Instruction: Generate impression based on medical findings.

Input: Hemangioma of skin and subcutaneous tissue [D18.01], Reason for Study: ^Reason: Evaluate for PHACE syndrome and possibly airway hemangioma in infant with segmental hemangioma of R face History: Hemangioma involving R lower lip, cheek, pre-auricular region and tragus Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion.There is no evidence of abnormal enhancement.Myelination degree is normal for the patient age. In particular, there is no evidence of posterior fossa brain abnormality.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries. Neck MRIThere are multifocal well-circumscribed multi compartmental lesion involving right parotid and right submandibular space as well as bilateral posterior triangles. The longest diameter of the lesion measured at the deep lobe of the right parotid gland which extends toward posterior aspect of the right medial pterygoid muscle is about 35mm and craniocaudal direction measurement is about 32mm.The lesions show T2 high signal intensity, T1 low or iso to adjacent muscle signal intensity with relatively homogeneous enhancement. Especially on T2 weighted images, some of compartments show fluid fluid level indicating internal blood products. Constellation of above findings indicate benign lesions such as such as muti-focal hemangiomas. Lymphangiomas and venous vascular malformations are differential diagnosis but less likely based on MR signal characteristics. Airway does not appear to be compromised and widely patent.

Output: 1. No evidence of intracranial abnormality, especially posterior fossa appears to be normal.2. Normal brain and neck MRA3. Multifocal hemangiomas involving right parotid space, right submandibular space as well as bilateral posterior triangles. Lymphangiomas and venous vascular malformations are differential diagnosis but less likely based on MR characteristics.4. No MR evidence of airway compromise due to the lesion.


Instruction: Generate impression based on medical findings.

Input: Traumatic brain injury, evaluate pituitary. Brain: There are numerous scattered foci of high T1 signal and susceptibility effect within the right inferior frontal, left basal ganglia, and left frontal, temporal, and insular lobes with associated vasogenic edema, as well as small areas of restricted diffusion in the left insular and basal ganglia. There is also edema in the left posterior corpus callosum, hypothalamus, left more than right, left thalamus, posterior limb of the right internal capsule, and midbrain. There are also scattered foci of susceptibility effect in the midbrain, pons, and right basal ganglia. There are small subdural hematomas along the bilateral cerebral convexities, measuring up to 3 mm in thickness. There is no midline shift or herniation. There is mild effacement of the left lateral ventricle. There is a mega cisterna magna. The major cerebral flow voids are intact. Mucosal thickening of the right maxillary sinus is noted. The orbits are grossly unremarkable. The multiple skull fractures are better depicted on the prior CT. There is a 10 mm thick left scalp hematoma and bilateral tympanomastoid fluid, with T1 hyperintense components suggestive of blood products.Pituitary: The pituitary gland is not enlarged and demonstrates an intact posterior bright spot and homogeneous enhancement. The infundibulum also appears to be intact.

Output: 1. Interval evolution of stigmata related to supratentorial and infratentorial diffuse axonal injury and hemorrhagic contusion with mild medialization of the left uncus. 2. Interval evolution of the small bilateral cerebral convexity subdural hemorrhages.3. Multiple skull fractures are better delineated on the prior CT.4. Edema related to traumatic brain injury is present within the hypothalamus, but the pituitary and infundibulum appear to be intact.


Instruction: Generate impression based on medical findings.

Input: Large left flank/sacral mass in girl with NF1. There is a partly imaged large mass in the left paraspinal region with a bag of worms appearance, which extends from the L1 level to the sacrococcygeal region. The tumor protrudes into the left L1-2 through S2-3 neural foramina, but does not enter the spinal canal. There is also an infiltrative mass with partial bag of worms appearance in the posterior lower back subcutaneous tissues that measures up to approximately 11.5 cm. There is scalloping of multiple lumbar and sacral vertebral bodies with widening of the spinal canal. There is exaggerated lumbar lordosis, but no spondylolisthesis. The imaged cauda equina nerve roots and spinal cord appear to be grossly unremarkable.

Output: 1. A partly imaged large mass in the left paraspinal region with a bag of worms appearance, which extends from the L1 level to the sacrococcygeal region likely represents a plexiform neurofibroma, although assessment is limited by the lack of contrast. The tumor protrudes into the left L1-2 through S2-3 neural foramina, but does not enter the spinal canal. Please refer to the separate pelvis MRI report for additional details.2. An infiltrative mass in the posterior lower back subcutaneous tissues that measures up to approximately 11.5 cm may represent a superficial neurofibroma combined with features of a plexiform neurofibroma.3. Multilevel posterior vertebral scalloping related to neurofibromatosis 1.


Instruction: Generate impression based on medical findings.

Input: 64 year old male with history of hypertension, diabetes and dyslipidemia presenting after troponin elevation during EGD study. MEDICATIONS: aspirin, simvastatin, nebivolol, losartan, hydrochlorothiazide First Pass PerfusionDuring hyperemia, no perfusion defects were present.Viability/ Myocardial ScarThere was no evidence of prior myocardial infarction. There is subtle diffuse uptake of late gadolinium enhancement involving much of the basal left ventricle but not the rest the ventricle. Similarly, the native T1 time at the left ventricular base is approximately 1200ms; where as, it is only 1100ms at the apex. The gadolinium kinetics based on the TI scout are unremarkable. There continues to be increased signal at the RV insertion points. Taken together, these findings suggest the presence of underlying myocardial fibrosis, inflammation, or infiltration. The diagnosis of early cardiac amyloidosis should be entertained. Left VentricleThe left ventricle is normal in size with mild left ventricular hypertrophy and low normal systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 84 ml/m2 (normal range: 74+/-15), the LVEDV is 185 ml (normal range 142+/-34), the LV end systolic volume index is 38 ml/m2 (normal range 25+/-9), the LVESV is 82 ml (normal range 47+/-19), the LV mass index is 49 g/m2, and the LV mass is 108 g. There are no regional wall motion abnormalities present.Left AtriumThe left atrium is moderately enlarged. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 67 ml/m2 (normal range 82+/-16), the RVEDV is 148 ml (normal range 142+/-31), the RV end systolic volume index is 34 ml/m2 (normal range 31+/-9), and the RVESV is 74 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is trace pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.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 mildly enlarged.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size with low normal systolic function and mild left ventricular hypertrophy (LVEF 55%). There is subtle diffuse uptake of late gadolinium enhancement involving much of the basal left ventricle but not the rest the ventricle. Similarly, the native T1 time at the left ventricular base is approximately 1200ms; where as, it is only 1100ms at the apex. Taken together, these findings suggest the presence of underlying myocardial fibrosis, inflammation, or infiltration. The diagnosis of early cardiac amyloidosis should be entertained. 4. Normal RV size and systolic function (RVEF 50%).5. Moderate left atrial dilation.6. Mild main pulmonary artery dilation. 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: Cervical spinal stenosis. C6 -- C7 stenosis. Left arm pain. CT of cervical spine without infusion:Sagittal reformatted images demonstrate moderate to advanced degenerative disk disease at C5 -- C6 and C6 -- C7 levels as well as hypertrophic and calcification of posterior longitudinal ligament and to a lesser degree degenerative changes of disks at the other levels.There is complete loss of cervical lordosis. There is straightening and minimal kyphotic deformity of the cervical spine centered at C4 -- C5 level. The bony density of the vertebral column is unremarkable with the exception of sclerotic changes related to disk disease.Foramen magnum.Examination at this level is unremarkable.C2 -- C3.Minimal degenerative disk disease is noted and otherwise unremarkable.C3 -- C4.Minimal degenerative disk disease and minimal hypertrophic changes of the articulating facets on the left. Hypertrophic changes at the level of the left uncovertebral is also present. Combination of a bald changes causes compromise of the left neuroforamina at this level.C4 -- C5.Calcification of posterior longitudinal ligament posterior to C4 is present. This causes indentation of thecal sac. There is mild hypertrophic changes of disks and posterior elements. Hypertrophic changes at the level of right uncovertebral causes compromise of right neural foramina. There is broad-based bulge of disk material which minimally flattens the ventral thecal sac. There is also suspected compromise of the left neural foramina secondary to degenerative changes.C5 -- C6.Heavy calcification of posterior longitudinal ligament which is in contact with the ventral aspect of the cord. Extensive hypertrophic changes of uncovertebral causes compromise of bilateral neural foramina. Bulge of disk material and ventral hypertrophic changes appear to do cause indentation of the ventral aspect of the cord and suspected central spinal stenosis.C6 -- C7.Advanced degenerative disk disease and extensive hypertrophic changes of uncovertebral bilaterally. Compromise of bilateral neural foramina. I suspect central spinal stenosis at this level however please reviewed dedicated report of MRI examination of cervical spine. C7 -- T1.Mild degenerative changes. No detectable central spinal stenosis or neural foramina compromise.limited view of upper thoracic spine to T4 level demonstrate normal degenerative changes and is otherwise unremarkable.

Output: Degenerative changes of disks, posterior elements, posterior longitudinal ligament as detailed above. Constellation of above findings results in multilevel neural frontal compromise and central spinal stenosis as detailed.


Instruction: Generate impression based on medical findings.

