Instruction: Generate impression based on medical findings.

Input: Several sequences are motion greater. Given this caveat:Brain MRI:T2 hyperintensity is present throughout the white matter, confluent in several locations, without associated mass effect, restricted diffusion, susceptibility abnormality, or enhancement. Gyriform susceptibility abnormality is noted within the right parietal lobe. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Mild mucosal thickening is present within the left maxillary sinus, otherwise the paranasal sinuses are clear. Mild inflammatory changes are noted in bilateral mastoid air cells with a few containing fluid. There is no abnormal enhancement within the brain. Cervical spine MRI:The marrow signal is benign. The cervical and upper thoracic cord is normal in signal without abnormal enhancement. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.There has been multilevel laminectomy extending from C2 through C6.C2/3: There is moderate left facet hypertrophy with facet fusion as well as mild right facet hypertrophy. Additionally, there is mild posterior aspect disc complex eccentric to the left. There is no central or right neural foraminal stenosis, however there is moderate left neural foraminal stenosis.C3/4: Trace anterolisthesis C3 on C4, posterior osteophyte disc complex, bilateral uncinate hypertrophy, ligamentum flavum thickening, very severe left facet hypertrophy, and severe right facet hypertrophy. There is moderate central and severe bilateral neural foraminal stenosis.C4/5: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, ligamentum flavum thickening, and very severe bilateral facet hypertrophy. There is associated focal cord atrophy with intrinsic T2 hyperintensity. There is mild to moderate central and severe bilateral neural foraminal stenosisC5/6: Minimal posterior osteophyte disc complex, bilateral uncinate hypertrophy, ligamentum flavum thickening, and severe bilateral facet hypertrophy with probable bilateral facet fusion. There is mild to moderate bilateral neural foraminal stenosis.C6/7: Minimal posterior osteophyte disc complex, bilateral facet hypertrophy, partial vertebral body fusion, and mild bilateral facet hypertrophy with facet fusion. There is moderate left neural foraminal stenosis.C7/T1: Trace anterolisthesis C7 on T1, minimal posterior osteophyte disc complex, and moderate bilateral facet hypertrophy. There is moderate bilateral neural foraminal stenosis.Multilevel facet hypertrophy is present in the visualized upper thoracic spine, encroaching the neural foramina, worse at T1/2 and T2/3.

Output: 1.Advanced chronic small vessel ischemic disease.2.Gyriform susceptibility abnormality within the right parietal lobe most likely represents hemosiderin sequela of remote small hemorrhagic cortical infarction.3.There has been multilevel laminectomy extending from C2 through C6.4.C2/3: Moderate left neural foraminal stenosis.5.C3/4: Moderate central and severe bilateral neural foraminal stenosis.6.C4/5: There is spondylitic-associated focal cord atrophy with intrinsic T2 hyperintensity as well as mild to moderate central and severe bilateral neural foraminal stenosis7.C5/6: Mild to moderate bilateral neural foraminal stenosis.8.C6/7: Moderate left neural foraminal stenosis.9.C7/T1: Moderate bilateral neural foraminal stenosis.10.Multilevel facet hypertrophy is present in the visualized upper thoracic spine, encroaching the neural foramina, worse at T1/2 and T2/3.


Instruction: Generate impression based on medical findings.

Input: 72-year-old man with history of prostate cancer status post prostatectomy, please evaluate for recurrence or regional lymphadenopathy. PELVIS:PROSTATE: Patient is status post prostatectomy. There is slight distortion in the left base of penis but no evidence of local recurrence.BLADDER: No significant abnormality noted of the bladder neck or urethra.LYMPH NODES: Small lymph nodes are noted measuring up to 1 cm in short axis.BONES, SOFT TISSUES: There is enhancement at the origin of the hamstring muscles on the right initial tuberosity (series 1801, image 63). No osseous lesions are identified.OTHER: No significant abnormality noted.

Output: 1.No evidence of local recurrence or regional lymphadenopathy.2.Enhancement at the right hamstring origin, likely tendinopathy.


Instruction: Generate impression based on medical findings.

Input: 80-year-old man with past medical history of colon cancer presents with severe lower back and right lateral hip pain. Severe osteoarthritis of the right hip has progressed when compared to CT dated 10/18/2013. This hip joint now appears essentially devoid of articular cartilage and there is flattening of the superior aspect of the femoral head. Multiple subchondral cysts and/or chronic erosions within the femoral head and acetabulum are seen. There is a small amount of fluid within the hip joint and extending anteriorly into a synovial recess that in retrospect was present on prior CT scan. There is also enhancement of the hip joint indicating synovitis. Edema type signal and enhancement of the femoral head extending into the intertrochanteric region as well as the acetabulum is suspected to be arthritic in etiology. Overall, these findings indicate progression of osteoarthritis perhaps secondary to underlying inflammatory or depositional arthritis. The distribution of signal intensity abnormality in the bone marrow is more in keeping with an arthritic process than a neoplastic one.There is a small amount of peritrochanteric fluid enhancement on the right relative to the left which may reflect a mild bursitis.There is also mild edema and enhancement of the adjacent gluteal and flexor musculature of the hip that is nonspecific but may reflect altered biomechanics or myositis. There is mild atrophy of gluteal and hip musculature, right greater than left.Relatively mild osteoarthritis affects the left hip.The sacroiliac joints appear normal.Mild degenerative disc disease and facet joint osteoarthritis affect the lower lumbar spine.The remaining bone marrow signal intensity is within normal limits.

Output: 1. Severe osteoarthritis of the right hip that has progressed when compared to the prior study and may be secondary to underlying chronic inflammatory or depositional arthritis. Bone marrow signal abnormalities are felt to be arthritic in etiology as well. We see no focal lesions to indicate metastatic disease to bone.2. Inflammatory changes of the musculature of the right hip and along the right greater trochanter as above.


Instruction: Generate impression based on medical findings.

Input: Reason: HCC screening, follow up pancreatic head cyst History: NASH cirrhosis, panc head cyst ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. Loss of signal on out of phase images suggest steatosis. Subcentimeter right hepatic cysts are unchanged. Arterial enhancing lesion seen on the prior exam is no longer evident and was likely perfusional. There is a new focus of arterial enhancement (11/57) which is not seen on additional phases which may also be perfusional. Common bile duct appears normal. Vasculature is patent.SPLEEN: Mild splenomegaly, unchanged.PANCREAS: Pancreatic duct is nondilated. Cystic lesion in the pancreatic head measuring 1.1 x 1.5 cm (5/32), is unchanged and likely represents a sidebranch IPMN. Multiple adjacent cystic lesions more medially in the pancreatic head measuring overall 2.5 x 1.6 cm (5/35) with multiple small septations are also unchanged, most likely side branch IPMNs (versus dominant multiseptated lesion). Additional punctate cystic foci in the pancreatic body is also unchanged and likely represents a side branch IPMN. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left hepatic T2 hyperintensity, likely a cyst.RETROPERITONEUM, LYMPH NODES: Prominent portacaval and retroperitoneal lymph nodes are unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stable cystic lesions in the pancreatic head, likely a side branch IPMNs; please refer to details above.2.Cirrhotic liver morphology. Arterially enhancing lesion seen on the prior exam is no longer evident and may have been perfusional in etiology.


Instruction: Generate impression based on medical findings.

Input: 70-year-old female with smoldering myeloma. Evaluate for bonelesions. BONE MARROW: There is a lobulated focus of increased signal abnormality on fluid sensitivesequences within the intertrochanteric region of the left femur with the imagingcharacteristics most consistent with an enchondroma. No additional bone marrow signalabnormality is identified.SOFT TISSUES: There is nonspecific subcutaneous edema along the posterior aspect of thelumbar spine. The imaged musculature of the pelvis is normal in appearance.JOINTS: There is a small amount of fluid within the hips without evidence of a largeeffusion.ADDITIONAL

Output: Findings most consistent with a benign enchondroma within the left femurwithout evidence of a definite myelomatous deposit affecting the pelvis.


Instruction: Generate impression based on medical findings.

Input: 59-year-old female with low back pain, history of lumbar fusion. Evaluate hardware and sagittal balance 2 views of the cervical spine reveal mild anterior osteophyte formation of the lower cervical spine, otherwise alignment is anatomic and the disc spaces are preserved.2 views of the thoracic spine show mild multilevel degenerative disc disease with anterior osteophyte formation.2 views of the lumbar spine reveal posterior stabilization rod and pedicle screws for L5/S1 fusion. There is minimal anterolisthesis of L5 on S1. Mild anterior osteophyte formation of the lower lumbar spine is noted, otherwise alignment is anatomic with preservation of the disc spaces.There is 5 mm positive sagittal balance and 0 mm coronal balance.

