Instruction: Generate impression based on medical findings.

Input: Malignant neoplasm of bronchus and lung, unspecified siteClinical question: Staging SCLCSigns and Symptoms: new SCLC The CSF spaces are appropriate for the patient's stated age with no midline shift. Exam is degraded by patient motion.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eye lenses are thin.

Output: 1.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 2.No evidence for brain metastases.3.Exam is degraded by patient motion. As a result more subtle abnormalities may be obscured.


Instruction: Generate impression based on medical findings.

Input: Female 64 years old with right knee pain. Evaluate for right knee meniscal tear. MENISCI: The menisci are intact.ARTICULAR CARTILAGE AND BONE: There is thinning of the articular cartilage in the medial and lateral compartments without evidence of full-thickness defect. The patellar cartilage is thinned and irregular with full-thickness loss over the median facet with underlying reactive marrow change. There is also thinning and irregularity of the cartilage in the femoral trochlea. Other than reactive marrow change, bone marrow signal intensity is within normal limits.There are lateral and tiny medial compartment osteophytes.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.No evidence of meniscal tear.2.2 loose bodies within the joint.3.Osteoarthritis as described above.


Instruction: Generate impression based on medical findings.

Input: Headaches and hypertension. Strong family history of aneurysm. Rule out aneurysm. Left neck pain with radiation and weakness in left arm. MRA brain: No evidence of aneurysms or vascular malformations. The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. MRI cervical spine: Craniovertebral junction appears within normal limits. The cervical vertebral bodies and intervertebral discs are appropriate in height. There is reversal of normal cervical lordosis with kyphotic angulation centered at the C4-C5 level, at least part of which is positional. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology. Individual levels as below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: No significant compromise to the spinal canal or neural foramina.C6-7: 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. No evidence of intracranial aneurysm.2. No significant disc disease or spinal canal or neural foraminal stenosis at any level in the cervical spine.3. Reversal of cervical lordosis which is at least in part positional.


Instruction: Generate impression based on medical findings.

Input: New headache, prior MRI showing Chiari malformation Low-lying cerebellar tonsils measuring 4 to 5 mm below the foramen magnum with a pointed configuration are again seen. There is mild crowding at the foramen magnum although the posterior fossa is incompletely evaluated on this cervical spine MRI. There is a small syrinx in the cervical cord extending from the C1 to the C4 levels, and measuring up to 2 mm at the mid C2 level which is similar to prior. There is minimal prominence of the central canal in the cervical cord inferior to the C4 level.The cervical vertebral bodies are appropriate in height. There is mild reversal of cervical lordosis with apex at the C3-C4 level, as before.. Bone marrow signal is benign. Multilevel degenerative changes are present as described below: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: There is a disc osteophyte complex including a small subligamentous disc extrusion and uncovertebral hypertrophy particularly on the right. There is mild to moderate spinal canal stenosis, particularly the right aspect of the spinal canal which appears minimally worse in the interval. There is moderate right neural foraminal stenosis as before. Minimal left neural foraminal narrowing.C4-5: Small disc osteophyte complex and prominent left-sided uncovertebral hypertrophy. Mild to moderate spinal canal stenosis is similar to prior. There is moderate to severe left neural foraminal stenosis which is similar to prior. Right neural foramen is patent.C5-6: Small disc osteophyte complex with very mild spinal canal narrowing. Mild left neural foraminal stenosis. Right neural foramen is patent.C6-7: No significant compromise to the spinal canal or right neural foramen. Moderate left-sided facet arthropathy with mild left neural foraminal stenosis.C7-T1: No significant compromise to the spinal canal or neural foramina. Right-sided facet arthropathy.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Findings compatible with a mild Chiari I malformation with a small cervical syrinx, not significantly changed since 3/25/2011. Note the posterior fossa is incompletely evaluated on this cervical spine study.2. Multilevel degenerative changes in the cervical spine which are stable to minimally worse since 2011. There is mild to moderate spinal canal stenosis at the C3-C4 level and to a milder degree at the C4-C5 and C5-C6 levels.3. Neural foraminal stenosis is worst at the right C3-C4 level and left C4-C5 levels similar to prior. Additional details as above.


Instruction: Generate impression based on medical findings.

Input: Metastatic lung cancer, EGFR mutated. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is scattered and confluent nonspecific cerebral white matter T2 hyperintensity. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There are bilateral lens implants and mild staphylomatous deformity of the globes. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is periodontal enhancement associated with tooth number 3.

Output: 1. No evidence of intracranial metastases. 2. Nonspecific cerebral white matter T2 hyperintensity may represent treatment effects or chronic small vessel ischemic disease. 3. Apparent periodontal inflammation associated with tooth number 3.


Instruction: Generate impression based on medical findings.

Input: Again demonstrated are post surgical changes related to left parietal lobe tumor resection with areas of increased T1 signal and susceptibility effects within the treatment cavity related to blood products. No abnormal enhancement to suggest recurrence. A small extra-axial fluid collection is seen which is less prominent along the left parietal convexity. The ventricles are normal in size. No mass effect or midline shift.There is mildly increased T2 signal which extends inferiorly within the periatrial region similar to previous.Previously demonstrated T2 hyperintense, enhancing mass in the left operculum demonstrates interval mild increase in size and slightly more heterogeneous enhancement on post gadolinium images relating to necrosis, overall measuring 3.7 x 2.7 x 3.1cm and previously 3.1 x 2.3 x 2.7 cm. Enlargement is more prominent when compared to 5/7/2015 study.Ventricles are normal in size. There is no mass effect or midline shift. The basal cisterns remain patent.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.

Output: 1. Compared to 5/7/2015 and 6/9/2015, there is continued enlargement of the left frontal operculum mass likely representing a separate focus of high-grade glial neoplasm. Increased necrosis within this tumor is also demonstrated.2. Stable postsurgical changes at the left parietal lobe resection cavity without discrete lesion to suggest recurrence at this site.


Instruction: Generate impression based on medical findings.

Input: 36-year-old with sarcoidosis and headaches. Evaluate for progression of abnormalities. The subtle cortical FLAIR abnormality questioned on the exam from 7/24/2013 is not identifiable on the current exam and was also not seen on the most recent previous study.There are one or 2 punctate foci of T2 hyperintensity within the inferior frontal lobes as on the previous exam and a new punctate T2 hyperintensity within the right parietal lobe. There is no associated mass effect, susceptibility artifact or enhancement. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal parenchymal or extra-axial enhancement. Although this is a nondedicated exam, the optic nerves appear unremarkable.The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.Several punctate subcortical white matter lesions are nonspecific, one new focus is seen in the right parietal lobe. 2.The subtle cortical FLAIR abnormality questioned on the exam from 7/2013 is again not identifiable on today's exam. The abnormality may have resolved or the finding may have been related to imaging artifact.


Instruction: Generate impression based on medical findings.

Input: Clinical question: 13-year-old male with chronic constipation, rule out tethered cord. Signs and symptoms: Long-standing constipation. Nonenhanced lumbar MRI:There is normal anatomical development of the visualized lumbosacral spine.There is normal signal intensity and anatomical alignment of vertebral column.There is normal termination of the cord at mid L1 level. There is normal signal intensity and morphology of cauda equina. There is no detectable fatty filum terminale.There is a tiny central linear T2 signal intensity in the lower most visualized thoracic cord likely representing central canal and of questionable clinical significance.There is anterior movement of the lower most visualized thoracic cord, conus and cauda equina on prone sagittal T2-weighted images. There is no detectable. Spinal soft tissue abnormalities.Expanded colon with low T2 signal intensity consistent with contrast within the bowel likely residual from prior GI study dated 5/26/2015.

Output: 1.Unremarkable lumbar MRI and in particular without evidence of tethered cord.2.Dilated colon with low T2 signal intensity content consistent with residual contrast from recent GI exam from 5-20 6-50.


Instruction: Generate impression based on medical findings.

Input: New onset headache and history of subjective left-sided weakness. No restricted diffusion to suggest acute ischemia. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. There are punctate foci of susceptibility including the right frontal lobe as well as the right occipital lobe compatible with chronic microhemorrhages. Few scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild age-related white matter changes. Brain parenchyma appears otherwise within normal limits.No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. There is mucosal thickening involving the right maxillary sinus and mild patchy opacification of the ethmoid air cells. Bone marrow signal and extracranial soft tissues are otherwise within normal limits.

Output: 1. No evidence of acute infarct. No intracranial mass or mass effect.2. Two punctate foci of chronic microhemorrhage in the right frontal and right occipital lobe which are nonspecific. Brain parenchyma is otherwise unremarkable.3. Mucosal thickening in the right maxillary sinus with frothy secretions which may represent acute sinusitis in the appropriate clinical setting.


Instruction: Generate impression based on medical findings.