Input: T4N0 adenoid cystic carcinoma of minor salivary gland/maxillary sinus with intracranial extension. There has been interval partial left maxillectomy. Thre is diffuse mild left maxillary sinus mucosal thickening, with persistent patchy enhancement in the underlying left maxillary alveolus and retromaxillary region. There is also persistent perineural tumor extension involving the left infraorbital nerve, pterygopalatine fossa, Vidian canal, foramen rotundum, foramen ovale, and cavernous sinus, as well as along the cisternal segment of the left trigeminal nerve, but no evidence of intraparenchymal extension. There is also persistent enhancing tumor within the medial left extraconal orbit, which measures up to 6 mm in width. There is no discernible residual right pituitary tumor. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is no evidence of significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable.

Output: 1. Interval post-treatment findings in the left sinonasal region with persistent perineural tumor involving the left trigeminal nerve branches with intracranial extension, as well as persistent patchy enhancement in the underlying left maxillary alveolus and retromaxillary region. 2. Persistent left medial orbit extraconal tumor.3. No evidence of brain parenchymal metastases.


Instruction: Generate impression based on medical findings.

Input: History of colon cancer now with PET avid lesion in the liver. Evaluate metastatic disease. ABDOMEN:LIVER, BILIARY TRACT: Borderline hepatomegaly with the liver measuring 17 cm in length. There is diffuse hepatic parenchymal signal loss in the out of phase images compatible with hepatic steatosis. The extrahepatic portal vein is occluded and there is cavernous transformation of the portal venous system. The hepatic veins and hepatic arteries are patent.There is patchy minimally increased T2 signal in the right hepatic lobe at the site of increased FDG activity seen on prior PET. This is not associated with restricted diffusion. There is mildly heterogeneous postcontrast enhancement throughout the liver likely secondary to the altered hemodynamics from portal venous occlusion. No suspicious masslike enhancement.Status post cholecystectomy. Scattered areas of minimal intrahepatic biliary ductal dilatation including in the right hepatic lobe at the region of interest.SPLEEN: No significant abnormality noted.PANCREAS: Postsurgical changes related to prior Whipple procedure. Stable minimal prominence of the distal pancreatic duct.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Numerous bilateral simple cysts.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy. Unchanged mildly prominent mesenteric lymph node in the right upper quadrant.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Hepatic steatosis and borderline hepatomegaly. There is heterogeneous signal throughout the liver likely related to the altered hemodynamics from portal vein occlusion. No definite enhancing mass lesion to indicate metastatic disease.2.Stable mildly prominent right upper quadrant mesenteric lymph node.3.Postoperative changes from prior Whipple with stable mild prominence of the distal pancreatic duct.


Instruction: Generate impression based on medical findings.

Input: Radicular pain in the left upper extremity, left C5/6. History of surgery to cervical spine. Craniocervical junction is within normal limits. The vertebral body heights are preserved. The spinal cord displays normal signal and morphology. Bone marrow signal is benign. There is straightening of the cervical spinal curvature similar to prior and grade 1 anterolisthesis of C7 on T1 measuring 3 mm, which is unchanged. Again seen is anterior cervical spinal fusion at C6-C7 with intervertebral disc spacer and wide decompressive laminectomies at C3-C7. C6 screw fractures better seen on prior CT.Multilevel degenerative changes are again seen which are not significantly changed since 3/28/2015. There are endplate degenerative changes at C4-C5 with severe loss of disc space. There is also mild loss of disc height at C3-C4, moderate loss of disc height at C5-C6, and severe loss of disc height at C7-T1. There is also mild multilevel facet arthropathy. The paravertebral soft tissues are unremarkable. There is a 10 mm nodule in the left thyroid lobe similar to prior. No abnormal enhancement in the spine.Individual levels as below:C2-C3: Unchanged small left paracentral disc osteophyte complex and ligamentum flavum thickening with mild spinal canal stenosis. No neural foraminal stenosis.C3-C4: Status post laminectomy. Large left paracentral osteophyte contributing to mild flattening of the left ventral cord similar to prior. There is likely mild mass effect on the left-sided nerve root although more laterally the neural foramen is patent.C4-C5: Status post laminectomy. Disc osteophyte complex with left uncinate spur, contributing to mild left foraminal stenosis. No significant right foraminal stenosis. These findings are also similar to prior.C5-C6: Status post laminectomy. Small disc osteophyte complex. Minimal narrowing of the left neural foramen as before. Right neural foramen is patent. Findings are similar to prior.C6-C7: Status post laminectomy. Disc osteophyte complex with large central osteophyte, contributing to mild flattening of the ventral cord. There is mild to moderate left foraminal stenosis. Findings are similar to prior.C7-T1: Status post laminectomy. No significant spinal canal or right neural foraminal stenosis. Mild to moderate left neural foraminal stenosis similar to prior. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Multilevel degenerative changes in the cervical spine are again seen and not significantly changed since prior study from 3/28/2015. There is multilevel, mild or mild to moderate left-sided neural foraminal stenosis, as described above. There are also prominent left paracentral C3-C4 and central C6-C7 disc osteophyte complexes with mild impression on the ventral aspect of the cord. Spinal canal remains otherwise surgically well decompressed without evidence of high-grade stenosis at any level.


Instruction: Generate impression based on medical findings.

Input: Knee locking MENISCI: There is no evidence of a discrete meniscal tear.ARTICULAR CARTILAGE AND BONE: There is full-thickness articular cartilage loss of the medial compartment, particularly the femoral condyle. There is associated underlying degenerative marrow signal within the femoral condyle near the junction of the posterior horn and body.There is heterogeneity of the articular cartilage of the lateral compartment without fluid-filled partial or full-thickness defect.There is heterogeneity and fibrillation of the articular cartilage of the patellofemoral compartment particularly of the medial patellar facet and femoral trochlea centrally although there is no discrete full-thickness cleft.Tricompartmental osteophytes are evident, particularly along the medial tibial plateau. There is no evidence of discrete loose body.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Marked cartilage loss of the medial femoral compartment. The menisci are intact and there is no evidence of a discrete loose body.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old, with history of breast cancer. Baseline exam prior to starting on clinical trial. A 22 x 14 mm region of enhancing marrow replacement is evident within the right frontal bone. This correlates with an area of increased radiotracer uptake on prior bone scan. A lobular subcentimeter enhancing focus within the left parietal bone may simply represent a vascular space.Postcontrast images are degraded by motion artifact, but within this limitation, no definite pathologic parenchymal or extra-axial enhancement is seen. No evidence of active parenchymal edema is detected.Encephalomalacia is evident involving the right insula, basal ganglia and corona radiata with surrounding parenchymal T2 hyperintensity and mild associated susceptibility. Scattered additional foci of T2 hyperintensity are evident within the periventricular and subcortical white matter.No evidence of any acute intracranial hemorrhage is seen. No abnormal collections are detected. Ex vacuo dilatation of the right lateral ventricle is demonstrated. The ventricular system is otherwise within normal limits.

Output: 1.A lesion within the right frontal bone most likely represents a metastatic deposit, particularly given the nuclear medicine evidence for osseous metastatic disease elsewhere.2.Within the limitations of a motion degraded exam, no definite evidence of any parenchymal metastatic disease is seen.3.Chronic sequelae of right MCA distribution ischemia are demonstrated along with scattered lesions which likely reflect chronic microvascular ischemic disease.


Instruction: Generate impression based on medical findings.

Input: 45-year-old female recalled from screening mammography following identification of two new masses in the right breast, one at the 6:00 position, and the other at the 10:00 position. Six diagnostic mammograms of the right breast were performed including a standard ML view, spot compression MLO, ML and CC views as well as rolled medial and lateral CC views. Directed gray scale and color Doppler ultrasound was subsequently performed on the right breast.The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. The masses for which the patient was recalled appear as well-circumscribed oval masses at the 6:00 position and 10:00 position of the right breast. These are compatible with benign cysts as subsequently documented on ultrasound.Grayscale and color Doppler ultrasound identified two cysts as follows:1. A six o'clock periareolar 1.4 x 1.5 cm oval, circumscribed, anechoic cyst with posterior enhancement and no internal flow. This corresponds to the new mammographic finding. Incidentally, this cyst was seen on the prior MRI, and had completely benign features with no enhancement.2. A 10:00 periareolar 0.9 x 0.4 x 0.6 cm lobulated, circumscribed, anechoic cyst with posterior enhancement and no internal flow. The component lobulations measured 0.7 and 0.5 cm. These cysts correspond to the findings on the screening mammogram that triggered this exam.

Output: Simple cysts at the 10:00 and 6:00 positions of the right breast explain the findings on the recent screening mammogram that triggered this exam. No further evaluation is necessary. There is no mammographic evidence for malignancy. As long as the patient's physical examination remains normal, annual bilateral screening mammography is recommended.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram.


Instruction: Generate impression based on medical findings.

Input: History of rectal carcinoid tumor status post resection. Status post lower anterior resection. End to side coloanal anastomosis. 9/25/2014 pathology showed multifocal rectal wall differentiated neuroendocrine tumor. Family history of colon cancer. ABDOMEN:LIVER, BILIARY TRACT: Stable simple right hepatic lobe segment VIII cyst and segment 6/7 indeterminate focus. No focal suspicious lesion, biliary ductal dilatation or vascular abnormality. Normally distended gallbladder.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Right adnexal physiologic cyst. Small uterine fibroids. Nabothian cysts noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes from a lower anterior resection with side to end anastomosis appearing mildly thickened, but unchanged dating back to 4/13/2015. The appearance is unchanged from the prior study. No measurable residual or recurrent disease.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stable examination without evidence of residual or recurrent disease. Mild thickening/prominence at the side-to-end coloanal anastomosis without a focal lesion is unchanged dating back to 4/13/2015, correlate with colonoscopy findings.2.Stable indeterminate subcentimeter segment 6/7 lesion.


