Instruction: Generate impression based on medical findings.

Input: Global developmental delay, truncal hypotonia, and lower hyper-reflexia. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. Mild patchy areas of T2 hyperintensity in the posterior periventricular white matter regions may represent terminal zones of myelination. The brain parenchyma and pituitary gland otherwise appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Spine: The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The conus medullaris lies at the L1-2 level. There appears to be fine linear T1 hyperintensity along the filum terminale at the L4-5 level. The paravertebral soft tissues are unremarkable.

Output: 1. No evidence of intracranial malformations.2. Apparent fine linear T1 hyperintensity along the filum terminale at the L4-5 level may represent a fibrofatty filum. The spine otherwise appears unremarkable.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Lung cancer with history of treated brain metastases. Please reassess disease. Signs and symptoms: Same. Enhanced head CT:No additional contrast is given for this exam. This examination was performed immediately post enhanced CT of chest abdomen and pelvis.There is no evidence of metastatic disease of brain parenchyma, leptomeninges or the calvarium. Aexamination demonstrates a developmental venous anomaly of the left anterior temporal lobe as was noted on prior enhanced brain MRI examination.The cortical sulci, ventricular system and CSF cisterns remain operating normal. Very subtle subcortical and periventricular low attenuation of white matter as was noted on prior brain MRI history to represent small vessel ischemic disease of indeterminate age.

Output: 1.No evidence of metastatic disease.2.Minimal small vessel ischemic strokes of indeterminate age.3.Revisualization of the left anterior temporal lobe development of venous anomaly.


Instruction: Generate impression based on medical findings.

Input: Daily worsening migrainous headache with dizziness. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a right parietal lobe developmental venous anomaly. The brain parenchyma otherwise 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 intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. Incidental right parietal lobe developmental venous anomaly.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Unspecified optic neuritisClinical question: evaluate for autoimmune processSigns and Symptoms: vision loss MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated within the brain parenchyma. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate minor opacities.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI orbits:The eyeballs are intact. No intraconal or extraconal space mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. There is no optic nerve enhancement appreciated. The suprasellar cistern is intact .Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.No abnormal enhancing lesions are appreciated 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. There is a minor disc bulge present at this level.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a minor disc bulge present at this level.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a minor disc bulge present at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.MRI of the brain and orbits is within normal limits. There is no evidence for optic neuritis there are no stigmata of demyelinating disorder appreciated intracranially.2.No abnormal lesions are appreciated within the cervical spinal cord. There is no significant compromise to the cervical spinal canal or exiting nerve roots.


Instruction: Generate impression based on medical findings.

Input: 54-year-old male patient with severe back pain after fall. Pelvis: Three parallel pins affix the left proximal femur in near anatomic alignment. Osteoarthritis affects both hips with osteophyte formation and subchondral sclerosis. No acute fracture is evident.Lumbar spine: There is compression deformity of the L1 vertebral body with anterior wedging, which was not present on prior MRI from 6/4/2015. The remaining vertebral body heights are preserved. Mild degenerative changes affect the lumbar spine with small anterior osteophytes and facet joint osteoarthritis.

Output: Age indeterminate compression deformity of the L1 vertebral body, which was not present on prior MRI from 6/4/2015.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Cortical IPH. Signs and symptoms: Confusion. Pre-and post-enhanced brain MRI:Diffusion weighted images demonstrate previously known small parenchymal hematoma in the left posterior temporal and unremarkable otherwise.Examination demonstrates an acute superficially located hematoma in the left posterior temporal lobe measuring at 12 times 17-mm in size and with minimal surrounding vasogenic edema and associated mass effect. There is no interval change since prior head CT exam.In addition the study demonstrates findings of moderate chronic nonhemorrhagic small vessel ischemic strokes in the subcortical and periventricular white matter of cerebral hemispheres, bilateral basal ganglia, left thalamus and minimally in the right pons.Post enhanced images are negative for any abnormal parenchymal or leptomeningeal enhancement and there is also no detectable enhancement of the left temporal hematoma or its surrounding parenchyma. The signal intensity of calvarium and soft tissues of the scalp remains in normal and without abnormal enhancement.Unremarkable images through the orbits and including axial fat sat post enhanced series.All paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal pattern.