Input: 41-year-old with pelvic pain and menorrhagia. History of uterine fibroids status post myomectomy now undergoing evaluation for possible uterine artery embolization. PELVIS:UTERUS, ADNEXA: Anteverted anteflexed uterus measuring 7.8 x 4.5 x 5.6 cm. There is a single dominant submucosal low T1 and T2 signal mass along the dorsal surface of the endometrial canal compatible with a submucosal fibroid. This measures 1.7 cm in maximum dimension (series 3 image 22). There is an additional small subserosal fibroid at the fundal tip measuring 7 mm (series 3 image 25). On the postcontrast images there is prominent enhancement of the submucosal fibroid. The junctional zone is normal in thickness.The cervix is unremarkable aside from a few nabothian cysts.The ovaries are within normal limits bilaterally. They contain multiple subcentimeter cystic foci compatible with follicles.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Single dominant submucosal fibroid measuring 17 mm in maximum dimension which displays prominent vascularity. There is an additional small fundal subserosal fibroid.


Instruction: Generate impression based on medical findings.

Input: 65-year-old female with history of left thigh mass. Please evaluate for extent of disease and abnormalities. There is a large mass of predominantly fat signal intensity involving the posterior left thigh and extending into the left buttock. The superior extent of the mass is at the level of the origin of the left gluteus maximus muscle from the upper iliac wing. Here the mass lies between the gluteus maximus muscle and the gluteus medius muscle, deep to the iliotibial band. A small lobule of the mass extends beneath the left piriformis muscle into the sciatic notch. An additional small lobule extends medially just below the ischiofemoral space, with poor visualization of the quadratus femoris either due to infiltration or mass effect. Although the mass is of predominantly fat signal intensity, there are poorly defined whorls of nonadipose tissue within the mass, particularly anteriorly, some of which show enhancement following gadolinium administration. Several vessels are also noted within the mass. There is a bandlike focus of low signal intensity within the mass posteriorly that does not appear to enhance, perhaps representing fibrous tissue or mineralization.As the mass enters the upper thigh, it assumes a bilobed configuration. The smaller anterior lobe continues distally deep to the iliotibial band, tapering along the lateral margin of the vastus lateralis; it terminates approximately 4 to 5 cm below the level of the base of the greater trochanter. The larger posterior lobe extends inferiorly into the mid and distal thigh. It lies deep to the peripheral deep fascia, displacing the distal fibers of the gluteus maximus muscle laterally and the hamstring musculature medially. Within the proximal half of the thigh, the mass displaces the sciatic nerve medially, with a nerve coursing along the medial aspect of the mass. The mass terminates distally approximately 12 to 13 cm above the knee joint line. As in the pelvis, the mass is of predominantly fat signal intensity, but also containing thin septae and poorly defined nonadipose elements, some of which enhance following gadolinium administration. Small vascular structures also courses through the mass. Within the mid thigh, the mass is approximately 14 x 12 cm in greatest transverse dimension. The mass is not included on any single longitudinal image, which limits my ability to obtain an accurate measurement in this dimension; however, based on summative measurements, I estimate the mass to be between 35 and 40 cm in craniocaudal dimension.Pelvis: There is a mass of fat signal intensity at the level of the right hip joint situated between the proximal right sartorius muscle and the iliopsoas muscle. It measures no more than 6 cm in craniocaudal dimension and 2.5 cm in transverse dimension, and likely represents a benign lipoma. There also appears to be asymmetric fatty infiltration of the anterior half of the gluteus minimus muscle. I see no additional masses within the pelvis. Mild osteoarthritis affects both hips and sacroiliac joints. Bone marrow signal intensity is otherwise within normal limits. Although the study was not protocoled for detailed evaluation of the pelvic viscera, I see no gross abnormalities.Left femur/thigh: I see no additional masses within the left thigh. Bone marrow signal intensity of the left femur is normal. I see no edema within the musculature of the thigh. Osteoarthritis affects the left knee, particularly the patellofemoral joint with subchondral cyst formation and edema in the patella. There is also a small knee joint effusion, and enhancement of the synovium suggests mild synovitis of the knee. A few venous varicosities are noted within the soft tissues of the thigh.

Output: Large predominantly fatty mass of the left thigh extending into the left buttock as described above. Based on its size and signal characteristics, this most likely represents an atypical lipomatous tumor (well differentiated liposarcoma). Referral to orthopedic oncology is recommended. Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Altered mental status in a 55-year-old female. No evidence of hemorrhage, edema, mass effect or midline shift or hydrocephalus is detected. This examination is essentially normal limits for patient of stated age of 55. If clinical symptoms persist an MRI would be helpful. Calvarium, paranasal sinuses and mastoid air cells also unremarkable.

Output: Normal CT brain.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Patient with multiple myeloma, status post calibers stem cell transplant with relapsed disease. Signs and symptoms: Nausea and vomiting, central process suspected. Pre-and post-enhanced CT of brain:There is prominence of the supratentorial ventricular system when more apparent in the lateral ventricles and the third ventricle. There is also a paucity of cortical sulci. There is however no detectable cerebral edema and gray -- white matter differentiation is well-preserved. There are no old studies available for comparison. There is however partial visualization of the supratentorial ventricular system on prior CT of soft tissues of neck from 4 to 27 next 2010 which demonstrate similar sized ventricular system.There is no evidence of intracranial hemorrhage, edema or midline shift.Post infusion images demonstrate enhancement of thickened pituitary stalk that measures 6 mm in transaxial dimension. This finding was present on prior CT of soft tissues of neck from 4 -- 27 -- 2010.Examination also demonstrate thickening and enhancement along the left petroclinoid ligament which appears to be continuous with the enhancement of the cavernous sinus. There is no definitive associated bony changes however the dorsum sella on the left side and including the left posterior clinoid appear thinner than the right which may indicate erosive bony changes. The constellation of above findings could represent a metastatic disease or an infectious/granulomatous process. It is highly recommended that this finding to be followed with an enhanced MRI of pituitary and brain which would visualizes all the above regions of abnormal finding.Bony density of calvarial demonstrate multiple well demarcated small lytic lesions within the diploic space. Considering patient's history of multiple myeloma this finding may represent multiple myeloma. MRI examination with further clarified this finding.Above findings were discussed with the referring clinical service Garcia Ima pager number 5251 at the time of interpretation.80 cc of Omnipaque 350 was administered for this study.

Output: 1.Abnormal enhancement of the left cavernous sinus with extension posteriorly along the petroclinoid ligament and left CP angle. Thickened pituitary stalk with enhancement and with possible some thinning of dorsum sella as described above. Follow-up exam with an MRI is recommended. The constellation of above findings can be secondary to a metastatic disease, infectious or a granulomatous process.2.No definitive evidence of parenchymal abnormality of brain.3.Prominent lateral ventricles with only minimal dietitian of temporal horns. This finding may be a normal variation which was also partially visualized on prior CT of soft tissues of neck from 4 -- 27 -- 2010. This finding is not associated with any periventricular edema and I believe this is a normal anatomical variation for patient's age. Follow-up MRI would further assess this finding.4.Multiple well demarcated lytic lesions of calvarial with the largest measuring only 6 mm times 5-mm in the right frontal bone. Findings may also represent multiple myeloma.5.Above findings were discussed with referring clinical service Garcia Ima pager number 5251.


Instruction: Generate impression based on medical findings.

Input: 88 years Female (DOB:7/22/1927)Reason: fall with c2 fx, ?hematoma History: neck painPROVIDER/ATTENDING NAME: BEN-ZION ROITBERG BEN-ZION ROITBERG Cervical spine:There is traumatic spondylolisthesis of C2 (Hangman's fracture) associated with mild (2mm) anterior subluxation of C2 on C3, 4mm posterior displacement of C2 posterior elements . Fracture lines extend into the vertebral foramina at C2 and a small fracture fragment extends into the left vertebral foramen. There is no evidence for vertebral artery dissection. There is fluid within the C1-2 articulations and adjacent high signal within the lateral masses of C1 and C2.No foci of diffusion restriction are present in the brain.There is fluid ventral to the upper cervical vertebral bodies. There is some The cervical vertebral bodies are appropriate in overall height. At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is mild subluxation and narrowing of the facet joints. There is loss of disk space height at this level.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is mild subluxation and narrowing of the facet joints. There is loss of disk space height at this level.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is mild subluxation and narrowing of the facet joints. There is loss of disk space height at this level. There are endplate and uncovertebral osteophytes at this level.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is mild subluxation and narrowing of the facet joints. There is loss of disk space height at this level. There are endplate and uncovertebral osteophytes at this level with mild narrowing of the left neural foramen,At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is mild subluxation and narrowing of the facet joints. There is loss of disk space height at this level. There are endplate and uncovertebral osteophytes at this level with mild narrowing of the left neural foramen,At C7-T1 there is no significant compromise to the spinal canal or neural foramina.Since the prior CT exam circumferential thickening of the epidural space has resolved and was likely related to epidural venous engorgement from collateral venous flow.There is subdural effusion in the posterior fossa likely related to brain atrophy.The right lobe of the thyroid is enlarged and the thyroid id heterogenous.MRA neck:There is a 7x9mm pseudoaneurysm along the left vertebral artery. It originates at the proximal v3 segment at the proximal end of the vertebral foramen and is directed superiorly. There is subtle signal hyperintensity within the left half of the epidural venous plexus at this level. On the contrast enhanced MRV there is contrast present along the adjacent venous structures during the arterial phase of image acquisition. This is less dramatic than on the CTA where the pseudoaneurysm was obscured by the venous engorgement.There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.