Instruction: Generate impression based on medical findings.

Input: 83 year old woman with history of hypertension, breast cancer and ALL s/p chemotherapy with worsening LVH and diastolic dysfunction on echocardiogram; referred for cardiac MRI to evaluate for possible amyloidosis or infiltrate cardiomyopathy. Left VentricleThe left ventricle is normal sized with mildly reduced systolic function. There is LVH; on the 3 chamber view at end diastole, the anterior septum measures 23 mm. The basal inferolateral wall measures 18 mm. The overall LV ejection fraction is 49%, the LV end diastolic volume index is 67 ml/m2 (normal range: 65+/-11), the LVEDV is 136 ml (normal range 109+/-23), the LV end systolic volume index is 34 ml/m2 (normal range 18+/-5), the LVESV is 70 ml (normal range 31+/-10), the LV mass index is 84 g/m2 (normal range 67+/-11), and the LV mass is 172 g (normal range 114+/-24). There is hypokinesis of the basal segments, with preserved apical wall motion. There are diffuse, mid myocardial areas of intermediate late gadolinium enhancement involving the septum, lateral, anterior and basal inferior walls. There is late gadolinium enhancement in the right ventricular wall, as well as left atrium and adjacent to the mitral apparatus. There is shortening of the T1 inversion time post gadolinium administration. These findings are suggestive of an infiltrative process, such as amyloidosis. No intracardiac thrombus is present.Left AtriumThe left atrium is moderately dilated.Right VentricleThe right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 37%, the RV end diastolic volume index is 65 ml/m2 (normal range 69+/-14), the RVEDV is 133 ml (normal range 110+/-24), the RV end systolic volume index is 41 ml/m2 (normal range 22+/-8), and the RVESV is 83 ml (normal range 35+/-13). Enhancement is demonstrated by the right ventricular wall in the mid myocardial distribution, atypical for infarct.Right AtriumThe right atrium is moderately severely dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is trivial mitral regurgitation, but the severity of mitral regurgitation can be underestimated by the MRI pulse sequence used in this study.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation, but the severity of tricuspid regurgitation can be underestimated by the MRI pulse sequence used in this study.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC is normal in size and drains normally into the right atrium. The IVC appears dilated.PericardiumThere is a small pericardial effusion.Extracardiac FindingsThere are bilateral pleural effusions, right greater than left. There is focal high signal within the left lower lobe, suggestive of aspiration. This is new since the radiograph of May 2015.

Output: 1. Impaired left ventricular systolic function with EF 49%, and relative hypokinesis of the basal segments. There is basal LVH. Diffuse mid myocardial enhancement throughout the left ventricle, right ventricular free wall and left atrium. Findings are compatible with cardiac amyloidosis.2. Reduced right ventricular systolic function with EF 37% 3. Biatrial dilatation. 4. Trivial mitral regurgitation and mild tricuspid regurgitation.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: 71-year-old male presents with right shoulder pain, evaluate for rotator cuff tear. ROTATOR CUFF: There is a complete tear of the subscapularis tendon from its insertion on the lesser tuberosity. Portions of the tendon are retracted to the level of the glenoid. The subscapularis muscle appears normal. There is generalized thinning of the supraspinatus tendon likely reflecting chronic attritional tearing, but no full-thickness tear is identified. The anterior fibers of the infraspinatus tendon likewise appears thin, but without a full-thickness tear. The supraspinatus and infraspinatus muscles appear normal. The teres minor muscle and tendon are normal.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. A small amount of fluid is noted within the subdeltoid bursa anteriorly.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a glenohumeral joint effusion with fluid concentrated anteriorly. Intermediate signal intensity within the superior labrum may reflect degeneration. There is also enlargement of the anterior inferior labrum which may reflect degeneration or prior trauma.BICEPS TENDON: The tendon of the long head of the biceps appears intact, although edema anterior to the tendon at its transition from the rotator interval to the intertubercular groove may indicate injury to the pulley.

Output: Complete tear of the subscapularis tendon and other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Female, 38 years old, with Chiari malformation status post decompression with pseudomeningocele and CSF leak, recently admitted for infection involving the ventricular shunt and pseudomeningocele, status post EVD placement and removal, status post pseudomeningocele/abscess drainage and repair. Evidence of Chiari decompression status post redo is seen including suboccipital craniectomy and resection of the posterior arch of C1. The cerebellar tonsils prolapse into the widened foramen magnum with some crowding of the dorsal CSF space. Ventrally, there seems to be adequate CSF patency. The brainstem demonstrates a somewhat kinked morphology appearing drawn towards or perhaps tethered to the dorsal dural surface of the neo-foramen magnum. On cine flow images, biphasic CSF flow is seen through the ventral foramen magnum, but there is no significant flow dorsally. A previously seen thin midline fluid collection at the craniectomy site has completely or nearly completely resolved leaving behind a band of solidly enhancing tissue which likely represents granulation tissue and scarring.A small cystlike area of encephalomalacia affecting the right genu of the corpus callosum and adjacent parenchyma is probably unchanged when compared to prior CT examinations. Diffusion restriction and susceptibility effect within this lesion may reflect the presence of aging blood product. Sequelae of prior right frontal approach ventriculostomy catheter placement are seen. There is T2 hyperintensity along the prior catheter tract which may reflect gliosis or mild residual edema. The ventricles are dilated, similar to that seen on recent prior CT examinations. T2 hyperintensity is seen in the periventricular tissues, particularly at the frontal horns and the occipital horns.Elsewhere, no diffusion restriction or focal parenchymal edema is observed. A few scattered small foci of parenchymal T2 hyperintensity are nonspecific. No evidence of acute intracranial hemorrhage is seen. No pathologic parenchymal or extra-axial enhancement is observed.

Output: 1.Postoperative findings are seen compatible with Chiari decompression status post redo. The dorsal CSF space at the neoforamen magnum remains crowded and there is no detectable CSF flow in this location. Ventrally, the CSF space seems to be adequately patent. The brainstem demonstrates a somewhat kinked morphology suggesting tethering or adhesion to the dorsal thecal sac.2.The previously demonstrated infected pseudomeningocele has been repaired. Little if any actual fluid remains, and the involved tissue demonstrates findings compatible with granulation and scarring.3.Parenchymal injury along the genu of the right corpus callosum is perhaps related to prior ventriculostomy placement and/or infection. Signal abnormally along the prior ventriculostomy tract may reflect gliosis or mild residual edema.4.The ventricles remain dilated but similar to recent prior CT's. T2 hyperintensity in the periventricular tissues at the frontal and occipital horns may indicate transependymal CSF flow or perhaps the sequelae of prior infection.


Instruction: Generate impression based on medical findings.

Input: CNS lymphoma; restaging scan following chemotherapy. There are left transfrontal post-biopsy findings, including intrinsic T1 hyperintensity and susceptibility effect related to chronic blood products. There are also patchy areas of enhancement in the left frontal lobe periventricular white matter region, posterior left corpus callosum, as well as in the left basal ganglia. There are also numerous scattered nonspecific punctate foci of T2 hyperintensity in the cerebral white matter. There is no evidence of acute intracranial hemorrhage or acute infarct. There is diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. Artifacts related to dental implants obscures portions of the face.

Output: 1. Periventricular areas of enhancement in the left frontal lobe and posterior corpus callosum, as well as in the left basal ganglia, are compatible with central nervous system lymphoma superimposed upon prior left transfrontal post-biopsy effects. 2. Numerous scattered nonspecific punctate foci of T2 hyperintensity in the cerebral white matter may represent chronic small vessel ischemic disease, for example.


Instruction: Generate impression based on medical findings.

Input: Male 72 years old Reason: 72-year-old male with PSC patient currently for HCC or cholangio, strictures, etc History: Ulcerative colitis with PSC ABDOMEN:LIVER, BILIARY TRACT: Stable to slight improvement in the biliary ductal dilatation. A percutaneous right hepatic biliary drain terminates within the jejunum. Status post hepaticojejunostomy. The common hepatic duct is not visualized. No suspicious hepatic lesion. The contrast bolus is suboptimal as portion of it was extravasated.SPLEEN: No significant abnormality noted.PANCREAS: Small T2 hyperintense focus in the uncinate process of the pancreas likely represent small side branch type IPMN.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Possible small cysts in both kidneys. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Multiple perihepatic and peripancreatic lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stable to slight decrease in intrahepatic biliary ductal dilatation.2.No suspicious hepatic lesions.Contrast extravasation description:Supervising radiologist: Stephanie McCannMinor or major extravasation: MinorContrast type:20 cc of MultiHance were administered. 20ccAmount extravasated: approximately 20 ccLocation of extravasation: Right antecubital fossaSigns and symptoms: Swelling and pain, peripheral pulses were intact as well as tract. No paresthesias.Treatment given: Warm packDischarge instructions given: Yes


Instruction: Generate impression based on medical findings.

