Instruction: Generate impression based on medical findings.

Input: CVA No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus is detected. No definitive evidence of an acute cortical stroke is detected. A very small punctate low density in the right external capsule is again demonstrated with no interval change. Third of admission with a dedicated MRI examination is recommended to exclude acute small strokes. This examination remains stable since prior study.

Output: Essentially unremarkable CT of brain without infusion and no interval change since prior study. If clinical concern for stroke persists an MRI is highly recommended.


Instruction: Generate impression based on medical findings.

Input: Abnormal movements, hearing loss, abnormal MRI. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable, aside from terminal zones of myelination. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Internal auditory canals: The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. Aside from partial dehiscence of the right posterior semicircular canal, the inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. No evidence of gross inner ear anomalies, aside from partial dehiscence of the right posterior semicircular canal.


Instruction: Generate impression based on medical findings.

Input: 63 year old woman with GBM. Rule out bleed. There is no evidence of acute intracranial hemorrhage.Patient is status post left temporal craniotomy and left temporoparietal tumor resection. A resection cavity is present in the left temporoparietal region. The temporal horn of the left lateral ventricle is dilated, reflecting volume loss. Left-sided periventricular hypoattenuation and mild dilation of the body of the left lateral ventricle are present -- these findings likely reflect treatment-related gliosis/edema and volume loss. Meningeal thickening is present along the left greater wing of the sphenoid and the left temporal bone -- this is likely postoperative in nature. The study is inadequate to assess for the presence of residual or recurrent tumor -- recommend contrast enhanced MRI for this purpose.The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. No CT evidence of acute intracranial hemorrhage.2. Postoperative findings of left temporoparietal tumor resection as detailed above.


Instruction: Generate impression based on medical findings.

Input: Male, 41 years old, with back pain. Alignment is anatomic. Vertebral body height and morphology are within normal limits. No concerning marrow replacement or edema is seen.The distal spinal cord, conus and cauda equina demonstrate normal signal intensity and morphology. No epidural abnormalities are suspected.L1-2: Unremarkable. L2-3: Unremarkable. L3-4: Facet arthropathy with bilateral facet effusions. Loss of disc height and T2 signal. Right paracentral disc protrusion causing mild effacement of the right ventral thecal sac. The right neural foramen is minimally narrowed. Left neural foramen is patent. L4-5: Facet arthropathy. Loss of disc height and T2 signal. Central disc protrusion causing effacement of the ventral thecal sac but no obvious nerve root impingement. Mild bilateral foraminal narrowing. L5-S1: Facet arthropathy. Loss of disc height and T2 signal. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. Incidental note is made of a partially visualized cystic structure apparently arising from the left kidney.

Output: Degenerative disc disease is seen most notably at L3-4 and L4-5 where there are disc protrusions which efface the thecal sac but which do not appear to impinge upon any specific nerves. No high-grade foraminal stenosis is seen.


Instruction: Generate impression based on medical findings.

Input: 80 year old male with a history of prostate cancer presents with shoulder pain. ROTATOR CUFF: There is a full-thickness tear of the supraspinatus tendon at the level of its insertion on the greater tuberosity measuring approximately 13 mm in the AP dimension. The supraspinatus tendon is thickened with associated increased signal abnormality consistent with moderate tendinosis. There is approximately 11 mm of retraction of the supraspinatus tendon. There is mild undersurface fraying of the anterior fibers of the infraspinatus tendon. No full-thickness or near full-thickness tearing of the infraspinatus tendon or muscle is identified. The teres minor muscle and tendon appear intact. There is thickening with increased signal abnormality within the subscapularis tendon consistent with moderate tendinosis. The muscle belly of the subscapularis muscle is within normal limits.SUPRASPINATUS OUTLET: There is a small amount of fluid within the subacromial subdeltoid space.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a small amount of fluid within the glenohumeral joint. Although this examination was not protocoled for examination of the glenoid labrum, there is mild increased signal intensity within the superior glenoid labrum consistent with labral fraying/SLAP type I tear. There are mild degenerative arthritic changes affecting the glenohumeral and acromioclavicular joints.BICEPS TENDON: A small amount of fluid is identified along the long head of the biceps tendon which may reflect tenosynovitis versus fluid extension from the glenohumeral joint. ADDITIONAL

Output: Full-thickness tear of the supraspinatus tendon and other findings, as described above. No enhancing mass lesions or evidence of metastatic disease, as clinically questioned.


Instruction: Generate impression based on medical findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.he patient was placed supine on the fluoroscopy table. The right hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 3 ml of a of Omnipaque 240 (to confirm the intra-articular position of the needle) was injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. Next, a mixture of 1 cc Aristospan and 3 cc lidocaine was injected into the joint without complication. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 11 seconds

Output: Successful right hip injection without immediate complication.


Instruction: Generate impression based on medical findings.

Input: Head and neck cancer. Dry mouth. Head CT:There is no evidence of intracranial mass, hemorrhage or acute infarction. The enhancing focus in the left parietal lobe reported on the prior CT study is no longer well visualized. In this same area, there is subtle hypodensity, consistent with encephalomalacia, possibly from previous infarction. There are scattered areas of chronic infarction in the left cerebellum, left parietal lobe, right frontal lobe and right basal ganglia which are unchanged compared to prior study. There are new areas of hypodensity seen in the right frontal periventricular region, and at the left basal ganglia, with low density compatible with old infarctions that have evolved since the prior CT study. The lesion at the left basal ganglia was also seen on prior MRI brain of 9/26/2009. Scattered ill-defined cerebral white matter hypoattenuation is consistent with small vessel ischemic changes.Neck CT:The soft tissue thickening and asymmetry at the laryngeal region are unchanged compared to prior study. No pathological size lymph nodes, or necrotic lymph node is identified. Again noted is a diverticulum at the anterior aspect of the esophagus. There is degenerative disease of cervical spine. There is interval development of near-complete opacification of the right maxillary sinus, with mucosal thickening also seen in the left maxillary sinus.There are postsurgical changes in bilateral mastoid regions.

Output: 1. Multiple chronic infarctions in the brain as described above.2. Stable soft tissue asymmetry in the laryngeal region. No evidence of adenopathy.3. New bilateral maxillary sinus disease.


Instruction: Generate impression based on medical findings.

Input: Locoregional synovial sarcoma of spine (C2-T2) with cardiac extension; pulmonary relapse March 2016; surveillance imaging. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild scattered paranasal sinus mucosal thickening. There is also a mild effusion within the left mastoid air cells.Spine: There are postoperative findings related to C2-T2 laminoplasty and tumor debulking. There is interval decrease in size of the enhancing left paraspinal tumor with encasement of the left vertebral artery at these levels, with invasion of each neural foramen and minimal extension into the intraspinal epidural space, measuring up to 20 mm in thickness at the C3-4 level, previously 25 mm. There is persistent patchy heterogeneous marrow replacement throughout the cervical spine and upper thoracic spine, but the vertebral body heights are preserved. There is a kyphotic curvature at the cervico-thoracic junction, but no spondylolisthesis. The spinal canal is narrowed from C3-C7, which is in part attributable to kyphotic curvature, a tight laminoplasty and small posterior disc-osteophyte complexes. There is associated mild spinal cord flattening in this region, without spinal cord signal abnormality. The posterior paraspinal tissues are unchanged. There are nodules within the partially imaged right lung. There is a small right apical pneumothorax.

Output: 1. Slight interval decrease in size of the treated residual tumor along the 2. Persistent patchy heterogeneous marrow replacement throughout the cervical spine and upper thoracic spine, but the vertebral body heights are preserved. 3. The spinal canal is narrowed from C3-C7, which is in part attributable to kyphotic curvature, a tight laminoplasty and small posterior disc-osteophyte complexes. 4. No evidence of intracranial metastases.5. Pulmonary metastases and small right apical pneumothorax. Please refer to the separate chest CT report for additional details.


Instruction: Generate impression based on medical findings.

Input: Other benign neoplasm of connective and other soft tissue of unspecified site [215.9], Reason for Study: ^Reason: eval progression of cervical neuroma History: frequent falls There is intradural extramedullary nodular enhancing lesion especially on the left side from C4 to C7.The extent and MR characteristics do not show any significant interval change since prior exam.The left parotid gland centrally necrotic mass as well as multifocal cervical lymph nodes do not show any significant interval change either since prior exam.The cranial-cervical junction is normal. There is normal cervical lordosis. The cervical spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. Degenerative changes are specified by the intervertebral level as follows: C2-C3: no neuroforaminal narrowing or spinal stenosis. C3-C4: minimal bulging of disc, no neuroforaminal narrowing or spinal stenosis. C4-C5: minimal bulging of disc, no neuroforaminal narrowing or spinal stenosis. C5-C6: minimal bulging of disc with minimal bilateral ligamentum flavum thickening, no neuroforaminal narrowing or spinal stenosis. C6-C7: no neuroforaminal narrowing or spinal stenosis. C7-T1: no neuroforaminal narrowing or spinal stenosis.