Output: Postoperative and mild degenerative arthritic changes as described above.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Spinal stenosis, lumbar region, with neurogenic claudicationClinical question: spinal stenosisSigns and Symptoms: pain and weakness Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact. There is a levocurvature to the lumbar spine. There is left lateral translation of L4 on L5 and right lateral translation of L2 on L3. In addition the right side of the endplates at the L3-4 disc space abut each other.On T2 STIR imaging there is high vertebral body signal adjacent to the L4-5 endplates. On the prior exam similar finding was present at L2-3 and L5-S1.At L5-S1 there is no significant compromise to spinal canal. There is some left lateral translation of L5 on S1. There is loss of disc space height, endplate reactive change, diffuse disc bulge and facet hypertrophy at this level which results in effacement of the fat within the neural foramina bilaterally and encroachment of the exiting nerve roots with foramina bilaterally. There is fluid in the right facet joint at this level. Compared to the prior exam this has not changed substantially.At L4-5 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with facet hypertrophy bilaterally but worse on the right compared to the left. There is left lateral translation of L4 on L5 There is some mild triangulation of the thecal sac. There is ligamentum flavum hypertrophy at this level. There is encroachment of the right-sided exiting nerve roots at this level as a result of facet hypertrophy and disc bulge. Overall there is a mild degree of spinal stenosis present at this level. There is also some mild encroachment of the nerve roots at the right lateral recess at this level. Compared to the prior exam this has not changed substantially.At L3-4 there is no significant compromise to spinal canal or neural foramina. The right aspect of the endplates at this level abut each other. There is some facet and ligamentum flavum hypertrophy present at this level. The exiting nerve roots within the neural foramina are surrounded by fat.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is right lateral translation of L2 on L3 present. There is mild narrowing of the spinal canal at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There is a levocurvature of the lumbar spine present associated with multilevel degenerative changes as detailed above with encroachment of the exiting nerve roots bilaterally at L5-S1 and on the right side at L4-5. There is also some encroachment of the nerve roots of the right lateral recess at L4-5.2.Since the prior exam findings suggest that there is greater subacute inflammatory change on the current exam at L4-5 on the present study whereas this was previously the case at other levels on the prior exam.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old, status post seizure with left head deviation and convulsions. Again seen is an area of T2/FLAIR hyperintensity involving the subcortical white matter of the lateral/inferior aspect of the right precentral gyrus. Again noted are small foci of T2 hyperintensity extending medially towards the deep white matter. There is mild prominence of the adjacent perivascular spaces.No significant associated mass effect is detected. No definite associated volume loss. No diffusion restriction or significant susceptibility effect is noted. Elsewhere, brain parenchymal morphology is within normal limits. There are a small number of additional scattered foci of T2 hyperintensity in the cerebral hemispheres which are nonspecific. No acute intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. The ventricular system is normal in size and morphology. A cystic foci in the nasopharynx are compatible with mucous retention cysts versus Tornwaldt's cyst. There is mild mucosal thickening involving the paranasal sinuses. Calvarium and extra cranial soft tissues are otherwise unremarkable.

Output: Again seen is an area of T2/FLAIR hyperintensity in the right lateral precentral gyrus which is unchanged from 2/12/2016. No associated enhancement is appreciated. No significant mass effect or volume loss is detected. Differential remains gliosis from prior injury such as ischemia, cortical dysplasia, and less likely low grade neoplasm. If an old MRI is available, it would help narrow the differential. Alternatively would suggest short term follow-up in 1-2 months and longer term follow-ups if the lesion remains stable.


Instruction: Generate impression based on medical findings.

Input: 68-year-old female with finger numbness now with worsening arm pain on the right.Additional EMR Data: PMH of lumbar DDD with recent LESI and still without relief of lumbar radicular pain. Main complaint is R>L sharp neck and shoulder pain for 3 days without an inciting event which radiates into right arm to the fingers and down left arm to the elbow. Occasional numbness of the right fingers. No UE weakness. No apparent alleviating or aggravating factors. The craniovertebral junction appears within normal limits. The cervical spine alignment is maintained and the cervical vertebral bodies and disc spaces are appropriate in height. The bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: Trace central disc osteophyte complex without significant compromise to the spinal canal or neural foramina.C3-4: Small central disc osteophyte complex with mild-to-moderate bilateral neuroforaminal narrowing and mild to moderate spinal canal stenosis, which have progressed compared to the prior exam C4-5: Small left paracentral disc osteophyte complex with mild bilateral neuroforaminal stenosis and moderate left greater than right spinal canal stenosis, appearing similar to the prior exam. C5-6: Disc osteophyte complex with a small left paracentral disc protrusion, with facet and uncovertebral hypertrophy which contributes to moderate to severe right and severe left neural foraminal narrowing and mild spinal canal stenosis. This appears similar to the prior exam. C6-7: Central disc osteophyte complex, uncovertebral hypertrophy and facet arthropathy which contributes to mild bilateral neuroforaminal stenosis and minimal spinal canal stenosis but this is not significant changed.C7-T1: Trace disc osteophyte complex without 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. Incidental right thyroid nodule is nonspecific.

Output: Multilevel spondylosis with some progression at C3-4 compared to the prior exam where there is now mild-to-moderate bilateral neuroforaminal narrowing and mild to moderate spinal canal stenosis. The remainder of the degenerative findings are unchanged compared to the prior exam.


Instruction: Generate impression based on medical findings.

Input: 67 year old female pre-vertebroplasty procedure scan There is normal lumbar spine lordosis. Examination again shows mild collapse of the L5 vertebral body with sclerotic change, more prominent on the left side. Axial images show soft tissue density intra-osseous mass on the left with posterior extension to the left hepatic lobe and transverse process, and extending into the neural foramen and adjacent paraspinal space (axial image 60/105, sagittal image 28). There is vacuum phenomenon at L5-S1 intervertebral disk space.There is no vertebral body destruction in the residual lumbar spine. No bony destruction is identified in other segments of posterior elements.Disk bulge is noticed at L2-3, L3-4 and L4-5 level. Please refer to the dedicated lumbar spine MRI examination for more details on degenerative change findings.

Output: L5 vertebral column metastatic lesion as detailed above.


Instruction: Generate impression based on medical findings.

Input: 12-year-old female with history of medulloblastoma status post craniotomy, chemotherapy and radiation therapy. MRI Brain: This study is again limited by artifact related to dental hardware and the post-contrast images are also limited by motion. Within these limitations, there are unchanged findings related to prior surgery and treatment within the posterior fossa. The tumor resection bed, and associated encephalomalacia of the cerebellar hemispheres, are stable in appearance. A small area of enhancement measuring 6 x 4 mm along the right margin of the fourth ventricle is grossly unchanged. There is no new suspicious enhancement.Elsewhere in the brain, encephalomalacia affecting the right occipital lobe is unchanged and there are no new foci of pathologic enhancement. The numerous foci of susceptibility artifact within the brain parenchyma and along the ventricular margins are not significantly changed. Ventricles are unchanged.MRI Complete Spine: Spinal cord morphology and signal characteristics are within normal limits. There is no pathologic intrathecal contrast enhancement but the cervical spine is partially obscured by artifact on the postcontrast images.Fatty marrow replacement at some levels of the spine is compatible with prior radiation therapy. There is no suspicious marrow signal abnormality, otherwise.Spinal alignment is anatomic, coming for cervical and lumbar straightening which can be related to patient position. Vertebral body heights and morphology are within normal limits. There is no spinal canal or neuroforaminal stenosis.

Output: 1.The exam is limited by artifact related to dental hardware and the post-contrast brain sequences are also limited by motion.2.Within these limitations, the posttreatment findings in the posterior fossa remain unchanged without sign of local recurrence. Minimal contrast enhancement along the right lateral fourth ventricular wall is unchanged since May 2014.3.Spinal imaging is notable for radiation treatment findings in the marrow but no sign of metastasis is seen.


Instruction: Generate impression based on medical findings.

Input: Cervicalgia. Rule out spinal cord compression. Per technologist note, patient was claustrophobic and had difficulty tolerating the study. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is minimal retrolisthesis of C5 on C6. Alignment is otherwise maintained. Bone marrow signal is heterogeneous which is nonspecific but without discrete suspicious lesion demonstrated. Small T1 hyperintense focus at C5 is compatible with small hemangioma or focus of fat.The cervical spinal cord has normal signal characteristics and overall morphology.Mild degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Minimal disc bulge. No significant compromise to the spinal canal or neural foramina.C4-5: Small right foraminal disc protrusion. No significant compromise to the spinal canal or neural foramina.C5-6: Mild disc bulge. No significant compromise to the spinal canal or neural foramina.C6-7: Minimal right paracentral disc protrusion. No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Mild degenerative changes in the cervical spine without spinal canal or neural foraminal stenosis at any level.


Instruction: Generate impression based on medical findings.