Input: Patient is a 60-year-old female with recent biopsy proven left breast cancer who presents for ultrasound-guided biopsy of the additional lesion in the left breast. Upon review the mammogram from outside facility, there is a satellite lesion posterior to the index mass on the mammogram without a sonographic correlate. Repeat ultrasound of the left breast reidentified the index lesion with the clip at 12:00, 1 cm from the nipple. Subsequently, 1 cm lateral and inferomedial to the index mass, in the left breast, 1:00 location, 1 cm from the nipple, there is a 10 x 9 x 5 mm slightly hypoechoic irregular mass with increased flow, which likely corresponds to the posterior satellite lesion on the mammogram. In addition, in the left breast, 2:00 location, 1 cm from the nipple, there is a 6 mm lesion 6 mm inferior and lateral to the index mass and likely corresponding to the findings on the MRI 10/26/2015. These findings were reviewed with Dr. Jaskowiak in the reading room. The 2:00 satellite lesion would be targeted for biopsy and clip placed along the lateral/posterior aspect of the 2:00 mass, towards the 1:00 finding. PROCEDURE: The procedure and its risks, including bleeding, infection, and failure to diagnose, and expected benefits of ultrasound-guided core biopsy with percutaneous placement of a marking clip and post-procedure unilateral mammogram were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time-out form was completed to confirm patient identity and side/type of procedure.The left breast was cleansed with chlorhexidine over the target area. Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially, with 1% lidocaine with 1:100,000 epinephrine at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a inferolateral to superomedial approach, three 14-gauge core needle (Achieve) specimens were obtained of the lesion. Targeting was judged very good. Two specimens sank to the bottom of the prefilled container of 10% formalin. One specimen floated. The floating specimen was the initial core, towards the 1:00 lesion obtained with open trough technique. Subsequently, firing technique was needed to get through the patient's dense tissue and more accurately target the 2:00 finding. Both subsequent cores sank. Specimen quality was judged very good.Specimens were sent to Pathology with an accompanying history sheet. Using continuous ultrasound-guidance a Hydromark clip was placed near the 2:00 lesion, towards the 1:00 lesion. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. Post-procedure digital left CC and ML views revealed the percutaneously placed clip to be in the expected location. No evidence of hematoma or other complication.A pressure dressing was positioned over the biopsy site and an ice pack positioned over the pressure dressing. Post-procedure instructions were reviewed with the patient both verbally and in writing. She tolerated the procedure well with no evident complications and left the Breast Imaging Department in stable condition.The procedure was performed by Dr. Schacht. Dr. Schacht was present during the procedure at all times.

Output: Successful ultrasound-guided core biopsy of the left breast satellite lesion and clip placement. Pathology is pending at this time.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on medical findings.

Input: History of von Hippel-Lindau disease. Evaluate for renal, pancreatic or adrenal lesion mass. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology size and signal intensity without a focal suspicious lesion biliary ductal dilatation or vascular abnormality.SPLEEN: Normal splenic size without a focal lesion.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: T2 hyperintense lesion involving the lower thoracic spinal cord is better evaluated on the dedicated MRI of the spine, associated small focal enhancing nodularity suggested.

Output: 1.No suspicious lesion of the abdominopelvic visceral organs.2.Please see the separately dictated report of the dedicated MRI of the spine regarding a cystic thoracic spinal cord lesion, suspicious for hemangioblastoma given the clinical history of von Hippel-Lindau syndrome.


Instruction: Generate impression based on medical findings.

Input: Again seen is is atrophy of the left caudate with volume loss of the left thalamus and in the region of the left corona radiata, internal capsule and centrum semiovale. Left cerebral peduncle is smaller compared to the right slight with asymmetric atrophy of the left pons and left medulla, related to Wallerian degeneration. There is ex vacuo dilatation of the left lateral ventricle. FLAIR hyperintensity is demonstrated along the edges of the dilated left lateral ventricle, likely related to gliosis. The lateral wall of the left lateral ventricle is irregular. There is prominence of the rest of the ventricular system with the exception of the fourth ventricle. Blood degradation products better demonstrated previously along the left caudothalamic groove and lateral ventricular margin.Corpus callosum is thinned, but fully formed. There is normal myelination. Flow-voids are seen from major intracranial vascular structures.Dedicated images of the pituitary gland demonstrate absence of the normal T1 hyperintensity associated with the neurohypophysis. Visualized pituitary gland is otherwise within normal limits for age with homogeneous enhancement. No evidence of micro-or macroadenoma. Visualized optic apparatus is unremarkable. Septum pellucidum is present.

Output: 1. Compared to 2/25/2014, no significant change in atrophy in the left basal ganglia and left frontal lobe with ex vacuo dilatation of the left lateral ventricle. Findings are consistent with remote history of grade IV IVH.2. Absence of the T1 hyperintensity of the neurohypophysis (which was present on remote MRI studies from 2012), finding which can be seen in patients with central diabetes insipidus. MR appearance of the hypothalamus, infundibulum and pituitary gland is otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Benign neoplasm of meninges, unspecifiedClinical question: change in meningiomaSigns and Symptoms: multiple unrelated There is redemonstration of a calcified focus present along the falx cerebri on the right side it is low signal on all pulse sequences and has susceptibility effect associated with it.There are several periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Exam is mildly degraded due to patient motion which may obscure more subtle abnormalities.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 some scattered opacities in the maxillary sinuses which were also present on the prior exam.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.A right parafalcine lesion is calcified. It could represent a branch out meningioma for example. It is unchanged since previous exams2.Exam is mildly degraded due to patient motion which may obscure more subtle abnormalities.3.Periventricular and subcortical white matter signal changes of a mild degree are present. Given the small number, it is suspected that these are of little clinical significance.


Instruction: Generate impression based on medical findings.

Input: No diffusion-weighted abnormalities are identified. No evidence of intracranial hemorrhage. There are no masses, mass effect or midline shift. The ventricles and sulci are normal in size. There are no extraaxial fluid collections. The cerebellar tonsils are in normal position. The pituitary gland is normal in size. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are unremarkable. The orbits are intact. There is no abnormal enhancement within the brain. Focal left occipital calvarial T1 and T2 hyperintensity that is nonenhancing, likely representing focal fat deposit.

Output: No evidence of intracranial metastasis.


Instruction: Generate impression based on medical findings.

Input: Reason: staging exam History: new prostate cancer PELVIS:PROSTATE:Prostate Size: 5.0 x 4.0 x 4.5 cmPeripheral Zone: There is hemorrhage in the left base peripheral zone and right mid gland and apex peripheral zone. In the nonhemorrhagic regions, there is a large area of low T2/ADC signal with early enhancement extending throughout the right base, mid gland and apex. In the right mid gland, this lesion measures 3.1 x 2.3 cm (401/10).Central Gland: BPH nodules.Seminal Vesicles: Large right-sided lesion abuts the seminal vesicles.Extracapsular Extension: There is irregularity of the capsule in the right mid gland (401/9), likely representing extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: Small right external iliac node measuring 11 x 8 mm (1301/90). Small pelvic sidewall node measures 1.0 x 0.9 cm (1301/90).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Fat-containing inguinal hernias.

Output: 1.Large right-sided lesion throughout the base, mid gland and apex is suspicious for prostatic adenocarcinoma with findings suggesting extracapsular extension.2.Mildly enlarged pelvic lymph nodes are suspicious for nodal metastases.


Instruction: Generate impression based on medical findings.

Input: 51 year old female with a personal history of right breast lumpectomy for invasive ductal carcinoma with DCIS in 2009 followed by chemotherapy and radiation therapy. She also has a personal history of Hodgkin's lymphoma, right breast reconstruction and left breast lift in 2012. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No suspicious enhancement is seen in either breast. Post-operative changes in the right lumpectomy bed are stable. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on medical findings.

Input: New onset headache and dizziness. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is confluent periventricular white matter T2 hyperintensity and a few scattered deep white matter T2 hyperintensity foci. There is no abnormal intracranial enhancement. There is perhaps mild diffuse cerebral volume loss. There is a mega cisterna magna. 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 are scattered paranasal sinus small retentions cysts, including adjacent to the left nasolacrimal duct.

Output: Perhaps mild diffuse cerebral volume loss and nonspecific areas of cerebral white matter signal abnormality may represent chronic small vessel ischemic disease, for example. Otherwise, no evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on medical findings.

Input: 88 years Female (DOB:12/6/1927)Reason: stroke History: Left MCA syndromePROVIDER/ATTENDING NAME: KEEGAN CHECKETT AGNIESZKA ANNA ARDELT MRI of the brainThere is a focus of diffusion restriction involving the right SCA territory measuring 40x28mm axial dimensions. There is a focus of diffusion restriction involving the left thalamus measuring 18x12mm axial dimensions. The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses demonstrate mild mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is occlusion of a short segment of the basilar artery distal to AICA origin which does not involve the top of the basilar artery. The right PCOMA is medium sized and supplies the top of the basilar artery. There is occlusion of the right SCA and the left PCA. There is narrowing of the distal right RVA at the VB junction.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.

