendon.SUPRASPINATUS OUTLET: Degenerative changes affect the acromioclavicular joint. There is a small amount of fluid within the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a moderate sized glenohumeral joint effusion. Although this examination was not protocol for examination of the glenoid labrum, there appears to be increased linear signal abnormality traversing the posterosuperior glenoid labrum suspicious for degenerative tearing.BICEPS TENDON: There is a small amount of circumferential fluid within the tendon sheath of the long head of the biceps which may represent fluid extension from the glenohumeral joint. ADDITIONAL

Output: Findings consistent with pyomyositis/soft tissue infection most pronounced along the anterior aspect of the shoulder with associated abscess formation and glenohumeral joint effusion, raising the question of septic arthritis.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate menisci History: medial joint line pain, effusion, "popping" Several sequences are limited by patient motion artifact.MENISCI: There is blunting of the body and posterior horn of the medial meniscus that may be due to tearing or prior partial meniscectomy. There is also increased signal intensity within the remaining body and posterior horn of the medial meniscus which extends to the femoral articular surface and likely to the tibial articular surface as well, indicating a complex tear with extension of signal abnormality through the periphery of the body of the meniscus and decompression into small parameniscal cysts. The signal abnormality includes a fluid-filled defect along the femoral articular surface of the body of the medial meniscus. There appears to be additional tearing of the peripheral fibers of the posterior horn of the medial meniscus. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is full-thickness degeneration of the articular cartilage of the medial femoral condyle above the torn posterior meniscal horn. More anteriorly, along the medial femoral condyle, there is also a more focal full-thickness articular cartilage defect above the free edge of the anterior horn of the medial meniscus. There is superficial fraying of the articular cartilage of the medial tibial plateau. There is a full-thickness defect with delamination of the articular cartilage of the lateral facet of the femoral trochlea. There is heterogeneity of the medial facet and central portions of the femoral trochlea representing additional areas of degeneration. The articular cartilage of the lateral compartment appears relatively intact. There are tricompartmental osteophytes.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Complex tearing of the medial meniscus.2. Osteoarthritis, particularly affecting the medial and patellofemoral compartments.3. Joint effusion and Baker's cyst.


Instruction: Generate impression based on medical findings.

Input: Clinical question: 61-year-old African-American female with PVD, clots, no not withdrawing to pain left upper extremity. Signs and symptoms: Left upper extremity weakness. Nonenhanced brain MRI:There is no evidence of an acute intracranial process and in particular no evidence of acute ischemic stroke detected.There are patchy foci of flair hyperintensity in the subcortical and minimally ventricular white matter of cerebral hemispheres which are nonspecific however in proper clinical setting could represent mild chronic small vessel ischemic strokes.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination otherwise.The signal void of major intracranial arterial branches are identified.Calvarium is intact. There is a focus of subgaleal hemorrhage and in right posterior temporal region measuring maximum of 1.8-mm in thickness. Unremarkable images through the orbits, paranasal sinuses. Extensive opacification of bilateral mastoid air cells.

Output: 1.No acute ischemic stroke.2.Findings suggestive of mild age indeterminate small vessel ischemic disease.3.Tiny focus of subgaleal hemorrhage in the left posterior temporal.4.Extensive bilateral mastoid air cell opacification.


Instruction: Generate impression based on medical findings.

Input: 52 years Male (DOB:5/18/1963)Reason: schwannoma removed. 6 month follow up History: 6 month follow upReferring Attending: EDWIN RAMOS Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. The patient status post right-sided hemilaminectomy at the L3 vertebral body level for removal of an intrathecal mass. There is some central and to lesser degree peripheral clumping of nerve roots present at the L3-4 disc space level at the prior location of the patient's intrathecal mass. There is a fluid collection present at the hemilaminectomy site currently measuring 20 x 27 mm axial dimensions and previously measuring approximately 16 x 11 mm axial dimensions. It currently measures 27 x 47 mm sagittal dimensions. It has a thin enhancing wall. Previously noted fluid in the subcutaneous tissues superficial to the paravertebral muscles at the incision site has resolved.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation, loss of disc space height and a disc bulge at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation, loss of disc space height and a disc bulge at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.A previously noted 27 x 28 mm axial dimension mass at the inferior pole of the left kidney which also be identified on the recent abdomen CT from 10/29/2015 is not included on the current exam.

Output: 1.Since the prior exam, a fluid collection at the right hemilaminectomy site at L3 has enlarged. It is not clear based on this exam whether this communicates with the thecal sac.2.Some clumping of nerve roots at the level of the mass is concerning for potential arachnoiditis. Please correlate with clinical symptoms.


Instruction: Generate impression based on medical findings.