Input: Brain MRI:There is a small focus of restricted diffusion with matching ADC hypointensity within the left centrum semiovale consistent with small vessel acute to subacute infarction. It demonstrates T2 hyperintensity, mild T1 hypointensity, and no susceptibility hypointensity.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Scattered foci of mucosal thickening can be found within the paranasal sinuses without air-fluid levels. The mastoid air cells are clear. Brain MRA: Images are motion degraded. Given this caveat:There is a small 2-3 mm aneurysm at the junction of the left A1/A2 ACA segments with the anterior communicating artery. There is antegrade flow within the distal bilateral internal carotid arteries and carotid siphons and bilateral anterior, middle and posterior cerebral arteries without occlusion. The distal right vertebral artery appears to end in PICA and is diminutive (please see MRA neck discussion below). Artifact is noted through the mid basilar artery which is otherwise intact with antegrade flow. Intact antegrade flow is also noted within bilateral PCA vessels.Neck MRA:There is conventional takeoff of the great vessels from the aortic arch without evidence for stenosis of the origin of the great vessels. There are no significant stenoses of the bilateral common, internal or external carotid arteries or of the bilateral carotid bifurcations. The right vertebral artery is diminutive in its entirety and appears to end in PICA. However, significant stenosis appears to involve the left vertebral artery origin, and there is irregularity of the lumen at several locations throughout its length, suggesting there may have been previous dissection. Mild stenosis is noted at the origin of the left vertebral artery which is otherwise unremarkable.

Output: 1.There is a small focus of restricted diffusion with matching ADC hypointensity within the left centrum semiovale consistent with small vessel acute to subacute infarction.2.There is a small 2-3 mm aneurysm at the junction of the left A1/A2 ACA segments with the anterior communicating artery. 3.The right vertebral artery is diminutive in its entirety and appears to end in PICA. However, significant stenosis appears to involve the left vertebral artery origin, and there is irregularity of the lumen at several locations throughout its length, suggesting there may have been previous dissection. 4.Mild stenosis is noted at the origin of the left vertebral artery which is otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Seizure and worsening headaches. Evaluate for structural lesion. Some of the sequences are degrade by patient motion. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is minimal nonspecific periventricular white matter T2 hyperintensity. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There are bilateral lens implants. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is fluid signal in the left mastoid air cells.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Fluid signal in the left mastoid air cells may represent mastoiditis.


Instruction: Generate impression based on medical findings.

Input: 76 years, Male, Reason: prostate cancer, please evaluate the prostate and regional nodes History: prostate cancer. Biopsy 1/7/2015: Left base cancer. Right lateral base to apex cancer. Gleason 7. PELVIS:PROSTATE:Prostate Size: 5.3 x 3.9 x 4.3 cm.Peripheral Zone: There is a lesion in the right peripheral zone measuring approximately 1.1 x 0.9 cm (703/444) extending from the right base to mid prostate which is low signal on ADC/T2 with early enhancement, suspicious for prosthetic adenocarcinoma.Additional foci of intrinsic T1 shortening likely represents hemorrhage from prior biopsy.Central Gland: Scattered well-defined nodules suggest benign prosthetic hypertrophy.Seminal Vesicles: No involvementExtracapsular Extension: Lesion abuts the right aspect of the lateral capsule without definite extensionBLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Bilateral fat containing inguinal hernias.

Output: 1.Lesion extending from the right base to mid gland with signal characteristics suspicious for prostatic adenocarcinoma.2.No lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: Reason: thoracic syrinx and fatty filum, follow up after hospitalization for pain crisis. please do on 3 T scanner with tethered cord protocol. Thoracic spine: Alignment is anatomic. The vertebral bodies are normal in height. There is no suspicious marrow signal abnormality. There is disc height loss at T7-T8 without significant disc herniation. The spinal canal and the neural foramina are preserved.Again seen is a thoracic syrinx predominate from the upper T5 to the upper T7 level with minimal prominence of the central canal more superiorly as well as inferiorly extending to the conus. There is no significant change in size. Syrinx is maximal at the T5-T6 level where it measures 2 x 3 mm in the AP and transverse dimension which is similar to prior.There are tiny pleural effusions, also present previously.Lumbar spine: Alignment is anatomic. The vertebral bodies are preserved in height. Of note, L5 is partially sacralized. The spinal canal and the neural foramina are preserved. Intervertebral disks are normal. The conus terminates at the inferior L1 level which is within normal limits. Fatty signal within the filum terminale at L2-L3 has not changed and remains very thin and short segment.Prone images demonstrate appropriate ventral motion of the conus.There are free fluid in the pelvis which appears prominent for patient's age.

Output: 1. Unchanged small thoracic syrinx compared to 11/20/2015. 2. Conus terminates at the inferior L1 level. Mild fatty infiltration of the filum terminale at L2-L3 again seen. There is appropriate ventral motion of the conus on prone sequences. There is no clear evidence of cord tethering by imaging but can be correlated with clinical findings.3. There is small to moderate amount of free fluid in the pelvis which appears slightly prominent for patient's age. This finding is nonspecific.


Instruction: Generate impression based on medical findings.

Input: Altered mental status, unspecified [R41.82], Reason for Study: ^Reason: assess progression of infarct History: multiple CVAs There is a 20 mm x 46 mm sized right cerebellar intraparenchymal hemorrhage with surrounding edema. Ventricle size appears to be slightly enlarged however, comparing to prior CT scan, no significant interval change since prior scan considering the difference of imaging modality.There are multifocal diffusion restriction lesions on the right hemisphere including right superior frontal gyrus, right internal capsule posterior limb, right thalamus indicating multifocal acute ischemic infarct. There is no evidence of hemorrhagic conversion on above acute ischemic infarct lesions.There is evidence of chronic ischemic infarct with encephalomalacia on the right occipital lobe.The sulci and cisterns are unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Intraparenchymal hemorrhage on the right cerebellar hemisphere with surrounding edema as described above.2. Multifocal scattered right hemispheric acute ischemic infarctions without evidence of hemorrhagic conversion.3. Chronic ischemic infarction with encephalomalacia, right occipital lobe.


Instruction: Generate impression based on medical findings.

Input: Syncope and collapse: evaluate right lower midbrain lesion, see CT reportSigns and Symptoms: syncope, dizziness The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional punctate foci of signal hyperintensity on T2 and FLAIR MRI are present in the brainstem and thalami as well as the basal ganglia. In particular lesion in the right midbrain is a low signal on FLAIR and T1, high signal on T2 and not associated with diffusion restriction. This could represent a perivascular space or prior lacunar infarct.No foci of diffusion restriction are appreciated within the brain parenchyma.On susceptibility imaging there are 10-15 punctate foci of signal loss in the subcortical white matter located in the parietal lobes and temporal lobesNo abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a mucous retention cyst in the right maxillary sinus and mild mucosal thickening elsewhere. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. There is medial deviation of the right lamina papyracea. This could be related to a prior right orbital medial blowout fractureThere is a small subdural effusion present which is likely related to volume loss.

Output: 1.Periventricular and subcortical white matter changes of a mild to moderate degree are nonspecific. At this age they are most likely vascular related. 2.Punctate lesions in the brainstem, thalami and a subtle ganglia are also likely vascular related . In particular the lesion in the right lower midbrain most likely represents an old lacunar infarct.3.Subcortical microhemorrhages of a mild degree are present. Their distribution in the subcortical white matter would raise the question of amyloid angiopathy. They predominate in the temporal lobes and to a lesser degree parietal lobes.


Instruction: Generate impression based on medical findings.

Input: Other headache syndrome [G44.89], Reason for Study: ^Reason: R/O venous obstruction, structural abnormality History: headaches Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRV2-D and 3D MRV brain noncontrast enhanced with maximum intensity projections of the superficial/deep intracranial venous drainage demonstrate normal flow enhancement in the superior sagittal sinus, transverse sinuses, sigmoid sinuses, internal cerebral veins, vein of Galen and straight sinus.

Output: 1. Normal brain MRI.2. No evidence of dural sinus occlusion or stenosis. There is no evidence of venous congestive encephalopathy.


Instruction: Generate impression based on medical findings.

Input: 30 year-old female with hypertension, coronary artery disease and history of falls. Question bleed. There is no evidence of intracranial hemorrhage, mass or edema. Multiple areas of diffuse periventricular hypodensity consistent with small vessel disease common age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered. Ventricles are prominent but may be within normal limits for age.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Small vessel disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.


Instruction: Generate impression based on medical findings.

Input: Headache after trauma. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are scattered foci of cerebral white matter T2 hyperintensity. 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. There is fluid within the right mastoid air cells.

Output: Scattered foci of cerebral white matter T2 hyperintensity are nonspecific, but may represent chronic small vessel ischemic disease. No evidence of acute intracranial hemorrhage, mass, or acute infarct. Fluid in the right mastoid air cells may indicate mastoiditis.


Instruction: Generate impression based on medical findings.

Input: Right-sided acoustic neuroma, status post resection: yearly surveillance. Internal Auditory Canals: There are postoperative findings related to right retrosigmoid craniotomy, with mild right cerebellar hemisphere encephalomalacia. There is persistent enhancing tissue within the right internal auditory canal, with adjacent dural enhancement. The right inner ear structures are unremarkable. The left internal auditory canal and inner ear structures are unremarkable.Brain: There is no evidence of acute intracranial hemorrhage or acute infarct. There is minimal nonspecific scattered cerebral white matter T2 hyperintensity. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is mucosal thickening and secretions in the right maxillary sinus.