Output: 1. No change of extramedullary intradural enhancing lesion which likely represent neurogenic tumor in terms of size, extent and enhancement pattern since prior exam.2. No change of left parotid gland mass and multifocal cervical lymph nodes since prior scan.3. Spinal cord signal intensity is normal.4. Multilevel degenerative changes of intervertebral discs and ligamentum flavum as described above.


Instruction: Generate impression based on medical findings.

Input: 16-year-old male. Lateral pain. Evaluate for lateral meniscus tear. MENISCI: Horizontal signal abnormality predominately within the posterior horn and body of the lateral meniscus extending to the free edge of the meniscus and the femoral articular surface indicating a horizontal tear. There is small intrameniscal cyst formation particularly within the periphery of the posterior horn and the contents of the tear also decompress laterally into a multiloculated para-meniscal cyst located between the lateral capsular structures and the meniscal body. This cyst measures approximately 2 cm in AP dimension, 1.5 cm in CC dimension, and 5 mm in mediolateral dimension with adjacent edema type signal. The body of the lateral meniscus itself appears slightly prominent, suggesting a partial discoid morphology. The medial meniscus is intact.ARTICULAR CARTILAGE AND BONE: Bone marrow signal intensity is normal without evidence of contusion. The tibiofemoral and patellofemoral compartment cartilage is intact with no focal defect.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. Horizontal tear of the lateral meniscus with para-meniscal cyst formation, as described above. Prominence of the body of the lateral meniscus suggests a partial discoid morphology.2. Approximately 1 cm disc shaped focus of intermediate to low signal intensity within the patellofemoral joint, as described above, may simply represent a peculiar synovial fold/plica but we cannot entirely exclude the possibility of a loose cartilaginous fragment. We see no cartilage defects.


Instruction: Generate impression based on medical findings.

Input: Female 23 years old Reason: rectal fullness, hx of fevers. assess for abscess, pelvic pathology History: rectal fullness, hx of fevers ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No focal suspicious hepatic lesions. Hepatic and portal veins are patent. No significant fatty infiltration.No biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Pancreas is normal in morphology. Pancreatic duct is normal in caliber.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small bowel is normal in caliber and course. The terminal ileum is not imaged.There is diffuse rectal wall thickening involving the distal rectosigmoid up to a 12 cm segment. This segment shows hyperenhancement, wall edema and increased surrounding vascularity.No associated abscess. This is subtle T2 hyperintense linear band extending from the 12 o'clock position of the anus towards the vagina and is suspicious for a small perianal fistula that extends to the right.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Small physiologic adnexal follicles.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Please see above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Findings of active inflammation involving the rectum and distal sigmoid for a 12 cm segment.2.Findings of a small perianal fistula extending from the 12 o'clock position extending anteriorly to the right..


Instruction: Generate impression based on medical findings.

Input: Ms. Messmacher is a 45 year old female with left breast lumpectomy in Aug 2016 for DCIS with negative final margins. She presents for MRI imaging evaluation. There is heterogeneous amount of fibroglandular tissue in both breasts. Moderate background parenchymal enhancement is noted bilaterally.In the left upper outer breast, anterior depth, there are minimal postsurgical changes compatible with provided history of left breast lumpectomy. There is no abnormal enhancement identified in the lumpectomy bed or elsewhere in the left breast.There is no abnormal enhancement seen in the right breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: Expected postsurgical changes of the left breast. No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on medical findings.

Input: 13 year old male with history of Proteus and lymphatic-venous malformation.EXAMINATION: CT of the right lower extremity from the lower pelvis to the ankles after IV administration of 80 cc Omnipaque 300. 1/29/16. There is diffuse subcutaneous reticulation within the lateral aspect of the left lower leg and bilateral right greater than left thighs extending into the gluteal soft tissues. There is a large soft tissue lesion located medial to the biceps femoris spanning a craniocaudal distance of 10.5 cm with maximal axial dimensions of 3.6 x 1.7 cm likely representing a lymphatic venous malformation. The underlying osseous structures are unremarkable. No hip or knee joint effusions. The femoral heads are directed into well-formed acetabula.The known vascular malformations within the pelvis are better evaluated on recent MRI, however appear stable in size. There is diffuse reticulation and skin thickening of the scrotum. There is a well-circumscribed fluid density lesion within the right anterior inferior pelvis extending into the right inguinal canal measuring 5.4 x 2.5 cm

Output: Extensive venous lymphatic malformations as above.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old, status post tumor resection. Evidence of laminectomy is seen at least at T5 and possibly at T4 and T6 as well though these areas are obscured by metal artifact. Instrumented posterior spinal fusion has been performed with bilateral pedicle screws in the T4 and T6 vertebral bodies affixed to posterior stabilization rods.A previously seen bulky tumor involving the left T5 pedicle, transverse process, a small part of the vertebral body and the adjacent rib head appears to have been at least partially resected. The transverse process and part of the vertebral body are absent. Part of the adjacent left rib head may also have been resected. The tumor bed does remain filled with soft tissue material of uncertain composition, possibly representing a combination of residual tumor and surgical packing material. Of note, it does appear that epidural encroachment and deformation of the left lateral thecal sac seen on the prior examination has been relieved.There appears to be a fracture of the proximal left T4 rib, with T1 hypointensity in the adjacent marrow possibly reflecting edema or marrow replacement. This finding was present on the prior examination.Evaluation of the spinal cord is limited in the region of the pedicle screws, but elsewhere the cord shows normal signal intensity and morphology. No areas of significant spinal canal stenosis or cord impingement are suspected.Vertebral bodies are normally aligned with a slightly exaggerated thoracic kyphosis. Vertebral body heights are preserved.

Output: Findings are seen compatible with at least partial resection of a tumor deposit involving the T5 pedicle, transverse process and rib head. Posterior instrumented spinal fusion has also been performed from T4 through T6.Soft tissue material in the tumor bed is of uncertain etiology and could represent a combination of both residual tumor and surgical packing. Epidural encroachment and deformation of the left lateral thecal sac seen on the prior examination have been relieved.A fracture through the proximal left T4 rib is suspected, unchanged from the prior examination. It is unclear if this is a benign fracture or a fracture through a metastatic deposit.


Instruction: Generate impression based on medical findings.

Input: 24-year-old female with primary sclerosing cholangitis, evaluate for cholangiocarcinoma. ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis.Intrahepatic biliary ductal dilatation has increased from the prior exam. There areas of intrahepatic beading and narrowing, which have progressed since prior exam. No dominant stricture is evident. The common bile duct measures 9 mm to the level of the ampulla, previously 7 mm.No suspicious hepatic lesions. Mildly prominent portacaval lymph nodes.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: A thick walled pouch is present within the pelvis.BONES, SOFT TISSUES: Mild rightward curvature of the spine.OTHER: Small amount of free fluid in the pelvis and small follicles are likely physiologic.

Output: 1.Intrahepatic biliary ductal dilatation and intrahepatic strictures likely related to primary sclerosing cholangitis have increased since the prior exam.2.Increased dilatation of the common bile duct to the level of the ampulla, which is likely stenosed.3.No suspicious hepatic lesions to suggest cholangiocarcinoma.


Instruction: Generate impression based on medical findings.

Input: Reason: Is there a rotator cuff tear? History: pain in shoulder after shoveling snow in a volleyball coach ROTATOR CUFF: There is intermediate signal intensity and thickening of the supraspinatus indicating moderate tendinosis. There is superficial fraying of the bursal surface fibers of the supraspinatus. No full-thickness tear or retraction is identified. The supraspinatus muscle appears intact. The infraspinatus muscle and tendon appear intact. There is intermediate signal intensity within the subscapularis indicating mild tendinosis. The subscapularis muscle and tendon appear intact.SUPRASPINATUS OUTLET: There is a small amount of fluid within the subacromial subdeltoid bursa which may reflect a mild bursitis. Mild osteoarthritis affects the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. There is heterogeneity and intermediate signal intensity within the anterior and inferior glenoid labrum indicating degeneration and degenerative tearing. No fluid-filled tear is identified within the limitations of this non arthrogram study.BICEPS TENDON: The tendon of the long head of the biceps appears intact. ADDITIONAL

Output: 1. Tendinosis of the rotator cuff as well as superficial fraying of the supraspinatus without evidence of a full-thickness rotator cuff tear or retraction. 2. Findings indicating a mild subacromial subdeltoid bursitis. 3. Mild osteoarthritis of the shoulder.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o osteomyelitis History: fever, back pain MRI thoracic spine:At T10-T11 there is loss of vertebral body height, irregularity of the endplates and heterogeneous signal within the disk space as well as marrow replacement within the vertebral bodies and posterior elements. There is epidural extension of disk material associated with the compression of the thecal sac and mild compression of the spinal cord. There is a CT of the abdomen study from 7/16/14 which indicates that the endplates were intact at that time. There is a peri-vertebral infiltration present.The thoracic vertebral bodies are appropriate in the overall alignment. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. No abnormal enhancing lesions are appreciated in the thoracic spine.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.No abnormal enhancing lesions are appreciated in the lumbar spine.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.Findings are compatible with diskitis and osteomyelitis at T10-T11 associated with epidural extension and some mild compression of the spinal cord. There is both the anterior and posterior element involvement associated with compression deformities of T10 and T11. Post-contrast imaging of the thoracic spine may help further assess the extent of involvement.2.Exam is somewhat limited due to inability on for the patient to tolerate the exam.3.Findings were discussed with Dr Pulimi at the time of this interpretation at approximately 9:40 a.m.


