Instruction: Generate impression based on medical findings.

Input: 46-year-old male found down during fire. Evaluate for ligamentous injury Cervical spine:There is mild reversal of cervical lordosis at the C3-C4 level. Vertebral body heights are grossly maintained. Focus of increased T1 and T2 signal in the posterior aspect of the C5 vertebral body compatible with hemangioma.Anterior and posterior longitudinal ligaments as well as the ligamentum flavum appear intact. There is mildly increased T2 signal in the interspinous ligaments extending from C3 to C7 which may reflect mild ligamentous injury. No evidence of epidural hematoma. No evidence of hemorrhagic cord contusion.There is a large central disc protrusion at C3-C4 with mass effect and deformity of the cervical cord at this level. The anterior cord demonstrates increased T2 signal from C3 to C6 which may reflect gliosis with possible component of edema. Additional details as below.C2-C3: No disc bulge or spinal canal stenosis. No neural foraminal stenosis.C3-C4: Generalized disc bulge with focal central disc protrusion. There is complete effacement of the anterior and posterior thecal sac as well as focal mass effect and distortion of the underlying cord. Moderate left and mild right neural foraminal stenosis.C4-C5: Central disc protrusion with effacement of the ventral thecal sac results in mild spinal canal stenosis. No neural foraminal stenosis.C5-C6: Central disc protrusion slightly asymmetric to the right with effacement of the ventral thecal sac. Mild spinal canal stenosis. Minimal bilateral neural foraminal stenosis.C6-C7: Mild generalized disc bulge. No significant neural foraminal or spinal canal stenosis.C7-T1: No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.

Output: 1. Increased T2 signal in the interspinous ligaments raising possibility of interspinous ligamentous injury. Remainder of the ligaments including the anterior and posterior longitudinal ligaments as well as the ligamentum flavum are intact. No evidence of epidural hematoma or hemorrhagic contusion involving the cervical cord.2. Large central disc protrusion at C3-4 with mass effect and deformity of the cervical cord at this level. Smaller disc protrusions are evident at the C4-C5 and C5-C6 levels with minimal to mild mass effect on the cord. There is abnormal T2 signal within the cervical cord from C3 to C6 which may reflect gliosis/myelomalacia although component of acute edema can not be entirely excluded.3. Moderate left C3-C4 neural foraminal stenosis.


Instruction: Generate impression based on medical findings.

Input: Merkel cell carcinoma, staging Innumerable subcutaneous nodules are identified along the left lower extremity. These lesions are slightly hyperintense to skeletal muscle on T1 sequences and hyperintense to skeletal muscle on T2 sequences. Following contrast administration, there is generally solid enhancement although some of the larger lesions demonstrates central areas of nonenhancement which likely the result of necrosis.Index lesions are as follows: -Medial soft tissues of the thigh, series 26 image 21/50. 4.9 x 3.9 x 2.7 cm in the greatest AP, transverse, and craniocaudal dimensions-Anterior thigh, series 26 image 8/50, 1.6 x 1.9 x 2.3 cm, -Medial to the patella, series 26 image 37/50, 1.3 x 2.1 x 2.1 cm The underlying marrow signal of the femur is normal. There is mild diffuse subcutaneous edema of the thigh particularly medially. A cystic lesion is identified within the medial subcutaneous tissues just the at the level of the distal metaphysis. This lesion demonstrates signal characteristics of a simple cyst with thin peripheral rim-like enhancement. Additionally, there are multiple enlarged inguinal and iliac chain lymph nodes. Index nodes are as follows:-Left iliac chain, series 25 image 8/51, 3 x 3 cm-Left iliac chain, series 25 image 10/51, 3.5 x 2.2 cm-Left inguinal canal, series 25 image 22/51, 3 x 2.6 cm

Output: 1. Innumerable subcutaneous nodules consistent with the known diagnosis of Merkel cell carcinoma.2. Multiple enlarged inguinal and pelvic lymph nodes reflecting metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Acute on chronic liver failure and respiratory failure requiring mechanical ventilation with progressive development of ARDS in setting of parainfluenza infection with likely secondary Aspergillus and MSSA pneumonia and probable cystic fibrosis. There appear to be two contiguous lesions in the right occipital lobe with peripheral T1 hyperintensity and extensive susceptibility effect and central restricted diffusion, the largest of which measures up to approximately 25 mm. There is surrounding vasogenic edema and overlying sulcal T2 hyperintensity and enhancement. In addition, there are punctate (1 to 3 mm diameter) enhancing lesions in the left frontal lobe periventricular white matter and in the grey-white matter junctions of the left postcentral gyrus, left inferior parietal lobule, and right middle frontal gyrus. There are punctate foci of susceptibility effect in the left cerebellar hemisphere. There is no evidence of acute infarct. There is no midline shift or herniation. The ventricles are unchanged in size and configuration. The major cerebral flow voids are intact. There is fluid signal in the bilateral mastoid air cells. There is diffuse mucosal thickening and enhancement, as well as secretions within the pneumatized portions of the paranasal sinuses. There is a partially-imaged right nasoenteric tube. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: 1. The lesions in the right occipital lobe may represent abscess, either pyogenic or fungal, with superimposed hemorrhage and regional cerebritis and meningitis and/or superimposed subarachnoid hemorrhage. Metastatic disease is nevertheless an imaging differential consideration.2. A few scattered punctate enhancing lesions in the bilateral cerebral hemispheres may represent septic emboli. Similarly, punctate foci of susceptibility effect in the left cerebellar hemisphere may represent hemorrhagic microabscesses or chronic aseptic microhemorrhages related to the underlying coagulopathy. Metastatic disease is nevertheless an imaging differential consideration.3. Apparent inflammatory changes in the paranasal sinuses are suggestive of acute sinusitis, perhaps related to cystic fibrosis.4. Effusions within the bilateral mastoid air cells may represent mastoiditis or may be related to intubation.


Instruction: Generate impression based on medical findings.

Input: Radiculopathy. Two month history of left neck/shoulder pain and tingling with preceding trauma. Please note only sagittal sequences were obtained. Patient was in pain and could not tolerate further imaging. The obtained sagittal sequences are also motion degraded.Within this limitation, vertebral body heights are normal. There is mild nonspecific heterogeneity of the bone marrow without focal destructive lesions, including areas of T1 shortening in the bone marrow possibly related to prior radioiodine ablation. No obvious cord signal abnormality. Degenerative changes are seen with mild multilevel facet arthropathy as well as disc osteophyte complexes which mildly efface the ventral thecal sac at multiple levels. There is however no evidence of significant spinal canal stenosis at any level. Neural foramina are not well evaluated without axial images, although bony foraminal stenosis is evident on recent radiographs. No gross evidence of ligamentous injury within the limitations above.

Output: Severely limited exam as described above. There are mild multilevel degenerative changes without significant spinal canal stenosis at any level. Neural foramina cannot be evaluated without axial images although multilevel foraminal stenoses are evident on recent radiographs. Repeat examination with sedation can be considered as clinically indicated.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Patient was transferred from an outside institution for respiratory failure. Found down at trauma on paralytics and sedated at outside hospital. Now lie attending sedation and off paralytic agents. Still minimally responsive. Non-enhanced CT of brain:There is lower than expected hypoattenuation of the white matter of bilateral cerebral hemispheres. There is however no evidence of effacement of cortical sulci, mass effect midline shift or hydrocephalus. The density of cortex and basal ganglia and thalami remain within normal limits. Considering provided clinical date of possibly two underlying diffuse cerebral edema cannot be entirely ruled out and follow-up with an MRI is recommended. It is also possible that this appearance may be technique related. Images through posterior fossa are essentially unremarkable.

Output: Suspected cerebral edema of bihemispheric white matter as detailed. Considering patient's provided clinical date of follow-up with an MRI is recommended. There is no evidence of hemorrhage, mass-effect, midline shift or hydrocephalus. Please see above comments.


Instruction: Generate impression based on medical findings.

Input: 72 years, Male, Reason: neurodeg disease History: ataxia, cognetive. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. There is global parenchymal volume loss supra and infratentorially without a distribution to suggest a particular neural degenerative process. There is volume loss involving the hippocampi bilaterally which is not disproportional. No focal signal abnormalities involving the basal ganglia or midbrain.Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter as well as in the pons, which are nonspecific, but compatible with mild chronic small vessel ischemic disease. Brain parenchyma is otherwise unremarkable for age. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. Global parenchymal volume loss. 2. No intracranial mass or mass effect. 3. Mild chronic small vessel ischemic disease.


Instruction: Generate impression based on medical findings.

Input: Female 87 years old with a history of metastatic medullary thyroid cancer, compare to previous, measurements please. ABDOMEN:LIVER, BILIARY TRACT: Again seen are several enhancing liver lesions stable in size and number compared to the previous the reference right hepatic lobe lesion measures 2 5 x 2.4 cm (series 1308, image 228), unchanged.The gallbladder is normally distended without cholelithiasis. The common duct is dilated up to 1.1 cm in diameter, not significantly changed. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable left simple renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.INDEX LESION MEASUREMENTS (Current exam date/time: 11/30/2016 13:45:00)RIGHT HEPATIC LESION: 2.5 x 2.4 cm (Image 228, Series 1308); 2.5 x 2.4 cm on prior (10/5/2015) (Image 40, Series 10).

