Instruction: Generate impression based on medical findings.

Input: Left trapezius pain. Concern for neural foraminal stenosis. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Mild degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: Small right paracentral disc osteophyte complex and ligamentum flavum thickening. No significant compromise to the spinal canal or neural foramina.C6-7: Small left paracentral disc osteophyte complex and ligamentum flavum thickening. No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Mild degenerative changes in the cervical spine. No significant spinal canal stenosis or neural foraminal stenosis at any level.


Instruction: Generate impression based on medical findings.

Input: 71 year old male with a history of ventricular tachycardia s/p EP ablation resulting in perforation of LV free wall. Referred for cardiovascular MRI to evaluate for underlying infiltrative or inflammatory disease. Left VentricleThe left ventricle is normal in size and systolic function. There is abnormal septal motion which may be the result of sternotomy. The overall LV ejection fraction is 57%, the LV end diastolic volume index is 64 ml/m2 (normal range: 74+/-15), the LVEDV is 130 ml (normal range 142+/-34), the LV end systolic volume index is 27 ml/m2 (normal range 25+/-9), the LVESV is 75 ml (normal range 47+/-19), the LV mass index is 61 g/m2 (normal range 85+/-15), and the LV mass is 123 g (normal range 164+/-36). There is a small focal region of late gadolinium enhancement in the mid lateral wall, which suggests the presence of a focal underlying fibrosing, infiltrative, or inflammatory process.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 52%, the RV end diastolic volume index is 92 ml/m2 (normal range 82+/-16), the RVEDV is 125 ml (normal range 142+/-31), the RV end systolic volume index is 30 ml/m2 (normal range 31+/-9), and the RVESV is 60 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 mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is a minimal pericardial effusion. There is mild late gadolinium enhancement of the pericardium.Extracardiac FindingsAir seen in the proximal esophagus. Sternotomy. 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 left ventricular size and systolic function (LVEF 57%). There is a small focal region of late gadolinium enhancement in the mid lateral wall, which suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process.2. Normal right ventricular size and systolic function (RVEF 52%).3. Minimal pericardial effusion, and late gadolinium enhancement of the pericardium. 4. See extracardiac findings.


Instruction: Generate impression based on medical findings.

Input: Female, 41 years old, with history of pituitary adenoma status post resection x 2 at an outside facility, assess for growth. A lobular, T1 hyperintense and T2 hypointense lesion is redemonstrated occupying the sella and extending into the suprasellar cistern. The lesion does not appear to enhance above and beyond its intrinsic T1 hyperintensity. The lesion has perhaps changed shape slightly when compared to the prior examination, however the overall size is approximately similar. Due to differences in head positioning, the most accurate measurements are obtained in the sagittal plane where the lesion measures 22 x 16 mm (see image eight series 3), previously 22 x 16 mm. There may be a septation in the left anterior inferior portion of the lesion, but this is better visualized previously.The lesion extends into the suprasellar cistern, probably contacting the optic apparatus. No definite evidence of cavernous sinus invasion is seen. The native pituitary gland is not clearly visualized but a portion of it may be present along the right sellar floor. The pituitary stalk is not distinctly visualized as separate from the lesion.

Output: A lobular lesion involving the sella and suprasellar cistern is redemonstrated showing no overall change in size though the shape of the lesion may have changed slightly. The nature of the lesion remains unclear. The particular signal characteristics of the lesion could reflect proteinaceous or mucoid secretions as well as blood product, each of which can be seen within a macroadenoma.


Instruction: Generate impression based on medical findings.

Input: Thoracic back pain with radiation to the legs. Alignment of the thoracic and lumbar spine is unremarkable. No acute fracture or dislocation is seen. At L5 -- S1 intervertebral level, there is suggestion of an epidural lesion at the central and left central location, causing effacement of the thecal sac and impingement of the left S1 nerve root. This can be seen on series 11, image number 153. It is uncertain whether this represents image artifact, disk extrusion, or other epidural lesions. Further imaging can be obtained with CT myelogram or MRI.The spinal canal and neural foramina at the other levels appear patent.A 12-mm gallstone is noted.

Output: 1. Possible epidural lesion at L5 -- S1 level, effacing the thecal sac and impinging the left S1 nerve root. Further imaging can be obtained with CT myelogram or MRI.2. 12-mm gallstone.Dr. Eileen Wang (page # 2992) was paged at time of reporting of the study, but she was not available. A note to alert the physician of the availability of the final report was left on the paging.


Instruction: Generate impression based on medical findings.

Input: Possible wound infection versus osteomyelitis. History of stump infections. Fell today. Bilateral BKA secondary to diabetes. Several sequences are limited by motion artifact.Patient is status post right below-the-knee amputation. There appears to be a small skin defect of the distal stump (series 5, images 11-13). The subcutaneous fat of the stump distal to the tibia demonstrates intermediate signal intensity on T1-weighted images, mixed signal intensity on T2-weighted images, and enhancement on postcontrast images. This likely represents a combination of inflammation and scarring. However, the underlying marrow signal intensity of the adjacent tibia appears normal on T1-weighted images without evidence of osteomyelitis. The marrow intensity of the fibula likewise appears normal.No rim-enhancing fluid collection is present to suggest abscess. Overall there is expected fatty atrophy of the musculature of the leg with mild edema of the remaining tibialis anterior muscle, which is nonspecific. Mild edema and enhancement of the lateral aspect of the patella may represent a bone contusion.Postoperative changes of left below-the-knee amputation are also noted, without evidence of osteomyelitis of the left tibia or fibula.

Output: 1.Mild inflammatory changes of the distal soft tissues of the stump, without evidence of abscess or osteomyelitis.2.Mild edema and enhancement of the patella may represent contusion.


Instruction: Generate impression based on medical findings.

Input: Female, 14 years old, with headaches for 2 years status post concussion. Assess for diffuse axonal injury. A single 4 mm focus of T2 hyperintensity is evident within the left aspect of the body of the corpus callosum (see image 19 series 701). This was present on the prior MRI examination from 2010 and has not significantly changed.The cerebral and cerebellar hemispheres and brainstem otherwise show normal signal intensity and morphology. No restricted diffusion is seen. The pattern of parenchymal enhancement is within normal limits.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. Signal intensity of the bone marrow is unremarkable. No significant abnormalities of the paranasal sinuses are detected.

Output: A single 4 mm focus of signal abnormality is evident within the left aspect of the body of the corpus callosum, stable when compared to a prior examination from 2010. This finding is nonspecific.No additional evidence to suggest diffuse axonal injury or other significant posttraumatic injury to the brain.


Instruction: Generate impression based on medical findings.

Input: 18-year-old male with history of left knee pain. Evaluate for ACL/PCL tear. MENISCI: The lateral meniscus is completely torn with the anterior horn avulsed from its insertion on the tibia and flipped posteriorly with the meniscal fragments located in the posterior aspect of the lateral tibiofemoral joint space. There is longitudinal and branching fluid signal abnormality within a body of the medial meniscus extending to the articular surfaces compatible with a complex tear.ARTICULAR CARTILAGE AND BONE: Artifact from intramedullary rod limits evaluation of the distal tibia. There is edema type signal about the anterolateral aspect of the tibial plateau and the medial femoral condyle. The articular cartilage is relatively intact. There is no evidence of fracture.LIGAMENTS: There is complete disruption of the PCL. The majority of the ACL fibers are not well visualized with a few intact fibers compatible with at least a partial tear. The fibular femoral ligament is not visualized and may be also torn. The IT band and biceps femoris tendon are intact. The MCL is unremarkable.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Complex and extensive tearing of the lateral meniscus as above.2.Longitudinal tear of the body of the medial meniscus.3.Complete tear of the PCL with a high grade partial tear of the ACL.4.Nonvisualized fibular femoral ligament may indicate tear.5.Other findings as above.


Instruction: Generate impression based on medical findings.

Input: Infrapatellar pain. Tiny osteophytes suggest minimal osteoarthritis, essentially within normal limits considering the patient's age. There is perhaps a slight varus deformity of the knee but otherwise alignment is within normal limits. I see no joint effusion. The patellar tendon silhouette appears normal.

Output: Minimal osteoarthritis, essentially within normal limits considering the patient's age.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p excision/xrt of left wrist soft tissue sarcoma, evaluate for local recurrence3 History: above The field-of-view was increased to include the distal forearm. Foci of metallic susceptibility artifact are noted along the ulnar aspect of the wrist, compatible with prior synovial sarcoma resection.We see no mass lesion to suggest tumor recurrence. Again seen is reticulation of the subcutaneous fat along the ulnar aspect of the forearm and wrist which appears similar to the prior examination. There is mild edema and enhancement of the pronator quadratus muscle and extensor digitorum muscle which may reflect post therapy changes, appearing similar to the prior study. The extensor and flexor tendons appear intact. There is a small amount of fluid within the radiocarpal joint with foci of nodular enhancement likely representing a mild synovitis.

