Instruction: Generate impression based on medical findings.

Input: History of retroperitoneal liposarcoma. Evaluate for response to treatment. PELVIS:UTERUS, ADNEXA: The uterus is displaced towards the left by the large right hemipelvis mass. Otherwise it is unremarkable. The adnexa are not clearly identified.BLADDER: The bladder is mostly collapsed and displaced by the large right hemipelvis mass.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Demonstrated again is the heterogeneously enhancing mass in the right hemipelvis measuring 11.8 x 8.1 cm in maximal cross section (series 13/16), compared to 11.5 x 7.8 cm previously. In the craniocaudal dimension the lesion measures 12.9 cm (series 12/18). It contains heterogeneously intrinsic signal, including that of fat intensity compatible with states history of liposarcoma.The mass displaces the bladder, uterus and mesorectal fascia towards the left.The fat planes between the mass, the right piriformis muscle, uterus and bladder are indistinct, appearing similar to the prior study.The mass partially encases the right common and external iliac artery and vein, similar to the prior study. The lesion encases the right internal iliac artery and vein and their branches which are generally opacified, unchanged.The component of the lesion extending through the sacrosciatic notch to the level of the ischial tuberosity is not significantly changed in size. It encases the sciatic nerve as well as the more proximal sacral nerve roots. The tumor tracks along the sacral plexus to level of the right L5 and S1 neural foramen. The lesion abuts the right sacral ala and medial right iliac bone without definite osseous invasion, similar to prior.Small amount of presacral fluid is unchanged.OTHER: No significant abnormality noted.

Output: 1. No significant interval change in the right pelvic mass with extensive mass effect and soft tissue involvement as described.2. Stable involvement of the sciatic nerve to the level of the ischial tuberosity and tracking along the sacral plexus to the L5 and S1 right neural foramen.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Malignant neoplasm of liver, primary, unspecified as to typeClinical question: eval for metastatic diseaseSigns and Symptoms: back pain, hcc 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. A T1 signal hyperintense lesion measuring 1 cm located within the L4 vertebral body most likely represents a hemangioma.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, disc desiccation and endplate reactive change present at this level is associated with mild narrowing of the neural foramina bilaterally. There is mild facet hypertrophy at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is mild facet hypertrophy present 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.There is a nonenhancing focus of signal abnormality present within the right kidney with a wedgelike configuration. Measuring approximately 22 mm in size .

Output: 1.Some degenerative changes are present in the lumbar spine without compromise to lumbar spinal canal or neural foramina.2.There is a lesion within the right kidney. It is suspected to represent possibly an infarction but is nonspecific. If clinically appropriate additional imaging of the kidneys with help further evaluate this.


Instruction: Generate impression based on medical findings.

Input: 66-year-old woman with coarse hepatic echotexture and possible mass in the dome of the liver seen on recent ultrasound. ABDOMEN:LIVER, BILIARY TRACT: In segment 8 of the liver (601/36), there is an 83 x 73 mm multilobulated lesion. This lesion is markedly T2 hyperintense. Additionally, there is peripheral nodular enhancement of this lesion on the delayed postcontrast images (1504/84). This lesion appears hyperechoic on comparison ultrasound.Additional, smaller lesions with similar imaging characteristics are noted in the right lobe and measure up to 2 cm.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple right renal cysts noted. Left kidney appears normal.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Significant dielectric artifact from the distended stomach. The remaining, partially visualized small bowel and colon otherwise appear normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small-moderate bilateral pleural effusions noted.

Output: 1.Significantly limited study due to failure of fat saturation and dielectric artifact from a markedly distended stomach. The perfusion sequences are nondiagnostic. 2.Large lesion in segment 8 of the liver with smaller similar lesions scattered throughout the right lobe. Due to the aforementioned limitations, imaging findings are suggestive but not entirely diagnostic of hemangiomata. 3.Follow up MR imaging can be considered in 3-6 months or the perfusion sequences can be repeated at no additional cost to the patient.


Instruction: Generate impression based on medical findings.

Input: 43 year old with strong family history of breast cancer There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on medical findings.

Input: 64-year-old male with metastatic brain tumor with bleeding in the right frontal. Follow-up Multiple foci of vasogenic edema are consistent with peritumoral edema from patient's known metastatic lesions. A small hemorrhagic and necrotic tumor superficially within the high convexity left frontal lobe measuring 9.6-mm times 9-mm on axial image 22 is noted. A second solid hemorrhagic tumor in the right frontal lobe measures 12.2-mm x 9.7-mm on axial image 18. Both of these lesions were present on the prior MRI exam and demonstrates no definitive interval change.

Output: Multiple foci of vasogenic edema with two hemorrhagic METs as detailed above.


Instruction: Generate impression based on medical findings.

Input: 9 months old with post-operative seizure secondary to hypoglycemia. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears normal. The medial temporal lobes appear symmetric. The anterior and posterior pituitary normal in appearance. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. There are minimal bilateral mastoid effusions.

Output: 1. No discernible seizure focus or stigmata of hypoglycemic encephalopathy.2. Nonspecific minimal bilateral mastoid effusions.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: Diagnosis: Other symptoms and signs involving the musculoskeletal systemClinical question: Rule out focal brain findingSigns and Symptoms: Upper and lower extremity weakness, altered mental status Minimal artifact from patient's dentition distorts the appearance of the frontal lobes and obviates visualization of the orbits.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.

Output: Examination is partially degraded due to metal artifact which obscures some visualization of the orbits and paranasal sinuses and degrades visualization of the frontal lobes. The brain is only partly visualized on susceptibility imaging (which would be used to identify foci of hemorrhage). To extent of visualization no abnormal mass lesion is appreciated to account for the patient's upper and lower extremity weakness and altered mental status.


Instruction: Generate impression based on medical findings.

Input: History of HCC treated with radiofrequency ablation x 2. Study is slightly limited by patient's body habitus and inability to place arms above the head.ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology with findings of segment V/VIII focal confluent fibrosis. Stigmata of portal hypertension including splenomegaly, gastroesophageal varices and recannulized periumbilical vein.The liver parenchyma demonstrates loss of signal on in phase imaging compatible with iron deposition.In segment 3, inferior lateral segment of the left hepatic lobe there is a 2.7 x 1.7 cm postablation halo (series 9/41) which is intrinsically T1 hyperintense. No residual arterial enhancing lesion is evident.Several scattered arterial enhancing foci become isointense on the delayed imaging likely representing perfusional anomalies.No new suspicious arterially enhancing lesion demonstrating washout.Segment 7 and segment 8 simple cyst.The hepatic vessels appear patent. Portal vein enlargement compatible portal hypertension.Cholelithiasis within a normally distended gallbladder. No biliary ductal dilatation.SPLEEN: Marked splenomegaly with the spleen measuring 22 cm in craniocaudal dimension. Splenic hilar collateral vessels. PANCREAS: Multiple T2 hyperintense lesions within the pancreas most of which appear to communicate with the main pancreatic duct and likely represent side branch IPMNs. The main pancreatic duct is normal in caliber. The largest lesion is in the pancreatic body/tail measuring 1.6 x 1.1 cm (series 5/17), not significantly increased in size. No suspicious enhancing imaging features. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small right renal exophytic simple cyst. No hydronephrosisRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small right pleural effusion with compressive atelectasis. Rate recanalized periumbilical vein.

Output: Interval re-ablation of the segment 3 hepatic lesion without evidence of residual or recurrent disease. No new suspicious lesion. Cirrhosis with portal hypertension. Small right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male 66 years old Reason: hx of prostate cancer in focal ablation trial History: see above PELVIS:PROSTATE:Prostate Size: 5.5 x 5.5 x 3.8 cmPeripheral Zone: Focal atrophy and post-ablation changes at the left apex. No focal lesions suspicious for prostate cancer.Central Gland: Heterogenous. Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: None.BLADDER: Mild circumferential bladder wall thickening with trabeculation, suggestive of chronic outlet obstruction.LYMPH NODES: No pathologically enlarged lymph nodes nodes.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Focal atrophy and post-ablation changes at the left apex of the prostate gland. No evidence of prostate cancer.


Instruction: Generate impression based on medical findings.