Output: Multiple enhancing hepatic lesions are stable in size and number. No new sites of disease.


Instruction: Generate impression based on medical findings.

Input: Female 44 years old Reason: 44yo female with evidence of quiescent Crohn's in cecum/ileocecal valve with continue diarrhea and abdominal pain. Evaluate for small bowel Crohn's disease History: diarrhea and abdominal pain ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No suspicious hepatic lesions. Hepatic and portal veins are patent. Signal loss on out of phase imaging compatible with fatty infiltration.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: Small bowel is normal in caliber and course. The terminal ileum is normal in caliber. The ileocecal valve is patent. No surrounding inflammatory changes or evidence for hyperemia.There is a focal segment of narrowing involving the sigmoid colon measuring 2.5 cm.There are additional segments distal to this that are collapsed but show mucosal hyperenhancement.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Please see aboveBONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No evidence of stricture or inflammation involving the terminal ileum..2.Findings of narrowing and mucosal enhancement within the sigmoid colon.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Benign neoplasm of brainClinical question: h/o 4th ventricular mass and shuntSigns and Symptoms: surveillance The patient is status post ventriculostomy tube with associated shunt placement. The ventriculostomy tube courses through the right occipital lobe into the right lateral ventricle and has its tip against the septum pellucidum.There is a 8 x 6 mm axial dimension and 12 x 7 mm sagittal dimension mass located inferior aspect of the fourth ventricle which appears stable when compared to the previous exam. There is associated susceptibility effect. This lesion is known to be calcified based on the CT scan from 11/8/2007. It is located in the region of the foramen of Magendie.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.A fourth ventricular calcified lesion is stable and compared to the prior exam from 11/28/2012 as well as exams dating back as far as 2008.2.The patient's shunt catheter is in stable position. There is no convincing evidence for ventriculomegaly


Instruction: Generate impression based on medical findings.

Input: Pituitary microadenoma: galactorrhea. There is no significant interval in size of the hypoenhancing lesion in the anterior pituitary gland, which measures up to 7 mm in width and 3 mm in height. The infundibulum is intact and situated in the midline. There is no disruption of the optic apparatus. The cavernous sinuses and intracranial internal carotid arteries are intact.

Output: No significant interval change in size of the pituitary microadenoma.


Instruction: Generate impression based on medical findings.

Input: History of hepatitis C, assess for hepatocellular carcinoma ABDOMEN:LIVER, BILIARY TRACT: Arterially enhancing lesion in segment 7-8 measures 9 x 11 mm, unchanged. There is no demonstrable washout within this lesion. Additionally, there is a punctate hyperenhancing lesion at the hepatic dome.Portal vein is patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No focal hepatic lesions which meet criteria for HCC. Continued surveillance is recommended.


Instruction: Generate impression based on medical findings.

Input: Motion degrades sensitivity. For the purpose of this study the most inferior level is defined as L5-S1. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord terminates at the T12 inferior endplate and displays normal signal and morphology. Atrophy of the lower lumbar paraspinal musculature noted. Partially imaged left renal cysts.Multilevel degenerative changes are seen, as describe below:T12-L1, L1-L2: No significant spinal canal or foraminal stenosis.L2-3: Minimal disc bulging with mild bilateral facet arthropathy. No significant spinal canal or foraminal stenosis.L3-4: Disc bulge and bilateral facet arthropathy as well as prominence of the dorsal epidural fat contribute to mild to moderate spinal canal stenosis, slightly worse since prior exam. There is mild bilateral neural foraminal stenosis, not significantly changed from prior exam. Widening of the facet joints again noted. L4-5: Post-surgical changes of a remote laminectomy with areas of osseous fusion involving the posterior elements from L4-S1. No evidence of significant central or neural foraminal stenosis.L5-S1: No significant spinal canal stenosis. Minimal narrowing of the neural foramina. Prior right-sided laminectomy.

Output: 1. Post-surgical changes in the lumbar spine with laminectomies at L4-L5 and L5-S1 and solid osseous fusion involving the posterior elements from L4 through S1 better seen on prior CT. 2. Mild to moderate spinal canal stenosis at L3-4, which appears slightly worse since prior exam from 9/5/2012. 3. Mild L3-L4 and minimal L5-S1 bilateral neural foraminal narrowing. Neural foramina are otherwise patent.


Instruction: Generate impression based on medical findings.

Input: Syncope and collapse [R55] / Malignant neoplasm of lower-outer quadrant of left female breast [C50.512], Reason for Study: ^Reason: eval for brain metastases History: breast cancer, syncope No evidence of acute ischemic or hemorrhagic lesion. No evidence of abnormal enhancementThe ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. Mucosal thickening with retention cysts seen on bilateral maxillary sinus, bilateral ethmoid sinus, frontal sinus and sphenoid sinus

Output: 1. No evidence of acute ischemic or hemorrhagic lesion. No evidence of abnormal enhancement.2. Pansinusitis.


Instruction: Generate impression based on medical findings.

Input: 61 year old woman with history of recently diagnosed breast cancer, hypertension, mild LV dysfunction and LBBB on ECG referred for vasodilator stress cardiac MRI to evaluate for etiologies MEDICATIONS: lisinopril First Pass PerfusionDuring hyperemia, a perfusion defect is noted in the basal anterior and septal walls and the apical septal walls. Although this finding may be due to ischemia, the possibility that it is secondary to the LBBB.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. Left VentricleThe left ventricle is moderately dilated with low-normal systolic function. The overall LV ejection fraction is 53%, the LV end diastolic volume index is 101 ml/m2 (normal range: 65+/-11), the LVEDV is 186 ml (normal range 109+/-23), the LV end systolic volume index is 48 ml/m2 (normal range 18+/-5), the LVESV is 87 ml (normal range 31+/-10), the LV mass index is 47 g/m2, and the LV mass is 86 g. There is abnormal septal wall motion abnormality due to LBBB. The native T1 myocardial relaxation time is normal (1030ms).Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 47%, the RV end diastolic volume index is 85 ml/m2 (normal range 69+/-14), the RVEDV is 155 ml (normal range 110+/-24), the RV end systolic volume index is 45 ml/m2 (normal range 22+/-8), and the RVESV is 82 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trivial tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThyroid enlargement involvement. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. During hyperemia, a perfusion defect is noted in the basal anterior and septal walls and the apical septal walls. Although this finding may be due to ischemia, the possibility that it is secondary to the LBBB must also be considered.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and lower normal systolic function (LVEF 53%).4. Normal RV size and mildly reduced systolic function (RVEF 47%).5. Left atrial 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: Male; 59 years old. Reason: Eval liver lesions, masses, HCC S/P TACE/RFA on 3/5-6/15 History: HCC, cirrhosis, HBV LIVER, BILIARY TRACT: New right hepatic lobe anterior/superior ablation measures 3.4 x 1.9 cm (series 10/36).Right hepatic lobe posterior/superior ablation cavity measures 2.7 x 1.9 cm (series 10/34), previously 2.7 x 1.9 cm.Right hepatic lobe inferior ablation cavity measures 2.1 x 1.9 cm (series 10/42), previously 2.1 x 1.9 cm.Between the two superior ablation cavities, there is mild nodular arterial enhancement measuring up to 0.6 x 0.8 cm posteriorly (series 10/33), with smaller focus seen slightly anteriorly (series 10/32), suspicious for mild residual disease though not entirely specific with no restricted diffusion or washout seen.No biliary ductal dilatation. Main portal vein is patent. SPLEEN: Stable splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant retroperitoneal or mesenteric adenopathy.BOWEL, MESENTERY: Small hiatal hernia.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Gastroesophageal varices.

Output: New right hepatic lobe ablation cavity with mild adjacent nodular arterial enhancement, suspicious for mild residual disease though not entirely specific with no restricted diffusion or washout seen.


Instruction: Generate impression based on medical findings.

Input: Metastatic melanoma, known T9 compression fracture: back pain. There is a heterogenous tumor in the T9 vertebral body that measures up to 25 mm. There is up to 40% loss of height of the T9 vertebral body centrally, which may be due to a combination of pathological fracture and underlying intravertebral disc herniation, which is otherwise apparent at multiple other levels of the thoracic spine. There is no retropulsion of tumor into the spinal canal. There is no spondylolisthesis. The spinal cord appears to be intact. There is a partially imaged bulky right hilar mass.