Output: Posttreatment changes following synovial sarcoma resection without evidence of tumor recurrence. Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: 65-year-old female patient with history of nausea, vomiting, and abnormal LFTs. Evaluate for pancreatic biliary etiology and liver morphology. ABDOMEN:LIVER, BILIARY TRACT: There is mild intrahepatic and extrahepatic biliary ductal dilatation to the level of the ampulla. However, there is no stone or soft tissue lesion seen. Multiple nonenhancing probable hepatic cysts are too small to characterize.The gallbladder is distended and filled with sludge and gallstones.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic duct is diffusely dilated up to 4 mm.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Prominent left retroperitoneal lymph node measures 1.5 x 0.9 cm (series 3 image 8).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Intra and extrahepatic biliary dilatation to the level of the ampulla without evidence of stone or obstructive soft tissue lesion. There may be a benign ampullary stricture. 2.Diffuse mild pancreatic duct dilatation.


Instruction: Generate impression based on medical findings.

Input: T4N0 adenoid cystic carcinoma of minor salivary gland/maxillary sinus with intracranial extension. There are postoperative findings related to partial left maxillectomy. There is diffuse mild left maxillary sinus mucosal thickening, with slightly more prominent infiltrative tumor involving the left maxillary alveolus, premalar subcutaneous tissue, and retromaxillary region. There is also persistent perineural tumor extension involving the left infraorbital nerve, pterygopalatine fossa, Vidian canal, foramen rotundum, foramen ovale, cavernous sinus, and Meckel cave, measuring up to 5mm in thickness, previously also 5 mm. There is no evidence of intraparenchymal extension. There is increased enhancing tumor within the medial left extraconal orbit, which measures up to 10 mm in width, previously 6 mm. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is no evidence of significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable.

Output: 1. Post-treatment findings in the left sinonasal region with persistent perineural tumor involving the left trigeminal nerve branches with intracranial extension2. Infiltrative tumor involving the left maxillary alveolus, premalar subcutaneous tissue, and retromaxillary region appears to be slightly more prominent. 3. Increased left medial orbit extraconal tumor.4. No evidence of brain parenchymal metastases.


Instruction: Generate impression based on medical findings.

Input: Reason: Staph aureus bacteremia and prior imaging with concern for cervical epidural abscess, monitor status on antibiotics History: bacteremia, septic thrombophlebitis, ? mastoiditis, ? epidural abscess Images are degraded by motion artifact. Given this limitation, the following findings are noted.An epidural collection seen on the prior study at the C1/2 level has resolved. There is persistent adjacent paraspinal soft tissue edema. No additional fluid collection is identified. Again seen is left jugular thrombus with loss of flow-void.Bilateral mastoid air cell opacification, left greater than right. Cervical medullary junction is unremarkable. Cerebral tonsils are in normal position. Spinal cord has a smooth contour without focal atrophy or edema. No intraspinal hematoma or mass.There is multilevel degenerative disease of the cervical spine. There is grade 1 retrolisthesis of C5 over C6. There is linear increased STIR/T2 signal in the posterior T1 vertebral body which may represent a somewhat atypical hemangioma. Vertebral body heights are maintained. There is diffuse disc desiccation.C1/C2: No significant spinal canal stenosis or foraminal narrowing. C2/C3: No significant spinal canal stenosis or foraminal narrowing. C3/C4: No significant spinal canal stenosis. Mild facet arthropathy with mild bilateral foraminal narrowing. C4/C5: Posterior disc osteophyte complex with focal left paracentral, foraminal component. Mild spinal canal stenosis. Moderate left foraminal narrowing.C5/C6: Grade 1 retrolisthesis of C5 over C6 with mild spinal canal stenosis and bilateral moderate to severe foraminal narrowing. Loss of disc height.C6/C7: Posterior disc osteophyte complex with mild spinal canal stenosis. Moderate left and mild right foraminal narrowing.C7/T1: No significant spinal canal stenosis. Mild facet arthropathy with mild left foraminal narrowing.T1/T2: Posterior disc osteophyte complex partially evaluated on lateral view.T2/T3: Posterior disc osteophyte complex partially evaluated on lateral view with apparent spinal canal stenosis.

Output: 1.The epidural collection seen on the previous study has resolved with persistent paraspinal soft tissue edema.2.Degenerative changes of the spine as above.


Instruction: Generate impression based on medical findings.

Input: Decubitus ulcer. Evaluate osteo-. There is gas within the soft tissues extending along the greater trochanter and subtrochanteric femur. The margins of the adjacent greater trochanter are indistinct compatible with osteomyelitis as seen on the recent MRI examination. Heterotopic mineralization superior to the greater trochanter has perhaps increased slightly when compared with the prior study. Additional gas density is noted in the soft tissues more posteriorly, appearing to extend to the inferior pubic ramus/ischium. The inferior pubic ramus/ischium are sclerotic with adjacent bone formation, compatible with chronic osteomyelitis. Overall, the bones appear demineralized. Mild osteoarthritis affects both hips. The lower sacrum and coccyx are not well visualized due to demineralization and overlying bowel contents. Facet joint osteoarthritis and degenerative disc disease affect the lower lumbar spine. Overall the findings are similar to those seen on the pelvis radiograph from November 28 accounting for positional and technical differences.

Output: Soft tissue ulceration/gas with radiographic features of osteomyelitis of the left greater trochanter and inferior pubic ramus/ischium appearing similar to the prior study.


Instruction: Generate impression based on medical findings.

Input: Male, 8 years old, status post DNET tumor resection, three-month follow-up exam. Redemonstrated is evidence of right temporal tumor resection. The previously seen acute postoperative changes have resolved. The resection cavity is slightly smaller and contains fluid which has cleared becoming identical to CSF. Thin nonspecific T2 hyperintensity along the cavity margins is seen. No evidence of significant parenchymal edema or mass effect is detected. No pathologic enhancement is identified in the vicinity of the resection or elsewhere. No acute intracranial hemorrhage is seen. There is mild hemosiderin staining of the resection cavity, and linear tracts of susceptibility related to prior depth electrode placement.

Output: Expected evolution of postoperative findings compatible with tumor resection from the right temporal lobe. No new or growing lesions are seen.


Instruction: Generate impression based on medical findings.

Input: 39 year old man with newly diagnosed LV dysfunction referred to determine etiology. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 10%, the LV end diastolic volume index is 273 ml/m2 (normal range: 74+/-15), the LVEDV is 466 ml (normal range 142+/-34), the LV end systolic volume index is 246 ml/m2 (normal range 25+/-9), the LVESV is 419 ml (normal range 47+/-19), the LV mass index is 135 g/m2 (normal range 85+/-15), and the LV mass is 229 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is a mid myocardial stripe and epicardial pattern of late gadolinium enhancement involving the septum and the inferior/inferolateral walls at the mid ventricular level. This finding suggests the presence of an underlying fibrosing infiltrative and inflammatory process. It is very atypical for prior myocardial infarction. The finding has been classically described in dilated cardiomyopathy. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is severely dilated with severely reduced systolic function. The overall RV ejection fraction is 8%, the RV end diastolic volume index is 195 ml/m2 (normal range 82+/-16), the RVEDV is 332 ml (normal range 142+/-31), the RV end systolic volume index is 179 ml/m2 (normal range 31+/-9), and the RVESV is 305 ml (normal range 54+/-17).Right AtriumThe right atrium is severely dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is severe mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSmall right pleural effusion with evidence of a wedge shaped infarct involving the right lower lung. 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. Severe LV dilation was severely reduced systolic function (LVEF 10%) with evidence of epicardial and mid wall fibrosis involving the entire mid left ventricle. No evidence of prior myocardial infarction. No evidence of myocardial infarction. No evidence of acute myocarditis.2. Severe RV dilation with severely reduced systolic function (RVEF 8%)3. Severe biatrial dilation4. Severe mitral regurgitation5. See extracardiac findings


Instruction: Generate impression based on medical findings.

Input: 20-year-old female with history of hemoglobin SS with lower back pain, shooting down leg. Diffuse hypointensity of the bone marrow again seen without abnormal enhancement or evidence of bone marrow edema. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The conus medullaris is normal in signal and morphology and terminates at an appropriate level. There is no significant spinal canal or neural foraminal stenosis at any level. The paravertebral soft tissues are unremarkable. There is diffuse low signal in the partially imaged liver and also present previously.

Output: 1. No significant disc disease, spinal canal or neural foraminal stenosis at any level.2. Diffuse marrow signal hypointensity as well as low signal in the partially imaged liver consistent with known sickle cell anemia and iron overload.


Instruction: Generate impression based on medical findings.