Input: 57 year old male with heart failure with reduced ejection fraction (HFrEF), s/p renal transplant in 2007, COPD, HTN, DM, NSTEMI during neutropenic sepsis recently, cardiac cath deferred due to acute kidney injury, atrial fibrillation. Evaluation for viability/scar. First Pass PerfusionDuring hyperemia, no perfusion defects were presentViability/ Myocardial ScarThere is no evidence of prior myocardial infarction. There is a very small focal region of epicardial late gadolinium enhancement in the apical inferolateral wall which suggests the presence of a small amount of fibrosis, inflammation, or infiltration. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is mildly decreased 49%. The LVEDV is 187 ml (normal range 142+/-34), the LV end diastolic volume index is 90 ml/m2 (normal range: 74+/-15), the LVESV is 96 ml (normal range 47+/-19) and the LV end systolic volume index is 50 ml/m2 (normal range 25+/-9). The LV mass is 172 g (normal range 164+/-36) and the LV mass index is 90 g/m2 (normal range 85+/-15). There are no regional wall motion abnormalities present. There is no LV thrombus. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 51%. The RVEDV is 164 ml (normal range 142+/-31), RV end diastolic volume index is 86 ml/m2 (normal range 82+/-16), the RVESV is 80 ml (normal range 54+/-17), and the RV end systolic volume index is 42 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere are small bilateral pleural effusions and a possible right lung infiltrate near the hilum, correlation with recent non-contrast chest CT or chest x-ray suggested. 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. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and mildly decreased systolic function (LVEF 49%) with a very small focal region of epicardial late gadolinium enhancement in the apical inferolateral wall which suggests the presence of a small amount of fibrosis, inflammation, or infiltration. The pattern is not consistent with prior myocardial infarction.4. Normal RV size with normal systolic function (RVEF 51%). See extra cardiac findings.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: 68 year female. Smouldering multiple myeloma. Evaluate for myelomatous lesions. Heterogeneous signal intensity of the lower lumbar spine and pelvis with no focal myelomatous lesion. T1 hyperintensity in the central sacrum consistent with fatty marrow. Mild osteoarthritis of the bilateral hips.Degenerative arthritic changes of the lower lumbar spine, refer to same day MRI complete spine report for further details.

Output: No focal suspicious lesion. Degenerative arthritic changes.


Instruction: Generate impression based on medical findings.

Input: Reason: Evaluate for persistent right shoulder pain , evaluate for bicipital tendinitis or adhesive capsulitis ROTATOR CUFF: The supraspinatus, infraspinatus, subscapularis, and teres minor tendons are intact without evidence of tearing.SUPRASPINATUS OUTLET: Degenerative changes affect the acromioclavicular joint with a small amount of fluid in the joint space. The coracohumeral ligament appears normal.GLENOHUMERAL JOINT AND GLENOID LABRUM: Mild degenerative changes affect the glenohumeral joint, with multiple small subchondral cysts in the humeral head.BICEPS TENDON: The long and short heads of the biceps tendon are intact without evidence of tearing. ADDITIONAL

Output: Mild degenerative changes as described above without focal tearing or specific evidence of adhesive capsulitis.


Instruction: Generate impression based on medical findings.

Input: Pain. Rule out soft tissue pathology. Evaluation of the shoulder is slightly limited due to relatively poor signal on the fat-suppressed T2-weighted images.ROTATOR CUFF: There is a complete tear of the supraspinatus tendon from the greater tuberosity with retraction of the tendon to the level of the glenohumeral joint. Increased signal intensity within the distal end of the retracted tendon suggests tendinosis. There is mild fatty atrophy of the supraspinatus muscle. There is a near-complete to complete tear of the infraspinatus tendon, possibly with a few tendinous strands extending to the greater tuberosity posteriorly. The majority of the tendon is retracted to the level of the glenohumeral joint. Increased signal intensity within the retracted tendon reflects tendinosis and interstitial tearing. There is moderate fatty atrophy of the infraspinatus muscle. The teres minor muscle and tendon appear intact. There is thickening of the subscapularis tendon near its insertion on the lesser tuberosity that likely reflects a combination of tendinosis and redundancy due to internal rotation of the humeral head. Additional foci of increased signal intensity within the distal subscapularis tendon likely reflect interstitial and undersurface tearing. The subscapularis muscle is within normal limits for age.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. There is a small amount of fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The humeral head is high riding, but otherwise alignment is within normal limits. There is mild to moderate degeneration of the articular cartilage of the glenohumeral joint. Intermediate signal intensity within the superior labrum likely reflects degeneration, but I see no fluid-filled labral tear.BICEPS TENDON: The tendon of the long head of the biceps is poorly defined within the rotator interval which may simply be a technical phenomenon. The tendon is visualized within the intertubercular groove with a small amount of fluid in the biceps tendon sheath. Bone marrow signal intensity is within normal limits.

Output: Rotator cuff tear and other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Left-sided ulcerative colitis. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mild inflammatory changes of the rectum. The bowel is otherwise normal in appearance. Specifically, the terminal ileum is normal in caliber and without inflammatory changes. There is no abscess, fistula or perforation.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mild inflammatory changes of the rectum. The bowel is otherwise normal in appearance. Specifically, the terminal ileum is normal in caliber and without inflammatory changes. There is no abscess, fistula or perforation.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Mild inflammatory changes of the rectum. No other abnormality identified.


Instruction: Generate impression based on medical findings.

Input: Right auditory nerve schwannoma: dizziness, tinnitus, and right-sided hearing loss There is a punctate focus of restricted diffusion and high T2 signal in the posterior aspect of the left cerebellar hemisphere, compatible with acute infarct. There are also a few scattered periventricular and subcortical white matter T2 hyperintense foci without restricted diffusion. There is an avidly enhancing tubular lesion in the right internal auditory canal that measures up to approximately 10 mm. There is no evidence of acute intracranial hemorrhage. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.Punctate acute infarct in the left posterior cerebellar hemisphere. 2.Unchanged right vestibular schwannoma.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 cirrhosis and nonspecific lesion on prior MRI. ABDOMEN:LIVER, BILIARY TRACT: The liver is shrunken and nodular in morphology. There are small esophageal and perigastric varices. Small volume of perihepatic ascites. Borderline enlarged spleen. These findings are consistent with cirrhosis.A TIPS is in place. The portal vein proximal to the TIPS catheter is patent. The hepatic artery is patent as well as the middle and left hepatic veins. The right hepatic vein is not visualized due to artifact from the TIPS.Stable 9 x 9 mm lesion (series 9/17) in the right hepatic dome is difficult to see on T2-weighted imaging, appears mildly hyperintense on T1-weighted images. There is questionable faint arterial enhancement without restricted diffusion, no definite washout on subsequent delayed imaging.Stable peripheral wedge-shaped arterially enhancing focus extending from the distal end of the TIPS to the hepatic dome with persistent enhancement on delayed sequences with mild T2-weighted signal hyperintensity, likely a perfusion abnormality.SPLEEN: Mildly prominent spleen measuring 11 cm. Stable 1.8 cm distal splenic artery aneurysm (series 5/13).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 broad-based umbilical hernia containing small bowel without evidence of complication.Small loculated pocket of fluid at the GE junction is unchanged.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stable size and nonspecific appearance of the right hepatic dome lesion not meeting strict criteria for HCC. No new suspicious lesion.2.Cirrhosis, portal hypertension and TIPS placement.3.Stable 1.8 cm distal splenic artery aneurysm.


Instruction: Generate impression based on medical findings.

Input: 75-year-old male with lower back pain that is followed by increased stool frequency, evaluate for active small bowel inflammation from Crohn's disease. ABDOMEN:LIVER, BILIARY TRACT: The liver is cirrhotic in morphology. There is once again mild irregularity of the central intrahepatic biliary ducts appearing similar to prior, though this examination is not tailored for examination of the bile ducts. There is cholelithiasis without specific evidence of cholecystitis.SPLEEN: Splenomegaly, measuring up to approximately 17 cm in the cranial caudal dimension.PANCREAS: The previously described multiloculated cystic lesion in the uncinate process of the pancreas (series 3, image 18) measures approximately 1.1 x 1.4 cm, previously 1.1 x 1.4 cm.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Reference upper abdominal retroperitoneal lymph node (series 15, image 18) measures 3.9 x 1.3 cm, previously 3.9 x 1.3 cm. Other non and extrahepatic peritoneal lymph nodes appear similar to the prior examination.BOWEL, MESENTERY: There is increased fibrofatty proliferation involving the jejunum. Postsurgical changes of ileal resection are present. There is narrowing and decreased distensibility involving an approximately 10 cm segment of the distal neoterminal ileum without evidence of associated upstream obstruction. There is no associated bowel wall thickening, increased mucosal enhancement, or other signal abnormalities to suggest active inflammation.BONES, SOFT TISSUES: Degenerative changes affect the spine particularly the lower thoracic spine. Postsurgical changes are present in the anterior abdominal wall.OTHER: No significant abnormality noted.