Output: 1.There is a 7x9mm pseudoaneurysm along the V3 segment of the left vertebral artery associated with an arteriovenous fistula which is less dramatic than on the CTA. This could represent a traumatic arteriovenous fistula on the CTA which is now regressing but has not resolved. A follow-up MRA using the same exact technique in 24 hours may help monitor its progress,2.Traumatic spondylolisthesis of C2 associated with fracture lines extending into the vertebral artery foramina. There is associated bone edema and ligamentous injury.3.Since the prior CT exam circumferential thickening of the epidural space has resolved and was likely related to epidural venous engorgement from collateral venous flow.4.There is no evidence for acute ischemic cerebral infarction.5.Enlarged right thyroid lobe. Please note that MRI and CT are not accurate in the evaluation of the thyroid.6.Findings were discussed with Dr Roitberg


Instruction: Generate impression based on medical findings.

Input: Achilles tendinitis TENDONS: No significant abnormality noted. Specifically, the Achilles tendon appears normal. LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: There is a small articular cartilage defect involving the posterior tibial plafond best appreciated on series 8 image 15/25. There are mild degenerative cystic changes present within the posterior talus as well. A small amount of marrow signal change is also evident in the base of the third metatarsal (series 1101 image 8) which is nonspecific in nature. There is no significant joint fluid. Note is made of an os peroneal (series 6 image 17).ADDITIONAL

Output: 1. Osteoarthritis of the tibiotalar joint with a small articular cartilage defect affecting the tibial plafond posteriorly.2. Normal appearance of the Achilles tendon.


Instruction: Generate impression based on medical findings.

Input: 53 years, Male, increased pain in back of head, dizziness, diplopia. Evaluate Arnold-Chiari malformation.. Brain: Again seen is evidence of Chiari I malformation with ectopic cerebellar tonsils measuring up to 1 cm below the foramen magnum similar to prior. There is crowding with diminished CSF spaces ventrally and dorsally at the foramen magnum. Biphasic CSF flow is present but mildly diminished ventrally and severely diminished dorsally at the foramen magnum.Abnormal T1 hyperintensity involving the neurohypophysis previously described is not well assessed on the current study and can be better assessed on dedicated pituitary MRI if clinically indicated. Remainder of the brain parenchyma appears unremarkable for patient's age. No intracranial mass or mass effect. No evidence of infarct or hemorrhage. There is asymmetric size of the lateral ventricles which can be normal ventricle. No hydrocephalus. No extra-axial collections. Calvarium and extracranial soft tissues are unremarkable.Cervical Spine:No abnormal signal in the cervical cord or evidence of syrinx. Vertebral body heights in the cervical spine. There is mild retrolisthesis of C3 on C4 and C6 on C7. Bone marrow signal is benign. T1 hyperintense lesion involving the T1 bright device consistent with a hemangioma.C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Small disc osteophyte complex and ligamentum flavum thickening with mild spinal canal stenosis. Minimal right neural foraminal stenosis. No significant left neural foraminal narrowing. C4-5: Minimal central disc protrusion. No significant spinal canal or neural foraminal stenosis.C5-6: Disc osteophyte complex and bilateral uncovertebral hypertrophy. There is no significant spinal canal stenosis. There is moderate right and mild left neural foraminal stenosis.C6-7: Disc osteophyte complex and uncovertebral hypertrophy. There is moderate bilateral neural foraminal stenosis, slightly worse on the right. No significant spinal canal stenosis.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. Findings of Chiari I malformation are similar to prior with tonsillar descent measuring up to 1 cm below the foramen magnum. There is associated diminished CSF spaces and CSF flow at the foramen magnum as described above.2. No evidence of cervical syrinx.3. Degenerative changes in the cervical spine, relatively worse at the C3-C4, C5-C6, and C6-C7 levels as above.


Instruction: Generate impression based on medical findings.

Input: A 67 year old male with history of coronary artery disease, s/p PCI X3 to LCx (2005), hyperlipidemia, left ventricular dysfunction, cardiomyopathy suspected to be secondary to frequent PVC's, s/p attempted ablation (endo and epicardial). A recent echocardiography showed LVEF of 44.7%. Referred to cardiac MRI for further evaluation Left VentricleThe left ventricle is normal in size with moderately reduced systolic function. The overall LV ejection fraction is 31%, the LV end diastolic volume index is 90 ml/m2 (normal range: 74+/-15), the LVEDV is 176 ml (normal range 142+/-34), the LV end systolic volume index is 62 ml/m2 (normal range 25+/-9), the LVESV is 122 ml (normal range 47+/-19), the LV mass index is 51 g/m2 (normal range 85+/-15), and the LV mass is 100 g (normal range 164+/-36). Due to frequent PVC's, volumetric quantification is limited. On late gadolinium enhancement images, there is transmural hypoperfusion of the basal to mid anterior wall (i.e. along the left ventricular summit) with a thin rim of hyperenhancement consistent with microvascular obstruction from the patient's recent ablation procedure. There is no myocardial iron overload. No intracavitary thrombus was noted.Left AtriumThe left atrium is moderately dilated (126ml). Right VentricleThe right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 37%, the RV end diastolic volume index is 54 ml/m2 (normal range 82+/-16), the RVEDV is 105 ml (normal range 142+/-31), the RV end systolic volume index is 34 ml/m2 (normal range 31+/-9), and the RVESV is 66 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation. There is mitral annulus calcification and thickening of the leaflets.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 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 a trace pericardial effusion, mainly around the RV and RA. Extracardiac FindingsBilateral small pleural effusions were 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. The left ventricle is normal in size with moderately reduced systolic function, the LVEF is 31%. However, quantification is limited by frequent PVC's. 2. On late gadolinium enhancement images, there is transmural hypoperfusion of the basal to mid anterior wall (i.e. along the left ventricular summit) with a thin rim of hyperenhancement consistent with microvascular obstruction from the patient's recent ablation procedure. 3. There is biatrial dilation. 4. The right ventricle is normal in size with moderately reduced systolic function, the RVEF is 37%. 5. There is mitral annulus calcification and thickening of the leaflets. No significant MR was seen.6. See extracardiac findings. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: 18-year-old male patient with history of partial lateral meniscectomy in the past presents with lateral knee pain. MENISCI: There is attenuation of the body and posterior horn of the lateral meniscus as well as blunting and complex tearing of the free edge, likely representing a re-tear. The medial meniscus is intact without discrete tearing.ARTICULAR CARTILAGE AND BONE: Tiny osteophytes are noted in the lateral compartment. There are no fluid-filled cartilage defects.LIGAMENTS: The anterior cruciate ligament, posterior cruciate ligament, medial collateral ligament, lateral collateral ligament complex, and patellar retinacula are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Findings compatible with a re-tear of the free edge of the body and posterior horn of the lateral meniscus.2.Moderate joint effusion.


Instruction: Generate impression based on medical findings.

Input: Radicular low back pain. History of spinal stenosis. Left lower extremity pain and weakness. The study is limited mildly by patient motion and body habitus. Five lumbar type vertebral bodies are present, which are appropriate in overall alignment and height, accounting for straightening. There is diffusely hypointense vertebral bone marrow signal that is probably reflective of red marrow reconversion. The lower spinal cord and conus medullaris are unremarkable. At L4-5, there is a disk bulge without significant central canal stenosis. There is moderate to severe left and moderate right neural foraminal narrowing, unchanged. At L5-S1, an eccentrically right-sided disc extrusion results in compression of the right subarticular recess and to a lesser extent the left lateral recess, as well as severe right and moderate left neural foraminal narrowing. There is bilateral facet productive changes and mild bilateral ligamentum flavum hypertrophy and buckling, which also contribute to spinal canal narrowing at this level.

Output: An L5-S1 disc extrusion with compression of the right subarticular recess results in severe narrowing of the right neural foramen, although this has not significantly changed since September 2013.


Instruction: Generate impression based on medical findings.

Input: Reason: Is there any sign of calcific tendinitis? History: right shoulder pain, severe Normal appearing right shoulder without findings to account for the patient's pain. Specifically, we see no radiographic findings to suggest calcific tendinopathy.

Output: Normal appearing right shoulder without radiographic findings to suggest calcific tendinopathy or other findings to account for the patient's pain.