Input: 62-year-old female with neck pain and pain in the left arm which radiates to the hand including all fingers. The patient has known cervical stenosis. Compare to previous MRI done 2/5/2015. Postoperative changes of Chiari decompression are again seen with preserved CSF spaces and biphasic flow at the foramen magnum. There is no discrete syrinx in the cervical spine, although there is trace prominence of the central canal as seen before. Postoperative changes are seen of multilevel laminectomies involving the lower cervical and upper thoracic spine which are unchanged. There is unchanged T2 signal abnormality along the dorsal aspect of the thoracic cord at the T1-T2 level. The cord at the T1-T2 level again abuts the dorsal dura suggesting possibility of tethering but is unchanged.There is minimal retrolisthesis of C3 on C4 and C4 on C5 which is unchanged. The vertebral body heights are maintained. There is some loss of disc height at the C3-4, C4-5 and mildly at the C5-6 levels. There are degenerative Schmorl's nodes in the C4 vertebral body which are unchanged. Otherwise there is no focal worrisome marrow signal abnormality. Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Small disc osteophyte complex as well as mild uncovertebral hypertrophy which contributes to mild to moderate spinal canal and mild bilateral neuroforaminal stenosis. C4-5: Small disc osteophyte complex as well as mild uncovertebral and facet hypertrophy with mild ligamentum flavum thickening. There is mild to moderate spinal canal stenosis with mild to moderate left and mild right neuroforaminal stenosis.C5-6: Minimal right greater than left disc osteophyte complex, mild facet arthropathy and mild ligamentum flavum thickening without spinal canal or neuroforaminal stenosis.C6-7: Minimal disc osteophyte complex and mild ligamentum flavum thickening. No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1.Postoperative changes of Chiari decompression with preserved CSF spaces and flow across the foramen magnum.2.No discrete syrinx in the cervical spine. Unchanged trace prominence of the central canal in the upper cervical cord.3.Postoperative changes of lower cervical/upper thoracic laminectomies. Unchanged appearance of the upper thoracic cord which is dorsally positioned as before suggesting possibility of tethering. Stable T2 signal abnormality/myelomalacia along the dorsal aspect of the thoracic cord at the T1-2 level.4.Degenerative changes as described above with mild-to-moderate spinal canal stenosis at the C3-4 and C4-5 levels as well as up to mild to moderate left C4-5 neural foraminal stenosis.


Instruction: Generate impression based on medical findings.

Input: Exam is limited by significant motion artifact. Within these limitations there is no definite evidence of cord compression. The vertebral body heights are maintained. There is disc space narrowing with posterior disc bulge and hypertrophy of the ligamentum flavum at C5-6. There is no definite cord signal abnormality. There is no significant spinal canal narrowing in the thoracic or lumbar spine. There is mild edema in the paraspinal soft tissues in the left lower lumbar region, of uncertain etiology.

Output: Limited study due to motion artifact. Multilevel spondylosis, with moderate spinal canal narrowing at C5-6. No definite evidence of cord compression or cord signal abnormality.


Instruction: Generate impression based on medical findings.

Input: 58-year-old female with two years history of left cheek swelling on 3 separate occasions. Swelling decreases with antibiotics. Patient has bony defect in the left maxillary sinus anterior wall in the region of intra-orbital foramina. Also asymmetric enlargement of the left infera-orbital canal along the roof of the left maxillary sinus with a small defect in orbital floor. Examination demonstrates soft tissue thickening anteriorly to the anterior wall of left maxillary sinus which appears to extend superiorly anterior to the body of the zygoma. There is also evidence of increased soft tissue density along the floor of the orbit lateral to the infraorbital nerve groove. There is also soft tissue thickening within the maxillary sinus immediately posterior to the anterior wall of the left maxillary sinus. Soft tissue prominence appears to extend slightly posteriorly and posterior laterally to the left maxillary sinus. Bony density of area of the exam demonstrates subtle suspected lytic changes of the left zygoma. There is also uniformly enlarged infraorbital nerve groove which is filled with soft tissue density which is contiguous with above described soft tissue changes. Considering provided clinical data the findings are suspicious for an infectious process. However possibility of a mass cannot be entirely ruled out particularly considering presence of expansion of infraorbital nerve groove (V2). Further evaluation with an MRI examination with infusion is recommended. The retro-orbital fat remains within normal limits. Extraocular musculature and globe remain within normal limits. No definitive abnormality of cavernous sinus or Meckel's cave on this exam is detected. Limited view of nasopharynx demonstrates no abnormality. Minimal chronic sinus disease of bilateral ethmoids is also present.

Output: Abnormal soft tissue within the left maxillary sinus, left orbit, left inter-temporalis fossa with associated bony changes of zygoma and anterior wall of the maxillary sinus as well as left infraorbital nerve groove as detailed. Follow-up been an MRI examination with infusion is highly recommended. Please see above comments.


Instruction: Generate impression based on medical findings.

Input: Male; 69 years old. Reason: h/o chronic prostatitis, now w neutropenic fever, concern for abscess History: chronic prostatitis PELVIS:PROSTATE:Prostate Size: Enlarged prostate gland measuring up to 5.3 x 6.2 x 7.7 cm.Peripheral Zone: No evidence of prostate cancer or abscess.Central Gland: Heterogeneous with scattered foci of T1 hyperintensity due to hemorrhage and multiple BPH nodules. No evidence of abscess.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: Stable specific, mildly enlarged perirectal lymph nodes (e.g. series 1601/120).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Prostatomegaly without focal lesion suspicious for prostate cancer or abscess.2. Stable nonspecific, mildly enlarged perirectal lymph nodes.


Instruction: Generate impression based on medical findings.

Input: The thoracic spine is in normal alignment. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine. Disc herniation at the right L5-S1 level is again noted on the sagittal counting sequence and more completely imaged on recent lumbar spine MRI from 9/24/2016.

Output: 1. Unremarkable thoracic spine MRI.2. Disc herniation at the right L5-S1 level is again noted and more completely imaged on recent lumbar spine MRI from 9/24/2016.


Instruction: Generate impression based on medical findings.

Input: Pain the flexion, positive McMurray's. Evaluate for loose body and medial meniscus tear. MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: There is mild bone marrow edema along the anterior aspect of the medial femoral condyle. The articular cartilage of the medial and lateral compartments is intact. There is thinning of the articular cartilage of the medial femoral trochlea and partial thickness fissuring of the articular cartilage of the patellar apex.LIGAMENTS: The collateral and cruciate ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. Small intraarticular loose body.2. Medial femoral condyle bone contusion3. Intact menisci and ligaments.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old, with left-sided numbness and pain. Left hemibody sensory deficits to light touch and pain, sudden onset. Brain MRI:A band of T2 hyperintensity is seen traversing the pons. There is some associated diffusion hyperintensity but no ADC correlate to verify acute ischemia/cytotoxic edema. A few additional scattered small foci of T2 hyperintensity are seen through the cerebral hemispheres. No lesions of the thalami are seen. No edema or mass effect is detected. There are no findings to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collection. Ventricular size and morphology are within normal limits.Brain MRA:No evidence of significant vascular stenosis or occlusion is seen. No aneurysm or vascular malformation is suspected. The left intracranial vertebral artery is diminutive, but this can be a normal variant. The extracranial vertebral artery is better assessed on subsequent neck MRA. C-spine MRI:Alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement is seen. There may be mild endplate edema at C7. The visualized spinal cord shows normal signal intensity and morphology. No epidural abnormalities are suspected.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Minimal posterior disc-osteophyte complex formation. No spinal canal or foraminal stenosis. C4-5: No spinal canal stenosis or neuroforaminal narrowing. C5-6: Posterior disc-osteophyte complex formation with slight effacement of the ventral thecal sac. No significant spinal canal stenosis. Mild right foraminal narrowing. C6-7: Minimal posterior disc-osteophyte complex formation. No spinal canal stenosis. No foraminal narrowing. C7-T1: Posterior disc-osteophyte complex formation. Slight effacement of ventral thecal sac. No significant spinal canal stenosis. Moderate bilateral foraminal narrowing.

Output: 1.No definite acute intracranial abnormality is seen. Signal abnormality in the pons is favored to be chronic and may reflect the sequelae of microvascular ischemia.2.Unremarkable MRA evaluation of the brain.3.Mild degenerative disease is seen in the cervical spine. No significant cord or nerve root impingement is seen. No abnormalities of the spinal cord are detected.


Instruction: Generate impression based on medical findings.

Input: 59 years Female (DOB:8/6/1956)Reason: AMS s/p liver transplant. MR Brain w/o to assess for PRES or other CNS pathology per neuro recs History: as abovePROVIDER/ATTENDING NAME: CHRISTINE TROTTER JOHN F. RENZ The CSF spaces are appropriate for the patient's stated age with no midline shift. Since the prior exam T2 and FLAIR signal hyperintensity involving the globus pallidus I has mildly regressed but not resolved.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate partial opacification of the sphenoid sinus as well as some mucosal thickening in the maxillary sinuses. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.Susceptibility weighted imaging is degraded by motion artifact. Axial T1 and coronal T2 imaging is degraded by patient motion artifact.

Output: 1.Since the prior exam abnormal signal within the globus pallidus I has regressed. This is nonspecific but could relate to a toxic or metabolic process.2.No new lesions are appreciated intracranially.3.Exam is degraded due to patient motion which may obscure more subtle abnormalities.