Output: 1.Acute infarctions involving the right SCA territory and the left thalamus. The brainstem is not involved.2.Occlusion of the distal basilar artery, the right SCA and the left PCA. The top of the basilar artery is supplied by the right PCOMA.3. Findings were discussed with Dr Ardelt at the time of the exam.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: 54-year-old male with pain in the left knee. Evaluate medial meniscus. MENISCI: There is a small amount of increased internal signal within the posterior horn of the medial meniscus which does not extend to the articular surface and therefore is not a tear. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is increased T2 signal within the tibia involving both the medial and lateral tibial epiphysis which extends distally into the metaphysis. The increased signal does not extend to the cortical margin and is somewhat serpentine in contour and likely represents an unusual appearance of bone infarction. There is a small anterior osteophyte within the medial compartment. The patellar cartilage is intact. There is no significant thinning of the remaining intra-articular cartilage.LIGAMENTS: The collateral and cruciate ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. Increased signal within the medial and lateral tibia which is somewhat serpentine in contour and likely represents an unusual appearance of bone infarction. 2. No evidence of meniscal or ligamentous injury.


Instruction: Generate impression based on medical findings.

Input: 72-year-old patient with left breast cancer status post neoadjuvant treatment chemotherapy with MRI showing some response, status post seed localization to help guide surgery. Patient status post surgery. Orthogonal digital specimen radiographs revealed the mass, localization seed, and clip to be within the specimen. Dense breast tissue as well as calcifications are noted at the periphery of the specimen, specifically posteriorly. The breast surgeon will excise additional tissue posteriorly; this additional excised tissue will not be imaged.

Output: Mass, localization seed, and clip within the specimen as above. The breast surgeon will excise additional tissue posteriorly; this additional excised tissue will not be imaged.


Instruction: Generate impression based on medical findings.

Input: 85 year old patient with left pontine infarct in bilateral cerebellar lesions please evaluate patient has right hemiparesis and gaze deviation to the rightTechnique: Contiguous axial images of the brain. Subsequently high resolution contiguous axial images were obtained through the lower half of the head and neck and aortic arch during bolus injection of intravenous contrast.The patient was brought back to the CT area later on the date of the exam for repetition of the exam due to poor timing of the initial contrast bolus. On the noncontrast head CT a hypodense focus corresponding to the MRI abnormality along the left cerebellar hemisphere measuring 25 x 15 mm axial dimensions is present and not clearly evident on the prior exam. Hypodense foci in the lower mid brain and upper pons predominant involving the left upper pons and lower midbrain were also not readily identified on the prior exam. There are punctate lesions present along the right posterior inferior cerebellar artery territory and to a lesser degree left posterior inferior cerebellar artery territory.There is opacification of both distal vertebral arteries along their cervical segments. The right vertebral artery is somewhat smaller than the left intracranially and along the cervical segment. The right posterior inferior cerebellar artery does display contrast enhancement as does the left, however, the right vertebral artery does not opacify distal to the posterior inferior cerebellar artery suggesting that it is likely either highly stenotic or occluded. The basilar artery, therefore fills from the left vertebral artery. There are some mural calcifications associated with luminal narrowing as the left vertebral artery enters the subarachnoid space. The left anterior inferior cerebellar artery is larger than its right counterpart. The basilar artery is highly attenuated distal to the AICA origins and suspected to be occluded below the level of the superior cerebellar arteries. The posterior communicating arteries are of similar in size to the P2 segments. The P1 segments are asymmetric right larger than left. The right P1 segment is about the same size as the posterior communicating artery on the right side the left one is smaller than the left P2 segment. It is and therefore considered that the superior cerebellar arteries fill from the anterior circulation as do the posterior cerebral arteries in this patient.There are atherosclerotic calcifications along the distal internal carotid arteries bilaterally. No significant stenosis is appreciated along the anterior or posterior cerebral arteries. The anterior communicating artery is identified and is relatively small compared to the A1 segments which are approximately equal in size. There are atherosclerotic calcifications present along the carotid bifurcations however on the basis of NASCETcriteria no significant stenosis is present along the carotid bifurcations. There is some mild narrowing of the left internal card artery just distal to its origin but approximately a 40%.The left vertebral artery is significantly narrowed at its origin with approximately an 80% stenosis along its cervical segment there are foci of narrowing along the mid cervical vertebral artery with approximately 60% stenosis at the C4-5 disk space level. View right vertebral artery is small and intracranially essentially only supplies the right posterior inferior cerebellar artery which is otherwise disconnected. There is some mild prominent muscular branch is present along the the tube in segment collateralization to the left occipital artery is unknown basis of this exam.The patient is intubated both endotracheally and nasogastric.Some atherosclerotic calcifications are present along the aorta and some of the branches. There is atherosclerotic in narrowing of the innominate artery by approximately 75%. There are degenerative changes present along the cervical spine at C6-7 with left sided neural foraminal narrowing, and c3-4 with right sided neural foraminal narrowing.

Output: 1.Subacute foci of infarction in the left cerebellar hemisphere more than the right as well is within the upper pons and lower midbrain left worse than right. No evidence for hemorrhagic conversion2.Occlusion or near occlusion of the right vertebral artery distal to the origin of the posterior inferior cerebellar artery.3.High-grade stenosis at the origin of the left vertebral artery with a tandem lesion along the mid cervical segment of the left vertebral artery and atherosclerotic in narrowing of the left internal artery as it enters the subarachnoid space. 4.There is occlusion or near occlusion of the basilar artery between the anterior inferior cerebellar artery and the superior cerebellar artery origins.5.The posterior communicating arteries are fairly large as described above. The anterior circulation appears to be the dominant supply for the posterior cerebral arteries as well is the superior cerebellar arteries. 6.High-grade stenosis (approximately 75%) of the innominate artery due to atherosclerotic narrowing7.Mild narrowing at the left internal carotid artery origin as described above. no significant stenosis at the carotid bifurcations on the basiss of NASCET criteria.8.If clinically appropriate, a more detailed assessment of the supply to the posterior circulation may be provided via conventional angiography to confirm or exclude complete occlusion of right vertebral artery and basilar artery and to provide a more accurate description of the percent of stenoses described above, assess circulation time and to identify any collateralization from the external circulation to the intracranial circulation - which cannot be identified on this exam.9.Degenerative changes are present in the cervical spine as indicacated above. Please correlate with clinical symptoms.


Instruction: Generate impression based on medical findings.

Input: Multiple sclerosis: paresthesias. Brain: There are multiple, greater than 20, T2 hyperintense lesions within the cerebral white matter, in a periventricular, deep, and juxtacortical distribution. Many of the lesions are also T1 hypointense. There is no evidence of infratentorial lesions. There is no evidence of intracranial hemorrhage, mass, or acute infarct. 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.Spine: The spinal cord displays normal signal and morphology. 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 a trace posterior disc-osteophyte complex at C6-7, but there is no significant spinal canal stenosis in the cervical or thoracic spine. The paravertebral soft tissues are unremarkable.

Output: 1. Multiple demyelinating lesions in the brain do not appear to be significantly changed, accounting for differences in technique. 2. No evidence of demyelinating lesions in the spinal cord.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Other convulsionsClinical question: First time focal seizureSigns and Symptoms: focal seizureComments: Seizure 2 protocol | The CSF spaces are appropriate for the patient's stated age with no midline shift. There is mild pneumatization of the internal capsule as well as corpus callosum on the T1-weighted imaging. This is appropriate for 6 months age. Frontal lobe and temporal lobe subcortical white matter is not yet myelinated.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.

Output: Myelination appears to be age-appropriate. There is no intracranial mass lesion that would account for the patient's seizures.


Instruction: Generate impression based on medical findings.

Input: The vertebral column alignment is within normal limits. The vertebral body heights are preserved. There is a mild degree of degenerative bone marrow signal alteration at the endplates of T11-T12, T12-L1, L4-L5, and L5-S1. The vertebral bone marrow signal is otherwise unremarkable. The distal spinal cord and conus medullaris display normal signal and morphology. The paravertebral soft tissues are unremarkable, aside from dependent edema. There is prominence of the epidural fat throughout the lumbar spine.L1-L2, L2-L3, and L3-L4: There are mild disc bulged, bilateral facet arthropathy, and ligament flavum thickening, without significant spinal canal or neural foraminal stenosis.L4-L5: There is a moderate disc bulge, bilateral facet arthropathy, and ligamentum flavum thickening. There is resultant mild spinal canal stenosis and moderate to severe neural foraminal narrowing bilaterally. There appears to be mild impingement on the exiting L4 nerve roots.L5-S1: There is a mild disc bulge, bilateral facet arthropathy and ligamentum flavum thickening. There is resultant mild spinal canal and moderate bilateral neural foraminal stenosis.There is marked left hydronephrosis and atrophy of bilateral kidneys.

Output: 1. Multilevel lumbar spondylosis, which is most pronounced at L4-L5, with resultant mild spinal canal and moderate to severe bilateral neural foraminal stenosis with impingement of bilateral exiting nerve roots.2. Epidural lipomatosis, which contributes to spinal canal narrowing, particularly int he lower lumbar and sacral regions.3. Marked left hydronephrosis and atrophy of bilateral kidneys.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: 55-year-old male with history of renal cell carcinoma with back and leg pain, evaluate for metastases. Recent tumor resection and orthopedic fixation There is been an interval laminectomy of L1 through L4 and posterior fusion of L1 through L5 with posterior stabilization rods, bilateral screws entering the pedicles of L5, L2 and L1 and right-sided screws entering L3 and L4. Artifact limits the evaluation of these levels. There is edema in the paraspinal and posterior soft tissues. Alignment is anatomic. There is subtle nonenhancing soft T1 hypoattenuation along the left posterior aspect of the L3 and L4 vertebral bodies which may represent edema or residual tumor. Vertebral body heights are intact. Mild multilevel disk desiccation. Signal within the distal cord and conus is normal. L1-L2: No central or neuroforaminal stenosis.L2-L3 No central or neuroforaminal stenosis.L3-L4: No central or neuroforaminal stenosis.L4-L5: No central or neuroforaminal stenosis.L5-S1: Mild diffuse disk bulge. No central or neuroforaminal stenosis.Large heterogeneous enhancing left renal mass is partially visualized.