Instruction: Generate impression based on medical findings.

Input: 16 year-old male with knee injury MENISCI: Complex tear of the posterior horn of the medial meniscus with horizontal and vertical components. Vertical signal abnormality within the posterior horn of lateral meniscus extending from the attachment of the meniscofemoral ligament laterally consistent with a vertical longitudinal tear of the posterior horn. ARTICULAR CARTILAGE AND BONE: There are small contusions within the posterolateral tibial condyle and anterolateral femoral condyle. The articular cartilage is intact.LIGAMENTS: The ACL is torn. The PCL is intact. The MCL appears normal. The lateral collateral ligament complex is intact. EXTENSOR MECHANISM: Intact.ADDITIONAL

Output: 1. ACL tear with kissing contusions in the posterolateral tibial and anterolateral femoral condyles.2. Complex tear of the posterior horn of the medial meniscus and vertical longitudinal tear of the posterior horn of lateral meniscus ("Wrisberg rip"). 3. Large joint effusion.


Instruction: Generate impression based on medical findings.

Input: 55-year-old female, follow-up L4 extraspinal lesionIMAGE ACQUISITIONS: Lumbar spine CT without contrast Soft tissue mass at the L4/L5 level is not well-visualized on this exam. If clinical concern remains, an MRI could be obtained for further evaluation.The alignment of the lumbar spine is anatomic. The vertebral body heights and disk spaces are preserved. There is minimal disc bulging with no mass effect upon the cord at L2/L3 and L3/L4. There is diffuse disc bulging at L4/L5 with narrowing of the neural foramina, left greater than right. At L5/S1 diffuse disc bulge is seen with no mass effect upon the cord.

Output: 1. previously seen left-sided soft tissue mass is not well-visualized on this study and can be further evaluated with MRI2. degenerative disc disease of the lumbar spine as described.


Instruction: Generate impression based on medical findings.

Input: 28-year-old female patient status post resection of pelvic schwannoma. Evaluate postsurgical changes. ABDOMEN:LIVER, BILIARY TRACT: The common bile duct is prominent in diameter but smoothly tapers distally without evidence of a distal obstructing lesion, unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Mild bilateral pelvocaliectasis with bilateral ureteral stents noted.RETROPERITONEUM, LYMPH NODES: There are two enhancing nodules within the left retroperitoneum posterior to the left psoas muscle measuring up to 1.3 cm (image 83, series 1103), which are stable.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Susceptibility artifact from lumbosacral orthopedic fixation hardware. Post-surgical changes of the midline abdominopelvic ventral wall. OTHER: There are prominent periaortic lymph nodes within the chest. PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Bilateral ureteral stents. LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Susceptibility artifact from lumbosacral orthopedic hardware limits evaluation of pelvic bony structures. Post-surgical changes in the left hemipelvis with a T2 hyperintense collection with peripheral thick enhancement within the surgical bed measuring 5.5 x 9.2 x 9.7 cm. Foci of susceptibility artifact within this collection are compatible with foci of air as seen on prior CT. Enhancing tissue is present along the inferior margin of the surgical bed and is invading the left sacrum, as seen on prior studies, compatible with residual tumor (image 82, series 1901). OTHER: No significant abnormality noted.

Output: Post-surgical changes in the left hemipelvis with a large thick walled fluid collection within the surgical bed and enhancing soft tissue along the posterior margin compatible with residual tumor; this may represent an evolving post-operative seroma though abscess is not excluded in the appropriate clinical context.


Instruction: Generate impression based on medical findings.

Input: Female, 3 years old, nonverbal with development delay and seizures, with a white matter lesion in the left frontal lobe on prior MRI. Please reevaluate. Again seen is ill-defined T2 hyperintense, T1 hypointense signal within the white matter along the lateral margin of the left frontal horn. Accounting for differences in technique, there has been no convincing interval change in the size or appearance of this abnormality. No definite abnormality of the overlying cortex is seen. On postcontrast images, there is no associated pathologic enhancement.Elsewhere, the appearance of the brain is unremarkable. No restricted diffusion is seen. No parenchymal edema or mass effect is detected. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. No pathologic parenchymal or extra-axial enhancement is seen.Paranasal sinus mucosal inflammation evident on the prior examination has resolved.

Output: Since the prior examination, there has been no significant or convincing interval change in the size or appearance of the ill-defined signal abnormality along the left frontal horn. No associated pathologic enhancement is seen. The differential diagnosis would continue to include chronic sequela of prior infection, inflammation or ischemia. The possibility of some form of focal cortical dysplasia is less likely given the normal appearance of the overlying cortex.


Instruction: Generate impression based on medical findings.

Input: Syrinx spine, yearly eval for changes. There are stable multi-level segmentation anomalies and scoliosis involving virtually the entire spine. There is an unchanged low-lying conus medullaris, which is positioned at the L3 vertebral body level, which nevertheless demonstrates anterior translation on prone imaging. There is an unchanged syrinx in the lower spinal cord, which measures 6 x 7 mm in transverse section. There is an unchanged fibrofatty filum terminale, which measures up to 5 mm in width. There is no significant spinal canal stenosis. The vertebral bone marrow signal is unremarkable. The paraspinal soft tissues are unchanged.

Output: 1. Unchanged syrinx in the lower spinal cord.2. Unchanged low-lying conus medullaris, which is positioned at the L3 vertebral body level, which nevertheless demonstrates anterior translation on prone imaging. 3. Unchanged multi-level segmentation anomalies and scoliosis.4. Unchanged fibrofatty filum terminale.


Instruction: Generate impression based on medical findings.

Input: T1 axial anatomic images again demonstrate mild asymmetric enlargement right temporal horn. The hand, foot, and tongue sensory and motor activation centers map to their expected locations along the pre- and post central gyri. Language is left dominant with Broca's area mapping to the left pars triangularis and pars operculararis while two regions of activation within the posterior left superior temporal gyrus are compatible with Wernicke's area.

Output: 1.Left dominant language activation.2.Hand, foot, and tongue motor and sensory activation is found in their expected locations along the pre- and post-central gyri.


Instruction: Generate impression based on medical findings.

Input: Brain: Again seen are findings of Chiari 2 malformation with herniation of the cerebellar tonsils which lie at the lower C3 level. There are findings of sub-occipital decompression. A 4th ventricular catheter is unchanged in position. A stable left parietal approach ventriculostomy catheter terminates near the midline. The 4th ventricle measures minimally larger in the AP dimension at 5 mm compared to 3-4 mm on examination from 6/30/2015 and 4 to 5 mm on 12/16/2014. The subtle differences may be related to differences in slice position. The lateral and third ventricles are also not significantly changed in size compared to recent CT and MRI studies. There is stable mild T2 hyperintensity adjacent to the occipital horns. No abnormal parenchymal or meningeal enhancement is appreciated. There is dysgenesis of the corpus collosum with absent posterior body and splenium. Again seen is enlargement of the CSF space anterior to the brainstem with clival scalloping raising possibility of arachnoid cyst but unchanged. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is unchanged prominence of the distal right internal carotid artery. Calvarium and extra cranial soft tissues are grossly unremarkable.Spine:There is syringohydromyelia which begins at the C3 level and extends inferiorly through the entire length of the spinal cord. It is unchanged in size and measures up to 4 mm in the AP dimension at the C7 level. There is significant thinning of the surrounding cervical cord parenchyma.Syrinx in the thoracic cord is similar, measuring 8x8 mm at the T4 level, previously 8x9 mm. At T6, syrinx measures 7 x 7 mm, previously 8 x 8 mm. There is severe mid-thoracic dextroscoliosis. There are posterior disc protrusions at C4-C5, C5-C6 and relatively worst at the C6-C7 where there is indentation of the spinal cord similar to prior. Dorsal thecal sac is widely patent at these levels. Enhancement of the paraspinous soft tissues is consistent with postsurgical change.Again seen is evidence of prior lumbosacral myelomeningocele repair with small stable pseudomeningocele. The distal neural placode is located along the dorsal aspect of the thecal sac and terminates at approximately the L5 level. No significant ventral motion of the distal neural tissue on the prone sequences.There is unchanged angulation of the coccyx. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The paravertebral soft tissues are grossly unremarkable.

Output: 1. Again seen are findings related to Chiari II malformation status post decompression, VP shunt placement, fourth ventricular stent placement, as well as lumbar myelomeningocele repair. There is overall no significant change in caliber of the ventricular system or syringohydromyelia extending the length of the spinal cord. There are minimal differences in measurement as noted above. No abnormal parenchymal or meningeal enhancement in the brain or spine is appreciated.2. There is no significant change in appearance of distal cord and conus with no significant ventral motion on the prone sequences. Finding raise possibility of cord re-tethering in the appropriate clinical setting.3. Unchanged dilated caliber of the distal right internal carotid artery suspicious for aneurysm for which an MRA is recommended for further characterization.