Instruction: Generate impression based on medical findings.

Input: 68 year old with hypertrophic cardiomyopathy presenting for cardiac function and scar evaluation. Left VentricleThe left ventricle is normal in size with normal systolic function. There is left ventricular hypertrophy that is asymmetry. The septal wall thickness is 15-16 mm while the anterior and lateral walls are 13-14mm. The overall LV ejection fraction is 65%, the LV end diastolic volume index is 92 ml/m2 (normal range: 65+/-11), the LVEDV is 177 ml (normal range 109+/-23), the LV end systolic volume index is 33 ml/m2 (normal range 18+/-5), the LVESV is 63 ml (normal range 31+/-10). There are no regional wall motion abnormalities present. There is small amount of mid myocardial late gadolinium enhancement in the basal inferior wall that suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process in a pattern that is atypical for myocardial infarction. Left AtriumThe left atrium is mild to moderately dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 59%, the RV end diastolic volume index is 61 ml/m2 (normal range 69+/-14), the RVEDV is 117 ml (normal range 110+/-24), the RV end systolic volume index is 25 ml/m2 (normal range 22+/-8), and the RVESV is 48 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is jet of eccentric mitral regurgitation that is at least mild. There is systolic anterior motion (SAM) seen with flow acceleration in the LVOT. 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 with a common origin to the right innominate and left common carotid (normal variant - "pseudo-bovine"). The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease. Pericardial fat was seen. Extracardiac FindingsProbable left renal cysts. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function. There is left ventricular hypertrophy that is asymmetry. The septal wall thickness is 15-16 mm while the anterior and lateral walls are 13-14mm. The overall LV ejection fraction is 65%.There are no regional wall motion abnormalities present. There is a small amount of mid myocardial late gadolinium enhancement in the basal inferior wall that suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process in a pattern that is atypical for myocardial infarction. 2. Asymmetric left ventricular hypertrophy with systolic anterior motion of the mitral valve with associated flow acceleration. 3. The right ventricle is normal in size and systolic function (RVEF 59%). 4. Left atrial enlargement.


Instruction: Generate impression based on medical findings.

Input: Brain MRI:There is no restricted diffusion on diffusion weighted images to indicate an infarct. No susceptibility weighted abnormalities to indicate intracranial hemorrhage. Note is made of very mild periventricular and subcortical white matter T2/Flair signal abnormalities which is nonspecific but compatible with very mild chronic small vessel ischemic changes.There is advanced global parenchymal volume loss commensurate with age. The ventricles are somewhat prominent compared to the sulci. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There are no extraaxial fluid collections or subdural hematomas. Mild right maxillary and ethmoid opacification. The paranasal sinuses and mastoid air cells are otherwise clear. Mild degenerative changes are noted of the visualized upper cervical spine.Brain MRA: There is antegrade flow within the distal bilateral vertebral arteries, within the basilar artery, distal bilateral internal carotid arteries and carotid siphons and bilateral anterior, middle and posterior cerebral arteries. There is some narrowing of the left M2/M3 segments which may be due to atherosclerotic disease. No arterial occlusions or aneurysms are identified. No arteriovenous malformations are identified and there is no evidence for cerebral vasculitis. There is a left dominant vertebral artery. A small left A1 segment and small left PICA is noted.Neck MRA:There is conventional takeoff of the great vessels from the aortic arch without evidence for stenosis of the origin of the great vessels or of the bilateral vertebral arteries which are codominant. There are no stenoses of the bilateral common, internal or external carotid arteries or at the bilateral carotid bifurcations. There is no evidence for vasculitis, fibromuscular dysplasia or dissection of the carotid or vertebral arterial systems within the neck. There are no vascular masses identified. The left vertebral artery is tortuous within the neck but there is no stenosis.

Output: 1. No evidence of acute infarct.2. Global parenchymal volume loss commensurate with patient's age. There is slight prominence of the ventricles compared to the degree of volume loss raising question of communicating hydrocephalus/NPH in the appropriate clinical setting. No significant change since 8/5/2010. 3. No significant steno-occlusive disease of the arteries of the brain or neck.


Instruction: Generate impression based on medical findings.

Input: Female, 41 years old, status post meningioma resection in 3/2014. Yearly surveillance, on antiseizure medications. Postoperative changes related to resection of large left frontotemporal meningioma is again seen without appreciable change in appearance of the resection cavity and small areas of encephalomalacia in the left frontal and temporal lobes. Again seen is linear dural thickening and enhancement in the left middle cranial fossa abutting the greater wing sphenoid wing and extending medially to the level of the superior orbital fissure and inferiorly to the foramen rotundum. The thickening measures approximately 6 mm, previously approximately 5 mm. The left greater sphenoid wing remains expanded with minimal medial bowing of the lateral orbital wall. No mass effect on the optic nerve at the optic canal. No abnormal signal in the optic nerve or intraorbital extension of the tumor.Chronic blood products are present in the surgical bed. Elsewhere, brain parenchymal morphology is unremarkable. No new pathologic enhancement is seen. No evidence of acute ischemia or hemorrhage. Ventricles are stable and normal in size. Major vascular structures remain patent.

Output: Postoperative changes related to resection of a large left frontotemporal meningioma are again seen. Compared to 1/19/2015, there is stable to perhaps minimal interval increase in thickness of the enhancing rind of tissue in the left middle cranial fossa which abuts the left greater sphenoid wing and extends medially to the level of the superior orbital fissure. This tissue measures 6 mm in thickness, previously 5 mm, and is suspected to represent minimal residual tumor. Optic canal remains patent.


Instruction: Generate impression based on medical findings.

Input: Altered mental status: recently diagnosed lung adenocarcinoma with brain mets s/p radiation and steroids. MRI: There are new areas of restricted diffusion and high T2 signal in the left insula, perirolandic region, parietal lobe, and medial occipital lobe superimposed upon pre-existing areas of restricted diffusion in the left basal ganglia and lateral occipital lobe. There are multiple areas of peripheral and gyriform enhancement in the left cerebral hemisphere with an overall background of decreased perfusion. The largest peripherally enhancing lesion of the left cerebral hemisphere is located in the paracentral lobe, measuring up to 15 mm. Some of the lesions demonstrate susceptibility effect and intrinsic T1 hyperintensity, particularly in the left basal ganglia and occipital lobe. There are also ring-enhancing lesions in the left cerebral hemisphere, which measure up to 5 mm. There are scattered nonspecific foci of T2 hyperintensity without restricted diffuse in the cerebral white matter. There is an enhancing pituitary mass with suprasellar extension and mass effect upon the optic apparatus that measures up to 3 cm. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA: There is an abrupt cut-off of flow-related enhancement in a left M2 branch proximally. There is also an abrupt cut-off of flow-related enhancement in a left P2 segment. The rest of the major cerebral arteries appear to be intact otherwise.

Output: 1. Acute upon subacute infarcts in the left middle and posterior cerebral artery territories associated with areas of microhemorrhage and enhancement. However, a portion of the enhancing lesions in the bilateral cerebral hemispheres likely represent underlying metastases.2. Abrupt cut-off of left M2 and P2 branches may be due to thromboembolic disease. Vascular imaging of the neck may be useful.3. A pituitary mass likely represents a macroadenoma.Discussed with Dr. GAJEWSKI at 3:15 PM on 7/10/15.


Instruction: Generate impression based on medical findings.

Input: Evaluate for abnormality/metastatic disease; history ovarian cancer. Brain: There is a peripherally enhancing mass in the medial left occipital lobe that measures up to 24 mm, with extensive surrounding vasogenic edema. There is also a heterogeneously enhancing mass in the right cerebellar hemisphere, which measures up to 15 mm, also with extensive surrounding vasogenic edema. The cerebellar tonsils extend up to 6 mm inferior to the foramen magnum. There is no evidence of intracranial hemorrhage or acute infarct. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Complete Spine: There is fatty bone marrow signal in the lumbosacral spine related to radiation effects. There is also irregular linear low T1 signal and enhancement that traverses the right sacral ala. There are prominent sacral perineural cysts with remodelling of the sacrum. Otherwise, there is no evidence of mass lesions in the spine. There are mild degenerative changes in the lower cervical spine and at L5-S1 without significant spinal canal stenosis. The vertebral body heights are preserved. There is no significant spondylolisthesis. The spinal cord signal and morphology is normal. There is a right pleural effusion.

Output: 1. Metastases in the right cerebellar hemisphere and left occipital lobe with associated vasogenic edema.2. Radiation effects in the lumbosacral spine bone marrow with probable right sacral insufficiency fracture versus less likely an infiltrative metastasis.3. Low-lying cerebellar tonsils may represent Chiari 1 malformation.4. Right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: 50 years, Male, gait disturbance and hyperreflexic. Evaluate for brain lesion. There is no restricted diffusion to suggest acute ischemia. There is no intracranial hemorrhage, intracranial mass or mass-effect. There is sulcal and ventricular prominence, compatible with moderate generalized parenchymal volume loss, greater than expected for age. There is no hydrocephalus.Several foci of T2 hyperintensity are seen in the bilateral subcortical and periventricular white matter. Brain parenchyma is otherwise unremarkable. No abnormal parenchymal or meningeal enhancement is identified. Normal flow-voids are present within the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.