Output: 1. Postoperative findings related to right vestibular schwannoma resection, without significant change in the appearance of the surgical bed.2. Findings suggestive of acute right maxillary sinusitis.


Instruction: Generate impression based on medical findings.

Input: BRACHIAL PLEXUS: There is an approximately 5.3 x 1.8 cm left supraclavicular ill-defined mass that extends into and expands the left C6-C7 neural foramen and tracks along the roots and trunks of the left brachial plexus. There is a well-defined remodelling of the adjacent left C7 vertebral body and left posterior elements. There is no resultant spinal canal stenosis. CERVICAL SPINE:The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is slightly heterogenous, a non-specific appearance. The imaged spinal cord displays normal signal and morphology. There is multilevel disc desiccation and a congenitally narrow cervical spinal canal.C2-C3: There is bilateral facet arthropathy as well as a right paracentral disc osteophyte complex without significant spinal canal or neural foramen stenosis.C3-C4: There is bilateral facet arthropathy, left greater than right, as well as mild bilateral uncovertebral joint arthropathy and a small central disc osteophyte complex. There is moderate left neural foramen narrowing and mild spinal canal stenosis.C4-C5: There is moderate left facet arthropathy and bilateral uncovertebral arthropathy as well as a mild disc osteophyte complex. These findings result in mild bilateral neural foramen narrowing and mild spinal canal stenosis.C5-C6: There is loss of disc height, endplate degenerative change, mild bilateral facet arthropathy, and bilateral uncovertebral arthropathy, left greater than right, as well as a posterior disc osteophyte complex. These findings result in moderate left and mild right neural foramen stenosis and mild spinal canal stenosis.C6-C7: There is mild disc height loss and mild posterior disc osteophyte complex. There is also a left paraspinal mass that is further described in the brachial plexus portion of the report. There is no significant spinal canal or right neural foramen stenosis.C7-T1: There is no disc bulge or herniation, and no significant spinal canal or neural foramen stenosis.

Output: 1.Left supraclavicular mass extending along the roots and trunks of the left brachial plexus, as well as into the left C6-C7 neural foramen with adjacent bony remodeling but without associated spinal canal stenosis. The differential diagnosis includes neural tumor such as schwannoma or neurofibroma.2.Mild cervical spine degenerative changes superimposed on a congenitally narrow spinal canal resulting in multilevel mild spinal canal stenosis and multilevel neural foramen narrowing as detailed above.


Instruction: Generate impression based on medical findings.

Input: Loss of patellar reflex on left leg and weakness and pain of left lower extremity. Evaluate for compression of L4. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Severe loss of disc space at the L3-L4 level as well as grade 1 retrolisthesis which appears slightly worse since 6/23/2014. Associated endplate marrow edema however has slightly decreased. Previously seen disc extrusion at this level is no longer present. Conus is in normal position. No suspicious osseous lesions. Multilevel degenerative changes are described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: Severe loss of disc height and mild retrolisthesis which has slightly progressed. There is interval resolution of previously seen disc extrusion. There is mild narrowing of the left lateral aspect of the spinal canal related to facet arthropathy, otherwise no significant spinal canal stenosis at this level. There is minimal right neural foraminal narrowing and mild left neural foraminal narrowing. Previously seen right lateral recess effacement has resolved related to surgical removal of disc material.L4-L5: There is moderate to severe spinal canal stenosis at this level which appears progressed, and related to combination of facet arthropathy, ligamentum flavum thickening, and mild disc bulge. There is also lobulated soft tissue measuring approximately 6 mm in the AP dimension along the dorsal aspect of the spinal canal which may be related to postoperative scar tissue, chronic blood products, or possibly synovial cyst. There is moderate narrowing of the left neural foramen and mild narrowing of the right neural foramen which appear worse. There is effacement of the left lateral recess partially related to disc material. There is mild interval in distention of the bilateral facetsL5-S1: Disc height loss and mild bulge. Mild facet arthropathy. No significant spinal canal stenosis. There is mild bilateral neural foraminal narrowing.

Output: Multilevel degenerative changes in the lumbar spine are again seen. Compared to 6/4/2014, interval removal of disc extrusion at the right L3-L4 level is seen with marked improvement in the previously seen spinal canal stenosis at this level. There is slight interval worsening of disc height loss and retrolisthesis at this level.At the L4-L5 level, there is moderate to severe spinal canal stenosis which is worse in the interval as well as worsened neural foraminal stenosis, particularly on the left, where there may be impingement of the left L4 nerve root. There may also be impingement of the left L5 nerve root in the left lateral recess. Please see additional details above.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old, with headache and back pain, history of spinal tumor, concern for mass recurrence. A uniformly enhancing plaque-like dural/epidural mass is evident extending along the clivus to the craniocervical junction. A small tail of this lesion also extends laterally along the skull base towards the left jugular foramen. This lesion measures up to 48 x 13 mm in the sagittal plane with encroachment upon the prepontine cistern, displacement of the vertebral arteries, and mild deformity of the brainstem. No outside examinations are available at the time of this interpretation for comparison purposes.No evidence of parenchymal edema is seen. Numerous scattered foci of white matter T2 hyperintensity are evident in the bilateral cerebral hemispheres, a nonspecific finding which may reflect chronic microvascular ischemic disease. No evidence of diffusion restriction is seen.No other areas of pathologic parenchymal or extra-axial enhancement is seen. No intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. The ventricular system is patent and normal in size.

Output: 1.A dural/epidural plaque-like mass is evident extending along the clivus down to the level of the craniocervical junction, and laterally towards the left jugular foramen. This lesion effaces the prepontine cistern and causes mild mass effect upon the adjacent brainstem, but no evidence of parenchymal invasion or parenchymal edema is seen.2.No outside examinations are available at the time of this interpretation for comparison purposes. If these can be made available, comparison will be made and an addended report will be generated.3. No other significant intracranial lesions are seen. Findings are noted likely related to chronic microvascular ischemic disease.


Instruction: Generate impression based on medical findings.

Input: Reason: S/p R knee ACL reconstruction, MFC allograft, evaluate for meniscus tear or cartilage lesion Evaluation of medial compartment is limited by metallic susceptibility artifact.MENISCI: Evaluation of the medial meniscus is somewhat limited due to adjacent metallic susceptibility artifact. There is attenuation of the medial meniscus, which we suspect is from prior partial meniscectomy, but may reflect chronic attritional tearing if there is no such history. Slight medial extrusion of the body of the medial meniscus is noted. However, we see no intrameniscal fluid signal or other findings to suggest unstable medial meniscal tear.There is a thin vertically oriented increased signal intensity in the anterior horn of the lateral meniscus near the root (series 3 image 10). This may simply reflect normal signal that can be seen in the lateral meniscus at this location, but also could conceivably reflect vertical tear, which may not be of current clinical significance.ARTICULAR CARTILAGE AND BONE: There is slight prominence of the bone along the articular surface of the medial femoral condyle above the posterior horn of the medial meniscus, which presumably reflects the site of medial femoral condyle allograft placement (series 3 image 19). The allograft appears healed. There is mild heterogeneity of the overlying cartilage, which may reflect degeneration, but we see no fluid-filled defect of the cartilage. There is mild heterogeneity of the medial tibial plateau cartilage suggestive of mild degeneration. There is also cyst formation in the posterior tibial plateau.There is small focus of increased signal intensity in the articular cartilage of the lateral tibial plateau below the free edge of the anterior horn of the lateral meniscus (series 3 image 9), likely reflecting focal defect/degeneration. There is also small focus of increased signal intensity in the articular cartilage of the lateral femoral condyle more centrally along the intercondylar notch (series 3 image 14), suggestive of focal defect/degeneration.Increased signal intensity of the articular cartilage of the trochlea centrally reflects focal degeneration (series 3 image 15). Patellar cartilage appears intact.There are small tricompartmental osteophytes.LIGAMENTS: Patient has undergone ACL reconstruction. The ACL graft appears thin but intact (series 3 image 14). There is increased signal intensity of the PCL proximally, which may reflect degeneration or prior injury. Intermediate signal intensity in the vicinity of the cruciate ligaments likely reflect scarring. The medial collateral ligament and lateral collateral ligaments appear intact. EXTENSOR MECHANISM: Quadriceps tendon and patellar ligament are intact.ADDITIONAL

Output: Evaluation of the medial compartment is limited by extensive metallic susceptibility artifact.1. Attenuation and mild extrusion of the medial meniscus without intrameniscal fluid signal or other findings of unstable meniscal tear.2. Vertically oriented increased signal intensity in the lateral meniscus near the anterior horn/root may represent tear of questionable current clinical significance or may simply represent normal signal at this location.3. Postsurgical changes of the medial femoral condyle allograft with mild heterogeneity of the overlying cartilage, which may represent degeneration. However, we see no fluid-filled cartilage defect. Additional foci of cartilage degeneration as described above.4. Postsurgical changes of ACL reconstruction. ACL graft appears thin but otherwise intact.5. Other findings as above.