Instruction: Generate impression based on medical findings.

Input: 37 years Female (DOB:2/3/1979)Reason: eval for progression of bleed History: eval for progression of bleedPROVIDER/ATTENDING NAME: KRUPA G ANDALKAR CHRISTOPHER L KRAMER MRI of the brainThere is a large hematoma centered along the posterior and medial aspect of the right frontal lobe. It is stable. It is associated with vasogenic an cytotoxic edema and mild mass effect.Findings suggest a cord sign along the cortical draining vein adjacent to the hematoma with some thrombus extending into the superior sagittal sinus. This is best identified on coronal T2 imaging image 19 of series 9..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.MRV brain:The dural venous sinuses are patent. Straight sinus, internal cerebral veins and basal veins are identified and appear patent. The MRV of the brain is degraded by patient motion which may obscure more subtle abnormalities

Output: 1.There is redemonstration of a large hematoma associated with edema centered along the posterior and medial aspect of the right frontal lobe. Differences in modality makes it difficult to compare interval change.2.Findings are suggestive of a "cord sign" which may represent an occluded cortical vein adjacent to the hematoma.3.The superior sagittal sinus appears patent as do all the dural venous sinuses although there may be some thrombus within the superior sagittal sinus adjacent to the hematoma.4.Examination is degraded due to patient motion which would obscure more subtle findings.


Instruction: Generate impression based on medical findings.

Input: Left frontal opacification. There are post-surgical findings related to left orbital exenteration, left maxillectomy, left ethmoidectomy, and left rhinectomy. There are secretions in the left anterior ethmoid sinuses and frontoethmoid recess deep to the surgical flap. There is trace mucosal thickening in the left frontal sinus, but no evidence of secretions. The right maxillary, right ethmoid, right frontal, and bilateral sphenoid sinuses are unremarkable. There is patchy presumed enhancement of the soft tissues in the posterior left orbital exenteration cavity. The right orbit is unremarkable. There is extensive irregularity and presumed enhancement of the left maxillary alveolus. The intracranial structures are unremarkable.

Output: 1. Postoperative findings in the left face with retained secretions in the left anterior ethmoid sinuses and frontoethmoid recess deep to the surgical flap. 2. Persistent nonspecific patchy presumed enhancement of the soft tissues in the posterior left orbital exenteration cavity, which is incompletely characterized on this exam, but may represent treatment effects or a small amount of tumor. 3. Extensive irregularity and presumed enhancement of the left maxillary alveolus may be related to radiation necrosis. Please refer to the prior CT report for additional details.


Instruction: Generate impression based on medical findings.

Input: 65-year-old female with HCC, please evaluate for metastases LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.The prominent pericardial recess in the right paratracheal region.Probable tracheal diverticulum unchanged from the prior exam.CHEST WALL: Degenerative changes in the thoracic spineUPPER ABDOMEN: Hypodense lesions with internal calcification within the right lobe of liver compatible with treatedtumor (recent MRI dated 6/29/11).

Output: No evidence of metastatic disease within the chest.


Instruction: Generate impression based on medical findings.

Input: Right Lateral knee pain MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Negative MRI examination of the right knee


Instruction: Generate impression based on medical findings.

Input: New onset of back pain. Please evaluate for myeloma lesions. Evaluation of the upper thoracic spine is limited on the lateral view due to overlying anatomy. There is multilevel degenerative disc disease affecting the cervical, thoracic, and lumbar spine. The vertebral lesions seen on the prior MRI study are not evident on the on this spine survey. There is a slight leftward curvature of the thoracolumbar spine. There is a positive sagittal balance of approximately 4 cm. Components of a left total hip arthroplasty are incompletely imaged on this study.

Output: Degenerative disc disease of the cervical, thoracic, and lumbar spine, without focal myelomatous lesions evident.


Instruction: Generate impression based on medical findings.

Input: History of right breast cancer status post bilateral mastectomy with implant reconstruction with new area of concern in right axilla Status post bilateral mastectomies.Minimal parenchymal enhancement is noted bilaterally. Bilateral implants appear intact.No abnormal enhancement is seen in either chest wall. No abnormal axillary lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy especially in patient's area of concern in the right axillary region. Ultrasound can be performed to further evaluate the concern in the right axillary region if clinically needed. BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed.


Instruction: Generate impression based on medical findings.

Input: 45 years Female (DOB:10/4/1970)Reason: s/p resection brain mat a long time ago. PLease evaluate for progression in brainstem History: WobblyPROVIDER/ATTENDING NAME: STEVEN J. CHMURA STEVEN J. CHMURA There is redemonstration of enhancing lesions within the brain parenchyma. One in the left middle frontal gyrus posteriorly measures 7 mm and previously measured approximately the same. One along the left inferior frontal gyrus measures 6 mm and previously measured similar dimensions. One in the right centrum semiovale measures 5 mm and previously measured the same. One in the medial aspect of the right occipital lobe measures 7 mm and previously measured approximately the same though it enhances less on the current exam. One in the left cerebellar hemisphere measures 15 mm and is stable. One in the pons measures 10 x 13 mm and is stable. One in the left cerebellar hemisphere inferiorly measures 10 mm and previously measured the sameThe patient status post left frontal craniotomy and suboccipital craniotomy. There is a enhancement along the margins of the left frontal craniotomy site the calvarium and adjacent soft tissues. This most likely postoperative in nature. Within the suboccipital craniotomy site there are fluid collections present within the subcutaneous tissues which appear to be more organized on the current exam versus the prior.There is no abnormal enhancing lesion identified in the left frontal lobe at the surgical site. Previously within the posterior fossa at the surgical site there are 2 large lesions present. One was at the left cerebellar hemisphere inferiorly and the other one was medial aspect of the right cerebellar hemisphere. Comparing with the preoperative exam from 5/2/2016 there is a there are small foci of nodular enhancement present at the surgical margins which are more apparent on the current exam than on the prior. Small nodule is present along the left inferior cerebellum at the surgical margin which is not clearly delineated on the prior exam and was possibly obscured by associated findings. Another focus of nodular enhancement is present along the inferior aspect of the right cerebellar hemisphere at the surgical margin measuring 9 x 6 mm. There is also redemonstration of a enhancement along the surface of the cerebellum along the posterior fossa surgical sites which is likely postoperative in nature.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There are multiple lesions scattered within the brain parenchyma including supratentorial and infratentorial brain compatible with metastases. These are stable since the examination from May 4.2.The patient is status post suboccipital craniotomy for tumor removal/debulking. Postoperative changes include fluid collections at the surgical site. This could represent seroma or CSF leak. At the surgical margins within the cerebellum there are nodules in the enhancement which are suggestive of a small bits of residual or recurrent neoplasm.3.The patient is status post left frontal lobe surgery. There is no evidence for local recurrence.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Low back painClinical question: Persistent left sided low back pain. ? Etiology. Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.A small amount of fluid is present in the uterus and in the peritoneum.

Output: 1.No compromise to lumbar spinal canal or neural foramina.2.Fluid in the uterus and peritoneum at this age is non-specific and may be simply related to menses. Please correlate with the clinical history.


Instruction: Generate impression based on medical findings.

Input: Male, 12 years old. Reason: Evaluate lesion in right temporal lobe, evaluate stability and characterization History: Right temporal lobe lesion, seizure Motion somewhat degrades evaluation. The previously seen focus of susceptibility artifact in the right corona radiata (series 1002, image 109) appears unchanged. The previously described subcentimeter T2 hyperintense subcortical focus in the inferior right temporal lobe is unchanged from the prior study dated 06/12/2015. The lesion does not appear to suppress readily on FLAIR, although this in part could relate to slice selection. Evaluation for enhancement is markedly limited by local pulsation and motion artifacts. 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 grossly stable although does not definitely appear to suppress on FLAIR. Differential is unchanged, although additional follow-up imaging at 3T, to include 3-D T1 postcontrast and 3-D FLAIR sequences provided the small size of the lesion, is recommended to confirm FLAIR characteristics and to more completely assess for associated enhancement.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: 67 year old with BRCA2 mutation and personal history of breast and ovarian cancer. Prior left lumpectomy, radiation therapy and chemotherapy in 2002. Family history of breast cancer in her sister and maternal aunt. Mild parenchymal enhancement is noted bilaterally. Asymmetric breast size left smaller than right, compatible with prior surgery. Mild postsurgical scarring in the left medial breast and left axilla again noted.No suspicious enhancement is seen in either breast. Intramammary lymph node in the posterior left breast near 3:00 again seen.No abnormal axillary lymph nodes are identified in either axillary region.High T2 liver lesions again noted, likely benign cysts.