Output: 1.Several foci of T2 hyperintensity within the bilateral subcortical and periventricular white matter are nonspecific, and statistically most likely represent chronic small vessel disease. However, other differential considerations include migraine sequela, infectious/inflammatory etiology, trauma or demyelinating disease.2.Moderate generalized parenchymal volume loss, greater than expected for age.


Instruction: Generate impression based on medical findings.

Input: T4N0 adenoid cystic carcinoma of minor salivary gland/maxillary sinus with intracranial extension. There are postoperative findings related to partial left maxillectomy. There is diffuse mild left maxillary sinus mucosal thickening, with slightly more prominent infiltrative tumor involving the left maxillary alveolus, premalar subcutaneous tissue, and retromaxillary region. There is also persistent perineural tumor extension involving the left infraorbital nerve, pterygopalatine fossa, Vidian canal, foramen rotundum, foramen ovale, cavernous sinus, and Meckel cave, measuring up to 5mm in thickness, previously also 5 mm. There is no evidence of intraparenchymal extension. There is increased enhancing tumor within the medial left extraconal orbit, which measures up to 10 mm in width, previously 6 mm. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is no evidence of significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable. There is an enhancing lesion in the T1 vertebral body, which measures approximately up to 10 mm.

Output: 1. Post-treatment findings in the left sinonasal region with persistent perineural tumor involving the left trigeminal nerve branches with intracranial extension2. Infiltrative tumor involving the left maxillary alveolus, premalar subcutaneous tissue, and retromaxillary region appears to be slightly more prominent. 3. Increased left medial orbit extraconal tumor.4. No evidence of brain parenchymal metastases.5. A lesion in the T1 vertebral body may represent a metastasis.


Instruction: Generate impression based on medical findings.

Input: Female, 36 years old, with MS, f/u progression. Numerous lesions are redemonstrated involving the corpus callosum, periventricular and subcortical white matter both supra- and infratentorially. These show a morphology consistent with demyelination.Since the prior examination, a prominent lesion within the left cerebellum/middle cerebellar peduncle has decreased in size. A prior lesion within the left parietal subcortical white matter is also decreased in size. However, some lesions have increased in size or are new including one in the left frontal subcortical white matter (image 19 series 801), and two within the right cerebellum (image 8 series 8 a one). Most of the numerous additional lesions are unchanged.The corpus callosum is mildly thinned but brain parenchymal morphology is otherwise unremarkable. No evidence of significant mass effect is seen. No intracranial hemorrhage is suspected. There are no abnormal extra-axial collections and the ventricles are normal in size and morphology.

Output: Most of the numerous white matter lesions, compatible with the history of multiple sclerosis, are unchanged. However, at least two lesions seen on the prior examination have improved in terms of size and conspicuity, and three lesions are either new or increased in size.


Instruction: Generate impression based on medical findings.

Input: Reason: metastatic Prostate cancer, right sided lower thoracic spine predominantly sclerotic lesions amenable to biopsy (per Dr Christoforidis) History: Requiered per Protocol 12-0109 Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the vertebral lesion. Incidental note is made of calcific gallstones which have moved to a dependent position on the prone position scan relative to the prior supine position CT of the abdomen from 8/27/13.

Output: 1.T10 vertebral bone biopsy under CT guidance. A total of six samples were delivered to pathology for analysis.2.Gallstones


Instruction: Generate impression based on medical findings.

Input: Patient with an acute hemoglobin drop and right lower extremity sarcoma. Please evaluate for hematoma.IMAGE ACQUISITIONS: CT of the right thigh without contrast enhancement; transverse, coronal, and sagittal views are provided CT of the right thigh without contrast enhancement again shows a large heterogeneous mass within the posterior thigh, which appears comparable to that seen on the MRI from June. Centrally, the mass is of prominently low density, which likely represents a combination of blood, fluid and/or necrosis. The periphery of the mass is isodense to muscle. Although the previous MRI showed findings consistent with internal hemorrhage, there are no specific findings on this exam showing new hemorrhage or hematoma. However, acute extravasation cannot be assessed in the absence of contrast enhancement. The right sacroiliac joint is fused as seen previously.

Output: There is a large soft tissue sarcoma which is comparable in appearance to the previous MRI study. The heterogeneous appearance may be due to internal hemorrhage as seen on the previous MRI; however, the possibility of acute extravasation cannot be determined in the absence of contrast.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old, with history of multiple sclerosis on Rebif. Follow-up examination. Brain:Multiple scattered T2 hyperintense lesions are demonstrated within the periventricular and subcortical white matter, the corpus callosum, and minimally in the cerebellum. The number and size of these lesions have not significantly changed from the prior examination. No convincing lesional enhancement is seen. Most, however, are associated with moderate to marked T1 hypointensity. There is no evidence of significant parenchymal edema or mass effect. Overall brain volume is relatively preserved. No evidence of acute intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricles are normal in size and morphology. C-spine:Slight reversal of the cervical lordosis is unchanged. Vertebral body heights are preserved. No worrisome marrow signal replacement or edema is detected. No pathologic marrow enhancement is seen. Signal characteristics compatible with benign hemangiomas are seen within the C5 and T1 vertebral bodies.A focus of T2 hyperintensity is seen within the right posterolateral cord at C5, unchanged from prior. There may be a few additional scattered foci of cord T2 hyperintensity, but imaging artifact prevents definitive visualization. No pathologic cord enhancement is seen.C2-3: Unremarkable. C3-4: Unremarkable. C4-5: Mild posterior disc-osteophyte complex formation and right uncovertebral hypertrophy. No significant spinal canal stenosis. Mild right foraminal narrowing. No interval changes. C5-6: Posterior disc-osteophyte complex formation with a right paracentral extrusion extending predominantly below the disc space, progressed from prior. There is effacement of the right ventral sac and perhaps very slight impingement of the right ventral cord. No significant foraminal narrowing. C6-7: Unremarkable. C7-T1: Unremarkable.

Output: 1.White matter lesions are identified in the brain compatible with multiple sclerosis. The size and number of these lesions have not significantly changed.2.At least one, but possibly several small lesions are seen within the visualized spinal cord. No significant interval change is suspected.3.A right paracentral disc extrusion at C5-6 has increased in size since the prior examination with resultant progressive effacement of the thecal sac.


Instruction: Generate impression based on medical findings.

Input: 45 years Male (DOB:10/6/1970)Reason: Evaluate for disc herniation, nerve root compression History: RLE radiculopathy + lumbar back painPROVIDER/ATTENDING NAME: JAMES M MOK JAMES M MOK 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.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: No compromise to lumbar spinal canal or neural foramina.


Instruction: Generate impression based on medical findings.

Input: 79 year old female with continued burning chest pain, prior abnormal stress. First Pass PerfusionDuring hyperemia, a perfusion defect is noted in the basal anteroseptum and the mid inferoseptum, anteroseptum, anterior, and anterolateral walls. Based on the atypical distribution of the perfusion defect, the differential diagnosis includes microvascular dysfunction and epicardial coronary disease. Left VentricleThe left ventricle is normal in size and global function. The overall LV ejection fraction is 66%, the LV end diastolic volume index is 56 ml/m2 (normal range: 65+/-11), the LVEDV is 100 ml (normal range 109+/-23), the LV end systolic volume index is 19 ml/m2 (normal range 18+/-5), the LVESV is 34 ml (normal range 31+/-10), the LV mass index is 48 g/m2, and the LV mass is 86 g. There are no regional wall motion abnormalities present. There is late gadolinium enhancement involving the basal inferior, inferoseptal, and anteroseptal walls. In the inferior wall it is in a mid-wall pattern; however, in the inferolateral and anterolateral walls it is subendocardial and involves ~50% of the wall thickness. Although this pattern is consistent with myocardial infarction, it may also represent an infiltrative process as the wall thickness is preserved.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size and function. The overall RV ejection fraction is 66%, the RV end diastolic volume index is 48 ml/m2 (normal range 69+/-14), the RVEDV is 86 ml (normal range 110+/-24), the RV end systolic volume index is 16 ml/m2 (normal range 22+/-8), and the RVESV is 29 ml (normal range 35+/-13). Right AtriumThe right atrium is normal. 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 moderate tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsHiatal hernia is 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. During hyperemia, a perfusion defect is noted in the basal anteroseptum and the mid inferoseptum, anteroseptum, anterior, and anterolateral walls. Based on the atypical distribution of the perfusion defect, the differential diagnosis includes microvascular dysfunction and epicardial coronary disease.2. There is late gadolinium enhancement involving the basal inferior, inferoseptal, and anteroseptal walls. In the inferior wall it is in a mid-wall pattern; however, in the inferolateral and anterolateral walls it is subendocardial and involves ~50% of the wall thickness. Although this pattern is consistent with myocardial infarction, it may also represent an infiltrative process as the wall thickness is preserved.3. Normal LV size and systolic function (LVEF 66%).4. Normal RV size and systolic function (RVEF 66%).5. Moderate tricuspid regurgitation.6. Hiatal hernia is noted. 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: 83 years, Female, right-sided weakness and aphasia. There are areas of restricted diffusion involving the left posterior frontal and anterior parietal lobes including the pre and post central gyri and extending laterally into the operculum. There is corresponding T2/FLAIR hyperintensity. There is a 4 mm focus of susceptibility effect involving the left lateral post central gyrus suspicious for hemorrhagic transformation. No significant edema or mass effect.Again seen are multiple chronic infarcts including the right parieto-occipital lobes and bilateral cerebellar hemispheres with evolution of the previously seen right superior cerebellar artery territory infarct on prior MRI from 2/17/2011. There is susceptibility compatible with chronic hemosiderin deposition involving the prior right cerebellar infarct.No intracranial mass or mass effect. No extra-axial collections. No hydrocephalus. Bilateral T2/FLAIR hyperintensity involving the bilateral periventricular and subcortical white matter is compatible with background of moderate chronic small vessel ischemic disease. Major flow-voids are preserved. Calvarium and extracranial soft tissues are grossly unremarkable.