Input: 24-year-old female with likely from a syndrome with history of breast cancer, glioblastoma and known hepatic metastasis ABDOMEN:LIVER, BILIARY TRACT: Mild loss of signal on the out of phase images consistent with fatty infiltration. Multiple lesions are present within the liver.Two large segment 6/7 and inferior segment 6 lesions are not significantly changed when compared to the prior exam, demonstrating fat saturation, and lacking enhancement compatible with a macroscopic fat containing lesion such as a lipoma. In the location of the previously described homogenously arterially enhancing, inferior right hepatic lobe lesion is a smaller microscopic fat containing lesion that demonstrates mild arterial enhancement and questionable washout. This lesions now measures 13 x 9 mm, previously 15 x 16 mm (series 6, image 34). Several arterially enhancing subcentimeter foci are again seen in segment six, segment seven, and segment eight not significantly changed in size. These lesions demonstrate signal drop on out of phase imaging compatible with microscopic fat. Redemonstrated is a wedge shaped region of postcontrast enhancement in hepatic lobe segment seven that demonstrates mild diffusion restriction and signal drop on out of phase sequence. Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Status post bilateral mastectomy with susceptibility artifact from prior surgery.OTHER: No significant abnormality noted.

Output: 1.Two large lesions compatible with lipomas are unchanged. 2.Intracellular fat containing lesion in the inferior right hepatic lobe with mild arterial enhancement is decreased in size when compared to the prior examination. Continued follow-up of this lesion is recommended. 3.Wedge shaped region on arterial enhancement in hepatic segment 7 also demonstrates intracellular fat and is unchanged in size when compared to the prior examination. 4.Several additional arterially enhancing lesions in the liver as described above also demonstrate signal changes consistent with intracellular fat.


Instruction: Generate impression based on medical findings.

Input: 64-year-old male with low risk prostate cancer. Assess for extent of disease.Additional history per EMR: March 2015 PSA 6.88, biopsy confirmed prostate cancer. Most recent PSA 6.92. cT1c, Gleason score 3+3, 6/12 cores. PELVIS:PROSTATE:Prostate Size: 4.5 x 3.1 cm.Peripheral Zone: There are multiple T2/ADC hypointense lesions in the left and right mid gland peripheral zone (series 801, images 17 and 18) with possible associated enhancement. These may represent foci of patient's known prostatic malignancy. There is no evidence of neurovascular bundle invasion or extracapsular extension.Central Gland: Multiple T2/ADC signal hypointense nodules, the largest of which measures 9 x 6 mm in the left mid gland. None demonstrate definite abnormal contrast enhancement and their morphology favors benign etiology. Seminal Vesicles: Seminal vesicles are unremarkable.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Several peripheral zone lesions with findings suggestive of patient's known prostatic malignancy. No evidence of neurovascular bundle invasion or extracapsular extension.


Instruction: Generate impression based on medical findings.

Input: 47 year male with history of CAD, s/p PCI to RCA CTO, here for evaluation after procedure Left VentricleThe left ventricle is normal in size with mildly decreased ejection fraction. The overall LV ejection fraction is 48%, the LV end diastolic volume index is 102 ml/m2 (normal range: 74+/-15), the LVEDV is 209 ml (normal range 142+/-34), the LV end systolic volume index is 53 ml/m2 (normal range 25+/-9), the LVESV is 108 ml (normal range 47+/-19), the LV mass index is 64 g/m2 (normal range 85+/-15), and the LV mass is 131 g (normal range 164+/-36). There is mild basal inferoseptal tardokinesis. There is small area of late gadolinium enhancement in the basal inferior myocardial wall involving the subendocardium. This pattern of late gadolinium enhancement is consistent with prior myocardial infarction and is likely not viable. The remainder of the ventricular myocardium is viable. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size and function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 113 ml/m2 (normal range 82+/-16), the RVEDV is 231 ml (normal range 142+/-31), the RV end systolic volume index is 57 ml/m2 (normal range 31+/-9), and the RVESV is 116 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.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 FindingsThere are several left sided axillary nodes. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with mildly decreased systolic function at 48%. 2. The right ventricle is normal in size with mildly decreased systolic function at 50%.3. There is mild basal inferoseptal tardokinesis. There is small area of late gadolinium enhancement in the basal inferior myocardial wall involving the subendocardium. This pattern of late gadolinium enhancement is consistent with prior myocardial infarction and is likely not viable. The remainder of the myocardium is viable. 4. Mild biatrial enlargement.5. See extracardiac findings


Instruction: Generate impression based on medical findings.

Input: Asymmetric sensorineural hearing loss and tinnitus. The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable. There is an incompletely outpouching along the medial aspect of the right supraclinoid internal carotid artery that measures at least 5 mm in width. There an enhancing lesion in the left nasal cavity that measures up to 12 x 25 mm, adjacent to the left middle turbinate. There is relatively focal prominence of the median adenoids with intact striations, which likely represents hyperplasia.

Output: 1. No evidence of inner ear or retrocochlear lesions.2. An enhancing lesion in the left nasal cavity that appears intimately associated with the left middle turbinate, which may represent a neoplasm. Dedicated sinus imaging or endoscopic examination may be useful for further characterization.3. An incompletely imaged outpouching along the medial aspect of the right supraclinoid internal carotid artery that measures at least 5 mm in width likely represents an aneurysm. Dedicated vascular imaging can be performed for further evaluation. Discussed with Maureen Crowley at 4PM on 7/22/15.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Status post Omaaya placement. Signs and symptoms: Same Nonenhanced head CT:Interval placement of a right frontal Omaaya placement.The tip of the shunt catheter is in the dilated right frontal horn. Minimal expected post operative air in the ventricle and the subarachnoid space is present.There is no definitive decrease in the size of the ventricles since prior MRI exam.Extensive post operative changes of a left anterior temporal lobectomy and residual encephalomalacia is noted.