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


Instruction: Generate impression based on medical findings.

Input: Pain MENISCI: There is fragmentation of the body of the lateral meniscus, with globular degenerative signal in the remaining lateral meniscus. There is globular degenerative signal in the posterior horn of the medial meniscus, extending to the superior surface, without discrete linear signal. ARTICULAR CARTILAGE AND BONE: There are large full thickness cartilage defects in the lateral compartment, the largest of which measures 16 mm at the lateral femoral condyle. Mild bone marrow reactive changes are present in the lateral femoral condyle. There is otherwise mild diffuse cartilaginous degeneration.LIGAMENTS: There is increased signal in the ACL graft, however, the fibers appear intact. No evidence of an ACL cyst. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Large full thickness cartilage defects in the lateral compartment of the knee.2. Fragmentation of the body of the lateral meniscus.3. Intact ACL graft.


Instruction: Generate impression based on medical findings.

Input: Chronic meningoencephalitis, neoplasm, vasculitis. Persistent bilateral lower extremity weakness and encephalopathy of unclear etiology. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are extensive areas of abnormal T2 hyperintensity within the periventricular and subcortical white matter, a few of which are increased in size or new, notably in the left temporal lobe and posterior limbs of the bilateral internal capsules. There are similar signal changes in bilateral basal ganglia and bilateral paramedian pons to a lesser degree. There is no abnormal parenchymal or leptomeningeal enhancement. There is an apparent prior right transfrontal surgical track with linear susceptibility effect. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There is a nonspecific peripherally enhancing 6 mm nodule in the right temporal subcutaneous tissues, which is unchanged from 11/17/2014. There are multiple prominent occipital arachnoid granulations. There is right posterior frontal burr hole. There is a mucous retention cyst in the right maxillary sinus.

Output: 1. No evidence of acute intracranial hemorrhage, mass, brain abscess, or acute cerebral infarct.2. Extensive areas of abnormal signal in the cerebral white matter are non-specific, but may represent chronic small vessel ischemic disease. 3. Nonspecific subcentimeter nodule in the right temporal subcutaneous tissues, unchanged from 11/17/2014.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Benign neoplasm of pituitary glandClinical question: pituitary adenomaSigns and Symptoms: headaches There is a 6 mm x 7 mm T1 and T2 hyperintense lesion present within the right half of the pituitary gland centered within a nonenhancing cystic-appearing mass which was described on the prior exam.The pituitary gland is appropriate in overall height. The infundibulum of the pituitary gland is midline. The cavernous sinuses are intact bilaterally.

Output: Findings suggest subacute hemorrhage within the previously noted pituitary lesion. Please correlate with clinical symptoms for possible pituitary apoplexy.


Instruction: Generate impression based on medical findings.

Input: Unspecified cerebral artery occlusion with cerebral infarction [434.91] / Cerebral aneurysm, nonruptured [437.3] / Aphasia [784.3] / Memory loss [780.93], Reason for Study: ^Reason: hx of therapeutic carotid artery occlusion for aneurysm, chronic ischemia. Significant metallic artifacts on the left skull base which reflects prior coil embolization of the left ICA and aneurysm.There is no MR evidence of acute ischemic or hemorrhagic lesion on this scan.There is evidence of focal parenchymal chronic hemorrhage on the right centrum semiovale and tissue losses indicating chronic ischemic lesions on the left centrum semiovale. Underlying brain shows multiple scattered high signal intensity lesions on FLAIR images around periventricular white matter indicating non specific small vessel ischemic disease.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. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal right ICA, bilateral MCAs and ACAs. Distal left ICA from the origin of the left ophthalmic artery is visualized. Vertebrobasilar system appears to be normal.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion on this scan.2. The left distal ICA is reconstituted through both Acom and left Pcom arteries, no evidence arterial luminal stenosis or evidence of intracranial arterial aneurysm.3. Chronic hemorrhagic lesion on the right centrum semiovale and chronic ischemic lesion on the left centrum semiovale as described above.


Instruction: Generate impression based on medical findings.

Input: Ms. Lee is a 68-year-old female with biopsy-proven multicentric disease of the right breast (IDC/DCIS). She presents today for MR imaging for further evaluation. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.RIGHT BREAST: No abnormal enhancement is seen in the right breast. No abnormal axillary lymph nodes are identified in the right axillary region.LEFT BREAST:There is extensive clumped nonmass enhancement identified in the left lateral breast, measuring approximately 7.1 x 3.0 x 3.7 cm (AP x ML x SI). This enhancement extends up to the left nipple base. Susceptibility artifact from Hydromark clip is seen in the central aspect of this clumped nonmass enhancement. Susceptibility artifact from ribbon biopsy marker clip is seen at the posterior aspect of this enhancement. The distance between the 2 clips on the diagnostic mammogram is approximately 5.3 cm in the AP dimension. No abnormal axillary lymph nodes are identified in the left axillary region.Few scattered nonenhancing T2 hyperintense lesions are identified in the liver, which may represent simple cysts versus hemangiomas.

Output: (1) 7 cm span of abnormal clumped non-mass enhancement in the left breast, extending up to the left nipple base, corresponding to the mammographically detected abnormality. Two biopsy marker clips are located approximately 5.3 cm apart in the AP dimension.(2) No abnormal left axillary lymph nodes.(3) No MRI evidence of malignancy in the right breast.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on medical findings.

Input: Cavernous angioma follow-up. There is an unchanged cavernous malformation that measures up to 9 mm, with an associated developmental venous anomaly in the left frontal lobe, but no surrounding edema. There is also an unchanged subcortical focus of high T2 signal in the posterior left frontal lobe without enhancement or susceptibility effect. There is no evidence of acute intracranial hemorrhage or infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.Unchanged left frontal lobe cavernous malformation and associated developmental venous anomaly.2.A persistent small lesion in the posterior left frontal lobe remains nonspecific, but may represent a form of white matter abnormality that can be associated with cavernous malformations, for example.


Instruction: Generate impression based on medical findings.

Input: There is a punctate focus of T2 hyperintensity in the white matter adjacent to the left frontal horn without restricted diffusion. This is a nonspecific finding, but may be related to early chronic small vessel ischemic disease. There is no evidence of acute infarct. There is a developmental venous anomaly in the right middle frontal gyrus. There is no evidence of associated hemorrhage or edema. There is no midline shift or herniation. The ventricles are normal in size and configuration. There is a polypoid lesion within the right maxillary sinus, which likely represents a mucous retention cyst or polyp.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. Developmental venous anomaly in the right frontal lobe without associated hemorrhage.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, 20 years old. Dorsal radial wrist pain There is moderate fluid within the radiocarpal joint. A bilobed cystic structure is located dorsally centered on the radiocarpal joint, measuring proximately 6 x 3 x 4 mm (series 501, image 13; series 801, image seven). Additionally some focal intermediate signal along the dorsal aspect of the radiocarpal joint may reflect synovitis.The osseous structures are unremarkable, with normal cortical thickness and marrow signal. The visualized muscles and tendons are normal. The ligaments and triangular fibrocartilage complex are intact.

Output: 1.Small cystic structure centered on the dorsal radiocarpal joint as described above.2.Additional focal intermediate signal within the dorsal radiocarpal joint may reflect synovitis.


Instruction: Generate impression based on medical findings.

Input: Intracranial hemorrhage. Please evaluate for underlying cause. The CSF spaces are appropriate for the patient's stated age with no midline shift. There is an intraparenchymal hematoma (IPH) centered in the right superior temporal lobe sulcus and right superior temporal gyrus but involves the posterior aspect of the right middle temporal gyrus and a small portion of the posterior aspect of the right inferior temporal gyrus and extends into the right inferior parietal lobule. It measures 89x51mm sagittal dimensions, 51x44mm coronal dimensions and 83 x 48 mm axial dimensions. The discrepancy in size between these measurements and the CT are likely related to differences in modality because there are fluid like components with fluid fluid levels along the anterior aspect of the hematoma which are hypodense on the CT scan. There is a halo of edema present.The septum pellucidum is shifted 7mm to the left of midline and is stable since the prior CT. There is compression of the right lateral ventricle.There is redemonstration of a subdural hematoma and subarachnoid blood adjacent to the above described IPH. The subdural hematoma measures 5mm thickness. There is a small amount of intraventricular blood present.The right PCOMA appears compressed. The right nasal vein of Rosenthal is asymmetrically smaller.There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There is no convincing evidence for microhemorrhage to support a diagnosis of amyloid angiopathy.The visualized portions of the paranasal sinuses demonstrate mild mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eye lenses are thin.Incidental note is made of partial empty sella.