Output: 1. A metastasis n the T9 vertebral body measures up to 25 mm. There is up to 40% loss of height of the T9 vertebral body centrally, which may be due to a combination of pathological fracture and underlying intravertebral disc herniation, which is otherwise apparent at multiple other levels of the thoracic spine.2. A partially imaged right hilar metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Clinical question: T12 compression fracture with neurologic changes. Signs and symptoms: Neurologic changes. Nonenhanced thoracic MRI:Examination demonstrates more than 50% compression fracture of T12 vertebrae with extensive T2/T2 hyperintensity of bone marrow consistent with edema and representing acute fracture. There is posterior expansion of compressed vertebrae into the spinal canal with resultant mass effect, flattening and posterior displacement of the cord and resultant moderate central spinal stenosis without neural foraminal compromise. There is also evidence of circumferential epidural hemorrhage (more along the dorsal aspect of the spinal canal) which extends superiorly to at least T3 level. Epidural hemorrhage is larger at T11 and T12 levels and measuring approximately 5.5 mm in thickness posterior. Epidural hemorrhage at L1 level with mass effect on the conus and the proximal cauda equina measures approximately 6.2 mm thickness. There is increased T2 signal intensity of the cord highly suspicious for edema without convincing evidence of hemorrhage and extending from T10-T11 disc level to the conus.Unremarkable nonenhanced MRI of thoracic spine and without evidence of spinal stenosis or significant neural foraminal compromise at any level.Nonenhanced lumbar MRI:Examination demonstrates dorsal epidural hemorrhage from acute T12 lumbar fracture with mass effect and forward displacement of conus and proximal cauda equina. There is increased T2 signal intensity extending from L1-L2 disc level inferiorly to S2 level with mass effect and forward displacement of cauda equina which is also suspected for hemorrhage within the spinal canal/subarachnoid space. This finding measures approximately at 9.5 mm at L3 level and 8mm at L5 level. This finding appears as a low signal intensity on T1-weighted images. There is no evidence of fracture or malalignment of the lumbosacral spine.T2 hypointense kidneys are noted. To exclude possibility of underlying pathology recommend follow-up with ultrasound studies.

Output: 1.Acute larger than 50% compression fracture of T12 vertebral body, retropulsion into the spinal canal, mass effect and posterior displacement of the cord with resultant moderate central spinal stenosis without neural foraminal compromise. There is evidence of cord edema extending from T10-T11 disc level to the conus.2.Circumferential epidural hemorrhage extending from the fracture site superiorly to at least T3 and inferiorly to approximately L1-L2 disc level with associated mass effect as detailed/measured above.3.Hemorrhage within the spinal canal extending from approximately the L1 level to S2 and with resultant mass effect and forward displacement of cauda equina along its entire course.


Instruction: Generate impression based on medical findings.

Input: 75 years Female (DOB:5/15/1941)Reason: r/o cva History: cognitive impairmentPROVIDER/ATTENDING NAME: SHELLIE N. WILLIAMS SHELLIE N. WILLIAMS The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. One of these lesions in the left centrum semiovale adjacent left frontal lobe measures 15 x 11 mm axial dimensions. There are some punctate lesions present in the brainstem which are hyperintense on T2 and FLAIR MRI.There is a large flow void present adjacent to the ophthalmic segment of the right internal carotid artery which measures 14 x 10 mm in coronal dimensions. 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.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 some mucosal thickening at the floor of the right maxillary sinus.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.There is a signal hyperintense lesion on all pulse sequences located in the trigone of the left lateral ventricle which most likely represents calcifications.

Output: 1.There is a large aneurysm present at the distal right internal carotid artery at the proximal ophthalmic segment which is directed superiorly and abuts the right olfactory trigone and posterior olfactory sulcus. An MR angiogram may help further evaluate for this and additional aneurysms. Alternatively an CT angiogram may be useful.2.Periventricular and subcortical white matter lesions of a mild to moderate degree and some punctate lesions in the brainstem are nonspecific. A larger lesion in the left centrum semiovale may represent an old lacunar infarct. At this age they are most likely vascular related. 3.There is no evidence for acute ischemic cerebral infarction.4.Findings were discussed with Dr. Williams.


Instruction: Generate impression based on medical findings.

Input: 59 year old man with history of DM1, CAD referred for stress cardiac MRI to evaluate for ischemia. MEDICATIONS: ASA, Lipitor, Bumex, Eplerenone, labetalol First Pass PerfusionDuring hyperemia, no perfusion defects were present. A prominent dark rim artifact was noted. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 65%, the LV end diastolic volume index is 101 ml/m2 (normal range: 74+/-15), the LVEDV is 233 ml (normal range 142+/-34), the LV end systolic volume index is 36 ml/m2 (normal range 25+/-9), the LVESV is 82 ml (normal range 47+/-19), the LV mass index is 65 g/m2, and the LV mass is 150 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 69%, the RV end diastolic volume index is 79 ml/m2 (normal range 82+/-16), the RVEDV is 183 ml (normal range 142+/-31), the RV end systolic volume index is 24 ml/m2 (normal range 31+/-9), and the RVESV is 56 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 65%) without evidence of underlying fibrosis, inflammation, or infiltration. 4. Normal RV size and systolic function (RVEF 69%).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: Clinical question: Progressive ataxia. Please perform Dr.Javed's multiple sclerosis protocol. Signs and symptoms: Progressive ataxia. Nonenhanced cervical MRI:There is normal signal intensity and alignment of the vertebral column.There is no detectable spinal stenosis or neural foraminal compromise at any level.There is normal signal intensity and caliber of the cervical and upper most visualized thoracic cord. There is no finding to suggest demyelinating disease.Unremarkable images at the level of foramen magnum.

Output: 1.Unremarkable nonenhanced cervical MRI.2.No evidence of demyelinating disease of the cervical or upper most visualized thoracic cord.


Instruction: Generate impression based on medical findings.

Input: 47 year old female with suspicious mass in the left breast with suspicious left axillary lymph node, presents for research MRI scan. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.Highly suspicious, lobulated enhancing mass is demonstrated at posterior 2 o'clock position, measuring 27 x 28 x 30 mm (AP x LR x CC), in the left breast. It is located near pectoralis muscle, but there is a fatty plane between the mass and the muscle. No other suspicious lesions are present in the left breast.In the left axilla, one enlarged lymph node, measuring 23 mm in maximum diameter, with effaced hilum at upper aspect.In the right breast, there is an enhancing mass with possible internal dark septation, measuring 8 x 9 x 9 mm at 3 o'clock position.No abnormal lymph nodes are identified in either axillary region.

Output: 1. Highly suspicious mass in the left breast with suspicious left axillary lymph node. Ultrasound guided biopsy were performed for both lesions later today.2. Enhancing mass in the right 3 o'clock position, likely fibroadenoma. MR directed ultrasound, performed later today, detected a correlate, and subsequently biopsy was performed under ultrasound guidance.BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on medical findings.

Input: CNS lymphoma, evaluate for recurrence: fatigue. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a right transfrontal Ommaya catheter that terminates in the right lateral ventricle. There is a cystic cavity in the surrounding right frontal lobe parenchyma that measures up to 31 mm. The ventricles and basal cisterns are unchanged in size and configuration, with mild diffuse cerebral volume loss. There is mild diffuse periventricular white matter T2 hyperintensity. There is no midline shift or herniation. The major cerebral flow voids are intact. There is persistent high T2 signal and enhancement in the clivus, with prominent trabeculae. There is mild left maxillary sinus mucosal thickening.Orbits: There is persistent mild diffuse enhancement along the bilateral optic nerve sheaths, but otherwise no evidence of intraorbital mass lesions. There are bilateral staphylomatous globe deformities and a left lens implant. Spine: There is persistent mild enhancement along multiple cauda equina nerves roots diffusely and along the surface of portions of the thoracic spinal cord. The spinal cord otherwise displays normal signal and morphology. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. There is degenerative spondylosis involving multiple levels of the lower lumbar spine with inflammatory changes in multiple facet joints, but no significant spinal canal or neural foraminal stenosis. Aside from degenerative signal alterations, the vertebral bone marrow signal is unremarkable. However, there is persistent signal abnormality in the bilateral iliac bones. The paravertebral soft tissues are unremarkable.

Output: 1. No evidence of intracranial tumors.2. Cavitation surrounding the right transfrontal Ommaya catheter may represent sequela of necrosis.3. The ventricles are unchanged in size. 4. Persistent mild diffuse enhancement along the bilateral optic nerve sheaths, which may be related to lymphoma or represent perineuritis, but otherwise no evidence of intraorbital mass lesions.5. Persistent mild enhancement along multiple cauda equina nerves roots diffusely and along the surface of portions of the thoracic spinal cord likely related to lymphoma.6. Nonspecific persistent abnormality in the clivus and iliac bones.7. Multilevel degenerative spondylosis in the lower lumbar spine, with inflammatory facet arthropathy.


Instruction: Generate impression based on medical findings.