Output: 1. Acute infarct involving the left posterior frontal and anterior parietal lobes including the pre and post central gyri and extending laterally into the operculum. There is a 4 mm focus of susceptibility involving the left lateral post central gyrus suspicious for minor hemorrhagic transformation.2. Multiple chronic infarcts including the right parietal lobe as well as bilateral cerebellar hemispheres. There has been interval evolution of the previously seen large right superior cerebellar artery territory infarct seen on MRI dated 2/17/2011 with chronic hemosiderin deposition also present in this region. 3. Evidence of moderate chronic small vessel ischemic disease also again seen.Dr. Ali discussed findings with Dr. Del Brutto Andrade at 930 hrs on 11/15/2015.


Instruction: Generate impression based on medical findings.

Input: Shoulder pain Note that the exam is limited by motion artifact.ROTATOR CUFF: There is a small full-thickness tear of the distal posterior fibers of the supraspinatus tendon. This may extend into the anterior fibers of the infraspinatus tendon although this is unclear given the limitations due to motion. There is increased thickness and signal of the supraspinatus tendon reflecting tendinosis.SUPRASPINATUS OUTLET: There is moderate acromioclavicular arthrosis with a trace amount of fluid in the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is degenerative signal of the superior labrum but the labrum otherwise appears intact. There is severe cartilage loss of the humeral head reflecting moderate to severe osteoarthritis of the glenohumeral joint.BICEPS TENDON: The intra-articular portion of the biceps tendon appears intact.ADDITIONAL

Output: Significantly limited exam secondary to motion artifact. Within normal limits, there is a small full-thickness tear of the distal supraspinatus tendon which may extend to involve the anterior infraspinatus tendon although this is unclear.


Instruction: Generate impression based on medical findings.

Input: Assess for vascular malformations compressing IAC nerve bundles: vertigo and noise in the left ear. Internal Auditory Canals MRI: The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable. There are secretions within the right maxillary sinus.Brain MRA: There is no evidence of significant steno-occlusive lesions, aneurysms, or vascular malformations. There is an accessory left superior cerebellar artery, which is a normal variant.

Output: No evidence of lesions compromising the internal auditory canal contents.


Instruction: Generate impression based on medical findings.

Input: eval AVN talus L History: pain TENDONS: The imaged tendons of the foot and ankle are intact. The Achilles tendon is normal in caliber and signal.LIGAMENTS: The ligaments of the ankle and midfoot are intact.ARTICULAR SURFACES AND BONE: The articular cartilage demonstrates normal signal and morphology. Vertically oriented linear high signal within the mid calcaneus is consistent with a prominent vascular remnant. ADDITIONAL

Output: Normal examination. No osseous signal abnormality to suggest avascular necrosis as suggested clinically.


Instruction: Generate impression based on medical findings.

Input: 34-year-old male with primary sclerosing cholangitis, evaluate for cholangiocarcinoma. ABDOMEN:LIVER, BILIARY TRACT: There are moderate multifocal areas of narrowing of the intrahepatic biliary ducts compatible with history of primary sclerosing disease. A biliary walls are mild thickening and hyper enhancing throughout the intra and extrahepatic biliary system. Specifically, the right intrahepatic biliary wall is thickened and enhancing. The common bile duct measures 6 mm in diameter with irregularity along its course. There is severe stricturing distally (5/46) and mild stricturing along the midportion.No suspicious hepatic lesions to suggest cholangiocarcinoma.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: There are multiple enlarged peripancreatic lymph nodes, adjacent to the common bile duct, measuring up to 2.0 x 2.8 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Intrahepatic and extrahepatic biliary strictures compatible with history of primary sclerosing cholangitis.2.Biliary walls are thickened and hyperenhancing, which may represent cholangitis.3.No specific evidence of cholangiocarcinoma.4.Multiple enlarged peripancreatic lymph nodes.


Instruction: Generate impression based on medical findings.

Input: Ileocolonic Crohn's and left sided abdominal pain. 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: There is mild wall thickening and increased enhancement of the distal ileum connecting to the cecum and proximal cecum. These findings are suggestive of mild active Crohn's disease.There is also increased enhancement and wall thickening of the rectosigmoid colon. There is a left perirectal abscess measuring 2 x 1.6 cm on image #20, series #17 with fluid fluid levels.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. MR findings compatible with active inflammation of rectosigmoid colon and terminal ileum and cecum. Small left perirectal abscess.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: Other symptoms and signs involving the musculoskeletal system [R29.898], Reason for Study: ^Reason: hx of metastatic melanoma, eval for mets to brain History: R shoulder twitching There is no evidence of acute ischemic lesion.Multiple susceptibility lesions on bilateral basal ganglia as well as a focal nodular susceptibility lesion on the right inferior parietal lobule are again seen without showing evidence of enhancement or surrounding edema.Curvilinear high signal intensity cortical lesions on the right inferior frontal gyrus , right parietal operculum and the left precentral gyrus are again seen without evidence of contrast enhancement, unchanged.There is no evidence of abnormal enhancement since prior scan.Scattered somewhat patchy bilateral periventricular white matter and centrum semiovale T2/FLAIR high signal intensity lesions indicating non specific small vessel ischemic lesions, unchanged.The ventricles, sulci and cisterns are unremarkable. There is no mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement.2. Unchanged multifocal bilateral basal ganglia and the right inferior parietal lobule susceptibility lesions.3. Curvilinear bihemispheric non enhancing T1 high signal intensity lesions are seen, unchanged.4. Unchanged non specific small vessel ischemic disease.


Instruction: Generate impression based on medical findings.

Input: Ms. Klipstein is a 69-year-old woman with a personal history of right simple mastectomy for invasive mammary carcinoma in 2007 presents for follow-up. Patient also received hormonal therapy for 8 years. There is heterogeneous amount of fibroglandular tissue in the left breast. Minimal parenchymal enhancement is noted in the left breast. There is no abnormal enhancement seen in the left breast. A few cysts are seen in the left breast. There are postsurgical changes of right breast mastectomy with implant-based reconstruction. There is no abnormal enhancement surrounding the retropectoral silicone implant or in the right chest wall. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on medical findings.

Input: History of prostate cancer, status post radical prostatectomy in 2011 (pT3aN0) with detectable PSA. PELVIS:PROSTATE: Status post prostatectomy. There is a subtle 2-3 mm irregular nodularity at the vesicoureteral anastomosis on the right, which is best seen on the axial T2 series (series 501 image 40). No definite corresponding abnormality is identified on the postcontrast images.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Status post prostatectomy. A subtle 2 to 3 mm irregular nodularity at the right vesicoureteral anastomosis could represent a small focus of recurrence.


Instruction: Generate impression based on medical findings.

Input: Altered mental status, hemorrhagic brain metastasis. Redemonstration of 2 parenchymal hemorrhagic foci including left caudate body and right occipital lobe with evidence of gadolinium enhancement. These lesions show MR evidence of localized surrounding edema.There is no other enhancing lesion is seen. On FLAIR images, there is a focal high signal intensity lesion on the right side of caudate splenium without evidence of Gad enhancement nor evidence of hemorrhage. Since the lesion shows low signal intensity on T1, this lesion may represent prior small tissue defects possibly related to lacunar infarction.There is a suspicious focal tissue defect (myelomalacia) on spinal cord at the level of C12 level (series 1201, image 17/33) with subtle adjacent enhancement. The enhancement could be related to partial volume averaging artifacts from epidural venous plexus. However, considering the patient's other intracranial enhancing lesions, if clinically indicated, dedicated cervical spine MRI with and without contrast can be considered for further evaluation.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Two intra axial hemorrhagic foci with enhancement as described above likely representing metastatic foci than simple intracranial hemorrhages.2. No other abnormal enhancement is seen.3. Suspicious C12 level cervical cord lesion as described above, if clinically indicated, dedicated cervical spine with and without contrast enhancement can be considered.