Output: 1.Negative diffusion weighted series.2.Left temporal small parenchymal hematoma measuring 12 x 17-mm and without abnormal enhancement. Nonhemorrhagic small vessel ischemic strokes of moderate degree.3.No detectable abnormal enhancement.4.Chronic


Instruction: Generate impression based on medical findings.

Input: Reason: hx atypical meningioma. Eval for growth History: none- surveillance Postoperative changes are again seen from previous right parietal craniotomy with paramedian craniectomy with subsequent cranioplasty.There is a small focus of diffusion restriction and intrinsic T1 hyperintensity anterior to the left paramedian parietal resection cavity with peripheral susceptibility, likely representing a small hematoma. There are other areas of other curvilinear susceptibility along the parietal lobes bilaterally, greater on the left side, consistent with chronic hemosiderin deposition. There is a similar configuration of extra-axial fluid subjacent to the craniectomy.There is redemonstration of an irregular heterogeneously enhancing nodule along the left parietal lobe at the upper margin of the resection cavity. Overall the pattern of enhancement appears slightly less confluent than on the prior exam, with a more lacelike appearance despite similar order of postcontrast imaging. This area of nodular enhancement measures up to 2.4 cm on the current exam on 1201/122, compared to previous comparable 2.8 cm. However, the rind of enhancement along the anterior aspect of the resection cavity measures 8 mm in greatest thickness on the current exam, previously 5 mm. In addition, there is a small area of new nodular enhancement anteromedial to the resection cavity as seen on 1201/128 which measures 6 x 5 mm in greatest axial dimensions. More inferiorly, this area of nodularity is again confluent with the prominent nodular enhancement located along the inferior aspect of the resection cavity extending to the right of midline which appears similar in overall size.The degree of T2/FLAIR hyperintensity within the surrounding parietal lobes in a vasogenic pattern appears similar. Areas of cystic degeneration are again seen along the right parietal lobe appears stable in size. Other scattered foci of nonspecific T2/FLAIR hyperintensity are seen within the periventricular and subcortical white matter. Ventricular caliber appears similar consistent with global volume loss.There is persistent left frontal sinus opacification. Scattered ethmoidal air cell opacification is also noted.

Output: 1.Findings concerning for slight progression of tumor at the site of prior tumor resection in the high parietal regions, although slight decreased size and confluence of enhancement of the more superior posterior heterogeneous nodule.2.Stable pattern of edema the parietal lobes with evidence of cystic encephalomalacia in the right parietal lobe.3.Small focus of likely interval blood product anterior to the resection cavity.


Instruction: Generate impression based on medical findings.

Input: Ms. Williams is a 35-year-old female with a personal history of left breast lumpectomy in 2013 for triple negative IDC. Patient did not receive any chemotherapy or radiation therapy. Personal history of benign left MRI guided biopsy. She has no current breast related complaints. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Few scattered enhancing foci are identified bilaterally, all of which appear stable in appearance and distribution when compared to prior examination. Stable postsurgical changes are identified in the left upper outer breast, at site of prior lumpectomy. Susceptibility artifact from biopsy marker clip is stable in the left upper outer breast. There is no new 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.


Instruction: Generate impression based on medical findings.