Instruction: Generate impression based on medical findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The left hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 12 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 34 seconds

Output: Successful fluoroscopic left hip arthrogram injection.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Resolution of cervical diskitis and acute right osteomyelitis. Signs and symptoms: Cervical diskitis and vertebral osteomyelitis status post IV antibiotics. Pre-and post enhanced cervical MRI:Examination demonstrate interval complete resolution of T2 and T2 stir hyperintensity signal changes consistent with bone marrow edema of the vertebral bodies of C3 and C4. There is also no evidence of additional T2 hyperintensity of the intervertebral disk spaces. Trace faint enhancement of the disk space at C3 -- C4 is identified. There is no detectable abnormal epidural, leptomeningeal or perispinal soft tissue enhancement.Foramen magnum is unremarkable.C2 -- C3 demonstrate no spinal stenosis or neural foraminal compromise. C3 -- C4 demonstrate advanced disk disease with near complete loss of disk height, mild bilateral facet and ligamentum flavum hypertrophy. Constellation of changes however results in flattening and posterior displacement of the cord and moderate central spinal stenosis as well as significant right and moderate left neural foraminal compromise.C4 -- C5 demonstrate advanced disk disease and loss of disk height, ventral hypertrophic changes and possible a central disk protrusion at this level results in significant mass effect and posterior displacement of the cord and central spinal stenosis. Significant bilateral neural foraminal compromise is also present. This appearance remains fairly similar to prior exam. There are punctate and linear foci of cord T2 hyperintensity similar to prior exam and consistent with cord myelomalacia. This finding is most noticeable at C4 -- C5 however it extends beyond this level.C5 -- C6 demonstrate mild to moderate disk disease and loss of disk height, broad-based bulging disk and a tiny central disk protrusion at this level results in significant flattening deformity and posterior displacement of the cord and moderate central spinal stenosis as well as significant bilateral neural foraminal compromise.C6 -- C7 demonstrate moderate to advanced disk disease and loss of disk height bulging disk and a central disk protrusion, mild bilateral facet and ligamentum flavum hypertrophy. Constellation of changes results in significant bilateral neural foraminal compromise and moderate central spinal stenosis.C7 -- T1 demonstrate asymmetric right-sided moderate facet hypertrophic changes and moderate bilateral ligamentum flavum hypertrophy with resultant significant right neural foraminal compromise and no central spinal stenosis.Pre-and post enhanced thoracic MRI:Examination demonstrate normal anatomical alignment of vertebral column. There is no detectable abnormal enhancement of the vertebral column, thoracic cord or the leptomeninges. Multi-level degenerative changes with tiny ventral hypertrophic change and bulging disks results in multilevel mild effacement of ventral subarachnoid space, however without evidence of spinal stenosis at any level. Mild neural foraminal compromise in mid to lower thoracic spine without significant change since prior exam.

Output: 1.Examination demonstrate interval resolution of bone marrow edema at C3 and C4 vertebral bodies without residual enhancement. Very subtle trace residual enhancement at C3 -- C4 disk level is detected. Cervical cord myelomalacia without interval change since prior exam as detailed. Very advanced degenerative changes of cervical spine with resultant multilevel significant central spinal stenosis and bilateral neural foraminal compromise as detailed per level above.2.Pre and post enhanced MRI of thoracic spine demonstrate no evidence of abnormal enhancement. No evidence of central spinal stenosis. Mild to moderate degenerative changes of cervical spine without significant change since prior exam as detailed above.


Instruction: Generate impression based on medical findings.

Input: 46-year-old male with severe left hip pain. Evaluate for severity of avascular necrosis or signs of osteoporosis or infection. There is advanced osteonecrosis of the femoral head with collapse and fragmentation as seen on recent radiographs. There is also severe osteoarthritis of the hip with full-thickness cartilage loss superiorly. There is a small amount of fluid within the joint along with synovial enhancement which is nonspecific and could certainly be secondary to the patient's severe avascular necrosis and osteoarthritis, although it is impossible to exclude septic arthritis. Similarly, there is abnormal edema type signal abnormality within the neck and intertrochanteric region of the proximal femur as well as within the acetabulum that is nonspecific and could represent bone ischemia, reactive changes due to severe degenerative osteoarthritis or osteomyelitis. There is mild to moderate edema and enhancement of the musculature of the hip. The large field-of-view sequence of the pelvis shows less advanced osteonecrosis of the right femoral head. There is residual red marrow within the bones of the pelvis and proximal right femur. The sacroiliac joints are within normal limits. The pubic symphysis is within normal limits.

Output: Advanced avascular necrosis and osteonecrosis of the left hip. A small amount of fluid within the joint with enhancement of the synovium, surrounding soft tissues, and adjacent bone marrow may simply be due to the patient's underlying severe avascular necrosis and osteoarthritis, however, we cannot exclude the possibility of a septic joint.


Instruction: Generate impression based on medical findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.he patient was placed supine on the fluoroscopy table. The left hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 20 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 79 seconds

Output: Successful left hip arthrogram as described above.


Instruction: Generate impression based on medical findings.

Input: There are postsurgical findings related to right paramedian frontal lobe tumor, with diffuse nodular enhancement along the resection cavity, more prominent anteriorly. There is trace leptomeningeal enhancement along the marginal branch of the right cingulate sulcus, which is unchanged. Extensive T2 hyperintensity that likely represents vasogenic edema in much of the upper right cerebral hemisphere white matter persists. There is no evidence of acute infarction. There is slight midline shift to the left. There is a small right cerebellar hemisphere developmental venous anomaly. The skull and extracranial structures appear to be unchanged.

Output: Postoperative findings with persistent abnormality along the right paramedian frontal lobe, which is suspicious for residual tumor. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Male, 7 years old, history of DNET, yearly follow-up for tumor recurrence. Postoperative findings are again seen related to prior right anterior temporal tumor resection. The surgical cavity cavity is unchanged in size and morphology. Residual T2 hyperintense thickening is again seen posterior to the resection cavity occupying the superior and middle temporal gyri with extension through the temporal stem towards the insula. This tissue shows no significant interval change. No pathologic enhancement is seen within this thickened tissue or anywhere in the vicinity of the resection cavity.Brain parenchymal morphology is otherwise unremarkable. No evidence of new parenchymal signal abnormality, edema or mass effect is seen. No new abnormal fluid collections are detected. The ventricular system is normal in size and morphology.

Output: 1.Demonstration of postoperative findings without significant interval change.2.Residual thickened tissue posterior to the resection cavity is stable in size and morphology and free of pathologic enhancement.


Instruction: Generate impression based on medical findings.

Input: Follow-up exophytic right renal lesion. ABDOMEN:LIVER, BILIARY TRACT: Normal morphology without a focal lesion on this limited nonenhanced study. Status post cholecystectomy. Mild common and central bile duct dilatation likely reflects postcholecystectomy state. It tapers smoothly at the ampulla without a focal lesion.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Exophytic right renal T2 hyperintense 1.2 cm lesion is incompletely characterized without contrast but is most compatible with a simple cyst. It has minimally grown from the 2012 study. No suspicious mural nodularity or signal intensity. No hydroureteronephrosis or other suspicious renal lesion.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Limited noncontrast study. The exophytic right renal cystic lesion is most compatible with a simple cyst, minimally increased from the 2012 study without suspicious imaging characteristics.


Instruction: Generate impression based on medical findings.

Input: Female, 31 years old, with burning sensation in the skin and pain. Thoracic:Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. Scattered patchy areas of T1 and T2 hyperintensity within several of the thoracic vertebral bodies likely represent areas of focal fat or benign hemangiomas. No pathologic marrow signal abnormality or enhancement is seen.Spinal cord demonstrates normal signal intensity and morphology. No areas of pathologic cord or left meningeal enhancement are seen. No epidural abnormalities are suspected.The intervertebral discs are preserved. No significant disc bulge or herniation is seen. The spinal canal and neural foramina are patent.Lumbar:Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits.Scattered patchy areas of T1 and T2 hyperintensity within the vertebral bodies likely represent areas of focal fat or benign hemangiomas. No pathologic marrow signal abnormality or enhancement is seen.The visualized distal spinal cord, conus and nerve roots of the cauda equina are unremarkable. No pathologic intraspinal or leptomeningeal enhancement is seen. No epidural abnormalities are suspected.The intervertebral disc spaces are preserved. No significant disc bulge or herniation is noted. The spinal canal and neural foramina are patent. Mild facet arthropathy is demonstrated at L4-5 and L5-S1.

Output: No findings are seen in the thoracic or lumbar spine to account for the patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: Multiple sclerosis, left thalamic stimulator, and altered mental status. The images are degraded by patient motion. There is a left transfrontal approach brain stimulator tip in the left thalamus. There is diffuse prominence of the ventricles and sulci due to cerebral volume loss. There are extensive non-enhancing lesions in the bilateral subcortical and periventricular white matter.