Output: 1.Large intraparenchymal hematoma centered in the right temporal lobe and its sulci with associated subdural hematoma and subarachnoid blood as well as uncal herniation.2.No convincing MRI evidence for AVM on the basis of this exam although a small AVM may not be visible or an AVM may be obscured by mass effect.3.No convincing MR evidence for amyloid angiopathy.4.Periventricular and subcortical white matter lesions of a moderate degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on medical findings.

Input: Female 43 years old; Reason: h/o pancreatitis, now w/ abd pain, eval for pancreatic mass/inflammation History: belly pain Lack of intravenous contrast limits sensitivity for solid organ pathology. Motion artifact also limits multiple sequences.ABDOMEN:LUNG BASES: Cardiomegaly, partially visualized.LIVER, BILIARY TRACT: No focal hepatic lesions. Paradoxical loss of signal of the liver diffusely on opposed phase images, suggestive of hemosiderin deposition. No biliary ductal dilation. Gallbladder appears within normal limits.PANCREAS: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The kidneys are atrophic bilaterally with subcentimeter renal cysts, incomplete with a characterized on this exam.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small hiatal hernia.BONES, SOFT TISSUES: Mild degenerative arthritic changes of the visualized spine.OTHER: Body wall anasarca.

Output: Limited examination without evidence of pancreatic pathology, as clinically questioned. Evidence of hemosiderosis.


Instruction: Generate impression based on medical findings.

Input: 54-year-old female with a personal history of left breast mastectomy in 2007 for IDC followed by chemotherapy and tamoxifen. Status post right breast lift and implant placement and left breast reconstruction. Family history of breast cancer in maternal aunt, diagnosed at the age of 40. Status post left mastectomy with reconstruction. Retropectoral right saline implant is unchanged in position and contour.There is heterogeneous amount of fibroglandular tissue in the right breast.Mild parenchymal enhancement is noted in the right breast.A small enhancing mass is seen in the left lower chest wall, likely a lymph node. Prior MRI did not cover this lower part of the chest wall.In the right 7:00 position, there is a skin lesion, measuring 7 mm.No abnormal lymph nodes are identified in either axillary region.

Output: Benign appearing mass in the left breast and skin lesion in the right breast. Follow up MRI in 6 months is recommended.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months).


Instruction: Generate impression based on medical findings.

Input: 80-year-old male with history of COPD, CKD, DM with lung nodules and mediastinal lymphadenopathy concerning for sarcoidosis vs lymphoma. Referred for cardiac MRI to evaluate for possible cardiac sarcoid. Left VentricleThe left ventricle is normal in size with normal systolic function. There is no LV hypertrophy. The overall LV ejection fraction is 58%. The LVEDV is 171 ml (normal range 142+/-34), the LV end diastolic volume index is 68 ml/m2 (normal range: 74+/-15), the LVESV is 71 ml (normal range 47+/-19) and the LV end systolic volume index is 28 ml/m2 (normal range 25+/-9). The LV mass is 112 g (normal range 164+/-36) and the LV mass index is 44 g/m2 (normal range 85+/-15). No evidence of inflammation/edema of the myocardium on T2 STIR images. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.There is no LV thrombus. Left AtriumThe left atrium is mildly dilated. Lipomatous inter-atrial septum.Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 50%. The RVEDV is 219 ml (normal range 142+/-31), RV end diastolic volume index is 86 ml/m2 (normal range 82+/-16), the RVESV is 108 ml (normal range 54+/-17), and the RV end systolic volume index is 43 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve is trileaflet, opens widely and there is trivial aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is 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 drain normally into the right atrium.PericardiumThere is thickening and prominence of the pericardial sac. On T2 STIR images there is notable hyperintensity of the pericardium. This is suggestive of underlying edema/inflammation of the pericardium and is consistent with pericarditis. There is also trace pericardial effusion.Extracardiac FindingsMediastinal adenopathy. Axillary nodes also noted in the left axillae. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1.The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 58%. No evidence of inflammation/edema of the myocardium on T2 STIR images. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.2.The right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 50%.3.There is thickening and prominence of the pericardial sac. On T2 STIR images there is notable hyperintensity of the pericardium. This is suggestive of underlying edema/inflammation of the pericardium and is consistent with pericarditis. There is also trace pericardial effusion.4.Lipomatous inter-atrial septum.5.See extra-cardiac findings. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Lumbar back pain with left lower extremity radiculopathy. Five lumbar type vertebral bodies are presumed to be present. Hypoplastic ribs are noted at T12. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as 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: Minimal disc bulge with foraminal component and bilateral facet arthropathy result in mild narrowing of the neural foramina. No spinal canal stenosis.L4-L5: Mild disc bulge with a tiny central disc extrusion component extending superiorly and endplate osteophyte. There is focus of enhancement within the region of the tiny extrusion which may be in part related to scar tissue. There is moderate bilateral facet arthropathy. There is fairly mild narrowing of the neural foramina. No spinal canal stenosis.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis. Moderate bilateral facet arthropathy.There is mild enhancement associated with the facet arthropathy at L3-L4, L4-L5, and L5-S1, which is likely on a degenerative basis. There is focal enhancement at the L4-L5 level as described above. Otherwise no significant enhancement within the thecal sac or epidural space. Calcified uterine fibroids are partially imaged.

Output: 1. Multilevel degenerative changes in the lumbar spine with fairly mild narrowing of the neural foramina at L3-L4 and L4-L5. No high-grade neural foraminal stenosis at any level. No spinal canal stenosis at any level.2. Moderate facet arthropathy at L4-L5 and L5-S1 and to a slightly lesser degree at the L3-L4 levels.3. Minimal focal enhancement in the left ventral epidural space at the L4-L5 level which may represent postoperative scar tissue and/or associated with tiny disc extrusion. No appreciable mass effect on the nerve roots.


Instruction: Generate impression based on medical findings.

Input: A patient submitted outside study for review. Submitted for review are breast MRI (8/31/15), digital mammographic images (9/10/15), ultrasound images of both breasts (9/10/2015), images from ultrasound guided biopsy of right breast and right axilla with post procedural right mammographic images (9/10/2015) performed at Northwestern Memorial Hospital. For comparison, digital mammographic images (10/1/14, 10/1/13) are available. As per outside report, the patient is BRCA2 mutation carrier, and there is a strong family history of breast cancer. BREAST MRI (8/31/15):The study was performed with a protocol outlined in the outside radiology report.There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There is a slowly enhancing, oval shaped mass at the central aspect of right breast, measuring 8 x 5 x 5 mm (AP x LR x CC). An enlarged lymph node is present at low right axilla.In the left breast, there is an intramammary lymph node at posterior lower outer quadrant. No abnormal enhancement is seen in left breast.DIGITAL MAMMOGRAPHIC IMAGES (9/10/15):The breast parenchyma is heterogeneously dense (BiRADS Density Category C), unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in either breast. Mildly enlarged lymph node is seen in the right low axilla.ULTRASOUND IMAGES OF BOTH BREASTS (9/10/2015):An oval hypoechoic mass with partially indistinct margins is detected at 10:00 position, 5 cm from nipple, in the right breast, likely corresponding to the mass seen on MRI.In the right lower axilla, there is a circumscribed oval mass with marked vascularity, likely an enlarged lymph node with effaced hilum.There is a possible normal intramammary lymph node at 3:00 position, 7 cm from nipple in the left breast.IMAGES FROM ULTRASOUND GUIDED BIOPSY OF RIGHT BREAST AND RIGHT AXILLA WITH POST PROCEDURAL RIGHT MAMMOGRAPHIC IMAGES (9/10/2015):Ultrasound guided biopsy of the mass in the right breast at 10:00 position, and the mass in the right axilla was performed with appropriate needle placement.Postprocedural mammograms demonstrates a coil clip at upper outer quadrant, and a wing clip in the left axillary mass.The pathology results are not available.

Output: 1. Status post ultrasound guided biopsy of the right breast mass and right axillary mass, both of which are initially detected on MRI. Pathology results are not available. Management should be determined based on the pathology results.2. No MRI or mammographic evidence for malignancy in left breast.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on medical findings.

Input: Female, 40 years old, with back pain, persistent after nonoperative treatment. Spinal alignment is within normal limits. Vertebral body heights are maintained. Bone marrow signal intensity is within normal limits. The visualized spinal cord, conus and cauda equina demonstrate normal signal intensity and morphology. No epidural abnormalities are seen.L1-2: Unremarkable. L2-3: Unremarkable. L3-4: Unremarkable. L4-5: Mild facet arthropathy. No significant spinal canal or foraminal stenosis. L5-S1: Moderate facet arthropathy. Loss of disc T2 signal. Small central disc protrusion. No significant generalized spinal canal stenosis. Mild left foraminal narrowing.

Output: 1.Degenerative findings are seen at L5-S1 with facet arthropathy, a small central disc protrusion and mild left foraminal stenosis.2.Elsewhere, no significant abnormalities are detected.


Instruction: Generate impression based on medical findings.