Output: 1.Postsurgical changes of prior ileal resection.2.Non-flow limiting chronic stricturing of approximately 10 cm segment of presumed neoterminal ileum without evidence of active inflammation.3.Grossly stable appearance of the biliary tree compatible with history of sclerosing cholangitis. Cirrhotic liver. Splenomegaly.4.Grossly stable cystic lesion in the uncinate process of the pancreas which most likely represents an IPMN. 5.No significant interval change in retroperitoneal lymphadenopathy.6.Apparently new 1.7 cm sclerotic focus within the left ilium which may represent a benign bone island but would be better characterized on dedicated CT or MRI if clinically indicated.


Instruction: Generate impression based on medical findings.

Input: Evaluate for residual posterior fossa tumor and possible spinal metastases: status post posterior fossa tumor resection. Brain: There are interval postoperative findings related to suboccipital craniotomy for resection of a posterior fossa tumor. There is residual non-enhancing extra-axial tumor in the right inferior fourth ventricle, cerebellopontine angle, right premedullary cistern, and the upper cervical spinal canal, which measures up to approximately 45 mm. There is associated mass effect upon the adjacent right cerebellar hemisphere, brainstem, and upper spinal cord. There is interval insertion of a right transfrontal ventricular catheter with high T2 signal and susceptibility effect surrounding the catheter in the right frontal lobe, as well as globular blood products surrounding the catheter in the right lateral ventricle and layering blood products in the bilateral occipital horns. There are areas of T2 hyperintensity and restricted diffusion in the medial cerebral hemispheres. The third and lateral ventricles are less dilated. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Spine: Aside from the mass effect upon the right and posterior upper cervical spinal cord by the inferior extension of the posterior fossa tumor, the rest of the spinal cord appears intact, without discernible abnormal signal. There is no evidence of drop metastases within the spinal canal. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant posterior disc herniation.

Output: 1. Interval partial resection of a tumor arising from the fourth ventricle with residual tumor in the right inferior fourth ventricle, cerebellopontine angle, right premedullary cistern, and the upper cervical spinal canal, measuring up to approximately 45 mm, and areas of acute ischemia along the medial cerebellar hemispheres bilaterally.2. Interval right transfrontal ventricular catheter insertion with decrease in size of the triventricular system, but complicated by mild right frontal lobe edema and scattered areas of intraventricular hemorrhage.3. No evidence of drop metastases within the spinal canal.


Instruction: Generate impression based on medical findings.

Input: 12 year old man who is s/p Tetralogy of Fallot repair with a transannular patch and monocuspid pulmonic valve. He is referred to assess for severity of pulmonic regurgitation and RV volumes and function. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 61%, the LV end diastolic volume index is 63 ml/m2 (normal range: 74+/-15), the LVEDV is 75 ml (normal range 142+/-34), the LV end systolic volume index is 25 ml/m2 (normal range 25+/-9), the LVESV is 29 ml (normal range 47+/-19), the LV mass index is 32 g/m2 (normal range 85+/-15), and the LV mass is 39 g (normal range 164+/-36). There are no regional wall motion abnormalities present.Left AtriumThe left atrium is normal in size. A small superiorly located secundum-type atrial septal defect is noted (11x7mm).Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 117 ml/m2 (normal range 82+/-16), the RVEDV is 140 ml (normal range 142+/-31), the RV end systolic volume index is 57 ml/m2 (normal range 31+/-9), and the RVESV is 69 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 is thickened and calcified. There is moderate to severe pulmonic regurgitation. The regurgitant fraction is 45%. Tricuspid ValveThe tricuspid valve opens widely. There is mild to moderate tricuspid regurgitation.AortaThere is an over-riding aorta. The aortic root is mildly dilated (sinus of Valsalva 34x32x32mm).Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size (19mm). The left pulmonary artery branch has an acute angled take off and is significantly narrowed (minimal diameter 5mm) with evidence of flow acceleration through the stenosis suggesting the narrowing is hemodynamically significant. The right pulmonary artery is normal in size (10mm). LPA flow 29ml (28% relative contribution) and RPA flow 75ml (72% relative contribution).Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsLarge thymus tissue noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal LV size and systolic function (LVEF 61%).2 Mild RV dilation (RVEDVi 117ml/m2) with normal systolic function (RVEF 51%). 3. Mild right atrial dilation.4. Small secundum-type atrial septal defect noted.5. Pulmonic valve is thickened and calcified with severe pulmonic valve regurgitation.6. Mild to moderate tricuspid regurgitation.7. Over-riding aorta with aortic root dilation.8. Left pulmonary artery stenosis resulting in only 28% of pulmonary flow.9. See extra-cardiac findings.


Instruction: Generate impression based on medical findings.

Input: Soft tissue mass Examination of the images reveals a soft tissue mass that measures approximately 2 x 3 x 1 cm dorsal to the fourth proximal phalanx. The soft tissue mass is of decreased signal intensity on the T1-weighted images and mixed on the T2-weighted images. It enhances with gadolinium. The lesion is adjacent to the bone but does not invade the osseous structures.

Output: Nonspecific enhancing soft tissue mass dorsal to the fourth toe suspicious for malignancy


Instruction: Generate impression based on medical findings.

Input: Delirium. Some of the images are degraded by patient motion. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild scattered paranasal sinus mucosal thickening.

Output: No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on medical findings.

Input: 48 years, Male, possible parkinsonism, gait difficulty. Question of hypoxic brain injury during birth. Per chart, patient also has history of recent fall with bruising on neck and back. Brain: No appreciable area of gliosis or volume loss to suggest prior ischemic injury. Mild hypoplasia of the inferior cerebellar vermis is suspected. Mild volume loss is also noted involving the cerebellar hemispheres. There is possible T1 hyperintensity along bilateral frontal dura which may be artifactual versus related to mineralization; finding is of doubtful clinical significance but can be correlated with prior CT if available. No corresponding signal abnormality is appreciated on the T2 or FLAIR sequences. There is no intracranial mass or mass effect. No focal parenchymal signal abnormality. No evidence of infarct or hemorrhage. No intracranial mass or mass effect. No hydrocephalus. No extra-axial collections. No volume loss, focal lesions, or abnormal iron deposition is evident within the basal ganglia, brainstem, or cerebellum. Major flow-voids are preserved. Trace mucosal thickening is evident in the paranasal sinuses. Calvarium and remainder of the extracranial soft tissue structures are unremarkable. Cervical spine: Some of the cervical spine sequences are motion degraded slightly limiting evaluation. There is mild edema involving the posterior soft tissues at the C5-C6 level at the level of the interspinous and supraspinous ligaments. Anterior and posterior longitudinal ligaments as well as ligamentum flavum demonstrate no disruption or signal abnormality. Vertebral body heights and alignment are maintained. Craniovertebral junction also appears within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology. No evidence of hematoma within the spinal canal.There is mild congenital narrowing of the cervical spinal canal with pedicle hypoplasia and superimposed mild degenerative changes as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Mild congenital narrowing of the spinal canal with superimposed thickening of the ligamentum flavum and small disc bulge. Mild left neural foraminal stenosis related to facet arthropathy and uncovertebral hypertrophy. No significant right neural foraminal narrowing.C4-5: Mild spinal canal stenosis related to congenital narrowing and superimposed mild disc bulge. There is moderate to severe right and moderate left neural foraminal stenosis related to uncovertebral hypertrophy. C5-6: There is mild to moderate narrowing of the spinal canal on a congenital basis as well as superimposed disc bulge and ligamentum flavum thickening. There is moderate to severe right and moderate left neural foraminal stenosis related to uncovertebral hypertrophy.C6-7: Mild spinal canal narrowing. There is moderate to severe bilateral neural foraminal narrowing related to disc bulge and uncovertebral hypertrophy.C7-T1: No significant compromise to the spinal canal or right neural foramen. Mild left neural foraminal narrowing related to facet arthropathy..The vertebral artery flow voids appear to be intact.