Output: Left thalamic stimulator and extensive demyelinating disease with diffuse cerebral volume loss.


Instruction: Generate impression based on medical findings.

Input: Increased headaches and previous possible history of syrinx. Brain: There cerebellar tonsils display a normal morphology and are not low-lying. There is intact CSF flow across the foramen magnum. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is mild asymmetry of the lateral ventricles, which can represent an anatomic variant. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is scattered paranasal sinus mucosal thickening.Cervical Spine: The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1. No evidence of Chiari malformation or cervical spinal cord syrinx.2. Scattered paranasal sinus mucosal thickening may indicate sinusitis.


Instruction: Generate impression based on medical findings.

Input: Benign neoplasm of cranial nerves [D33.3], Reason for Study: ^Reason: acoustic neuroma, RT planning History: RT planning This is limited study for RT planning protocol.There is about 11.2mm x 15mm sized right CP angle mass which extends toward right IAC. On Gad enhanced images, the lesion including intra canalicular portion shows intense enhancement with internal non enhancing areas indicating cystic or necrotic components. These findings are consistent with acoustic neuroma.The ventricles, sulci and cisterns are symmetric and unremarkable. The paranasal sinuses and mastoid air cells are clear.

Output: Right CPA tumor which extends toward right IAC, consistent with acoustic neuroma.


Instruction: Generate impression based on medical findings.

Input: 25 year old man with dilated non-ischemic cardiomyopathy, family history of heart failure (father with CHF in his 40's), referred for cardiac MR to evaluate for possible etiologies. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 17%, the LV end diastolic volume index is 181 ml/m2 (normal range: 74+/-15), the LVEDV is 478 ml (normal range 142+/-34), the LV end systolic volume index is 150 ml/m2 (normal range 25+/-9), the LVESV is 398 ml (normal range 47+/-19). There is global hypokinesis. There is mild late gadolinium enhancement in the mid inferoseptum at the RV insertion point, which can be seen in pulmonary hypertension. There is a focus of mild late gadolinium enhancement in the mid inferolateral and inferior wall which is atypical for previous infarction, and suggestive of previous inflammation, fibrosis or infiltrative process.The native T1 myocardial relaxation time is 1090ms in the basal septum. This value is borderline elevated.There is no evidence for myocardial iron overload (T2* relaxation time 30-38ms). There is no LV thrombus visualized on today's study. 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 27%, the RV end diastolic volume index is 148 ml/m2 (normal range 82+/-16), the RVEDV is 391 ml (normal range 142+/-31), the RV end systolic volume index is 107 ml/m2 (normal range 31+/-9), and the RVESV is 284 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 at least mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least mild-moderate tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is upper normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSmall right pleural effusion. 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. Severely dilated left ventricle with severely reduced systolic function (EF 17%). There are two foci of late gadolinium enhancement seen; one is located at the inferoseptum at the RV insertion point, which is a nonspecific finding that can be seen in pulmonary hypertension. There is a second focus of mild late gadolinium enhancement in the mid inferolateral and inferior wall which represents previous infiltration, inflammation or fibrosis. 2. No LV thrombus is visualized on today's study. 3. Severely dilated right ventricle with severely reduced systolic function (EF 27%). 4. Severe biatrial dilation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Acute myeloblastic leukemia, not having achieved remission [C92.00], Reason for Study: ^Reason: RULE OUT SPINE LESION History: NEW MULTIPLE LESIONS IN BRAIN. C-SpineReplacements of normal bone marrow fat are seen at C7. T1 and T2 vertebral bodies with inhomogeneous enhancement of cervical vertebral bodies from C2 to T2 indicating possible metastatic lesions or post-treatment related.There is anterolisthesis of C4 on C5 with moderate to severe spinal canal stenosis from the C34 level to C56. The spinal cord signal intensity appears to be normal.T-Spine:Inhomogenous bone marrow signal intensities on whole T spine vertebral bodies but without evidence of compression fracture or obvious focal enhancing lesion.Spine cord signal intensity appears to be normal.Normal kyphotic angulation is preserved.L-Spine:Again inhomogeneous marrow signal intensities without compression fracture of lumbar vertebral bodies. Post contrast enhancement scan shows inhomogenous and somewhat mass like enhancement especially seen at the level of L2 to S1 indicating metastatic lesions. In addition, there is focal nodular intrathecal enhancement at the level of left S1 nerve root. This lesion may suggest possible intrathecal nodular enhancement or small nerve root sheath tumor. There is no definitive evidence of cauda equina enhancement. Bilateral iliac bones and sacrum also show inhomogenous enhancing lesions indicating possible metastatic lesions.There is grade 1 spondylolisthesis of L4 on L5 with severe spinal stenosis at the level of L45.Moderate degree spinal stenosis are seen from the level of L23 to L45 with disc dessication. Spinal cord signal intensity is normal. The conus medullaris terminates at the level of L1.

Output: 1. Diffuse multifocal bone marrow replacement with inhomogenous enhancing lesions on whole spine and bilateral ilium indicating metastatic lesions as described above.2. Single nodular enhancing lesion at the level of left S1 nerve root suggesting possible intrathecal metastatic nodule or incidental nerve sheath tumor.3. Degenerative changes of C and L spine with anterolisthesis of C4 on C5 and L4 on L5 as described above. No evidence of abnormal spinal cord signal intensity.


Instruction: Generate impression based on medical findings.

Input: Systemic lupus erythematosus and neuromyelitis optica on research treatment protocol. Evaluation for progressive multifocal leukoencephalopathy is requested. There are numerous T2 hyperintense lesions in the cerebral white matter. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Multiple nonspecific cerebral white matter lesions, but no particular findings to suggest progressive multifocal leukoencephalopathy.


Instruction: Generate impression based on medical findings.

Input: Reason: pain, concern for meniscus and LCL History: pain MENISCI: There is linear increased signal abnormality within the posterior horn of the lateral meniscus which extends to the tibial articular surface indicating a longitudinal tear. The anterior horn appears intact. The medial meniscus appears intactARTICULAR CARTILAGE AND BONE: There is a focal full-thickness articular cartilage defect along the lateral facet of the femoral trochlea with underlying degenerative subchondral signal abnormality (image 13; series 501). This defect extends to involve the femoral trochlea centrally and a small portion of the medial facet of the femoral trochlea as well.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Longitudinal tear of the posterior horn of the lateral meniscus.2. Focal full-thickness articular cartilage defects along the femoral trochlea as described above. Other findings as described.


Instruction: Generate impression based on medical findings.

Input: A 17 year old male with atypical chest pain who was referred to echocardiography which showed a suspected membranous ventricular septal defect and suspected non-compaction cardiomyopathy. Referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is mildly dilated with mildly reduced systolic function. The ventricle is hypertrabeculated (at the level of the papillary muscles, in the short axis plane, the non-compacted to compacted ratio is >2.3; additionally, the myocardium at the mid to apical level has a wall thickness of approximately 4mm. The overall LV ejection fraction is 49%, the LV end diastolic volume index is 114 ml/m2 (normal range: 74+/-15), the LVEDV is 187 ml (normal range 142+/-34), the LV end systolic volume index is 58 ml/m2 (normal range 25+/-9), the LVESV is 95 ml (normal range 47+/-19), the LV mass index is 48 g/m2 (normal range 85+/-15), and the LV mass is 79 g (normal range 164+/-36). There is global mild hypokinesis. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.No intracavitary thrombus.No obvious ventricular septal defect is visualized during this study. These finding support the diagnosis of left ventricular non-compaction. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is in the upper limit of normal with a low normal systolic function. The overall RV ejection fraction is 49%, the RV end diastolic volume index is 114 ml/m2 (normal range 82+/-16), the RVEDV is 186 ml (normal range 142+/-31), the RV end systolic volume index is 58 ml/m2 (normal range 31+/-9), and the RVESV is 94 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a bovine 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 pericardial effusion.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is mildly dilated with mildly reduced systolic function, the LVEF is 49%. The ventricle is hypertrabeculated and the wall thickness is relatively thin at the mid to apical ventricular level. At the level of the papillary muscles, the diastolic non-compacted to compacted ratio is >2.3. In the appropriate setting, these findings support the diagnosis of left ventricular non-compaction. 2. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.3. No left ventricular thrombus is noted. 4. No ventricular septal defect is identified on this examination. 5. The right ventricle is in the upper limit of normal with a low normal systolic function, the RVEF is 49%. 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: Postoperative pain Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.Compared to 8/26/2015, interval postsurgical changes of decompressive laminectomy via left-sided approach at L2-L3 is seen. Expected postsurgical changes include small fluid collection in the laminectomy bed. There is persistent effacement of the thecal sac at this level with small central protrusion at the L2-L3 level again noted. There is no significant epidural or paraspinous hematoma.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild facet arthropathy.L2-L3: Decompressive laminectomy, small disc protrusion, small postoperative fluid collection in the surgical bed, and persistent effacement of the thecal sac as above. There is mild bilateral neural foraminal stenosis. Facet arthropathy.L3-L4: Disc bulge and facet arthropathy. There is mild effacement of the left lateral aspect of the thecal sac. There is mild right and mild-to-moderate left neural foraminal narrowing.L4-L5: Facet arthropathy and ligamentum flavum thickening as well as minimal disc bulge resulting in mild spinal canal stenosis. There is minimal neural foraminal narrowing.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis.