Input: Headache and blurred vision. History of pituitary macroadenoma, status post resection. Head CT scan from June 5, 2016 showed evidence of enlargement. BRAIN:There is no acute infarct or intracranial hemorrhage. There is no mass-effect, midline shift or brain herniation. The ventricles and the other CSF-containing spaces are normal in size. The brain parenchyma is unremarkable. Apart from a small right frontal developmental venous anomaly, the brain shows no abnormal contrast enhancement. The major intracranial vascular flow voids are preserved.There is moderate mucosal thickening in the left maxillary, left sphenoid and posterior right ethmoid sinuses associated with frothy secretions. In the proper clinical setting, this may reflect sinusitis. Orbits are unremarkable as well. The skull and scalp soft tissues are grossly unremarkable. There is mild nonspecific thickening of the nasopharyngeal mucosa with tiny retention cysts near midline. The parotid glands remain enlarged with small intraglandular nodes.PITUITARY:Compared to the previous, postoperative examination from May 2007, there has been increase in the size of the sellar mass with regrowth of the suprasellar part of the mass. The mass measures 24 mm craniocaudally, 21 mm anteroposteriorly and 27 mm in transverse compared to 11 mm, 15 mm and 19 mm previously. The mass is multilobulated and shows heterogeneous pattern of contrast enhancement with foci of poor contrast enhancement and dark T2 signal, which may indicate small cysts with high protein content. The mass superiorly displaces and compresses the optic chiasm and hypothalamus, more on the right than on the left. Laterally, the mass extends to partially encase the horizontal cavernous segment of the left internal carotid artery, with high likelihood of left cavernous sinus invasion. The mass abuts and partially compresses the right cavernous sinus though without definite sign of invasion. Both A1 segments are abutted by the mass but remain patent. The floor of the sella has been remodeled but there is no sign of intraosseous invasion. There are also changes of previous transsphenoidal resection.

Output: 1.There has been regrowth of the pituitary macroadenoma with significant suprasellar component, and displacing and compressing the optic chiasm. There is also suggestion of involvement of the left cavernous sinus.2.The brain shows no significant abnormality otherwise.3.Mucosal thickening and frothy secretions in the paranasal sinuses may indicate sinusitis in the proper clinical setting.


Instruction: Generate impression based on medical findings.

Input: Female 42 years old with left knee and ankle pain Knee: There are tiny osteophytes and there is a slight lateral tilt of the patella but otherwise the knee appears normal.Ankle: There is a mild Haglund deformity and small posterior and plantar calcaneal spurs appearing similar to the prior study.

Output: 1.Mild Haglund deformity and small calcaneal spurs perhaps of no clinical significance. We otherwise see no findings to explain the patient's ankle pain.2.Small osteophytes in the knee and mild lateral tilt of the patella.


Instruction: Generate impression based on medical findings.

Input: Right knee pain MENISCI: There is thinning and horizontally oriented increased signal intensity involving the posterior horn of the medial meniscus which extends to the tibial articular surface and is compatible with tear. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is marked full-thickness cartilage loss of the lateral femoral condyle, particularly anteriorly. This is superimposed upon mild diffuse thinning of the lateral compartment. Similar full-thickness loss is noted involving the medial femoral condyle anteriorly with full-thickness loss of the medial tibial plateau. There are areas of near full-thickness loss involving the lateral patellar facet with areas of heterogeneous signal intensity seen more centrally.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Predominantly horizontal tear of the posterior horn of the medial meniscus.2. Full-thickness cartilage loss of both the lateral and medial femoral condyle anteriorly with additional areas of cartilage loss and thinning detailed above.


Instruction: Generate impression based on medical findings.

Input: There is redemonstration of small focus of evolving restricted diffusion in the right inferior parietal lobe, that measures 12 mm and a punctate lesion of restricted diffusion in the left inferior parietal lobe. Additional focus of restricted diffusion is also visualized within the subcortical white matter of the right pre-cuneus and within the pons. These foci are unchanged since the previous study and are associated with hyperintensity in the T2/FLAIR sequences.. There are no new foci of restricted diffusion.There are T2/FLAIR hyperintensities in the pons and in the right middle cerebral peduncle with no restricted diffusion, unchanged since the previous study. There are punctate foci of T2/FLAIR hyperintensities in the periventricular and subcortical white matter representing chronic small vessel ischemic changes.Again noted diffuse punctate susceptibility signals throughout the brain, likely representing hemosiderin deposition. The pattern is suggestive of amyloid angiopathy.There is diffuse leptomeningeal FLAIR hyperintensity which may suggest meningoencephalitis, encephalitis, or vasculitis.Ventricular size is stable. No evidence of acute hemorrhage. Basal cisterns are patent. The T2 flow-voids are unremarkable.There is diffuse edema in the visualized cervical spinal cord.There is mucosal thickening in the maxillary sinuses and opacities in the mastoid air cells, most likely due to the patient being intubated.