Output: 1.Postsurgical changes tumor resection and posterior spinal fusion.2.Subtle T1 hypoattenuation along the posterior aspects of the L3 and L4 vertebral bodies may represent residual tumor or edema.


Instruction: Generate impression based on medical findings.

Input: NF-2, bilateral vestibular schwannomas who presents with acute on chronic gait worsening with extramedullary lesions observed on MRI causing thoracic spinal cord compression, status post thoracic spinal cord lesion removal. There are interval postoperative findings related to resection of an intradural extramedullary meningioma at the T4 level via bilateral T3, T4, and T5 laminectomy. There is fluid within the paraspinal space and epidural space along the surgical approach with associated narrowing of the thecal sac, such that there is minimal cerebrospinal fluid surrounding the spinal cord at the T3 though T5 levels. However, there is no measurable residual meningioma at this level. There are otherwise unchanged multiple enhancing tumors within the spinal canal, including an intradural extramedullary tumor that measures 5 mm in thickness within the left anterolateral aspect of the spinal canal at C4 and numerous subcentimeter nodules along the conus and nerve roots of the cauda equina. There are also multiple unchanged enhancing lesions within the cervical and upper thoracic spinal cord. The previously demonstrated bilateral internal auditory canal lesions are only partially-imaged. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable.

Output: 1. Interval postoperative findings related to resection of an intradural extramedullary meningioma at the T4 level via bilateral T3, T4, and T5 laminectomy. There is fluid within the paraspinal space and epidural space along the surgical approach with associated narrowing of the thecal sac, such that there is minimal cerebrospinal fluid surrounding the spinal cord at the T3 though T5 levels. However, there is no measurable residual meningioma at this level. 2. An intradural extramedullary tumor that measures 5 mm in thickness within the left anterolateral aspect of the spinal canal at C4 likely represents a meningioma.3. Numerous subcentimeter nodules along the conus and nerve roots of the cauda equina likely represent peripheral nerve sheath tumors. 4. Multiple lesions within the cervical and upper thoracic spinal cord likely represent ependymomas.5. The previously demonstrated bilateral internal auditory canal lesions are only partially-imaged.


Instruction: Generate impression based on medical findings.

Input: Neoplasm of unspecified behavior of brain [D49.6] / Benign neoplasm of pituitary gland [D35.2], Reason for Study: ^Reason: pituitary adenoma, 6 month follow up eval for changes History: 6 month follow up No evidence of acute ischemic or hemorrhagic lesion.There are pituitary macroadenoma sized about 32.3mm x 40.3mm on sagittal post contrast scan, unchanged since prior scan. The MR characteristics do not show any interval change either.Right frontal craniotomy is again seen with underlying encephalomalacia unchanged. Multiple meningiomas including tentorial based left occipital location, right frontal convexity, left anterior sylvian fissure area, and anterosuperior aspect of the falx, do not show any interval change in terms of size, configuration and MR characteristics since prior scan. The ventricles, sulci and cisterns are symmetric and unremarkable. 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.Pituitary Gland MRIPost transsphenoid surgery status.There is a large pituitary gland mass which does not show any interval change in terms of size, configuration and MR characteristics since prior scan.In particular, there is no change regarding suprasellar and bilateral cavernous sinus extensions since prior scan.There is no midline shift or herniation.The suprasellar cistern, optic chiasm, hypothalamus, and cavernous sinuses are unremarkable. Slightly diminutive optic chiasm and bilateral optic nerves indicating atrophic changes are again seen, unchanged.

Output: 1. Post right frontal craniotomy and post transspehnoidal surgery status.2. No change of multiple meningiomas and pituitary macroadenoma since piror scan.3. Slightly atrophic both optic chiasm and bilateral optic nerves, unchanged.


Instruction: Generate impression based on medical findings.

Input: A patient submitted outside study for review. There are two biopsy proven IDC (12:30 position and 1:00 position) in the left breast. Submitted for review are breast MRI (8/16/16) performed at outside institution. For comparison, digital mammographic images (6/14/16), ultrasound images of left breast (7/8/16), images from ultrasound guided biopsy of left breast and postprocedural left mammographic images (8/2/16) are available. Breast MRI was performed with a protocol outlined in the outside radiology report.There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.LEFT BREAST:There are two marker clips in the left breast from recent biopsy at 12:30 position and 1:00 position (12:30 clip is superior to 1:00 clip). Inferior to the 1:00 clip, there is a 17 mm hematoma. On the post-contrast images, there is an enhancing mass measuring 8 x 9 x 8 mm (AP x LR x CC) at immediately anterior to the 12:30 clip, and another enhancing mass around the 1:00 clip, measuring 9 x 10 x 6 mm, located just superior to the hematoma. Both correspond to the proven carcinoma. Overall measurement of these two masses is 15 x 15 x 24 mm.In addition, there is a linear non-mass enhancement extending anteriorly from the masses, measuring 30 x 12 x 12 mm. Overall AP measurement of the masses and the non-mass enhancement is 43 mm.RIGHT BREAST:No abnormal enhancement is seen in right breast. AXILLAE:No abnormal lymph nodes are identified in either axillary region.

Output: 1. Two proven carcinoma with clip associated with hematoma at 12:30 - 1:00 position in the left breast. Suspicious non-mass enhancement extending anteriorly from the proven cancer. MR guided biopsy of the non-mass enhancement should be considered if breast conservation surgery is planned.2. No abnormal enhancement in right breast. 3. No abnormal lymph nodes are identified in either axillary region.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.


Instruction: Generate impression based on medical findings.

Input: Status post Chiari decompression on 3/10. Postop follow-up. There are postoperative changes of suboccipital craniectomy and C1 laminectomy with interval increase in CSF spaces in the posterior fossa. Posterior fossa is well decompressed. There is good biphasic CSF flow ventrally and dorsally at the foramen magnum.The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is benign with T1 hyperintense lesion involving the left aspect of the C7 vertebral body compatible with a small hemangioma. Examination is motion degraded, however, no obvious cord signal abnormality or evidence of syrinx is appreciated. There is T2 hyperintensity in the pons which was present on prior brain MRI and may be related to small vessel ischemic disease.Mild degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: No significant compromise to the spinal canal or neural foramina.C6-7: Left paracentral disc extrusion with mild craniocaudal extension and associated mild stenosis involving the left aspect of the spinal canal. There is also mild left neural foraminal stenosis. Right neural foramen is patent. Prior imaging demonstrates minimal disc bulge at this level.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Expected postoperative changes of Chiari decompression. Posterior fossa structures are well decompressed with good biphasic CSF flow ventrally and dorsally at the foramen magnum. No appreciable cord signal abnormality or syrinx within the limits of a motion degraded study.2. Mild degenerative changes in the cervical spine including left paracentral disc extrusion at C6-C7 which is new since prior study from 9/29/2015.


Instruction: Generate impression based on medical findings.

Input: Possible AC joint separation ROTATOR CUFF: No significant abnormality noted.AC JOINT: There are multiple erosions and subchondral cysts at the acromioclavicular joint, predominantly along the articular surface, which are accentuated by the addition of intra-articular contrast. No fracture or malalignment is present. No specific features of infection are evident.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Multiple erosions and subchondral cysts at the acromioclavicular joint which are non-specific in appearance though possibly a combination of degenerative and post-traumatic. Weight lifting may produce similar changes. An inflammatory arthropathy can also be considered and correlation with imaging of additional joints may be helpful.


Instruction: Generate impression based on medical findings.

Input: Neurofibromatosis, type 1 (von Recklinghausen's disease). Please assess the margins of diffuse neurofibroma of occiput and upper neck which has grown significantly in past year. The extensive, infiltrative skin/subcutaneous mass involving the posterior aspect of the head/upper neck has not significantly changed in overall size though this is difficult to quantify. It is slightly smaller along its superior aspect (history of resection in 2015) while it has become slightly thicker and more nodular in the right retroauricular region. An underlying soft tissue nodule in the left suboccipital region has grown and now measures 13 mm in diameter (compared to 5 mm previously). This may represent a reactive lymph node but may also represent a localized neurofibroma. The underlying skull is intact.The brain shows no abnormality. The CSF-containing spaces, including the ventricles, are normal in size.The orbits are normal. Minimal mucosal thickening is present in the left maxillary and ethmoid sinuses without fluid, most likely of no significance. Mastoid air cells are clear.

Output: A large, diffuse neurofibroma involving the back of the hand and the upper neck has slightly grown in the right retroauricular region since 2007. There is no involvement of the underlying skull.


Instruction: Generate impression based on medical findings.