Input: Reason: Pt w/ GBM, s/p RT/TMZ and now only on Optune. History: GBM. Postoperative changes are again seen from previous right frontal craniotomy for resection of a right frontal lobe mass. There are section cavity along the high anterior right frontal lobe appears similar in configuration, with slight decreased marginal susceptibility relating to postoperative blood products.There has been interval development of a few scattered punctate foci of diffusion restriction along the medial right lateral ventricular margin at the level of the body, in addition to nodular appearing diffusion restriction along the body of the corpus callosum. Corresponding nodular enhancement is seen along the areas of new callosal abnormality. There is now ill-defined T2/FLAIR hyperintensity across the corpus callosum, with slight increased extent of periventricular FLAIR hyperintensity along the lateral ventricles, and now extension into the right lateral temporal lobe periventricular white matter as well. There is focal nodular enhancement now along the right temporal lobe periventricular white matter measuring up to 1.4 cm. Persistent nodular enhancement is also seen along the margins of the resection cavity extending towards the ventricular wall. Other more punctate foci of enhancement are seen within the intervening white matter, for example on 1300/114 in the right lateral frontal deep white matter.

Output: Progression of nodular enhancement and abnormal ill-defined signal across the body of the corpus callosum as well as now into the right temporal periventricular white matter suggestive of tumor progression.


Instruction: Generate impression based on medical findings.

Input: Transient right-sided weakness. Rule out stroke. BRAIN MRI: There is an area of restricted diffusion along the left posterior frontal corona radiata adjacent to the left lateral ventricle. There is no significant associated FLAIR hyperintensity. There are multiple foci of T2/FLAIR hyperintensity involving the periventricular and subcortical white matter as well as the pons which are nonspecific but compatible with chronic small vessel ischemic disease. The ventricles and other CSF-containing spaces are mildly enlarged, reflecting mild underlying brain volume loss. There is no midline shift or herniation. There is trace mucosal thickening in the ethmoid sinuses. There is deformity involving the posterior aspect of the globes/staphylomas, which may be associated with axial myopia.CRANIAL MRA:The internal carotid arteries show preserved caliber and flow-related signal. There is moderate stenosis involving the distal left M1 segments with mild attenuation of the distal middle cerebral artery branches. Moderate stenoses also involves the proximal left and mid right P2 segments with attenuated distal right posterior cerebral artery branches. Other milder, scattered stenoses involve the intracranial arteries. There is no aneurysm.CERVICAL MRA: Aortic branching pattern is conventional. There is no significant stenosis involving the bilateral common or internal carotid arteries. The vertebral arteries arise conventionally from the respective subclavian arteries. No significant stenosis involving the vertebral arteries at their origins or their course in the neck.

Output: 1.Acute/hyperacute ischemia involving the left posterior frontal corona radiata. No significant associated T2/FLAIR signal which may be related to hyperacute timing.2.Mild to moderate chronic small vessel ischemic disease.3.Multifocal atherosclerotic stenoses of the intracranial arteries, with moderate focal stenoses involving the left lateral M1 segment and the bilateral posterior cerebral arteries. 4.There is no significant stenosis of the cervical arteries.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: History of tuberous sclerosis, evaluate kidneys for angiomyolipomas and cysts. Note that this examination is protocoled for evaluation of the kidneys and as such portions of the upper abdomen are excluded from the field-of-view.ABDOMEN:LUNG BASES: Trace basilar atelectasis.LIVER, BILIARY TRACT: The visualized portion of the liver demonstrates normal parenchymal signal intensity without focal lesions.SPLEEN: The visualized portions of the spleen appears normal.PANCREAS: The pancreatic parenchyma demonstrates normal signal intensity and enhancement without focal lesions.ADRENAL GLANDS: The adrenal glands appear normal.KIDNEYS, URETERS: There are scattered 1-2 mm cystic lesions throughout both kidneys which are too small to characterize but do not demonstrate suspicious features. It is estimated that approximately 20 of these cysts are present in each kidney. A representative lesion in the right lower pole (series 501, image 8) measures 2 mm. No evidence of angiomyolipoma. There is no evidence of hydronephrosis. The kidneys demonstrate normal parenchymal enhancement and excretion of contrast.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy is identified.BOWEL, MESENTERY: The visualized bowel is not significantly dilated.BONES, SOFT TISSUES: The visualized osseous structures appear normal.OTHER: A trace amount of free fluid is present within the pelvis.

Output: Numerous 1-2 mm cystic lesions within both kidneys which are too small to characterize.


Instruction: Generate impression based on medical findings.

Input: The last well formed disk space is referred to as L5-S1. There is minimal grade 1 retrolisthesis of L5 on S1, and minimal grade 1 anterolisthesis of L4 on L5. The remainder of the spine shows normal alignment. There is loss of T2 signal in all visualized disks with moderate loss of disk height at L4-5 and L5-S1. There is diffusely heterogeneous marrow signal which is nonspecific. There are type II endplate degenerative changes at L4-5 and L5-S1. There is minimal edema in the right-sided L4 and L5 articulating facets and pedicles which is nonspecific, likely reflecting degenerative process. The conus terminates at L1-2 and shows normal caliber and signal.T12-L1: No disk herniation, central spinal or neural foraminal stenosis.L1-2: No disk herniation, central spinal or neural foraminal stenosis.L2-3: No disk herniation, central spinal or neural foraminal stenosis.L3-4: Minimal disk bulge and bilateral facet arthropathy contributing to mild to moderate bilateral neural foraminal stenosis. No central spinal stenosis.L4-5: Diffuse disk bulge, bilateral facet arthropathy and ligamentum flavum thickening causing moderate right and mild left neural foraminal stenosis and no significant central spinal stenosis. Disk material encroaches upon the bilateral subarticular zones without significant stenosis.L5-S1: Diffuse disk bulge asymmetric to the left with a left foraminal protrusion causing mild to moderate left and minimal right neural foraminal stenosis. No significant spinal canal stenosis.

Output: 1.Multilevel lumbar spondylosis with no significant central spinal canal stenosis and variable degrees of neural foraminal stenoses as described above.2.At L5-S1, there is mild to moderate left neural foraminal stenosis secondary to left foraminal disk protrusion and may be impinging on the exiting left L5 nerve root.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: dysphasia with muscular dysfunction and Atrial fibrillation. No evidence of acute ischemic or hemorrhagic lesion on this scan.Minimal diffuse brain atrophy with prominent ventricular system.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion on this scan.No abnormal Gad enhancement.


Instruction: Generate impression based on medical findings.

Input: There are interval postsurgical changes of a left frontotemporal craniotomy. There appears to be a partial resection primarily involving the left anterior temporal lobe, when compared to the outside postoperative CT. There are expected postoperative changes including a small left extra-axial collection and fluid filled resection cavity primarily in the left anterior temporal lobe. There is T1 shortening on postcontrast T1 sequences centered in the basal ganglia, which is suspected to represent residual enhancing tumor rather than only T1 shortening related to postoperative blood products. There is improvement in mass effect with persistent effacement of the left lateral ventricle. There is interval decrease in rightward midline shift measuring 5 mm, previously 13 mm. Previously seen uncal herniation is no longer evident. There is interval decrease in surrounding T2/FLAIR hyperintensity, which still extends superiorly into the left centrum semiovale and corona radiata. Nonspecific focus of T2 hyperintensity in the left pons is unchanged.

Output: Examination limited to sequences for treatment planning and an immediate postoperative MRI is not available. Based on outside postoperative CT, there appears to have been resection of primarily the left anterior temporal component of the tumor and without significant tumor resection in the left basal ganglia; would suggest correlation with operative history. The T1 shortening on the postcontrast sequence in the basal ganglia is therefore favored to represent enhancing residual tumor rather than intrinsic T1 shortening from blood products.


Instruction: Generate impression based on medical findings.

Input: 61 year old man with cardiomyopathy referred to evaluate for etiology. Left VentricleThe left ventricle is severely dilated with moderately reduced systolic function. The overall LV ejection fraction is 34%, the LV end diastolic volume index is 143 ml/m2 (normal range: 74+/-15), the LVEDV is 272 ml (normal range 142+/-34), the LV end systolic volume index is 95 ml/m2 (normal range 25+/-9), the LVESV is 181 ml (normal range 47+/-19), the LV mass index is 100 g/m2 (normal range 85+/-15), and the LV mass is 190 g (normal range 164+/-36). There is global hypokinesis with regional variation. There is late gadolinium enhancement involving the epicardial basal inferolateral wall and the mid-myocardial septum. The pattern is atypical for prior myocardial infarction and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pattern has been commonly been described in dilated cardiomyopathy and healed myocarditis.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is mildly dilated with moderately reduced systolic function. The overall RV ejection fraction is 36%, the RV end diastolic volume index is 121 ml/m2 (normal range 82+/-16), the RVEDV is 229 ml (normal range 142+/-31), the RV end systolic volume index is 77 ml/m2 (normal range 31+/-9), and the RVESV is 146 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild to moderate tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is a wedge-shaped, pleural-based finding consistent with mass/infiltrate/ infarction. It was also present on recent chest CT scan. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is severely dilated with moderately reduced systolic function (LVEF 34%). There is late gadolinium enhancement, as described above, in a pattern that is atypical for prior myocardial infarction and suggests the presence of underlying myocardial fibrosis, inflammation, or infiltration. The pattern of late gadolinium enhancement has been commonly described in dilated cardiomyopathy and healed myocarditis. 2. Mild right ventricular dilation with moderately reduced systolic function (RVEF 36%).3. Severe left atrial dilation.4. Mild to moderate tricuspid regurgitation.5. See extra-cardiac finding.