Input: Reason: please include proximal femur soft tissue sarcoma History: new onset of pain Note is made of increased signal abnormality on fluid sensitive sequences along the posterior aspect of the left hip and thigh abutting the medial aspect of the hamstring musculature and vastus lateralis. There is minimal, if any, enhancement on postcontrast sequences, however, no nodular or masslike enhancement is seen. No focal masses are identified. Skin markers overlie the posterior aspect of the thigh, presumably corresponding to the patient's surgical scar. There is diffuse mild fatty infiltration of the imaged musculature of the left hip and thigh. There are multiple foci of metallic susceptibility artifact within the soft tissues along the posterior aspect of the thigh, presumably postsurgical in etiology. There is linear decreased signal abnormality within the subcutaneous tissue along the posterior aspect of the thigh likely representing postsurgical scarring. No bone marrow signal abnormality is identified. There is a small amount of fluid within the left hip which is likely of no clinical significance.

Output: Minimally enhancing signal abnormality within the soft tissues along the posterior aspect of the left hip and thigh likely representing postsurgical change/granulation tissue. While no masslike enhancement is identified to suggest residual or recurrent disease, follow-up examination is recommended to evaluate for interval change, particularly given the lack of prior examinations for comparison.


Instruction: Generate impression based on medical findings.

Input: Seizure. Follow-up of brain lesion. New daily persistent headache. The poorly defined increased T2 signal lesion involving the mesial right temporal lobe (both the amygdala and the hippocampus) has improved since the previous examination. Both the bulkiness of this tissue and the degree of T2 signal abnormality have diminished, particularly within the amygdala, with some reexpansion of the right temporal horn. Minimal enhancement within this lesion seen on the prior examination has resolved.However, there are 2 new small foci of contrast enhancement: one situated in the anteromedial aspect of the right temporal lobe (see image 123 series 1101) and one in the right subinsular region (see image 175 series 1101). Both lesions correlate with focal T2 hyperintensity which also was not present previously. Neither lesion is associated with diffusion restriction. On single voxel MR spectroscopy (TE 35 ms), there is a decreased NAA peak within the right mesial temporal lobe lesion, with no significant change in the other major metabolites when comparison is made to the contralateral normal side. Single voxel spectroscopy was also performed of the right subinsular lesion which shows minimal if any elevation of the choline peak relative to the contralateral side and an otherwise normal pattern.There is new diffuse increased sulcal contrast enhancement, most pronounced in the right cerebral sulci, best visualized on the postcontrast FLAIR sequences (see series 1601). These findings probably reflect a combination of hyperemia and increased sulcal vascular permeability.The remainder of the brain is free of significant abnormalities. The dural venous sinuses and major intracranial arterial flow voids are preserved. There is a small retention cyst in the right maxillary sinus. There is mild right ethmoid mucosal thickening.

Output: 1.Compared to the previous examination of November 2015, the abnormal signal and mild expansion involving the mesial right temporal lobe have improved, and a small focus of enhancement seen previously within this lesion has resolved. MR spectroscopy of this lesion shows no evidence of a high-grade proliferative process, but rather, is suggestive of parenchymal injury and some neuronal loss.2.However, two new foci of T2-hyperintensity and contrast enhancement have developed in the anterior medial right temporal lobe and right subinsular region. MR spectroscopy of the subinsular lesion shows minimal if any choline elevation with an otherwise normal pattern which is nonspecific.3.New diffuse, predominantly right supratentorial sulcal contrast enhancement is probably reflective of hyperemia and increased regional vascular permeability suggesting the presence of an inflammatory process. 4.While a neoplastic process cannot be entirely excluded, the combination of improved mesial temporal signal abnormality and edema with development of new foci of contrast enhancement as well as signs of diffuse supratentorial hyperemia are more in favor of an inflammatory process. An encephalitic process should be considered including autoimmune or limbic encephalitis. In particular, anti-NMDA receptor encephalitis has been shown to present similarly.


Instruction: Generate impression based on medical findings.

Input: 58-year-old male with left knee pain continued despite injections and physical therapy. Evaluate left knee for meniscus tear. MENISCI: There is globular signal abnormality within the posterior horn of the medial meniscus consistent with intrasubstance degeneration which extends to the tibial and femoral articular surfaces consistent with complex degenerative tearing extending to involve the body of the meniscus. The anterior horn appears intact. There is globular increased signal abnormality within the anterior horn and body of the lateral meniscus consistent with intrasubstance degeneration. The signal appears to extend to the tibial and femoral articular surfaces and body of the meniscus suggestive of degenerative tearing.ARTICULAR CARTILAGE AND BONE: There is near full-thickness to full-thickness articular cartilage degeneration along the medial facet of the patella. There is a partial-thickness defect of the articular cartilage along the medial facet of the patella more centrally. There is near full-thickness articular cartilage degeneration along the medial facet of the femoral trochlea. There is near full-thickness thinning of the articular cartilage along the lateral facet of the patella and lateral femoral trochlea with underlying subchondral signal abnormality. There is near full-thickness articular cartilage degeneration along the lateral tibial plateau. There is near full-thickness to full-thickness articular cartilage degeneration along the weightbearing surface of the medial femoral condyle. There are tricompartmental osteophytes.LIGAMENTS: The cruciate and collateral ligaments appear intact EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Complex degenerative tearing of the medial and lateral meniscus as described above. 2. Tricompartmental degenerative changes, including near full-thickness to full-thickness articular cartilage degeneration, as described above. 3. Small joint effusion and moderate-sized Baker's cyst.


Instruction: Generate impression based on medical findings.

Input: There is no significant change in the size or appearance of a punctate non-enhancing focus of susceptibility effect in the right postcentral gyrus measuring 1 to 2mm in diameter. There are no new intracranial lesions. There is unchanged diffuse confluent cerebral white matter T2 hyperintensity, which is likely related to radiation therapy. There is no abnormal intracranial enhancement. There is no evidence of intracranial hemorrhage or acute infarction. The ventricles, sulci, and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There is no midline shift. There are bilateral maxillary sinus retention cysts and persistent fluid signal within the bilateral mastoid air cells.

Output: Post-treatment findings in the brain without evidence of progressive or new metastatic disease.


Instruction: Generate impression based on medical findings.

Input: 42 years Female (DOB:1/21/1974)Reason: R/O cervical cord lesion. R Horner's. Papillary thyroid carcinoma History: R Horner's, R arm numbnessPROVIDER/ATTENDING NAME: HELENE G. RUBEIZ HELENE G. RUBEIZ 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.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.There is a 45 x 42 mm heterogeneous cystic mass present centered in the left thyroid

Output: 1.No abnormal lesions are appreciated within the cervical spinal canal to account for the patient's Horner syndrome.2.There is a left thyroid lobe mass present which has been previously documented on a recent ultrasound exam. The patient is known to have papillary thyroid carcinoma.


Instruction: Generate impression based on medical findings.

Input: Rotator cuff injury in past. Patient presents with pain and weakness. ROTATOR CUFF: There is a near-complete to complete tear of the supraspinatus tendon with retraction of the majority of the tendon to the level of the glenohumeral joint although a few anterior fibers may extend to the greater tuberosity.There is a complete tear of the infraspinatus tendon with similar retraction to the level of the glenohumeral joint.There is severe fatty atrophy of the supraspinatus and infraspinatus muscles.The teres minor tendon appears intact. There is moderate fatty atrophy of the teres minor muscle.There is thickening and increased signal intensity of the subscapularis tendon indicating moderate tendinosis. There is mild fatty atrophy of the subscapularis muscle.SUPRASPINATUS OUTLET: Moderate osteoarthritis affects the acromioclavicular joint. There is a small amount of fluid in the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is mild to moderate osteoarthritis of the glenohumeral joint which has progressed slightly when compared to the prior study. The humeral head is high riding due to the chronic rotator cuff tear.There is a tear of the superior labrum extending down the posterior labrum that has perhaps progressed slightly when compared to the prior study.Increased signal intensity within the superior aspect of the anterior labrum likely also represents additional degenerative tearing.Multiple cysts are again noted within the greater tuberosity.There is a small glenohumeral joint effusion containing foci of intermediate signal intensity likely reflecting synovitis and cartilaginous debris. BICEPS TENDON: The tendon of the long head of the biceps is visualized within the inferior aspect of the bicipital groove, however it is not well visualized within the superior aspect of the groove or within the rotator interval, suspicious for a proximal tear. This appears similar to that seen on the prior study.

Output: 1. Tears of the supraspinatus and infraspinatus tendons as described above with further tendinous retraction as well as atrophy of the muscles. Other rotator cuff findings as described above2. Acromioclavicular joint osteoarthritis.3. Slight progression of glenohumeral joint osteoarthritis with labral tearing.4. Findings suggestive of proximal rupture of the tendon of the long head of the biceps.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for internal derangement /meniscus tear right knee History: eval for internal derangement /meniscus tear right knee MENISCI: The medial meniscus appears intact. The lateral meniscus appears intactARTICULAR CARTILAGE AND BONE: There is near full-thickness to full-thickness articular cartilage degeneration along the weightbearing portion of the medial femoral condyle above the posterior horn and body of the meniscus. There is subjective thinning of the lateral compartment cartilage. There is relative sparing of the patellofemoral articulation.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact. ADDITIONAL

Output: 1. Osteoarthritis of the knee including articular cartilage degeneration most pronounced along the weightbearing surface of the medial femoral condyle. 2. Edema within the quadriceps fat pad is nonspecific, but can be seen in patient's with fat pad impingement.