Output: Postsurgical changes of decompressive laminectomy at L2-L3. There is a small fluid collection in the laminectomy bed dorsal to the thecal sac which may represent residual seroma or pseudomeningocele. There is effacement of the thecal sac at the L2-L3 level in part related to this small fluid collection. Otherwise no significant epidural or paraspinous hematoma.


Instruction: Generate impression based on medical findings.

Input: Pituitary microadenoma, yearly follow up. BRAIN: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. There is a right maxillary sinus retention cyst. PITUITARY: There is redemonstration of mild prominence of the pituitary gland measuring 11 x 9 mm in the transverse by craniocaudal dimensions (image 8, series 801 and image 6, series 1101), which is unchanged in size. There is a symmetric convex superior margin of the gland. There is uniform enhancement of the pituitary gland without signal abnormality to suggest a discrete mass. There is minimal leftward deviation of the pituitary stalk, but it is normal in caliber, signal intensity, and enhancement. The suprasellar cistern, optic chiasm, hypothalamus, and cavernous sinuses are unremarkable.

Output: No significant interval change in mild pituitary prominence. No discrete pituitary mass is identified.


Instruction: Generate impression based on medical findings.

Input: One year follow up for cavernous malformations. There are innumerable cavernous malformations throughout the supratentorial and infratentorial brain. Subcentimeter lesions in the left middle cerebellar peduncle and in the right superior cerebellar hemisphere appear to be slightly larger, but there is no evidence of acute hemorrhage or associated edema. The other lesions appear to be essentially unchanged. There is no convincing evidence of associated developmental venous anomalies. The ventricles and basal cisterns are unchanged in size and configuration, without midline shift. There is no evidence of acute infarct. The paranasal sinuses, mastoid air cells, and orbits are unremarkable.

Output: Innumerable supratentorial and infratentorial cavernous malformations, with slight interval increase in size of subcentimeter lesions in the posterior fossa, but no evidence of acute hemorrhage or associated edema.


Instruction: Generate impression based on medical findings.

Input: Patient with metastatic small cell lung cancer status post whole brain radiation therapy. There is marked interval regression of the previously seen multiple intra-axial and extra-axial lesions. There is interval resolution of the right frontal dural metastasis with interval decrease in size of the adjacent T2 hyperintense lesion, measuring 11 x 19 mm (AP x TR), previously 36 x 16 mm. There is interval increase in the T2/FLAIR signal at the right frontal horn periventricular white matter, which approaches and is adjacent to the T2 hyperintense lesion medially. There are multiple T1- and T2/FLAIR hyperintensities corresponding to the previously seen supra- and infratentorial lesions with associated susceptibility artifact. There may be minimal, if any, residual enhancement associated with the previously seen lesions. The previously seen right dural thickening and enhancement has resolved. There is interval increase in size of the ventricles, which may be on the basis of ex vacuo dilatation and decreased mass effect from previously seen lesions, as the sulci are also more prominent. There is also increased periventricular FLAIR hyperintensity. There is no midline shift or herniation. There previously seen partially imaged mass at the right C2 level has regressed.

Output: 1. Marked interval regression of multiple supratentorial and infratentorial intracranial metastases. No new enhancing lesion. Interval resolution of right dural thickening and enhancement.2. Slight interval increase in size of the ventricles, which may be on the basis of ex vacuo dilatation, as the sulci are also more prominent. There is also interval increase in periventricular FLAIR hyperintensity which may be related to treatment change, however, given the slight increase in caliber the ventricular system, component of transependymal CSF flow cannot entirely be excluded. Suggest close follow up to exclude the possibility of developing communicating hydrocephalus.


Instruction: Generate impression based on medical findings.

Input: 53-year-old male with history of prostate cancer. Left lateral mid 3+3, left lateral apex 3+3, left apex 3+3, right lateral gland 3+4. PELVIS:PROSTATE:Prostate Size: The prostate measures 4.1 x 2.6 cm.Peripheral Zone: Right base lateral T2 hypointense lesion with corresponding decreased ADC measures 15 x 10 mm. Additional similarly appearing focus at the left base measures 6 x 5 mm.Central Gland: BPH.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: There is extra capsular extension of the right base lesion with possible neurovascular invasion.BLADDER: No significant abnormality noted.LYMPH NODES: Prominent external iliac nodes.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Right base peripheral lesion with extracapsular extension and possible neurovascular invasion. Additional smaller focus in the left base also suspicious for carcinoma.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Secondary malignant neoplasm of brainClinical question: cystic brain mets (breast primary) s/p drain placementSigns and Symptoms: eval for extent of disease; for study protocol (please see comments)Comments: Prior surgery: Rickham catheter placement into the L frontoparietal and R temporal lesions on 10/15/15 A ring-enhancing fluid collection present in the left frontal lobe measures 32 x 47 mm axial dimensions and 36 x 36 mm coronal dimensions. On the prior exam it measured 36 x 36 mm coronal dimensions and 35 x 45 mm axial dimensions. The right frontal lobe ring-enhancing lesion measures 8 mm x 9 mm and previously measured 8 mm x 9 mm. A right posterior temporal lobe lesion which is irregularly shaped currently measures 39 x 28 mm axial dimensions and previously measured 45 x 30 mm axial dimensions. This temporal lobe ring-enhancing lesion measures 29 x 14 mm coronal dimensions on the current exam and 39 23-mm coronal dimensions on the prior exam.There is no associated diffusion restriction within these fluid collections. Fluid collections have high signal on T2 and FLAIR imaging within them. There is surrounding halo of edema with each of these ring-enhancing lesions.The patient is status post catheter placement in the left frontal lobe cystic lesion as well as the right temporal lobe lesion through adjacent burr holes.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Since prior exam a right temporal lobe ring-enhancing lesion has decreased in size. The left frontal lobe lesion in the right frontal lobe lesion remains stable in overall dimensions.2.The patient is status post catheter placement in the left frontal lobe cystic lesion as well as the right temporal lobe lesion through adjacent burr holes.


Instruction: Generate impression based on medical findings.

Input: 53 years, Male, Reason: history of RALP for prostate cancer, now with biochemical recurrence. Evaluate for any nodules, nodes, or signs of recurrence History: biochemical recurrence of prostate cancer. PELVIS:PROSTATE:Prostate Size: Status post prostatectomy.Peripheral Zone: Status post prostatectomy.Central Gland: Status post prostatectomy. A small tubular focus with enhancement but no abnormal ADC/T2 signal in the surgical bed (1001/14 and 1901/1468) most likely represents a vessel. No definite evidence of recurrence.Seminal Vesicles: Status post removal of seminal vesicles.Extracapsular Extension: Status post prostatectomy.BLADDER: No significant abnormality noted.LYMPH NODES: Small inguinal lymph nodes.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of local recurrence.


Instruction: Generate impression based on medical findings.

Input: 84 year old male with bilateral leg weakness, stool incontinence, history of metastatic prostate cancer. Evaluate for cord compression. No large marrow infiltrating lesions are appreciated within the cervical, thoracic, or lumbar spine. No obvious epidural tumor. The vertebral bodies heights are grossly maintained. There is mild reversal of cervical lordosis. Alignment of the spine is otherwise grossly maintained. There are no findings to suggest acute cord compression.Degenerative changes are seen throughout the cervical spine with at least moderate degree of spinal canal stenosis at C3-C4 and C5-C6 and to a lesser degree C4-C5 levels related to disc bulge and ligamentum flavum thickening. Additional multilevel degenerative changes are also seen involving the lumbar spine, most prominently involving the L3-4 level where there is moderate to severe spinal canal stenosis which is better appreciated on the dedicated lumbar spine performed subsequently.Prominent endplate degenerative changes are present at L3-L4 and to a lesser degree at the L4-L5 levels. There is a prominent Schmorl's node involving the superior endplate of L4. There is also edema involving the superior L4 endplate which is favored to be on an advanced degenerative basis.