Instruction: Generate impression based on medical findings.

Input: Unspecified convulsionsClinical question: Rule out intracranial findingSigns and Symptoms: seizures on presentation The CSF spaces are appropriate for the patient's stated age with no midline shift. Myelination pattern is age-appropriate for 4 months there is myelination of anterior limb and posterior limb of the internal capsule as well as splenium in part of the body of the corpus callosum.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There is no intracranial mass lesion to explain the patient's convulsions..


Instruction: Generate impression based on medical findings.

Input: 42-year-old male with altered mental status and lethargy There is no evidence of intracranial hemorrhage, mass or edema. Encephalomalacia involving bilateral frontal lobes and bilateral temporal lobes are again noted and not significantly changed from comparison MRI accounting for technical differences. Otherwise symmetric prominence of a ventricular system is in proportion to the diffuse sulcal prominence compatible with generalized brain atrophy. Slight hyperdense lesion extending from the left basal ganglia into the left cerebral peduncle that corresponds to high T1 signal lesion on prior MR is of uncertain clinical etiology and significance.Basal ganglia and right insula calcifications have increased in size, but were likely present on prior MRI. There are atherosclerotic calcifications of the basilar artery as well as bilateral internal carotid arteries and middle cerebral arteries.Hyperostosis frontalis is noted. Otherwise, the calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Accounting for technical differences, there is no significant change compared to prior MRI as described above. Due to multiple abnormalities correlation with MRI should be considered for more definitive comparison.


Instruction: Generate impression based on medical findings.

Input: 35-year-old female with history of metastatic breast cancer who presents for evaluation of liver nodules seen on recent CT examination. ABDOMEN:LIVER, BILIARY TRACT: There are innumerable ill-defined hepatic lesions. Some of the lesions have coalesced and demonstrate central necrosis and debris; these are most consistent with tumor response. Some of the lesions demonstrate diffusion restriction and peripheral enhancement; these findings are concerning for active metastatic disease. The reference lesion in the right lobe measures 26 x 20 mm (series 1304, image 249), unchanged. Centrally the bile ducts are narrowed secondary to extrinsic compression. Portal vein is patent.SPLEEN: Subcentimeter T2 hyperintense focus at the periphery of the spleen (series 601, image 27) is nonspecific without evidence of enhancement.PANCREAS: There is interstitial and peripancreatic edema.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Linear T1 and T2 hypointensity of the right kidney without evidence of enhancement is consistent with a scar.RETROPERITONEUM, LYMPH NODES: Reference porta hepatis lymph node measures 20 x 12 mm (series 601, image 27), previously measuring 20 x 13 mm. Reference aortic lymph node measures 13 x 12 mm (series 601, image 15), unchanged.BOWEL, MESENTERY: Partially visualized ascites and diffuse mesenteric haziness. Carcinomatosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Persistent small right pleural effusion. Bilateral basilar subsegmental atelectasis.

Output: 1.Innumerable ill-defined hepatic lesions. Findings consistent with mixed response with necrosis and active tumor. 2.Findings concerning for acute pancreatitis. Correlation with lipase is recommended.3.Stable porta hepatis lymphadenopathy.4.Centrally bile ducts are narrowed secondary to extrinsic compression5.Stable small right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: 54-year-old female with osteomyelitis status post laminectomy, persistent back pain. Evaluate alignment, fracture, degeneration. There is severe disc space narrowing at L5-S1 with associated endplate cortical irregularity and indistinctness corresponding to the inflammatory changes seen on recent MRI study appear most compatible with discitis/osteomyelitis. Alignment is anatomic. The remaining lumbar vertebral bodies appear normal with mild anterior osteophyte formation.

Output: Findings most compatible with discitis/osteomyelitis at L5/S1 corresponding to findings seen on recent MRI study.


Instruction: Generate impression based on medical findings.

Input: 14-year-old male patient with history of pheochromocytoma, who presented to the ER with thumb pain and noted to have a soft tissue mass in the fifth digit on radiographs. A somewhat lobulated mass measures approximately 1.7 x 0.8 x 2.3 cm (transverse x AP x craniocaudal) centered dorsal to the fifth digit PIP joint and middle phalanx. This lesion demonstrates low T1 signal intensity and high T2 signal intensity with internal low T2 signal septae, which enhance. The underlying osseous cortex appears intact with normal bone marrow signal intensity. The extensor tendons are not clearly delineated within this region. The lesion displaces the normal blood vessels within the dorsum of the finger away from the bone. A linear transverse signal in the distal first metacarpal metaphysis corresponds to linear T2 signal compatible with a nondisplaced fracture with surrounding bone marrow edema.

Output: 1. Soft tissue mass about the dorsal surface of the fifth digit PIP joint most likely represents a lymphangioma. 2. Non-displaced transverse fracture of the first metacarpal.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Abnormal reflex. Other conditions of brain(348.89)Clinical question: left fronto parietal hypodensity on CT headSigns and Symptoms: right leg spastic, mildly weak, Babinski MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.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 demonstrate mild mucosal thickening in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine. There is mild reversal of the normal cervical curvature present.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is disk dessication present at this level. At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is disk dessication present at this level. There is left sided facet hypertrophy at this level associated with mild narrowing of the left neural foramen. At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is disk dessication present at this level. There is loss of disk space height at this level. There is a disk bulge at this level.At C5-6 there is no significant compromise to the spinal canal . There is disk dessication present at this level. There is loss of disk space height at this level. There is a disk bulge at this level. There are right sided uncovertebral osteophytes at this level associated with encroachment of the left exiting nerve roots.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is disk dessication present at this level. There is loss of disk space height at this level. There is a disk bulge at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There are multilevel degenerative changes in the cervical spine. There is no significant compromise to the spinal canal and only mild narrowing of the neural foramina 2.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 3.Mild reversal of the normal cervical curvature is a non-specific finding which can be seen with muscle spasm or patient positioning.


Instruction: Generate impression based on medical findings.

Input: 25 years Female (DOB:9/1/1991)Reason: 3 t scanner ccm protocol qsm/permeabililty evaluate for cavernoma History: screen for cavernomaPROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD There are multiple lesions with susceptibility effect scattered throughout the brain. The largest one is in the superior aspect of the vermis eccentric to the right side and measures 9 x 7 mm in axial dimensions on T1 imaging and 10 mm x 9 mm in sagittal imaging. A right occipital lobe measures 5 mm axial dimensions on T2 imaging and has a thick halo of susceptibility effect surrounding it. One in the left frontal lobe periventricular white matter measures 4 mm in diameter. Additional lesions are scattered elsewhere. One is located in the left cerebellar hemisphere, one is located in the right frontal lobe another one is located along the left superior frontal gyrus and another one along the right parietal lobe.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: There are multiple hemorrhagic lesions scattered throughout the brain compatible with cavernous hemangiomas. One in the right occipital lobe has a thick halo of hemosiderin suggesting may have hemorrhaged previously. The largest one appears to be located in the superior aspect of the vermis.


Instruction: Generate impression based on medical findings.

Input: Primary CNS lymphoma status post chemotherapy and transplant. There are otherwise unchanged post-treatment and post-biopsy findings with patchy T2 hyperintensity and associated susceptibility effect in the right cerebellar hemisphere and left anterior cingulate gyrus. There is also unchanged focal susceptibility effect in the right globus pallidus. There are unchanged areas of high T2 signal in the cerebral white matter. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, orbits, and scalp soft tissues are unremarkable. There is mild mucosal thickening in the left maxillary sinus.

Output: 1. No evidence of recurrent central nervous system lymphoma with stable post-treatment findings in the right cerebellar hemisphere and left cingulate gyrus.2. Unchanged areas of cerebral white matter signal abnormality in the cerebral white matter are otherwise nonspecific.


Instruction: Generate impression based on medical findings.

Input: Right knee pain and swelling following MENISCI: There is subtle abnormal signal intensity of the margin of the lateral meniscus suspicious for a small inner margin tear or fraying. This is best appreciated on series 601 image 18 and series 401 image 23. The medial meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is mild abnormal marrow signal of the medial femoral condyle posteriorly which is thought to represent a cortical desmoid. The marrow signal of the bone is otherwise normal. The articular cartilage of the medial, lateral, and patellofemoral compartments is preserved.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Findings suspicious for small inner margin tear/fraying of the lateral meniscus.2. Probable cortical desmoid of the medial femoral condyle posteriorly.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: Headache and seizures. There are postoperative findings related to right temporal craniotomy. There is unchanged encephalomalacia in the right temporal lobe. There are also unchanged scattered foci of cerebral white matter T2 hyperintensity. The hippocampi appears to be intact. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There is mild fusiform bulbous enlargement of the azygos anterior cerebral artery. The orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged.

Output: Postoperative findings with extensive right temporal lobe encephalomalacia and mild scattered probable chronic small vessel ischemic disease, but no evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on medical findings.