Instruction: Generate impression based on medical findings.

Input: Susceptibility artifact from left parietal approach ventriculocisternal catheter limits evaluation of the adjacent parenchyma on the diffusion sequence. There is no evidence of restricted diffusion to suggest acute ischemia. Interval normalization of the T2 hyperintensity previously seen within the left bilateral occipital lobes with suggestion of development of volume loss. There is also small foci of T2 hyperintensity and volume loss involving the bilateral thalami. These changes are compatible with evolution of previously seen ischemic injury.Bilateral transparietal catheters and disconnected left frontal catheter are again seen. Evidence of prior right frontal ventriculostomy also noted. There is mild interval enlargement of the lateral and third ventricles compared to prior MRI dated 12/2/2014 and minimally larger compared to outside CT dated 1/21/2015 with for example the third ventricle measuring 11 mm in diameter, compared to 7 mm on prior CT from 1/21/2015. Colpocephaly and thinning involving of the corpus callosum, particularly involving the mid callosal body again seen. Tiny foci of susceptibility are again noted along the margins of the ventricular system compatible with chronic blood products. Aqueductal stenosis again noted.No abnormal parenchymal or meningeal enhancement is seen. No evidence of abscess or empyema. Small focus of fluid intensity is seen at the right frontal burr hole site. Major flow-voids are demonstrated in the major intracranial vascular structures. There is significant interval improvement opacification of the mastoid air cells and paranasal sinuses compared to prior MR.

Output: 1. Susceptibility artifact from left transparietal catheter limits evaluation of the surrounding parenchyma. There is no evidence of acute ischemia in the visualized brain. No findings to suggest abscess or empyema. If there is suspicion for meningitis, consider lumbar puncture for more sensitive evaluation.2. Compared to prior MR from 12/2/2014, evolution of previously seen ischemic injury involving the occipital cortex and bilateral thalami seen.3. There is minimal interval enlargement of the ventricular system compared to most recent outside CT from 1/21/2015 and much more evident enlargement comparing to prior MRI from 12/2/2014. Third ventriculostomy appears grossly patent but better assessed on prior MRI from 12/2/2014 with high resolution 3D T2 and CSF flow sequence


Instruction: Generate impression based on medical findings.

Input: There was no change in the 7 x 6 mm left front subcortical white matter lesion between the 2/13/14 exam and this exam.

Output: No significant change in the non-specific sub-centimeter left frontal lobe lesion when compared to the MRI at the outside hospital dated 2/13/14 which has since been made available for comparison.


Instruction: Generate impression based on medical findings.

Input: Clinical question: PLEASE INCLUDE SI JOINTS., s/p Left hip arthroscopy, labral repair 8/26/14, continued low back SI joint pain, has had 2 SI joint injections without relief. Evaluate SI joints and evaluate for disc injury. Pain is on left sideSigns and Symptoms: Continued left side hip, SI joint pain. Nonenhanced lumbar MRI:There is normal anatomical alignment of vertebral column.The signal intensity of vertebral column is unremarkable changes secondary to discogenic disease.Unremarkable medial and most visualized thoracic spine and thoracic cord from T10 inferiorly.T12-L1 is unremarkable.L1-L2 demonstrates advanced disc disease and significant loss of disc height, there is shallow ventral disc osteophyte with resultant partial effacement of subarachnoid space however without central spinal stenosis. There is also no evidence of neural foraminal compromise.L2-L3 is unremarkable.L3-L4 is unremarkable.L4-L5 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.L4-L5 demonstrate mild disc disease and loss of disc height, mild bilateral ligamentum flavum and facet hypertrophic changes. No spinal stenosis or neural foraminal compromise. There is a linear T2 increased signal intensity within the annulus of the disc in the midline and consistent with an annular fissure.There is a shallow broad-based disc protrusion with resultant effacement of ventral subarachnoid space and without detectable mass effect on the thecal sac.L5-S1 demonstrate mild disc disease and loss of disc height, mild bilateral (L>R) facet and ligamentum flavum hypertrophy. No evidence of a spinal stenosis or neural foraminal compromise.Sacral spine demonstrate a left sided CSF signal intensity expansile lesion proximal left S2 neural foramina which a benign Tarlov cyst or perineural cyst. This finding demonstrate mass effect on the left S1 nerve root and its resultant flattening deformity which is best appreciated on axial T2 series 701 on images 2 through 4.Perispinal soft tissues demonstrate a smaller left psoas muscle compared to right and suspected of mild atrophy.Visualized SI joints demonstrate no appreciable degenerative changes or signal abnormality. On the left there is a well demarcated and primarily fatty signal intensity lesion measuring approximately 11 x 14 mm in transaxial dimensions. The finding is contiguous with the SI joint and medial well-demarcated cortical rim and is not associated with any adjacent marrow signal changes or soft tissue mass. Finding is consistent with benign fatty deposit and possibility of a benign hemangioma should also be considered. The clinical significance of this finding is questionable. This finding was also present on prior lumbar MRI exam without additional change.

Output: 1.Nonenhanced MRI of the lumbar spine demonstrate degenerative changes without evidence of central spinal stenosis or clinically significant neural foraminal compromise as detailed above. Small central disc protrusion at L5-S1 without mass effect on the thecal sac. Perineural cyst on the left at S2 neural foramina with resultant expansion of foramina and mass effect / flattening of left S2 nerve root. 2.Unremarkable SI joints. Fatty signal intensity lesion inseparable from the left SI joint space could represent benign fatty deposit or a benign hemangioma as detailed above..


Instruction: Generate impression based on medical findings.

Input: A patient submitted outside study for review. Submitted for review are digital mammographic images (4/21/2016), ultrasound images of right breast (4/21/2016), breast MRI (5/5/2016) performed at outside institution. DIGITAL MAMMOGRAPHIC IMAGES (4/21/2016):The breast parenchyma is mostly fatty replaced (BiRADS Density Category A). A small benign-appearing, circumscribed round mass is present at upper outer quadrant in the right breast.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in either breast. ULTRASOUND IMAGES OF RIGHT BREAST (4/21/2016):Multiple images of right nipple are obtained. No abnormal findings are present within the provided images. One normal-appearing lymph node is visualized in the right axilla.BREAST MRI (5/5/2016):Breast MRI was performed with a protocol outlined in the outside radiology report. Breast parenchyma is almost entirely fat in both breasts.Minimal parenchymal enhancement is noted bilaterally.A small cyst is visualized on T2-weighted images at upper outer quadrant in the right breast, corresponding to the small benign-appearing round mass seen on the mammogram.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.Nipples are enhancing symmetrically, without any abnormal findings.

Output: No mammographic, sonographic or MR evidence for malignancy in either breast.BIRADS: 1 - Negative.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on medical findings.

Input: 36 year old female with a history of bicuspid aortic valve. ?Aortopathy. Left VentricleThe left ventricle is mildly dilated with normal systolic function. The overall LV ejection fraction is 62%, the LV end diastolic volume index is 93 ml/m2 (normal range: 65+/-11), the LVEDV is 203 ml (normal range 109+/-23), the LV end systolic volume index is 35 ml/m2 (normal range 18+/-5), the LVESV is 76 ml (normal range 31+/-10). The left ventricular mass index is 58g/m2, and the left ventricular mass is 127g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is mildly dilated in size.Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 61%, the RV end diastolic volume index is 94 ml/m2 (normal range 69+/-14), the RVEDV is 204 ml (normal range 110+/-24), the RV end systolic volume index is 37 ml/m2 (normal range 22+/-8), and the RVESV is 80 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is bicuspid with fusion of the non-coronary and right coronary cusps. The is no significant aortic stenosis. There is trace aortic regurgitation (regurgitant fraction 3%, regurgitant volume 4ml), stable when compared to the previous exam.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 trace tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is dilated. There is no evidence of coarctation. The aortic measurements are as follows:Aortic annulus: 28mmSinus of valsalva: 39.4mmSinotubular junction: 31.5mmAscending aorta (4cm from annulus) : 34.4mmProximal aortic arch: 35mmDescending aorta: 22mmPulmonary 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 a trace pericardial effusion. Extracardiac FindingsThere are scattered lymph nodes most evident in the left axilla, the largest of which is <1cm. This was seen on the previous examination as well. 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 mildly dilated with systolic function. The overall LV ejection fraction is 60%.2. The right ventricle is normal in size and systolic function. The overall RV ejection fraction is 56%. 3. Bicuspid aortic valve without significant stenosis or regurgitation.4. No aortic coarctation.5. The aortic root is mildly dilated but measurements largely stable when compared to the previous exam of 12/2013.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Mass? Mesial temporal sclerosis. Signs and symptoms: Syncope and shaking. Pre and post enhanced brain MRI:No acute intracranial process and negative diffusion weighted series.Examination demonstrate scattered small varying size foci of FLAIR and T2 hyperintensity extensively in the periventricular and to a lesser degree subcortical white matter of bilateral cerebral hemispheres. None of specific, nonhemorrhagic and nonenhancing. The appearance is highly suggestive of chronic small vessel ischemic strokes as was noted on prior head CT. There is a slight prominence of cortical sulci and the lateral ventricles patient's stated age which could be as a result of small vessel ischemic strokes. There is no detectable abnormal parenchymal or meningeal enhancement.Examination is performed utilizing routine brain MRI protocol and without coronal FLAIR series. Within this limitation however there is suggestion of FLAIR/T2 hyperintensity and T1 hypointensity along the medial aspect of the left anterior temporal lobe without suggestion of parenchymal volume loss. Finding is highly suspected medial temporal sclerosis. Recommend follow-up with coronal FLAIR sequences for better assessment. Unremarkable images through the orbits including axial fat sat post enhanced series.Calvarium and soft tissues of the scalp are unremarkable.All paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal patterns.There are no prior MRI exams for comparison however if such studies are available and provided to the radiology department an addendum to this report will be submitted after comparison.