Output: 1.A small focus of infarction in the right inferior parietal lobule and microinfarcts in the right and left parietal lobes are stable and compared to the prior exam.2.Findings suggest a leptomeningeal disease. Differential considerations include meningoencephalitis, encephalitis, or vasculitis.3.Diffuse edema in the visualized spinal cord extends to the lower medulla.4.Multiple microhemorrhages are identified in subcortical white matter with a pattern of distribution suggestive of amyloid angiopathy.


Instruction: Generate impression based on medical findings.

Input: Headache(784.0) [784.0] / Subarachnoid hemorrhage [430], Reason for Study: ^Reason: evaluate for SAH, angio today consistent w/ vasospasm RCVS vs. Vasculitis History: recurrent thunderclap headache, beading on angiogram There is no evidence of acute ischemic or hemorrhagic lesion on the scan.The left lateral orbital gyrus is prominent and appears to be connected to the left inferior frontal lobe pars orbitalis. However, there is no evidence of abnormal gray matter and the thickness of gray matter on this region appears to be normal indicating normal variation. 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, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion.No evidence of intra and extra axial mass lesion.Normal variation of left lateral orbital gyrus connection to the left inferior frontal gyrus pars orbitalis.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old, with numbness on the left side of the body. History of ruptured aneurysm. Evaluate for change in basilar outpouching. A slitlike hemosiderin stained cavity is redemonstrated spanning the right subinsular and basal ganglia regions, without significant interval change. A punctate focus of susceptibility along the posterior limb of the left internal capsule is unchanged as well.Scattered patchy periventricular and subcortical white matter T2 hyperintensities are again seen without significant interval change. No edema or mass effect is detected. No restricted diffusion is seen. No abnormal extra axial fluid collections are present. The ventricles are normal in size and morphology.Mild/moderate narrowing of the cavernous ICAs is again seen. The ACOM artery is prominent and within normal limits. A moderate focal stenosis of the left A1 segment is unchanged. The left ACA is also generally of smaller caliber than the right, a stable finding. Scattered mild focal stenoses are probably present in the MCA distributions, similar to prior.The right vertebral artery is dominant. The left vertebral artery primarily supplies the PICA. Mild irregularity of the basilar artery is again seen. A 2 mm medially directed apparent outpouching is redemonstrated from the basilar artery at approximately the origin of the left AICA. This finding has not significantly changed. The basilar tip and PCAs are unremarkable. A moderately sized right and small left PCOM artery are present.

Output: 1.Stable hemosiderin-stained slitlike cavity in the right subinsular and basal ganglia regions likely representing an old cerebral hemorrhage or hemorrhagic infarct.2.Scattered T2 hyperintensities are not significantly changed likely representing moderate chronic small vessel ischemic disease.3.2 mm outpouching from the mid basilar artery is unchanged.4.Scattered intracranial atherosclerotic disease is unchanged.


Instruction: Generate impression based on medical findings.

Input: Symptomatic pontine cavernous malformation, associated with venous anomaly. Symptoms abated for a number of years, then the lesion grew with new gaze symptoms in 2010. The cavernoma was exophytic at the fourth ventricular floor and was resected via a posterior fossa trans-vermian exposure.. There are postoperative findings related to suboccipital craniotomy and trans-vermian approach for resection of a posterior pontine cavernous malformation, where there is a crescentic area of susceptibility effect that measures up to 8 mm in length. There are multiple other punctate foci of susceptibility effect in the pons and midbrain. There is also a left pons developmental venous anomaly. There is diffuse cerebral white matter T2 hyperintensity, primarily in a periventricular distribution. There is also nonspecific patchy T2 hyperintensity in the medulla. The ventricles and basal cisterns are normal in size. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is a nodule lesion in the left nasal bridge subcutaneous tissues that measures up to 12 mm and which likely represents an inclusion cyst. There is bilateral maxillary sinus mucosal thickening with fluid on the right side.