Input: Ms.Erica Izraeli, 42 years old, submitted outside study for review. She initially presented for follow-up of a probable benign right breast mass at 9:00 position on May 4, 2016 with diagnostic workup demonstrating 2 groups of indeterminate calcifications in the upper outer right breast. 2 site stereotactic biopsy on 5/9/2016 revealed IDC grade 1 in the posterior group and ALH in the anterior group. Ultrasound-guided biopsy of the right breast 9:00 mass revealed fibroadenoma. Patient has a strong family history of breast cancer in her to and ovarian cancer in her grandmother. Images performed at Northwestern Memorial Health Care submitted for review: Mammogram 5/4/2016Ultrasound of 5/4/2016Stereotactic guided biopsy two sites 5/9/2016Postprocedure right breast mammogram 5/9/2016MRI breast 5/20/2016Ultrasound guided biopsy of right breast 5/24 2016Images submitted for comparison:Mammogram 4/30/2015 and 4/23/2014 MAMMOGRAM 5/4/2016: Three standard views of both breasts and 2 additional spot compression views of the right breast were obtained. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. In the right breast upper outer quadrant, there are 2 clusters of amorphous calcifications and punctate calcifications with associated architectural distortion measuring 2.8 x 4.3 cm. Stable intramammary lymph node in the left breast. No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in the left breast. ULTRASOUND 5/4/2016 : Static ultrasound images are submitted for interpretation.Right breast targeted ultrasound demonstrated a circumscribed, iso to slightly hypoechoic mass measuring 0.6 x 0.5 x 0.2 cm the right breast 9:00 position, 3 cm from the nipple. No other solid or cystic masses are identified in the upper outer right breast.STEREOTACTIC GUIDED BIOPSY OF RIGHT BREAST 5/9/2016: The anterior and posterior aspect of the clustered calcifications in the right breast upper outer quadrant were the targets for the biopsy. Targeting appears appropriate. Calcifications are noted on one of the specimen radiograph. POST PROCEDURE MAMMOGRAM 5/9/2016: A dumbbell shape clip is placed in the posterior aspect of the right upper outer breast. One x shaped clip is in the anterior aspect of the right upper outer breast. Biopsy clips are at the expected locations. Small amount of residual calcifications are also present.MRI breast 5/20/2016:Multisequence MRI breast imaging with and without intravenous contrast was performed as per outside MRI breast protocol. The breasts are composed of heterogeneous fibroglandular tissue. There is marked background parenchymal enhancement bilaterally. Kinetic analysis of these images was not possible. RIGHT BREAST: There is artifact from the biopsy clip in the posterior right upper outer breast, 11:00 position. An irregular enhancing mass mass surrounding the biopsy clip measures 2.2 x 1.7 x 2.2 cm (AP x LR X SI). This corresponds to the biopsy-proven malignancy in the posterior right upper outer breast. There is no suspicious enhancement in the pectoralis minor muscle.Another susceptibility artifact is identified anterior and inferior to the above enhancing mass. There is rim enhancement associated with the biopsy track. This likely represents the biopsy site in the middle right upper outer breast.There is a 0.5 cm enhancing mass in the right breast 9:00 position approximately 3 cm from the nipple. This corresponds to the stable mass demonstrated on the prior ultrasound.LEFT BREAST:No suspicious enhancement is identified in the left breast. An intramammary lymph node is noted in the upper outer left breast.Axillae:Multiple nonspecific lymph nodes are identified bilaterally.ULTRASOUND-GUIDED BIOPSY OF right breast 9:00 mass 5/24/2016: Previously identified stable mass in the right breast 9:00 position is the target for the biopsy. Targeting appears appropriate.PER OUTSIDE PATHOLOGY:A. Posterior aspect of the right upper outer calcifications; stereotactic guided core needle biopsy:- Invasive ductal carcinoma, grade 1, with tubular features. LCIS with no associated microcalcifications and ADHB. Anterior aspect of the right upper outer calcifications; stereotactically guided core needle biopsy:-Atypical lobular hyperplasiaC. Right breast 9:00 masses; ultrasound-guided core needle biopsy:-Fibroadenoma- These results are concordant with the imaging findings.

Output: 1. 2.2 cm unifocal malignancy in the posterior right upper outer breast.2. ALH in the middle right upper outer breast.3. No malignancy in the left breast.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on medical findings.

Input: 53 year old man with history of CAD, nonsustained ventricular tachycardia and atrial fibrillation, referred for cardiac MRI to evaluate for scar burden. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 95 ml/m2 (normal range: 74+/-15), the LVEDV is 205 ml (normal range 142+/-34), the LV end systolic volume index is 41 ml/m2 (normal range 25+/-9), the LVESV is 89 ml (normal range 47+/-19), the LV mass index is 60 g/m2 (normal range 85+/-15), and the LV mass is 130 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.The native T1 myocardial relaxation time is 1129 ms, which is mildly elevated and suggests mild underlying diffuse fibrosis or infiltration. There is no myocardial iron overload. There is no LV thrombus. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 53%, the RV end diastolic volume index is 109 ml/m2 (normal range 82+/-16), the RVEDV is 238 ml (normal range 142+/-31), the RV end systolic volume index is 51 ml/m2 (normal range 31+/-9), and the RVESV is 112 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function (EF 56%). 2. There is no late gadolinium enhancement to suggest the presence of replacement fibrosis or obvious infiltration or inflammation. However the native T1 time is mildly elevated which can indicate a mild diffuse underlying interstitial fibrotic process. 3. The right ventricle is normal in size with normal systolic function (EF 53%). 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: 20 year old woman with history of Turner's syndrome, referred for cardiac MRI to evaluate for concomitant congenital heart disease. General: Cardiac situs is normal. Cardiac position is normal. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 61%, the LV end diastolic volume index is 77 ml/m2 (normal range: 65+/-11), the LVEDV is 109 ml (normal range 109+/-23), the LV end systolic volume index is 30 ml/m2 (normal range 18+/-5), the LVESV is 42 ml (normal range 31+/-10). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. No LVH.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 70 ml/m2 (normal range 69+/-14), the RVEDV is 99 ml (normal range 110+/-24), the RV end systolic volume index is 32 ml/m2 (normal range 22+/-8), and the RVESV is 46 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation. The aortic valve is tri-leaflet.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 normal brachiocephalic branching pattern. The aortic root, arch and descending aorta are normal in size. There is no evidence of aortic coarctation. 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. There is a persistent left superior vena cava and a dilated coronary sinus.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 61%.2. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 54%.3. There is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root, arch and descending aorta are normal in size. There is no evidence of aortic coarctation. 4. The aortic valve is tri-leaflet and opens widely with no significant aortic regurgitation.5. There is a persistent left superior vena cavaI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Worsening neck pain, radiculopathy, cervical stenosis Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is mild retrolisthesis of C4 on C5 and minimal at C5 on C6 similar to prior. There is minimal worsening of height loss involving the posterior posterior aspect of the C4-C5 and C5-C6 discs. Bone marrow signal is benign. Motion degradation on some of the sequences slightly limits evaluation. However no definite cord signal abnormality is appreciated.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: Disc osteophyte complex eccentric to the right with bilateral uncovertebral hypertrophy. There is mild spinal canal stenosis. There is moderate right and mild to moderate left neural foraminal stenosis. C5-6: Disc osteophyte complex with bilateral uncovertebral hypertrophy. There is mild to moderate spinal canal stenosis. There is moderate bilateral neural foraminal stenosis.C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or right neural foramen. Minimal left neural foraminal narrowing which appears slightly worseThe vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Minimal interval progression of degenerative changes compared to 12/10/2012. Degenerative changes are again seen at the C4-C5 and C5-C6 levels. There is mild C4-C5 and mild to moderate C5-C6 spinal canal stenosis. Neural foraminal stenosis at C4-C5 and C5-C6 is also evident bilaterally as described above.


Instruction: Generate impression based on medical findings.

Input: 52-year-old presents for breast cancer screening. Strong family history of breast cancer. Moderate parenchymal enhancement is noted bilaterally. There is a heterogeneous amount of fibroglandular tissue. No abnormal enhancement is seen in either breast. A similar degree of enhancement is again seen in both breasts, including the far posterior inferior right breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on medical findings.

Input: Sagittal imaging is diagnostic. Axial imaging is degraded secondary to motion artifact. Given this caveat:Cerebellar ectopia is noted measuring 6-7 mm below the level of the foramen magnum demonstrating a mild peglike morphology. CSF flow analysis demonstrates the presence of biphasic CSF flow posteriorly at the level of the cerebellar tonsils.Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. Postinflammatory cysts are noted in the nasopharynx. Otherwise the visualized paraspinal contents are unremarkable.C2/3: UnremarkableC3/4:UnremarkableC4/5: UnremarkableC5/6: Mild posterior osteophyte disc complex without stenosis.C6/7: Mild posterior osteophyte disc complex without stenosis.C7/T1: Unremarkable

Output: Cerebellar ectopia is noted measuring 6-7 mm below the level of the foramen magnum demonstrating a mild peglike morphology. CSF flow analysis demonstrates the presence of biphasic CSF flow posteriorly at the level of the cerebellar tonsils.