Input: 36-year-old male with history of Crohn's disease presents with fevers, chills, pain; evaluate for abscess. Status post recent fistula repair (on 2/5/2010) with abdominal pain. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Stable hypodense lesions within the liver.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Marked thickening of the terminal ileum and multiple loops of bowel appearing have resolved since the prior exam. The ileosigmoid fistula seen on the prior exam has been resected. There are post-op changes in the right lower quadrant from recent endocsopic procedure. Small amount of intraperitoneal fluid and subcutaneous / intraperitoneal gas are attributed to post-op changes. Contrast is present in the terminal ileum, but not the sigmoid, suggesting that the fistula has been repaired. BONES, SOFT TISSUES: No significant abnormality notedOTHER: New fluid collections with gas bubbles in the rectus muscles near the midline bilaterally, seen best on axial image 93/163 of series 12 and coronal image 67 have enhancing rims, compatible with abscess. These are new since the prior exam. PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Prominent bladder.LYMPH NODES: Borderline enlarged inguinal nodes. No other significant abnormality.BOWEL, MESENTERY: Rectal intramural fistula tract extending to the scrotum is reidentified and is subtle; however, this is incompletely evaluated by CT and may be better seen with MRI, if indicated.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1. Ileitis with narrowing of the terminal ileum and fistula between the ileum and the sigmoid colon have resolved since the prior exam. 2. A rectal intramural fistula to the scrotum is less prominent on this exam; however, it is incompletely evaluated on CT and MRI is recommended, if indicated.3. New abscess in the rectal sheath bilaterally.


Instruction: Generate impression based on medical findings.

Input: 5-day-old male with history of perinatal acidosis. Evaluate for parenchymal injury. Per chart, patient is an ex 37 2/7 weeks gestational age male born to a 34 year old G4P2012 mother with hypertension, superimposed pre-eclampsia, GDMA1, +HSV but no active lesions. Delivery complicated by non reassuring fetal heart tones and perinatal acidosis prompting hypothermic cooling protocol. Patient is s/p hypothermia cooling protocol and 72 hour EEG, with epileptiform discharges but no clinical or electrographic seizures. Images are limited by patient motion. There is no restricted diffusion on DWI sequences.Normal linear T1 hyperintense and T2 hypointense signal in the the posterior third of the posterior limb of the internal capsules is not optimally visualized bilaterally. The ventral lateral nuclei of the thalamus are well visualized bilaterally. There is no intraparenchymal hemorrhage or mass lesion. There is no extraaxial collection.The CSF spaces are within normal limits. There is an incidental cavum septum pellucidum et vergae. There is no mass effect or midline shift. Midline structures appear intact.There is a T2 hyperintense and T1 hypointense caput succedaneum along the central vertex, slightly greater to the right of midline, measuring up to 8 mm.

Output: Motion limited exam. Poor visualization of normal expected signal associated with myelination in the posterior limb of the internal capsule, concerning for mild hypoxic ischemic injury as described above. Clinical correlation is recommended. No acute infarct.


Instruction: Generate impression based on medical findings.

Input: Intra-articular contrast is identified extending into the distal radioulnar joint indicating a tear of the triangular fibrocartilage complex. No contrast is identified traversing the scapholunate or lunotriquetral ligaments or within the midcarpal joint to suggest a tear. Please refer to the subsequent MRI report for further information.Exposure time: 2 minutes and 20 seconds.

Output: Fluoroscopic guided injection of dilute gadolinium into the radiocarpal joint for subsequent MRI arthrogram examination with findings indicating tear of the triangular fibrocartilage complex. Please refer to the subsequent MRI report for additional details.


Instruction: Generate impression based on medical findings.

Input: Reason: please evaluate for possible soft tissue abscess located in post hip s/p revision left THA History: post hip mass with pain ARTICULAR CARTILAGE AND BONE: Metallic susceptibility artifact from the patient's left total hip arthroplasty device limits evaluation of the surrounding soft tissues of the left hip. No bone marrow signal abnormality is identified.SOFT TISSUES: Evaluation for abscess formation is limited on this noncontrast examination. Within this limitation, there is an encapsulated collection demonstrating fluid signal intensity within the subcutaneous tissues along the posterior and superior aspect of the inferior gluteal crease, measuring approximately 5.3 x 2.1 x 5.4 cm, likely representing abscess formation (image 37; series 4). Additionally, there is a moderate amount of fluid surrounding the superior and lateral aspect of the femoral component of the total hip arthroplasty device indicating an effusion. While this may be related to the patient's stated history of recent arthroplasty revision, superimposed infection cannot be excluded and clinical correlation is indicated.ADDITIONAL

Output: 1. Moderate-sized joint effusion particularly about the superolateral aspect of the femoral component. While this may be postsurgical in etiology, superimposed infection cannot be excluded and clinical correlation is indicated.2. 5.4 cm encapsulated fluid collection along the superior aspect of the inferior gluteal crease, on the right, likely representing abscess formation, within the limitations of this noncontrast examination. Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: 50 year-old female with pancreatic cancer on chemotherapy (gemcitabine). Additional history reveals patient is status post Whipple and radiation treatment. Please evaluate disease status. CHEST:LUNGS AND PLEURA: Bilateral pleural effusions with compressive atelectasis. Mild emphysema. No lung nodules identified.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Right-sided Port-A-Cath tip is in the SVC. No evidence of osseous metastatic disease. Bilateral thyroid nodules.ABDOMEN:LIVER, BILIARY TRACT: The liver is diffusely low-attenuation, due to fatty infiltration. In the posterior inferior right lobe of the liver the hypervascular lesion is grossly stable in size, measuring 2.4 x 1.9 cm (image 94/11 of series 4). This avid enhancement is unusual for a adenocarcinoma metastasis to the liver; however, enhancement on this study may appear exaggerated given the degree of fatty infiltration. The adjacent lesion in the lateral aspect of the liver is also grossly stable in size, currently measuring 1.1 x 0.8 cm (image 96/211 of series 4). This hypodense lesion in the left lobe liver near the falciform ligament is unchanged and had characteristics of a simple cyst on the patient's recent MRI. Attenuation differences within the liver elsewhere are likely due to transient differences due to phase of enhancement.There is a subcapsular fluid collection anterior to the right lobe of the liver. This measures 4.0 x 1.9 cm (image 68/211 series number 4).Extensive postsurgical changes are identified in the porta hepatis. There is fluid attenuation throughout the porta hepatis which may be postsurgical in etiology. Extrahepatic portal vein occlusion noted. Numerous varices are identified throughout the abdomen.SPLEEN: Stable mild splenomegaly. The splenic vein appears to drain inferiorly into the inferior mesenteric vein and there are splenic vein collaterals.PANCREAS: Patient status post Whipple with pancreatic head removal.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: The azygos and hemiazygos systems are dilated due to collateral blood flow.BOWEL, MESENTERY: Multiple collateral vessels are identified in the lack of flow through the portal vein. Diffuse ascites. There is diffuse infiltration of the mesentery as well as multiple soft tissue nodules which may be due to ascites. BONES, SOFT TISSUES: No significant abnormality noted. The osseous abnormalities identified on the patient's recent MRI are not seen on this exam.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The well-defined lesion identified medially to the right of the rectum measures 2.0 x 1.4 cm (image 29/211). This has peripheral calcification. Diffuse ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Gross stability of the two enhancing lesions in the right lobe of the liver. While the hypervascularity of these lesions is unusual for pancreatic adenocarcinoma, enhancement may be exaggerated given the degree of fatty infiltration throughout the remainder of the liver. Both should be followed to confirm stability.2. Multiple collateral vessels and ascites likely secondary to portal vein occlusion.


Instruction: Generate impression based on medical findings.

Input: 68-year-old with history of mammographically occult breast cancer. The patient is status post right partial mastectomy and sentinel lymph node biopsy in 2009 for breast cancer. There is scattered fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally. Postsurgical volume loss of the right breast is again noted.No suspicious enhancement is seen in either breast. Note is made of the right breast seroma which is similar in size. A tubular high T2 signal area with thin peripheral enhancement projecting anterior to the seroma is if anything less prominent on this exam.No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on medical findings.

Input: T4N0 nasopharynx adenoid cystic carcinoma status post chemoradiation. There is no significant interval change in the infiltrative mass within the left nasopharynx, left parapharyngeal, left carotid, left prevertebral spaces, with infiltration of the left central skull base and probable perineural extension into the left Vidian canal. There is minimal residual epidural enhancement along posterior aspect of the left petrous apex. There are mild persistent sinonasal inflammatory changes. There is no significant cervical lymphadenopathy. The thyroid and salivary glands appear unchanged. There is persistent fluid within the left mastoid air cells and middle ear. The orbits are unremarkable.

Output: 1. No significant interval change in the adenoid cystic carcinoma centered in the left nasopharynx with adjacent deep space and skull base extension.2. Persistent findings associated with left Eustachian tube dysfunction, as manifested by retained otomastoid secretions.


Instruction: Generate impression based on medical findings.