Instruction: Generate impression based on medical findings.

Input: Evaluate for gallbladder pathology. Elevated LFTs. Several imaging sequences are severely limited by respiratory motion.ABDOMEN:LIVER, BILIARY TRACT: Hepatic morphology suggestive of cirrhosis including left lobar hypertrophy and lobular contour. Enlarged hepatic veins likely related to elevated right-sided heart pressures.The clinical service the patient has a history of cardiac cirrhosis.No focal liver lesion is identified.The MRCP images are nondiagnostic. No intrahepatic biliary ductal dilatation. The common bile duct is somewhat poorly visualized but appears normal in caliber. No filling defect is seen but cannot be entirely excluded.Normally distended gallbladder without evidence of acute cholecystitis or gallstones.The portal vein appears patent.Stigmata of portal hypertension including perihepatic ascites and para esophageal varices.SPLEEN: Borderline slightly measuring 13 cm in the craniocaudal dimension.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: Limited evaluation of the bowel is unremarkable.BONES, SOFT TISSUES: Anasarca.OTHER: Large pericardial effusion. Right hilar and apical consolidation/mass, better evaluated on prior chest CT.

Output: 1.Limited examination as discussed above without biliary ductal dilatation or specific findings of cholangitis. Evaluation for a small filling defect is limited.2.Cirrhotic liver morphology with findings of portal hypertension.3.Large pericardial effusion. Cardiomegaly.4.Right hilar and apical lung mass is better characterized on recent CT.


Instruction: Generate impression based on medical findings.

Input: Clinical question: r/o disc disease. Signs and Symptoms: pain. Nonenhanced cervical MRI:Foramen magnum is unremarkable.C2-C3 is unremarkable.C3-C4 demonstrate mild asymmetric right-sided uncovertebral hypertrophic changes with resultant moderate to severe right neural foraminal compromise.C4-C5 demonstrate mild degenerative changes without spinal stenosis or neural foraminalC5-C6 demonstrate mild disc disease and loss of disc height, shallow bulging disc, small bilateral uncovertebral hypertrophic spurs and mild facet and ligamentum flavum hypertrophy. Constellation of changes results in mild central spinal stenosis, moderate right and mild-to-moderate left neural foraminal compromise.C6-C7 demonstrate mild degenerative disc disease and mild ligamentum flavum hypertrophy without spinal stenosis or neural foraminal compromiseC7-T1 demonstrate mild degenerative disease without spinal stenosis or neural foraminal compromise.There is a tiny linear T2/T2 STIR hyperintensity is noted along the posterior right lateral aspect of the cord extending from mid C6 level to approximately upper C7 level best appreciated on sagittal T2 series 301 image 8 and axial T2 series 601 images 9 and 10. Finding is nonspecific however is suspected of a small focus of myelopathy.

Output: 1.Degenerative changes cervical spine with resultant mild central spinal stenosis only at C5-C6 level.2.Multi level neural foraminal compromise at detailed per level above.3.Tiny focus of T2 hyperintensity of the cervical cord at 6 level which is nonspecific however could represent small focus of myelopathy.


Instruction: Generate impression based on medical findings.

Input: 61 year old man referred for cardiac MRI prior to AF ablation. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 66%, the LV end diastolic volume index is 102 ml/m2 (normal range: 74+/-15), the LVEDV is 258 ml (normal range 142+/-34), the LV end systolic volume index is 33 ml/m2 (normal range 25+/-9), the LVESV is 174 ml (normal range 47+/-19). There is mild concentric LVH. There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is mild-moderately dilated (128ml).Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 53%, the RV end diastolic volume index is 104 ml/m2 (normal range 82+/-16), the RVEDV is 262 ml (normal range 142+/-31), the RV end systolic volume index is 49 ml/m2 (normal range 31+/-9), and the RVESV is 124 ml (normal range 54+/-17).Right AtriumThe right atrium is severely dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is trace mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root (SOV) is mildly dilated (42mm).Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.RUPV: 29 X 17mmRLPV: 18 X 17 mmLUPV: 16 x 8mmLLPV: 16 x 10mmPulmonary ArteryThe main pulmonary artery is moderately dilated.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. The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 66%.2. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 53%.3. The left atrium is mild-moderately dilated (128ml) with normal pulmonary vein anatomy.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: 31-year-old male with VP shunt. Headache. There has been interval removal of a right-sided shunt catheter. Overall, third and lateral ventriculomegaly is improved. Enlarged third ventricle correlates with findings on prior brain MRI. There is no evidence of intracranial hemorrhage.There is a large sellar mass with extension into the basal cistern. Extensive calcifications are again seen. No significant change in the sellar mass.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Improved ventriculomegaly of the lateral and third ventricles.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Eval progressive grade III oligodendroglioma s/p recent resection w/ adenoviral vector injection on clinical trial.Signs and Symptoms: grade III oligodendroglioma.Comments: Grade III oligodendroglioma s/p resection w/ adenoviral vector injection 2 weeks ago on a clinical trial. | The patient status post right frontal craniotomy for removal of a right frontal lobe mass. There is signal hyperintensity present along the right frontal lobe within the subcortical and periventricular white matter adjacent to the right superior middle and inferior frontal gyrus as well as the right external capsule. The extent of the white matter signal abnormality remains stable and compared to the previous exam from October 6, however, this white matter signal change appears to be more extensive than on the 7/23/2015 exam. Compared to the 9/15/2015 exam - which is preoperative- the outer extent of the white matter signal change appears very similar. There are punctate foci of susceptibility effect present within the white matter signal change adjacent to the resection site. These were also present on the 9/15/2015 exam. There is redemonstration of ill-defined enhancement were these punctate foci of susceptibility are surrounding the surgical margins .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: Since the previous exam is no substantial change. There is redemonstration of status post right frontal lobe surgery. The possibility of a residual neoplasm in the remaining right frontal lobe cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old. Reason: evaluating goiter noted on exam RIGHT LOBE MEASUREMENTS: 5.6 x 1.8 x 1.8 cmLEFT LOBE MEASUREMENTS: 5.1 x 1.6 x 1.7 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Minimally heterogeneous echotexture, without focal lesion.LEFT LOBE: Minimally heterogeneous echotexture. A nodule in the mid left lobe measures 0.3 x 0.3 x 0 .4 cm, spongiform, with minimal internal vascularity. An additional nodule in the mid left lobe measures 0.5 x 0.5 x 0.6 cm, homogeneous and hypoechoic, noncalcified, with minimal internal vascularity.ISTHMUS: Minimally heterogeneous echotexture, without focal lesion.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-appearing cervical lymph nodes are identified. A left level 2 lymph node measures 0.9 x 0.7 x 1.0 cm.OTHER: No significant abnormality noted.

Output: Non-enlarged thyroid with two subcentimeter nodules in the left lobe. No regional adenopathy.


Instruction: Generate impression based on medical findings.

Input: Sickle cell patient with persistent severe headaches, evaluate for signs of increased pressure and/or lesions MRI brain:No restricted diffusion to suggest acute ischemia. The signal intensity of the brain parenchyma is within normal limits. There is no abnormal enhancement within the brain parenchyma. The ventricles, sulci, and basal cisterns are normal in size. There are no masses, mass effect or midline shift. The cerebellar tonsils are normal in position. There is no evidence of intracranial hemorrhage or extraaxial fluid collections. Polypoid mucosal thickening of the maxillary sinuses. The remaining paranasal sinuses and mastoid air cells are grossly aerated. The orbits are unremarkable.MRA brain:MRI angiogram is somewhat motion graded yet demonstrates patent anterior and posterior intracranial circulations without evidence of flow limiting stenoses, significant atherosclerosis, or aneurysms.

Output: 1.Essentially normal MRI brain without findings to account for the patient's symptoms.2. Essentially normal MRA brain.


Instruction: Generate impression based on medical findings.

Input: 15-year-old male with hematochezia. Assess for Crohn's disease.EXAMINATION: MR enterography without and with IV contrast 11/23/2015, 1106. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Symmetric in size and normal enhancement.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY:Moderate fecal burden without evidence of dilatation or bowel wall thickening.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Moderate fecal burden without evidence of dilatation or bowel wall thickening.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Moderate fecal burden without evidence of inflammatory bowel disease.


Instruction: Generate impression based on medical findings.