Instruction: Generate impression based on medical findings.

Input: Male, 80 years old, with vertigo, nausea and vomiting. History of right acoustic neuroma and TIA. No definite restricted diffusion is seen. A punctate focus of bright diffusion signal along the left precentral sulcus shows no ADC correlate and may therefore be artifactual.Fairly extensive patchy T2 hyperintensity is seen within the cerebral white matter, predominantly in the periventricular regions. Most of this is unchanged relative to the prior examination. However, there is a new focus of FLAIR hyperintensity along the right precentral gyrus without mass effect or edema. Some of these areas of T2 signal abnormality are associated with mild susceptibility.A small focus of encephalomalacia within the left cerebellum is unchanged. No significant parenchymal edema or mass effect is detected. No abnormal extra-axial collections or acute intracranial hemorrhage is noted. The ventricles are stable in size and slightly prominent likely representing parenchymal volume loss.A 7 x 5 mm homogeneously enhancing nodule within the right internal auditory canal has not significantly changed in size or morphology. Both cranial nerves VII and VIII appear to pass through or along this lesion. The lesion is almost entirely contained within the internal auditory canal with no significant extension into the CP angle cistern. The inner ear and IAC structures are otherwise unremarkable.Elsewhere in the brain, no pathologic parenchymal or extra-axial enhancement is seen.A mucous retention cyst in the right maxillary sinus is unchanged.

Output: 1.Stable right IAC nodule likely representing a schwannoma. No new inner ear or IAC abnormalities are appreciated.2.Sequelae of fairly extensive chronic small vessel ischemic disease with perhaps some superimposed chronic cortical ischemia. Although no definite acute lesions are appreciated, one small lesion along the right precentral gyrus is new when compared to the prior examination.


Instruction: Generate impression based on medical findings.

Input: Ms. Streicher is a 67 year old female with a personal history of left breast lumpectomy in 2011 for carcinoma. Patient received radiation therapy. She has no current breast complaints. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Stable post-lumpectomy changes are present in the left upper outer breast. There is no abnormal enhancement seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: Stable postsurgical changes of the left breast. No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.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: 58-year-old female with fibroids, sciatica, unspecified pelvis and perineal pain. PELVIS:UTERUS, ADNEXA: Redemonstrated is an enlarged , lobular fibroid uterus. The uterus measures 9.1 x 10.6 x 8.5 cm. There is mass effect on the endometrial canal. The largest is a left intramural fibroid measuring 7.6 x 7.0 cm. There are subserosal fibroids on the right.BLADDER: No significant abnormality noted.LYMPH NODES: No significant lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Enlarged uterine fibroids as described above.


Instruction: Generate impression based on medical findings.

Input: 46-year-old female with right kidney lesion ABDOMEN:LIVER, BILIARY TRACT: T2 hyperdense cyst in the posterior right liver lobe. Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post right partial nephrectomy. T2 hyperintense simple cyst in the right kidney. Enhancing subcentimeter nodule at the right kidney resection bed measuring 6 x 5 mm (series 12, image 296). This lesion corresponds to the enhancing nodule seen on prior CT, unchanged in size since 9/10/2015. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Partial right nephrectomy with unchanged (from 9/2015 CT imaging) subcentimeter enhancing nodule in the surgical bed, differential considerations include postsurgical sequelae but continued followup suggested.


Instruction: Generate impression based on medical findings.

Input: Male 65 years old Reason: US--lesion in dome of liver History: HBV carrier ABDOMEN:LIVER, BILIARY TRACT: Liver has a smooth contour. There are multiple punctate T2 hyperintense foci compatible with small cysts. T2 hyperintense focus in segment 8 of the liver without central enhancement is also likely a cyst. No solid focal lesion is identified to correspond to the abnormality on ultrasound. Hepatic and portal veins are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Scattered hepatic cysts without suspicious lesion to correspond to the abnormality on ultrasound.


Instruction: Generate impression based on medical findings.

Input: Evaluation is limited due to lack of coronal T2-weighted images, and axial T2-weighted images are not of usual FSE technique. 3-D SPGR images are degraded by artifact. Axial T1 inversion recovery images are also not available to aid with myelination evaluation.There are numerous scattered foci of susceptibility, slightly more tubular in appearance along the right parietal lobe near the convexity, possibly representing hemosiderin deposition along the gray-white junction. Additional punctate foci are seen along the left anterior mid frontal lobe, the right anterior temporal lobe, the right greater than left occipital lobe, along the left greater than right tentorium, as well as near the cerebellar tonsils, perhaps along the fourth ventricular outflow on the left side. These are predominantly peripheral in location, possibly at the gray-white junction. The most conspicuous area of abnormal susceptibility is seen along the anterior left temporal lobe which may be subarachnoid in location given its plaque-like configuration. The right occipital lobe finding may involve the peripheral cortex, with possible foci in the adjacent extraparenchymal space.On axial T2-weighted images, there is prominence of extra-axial space along the frontal lobes with no significant traversing vessels, most conspicuous laterally. The collections are near isointense to CSF on all sequences, and remain only minimally hyperintense as suggested on coronal T1 postcontrast images. These measure up to approximately 5 mm in greatest thickness bilaterally. There is no significant prominence of extra-axial space along the anterior temporal lobes or anterior interhemispheric fissure to suggest underlying benign enlargement of subarachnoid spaces of infancy.The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of pathological enhancement. There is no diffusion abnormality.Normal flow-voids are demonstrated in the major intracranial vascular structures. The left cerebellar tonsil is minimally pointed in configuration, although does not appear to extend abnormally below the level of the foramen magnum. The remainder of the midline structures and craniocervical junction are within normal limits. There is scattered paranasal sinus opacification. There is also fluid opacification of bilateral middle ears and mastoids, greater on the right.

Output: 1.Essentially chronic small bilateral predominantly frontal subdural hematomas, with signal only very minimally greater than CSF on T1-weighted images, although evaluation is somewhat limited as detailed above.2.Multiple scattered areas of hemosiderin staining, with most conspicuous areas in the left anterior temporal region which may be subarachnoid in location, as well as more tubular appearing areas along the right parietal cortex likely near the gray-white junction. Other scattered foci are also more peripheral in location as well as possibly along the tentorium. Findings may relate to a shear injury mechanism, resulting in areas of focal axonal injury. Please correlate with any history of trauma, including nonaccidental trauma.3.Bilateral mastoid and middle ear fluid opacification. Please correlate clinically.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old, status post craniotomy for tumor resection. Compared to 2/19/2016, there has been evolution of postsurgical changes with decrease in blood products in the posterior fossa. Compared to 2/19/2016, there has been interval increase in heterogeneously enhancing tissue surrounding the resection cavity. The degree of FLAIR hyperintensity is minimally increased involving the cerebellar vermis and right greater than left cerebellar hemispheres. Partial effacement of the fourth ventricle is again seen. Ventricles remain not significantly changed in size with mild prominence, likely related to volume loss. No new lesions are seen elsewhere in the brain. A nonspecific focus of T2 hyperintensity within the white matter adjacent to the left frontal horn is unchanged. No evidence of significant intracranial mass effect, midline shift, or herniation.

Output: Compared to 2/19/2016 there has been interval increase in heterogeneously enhancing tissue surrounding the cerebellar resection cavity, which given history of recent radiation may reflect posttreatment change, but suggest close follow-up to exclude the possibility of true tumor progression.


Instruction: Generate impression based on medical findings.

Input: Decreased rectal tone, Left lower extremity pain and weakness. Reason for study: evaluate for spinal cord compression. The vertebral bodies are appropriate in the overall alignment and height. The spinal cord has normal signal characteristics and overall morphology. There is no acute cord compression. Multilevel spondylotic changes are seen in the cervical and lumbar spine which does narrow the spinal canal in some places. There is a synovial cyst in the right subarticular L4-L5 level which does narrow the spinal canal and was present on previous exam. There is bilateral degenerative advanced facet arthropathy with facet effusion at L4-L5, unchanged. No concerning marrow signal changes.

Output: No acute cord compression is identified. Multilevel degenerative changes noted.


Instruction: Generate impression based on medical findings.

Input: Respiratory distress syndrome. Extreme prematurity (born at 27 weeks gestational age; now 38 weeks). History of septic shock. Myelination is appropriate for the adjusted gestational age. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are preserved. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is fluid intensity in the left middle ear cavity and mastoid air cells.