Instruction: Generate impression based on medical findings.

Input: Reason: T2DM with osteomyelitis, pain with WB on R ankle History: pain, NWB Patient is status post transmetatarsal amputation. Diffuse soft tissue swelling. Ulceration beneath the remaining base of the fifth metatarsal again noted. Please refer to recent prior MRI for fifth metatarsal base osteomyelitis description. We see no ankle joint effusion or ankle bone osteomyelitis. Mild deformity of the distal fibula likely represents old fracture. No acute fracture is evident.

Output: Soft tissue swelling and ulceration as above. Please refer to recent prior MRI for fifth metatarsal base osteomyelitis description. No evidence of fracture or ankle osteomyelitis.


Instruction: Generate impression based on medical findings.

Input: 55-year-old male with history of elevated PSA and prior biopsy demonstrating right prostate gland base ASAP. PELVIS:PROSTATE:Prostate Size: 4.1 x 6.2 x 6.6 cm.Peripheral Zone: Single 4 mm focus of low T2 signal with questionable restricted diffusion in the right posterolateral base (series 100 1/20), equivocal for prostate cancer. Otherwise, no suspicious foci.Central Gland: Heterogeneous.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Single subcentimeter focus in the right base equivocal for prostate cancer, as described above. No definite prostate cancer.


Instruction: Generate impression based on medical findings.

Input: 13-year-old male with blunt trauma to cervical spine now with difficulty walking and pain. The spinal cord is normal in caliber and signal throughout. No evidence of any pathologic intradural or extradural fluid is seen. The conus tip terminates at the T12-L1 level which is within normal limits.Spinal alignment is anatomic. Vertebral body morphology and signal characteristics are normal. No evidence of marrow edema is seen. The spinal canal and neural foramina are patent throughout. No disc abnormalities are seen.

Output: Unremarkable evaluation of the spine.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Female, 39 years old, with vertigo. A single 2 mm focus of T2 hyperintensity within the white matter of the right superior frontal gyrus is unchanged. No other parenchymal lesions are seen. No evidence of edema, mass effect or restricted diffusion is demonstrated. No intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricles remain normal in size and morphology.

Output: A single nonspecific focus of signal abnormality within the right superior frontal gyrus is unchanged. No other significant intracranial findings are detected.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Evaluate for lesion, hydrocephalus, review CT report from 9-18-15 signs and symptoms: Status post fall, generalized weakness and lethargy. Nonenhanced brain MRI:No acute intracranial process and negative diffusion weighted images.As was noted on prior head CT this examination demonstrates fairly extensive periventricular and subcortical confluent FLAIR hyperintensity of white matter as well as large focus of cortical, subcortical and basal ganglia FLAIR hyperintensity involving extensively the left temporal and frontal lobes. Findings are believed to represent advanced chronic nonhemorrhagic small vessel ischemic strokes as well as a large left MCA territory chronic ischemic stroke. There is resultant ex vacuo dilatation of the lateral ventricles (L>R) as well as bilateral sacral cortical sulci.Images through posterior fossa are unremarkable.The signal void of major intracranial arterial branches are identified. There is anatomical variation of a partially empty sella.The signal intensity of intracranial venous sinuses are within normal.Unremarkable calvarium however with evidence of a prior left-sided remote craniotomy.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells..

Output: 1.No acute intracranial process and negative diffusion weighted series.2.Extensive bilateral hemispheric white matter and to a lesser degree of bilateral basal ganglia highly suggestive of chronic nonhemorrhagic advanced small vessel ischemic strokes. Large focus of encephalomalacia involving left temporal and frontal lobe highly suggestive of a large chronic nonhemorrhagic ischemic stroke in the left MCA territory.3.Constellation of above changes results in ex vacuo dilatation of lateral ventricles and the cortical sulci.4.Evidence of prior remote left sided craniotomy.


Instruction: Generate impression based on medical findings.

Input: Question of Crohn's disease. Evaluate for active Crohn's disease or fistulous tract. Questionable Crohn's disease of the ileocecal valve on biopsy. History of left hip pain. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted. No focal hepatic lesions. No cholelithiasis. No biliary ductal dilation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No bowel dilation, wall thickening, or abnormal wall enhancement. The ileocecal valve is within normal limits. No mesenteric fibrofatty changes are noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No bowel dilation, wall thickening, or abnormal wall enhancement. The ileocecal valve is within normal limits. No mesenteric fibrofatty changes are noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: No evidence of active Crohn's disease or specific findings otherwise to account for the patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: Headaches, ventricular shunt, hydrocephalus, and prior resection of a colloid cyst. There are postoperative findings related to right transfrontal resection of a colloid cyst with susceptibility from chronic blood products along the surgical approach, but no evidence of colloid cyst recurrence. There is a right transparietal ventricular catheter that termites in the posterior left lateral ventricle. The lateral ventricles remain disproportionately dilated with respect to the rest of the ventricular system. The brain parenchymal signal is otherwise unremarkable and there is no evidence of acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable.

Output: 1. Persistent disproportionate dilatation of the shunted lateral ventricles. 2. No evidence of recurrent colloid cyst.


Instruction: Generate impression based on medical findings.

Input: Reason: Restaging metastatic breast cancer to CNS History: Restaging The patient is status post left-sided frontal craniotomy. There is redemonstration of encephalomalacia in the left frontal lobe without evidence for local recurrence. There are punctate foci of susceptibility present in the tumor bed.Several punctate foci of susceptibility are present in the right periventricular white matter and right superior and parietal lobuleThere is a 5 x 7 mm enhancing nodule in the medial left frontal lobe at the anterior aspect of the superior frontal gyrus just anterior to the cingulate sulcus which previously measured 5 x 4 mm.  Another nodule measuring 5 x 3 mm is present along the left inferior frontal gyrus along the pars triangularis.A previously described enhancing nodule at the lateral aspect of the left precentral gyrus is not readily seen on the current exam.A previously described enhancing nodule in the left superior temporal gyrus is not readily identified on the current exam.A punctate questionably enhancing focus is present at the medial aspect of the right superior frontal gyrus anteriorly which is of uncertain significance.A previously described punctate lesion in the left basal ganglia is not readily identified on the current examThere is redemonstration of a microhemorrhage surface of the left thalamus superiorlyNormal 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 demonstrate minor opacities in the right mastoid air cells. The visualized portions of the orbits are intact.

Output: 1.Since the prior exam nodules in the left basal ganglia left superior temporal gyrus and the left precentral gyrus are not readily identified on the current exam.2.Since the prior exam nodules in the left inferior frontal gyrus and left superior frontal gyrus are slightly larger3.status post left frontal craniotomy for removal of a left frontal lobe mass


Instruction: Generate impression based on medical findings.

Input: Clinical question:syncope. Signs and symptoms: Syncope with altered mental status. Nonenhanced head CT:Examination demonstrate a well demarcated area of low attenuation in the left caudate and globus pallidus highly suspect that of an acute left basal ganglial infarct. There is no appreciable mass effect but this finding. Recommend follow-up with an MRI. There is no evidence of hemorrhage. Examination also demonstrate mild bilateral patchy areas of low attenuation of subcortical white matter highly suspected for small vessel ischemic disease of indeterminate age.Ventricular system and the CSF cisterns remain within normal.There is mild calcification and tortuosity of bilateral cavernous carotid.There is severe tortuosity and aneurysmal dilatation of the basilar artery (dolichoectatic basilar) representing atherosclerotic disease. Follow up with an MRA or a CTA is recommended.

Output: 1.Highly suspected acute nonhemorrhagic lacunar infarct of left caudate and globus pallidus. 2.Mild small vessel ischemic strokes of indeterminate age in the supratentorial brain parenchyma.3.Dolichoectatic basilar artery with calcification.4.Recommend follow-up with an MRI and MRA.


Instruction: Generate impression based on medical findings.

Input: Male, 13 years old. Reason: follow up structural abnormalities History: hyperintense T2 focus. The previously seen focus of susceptibility artifact in the right corona radiata appears unchanged. A lesion with edema. The previously described subcentimeter T2 hyperintense subcortical focus in the inferior right temporal lobe is unchanged. As before, this lesion does not appear to suppress readily with FLAIR technique. There is no abnormal associated enhancement. There is no mass effect or edema. The ventricles and basal cisterns are normal in size and configuration. No abnormal extra-axial fluid collection is identified. The midline structures and craniocervical junction are within normal limits. There is no diffusion abnormality. Normal flow-voids are demonstrated in the major intracranial vascular structures. The paranasal sinuses, mastoid air cells, and orbits are unremarkable.