Input: 54-year-old male with numbness and tingling. Non-enhanced CT of the cervical spine:Axial 3-mm nonenhanced CT of the cervical spine is obtained. Sagittal and coronal 2-D reformatted images were obtained as well.The bony density in the alignment the vertebral column is unremarkable. Very minimal degenerative disk disease is identified.Limited view of the skull base and review of foramina magnum are unremarkable.There is no evidence of bony central spinal stenosis.Minimal compromise of the left neural foramina at C5 -- C6 secondary to hypertrophic changes of the left uncovertebral is noted.Mild compromise of the left neural foramina at C6 -- C7 also secondary to hypertrophic changes of uncovertebral is present. This examination is otherwise unremarkable.For better evaluation of cervical spine and in particular for better assessment of soft tissues in particular the disk material and ligaments which could result in compromise of the neural foramina an MRI is recommended. This examination is not sensitive for detection of subtle abnormalities of the disk including herniated disk.

Output: 1.Mild degenerative disk disease and resultant compromise of the left neural foramina at C5 -- C6 and C6 -- C7 levels. No detectable bony central spinal stenosis.2.MRI examination of cervical spine is significantly more sensitive for detection of subtle disk abnormalities, neural foramina compromise and the spinal cord.


Instruction: Generate impression based on medical findings.

Input: History of spinal stenosis in the cervical region. Per Epic note: several months of increasing right lower extremity pain and weakness especially while driving for long hours. There are postoperative findings related to anterior cervical discectomy and fusion from C6 to T1. At C5-6, there is an eccentric right disc-osteophyte complex that results in moderate-to-severe right neural foraminal stenosis, but no significant spinal canal stenosis. At C6-7, there is bilateral facet and uncovertebral joint hypertrophy with perhaps mild-to-moderate bilateral neural foraminal stenoses. At C7-T1, there is bilateral facet and uncovertebral joint hypertrophy with perhaps minimal bilateral neural foraminal stenoses. There is no significant spinal canal or neural foraminal stenosis at the other levels of the cervical spine. The cervical spinal cord displays normal signal characteristics and morphology. The cervical spinal column alignment is near-anatomic. The paravertebral soft tissues are unremarkable.

Output: 1. Postoperative findings related to anterior cervical discectomy and fusion from C6 to T1.2. At C5-6, there is an eccentric right disc-osteophyte complex that results in moderate-to-severe right neural foraminal stenosis, but no significant spinal canal stenosis. 3. At C6-7, there is bilateral facet and uncovertebral joint hypertrophy with perhaps mild-to-moderate bilateral neural foraminal stenoses. 4. At C7-T1, there is bilateral facet and uncovertebral joint hypertrophy with perhaps minimal bilateral neural foraminal stenoses.


Instruction: Generate impression based on medical findings.

Input: Pain MENISCI: Similar minimal increased signal and fraying along the tibial surface of the body and posterior horn of the lateral meniscus is again observed. The menisci are otherwise preserved throughout, specifically no additional findings to suggest interval tearing. The above mentioned finding again most likely represents postsurgical changes from a previously described partial meniscectomy.ARTICULAR CARTILAGE AND BONE: Again previously observed heterogeneity of the articular cartilage most pronounced in the lateral compartment and along the weightbearing portions of the condyle are again observed. Specifically no progression and mild improvement is suggested, likely representing interval continued improvement from a prior surgical microfracture. Again no specific full-thickness articular cartilage abnormality is observed throughout, other than the thinning and heterogeneous signal in the lateral patellar facet.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: Similar mild patella alta, unchanged.ADDITIONAL

Output: Scattered postsurgical changes and degenerative findings, however no new interval significant new abnormalities. See details provided


Instruction: Generate impression based on medical findings.

Input: Right lower extremity pain, evaluate for right L5-S1 synovial cyst. Radiculopathy. There are small disc bulges and facet hypertrophy at L4-5 and L5-S1 with up to mild to moderate right L4-5 neural foraminal narrowing, but no significant spinal canal stenosis. The vertebral column alignment is within normal limits. There is mild loss of anterior vertebral body height of T12, with a superior end plate disc herniation, which is unchanged since October 2014. The disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. There is a subcentimeter sacral perineural cyst. There are bilateral probable inferior renal cysts.

Output: Degenerative spondylosis at L4-5 and L5-S1 with up to mild to moderate right L4-5 neural foraminal narrowing, but no significant spinal canal stenosis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old. Severe pain and swelling. Sjogren's. MENISCI: There is partial extrusion of the body of the medial meniscus with globular internal signal abnormality which is not definitely extend to an articular surface. There is apical blunting/finding loss of the anterior horn of the lateral meniscus. ARTICULAR CARTILAGE AND BONE: There is mild diffuse cartilage thinning of the patella, with a focal full-thickness defect along the lateral patellar facet with mild underlying marrow signal abnormality as well as a partial-thickness defect near the apex. There is a large area of full thickness cartilage loss involving the medial femoral condyle and medial tibial plateau with bone marrow reactive changes predominantly affecting the femoral condyle and to a lesser degree the tibial plateau. The lateral tibiofemoral articulation shows mild to moderate diffuse cartilage thinning without focal defect or underlying marrow signal abnormality.LIGAMENTS: Cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1.Full-thickness cartilage loss involving the medial tibiofemoral articulation with bone marrow reactive changes predominantly affecting the medial femoral condyle. Associated partial extrusion of the body of the medial meniscus without definite tear.2.Focal patellar full-thickness cartilage defects and associated marrow reactive changes as above.3.Moderate joint effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old, with GBM, follow-up examination. Postoperative changes are again seen compatible with left temporal/parietal craniotomy and tumor resection. The treatment bed shows a dense accumulation of susceptibility effect likely representing chronic hemosiderin, unchanged.Ill-defined T2 hyperintensity surrounding the treatment bed and extending through the left temporal, occipital, parietal and frontal lobes is unchanged. Irregular enhancement within the treatment bed centered on the ventricular atrium has not significantly changed in size or extent. Ependymal enhancement along the left occipital horn may be minimally thicker when compared to prior examination but this could also be technical in nature.No new enhancing or T2 hyperintense lesions are seen. Ill-defined T2 hyperintensity around the right lateral ventricle, and scattered small foci elsewhere in the brain, are unchanged. Ventricles are stable in size and morphology.

Output: No definite or significant interval change is seen in the size and distribution of irregular enhancement in the left parietotemporal treatment bed. Ependymal enhancement along the left occipital horn may be minimally increased in thickness but this could also be technical.


Instruction: Generate impression based on medical findings.

Input: Bilateral severe to profound sensorineural hearing loss. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is an appropriate degree of myelination, with terminal zones of myelination that are most pronounced in the bilateral parietal periventricular regions. Indeed, the brain parenchyma, brainstem, cerebellum, and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Internal Auditory Canals: The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. No discernible inner ear anomalies of cochlear nerve deficiency.


Instruction: Generate impression based on medical findings.

Input: 43-year-old woman with history of ulcerative colitis status post proctocolectomy with ileal pouch anal anastomosis 23 years ago, left ischiorectal fossa abscess status post drainage and seton placement in December 2015, please evaluate for fistulous tracts. PELVIS:UTERUS, ADNEXA: C-section scar noted. Nabothian cysts present. A simple 3.7 cm right ovarian cyst is noted, physiologic for a menstruating patient.BLADDER: No significant abnormality noted.LYMPH NODES: Mildly prominent inguinal lymph nodes noted, likely reactive.BOWEL, MESENTERY: There is a perianal seton within a transsphincteric fistulous tract extending from the 12:00 position of the rectum to the left gluteal cleft in the left ischioanal fossa. The surrounding soft tissues are indurated with increased T2 signal.Within this region (6/39) there is a questionable T2 hyperintense tract extending from the 1:00 position of the rectum to a 23 x 8 mm collection of fluid in the left labia majora (7/29) which demonstrates minimal peripheral enhancement. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Enhancing fluid collection in the left labia majora which, could represent a small abscess, but likely communicates with the rectum via a suspected (but not clearly visualized) fistulous tract.2.Seton within the left transsphincteric fistulous tract.


Instruction: Generate impression based on medical findings.

Input: Torticollis [M43.6], Severely decreased ROM at neck in all directions. Evaluate for spondyloarthropathy or DDD. The examination is significantly degraded by patient motion. There is a nonspecific heterogeneous bone marrow signal intensity. The vertebral body heights are grossly maintained. There is multilevel loss of intervertebral disc space, particularly at C6-7. The spinal cord demonstrates normal signal intensity, within the limitations of motion artifact. There is paucity of the left vertebral artery flow-void diffusely. The paraspinal soft tissues are grossly within normal limits.C2-3: There is no significant disc herniation, neural foraminal stenosis, or spinal stenosis.C3-4: There is a disc bulge causing mild effacement of the ventral thecal sac and perhaps mild bilateral neural foraminal stenosis.C4-5: There is a posterior disc osteophyte complex and hypertrophy of the ligamentum flavum resulting in mild spinal stenosis and left neural foraminal stenosis.C5-6: There is mild left neural foraminal stenosis secondary to posterior disc osteophyte complex and hypertrophy of the ligamentum flavum.C6-7: There is a posterior disc osteophyte complex and hypertrophy of the ligamentum flavum resulting in moderate spinal and moderate right neural foraminal stenosis.C7-T1: There is a small posterior disc osteophyte complex without significant spinal or neural foraminal stenosis.