Output: 1. Postoperative findings related to resection of a posterior pontine cavernous malformation with an associated left pons developmental venous anomaly. Areas of susceptibility effect along the margin of the surgical bed may represent postoperative hemorrhage versus residual hemosiderin that comprised the periphery of the cavernous malformation. More precise characterization is otherwise limited without available preoperative imaging.2. Punctate areas of susceptibility effect in the pons and midbrain beyond the surgical bed may represent microhemorrhages or additional cavernous malformations.3. Findings suggestive of acute sinusitis.


Instruction: Generate impression based on medical findings.

Input: Pain. Carpal abutment with possible TFCC tear. LIGAMENTS: The lunotriquetral and scapholunate ligaments appear intact. No contrast is noted within the midcarpal joint space.TRIANGULAR FIBROCARTILAGE COMPLEX: There is mild intermediate signal intensity within the ulnar fibers and lamina of the articular disc of the triangular fibrocartilage which may reflect focal degeneration or synovitis, but this is equivocal, and I see no gadolinium traversing the disc to indicate a tear. No gadolinium is noted within the distal radioulnar joint. Gadolinium does extend from the radiocarpal joint proximally along the medial aspect of the distal ulna volar to the extensor carpi ulnaris tendon, which could represent disruption of the medial capsular structures, but the clinical significance of this finding is uncertain.TENDONS: There is a longitudinal split of the extensor carpi ulnaris tendon distal to the ulnar styloid. The tendon otherwise appears normal, without fluid in the sheath, and hence this may represent a normal variant. The remaining tendons appear normal. BONES: The bones of the wrist appear normal.

Output: Possible mild focal degeneration/synovitis of the ulnar fibers and lamina of the articular disc of the triangular fibrocartilage, but this is equivocal and no fluid-filled tear is evident. Gadolinium extending from the radiocarpal joint proximally along the medial aspect of the ulna could represent a defect in the medial capsular structures, but is of uncertain clinical significance.


Instruction: Generate impression based on medical findings.

Input: 69 years Female (DOB:8/21/1947)Reason: evaluate for possible encephalomalacia History: dysarthria and dysphagiaPROVIDER/ATTENDING NAME: NAOUM ISSA NAOUM ISSA The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There is an 18 x 11 mm extra-axial mass adjacent to the right cavernous sinus and internal carotid artery. It encircles the right anterior clinoid.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.

Output: 1.There is an extra-axial mass suspicious for meningioma located in the right paraclinoid region. It abuts the right optic nerve. If clinically appropriate postcontrast imaging may be of further benefit in evaluating this.2.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on medical findings.

Input: Female, 7 months old, full term twin, with poor head growth. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen.The corpus callosum is fully formed and intact. The pattern of white matter myelination is within normal limits for age. The region of the pituitary gland is normal. The brainstem, cerebellar vermis and cerebellar hemispheres are also within normal limits.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology.

Output: Unremarkable evaluation of the brain.


Instruction: Generate impression based on medical findings.

Input: CERVICAL SPINE: Redemonstrated is a small caliber syrinx of the cervical cord without significant interval change in size or extent since prior study. The largest transaxial dimension of the syrinx measuring approximately 1.5 mm at the C6 level is unchanged. There is mild straightening of the cervical spine. The vertebral body and disc heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. There is no significant disc bulge, herniation, spinal canal or foraminal stenosis within the cervical spine. THORACIC SPINE: Redemonstrated is a mildly expansile syrinx of the mid to lower thoracic cord extending from T6 to L1 similar to the prior exam. The syrinx at T8 measures 3.9 x 3.9 mm (AP x TR), previously 3.5 x 3.8 mm. The syrinx at T11 measures 3.9 x 3.5 mm (AP x TR), previously 3.9 x 3.5 mm. The cord terminates at upper L2 level. The thoracic spine is in normal alignment, with a normal thoracic kyphosis. The vertebral body and disc heights are well maintained. No worrisome focal marrow signal abnormality is appreciated. There is no significant disc bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine.