Output: 1.No acute intracranial process.2.Findings suggestive of mild to moderate chronic nonhemorrhagic small vessel ischemic strokes primarily within the subcortical and periventricular white.3.No abnormal enhancement is detected.4.Increased T2/FLAIR signal intensity of the medial aspect of the left anterior temporal lobe without parenchymal volume loss suspected for mesial temporal sclerosis. Recommend follow-up with coronal FLAIR sequences for further assessment/confirmation.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Stroke. Signs and symptoms: Right-sided weakness. Non-enhanced CT brain:The examination is suboptimal due to fact that patient was unable to lie flat for study. The images are noisy and evaluation for subtle findings is not possible. Within this limitation however no definitive evidence of any abnormality is identified. No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Recommend repeat CT or an MRI of brain if concern for stroke persist.Calvarium, paranasal sinuses and mastoid air cells are unremarkable.

Output: Suboptimal exam due to difficulty positioning the patient within the gantry properly. No gross abnormalities detected. Follow up with repeat CT exam or an MRI is recommended if clinical concern for stroke persist.


Instruction: Generate impression based on medical findings.

Input: Reason: 54 y/o with follicular lymphoma with several mos L arm heaviness, please eval for etiology History: see above Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is multilevel disk dessication present.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a minor/mild disk bulge and posterior ligamentous hypertrophy at this level.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.MRI 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.

Output: 1.To the extent of visualization, there is no compromise to cervical spine or thoracic spine.2.No cervical or thoracic cord lesions are appreciated to explain the patient's left arm weakness.3.Please note that the patient refused contrast administration and did not complete axial imaging of the thoracic spine. As a result this exam is limited.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Secondary GBM. Signs and symptoms: Secondary GBM. Pre-and post-enhanced brain MRI:Negative diffusion weighted images for restricted diffusion.Examination redemonstrates a large focus of flair/T2 hyperintensity involving the left anterior temporal and left inferior frontal lobe and with extension into the left basal ganglia consistent with patient's previously known tumor. There is no appreciable change in the extent or size/morphology of this finding since prior study. On post enhanced images however previously noted large focus of enhancement representing tumor in the right inferior frontal lobe demonstrate interval decreased size since prior exam. This finding on current exam measures at 18 times 19-mm compared to prior study measurement of 19.3 x 23-mm. This focus of enhancing tumor on sagittal SPGR post enhanced series measured maximum of 25 mm in (cc) compared to today's exam measurements of between 13.7 to 17.8-mm.A second smaller satellite focus of enhancement demonstrate minimal interval decrease size however with significantly less intensity of enhancement. The lesion measured approximately at 6 x 6.3-mm compared to current study measurement of 5.5 x 5 mm. There is no detectable additional foci of parenchymal or leptomeningeal enhancement.Flair hyperintensity in the periventricular white matter of bilateral cerebral hemispheres (left greater than right) consistent the residual peritumoral edema and post-treatment/radiation change without appreciable interval progression.

Output: 1.Interval decreased size of focus of enhancing tumor in the left inferior frontal lobe compared to prior study as detailed/measured above.2.Minimal interval decreased size of a small satellite focus of enhancement in the left hemisphere however with significantly less intensity of enhancement since prior exam as detailed/ measured above.3.Stable extensive focus of nonenhancing flair hyperintensity with increased volume in the left frontal, left anterior temporal and left inferior frontal lobe.


Instruction: Generate impression based on medical findings.

Input: 18 months, Male, seizures. There is no intracranial mass or mass effect. No evidence of hemorrhage or ischemia. No findings to suggest cortical dysplasia, within the limitations in assessment due to incomplete myelination. No evidence of gray matter heterotopia or other lesions to suggest possible seizure focus. The hippocampi are grossly symmetric and unremarkable. The ventricles are within normal limits in size and configuration. Myelination appears appropriate for age. Midline structures including the corpus callosum and posterior fossa are within normal limits. Major flow-voids are preserved. Bone marrow signal and extracranial soft tissues are within normal limits for age.

Output: Examination appears within normal limits for patient's age. If patient has persistent seizures, follow-up examination in 6-12 months when myelination is complete may be helpful.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Rule out cord compression. Signs and symptoms: T7 lesion, back pain. Complete spine MRI:Examination is performed utilizing cord compression protocol which is a limited exam.Within this limitation examination demonstrates postoperative changes of posterior fusion and placement of transpedicular screws extending from T4 inferiorly to T11. Although images are degraded due to metallic hardware artifact there is no definitive evidence of cord compression however this possibility cannot be entirely excluded due to limited visibility of the cord at the level of surgery. There is evidence of marrow signal changes of T6 and T7 with suggestion of subtle extraosseous extension of signal abnormality which is concerning for tumor. Correlate with history and comparison made prior exams if available. Beyond the region of surgery there is normal signal intensity and caliber of the cord and without mass effect.Advanced degenerative changes at L4-L5 and L5-S1 levels are noted.Follow-up with pre- and post enhanced dedicated imaging is recommended.

Output: 1.There are postoperative changes of posterior fusion with multilevel transpedicular screws placement from T4 through T8 and with highly suspected mass of T6 and T7 with extraosseous spread of tumor.2.Within the limitation of metallic hardware artifact there is no definitive detectable mass effect on the cord however this possibility cannot be entirely excluded due to limitation of the exam.3.Beyond the region of surgery no evidence of mass effect on the cord is detected.4.Advanced degenerative disc disease at L4-L5 and L5-S1 levels are noted.5.Follow-up imaging for better assessment of tumor and cord compression of thoracic spine is recommended.6.If there are outside studies available and provided to radiology department and addendum to this report will be submitted after comparison.


Instruction: Generate impression based on medical findings.

Input: 57 years Female (DOB:7/10/1959)Reason: possible right sciatica History: right sciaticaPROVIDER/ATTENDING NAME: MINDY ALYCE SCHWARTZ MINDY ALYCE SCHWARTZ 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. There is mild disc desiccation present at L3-4 and L4-5. Incidental note is made of small Tarlov perineural cysts in the sacrumAt L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is a mild disc bulge present this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: No compromise to lumbar spinal canal or neural foramina. There are minor degenerative changes present in the lumbar spine.


Instruction: Generate impression based on medical findings.

Input: Right arm numbness and weakness. History of non-small cell lung cancer. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. No masses or abnormal enhancement involving the cervical spine.The cervical spinal cord has normal signal characteristics and overall morphology.Minimal degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: There is a disc bulge with a central disc extrusion component which contacts the ventral aspect of the cord. No cord signal abnormality. Dorsal thecal sac is patent without significant spinal canal stenosis at this level. There is minimal left neural foraminal narrowing. No significant right neural foraminal narrowing.C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina. Mild bilateral facet arthropathy.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. No evidence of metastatic disease in the cervical spine. 2. Mild degenerative changes including small disc extrusion at the C5-C6 level which contacts the ventral aspect of the cord, without evidence of cord impingement or signal abnormality. There is minimal left C5-C6 neural foraminal narrowing, otherwise no significant spinal canal or neural foraminal stenosis at any level.


Instruction: Generate impression based on medical findings.

Input: Left periventricular parietoccipital white matter lesion, re-evaluate for progression: transient left hemisensory syndrome, with persistent left retro-orbital headache. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is an unchanged T2 hyperintense periventricular parietoccipital white matter lesion that measures up to 25 mm. There is no abnormal intracranial enhancement. There is asymmetry of the lateral ventricles, right larger than left. There is no midline shift or herniation. The major cerebral flow voids are intact. There is mild plagiocephaly. The orbits, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is left greater than right tympanomastoid fluid.

Output: A periventricular parietoccipital white matter lesion may represent the sequela of remote ischemic injury. No evidence of intracranial hemorrhage, mass, or acute infarct.