Output: 1. Nonspecific diffusely heterogeneous appearance of the vertebral bone marrow.2. Multilevel degenerative spondylosis of the cervical spine, which is most pronounced at C6-7 due to at least moderate spinal stenosis associated with disc-osteophyte formation.3. The left vertebral artery does not demonstrate normal flow-voids, perhaps due to steno-occlusive disease. MRA or CTA may be useful for further evaluation.


Instruction: Generate impression based on medical findings.

Input: An 80 year old male with history oh hypertension, stroke, end stage renal disease and systemic amyloidosis. A recent echocardiography showed good left ventricular function with hypertrophy. Referred to cardiac MRI (without contrast due to low kidney function) to evaluate cardiac amyloidosis Left VentricleThe left ventricle is normal in size with hyperdynamic systolic function. The overall LV ejection fraction is 70%, the LV end diastolic volume index is 99 ml/m2 (normal range: 74+/-15), the LVEDV is 177 ml (normal range 142+/-34), the LV end systolic volume index is 30 ml/m2 (normal range 25+/-9), the LVESV is 54 ml (normal range 47+/-19). There is concentric LVH. There are no regional wall motion abnormalities present. T1-mapping showed normal values suggesting that there is no presence of an underlying fibrosing, infiltrative, or inflammatory process.No LV thrombus was seen. No evidence of iron overload was notedLeft AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 53%, the RV end diastolic volume index is 100 ml/m2 (normal range 82+/-16), the RVEDV is 178 ml (normal range 142+/-31), the RV end systolic volume index is 47 ml/m2 (normal range 31+/-9), and the RVESV is 84 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is moderate to severe aortic regurgitation (regurgitant fraction of 42%). The number of AV leaflets could not be determined.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium. The SVC is normal in size while the IVC is dilated.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with hyperdynamic systolic function, the LVEF is 70%. There is concentric LVH.2. T1-mapping showed normal values suggesting that there is no presence of an underlying fibrosing, infiltrative, or inflammatory process.3. The right ventricle is normal in size with normal systolic function, the RVEF is 53%. 4. There is moderate to severe aortic regurgitation (regurgitant fraction of 42%).


Instruction: Generate impression based on medical findings.

Input: Sign and symptoms: Dizziness and dizziness abnormal findings on diagnostic imaging of head.Reason for study: Further evaluation of right periatrial hyperintensity, also rule out CP angle lesion.History: Vertigo, dizziness and weakness.. There is a T2/FLAIR hyperintense focus in the right periatrial white matter with corresponding T1 hypointense signal (image 18, series 701). This is second T2 hyperintense similar focus adjacent to the right frontal horn of the lateral ventricle (image 16, series 701). There is a third focus of T2 hyperintensity along the lateral aspect of the right splenium of corpus callosum (image 17, series 701), which was better appreciated on the prior MRI. None of these lesions demonstrates diffusion restriction, or susceptibility effects or abnormal enhancement. There is no evidence of intracranial hemorrhage or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation.Note that this study is not dedicated for internal auditory meatus /temporal bone. However, no abnormal enhancement in the cerebellar hemispheres or cerebello pontine angles are visualized. Bilateral internal auditory canals show no abnormal enhancement. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.There are three T2 hyperintense foci in the right periatrial, adjacent to the frontal horn of the lateral ventricle white matter and lateral aspect of the right splenium of corpus callosum. These foci particularly along the corpus callosum is suspicious for demyelinating lesions. Suggested detailed clinical examination as well as correlation with laboratory parameters.2.No evidence of posterior fossa or cerebellopontine angle tumor.


Instruction: Generate impression based on medical findings.

Input: Female 49 years old Reason: right knee pain History: as above MENISCI: Mild intrasubstance degeneration involving the posterior horn of lateral meniscus and posterior horn of medial meniscus that does not extend to an articular surface. The menisci are otherwise unremarkable.ARTICULAR CARTILAGE AND BONE: There is diffuse chondral thinning in the medial and lateral compartments with small foci of deeper chondral defects. There is foci of cartilage fibrillation and degeneration involving the extensor compartment.Marrow signal is normal. No acute fracture or malalignment.LIGAMENTS: Anterior and posterior cruciate ligaments are intact. EXTENSOR MECHANISM: The quadriceps and patellar tendons are intact.ADDITIONAL

Output: Intact menisci and cruciate ligaments.Mild tricompartmental cartilage degeneration.


Instruction: Generate impression based on medical findings.

Input: Reason: Assess for rotator cuff tear - concern for supraspinatus and infraspinatus; acute injury 5/15 with new weakness and shoulder pain History: Right shoulder pain, supraspinatus and infraspinatus weakness after acute injury (fall) ROTATOR CUFF: Again seen is a full-thickness tear of the anterior fibers of the supraspinatus at the level of its insertion on the greater tuberosity measuring approximately 2.2 cm in the AP dimension. There is associated retraction of the proximal tendon fragment by approximately 4 cm. There is thickening and intermediate signal intensity within the proximal tendon fragment indicating tendinosis. There is moderate fatty atrophy of the supraspinatus. The infraspinatus muscle and tendon appear intact. There is thickening and intermediate signal intensity within the subscapularis indicating moderate tendinosis. There is linear fluid signal intensity within the tendon indicating interstitial tearing. The teres minor muscle and tendon appear intact.SUPRASPINATUS OUTLET: There is a small amount of fluid within the subacromial subdeltoid bursa with foci of low signal intensity internally which may reflect a bursitis or debris. Severe osteoarthritis affects the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. There is heterogeneity and increased signal abnormality within the inferior labrum likely representing a combination of degeneration and degenerative tearing.BICEPS TENDON: There is a small amount of fluid within the tendon sheath of the long head of biceps tendon which may represent fluid extension from the joint. The tendon itself appears intact. ADDITIONAL

Output: 1. Full-thickness tear of the anterior fibers of the supraspinatus with retraction which appears increased in size when compared to the prior study. Interstitial tearing of the subscapularis. Rotator cuff tendinosis.2. Osteoarthritis of the shoulder.3. Findings suggestive of a subacromial subdeltoid bursitis and possible glenohumeral joint synovitis. Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Reason: seizure focus? History: epilepsy The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.There is no evidence for mesial temporal sclerosis.The visualized portions of the paranasal sinuses demonstrate partial opacification of the ethmoid air cells as well as mucous retention cysts in the maxillary sinuses and right sphenoid sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.No evidence for intracranial mass lesion or other lesion that would explain the patient's seizures.


Instruction: Generate impression based on medical findings.

Input: There are no fractures. The marrow signal is benign. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable. There are no MRI findings of ligamentous injury.C2/3: Posterior osteophyte disc complex, ligamentum flavum thickening, and mild bilateral facet hypertrophy. There is mild central and moderate to severe bilateral neural foraminal stenosis.C3/4: Mild posterior osteophyte disc complex and ligamental flavum thickening. There is minimal central stenosis. There is slight flattening of the anterior cord surface without intrinsic cord signal abnormality.C4/5: Trace retrolisthesis C4 on C5, posterior osteophyte disc complex, bilateral uncinate hypertrophy, and ligamentum flavum thickening. Redemonstrated is a small focus of T2 hyperintensity within the left hemicord, not significantly changed, consistent with myomalacia. There is minimal central and moderate bilateral neural foraminal stenosis. There is slight flattening of the anterior cord surface without intrinsic cord signal abnormality.C5/6: Trace retrolisthesis C5 on C6, posterior osteophyte disc complex, bilateral uncinate hypertrophy, and ligamentum flavum thickening. There is mild to moderate central and moderate to severe bilateral neural foraminal stenosis. There is slight flattening of the anterior cord surface without intrinsic cord signal abnormality.C6/7: Trace retrolisthesis C6 on C7, posterior osteophyte disc complex, bilateral uncinate hypertrophy, and ligamentum flavum thickening. There is mild central, severe left neural foraminal, and moderate to severe right neural foraminal stenosis.C7/T1: Left facet hypertrophy results in mild left neural foraminal stenosis.

Output: 1.C2/3: Mild central and moderate to severe bilateral neural foraminal stenosis.2.C3/4: Minimal central stenosis. There is slight flattening of the anterior cord surface without intrinsic cord signal abnormality.3.C4/5: Redemonstrated is a small focus of T2 hyperintensity within the left hemicord, not significantly changed, consistent with myomalacia. There is minimal central and moderate bilateral neural foraminal stenosis.4.C5/6: Mild to moderate central and moderate to severe bilateral neural foraminal stenosis.5.C6/7: Mild central, severe left neural foraminal, and moderate to severe right neural foraminal stenosis.6.C7/T1: Mild left neural foraminal stenosis.


Instruction: Generate impression based on medical findings.