Output: 1. Stable appearance of syrinx in the cervical and mid to lower thoracic cord, without significant interval change in size and extent from prior exam.2. No significant spinal canal or neural foraminal stenosis.


Instruction: Generate impression based on medical findings.

Input: 43 year-old status post left lumpectomy in July 2015 and re-excision in September 2015 for DCIS. Final pathology reported negative surgical margins. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There are post-surgical changes, including a seroma, mild architectural distortions and a few surgical clips at 12:00 position in the left breast. No abnormal enhancement is seen near the surgical site in the left breast. An enhancing focus is unchanged in the left breast at upper outer quadrant. No suspicious enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. Stable enhancing focus in the left upper outer quadrant.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on medical findings.

Input: Foot pain Moderate osteoarthritis affects the first MTP joint. Small plantar and posterior calcaneal spurs are noted. The Achilles tendon silhouette appears thickened and slightly indistinct; this may reflect tendinosis but if there is clinical concern for tear, MRI can be obtained.

Output: Osteoarthritis of the first MTP joint with other findings described above.


Instruction: Generate impression based on medical findings.

Input: New onset lower back pain, evaluate for compression fracture. Five lumbar type vertebral bodies are presumed to be present. Again seen are compression fractures throughout the lumbar spine as well as the partially imaged lower thoracic spine. There is evidence of cement augmentation from the T12 through the L5 levels. Compared to 7/8/2016 there has been development of a mild compression fracture involving the superior endplate of the T11 vertebral body with minimal loss of height involving the mid aspect of the superior endplate. There is mild edema involving the superior aspect of the T11 level. In the interval, there has also been subtle worsening of height loss involving the L3 compression fracture involving the anterior aspect of the superior endplate, better seen on the T1-weighted sequence with bone cement now contacting the superior endplate. There is minimal edema involving the superior anterior endplate of L3 which is slightly decreased in the interval. Bone marrow edema involving the superior aspect of the T11 vertebral body is new. Remainder of the compression fractures are not appreciably changed. As seen before, there is mild retrolisthesis associated with the L4 compression fracture with up to moderate degree of spinal canal stenosis in association with the ligamentum flavum thickening and bilateral facet arthropathy. The degree of spinal canal stenosis is not significantly changed in the interval. Alignment of the lumbar spine is also not significantly changed including grade 1 anterolisthesis of L3 on L4.Multilevel degenerative changes also include mild multilevel disc bulges and moderate facet arthropathy throughout the lumbar spine. Aside from the L3-L4 level there is no high-grade spinal canal stenosis. Mild multilevel neural foraminal stenosis is present at all levels without high-grade foraminal stenoses at any level.Diffusely heterogeneous marrow signal is again noted. STIR hyperintense lesions are noted involving the left aspect of the sacrum and compatible with history of multiple myeloma. These lesions aren't completely imaged on this lumbar spine study.

Output: 1. Compression fractures involving all lumbar vertebral levels and the imaged T11 and T12 thoracic vertebral bodies. The T11 compression fracture involving the superior endplate is new and associated with minimal height loss. There is mild edema at this level, which is new.2. Minimal worsening of L3 compression fracture is also suspected. Remainder of the chronic compression fractures are not significantly changed. Retropulsion at the superior L4 level with moderate spinal canal stenosis at L3-L4 is also not significantly changed.3. Heterogeneous marrow signal abnormality again seen. STIR hyperintense lesions involving the left aspect of the sacrum are partially imaged but present previously and compatible with known multiple myeloma.


Instruction: Generate impression based on medical findings.