Output: 1. Expected pot op changes of right frontal ventricular catheter with the tip in the right frontal horn.2. No change in the size of dilated supra tentorial ventricles.3. Stable exam otherwise.


Instruction: Generate impression based on medical findings.

Input: Reason: signs of pseudotumor and pineal cyst. History: headaches. MRI: There is a cystic pineal gland that measures up to 10 mm. There is no evidence of intracranial hemorrhage 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 orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRV: There is no evidence of venous sinus thrombosis.

Output: 1. The cystic pineal gland measures up to 10 mm.2. No evidence of venous sinus thrombosis.


Instruction: Generate impression based on medical findings.

Input: Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position. Mild disc desiccation is seen at L2-3, L3-L4, L4-5 and L5-S1 levels. There is prominent epidural fat involving most on the lumbar levels resulting in developmental narrowing of the distal spinal cord. Multilevel degenerative changes are seen, as described below:L1-L2: There is mild ligamentum flavum thickening and left facet hypertrophy. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: There is ligamentum flavum thickening. No spinal canal or neural foraminal stenosis.L4-L5: There is mild disc bulging causing mild to moderate bilateral foraminal stenosis. There is ligamentum flavum hypertrophy. Moderate facet arthropathy is noted. No spinal canal stenosis.L5-S1: There is disc bulge with left more than right causing moderate left foraminal stenosis. There is bilateral facet hypertrophy. No spinal canal stenosis.Paraspinous soft tissues are within normal limits. Partly imaged rounded T2 bright lesion is seen in the upper medial cortex of the right kidney likely related to a cyst as seen on previous abdominal CT.

Output: 1. Mild to moderate multilevel degenerative disc disease predominantly affecting L5-S1 causing moderate left foraminal stenosis. Mild to moderate bilateral foraminal stenosis is seen at L4-L5 level.2. Prominent epidural lipomatosis without definite evidence of spinal canal stenosis.


Instruction: Generate impression based on medical findings.

Input: Bilateral lower extremity weakness since one week, upper extremity deltoid weakness, history of cancer The vertebral bodies are appropriate in the overall alignment and height. There is no evidence of cord compression or high-grade spinal canal stenosis in the cervical, thoracic, or lumbar spine.Degenerative changes are noted worst at the C4-C5 level with at least mild spinal canal stenosis at this level. Examination is inadequate to assess for cord signal abnormality at this level.There is subtle focal scalloping of the dorsal cord at the T3 level and focal anterior cord displacement. Mild degenerative changes are seen at multiple levels in the thoracolumbar spine. There is disk and endplate T2 hyperintensity at the T10-T11 level which is likely on a degenerative basis/Schmorl's node.

Output: 1. This is a limited exam specific for the exclusion of cord compression with additional axial T2 images of the upper thoracic cord. Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine. However, no cord compression or high grade spinal canal stenosis is identified.2. Dorsal scalloping of the thoracic cord at the T3 level and mild focal anterior displacement. Possibilities include arachnoid cyst versus transdural cord herniation. If patient has history of leptomeningeal disease, it is conceivable that this could be related to an adhesion. No cord signal abnormality is seen at this level. If clinically indicated, further evaluation of this area with myelogram can be considered. 3. Degenerative changes relatively worse at the C4-C5 level with at least mild spinal canal stenosis at this level related to disk osteophyte complex. Examination protocol is inadequate to assess for cord signal abnormality at this level.


Instruction: Generate impression based on medical findings.

Input: Male 56 years old Reason: Outside scan shows 4 cm lesion in left lobe near falciform ligament, 1 cm lesion near gallbladder History: HCV and ETOH cirrhosis ABDOMEN:LIVER, BILIARY TRACT: The liver has an advanced cirrhotic morphology with widened fissures and hypertrophy of the caudate. 1.1 cm hypervascular lesion in segment 5 of the liver on image 153/series 3 is stable. The lesion does not show washout on delayed imaging. However, the lesion shows abnormal signal characteristics on diffusion-weighted imaging.Within the left lateral segment of the liver there is a hypervascular lesion measuring 3.0 cm on image 154/series 13. This lesion also does not show washout. There is a prominent vessel within this lesion. Hepatic and portal veins are patent. Gallbladder contains multiple stones.SPLEEN: Spleen is enlargedPANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.1.1 cm segment 5 lesion which shows enhancement but no washout. It does not meet the criteria for HCC but remains suspicious.2.Left hepatic lobe lesion is hypervascular without washout. There is prominent vessel within the lesion and the lesion may be due to the shunt. This can be followed on subsequent imaging to evaluate for change.3.Cholelithiasis