Output: 1.A subcentimeter right temporal lobe T2 hyperintense focus is stable although as before does not suppress with FLAIR technique. The differential is unchanged, most likely representing a neuroglial cyst or prominent perivascular space. Repeat imaging in 1 year to assess for stability is recommended.2.A stable nonspecific focus of susceptibility in the right corona radiata may represent sequelae of prior microhemorrhage or may represent a small cavernoma.


Instruction: Generate impression based on medical findings.

Input: A patient submitted outside studies for review. Submitted for review are a diagnostic mammogram and ultrasound (7/18/16), right diagnostic mammogram (8/13/2016), and left diagnostic mammogram (9/28/2016) performed at Presence Saint Joseph Hospital. In addition, a breast MRI (10/11/2016) was done at Advocate Illinois Masonic Hospital. For comparison, a prior mammogram is available dated 7/25/2014. On 7/18/16, a screening mammogram was done at Presence Saint Joseph Hospital. The CC views are limited due to inadequate compression. The breast parenchyma is extremely dense, unchanged in pattern and distribution. There is a new cluster of calcifications spanning 2.2 cm within the right upper outer breast posterior depth, without a CC correlate secondary to technique. In addition, there are a few calcifications in the right breast noted 3.5 cm anteromedial to the cluster. In the left breast, a new faint cluster of calcifications is present in the upper outer quadrant. On 8/13/16, a right diagnostic mammogram with spot magnification and exaggerated CC views was done at Presence Saint Joseph Hospital. The breast parenchyma is extremely dense, unchanged in pattern and distribution. There redemonstration of a cluster of indeterminate calcifications within the right upper outer breast at posterior depth, which span 2.2 cm and overlie the pectoralis muscle on MLO view. There is also redemonstration of a few faint calcifications 3.5 cm anteromedial to the cluster. A same day ultrasound was done, which did not demonstrate a correlate lesion.On 9/28/16, a left diagnostic mammogram with spot magnification views was done at Presence Saint Joseph Hospital for a suspicious cluster of calcifications within the left upper outer quadrant. Same day stereotactic biopsy was done with clip placement. Post-procedure mammogram demonstrates a clip in the appropriate location with a 10 mm hematoma along the anterior aspect. Specimen radiograph shows the majority of the calcifications within the specimen. Pathology returned DCIS grade 2, which is concordant with mammographic findings.On 10/11/16 a breast MRI was completed at Advocate Illinois Masonic Hospital.Exam was post processed by Dynacad. Exam is limited due to motion along the lateral aspects of both breasts. No definite biopsy clips identified. On postcontrast images, extensive parenchymal enhancement is seen bilaterally. There is asymmetric bandlike non-mass enhancement along the posterolateral aspect of the right breast at the 9:00 position, but it is difficult to determine if it is parenchymal enhancement or non mass enhancement associated with the calcifications.

Output: Cluster of calcifications within the left upper outer quadrant with pathological diagnosis of DCIS grade 2. Clip in appropriate location. Additional cluster of suspicious calcifications within the right upper outer breast spanning 2.2 cm at posterior depth, with a couple of additional faint calcifications located more anteromedially. On MRI, there is question of asymmetric band-like non-mass enhancement along the posterolateral aspect of the right breast. However, extensive background parenchymal enhancement limits evaluation. Recommend repeat MRI during day 7-11 of the menstrual cycle for further evaluation.Stereotactic biopsy and post procedure mammogram of the right breast can be submitted. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: 22 years, Female, Reason: episodes of profuse bleeding for 2 months after spontaneous miscarriage. no retained products on ultrasound, small pumping vessel in uterine cavity. suspected pseudoaneurysm or uterine arteriovenous malformation. History: abnormal uterine bleeding requiring transfusion. PELVIS:UTERUS, ADNEXA: There is an enhancing focus within the uterine cavity along the posterior aspect of the fundus which appears to have a feeding vessel on arterial phase images (1102/442) it is associated with numerous flow voids and T2-weighted sequences. The uterine vessels on the right in this region appear engorged. There is intrinsic T1 shortening within the endometrial cavity, likely representing blood products.Right Bartholin's gland cyst measuring 1.8 cm. BLADDER: Diffuse bladder wall thickening. 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: Enhancing nidus in the posterior uterine fundus with numerous associated flow voids likely represents an AV malformation arising from the right uterine vessels. There is a small amount of associated blood within the endometrial cavity. Interventional radiology consult may be considered.Findings discussed with the service at the time of reporting.


Instruction: Generate impression based on medical findings.

Input: History of tuberous sclerosis and renal angiomyolipomas. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Stable nonspecific subcentimeter focus in the distal pancreatic body/tail.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Demonstrated again are multiple bilateral T1 and T2 hypointense renal masses demonstrating mild postcontrast enhancement. No macroscopic fat is apparent. The largest is a right superior pole lesion measuring 3.9 x 3.3 x 3.9 cm in maximal cross-section. This is increased from the prior study remeasured using similar technique. The remaining lesions measure less than 2.5 cm in maximal dimension. The largest left renal lesion measures 2.2 x 1.4 cm.No hydronephrosis.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: Bilateral renal lesions compatible with multiple lipid poor angiomyolipomas given the clinical history. The largest measures 3.9 cm in maximum dimension in the right superior pole, increased from the prior study.


Instruction: Generate impression based on medical findings.

Input: 30-year-old male patient with jaundice, transaminitis. Concern for PSC, PBC, ascending cholangitis. ABDOMEN:LIVER, BILIARY TRACT: The liver is enlarged measuring up to 25 cm in the craniocaudal dimension. No focal hepatic lesion. No intra or extrahepatic biliary ductal dilatation. No CBD stone seen, image 48 series 8. No significant biliary wall thickening, enhancement or restricted diffusion identified. There is periportal edema. The gallbladder wall is thickened measuring up to 8 mm in thickness and is mildly contracted. No cholelithiasis. SPLEEN: No significant abnormality noted.PANCREAS: The main pancreatic duct is normal in diameter. There is mild peripancreatic edema. Additionally, there is increased diffusion abnormality within the head of the pancreas. No pancreatic mass is identified.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is mild increased wall enhancement of the duodenum.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace ascites and trace bilateral pleural effusions.

Output: 1.Hepatomegaly without intra- or extrahepatic biliary ductal dilatation. 2.Thickened gallbladder wall without distension or cholelithiasis; this is non-specific and could be secondary to various etiologies including hepatitis and hypoalbuminemia. 3.Mild peripancreatic edema, diffusion abnormality (primarily within the pancreatic head), and duodenal wall enhancement; these findings raise concern for acute pancreatitis, correlate with lipase and amylase levels and patient's clinical history/physical exam.


Instruction: Generate impression based on medical findings.

Input: VHL and multiple hemangioblastomas. The evaluation for tumors is limited due to the lack of intravenous contrast. There are postoperative findings related to left transmastoid surgery with fat grafting, suboccipital craniotomy, as well as left enucleation with prosthesis. There are unchanged areas of confluent T2 hyperintensity in the bilateral cerebellar hemispheres with sulcal effacement. There is unchanged focal expansile T2 hyperintensity in the right cerebellar tonsil. There is also an unchanged focus of T2 hyperintensity in the left medulla. There are unchanged mild scattered foci of T2 hyperintensity in the cerebral white seen matter. There is a new fluid-fluid level within the right globe. The layering fluid measures up to 7 mm in thickness and is hypointense on T2 sequences and isointense on T1-weighted sequences, likely reflecting blood products. There is a right lens implant. There is no evidence of acute infarct. The ventricles and basal cisterns are stable in size and configuration. There is no midline shift or herniation. The paranasal sinuses are unremarkable.

Output: 1. Persistent signal abnormality in the bilateral cerebellar hemispheres and left medulla may represent edema related to residual hemangioblastomas, although the lack of intravenous contrast limits evaluation.2. No definite evidence of recurrent endolymphatic sac tumor, although the lack of intravenous contrast limits evaluation.3. New fluid-fluid level in the right globe, which likely represents vitreous hemorrhage, perhaps related to an underlying hemangioblastoma, although the lack of intravenous contrast limits evaluation.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: Post brain ablation for seizures: 3 month post op There are postoperative findings related to laser ablation of an exophytic hypothalamic hamartoma, which is unchanged in size, measuring up to 25 mm in width for example. There is concentric enhancement at the ablation site in the left lateral aspect of the lesion. The optic apparatus demonstrates normal signal characteristics. There is a non-enhancing T2 hyperintense focus in the region of the right anterior frontal lobe subcortical white matter that measures up to 12 mm, which has gradually increased in size, although there is no significant interval change. There is no evidence of acute cerebral infarction or hemorrhage. The ventricles are unchanged in size. There are findings related to prior frontal craniotomy and transcallosal surgery. There are small retained secretions within the left sphenoid and ethmoid sinuses.

Output: 1. Postoperative findings related to MRI guided laser ablation of a hypothalamic hamartoma, which is unchanged in size. 2. A nonspecific lesion in the region of the right frontal lobe that measures up to 12 mm has gradually increased in size. This may represent a hamartoma or low-grade neoplasm.