Output: 1. No imaging findings to suggest sequela of prior hypoxic-ischemic injury. No intracranial mass or mass effect. No focal lesions involving the basal ganglia, brainstem, or cerebellum are appreciated.2. Mild volume loss involving the cerebellar hemispheres which is nonspecific and may be related to chronic antiepileptic medications for example. Mild hypoplasia involving the inferior cerebellar vermis also suspected.3. Images of cervical spine demonstrates mild edema involving the posterior soft tissues at the C5-C6 level which may represent mild ligamentous injury involving the interspinous and supraspinous ligaments at C5-C6. The anterior and posterior longitudinal ligaments and ligamentum flavum are intact. No cord signal abnormality, evidence of fracture, or hematoma within the spinal canal.4. Congenital narrowing of the cervical spinal canal with superimposed degenerative changes. There is up to mild to moderate spinal canal stenosis at the C5-C6 level. Relatively mild spinal canal narrowing at additional levels without cord signal abnormality. There is also high-grade neural foraminal stenosis at multiple levels. Please see details above.


Instruction: Generate impression based on medical findings.

Input: 43-year-old female with disturbance of skin sensation. History of metastases to the spine. Rule out cord compression. The spinal cord has normal signal characteristics and overall morphology. There is no evidence of spinal canal narrowing. There is abnormal STIR signal within the bone marrow consistent with metastatic lesions in the T8, L2, L3, and L4 vertebral bodies which have been present from prior studies dating back to 2014. There is mild endplate depression of the T8 level, slightly progressed compared to prior study which could represent early development of a pathologic fracture. There is a slight disc bulge at the L3-4 level without significant spinal canal stenosis.There are multiple new areas of signal abnormality suspicious for metastatic disease. There is heterogeneous marrow signal in the C6, T1, T2, and T3 vertebral bodies which is suspicious for metastatic disease. There is T1 hypoattenuation with associated STIR signal abnormality in the anterior-inferior portion of the T6 and T9 vertebral bodies. There is is an expansile lesion with increase in STIR signal within the spinous process at the T7 level. There is an expansile lesion with STIR hyperintensity in the L5 pedicle. Homogeneous STIR signal abnormality is also present within the sacrum suspicious for metastatic disease. There is mild increased STIR signal in the posterior soft tissues at the level of the L2-L4 levels which likely represents dependent edema, given normal marrow signal in adjacent posterior elements.

Output: 1.This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No cord compression is identified.2.Multiple new multilevel lesions as above suspicious for metastatic disease and consistent with disease progression. Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine.


Instruction: Generate impression based on medical findings.

Input: Headaches of changing character and history of thyroid cancer. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o retear ACL graft History: pain and instability Exam is slightly limited secondary to artifact from femoral and tibial tunnels.MENISCI: There is evidence of prior partial medial meniscectomy. There is superimposed abnormal proton density and T2 signal hyperintensity signal in the anterior aspect of the posterior horn of the medial meniscus, which is more pronounced than on the prior study, suggesting a more acute oblique tear, which contacts the inferior articular surface (series 6, image 25). There is persistent abnormal signal hyperintensity in the anterior horn of the lateral meniscus, which was also seen previously, compatible with fibrosis.ARTICULAR CARTILAGE AND BONE: There is grade II chondromalacia in the posterior aspect of the medial femoral condyle. Otherwise, the articular cartilage is intact.There is a 14 x 13 mm osteochondral defect in the posterior aspect of the medial femoral condyle with near complete underlying T2 signal hyperintensity, and evidence of previous repair.LIGAMENTS: There is indistinctness of the anterior cruciate ligament graft along its midportion, which suggests at least partial tear (series 5, image 17).The posterior cruciate ligament is intact. The medial collateral ligament and lateral collateral ligament complexes are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Indistinctness of the ACL graft along its midportion suggesting at least partial tearing.2.Status post repair of an osteochondral defect in the medial femoral condyle with near complete underlying T2 signal abnormality which suggests there may be a component of partial instability.3.Prior partial medial meniscectomy with evidence of superimposed tear.


Instruction: Generate impression based on medical findings.

Input: Headache(784.0) [784.0], Reason for Study: ^Reason: evaluate for infarct; Head CT showing possible R lacunar infarct History: Head CT with possible R lacunar infarct; persistent headaches No evidence of acute ischemic or hemorrhagic lesion on the scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses are clear.Bilateral mastoid air cells are opacified.

Output: Normal brain MRI.


Instruction: Generate impression based on medical findings.

Input: Several sequences are motion degraded with repeat acquisition attempted. Given this caveat:The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Minimal mucosal thickening is present within ethmoid and maxillary sinuses. The remaining paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: Negative MRI of the brain including gadolinium enhancement. Specifically, there are no MRI findings to explain the patient's new seizures.


Instruction: Generate impression based on medical findings.

Input: 79 year old woman with history of severe coronary calcification on CT, HTN, HL and an abnormal nuclear stress test who was referred for vasodilator stress cardiac MRI for further evaluation.MEDICATIONS: rosuvastatin, nebivolol, lisinopril, amlodipine First Pass PerfusionNo evidence of ischemia.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 61%, the LV end diastolic volume index is 59 ml/m2 (normal range: 65+/-11), the LVEDV is 95 ml (normal range 109+/-23), the LV end systolic volume index is 51 ml/m2 (normal range 18+/-5), the LVESV is 34 ml (normal range 31+/-10), the LV mass index is 47 g/m2, and the LV mass is 76 g. There are no regional wall motion abnormalities present.No intracardiac thrombus.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 56%, the RV end diastolic volume index is 77 ml/m2 (normal range 69+/-14), the RVEDV is 124 ml (normal range 110+/-24), the RV end systolic volume index is 34 ml/m2 (normal range 22+/-8), and the RVESV is 55 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve is mildly thickened and opens widely.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is tricuspid regurgitation. Dedicated evaluation was not performed.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 pericardial effusion.Extracardiac FindingsThere is a rounded low-intensity signal focus at the last slice at the inferior field of view on axial images (301/1) measuring 9 x 9 mm. In the absence of outside imaging, recommend a CT thorax for further evaluation, to exclude pulmonary nodule. Mild levoscoliosis of the thoracolumbar spine.

Output: 1. No evidence of ischemia or myocardial infarct.2. Normal LV size and systolic function (LVEF 64%).3. Normal RV size and systolic function (RVEF 56%).4. A rounded focus is noted at the right costophrenic sulcus, incompletely imaged. If outside comparison imaging is not available, further evaluation with a CT thorax is recommended to exclude a pulmonary nodule.


Instruction: Generate impression based on medical findings.

Input: 21 year-old woman with history of right shoulder pain. ROTATOR CUFF: The rotator cuff tendons and muscles appear normal.SUPRASPINATUS OUTLET: The acromioclavicular joint appears normal. We see no fluid in the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. The anterosuperior labrum is separated from the underlying glenoid from the 2 o'clock to 3 o'clock positions, likely representing a normal variant sublabral foramen. There is a small, 3-4 mm collection of fluid signal intensity at the capsular insertion along the inferior aspect of the labrum which may represent a small cyst, but we see no associated labral tear. The anterior bundle of the inferior glenohumeral ligament can be followed from the glenoid to the humerus. Additional contrast tracking along the medial aspect of the proximal humeral diaphysis may represent a rent in the capsule.BICEPS TENDON: The long head of biceps tendon is intact. ADDITIONAL

Output: Normal appearing rotator cuff and labrum without specific findings to account for the patient's pain.


Instruction: Generate impression based on medical findings.

Input: 50-year-old female with right upper quadrant abdominal pain. Evaluate for hepatic or biliary disease. ABDOMEN:LIVER, BILIARY TRACT: No enhancing hepatic lesion. Few scattered subcentimeter hepatic cysts are noted. No intra or extrahepatic biliary ductal dilatation. No cholelithiasis, gallbladder wall thickening, pericholecystic fluid, or evidence of choledocholithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No evidence of edema or peripancreatic inflammatory changes. No pancreatic ductal dilatation.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: No evidence of hepatic or biliary etiology to account for patient's pain.


Instruction: Generate impression based on medical findings.