Output: 1.No definite evidence of acute intracranial hemorrhage, mass, or acute infarct. 2.Myelination is appropriate for the adjusted gestational age.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old. Pain. Evaluate for rotator cuff tear. Several sequences are limited by patient motion artifact. Multiple foci of signal void are noted in the soft tissues above the humeral head presumably representing metallic susceptibility artifact from prior surgery.ROTATOR CUFF: There is a full-thickness tear of the supraspinatus tendon with approximately 1 cm of proximal retraction. The tear involves the majority of the supraspinatus tendon, although a small portion of the tendon posteriorly appears to extend to the greater tuberosity. The remainder of the supraspinatus tendon appears thinned, likely reflecting chronic attritional tearing. There is mild fatty atrophy along the myotendinous junction. Otherwise, the supraspinatus muscle appears normal. Mild tendinosis affects the infraspinatus tendon, but we see no full-thickness tear. There is mild fatty atrophy of the infraspinatus muscle. The teres minor muscle and tendon are intact. There is increased signal intensity in the subscapularis tendon distally indicating moderate to severe tendinosis and interstitial tearing with propagation of tearing along the myotendinous junction and formation of a small intramuscular cyst. Small cysts are seen in the underlying lesser tuberosity. The subscapularis muscle appears intact. The coracohumeral interval is approximately 7 mm, raising the possibility of subcoracoid impingement.SUPRASPINATUS OUTLET: There is widening of the acromioclavicular joint presumably reflecting prior surgery. There is fluid in the subacromial/subdeltoid bursa, likely reflecting the patient's rotator cuff tear. The coracoacromial ligament appears slightly thickened.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is perhaps mild osteoarthritis of the glenohumeral joint. Intermediate signal intensity within the superior labrum suggests degeneration, but we see no fluid-filled labral tear. There is a small glenohumeral joint effusion with fluid concentrating in the subscapular recess.BICEPS TENDON: Although the tendon of the long head of the biceps is visualized within the bicipital groove, it is not visualized in the rotator interval, which may reflect rupture or prior tenotomy.

Output: 1.Full-thickness near-complete tear of the supraspinatus tendon with additional rotator cuff tendinopathy as described above.2.Surgical changes of acromioclavicular joint resection as above.3.Degeneration of the superior labrum with nonvisualization of the intra-articular biceps tendon, presumably reflecting rupture or prior tenotomy.


Instruction: Generate impression based on medical findings.

Input: 20 year old male with a history of IBD. Assess for perianal fistula. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Again seen is wall thickening involving the distal sigmoid colon and proximal rectum. Again seen are foci of increased T2 signal abnormality within the bowel wall as well as increased mesenteric vascularity, compatible with active inflammation. Redemonstrated transsphincteric perianal fistulae arising at the 5 o'clock and 7 o'clock positions extending to the skin surface with bilateral setons in place, appearing similar to the prior study. There is interval increase in size of the fluid collection along the right gluteal crease, measuring 11 mm in diameter, consistent with abscess formation (64; series 4). Additionally, note is made of an intersphincteric fistula extending from the 6 o'clock position of the which extends to the skin surface along the left gluteal crease and may communicate with the aforementioned left transsphincteric fistula, which appears more pronounced when compared to the prior examination. BONES, SOFT TISSUES: Heterogeneous lesion within the medial right iliac bone has high T1 and high T2 signal with mild peripheral enhancement consistent with a hemangioma. Heterogeneous bone marrow signal likely represents islands of red marrow.OTHER: Bilateral testicular hydroceles.

Output: 1.Persistent bilateral perianal fistula formation, as detailed above. There is slight interval increase in size of a 11-mm fluid collection along the right gluteal crease consistent with abscess formation. Additionally, a right intersphincteric fistula appears more pronounced when compared to the prior study.2.Acute on chronic inflammatory changes involving the sigmoid colon and rectum compatible with known inflammatory bowel disease.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old, with right leg weakness and numbness, follow-up epidural hematoma. A T2 hyperintense, T1 intermediate collection is again seen within the dorsal epidural space at the L4-5 disc level with rim enhancement compatible with an epidural hematoma. On comparison with the prior examination, this collection is no larger and, in fact, may even be slightly decreased in size.As before, this collection contributes, along with a bulging disc and central disc protrusion as well as facet and ligamentum flavum hypertrophy, to a significant spinal canal stenosis which, again, is stable or perhaps mildly improved. There remains some degree of crowding of the cauda equina nerve roots at this level. Mild to moderate bilateral foraminal narrowing is seen, not significantly changed.No significant degenerative disc disease is seen from T12-L1 through L2-3. At L3-4, facet and ligamentum flavum hypertrophy and bulging disc along with prominence of the dorsal epidural fat contribute to a significant spinal canal stenosis and crowding of the cauda equina which are unchanged. Mild bilateral foraminal narrowing is seen.At L5-S1, facet hypertrophy, ligamentum flavum thickening and a bulging disc contribute to a mild generalized spinal canal stenosis. The right neural foramen is severely narrowed and the left neural foramen is moderately narrowed.The lumbar lordosis is straightened. A slight retrolisthesis of L3 relative to L4 is unchanged. No areas of concerning marrow signal abnormality are seen apart from patchy fatty replacement and fatty degenerative endplate change at L4-5.

Output: 1.An epidural hematoma dorsal to the thecal sac at L4-5 is stable to slightly decreased in size. There remains a significant spinal canal stenosis at this level with crowding of the cauda equina, though the degree of stenosis may also be slightly improved. Mild to moderate bilateral foraminal narrowing at this level is unchanged.2.A significant spinal canal stenosis is also unchanged at L3-4 secondary to disc degeneration and posterior element hypertrophy.3.Severe right neuroforaminal narrowing at L5-S1 is unchanged.


Instruction: Generate impression based on medical findings.

Input: Interpretation of outside lumbar spine MRI dated 6/7/2014 is requested. Spina bifida and tethered cord and burning sensation in her foot. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position at the lower L1 level.Mild degenerative changes are seen with mild disc desiccation at all levels, individual levels as described below:L1-L2: Minimal disc bulge and small Schmorl's node. Endplate marrow signal changes involving the superior endplate of L2 are on a degenerative basis. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. Tiny Schmorl's node involving the anterior superior L3 endplate. No spinal canal or neural foraminal stenosis.L3-L4: Tiny dorsal annular fissure. Otherwise no significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: Small left dorsal annular fissure and minimal disc bulge eccentric to the left. No spinal canal or right neural foraminal stenosis. Minimal left neural foraminal narrowing.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: Mild degenerative changes in the lumbar spine with minimal left L4-L5 neural foraminal narrowing. Otherwise no spinal canal or neural foraminal stenosis in the remainder of the lumbar spine. No findings to suggest tethered cord.


Instruction: Generate impression based on medical findings.

Input: 39-year-old male with severe foot cellulitis. Evaluate for osteomyelitis. TENDONS: There is circumferential fluid signal about the flexor hallucis longus and flexor digitorum tendons which may represent a tenosynovitis.ARTICULAR SURFACES AND BONE: There is increased signal abnormality on fluid sensitive sequences within the proximal and distal phalanx of the first digit/great toe of the right foot. There is no decreased T1 signal abnormality or enhancement on postcontrast sequences associated with this finding, which likely represents reactive osteitis. No evidence of cortical destruction or other findings to suggest osteomyelitis.ADDITIONAL

Output: Findings consistent with stated history of soft tissue ulceration along the plantar aspect of the great toe with extensive inflammatory change in the surrounding area, without evidence of osteomyelitis.


Instruction: Generate impression based on medical findings.

Input: Unspecified esotropia [H50.00], Possible Mobius syndrome Esotropia, possible CN 6 palsy, also with sensorineural hearing loss. Medial rectus recession. The examination is limited by motion artifact.With regards to myelination, there is no significant deviation from the expected normal for patient's age. The dorsal pons and middle cerebellar peduncles appear slightly hypoplastic. The gray-white matter differentiation is preserved. No midline shift or mass effect is appreciated. The cortical sulci are in proportion to the cerebral ventricles. No intracranial hemorrhage is identified. There is no diffusion restriction to suggest acute ischemia. No abnormal parenchymal enhancement is seen. There is fluid present in the right mastoid air cells with mild scattered paranasal sinus because of thickening.The bilateral internal auditory canals are suboptimally evaluated secondary to motion artifact and technique, however appear to be grossly unremarkable. No cerebellopontine angle masses are identified. The CSF spaces around the brainstem are visualized.The globes appear symmetric and normal in size. The bilateral optic nerves demonstrate normal caliber and signal intensity. The ocular muscles appear unremarkable. No abnormal postcontrast orbital enhancement is identified.

Output: 1. The dorsal pons and middle cerebellar peduncles appear slightly hypoplastic. The cranial nerves are not well delineated on this examination. If further evaluation is needed, a dedicated cranial nerve protocol may be considered.2. There is fluid present in the right mastoid air cells with mild scattered paranasal sinus mucosal thickening.3. Grossly unremarkable appearance of the bilateral orbits.