Output: This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No acute cord compression is identified. Degenerative changes at multiple levels in the cervical and lumbar spine with at least moderate spinal canal stenosis at C3-C4 and C5-C6 and moderate to severe spinal canal stenosis at L3-L4. Please refer to separate dedicated lumbar spine MRI report.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: 72-year-old female with history of pancreatic cysts. Evaluate for any abnormalities. ABDOMEN:LIVER, BILIARY TRACT: Gallbladder sludge and stones. Few small hepatic cysts. No suspicious hepatic mass. No biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Scattered T2 hyperintense foci throughout the pancreas, some of which appear to connect to the pancreatic duct, likely side-branch IPMNs. No appreciable enhancement in these lesions on the limited post-contrast sequences. The largest lesion in the neck measures 1.4 x 1.9 cm (series 9, image 16).No pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Large T2 hyperintense foci in the left kidney, one in the upper pole is mildly complex with thin septations, presumably cysts. No definite enhancement is seen in the visualized portions of these lesions not obscured by metal artifact on the limited post-contrast sequences.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: 8 mm nonspecific enhancing nodule in the right lateral breast (series 12, image 10).Rods and screws throughout the thoracolumbar spine produces significant metal artifact that variably degrades MRI sequences.OTHER: No significant abnormality noted.

Output: 1. Scattered cystic foci throughout the pancreas, largest is 1.4 x 1.9 cm, most suggestive of side-branch IPMNs.2. Nonspecific 8 mm enhancing nodule in the lateral right breast, correlation with mammogram/ultrasound as clinically warranted.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Worsening vision on the right, tingling right hand, burning sensation in both legs, weakness and legs, gaite problem. Signs and symptoms: As above. Pre-and post-enhanced brain MRI:Negative diffusion weighted series.Examination demonstrates extensive tiny foci of flair hyperintensity in bilateral subcortical, periventricular white matter of city hemispheres and minimally in the posterior fossa. Findings consistent with patient's previously known multiple sclerosis. There is no significant interval change since prior exam on the extent of the above findings and none of the lesions demonstrate enhancement to suggest active demyelinating plaque.Ventricular system and cortical sulci remain within normal size and without evidence of any intracranial mass effect. The calvarium is unremarkable. Images through the orbits including axial fat sat series are unremarkable and without convincing evidence of abnormal enhancement.Pre-and post-enhanced MRI of orbits:Examination demonstrate normal signal intensity and caliber of the optic nerves bilaterally. There is no convincing evidence of enhancement of optic nerves. The optic chiasm demonstrate normal signal intensity and without detectable abnormal enhancement.There is normal signal intensity of the retro-orbital fat. The signal intensity, caliber and pattern of enhancement the extraocular musculature is also within normal.Lacrimal glands are within normal size and morphology and without detectable abnormal enhancement.Pre-and post-enhanced cervical MRI:Examination demonstrates fairly extensive foci of T2/T2 stir hyperintensity throughout the cervical cord and minimally in the uppermost visualized thoracic cord. Although difficult to precisely compare with prior exam due to technique difference there is suggestion of interval progression of disease. Examination however demonstrate no convincing evidence of an enhancing plaque.Foramen magnum is unremarkable.C2 -- C3 is unremarkable.C3 -- C4 demonstrate mild asymmetric right uncovertebral hypertrophic changes and a small central disk protrusion without spinal stenosis or neural foraminal compromise.C4 -- C5 demonstrates a prominent central and right paramedian broad-based disk protrusion which results in effacement of ventral subarachnoid space and slight flattening and posterior displacement of the cord resulting in mild central spinal stenosis. Mild bilateral neural foraminal compromise is also present.C5 -- C6 demonstrate degenerative changes resulting in moderate right neural foraminal compromise.C6 -- C7 demonstrate large asymmetric left uncovertebral hypertrophy, shallow broad-based disk protrusion and mild bilateral ligamentum flavum hypertrophic changes. Constellation of changes results in mild central spinal stenosis without convincing evidence of neural foraminal compromise.

Output: 1.Pre-and post-enhanced brain MRI demonstrate moderate supratentorial and mild infratentorial chronic findings of multiple sclerosis no abnormal enhancement or significant change since prior exam.2.Pre-and post-enhanced MRI of the orbits is unremarkable. 3.Pre-and post-enhanced MRI of cervical spine demonstrate extensive chronic findings of demyelinating disease with interval progression since prior exam. Large central disk protrusion at C4 -- C5 with resultant mild central spinal stenosis is noted. Degenerative changes and a shallow disk protrusion at C6 -- C7 with resultant mild central spinal stenosis. Neural foramina are compromised as detailed per level.


Instruction: Generate impression based on medical findings.

Input: Stage IV NED melanoma: assess for metastatic recurrence. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: No evidence of intracranial metastases.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old, with left-sided lumbar spine mass. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or enhancing marrow lesions are seen.The visualized distal spinal cord, conus and nerve roots of the cauda equina are unremarkable. No pathologic spinal cord or leptomeningeal enhancement is seen. No epidural abnormalities are suspected.Apart from some redundancy of the skin in the lower lumbar region, no masslike lesion is identified within the superficial or deep soft tissues. However, inflammation of the left L4-5 facet joint is seen, likely degenerative/osteoarthritic in nature.L1-2: Unremarkable. L2-3: Unremarkable. L3-4: Mild facet arthropathy. Minimal disc bulging with a small left foraminal annular fissure. No significant spinal canal stenosis. No significant foraminal narrowing. L4-5: Moderate facet arthropathy with edema and enhancement on the left indicating inflammation. Mild disc bulging with bilateral foraminal annular fissuring. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. L5-S1: Moderate facet arthropathy. Mild bulging disc with a small central disc protrusion. No significant spinal canal stenosis. No significant foraminal narrowing.

Output: No masslike lesion is evident within the posterior soft tissues of the lumbar region. However, the left L4-5 facet joint appears degenerated and inflamed which may be contributing to the patient's symptomatology. Otherwise, relatively mild degenerative/osteoarthritic findings are seen with no evidence of any high-grade spinal canal or foraminal stenosis.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Evaluate for hemorrhage. Signs and symptoms: Status-post grids in for seizure focus resection. Non-infused CT of brain:There is evidence of a large right temporal and frontal -- parietal craniotomy. Expected extra axial (epidural) air and fluid collection under the craniotomy flap is noted. There is overall increase mass effect in the right hemisphere with effacement of sulci and approximately 1 to 2-mm midline shift. There is evidence of a placement of epidural electrodes extending from the level of the floor of the right middle cranial fossa superiorly to above the level of lateral ventricles. Electrodes cover part of the right temporal lobe and extends superiorly into the parietal lobe. There is medial extension of electrodes which is best appreciated on axial image 11. The cortical sulci are not well visualized due to technique however I believe this component of electrodes are within the right sylvian fissure. There is no evidence of any parenchymal edema or hemorrhage. There is no evidence of ventriculomegaly. There is a focal area of CSF density within the expected level of right sylvian fissure noted on axial image 13. This corresponds with focal area widening of the sylvian fissure that was present on prior MRI examination. This is believed to represent a focal area of encephalomalacia of the operculum of right temporal lobe deep within the sylvian fissure. This is best appreciated on coronal T2 weighted images 15 through 17. No evidence of hemorrhage, edema, hydrocephalus is noted.

Output: 1.Expected postoperative changes of right craniotomy for placement of epidural electrodes over the right temporal and frontal lobes.2.Focal area of encephalomalacia believed to be within the operculum of right temporal lobe deep within the right sylvian fissure.


Instruction: Generate impression based on medical findings.

Input: History of esophageal cancer status post CRT. New, small but significantly hypermetabolic right iliac is focus is very suspicious for progression of a solitary intramuscular metastasis seen on PET. There is a small mass, measuring less than 1.5 cm in greatest dimension, situated between the deep fibers of the right iliacus muscle and the underlying iliac wing. It is isointense to skeletal muscle on T1-weighted images, hyperintense to skeletal muscle on fat-suppressed T2-weighted images, and shows mild enhancement following gadolinium administration. This corresponds to the hypermetabolic focus seen on the recent PET CT scan and is compatible with a soft tissue metastasis. There is edema surrounding this mass between the iliacus and the iliac wing, but I see no signal abnormality within the right ilium itself. Bone marrow signal intensity is within normal limits. I see no additional soft tissue masses.

Output: Small nodular mass within the right iliacus along the right iliac wing corresponding to the hypermetabolic focus on recent PET scan is compatible with a soft tissue metastasis from the patient's esophageal cancer.


Instruction: Generate impression based on medical findings.

Input: Status post MVC with neck pain, evaluate for ligamentous injury 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 evidence of edema or disruption involving the ligamentous structures is demonstrated. No evidence of epidural hematoma. No cord signal abnormality to suggest edema or hemorrhage.There is no significant spinal canal or neural foraminal stenosis at any level in the cervical spine.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits. There is opacification of the bilateral mastoid air cells.

Output: No findings to suggest ligamentous injury in the cervical spine spine. No appreciable bone marrow edema or soft tissue edema is demonstrated to suggest associated cervical spine fracture; please note however MRI is not sensitive for small fractures and CT can be considered as clinically indicated.