Input: A 44 year old female with history of heart surgery as an infant ?ASD repair. ECG showed WPW. Referred to cardiac MRI for further evaluation and to rule out ASD. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 83 ml/m2 (normal range: 65+/-11), the LVEDV is 190 ml (normal range 109+/-23), the LV end systolic volume index is 37 ml/m2 (normal range 18+/-5), the LVESV is 86 ml (normal range 31+/-10), the LV mass index is 43 g/m2 (normal range 67+/-11), and the LV mass is 99 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.No intracavitary thrombus was seen.AtriaThe left atrium is normal in size. The LA volume is 71 ml.The right atrium is normal in size. The RA volume is 69 ml. No shunt was noted, no atrial septal defect.Qp:Qs normal (1.08).Right VentricleThe right ventricle is mildly dilated with mildly reduced systolic function. The overall RV ejection fraction is 48%, the RV end diastolic volume index is 106 ml/m2 (normal range 69+/-14), the RVEDV is 243 ml (normal range 110+/-24), the RV end systolic volume index is 54 ml/m2 (normal range 22+/-8), and the RVESV is 125 ml (normal range 35+/-13). Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least mild to moderate tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size (32 mm).Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no pericardial effusion.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function, the LVEF is 55%. There is no late gadolinium enhancement.2. The right ventricle is mildly dilated with mildly reduced systolic function, the RVEF is 48%. 3. The left and right atria are normal in size.4. No hemodynamically significant atrial septal defect appreciated on this study. Qp:Qs normal (1.08).5. There is mild to moderate tricuspid regurgitation.


Instruction: Generate impression based on medical findings.

Input: 40 yo female. Progressive parenchymal abnormality involving the left paracentral lobule with associated right lower extremity seizure. fMRI requested for surgical planning. There is susceptibility artifact from the recent biopsy of the lesion involving the left paracentral lobule. There is also susceptibility effect related to the overlying skull and scalp postoperative changes.There is sensorimotor cortical activation as expected along the pre- and post-central gyri bilaterally for the hand and face.Lower extremity sensorimotor cortical activation also maps as expected to the paramedian paracentral lobules. This activation is of reduced intensity on the left relative to the right. Nevertheless, activity is seen on the left and maps to the posterior edge of the lesion. No definite cortical activation is seen specifically within the lesional tissue but this does not exclude functional capacity within the lesion. Cortical activation in the supplementary motor area was present bilaterally, even somewhat accentuated on the left side of the brain.

Output: Sensorimotor cortical activation maps as expected along the pre and postcentral gyri bilaterally.Sensorimotor cortical activation of the lower extremity is seen bilaterally though the intensity of this activation is markedly reduced on the left. This discrepancy may reflect the patient's right lower extremity clinical deficit, or it could be an artifact related to edema or lesion related neurovascular decoupling. Nevertheless, activity related to the right lower extremity maps along the posterior edge of the left paracentral lobule lesion. The presence of some functional capacity within the lesion is not excluded.


Instruction: Generate impression based on medical findings.

Input: SLE, 3rd lifetime seizures, provoked by URI. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma, including the hippocampi, appears unremarkable. There is a small pontine developmental venous anomaly. 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 mucosal thickening in the left maxillary sinus.

Output: No evidence of potential seizure foci.


Instruction: Generate impression based on medical findings.

Input: The patient submitted outside mammogram dated 6/2/2014, outside ultrasound dated 6/2/2014, and MRI dated 9/9/2014, from UICMC. Submitted outside study was compared to the current mammogram dated 7/23/2015.Interval increase in a circumscribed mass in the right breast at the 5:00 to 6:00 position from 10 to 18 mm; this area mostly corresponds to a clustered cyst seen on ultrasound dated 6/2/2014 with atypical blood flow. No abnormal enhancement is seen on MRI. A few cysts are noted in the right breast with the largest measuring 8 mm.

Output: Clustered cyst in the right breast with atypical blood flow on outside ultrasound, which is increased in size; this area needs further evaluation with ultrasound.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EB - Additional Mammo/Ultrasound Workup Required.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Unspecified convulsions Human immunodeficiency virus (HIV) diseaseDiagnosis Edits: |Clinical question: Pt w/ h/o HIV presenting w/ seizures. Assess for mass lesion or any other possible causesSigns and Symptoms: SeizuresComments: Patient states that he previously had pins placed in his foot. He believes that they have been removed. He states that he has had an MRI since that surgery w/o incident | Given the patient's stated age of 42 there is a mild degree of generalized brain atrophy present. There are some subtle FLAIR and T2 signal hyperintensity along the periventricular white matter. There are also several subcortical punctate foci of FLAIR and T2 signal hyperintensity present.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is mild degree of generalized brain atrophy present which is a little more than what is expected at this age. Given the patient's HIV status and may be related to HIV encephalitis.2.There is some mild FLAIR and T2 signal hyperintensity along the periventricular white matter. Which is nonspecific


Instruction: Generate impression based on medical findings.