Input: 7-year-old male with neurofibromatosis type I, assess for change of known brainstem tumor or optic glioma. Patient is experiencing headaches. MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of an infiltrative mass at the cervicomedullary junction associated with mass effect. It is predominantly high signal on T2 and low signal on T1. Given slight differences in level of slice acquisition, this is unchanged in size or morphology. Associated patchy contrast enhancement has has decreased, especially along its left lateral aspect.There is a redemonstration of a T2 signal hyperintense lesions located in the bilateral cerebellar gray nuclei as well as the thalami and basal ganglia which were also present on the prior exam and not substantially changedNormal 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.Mucosal thickening can be found throughout the paranasal sinuses, with complete obstruction of the left maxillary sinus. The visualized portions of the mastoid air cells are clear.MRI orbits:Redemonstrated is hypothalamic enlargement, unchanged in morphology, however demonstrating a new subtle focus of enhancement just superior to the junction with the pituitary stalk (best seen on image 3, series 3901).Redemonstrated is a small 3-mm T2 hyperintense, enhancing mass with hypointense center immediately inferior to the left optic nerve in the region of the left orbital apex, unchanged in appearance. Orbits and globes are otherwise unremarkable. The optic chiasm is normal. Optic tracts appear unremarkable. Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. Redemonstrated is enlargement of the central canal in the upper thoracic spine not entirely included on this exam.No abnormal enhancing lesions are appreciated in the cervical cord.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is a left-sided nerve sheath lesion associated with patchy contrast enhancement. It is associated with enlargement of the adjacent neural foramen. These findings are unchanged.At C4-5 there is a left-sided nerve sheath lesion which is stable compared to the prior exam. It is associated with patchy contrast enhancement and slight flattening of the left lateral cord. It is associated with enlargement of the adjacent neural foramen.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There is an infiltrative mass at the cervicomedullary junction associated with mass effect. It is predominantly high signal on T2 and low signal on T1. Given slight differences in level of slice acquisition, this is unchanged in size or morphology. Associated patchy contrast enhancement has has decreased, especially along its left lateral aspect.2.T2 signal hyperintense lesions located in the bilateral cerebellar gray nuclei as well as the thalami and basal ganglia have not substantially changed.3.Redemonstrated is hypothalamic enlargement, unchanged in morphology, however demonstrating a new subtle focus of enhancement just superior to the junction with the pituitary stalk (best seen on image 3, series 3901).4.There is a small 3-mm T2 hyperintense, enhancing mass with hypointense center immediately inferior to the left optic nerve in the region of the left orbital apex, unchanged in appearance.5.Redemonstrated is enlargement of the central canal in the upper thoracic spine not entirely included on this exam.6.At C3-4 there is a left-sided nerve sheath lesion associated with patchy contrast enhancement, unchanged.7.At C4-5 there is a left-sided nerve sheath lesion associated with patchy contrast enhancement and slight flattening of the left lateral cord, unchanged.


Instruction: Generate impression based on medical findings.

Input: 50-year-old female with history of ovarian cancer with new cystic mass in the pancreatic head. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic divisum is present.There is a 9 x 7 mm T2 hyperintense focus in the pancreatic head corresponding to that seen on the prior CT. This lesion communicates with the main pancreatic duct, compatible with a side branch IPMN. An additional 5 x 4 mm T2 hyperintense lesion with communication to the main pancreatic duct located closer to the ampulla also likely reflects a side branch IPMN.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Enlarged right and left cardiophrenic lymph nodes. Reference right cardiophrenic lymph node measures 11 mm in short axis (series 15, image 23).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Pancreatic divisum anatomy. 2.Cystic lesion corresponding to finding reported on prior CT is compatible with a sidebranch IPMN. Additional T2 hyperintense lesion as described above also likely reflects a sidebranch IPMN. Follow-up is recommended to document stability.


Instruction: Generate impression based on medical findings.

Input: 44-year-old female with history of pituitary tumor resection, surveillance, annual follow-up. Redemonstrated are postoperative findings related to transphenoidal pituitary resection. There is no significant interval change in the enhancing lesion in the right pituitary, which measures up to 13 mm (in AP dimension). The lesion extends slightly into the right cavernous sinus, without evidence of carotid encasement or narrowing. The mass also extends across the midline and causes slight deviation of the pituitary stalk to the left. Has before, there is no abutment of the optic apparatus.

Output: No significant interval change in the pituitary lesion.


Instruction: Generate impression based on medical findings.

Input: 24-year-old female with medial joint pain. Evaluate MCL and chondromalacia of medial joint. MENISCI: The medial lateral meniscus appear intact.ARTICULAR CARTILAGE AND BONE: No bone marrow signal abnormalities identified. No full-thickness or near full-thickness articular cartilage defects are identified.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: No findings to account for the patient's pain.


Instruction: Generate impression based on medical findings.

Input: Cervical Spine: There is no significant change in appearance of the craniocervical junction including 7 mm inferior displacement of cerebellar tonsils through a foramen magnum, retroverted odontoid, and postoperative changes. CSF space posterior to the cerebellar tonsils is preserved. Partially imaged brain also demonstrates dysplastic corpus callosum with abnormal T2 hyperintensity better assessed on prior dedicated brain MRI. Ventriculostomy catheter is partially imaged. Lateral ventricles are not well assessed but appear decompressed. There is preserved biphasic flow ventrally at the foramen magnum with diminished flow dorsally at the foramen magnum and upper cervical canal, similar to prior CSF flow study from 9/28/2012.The cervical spinal cord has normal signal characteristics and overall morphology aside from trace prominence of the central canal at the C2 level which is not appreciably changed since 4/26/2014.As before, there is straightening of the normal cervical lordosis which may be positional. The cervical vertebral bodies are appropriate in overall alignment and height. No spinal canal or neural foraminal stenosis at any level. Thoracic Spine: The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. There is no evidence of syrinx. Lumbar Spine: There are postoperative changes related to myelomeningocele repair and cord untethering. Laminectomy changes are again seen from L3 to S1 level, although there is likely also a component of preceding congenital posterior element dysplasia. The lumbar spine is normal in overall alignment and height. There is partial lumbarization of S1 vertebral body. The conus medullaris/distal neural tissue is low lying and terminates at L3 and abuts the posterior dura as before. Prone images demonstrate no appreciable ventral motion. Distal nerve root clumping also not significantly changed. There is no significant compromise to spinal canal or neural foramina. Small focus of fluid is again seen posterior to the left L3-L4 facet joint measuring 9 x 11 mm in the AP and transverse dimensions and is slightly increased in size. There is moderate degree of facet arthropathy at the L4-L5 level similar to prior to a milder degree more superiorly and inferiorly.

Output: 1.Unchanged appearance of the decompressed craniocervical junction including 7 mm inferior displacement of the cerebellar tonsils as well as diminished biphasic flow dorsally at the foramen magnum and upper cervical canal.2.Stable mild prominence of the central canal at C2. Otherwise, no cord signal abnormality to suggest new or enlarging syrinx. 3.Postsurgical changes in the lumbar spine related to prior myelomeningocele repair and cord untethering again seen. Unchanged appearance of the conus/ distal neural tissue which abuts the dorsal dural margin. No appreciable ventral motion is seen on the prone sequences which is unchanged. Cord re-tethering cannot be excluded and suggest correlation with clinical findings. Distal cauda equina nerve roots also abut the dorsal and lateral dural margins which may indicate arachnoiditis but also unchanged.4.Facet arthropathy in the lower lumbar spine is again seen. There is a small focus of fluid, presumed synovial cyst, posterior to the left L3-L4 facet joint which is slightly larger since 4/26/2014.


Instruction: Generate impression based on medical findings.

Input: Reason: Labral tear History: pain ROTATOR CUFF: The supraspinatus muscle and tendon appear intact. The infraspinatus muscle and tendon appear intact. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: No fluid or intra-articular gadolinium extends into the subacromial subdeltoid bursa. Mild degenerative changes affect the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. There is increased signal abnormality within the anterior superior labrum at the 2 o'clock position likely a normal variant sublabral foramen. There is heterogeneity of the posterior labrum which may represent very mild degeneration/superficial fraying. No fluid-filled labral tear is evident. No full-thickness articular cartilage defects are identified.BICEPS TENDON: The tendon of the long head of the biceps appears intact. ADDITIONAL

Output: Very mild degeneration/superficial fraying of the posterior labrum without evidence of a fluid filled tear. Mild osteoarthritis of the acromioclavicular joint.


Instruction: Generate impression based on medical findings.

Input: 38-year-old female with abdominal pain, fullness, gas, nausea and vomiting. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mildly prominent right lower quadrant mesenteric lymph nodes are present.BOWEL, MESENTERY: Postsurgical changes of a ileocecectomy with end to end anastomosis in the right mid-lower quadrant.Redemonstrated is circumferential wall thickening and luminal narrowing of a segment of neoterminal ileum measuring 5.8 cm. There is mild upstream dilation of bowel measuring 3.2 cm in diameter. There is corresponding diffusion involving this segment of bowel. A short segment of small bowel wall thickening and luminal narrowing several centimeters upstream (series 10020, image 250) may be due to underdistention although this may be another focus of disease. There are discontinuous areas of the rectum and descending colonic wall thickening and abnormal enhancement without significant upstream dilatation, similar to the prior examination.No free fluid or loculated fluid collection.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: T-shaped IUD device is again noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: As above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Active on chronic inflammation involving a 5.8 cm narrowed segment of the neoterminal ileum as described above. There is mild upstream dilation of small bowel measuring 3.2 cm in diameter reflecting mild flow-limiting stenosis.2.Additional short segment skip lesions of active inflammation involving the descending colon and rectum as described above. 3.No fluid collection or abscess is evident.