Input: Reason: assess for meniscal tear, ligamentous History: L. knee locking, giving away MENISCI: The lateral meniscus appears intact. The medial meniscus appears intact. No fluid-filled tear is evident.ARTICULAR CARTILAGE AND BONE: There is partial-thickness articular cartilage degeneration along the medial facet of the patella. Otherwise no full-thickness or near full-thickness articular cartilage defects are identifiedLIGAMENTS: The cruciate and collateral ligaments otherwise appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Articular cartilage degeneration affecting the patellofemoral articulation. No evidence of a meniscal tear.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old, with left frontal tumor and word finding deficits. Evaluate speech and language function for presurgical planning. Of the tested language paradigms, the most reliable language related cortical activation is seen with the word generation, verb generation, and sentence completion paradigms. Wernicke's area activity is particularly well visualized on the sentence completion paradigm where it maps to its expected location along the posterior aspect of the left superior temporal gyrus. Wernicke's activity is strongly left dominant.Presumed Broca's area activity, however, appears to be more evenly distributed between the right and left hemispheres. Potential Broca's area activity is best visualized on the word generation paradigm where it maps bilaterally to the inferior frontal gyri, particularly the pars opercularis and to a lesser degree the pars triangularis.The visualized putative Wernicke's area activity is well removed from the patient's large left frontal lobe tumor and the extensive edema which it creates. The visualized putative Broca's area activity sits mainly at the margins of the tumor-induced edema. The anterior medial aspect of this activity does, however, reach to within one gyrus of the inferior lateral margin of the tumor itself (see image 96, series 601, and image 46, series 602).No functional activation is identified frankly within the tumor itself or the edematous surrounding parenchyma. Please note, however, that nonvisualization of functional activity does not ensure that there is no functional capacity in these areas.Somewhat less than the typical amount of secondary language activity is seen in the middle frontal gyri. Language SMA activity is, however visualized in its expected paramedian location along the superior frontal gyri, and this too approaches the margin of tumoral edema.

Output: 1.Wernicke's area activity is strongly left dominant, visualized in its expected location along the posterior aspect of the superior left temporal gyrus, and is well removed from the patient's tumor.2.Broca's area activity is somewhat more evenly distributed between the right and left hemispheres, which may reflect compensation due to the clear extension of edema into the expected domain of Broca's area on the left. Cortical activation felt to reflect Broca's area approaches the margins of tumoral edema, primarily within the pars opercularis. The most anterior medial aspect of this activation does approach within one gyrus to the inferior lateral margin of the tumor.


Instruction: Generate impression based on medical findings.

Input: 62-year-old male. Transaminitis. Increased alk phos. Rising LFTs. Significant motion artifact and lack of intravenous contrast severely limits evaluation of solid organ pathology.ABDOMEN:LIVER, BILIARY TRACT: Diffusely decreased T2 signal in the liver suggestive of iron deposition. No biliary ductal dilatation. Gallbladder is collapsed and the cholecystostomy tube is not well-seen. No definite focal hepatic lesion within limits of exam.SPLEEN: Diffusely decreased T2 signal and signal loss on in phase images within the spleen suggestive of iron deposition. Focal T2 hyperintensity in the spleen correlating with an ill-defined hypodense lesion on prior CT (series 901, image 26), not well characterized due to significant motion and lack of contrast.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: T2 hyperintense foci in the mid to lower pole of right kidney, incompletely evaluated without contrast, likely a cyst. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Infrarenal IVC filter.BOWEL, MESENTERY: Small fat-containing umbilical hernia.BONES, SOFT TISSUES: Multiple compression deformities in the thoracolumbar spine with vertebroplasty changes. Anasarca. Small cystic foci at the sacral neural foramina, likely Tarlov cysts.OTHER: Foley catheter terminates in the bladder. Bilateral pleural effusions and nonspecific basilar opacities. 5 x 10.6 cm anterior mediastinal hematoma causing mild mass effect upon the right heart border; there is mild associated diffusion restriction and superimposed infection is not excluded. Trace scattered abdominal ascites. No loculated fluid collection.

Output: 1. No biliary ductal dilatation.2. Known anterior mediastinal hematoma with mild associated diffusion restriction, superimposed infection not excluded.


Instruction: Generate impression based on medical findings.

Input: 57-year-old female with history of primary osteoarthritis involving multiple joints, evaluate osteoarthritis Right hip:Tiny osteophytes suggesting mild osteoarthritis.Left hip:Tiny osteophytes suggesting mild osteoarthritis. Rounded calcifications in the pelvis suggest uterine fibroids.Right knee:There is moderate osteoarthritis particularly affecting the patellofemoral joint. Tricompartmental osteophytes noted. An ossicle posterior to the medial aspect of the distal femur probably represents a loose body within the joint. There are small foci of gas within the joint which presumably reflect recent intervention, although we cannot exclude the possibility of septic arthritis.Left knee:Mild osteoarthritis affects the left knee with tiny osteophytes and a subchondral cyst in the patella. There is an approximately 4 cm rounded soft tissue opacity overlying the posterolateral aspect of the knee that may represent a cutaneous or subcutaneous mass. This can be further evaluated with MRI if clinically warranted.

Output: 1. Osteoarthritis of both knees and both hips as described above.2. Small foci of gas density in the right knee joint presumably reflect recent intervention, please note if there has not been recent intervention septic arthritis should be considered. 3. Posterolateral knee mass as described above which can be further evaluated with MRI if clinically indicated.


Instruction: Generate impression based on medical findings.

Input: Clinical question: 24-year-old male with metastatic Ewing sarcoma, persistent headaches, evaluate for progression of Ewing's, brain abscess or other pathology. Signs and symptoms: Headaches Nonenhanced CT of brain:Examination demonstrate a large extra-axial mass of high density in the right posterior parietal region with associated lytic changes of inner table of the skull (axial images 35 through 38) the mass causes significant mass effect and buckling of the cortex. At this level there is also a large extracranial high-density mass which measures approximately 62 mm times 30 mm in size. This finding is also associated with some irregularity of the outer table of the skull. Considering the provided clinical history of Ewing sarcoma this finding is highly suspected of a metastatic lesion to the calvarium with intracranial and extracranial spread of tumor.There is evidence of associated edema of brain parenchyma adjacent to this finding (axial images 29 through 34). The extra-axial mass has higher density than brain parenchyma and on a few of the images appears like a subdural hematoma. Further evaluation with an enhanced MRI of brain is highly recommended.There is no evidence of parenchymal hemorrhage, hydrocephalus or midline shift.Visualized paranasal sinuses and mastoid air cells are unremarkable.

Output: Lytic changes of the inner and outer cortex of right parietal bone with associated large high density mass in the extra-axial intracranial space and within the soft tissues of the scalp. Finding is highly suspected of osseous metastatic lesion with both intracranial and extracranial spread. The combination of these masses measures approximately 40 mm in thickness and 85-mm in longus cranial slice cephalad axis (coronal reformatted image 47). There is evidence of mass effect on the brain parenchyma and vasogenic edema. No midline shift or hydrocephalus.Above findings were discussed with Dr. Gornli Jerome pager number 2841 at the time of interpretation.


Instruction: Generate impression based on medical findings.

Input: Tibial plateau fracture. Four views of the left knee appears similar to the prior radiographs, demonstrating no discrete fracture or malalignment. The osteochondral fracture seen on the prior MRI at the posterior aspect of the lateral tibial plateau is not well visualized on radiographs.

Output: Unchanged radiographic appearance of the left knee, without definite visualization of the osteochondral fracture seen on the prior MRI.


Instruction: Generate impression based on medical findings.

Input: Grade III astrocytoma status post RT/TMZ and 12 cycles of TMZ. Currently off all treatment. A curvilinear area of T2 hyperintensity within the left paramedian precentral gyrus has increased in size compared to the previous exam where it now measures 6 x 13 mm (series 11, image 6), compared to 2 x 6 mm previously.A new predominantly ring-enhancing lesion is visualized within the middle left temporal gyrus which measures 16 x 13 mm (series 11, image 20). This lesion was not distinctly visualized previously.The T2 hyperintense lesion within the left thalamus shows no significant interval change in size or morphology over multiple prior examinations. A biopsy marker remains evident in the center of the lesion. The lesion demonstrates intrinsic T1 hyperintensity with little if any true superimposed enhancement.A subcentimeter enhancing focus along the margin of the left occipital horn may be slightly larger in size compared to the previous exam.Ill-defined periventricular white matter T2 hyperintensity along the left lateral ventricle is stable when compared to the immediate prior examination, but shows slight expansion in geographic extent when compared to older exams. Some of this signal abnormality was evident on the patient's initial pretreatment studies.Numerous additional scattered small foci of T2 signal abnormality are seen throughout both cerebral hemispheres, without significant or convincing interval change. No new mass effect or parenchymal edema is detected. Ventricles are stable in size including mild ex vacuo dilatation of the left lateral ventricle.

Output: 1.Interval increase in size of the left paramedian precentral gyrus enhancing lesion and possible increase in size of the lesion adjacent to the left occipital horn compared to the previous exam, suspicious for growing tumor.2.Interval development of a new left middle temporal gyrus ring-enhancing lesion, suspicious for new tumor that was not discretely seen previously.3.Stable appearance of the treated lesion involving the left thalamus.4.Ill-defined left periventricular white matter T2 hyperintensity is stable relative to the previous two examinations.


Instruction: Generate impression based on medical findings.

Input: Knee pain and swelling. Check for ligamentous tear MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: Cartilage is well visualized without focal defects. Pronounced red marrow is also observed in the distal femur incompletely, may represent potential anemia given patient age.LIGAMENTS: Mild thickening of the MCL with surrounding inflammation, mild strain cannot be excluded. Fibers however appear intact. The LCL is grossly intact and similar increased signal in the ACL is also observed with fibers extending in the expected location; moderate sprain suspected. The PCL is intact EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Moderate ACL sprain without evidence of definite tear or retraction. Additional moderate sprain of the MCL must also be considered. Please correlate with patient's symptoms. Moderate knee effusion