Input: Ewing sarcoma, restaging Note that the evaluation of the femur is severely limited secondary to the presence of a femoral endoprosthesis and hip arthroplasty.The surgical changes in the lateral soft tissues of the right upper thigh with a linear tract extending from the skin to the the vastus lateral and intermedius are again observed. There is persistent low signal intensity on T1 and bright signal on T2 although the extent of T2 hyperintensity within the musculature again appears slightly improved from the prior exam. There is persistent heterogeneous enhancement of the left thigh without discrete mass. The fullness of the lateral thigh, thought to be related to muscular herniation or scarring, is similar to the prior exam. There is generalized mild fatty atrophy of the thigh musculature which is similar to the prior exam.

Output: Within the limits of the exam, there is no discrete enhancing mass or definite evidence of recurrence where evaluation is available.


Instruction: Generate impression based on medical findings.

Input: History of vertigo, numbness, and weakness. HTN, POAG, Retinal detachment OS status post laser who presents for follow-up for optic disc pallor versus cupping. Orbits: There is volume loss and high T2 signal in the posterior orbital segment and canalicular segment of the right optic nerve. The right globe, extraocular muscles, and lacrimal gland are unremarkable. There is no evidence of intraorbital mass or abnormal enhancement. The left orbit is unremarkable.Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is minimal nonspecific cerebral white mater T2 hyperintensity. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are unremarkable. There is a small right maxillary sinus retention cyst.

Output: 1. Right optic nerve atrophy may be secondary to a prior ischemic event.2. No evidence of demyelinating lesions, mass, or acute infarction.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Patient with GBM, status post surgery, RT and now on TMZ. Compared to outside institution MRI exam. Signs and symptoms: GBM. Pre and post enhanced brain MRI:Examination demonstrates post operative changes of a right posterior temporal-parietal craniotomy. A surgical cavity with CSF signal intensity in the right superior gyral of posterior temporal lobe measures at approximately 25 x 20 mm similar to prior exam. Extensive surrounding FLAIR hyperintensity without appreciable mass effect also remains nearly identical to prior exam. On post enhanced images there is a linear inhomogeneous enhancement along the posterior surgical cavity wall which considering the technique difference between the 2 exam (current study with thin slices compared to OSH exam of 6 mm slice thickness) demonstrate no convincing evidence of change. There is however a well-demarcated thick focus of enhancement along the anterior inferior aspect of the surgical cavity measuring at 4.5 mm in thickness and 6 mm at the base along the cavity wall which is highly concerning for focus of recurrence or residual tumor. This finding is barely detected on prior exam on post enhanced series 11 image 11. Unremarkable exam otherwise for patient's stated age of 73 and without evidence of any new findings.

Output: 1.A focus of enhancement in the right posterior temporal surgical cavity wall (anterior- inferior) concerning for residual or recurrence tumor, measuring 6 x 4.5 mm with significant interval increase since prior study.2.Postoperative changes of tumor removal in the right posterior temporal with stable thin however irregular band of enhancement along the posterior surgical cavity wall which could represent postsurgical change or residual tumor. Further follow-up is needed for further assessment.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Abdominal pain, right lower quadrantClinical question: r/p cauda equina/stenosisSigns and Symptoms: unable to hold urine Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. No abnormal enhancing lesions are appreciated in the lumbar spine.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is bilateral facet hypertrophy of a moderate degree at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is some mild ligamentum flavum hypertrophy at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There is no compromise to lumbar spinal canal or exiting nerve roots. No abnormal mass lesions are appreciated in the lumbar spine.2.There are some degenerative changes present in the lower lumbar spine.


Instruction: Generate impression based on medical findings.

Input: 80-year-old male with lower extremity weakness that began 2 days ago and the sudden onset. Evaluate for cord compression. MRI Cord compression protocol:Severely motion limited exam with high suspicion of cord compression spanning from the T5 vertebral level through approximately T7. Therefore, additional sequences were obtained in the axial plane in attempt to better visualized the thoracic spine as described below. Elsewhere outside the thoracic spine, there is evidence of diffuse osseous metastatic disease which is progressed compared to the prior MRI exam from 11/18/2011. There are degenerative changes involving the cervical spine, upper thoracic spine and lumbar spine with scoliosis but without evidence of cord compression or high grade stenosis in these regions. MRI thoracic spine:Again seen is diffuse metastatic disease involving the vertebral bodies of the thoracic spine, progressed compared to the previous MRI exam. Motion degradation artifact limits full evaluation. Within these limitations, there is suspected severe spinal canal stenosis secondary to circumferential tumor encasing the spinal cord and spanning from the T5-6 to T6-7 vertebral body levels. There is questionable cord signal abnormality at this level not well assessed. There is also evidence of tumor within the the spinal canal to a somewhat lesser degree spanning from the T7 level to the T10 level. There is prominent dextroscoliosis of the thoracolumbar spine which has progressed compared to the prior MRI.MRI lumbar spine:There is diffuse osseous metastatic disease involving the visualized lumbar spine and pelvis which has progressed compared to the MRI from 11/18/2011 but unchanged compared to the CT abdomen and pelvis from 2/1/2016. With an unchanged mild compression fracture involving the L1 vertebral body anteroinferiorly, which along with severe disc loss, causes a mild focal kyphosis at this level. There is also mild rightward lateral translation of L2 on L3 and severe loss of disc height at this level. There are areas of minimal to mild vertebral body height loss at multiple levels relatively more prominent at T10.There are multilevel degenerative changes throughout the lumbar spine with disc bulges, facet arthropathy, and ligamentum flavum thickening. There is no significant central spinal canal stenosis at any level in the lumbar spine. There is multilevel neural foraminal stenosis, relatively worst at the right L5-S1 level.

Output: 1.Motion degradation artifact limits full evaluation. Within these limitations, there is suspected severe spinal canal stenosis secondary to circumferential epidural tumor spanning from the T5-T6 to T6-T7 vertebral body levels. There is questionable cord signal abnormality at this level but poorly assessed. Contrast enhanced imaging is recommended for further evaluation. Consider anesthesia assistance given the extensive motion.2.There is also tumor involvement of the spinal canal to a somewhat lesser degree spanning from the T7 level to the T10 level.3.Multilevel degenerative changes are visualized as described above but there is no evidence of high-grade spinal canal stenosis or cord compression in the remainder of the cervical, upper thoracic or lumbar spine.4.Findings were discussed with Dr. Choi of the Heme-Onc service at the time of the preliminary entry for the patient at 08:16 pm on 8/27/2016 by Dr. Veronesi, Neuroradiology Fellow.


Instruction: Generate impression based on medical findings.

Input: Reason: 64 yo woman with pain, swelling ulnar aspect of right hand/wrist. Dystrophic calcifications seen in soft tissue of right hand History: pain, swelling ulnar aspect of right hand/wrist There is degenerative subchondral cyst formation within the lunate and capitate bones. Note is made of a short fourth metacarpal. There is peripherally enhancing fluid within the ulnocarpal joint indicating a synovitis. There are multiple foci of decreased signal abnormality within the abductor digiti minimi muscle corresponding to the findings on recent radiographs which may reflect dystrophic calcification. There is enhancing signal abnormality within the abductor digiti minimi muscle at the level of the myotendinous junction indicating nonspecific inflammatory change. Although this examination was not optimized for evaluation of the triangular fibrocartilage complex, there is increased signal abnormality within the articular cartilage disc just proximal to its attachment on the ulnar styloid indicating degeneration or perhaps degenerative tearing. There is increased signal abnormality within the extensor carpi ulnaris tendon which may reflect a mild tendinosis. The flexor and chest with tendons appear intact. No additional bone marrow signal abnormality is identified.

Output: 1. Findings indicating a synovitis of the ulnocarpal articulation.2. Nonspecific inflammatory change within the abductor digiti minimi muscle at the level of the myotendinous junction.3. Punctate foci of decreased signal abnormality within the abductor digit minimi may represent dystrophic calcification.4. Short fourth metacarpal.


Instruction: Generate impression based on medical findings.

Input: Female, 16 years old, with history of chronic intermittent headaches. Please evaluate for structural abnormality, especially the craniocervical junction. The right cerebellar tonsil demonstrates a pointed configuration and descends approximately 4 mm below the level of the foramen magnum. The CSF space is effaced around the right tonsil. The left cerebellar tonsil seems to terminate at the level of the foramen magnum and shows a normal round morphology.The remainder of the brain demonstrates normal morphology and signal characteristics. No restricted diffusion is seen. No parenchymal edema or mass effect is identified. There is no evidence of intracranial hemorrhage or any abnormal extra axial fluid collection. The ventricular system is normal.

Output: Descent of the right cerebellar tonsil approximately 4 mm below the level of the foramen magnum is at least compatible with ectopia. Although the strict imaging criteria for a Chiari I malformation are not met, the fact that the tonsil is relatively pointed with effacement of the surrounding CSF space would nevertheless suggest the possibility of a Chiari I-type process.The remainder of the examination is unremarkable with no additional findings to account for the patient's headaches.