Instruction: Generate impression based on medical findings.

Input: Acute right knee pain for seven days. History of right knee surgery for meniscal tear (done in Netherlands), now with right knee "inside the knee" and medially. Exam today though is unremarkable other than clicking and sensation of instability on exam. MENISCI: There is abrupt truncation of the posterior horn of the lateral meniscus that may either reflect a radial tear or partial meniscectomy. There is also, however, branching signal abnormality within the body of the lateral meniscus, including curvilinear fluid signal intensity extending to the femoral articular surface, indicating a complex tear. The anterior horn of the lateral meniscus appears intact.There is abnormal, predominantly horizontally-oriented signal abnormality within the posterior horn and body of the medial meniscus extending to the femoral articular surface, indicating a tear. The tear also extends through the periphery of the meniscus and decompresses into a small heterogeneous parameniscal cyst. The anterior horn of the medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is a full-thickness defect of the articular cartilage of the lateral tibial plateau beneath the truncated posterior horn of the lateral meniscus with mild degenerative signal abnormality in the underlying subchondral bone. There is osteophyte formation along the medial femoral condyle anterior to the meniscus with loss of overlying cartilage. There is also surface fraying and multiple clefts/fissures affecting the articular cartilage of the patella and femoral trochlea.LIGAMENTS: The cruciate and collateral ligaments are intact EXTENSOR MECHANISM: The extensor mechanism is intactADDITIONAL

Output: 1.Medial and lateral meniscal tears as described above. Abrupt truncation of the posterior horn of the lateral meniscus may either reflect additional tearing or changes following partial meniscectomy.2.Articular cartilage defects/degeneration as above.


Instruction: Generate impression based on medical findings.

Input: Moya moya, f/u pial synangiosis: surveillance. MRI: There are areas of T2 hyperintensity in the subcortical and deep cerebral white matter bilaterally. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA: There are postoperative findings related to bilateral pial synangiosis. There is apparent focal loss of flow-related signal in the distal portion of the otherwise patent right superficial temporal artery at the microcraniotomy site, but there is abundant underlying pial vasculature. There is a small caliber left superficial temporal artery diffusely, but there is abundant underlying pial vasculature. There is severe steno-occlusive disease of the supraclinoid right internal carotid artery and proximal right middle and anterior cerebral arteries. There is also severe steno-occlusive disease throughout the length of the left internal carotid artery and proximal right middle and anterior cerebral arteries. There are numerous moyamoya collateral vessels. The posterior cerebral circulation is intact.

Output: 1. MRI: Stigmata of moyamoya disease with what may represent chronic ischemic disease, but no acute infarction. The degree of cerebrovascular steno-occlusive disease is similar to the prior exam. 2. MRA: Findings related to bilateral pial synangiosis with apparent focal loss of flow-related signal in the distal portion of the right superficial temporal artery at the microcraniotomy site, which may be due to stenosis or artifact, but there is abundant underlying pial vasculature. The left superficial temporal artery is of diffusely small caliber, but there is abundant underlying pial vasculature.


Instruction: Generate impression based on medical findings.

Input: There is mild anterolisthesis of L4 on L5 and mild retrolisthesis of L5 on S1. There are defects at the superior endplates of the T12 and L1 vertebral bodies, again noted. There is multilevel loss of disc height and disc dessication. There is mild heterogeneity of the marrow signal. The spinal cord displays normal signal and morphology. The distal spinal cord and conus are within normal limits with the conus terminating at the L1 level. There is some mild clumping of the nerve roots at the lower lumbar spinal canal.T12-L1: Bilateral facet arthropathy. No significant disc bulge, spinal canal or foraminal stenosis. L1-L2: Disc bulge, bilateral facet arthropathy and thickening of the ligamentum flavum, contributing to mild bilateral foraminal stenosis and moderate spinal canal stenosis. L2-L3: Disc bulge, bilateral facet arthropathy and thickening of the ligamentum flavum, contributing to mild bilateral foraminal stenosis and moderate spinal canal stenosis. L3-L4: Disc bulge, bilateral facet arthropathy, and thickening of the ligamentum flavum, contributing to mild bilateral foraminal stenosis and progressed moderate spinal canal stenosis. L4-L5: Evidence of left laminotomy. Pseudo disc bulge and superimposed small central disc protrusion, bilateral facet arthropathy, and thickening of the ligamentum flavum, contributing to effacement of the bilateral lateral recesses, mild bilateral foraminal stenosis and improved moderate spinal canal stenosis. L5-S1: Disc bulge with central to left paracentral to left foraminal disc protrusion, bilateral facet arthropathy, and thickening of the ligamentum flavum, contributing to left greater than right lateral recess narrowing and mild bilateral foraminal stenosis with impingement of the descending left S1 nerve root. No significant spinal canal stenosis.

Output: 1.Degenerative spondylosis of the lumbar spine with interval progression of moderate spinal canal stenosis at L3-L4, improved moderate spinal canal stenosis at L4-L5 and unchanged moderate spinal canal stenosis at L2-L3. 2.Left laminotomy changes at L4-L5. 3.Left paracentral/foraminal disc protrusion at L5-S1 with impingement of the left S1 nerve.There is suspicion for some nerve root clumping in the lower lumbar spinal canal. Please correlate with clinical symptoms to assess for possible arachnoiditis.


Instruction: Generate impression based on medical findings.

Input: 81-year-old female right hip pain after fall two years ago, rule out dislocation versus labral tear. ACETABULAR LABRUM: There is near complete loss of articular cartilage of the right hip.ARTICULAR CARTILAGE AND BONE: There is near complete loss of articular cartilage of the right hip with near bone-on-bone apposition.SOFT TISSUES: Multiple uterine fibroids are noted. ADDITIONAL

Output: Limited examination due to the patient's inability to tolerate the exam secondary to pain. Heterogeneous high T2 signal and low T1 signal within the right femoral head and neck with associated subchondral collapse and joint effusion, most consistent with avascular necrosis. However, if there is concern for septic arthritis, joint aspiration is recommended.


Instruction: Generate impression based on medical findings.

Input: 84-year-old female with altered mental status x 1 week and visual hallucinations. Chronic headache. Question of ischemic stroke. There is no evidence of intracranial hemorrhage, mass or edema. Multiple areas of periventricular and subcortical white matter hypodensity consistent with small vessel ischemic disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered. Well-defined focal hypodensity adjacent to the left basal ganglia consistent with old hemorrhagic stroke. No acute cortical stroke.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Prior strokes and small vessel ischemic disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.


Instruction: Generate impression based on medical findings.

Input: 63 year old male with history of Hodgkin's lymphoma, hypertension, dyslipidemia, chronic kidney disease and coronary artery disease (on stress perfusion testing) presenting for evaluation of atypical chest pain. MEDICATIONS: valsartan, metoprolol, aspirin, rosuvastatin First Pass PerfusionDuring hyperemia, no perfusion defects were present. There was matched defects present on rest and stress images consistent with artifact. Notably the lateral wall perfusion defect seen on previous imaging is no longer seen. 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 mild, global reduced systolic function. The overall LV ejection fraction is 51%, the LV end diastolic volume index is 105 ml/m2 (normal range: 74+/-15), the LVEDV is 227 ml (normal range 142+/-34), the LV end systolic volume index is 51 ml/m2 (normal range 25+/-9), the LVESV is 110 ml (normal range 47+/-19), the LV mass index is 49 g/m2, and the LV mass is 106 g. No intracardiac thrombus.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 84 ml/m2 (normal range 82+/-16), the RVEDV is 181 ml (normal range 142+/-31), the RV end systolic volume index is 42 ml/m2 (normal range 31+/-9), and the RVESV is 91 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is 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 three vessel arch.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 pericardial effusion.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia. Compared to previous study of 12/14/2010, the lateral wall perfusion defect has resolved.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and mildly reduced systolic function (LVEF 51%).4. Normal RV size and systolic function (RVEF 50%).


Instruction: Generate impression based on medical findings.

Input: 35-year-old female with left knee pain. MENISCI: The lateral meniscus appears intact. The medial meniscus appears intactARTICULAR CARTILAGE AND BONE: There is partial-thickness articular cartilage degeneration along the medial femoral condyle. The articular cartilage along the lateral tibial femoral compartment is relatively spared. There is partial-thickness articular cartilage degeneration and superficial fraying along the lateral facet of the patella. There is a focal near full-thickness articular cartilage defect along the lateral facet of the femoral trochlea with areas nearly completely devoid of articular cartilage. Heterogeneous bone marrow signal abnormality is nonspecific but may represent residual islands of red marrow. There are tricompartmental osteophytes.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Mild osteoarthritic changes of the knee as described above including a near full-thickness articular cartilage defect along the lateral facet of the femoral trochlea.2. Small joint effusion extending posteromedially into a tiny Baker's cyst. Multiple foci of low signal abnormality within the joint space may represent loose bodies/articular cartilage fragments versus a synovitis as described above.


Instruction: Generate impression based on medical findings.

Input: 45 year-old female with shortness of breath and previous MRI suggestive of constriction. For follow-up study. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 65%, the LV end diastolic volume index is 52 ml/m2 (normal range: 65+/-11), the LVEDV is 98 ml (normal range 109+/-23), the LV end systolic volume index is 18 ml/m2 (normal range 18+/-5), the LVESV is 34 ml (normal range 31+/-10). There is systolic and diastolic flattening of the septum. Free-breathing sequences suggestive respirophasic shift of the septum. There is no myocardial late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size with mild systolic dysfunction. The overall RV ejection fraction is 44%, the RV end diastolic volume index is 93 ml/m2 (normal range 69+/-14), the RVEDV is 175 ml (normal range 110+/-24), the RV end systolic volume index is 52 ml/m2 (normal range 22+/-8), and the RVESV is 98 ml (normal range 35+/-13). 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 at least mild-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 moderately dilated (35 mm). Venous AnatomyThe IVC is dilated. PericardiumSevere calcification of the pericardium. Pericardium thickness measured to be ~ 4-6 mm. Tagged images show that there is tethering of the pericardium to the myocardium at the basal lateral wall of the LV suggesting evidence of constriction. Extracardiac FindingsMediastinal adenopathy. Bilateral pleural effusions. 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 ventricular size and systolic function are normal. LVEF is 65%.2. The right ventricular size is normal with mildly reduced systolic function. RVEF is 44 %.3. Thickening of the pericardium with extensive calcification of the pericardium at the base of the ventricles with evidence of respirophasic septal shift. In addition, the base of the ventricle is tethered to the pericardium. There is additionally significant IVC and biatrial dilation. These constellation of findings are strongly suggestive of the diagnosis of pericardial constriction.4. Findings in keeping with previous MRI done in 2014.


Instruction: Generate impression based on medical findings.

Input: Male 20 years old Reason: Evaluate for DAI History: Fell off bicycle, possible DAI read on CT head. There is no evidence of intracranial hemorrhage. Hypoattenuating focus on CT corresponds to a focus of T2 hyperintensity in the subcortical white matter of the right frontal lobe. There are additional small foci of periventricular and subcortical white matter T2 hyperintensity in both frontal lobes and parietal lobes. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.No evidence of acute intracranial hemorrhage. 2.Focus of T2 hyperintensity in subcortical white matter of the right frontal lobe with additional small foci of white matter T2 hyperintensity. These findings are nonspecific, but are unlikely related to nonhemorrhagic diffuse axonal injury. These findings may be seen in the setting of chronic migraine headaches, demyelinating disease, as well as migrational abnormalities. Clinical significance of this lesion is unclear.


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old. Reason: hyper reflexia of RLE, r/o cord compression History: above Redemonstrated are postsurgical findings of myelomeningocele repair with a low-lying cord, likely tethered, terminating in the sacral region, unchanged.The vertebral bodies are appropriate in overall alignment and height. The spinal cord has normal signal characteristics. There is no compromise of the spinal cord to suggest acute cord compression.

Output: This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No cord compression is identified. Grossly unchanged postsurgical findings in the lumbosacral spine as described above.


Instruction: Generate impression based on medical findings.

Input: 56 years Female (DOB:8/13/1959)Reason: Eval posterior stroke History: dizzinessPROVIDER/ATTENDING NAME: ROBERT A MULLIKEN JEANNE M DECARA MRI of the brainSeveral punctate foci of diffusion restriction are identified. One is located in the right periventricular white matter. One is located in the left centrum semiovale. One is located in the left occipital lobe.There are 4 or 5 periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images..Is a punctate focus of signal loss and susceptibility imaging in the left half of the splenium of the corpus callosum. Initial location this is of unknown clinical significance.The CSF spaces are appropriate for the patient's stated age with no midline shift. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal left vertebral artery, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is small. The posterior communicating arteries are there are small. The right vertebral artery is not readily identified. The right posterior inferior cerebellar artery territory and appears to be supplied via the right anterior inferior cerebellar artery. There is extracranial origin of the left posterior inferior cerebellar artery.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. The right vertebral artery is small and ends just proximal to the level of the foramen magnum. The anterior spinal artery years to be supplied from the left vertebral artery. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.

Output: 1.There are several acute microinfarcts identified in the periventricular and subcortical white matter in the multiple cerebral territories.2.Occlusion of the right vertebral artery distally. Radiology is not established on this exam.3.Anterior spinal artery is prominent but otherwise unremarkable. It is possible this represents a collateral supply to right vertebral artery territory to the brainstem.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old, with neck pain, feeling unable to support head. Spinal alignment is anatomic. Vertebral body morphology is normal. No concerning marrow replacement or significant marrow edema is seen. The spinal cord shows normal signal intensity and morphology throughout. Please note that some images are degraded by motion artifact, but within this limitation, the following level specific findings are made:C2-3: Minimal thickening of the PLL. No significant spinal canal stenosis or neuroforaminal narrowing.C3-4: Mild posterior disk osteophyte formation. No significant spinal canal stenosis. Mild right foraminal narrowing.C4-5: Minimal central disk protrusion. No significant spinal canal or neuroforaminal stenosis. C5-6: Unremarkable. C6-7: Posterior disk osteophyte formation with a right paracentral disk protrusion. Mild generalized spinal canal stenosis. Mild bilateral foraminal narrowing. C7-T1: Unremarkable. The paraspinal soft tissues are unremarkable. The musculature of the neck as visualized is within normal limits. The ligamentous structures at the craniocervical junction are intact.

Output: Mild degenerative disk findings as detailed above without high-grade spinal canal or neuroforaminal stenosis.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old, with persistent back pain three months after ceiling fell on her. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No evidence of marrow replacement or marrow edema is observed. The distal spinal cord, conus and nerve roots of the cauda equina are within normal limits. No epidural abnormalities are suspected.T12-L1 through L3-4: The intervertebral discs are preserved with no evidence of spinal canal or foraminal stenosis. Mild facet arthropathy is seen at L3-4.L4-5: Moderate facet arthropathy is noted. Slight loss of disc T2 signal and minimal right foraminal annular fissuring. No significant disc herniation is seen. The spinal canal and neural foramina are not significantly narrowed. L5-S1: Moderate facet arthropathy noted. Disc bulging with a small central disc protrusion. No significant generalized spinal canal stenosis. The left neural foramen is mildly narrowed.

Output: 1.No evidence of any posttraumatic lumbar spine injury.2.Facet arthropathy develops at lower lumbar levels.3.Findings related to mild disc degeneration are seen at L4-5 and L5-S1 without significant spinal canal stenosis.


Instruction: Generate impression based on medical findings.

Input: Epilepsy and autism with increased frequency of staring episodes and worsening behavior and sleep issues. There is persistent subcortical T2 hyperintensity in the right parahippocampal and fusiform gyri without appreciable mass-effect or volume loss. The hippocampi appear to be unaffected. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a small right maxillary sinus retention cyst.

Output: A persistent subcortical lesion involving the right parahippocampal and fusiform gyri without appreciable mass-effect may represent gliosis rather than a low-grade neoplasm, for example. Follow up via MRI with contrast may potentially offer additional insights.


Instruction: Generate impression based on medical findings.

Input: Female 55 years old restaging cervical cancer prior to brachytherapy. PELVIS:UTERUS, ADNEXA: There is a large heterogeneous cervical mass best seen on T2 weighted images, it measures 2.9 x 2.7 x 3.6 cm (series 601, image 46 and series 401, image 35). It demonstrates heterogeneous enhancement, evidence of parametrial extension particularly on the left, and extension into the lower aspect of the uterus. The endometrial canal is fluid-filled, likely due to to obstruction from the mass.The adnexa are unremarkable.BLADDER: No significant abnormality noted.LYMPH NODES: A right external iliac lymph node measures 1.4 x 0.8 cm (series 804, image 549) and is indeterminate but suspicious for metastasis.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No hydroureter.

Output: 1.Large cervical mass with parametrial extension.2.Right external iliac lymph node is indeterminate but suspicious for metastasis.


Instruction: Generate impression based on medical findings.

Input: 30 year old male with non-ischemic cardiomyopathy referred for further evaluation. Left VentricleThe left ventricle is moderately dilated with severely reduced ejection fraction. The overall LV ejection fraction is 31%, the LV end diastolic volume index is 148 ml/m2 (normal range: 74+/-15), the LVEDV is 380 ml (normal range 142+/-34), the LV end systolic volume index is 102 ml/m2 (normal range 25+/-9), the LVESV is 260 ml (normal range 47+/-19). There is global hypokinesis present. There is no obvious late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process however there is artifact that reduces the diagnostic quality of the images. The pre-contrast native myocardial T1 relaxation time is normal (1060 ms of the mid septal wall).Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with mildly reduced ejection fraction. The overall RV ejection fraction is 40%, the RV end diastolic volume index is 94 ml/m2 (normal range 82+/-16), the RVEDV is 241 ml (normal range 142+/-31), the RV end systolic volume index is 57 ml/m2 (normal range 31+/-9), and the RVESV is 145 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant 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 are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac Findings . 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 moderately dilated with severely reduced ejection fraction (LVEF 31%).2. The right ventricle is normal in size with mildly reduced ejection fraction (RVEF 40%). 3. There is no obvious late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process however there is artifact that reduces the diagnostic quality of the images. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: 71-year-old female with non-small cell lung cancer. Status post several cycles of treatment. New T5 lesion. Back pain and urinary incontinence. Restaging. LUNGS AND PLEURA: Slight interval decrease in right-sided pleural effusion. New atelectasis in the anterior right lung. Multiple pleural based nodules are grossly similar in size. New suspicious pulmonary nodules in right upper lobe measure 7 mm in diameter at images 43 and 44 of series 3. Probable new segmental right upper lobe atelectasis at image 44 of series 3 with ill-defined mass at major fissure. MEDIASTINUM AND HILA: Stable right paramediastinal nodular thickening at the level of the carina measures 34 x 9 mm, (image 32, series 3). Paraesophageal lymph node is stable measuring 25 x 16 mm, (image 64, series 3). Aortic calcifications. Stable subcentimeter left thyroid gland hypodense lesion.CHEST WALL: Lytic lesion in left T5 vertebral body and pedicle at axial image 26 of series 3.ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter hepatic hypodensities are too small to characterize.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild lumbar spine degenerative disease.PELVIS:UTERUS, ADNEXA: Status post hysterectomy. Diffuse round calcifications in the left adnexa at axial image 162 of series 3.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Degenerative changes in the lumbosacral spine and pelvis.OTHER: Multiple enhancing focal lesions seen throughout the spine and sacrum on the recent MRI exam, concerning for metastatic involvement, are not detected on this CT exam.

Output: 1. Pleural-based nodules and right pleural effusion.2. Increased atelectasis anteriorly in the right lung.3. New 7-mm right upper lobe nodules. Lytic lesion in left T5 pedicle.


Instruction: Generate impression based on medical findings.

Input: History of transphenoidal resection of pituitary tumor with residual tumor: new headache and feeling of pressure behind eyes. Pituitary: There are stable postoperative findings related to transsphenoidal surgery. There is an unchanged subcentimeter enhancing focus within the right posterolateral aspect of the sella, which otherwise displays a partially empty configuration. The infundibulum is deviated slightly to the right. There is no mass effect upon the optic apparatus. Brain: There are subcentimeter defects in the right cerebellar hemisphere. There is also mild scattered nonspecific cerebral white matter T2 hyperintensity. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles are unchanged in size and configuration. There is no midline shift or herniation.

Output: 1. Stable postoperative findings with an unchanged 6 mm focus of enhancement within the right posterolateral aspect of the sella.2. Chronic right cerebellar lacunar infarcts.


Instruction: Generate impression based on medical findings.

Input: Reason: 84 F w 17mm lesion in liver. Please also perform MRCP, family history of pancreatic carcinoma ABDOMEN:LIVER, BILIARY TRACT: Large heterogenous enhancing T1 dark, T2 bright segment 7 lesion, measurement as below. There is also mildly T2 bright lesion in segment 6, suspicious for metastasis. Scattered T2 hyperintense lesions compatible with cysts. There is intrahepatic and extrahepatic biliary ductal dilatation with common bile duct measuring up to 12 mm with abrupt cut off at the pancreatic head mass.SPLEEN: No significant abnormality noted.PANCREAS: Large mass, presumably arising from the pancreatic head, measurement as below. There is small fluid collection adjacent to this mass and enlarged peripancreatic lymph nodes. SMV is not well seen and may be occluded from this mass. There is soft tissue infiltration around SMA, suspicious for cancer spread. Distal pancreas is not well seen, likely atrophied. Pancreatic duct is not well visualized. This is suspicious for adenocarcinoma but EUS may be more definitive if indicated.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral T2 hyperintense lesions, compatible with cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Large abdominal ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Significantly elevated left hemidiaphragm with abdominal contents having cardiomediastinal shift to the right. INDEX LESION MEASUREMENTS (Current exam date/time: 12/28/2016 12:55:29)SEGMENT 7 HEPATIC LESION: 4.2 x 4.0 cm (Image 24, Series 8).PANCREATIC MASS: 5.6 x 6.1 cm (Image 330, Series 12).

Output: 1.Large mass presumably arising from the head of the pancreas as described above with metastatic lesions in the liver. CT chest is recommended for complete staging. 2.Significantly elevated left hemidiaphragm with abdominal contents causing cardiomediastinal shift to the right. 3.Findings were text paged to Dr. Bianca Chang.


Instruction: Generate impression based on medical findings.

Input: 67-year-old male with a history of non-small cell lung cancer. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are mildly prominent compatible with age-appropriate volume loss.No significant change in small left middle cranial fossa arachnoid cyst which measures 1.4 x 1.3 cm (series 10, image 14) and associated with mild bony remodeling. 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. Note is made of bilateral lens implants. Redemonstration of bilateral mastoid air cell opacification (right greater than left). Also again seen are bilateral maxillary sinus mucus retention. Bone marrow signal and extracranial soft tissues are otherwise within normal limits.

Output: 1. No evidence of intracranial metastases.2. Unchanged small left middle cranial fossa arachnoid cyst without significant mass effect.3. Redemonstration of bilateral mastoid air cell opacification (right greater than left) and bilateral maxillary mucous retention cysts.


Instruction: Generate impression based on medical findings.

Input: THORACIC: There is a thin syrinx in the thoracic spine measuring up to 2 x 1 mm extending from T6-T12 vertebral bodies (on axial images). There is no other cord signal or caliber abnormality. There is normal alignment of the thoracic spine. The osseous marrow signal is benign. There are scattered high T1 signal foci in the vertebral bodies likely representing hemangiomas. There is no sniffing disk herniation or spinal stenosis in the thoracic spine.LUMBAR: There are the usual compliment of 5 lumbar type non-rib bearing vertebral bodies and the last well formed disk space is referred to as L5-S1. There is normal alignment of the lumbar spine. The osseous marrow signal is benign. There are scattered hemangiomas/fatty marrow deposition. There is no osseous marrow edema. The conus terminates at L1, within normal limits. There is no fatty filum/lipoma or dysraphism.L1-2: No disk herniation or spinal stenosis.L2-3: Minimal disk bulge with no spinal stenosis.L3-4: Mild disk desiccation and loss of disk height, left paracentral annular fissure, and mild disk bulge. No spinal stenosis.L4-5: Disk desiccation, moderate loss of disk height, right paracentral annular fissure and protrusion superimposed on diffuse disk bulge and facet arthropathy with disk material abutting the right subarticular zone. No significant spinal stenosis.L5-S1: Diffuse disk bulge, central annular fissure, facet arthropathy. No spinal stenosis.

Output: 1.Thin 2 x 1 mm thoracic cord syrinx extending from the T6-T12 vertebral body levels.2.No tethered cord, fatty filum/lipoma or dysraphism.