Input: 39-year-old female with persistent pain status post sprain TENDONS: There is perhaps mild tendinosis of the peroneus brevis as it courses below the fibular tip, although this is equivocal. Otherwise the peroneus tendons are intact. The tendons of the achilles, tibialis posterior, flexor digitorum longus, flexor hallucis longus, tibialis anterior, extensor hallucis longus, and extensor digitorum longus are grossly intact. LIGAMENTS: A marker was placed along the lateral aspect of the ankle. The anterior talofibular ligament is thickened and poorly defined compatible with prior tear. Its attachment to the talus is also poorly defined. The calcaneofibular ligament is also thickened indicating a sprain. The posterior talofibular ligament is grossly intact. The distal tibiofibular ligament complex is grossly intact. The deep fibers of the deltoid ligament have lost some of their normal striations suggesting prior sprain. ARTICULAR SURFACES AND BONE: Small amount of fluid in the tibiotalar joint which is probably within normal limits. We see no osteochondral defect. Small amount of fluid within the recesses of the subtalar joint is also within normal limits. Tiny osteophytes at the talonavicular joint suggesting mild osteoarthritis.

Output: Findings compatible with prior tear of the anterior talofibular ligament and sprain of the calcaneofibular ligament.


Instruction: Generate impression based on medical findings.

Input: 57-year-old male with history of chronic heart failure abdominal pain The study is limited due to poor perfusion secondary to patient's heart failure. Focal lesions and distal organs cannot be optimally evaluated.ABDOMEN:LUNG BASES: Significant cardiomegaly, bilateral pleural effusions, more prominent on the right compared to the left with dependent atelectasis consistent with patient's known heart failure.LIVER, BILIARY TRACT: Liver is enlarged with dilated hepatic veins and IVC secondary to heart failure. Focal, peripheral increased attenuation in the right lobe of the liver likely represents a perfusion abnormality. Focal lesions in the liver cannot be excluded.SPLEEN: No significant abnormality notedPANCREAS: Pancreas is atrophic with dilated duct and numerous parenchymal intraductal calcifications consistent with chronic pancreatitis.ADRENAL GLANDS: Slightly thickened left adrenal gland.KIDNEYS, URETERS: Perfusion of the kidneys is limited. Extensive atherosclerotic disease involving the aorta and renal arteries. Right renal cyst. Calcifications in the kidneys are likely vascular, however, small stones cannot be excluded.RETROPERITONEUM, LYMPH NODES: Extensive atherosclerotic calcifications involving the entire vasculature atherosclerotic plaques and stenosis involving most of the visceral branches of the abdominal aortaBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of ascites. Generalized anasarca.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: The tip of the left femoral venous catheter is in the right ventricle.Ill-defined enhancing lesions lateral to the right psoas muscle in the pelvis. On image number 79, series number 3, at the inferior aspect of this lesion, the lesion measures 2.4 x 2 cm. The etiology is unknown. MRI of the abdomen and pelvis may be helpful for further evaluation.

Output: Limited study due to poor perfusion secondary to patient's congestive heart failure.Cardiomegaly, bilateral pleural effusions, hepatomegaly, ascites, generalized anasarca secondary to patient's known heart failure.Severe and extensive atherosclerotic disease involving the entire vasculature.The tip of the left femoral venous catheter is in the right ventricle.Severe chronic pancreatitis.Enhancing soft tissue density lesions in the right retroperitoneum, adjacent to the psoas muscle. There etiology is unknown. They may represent neoplasm versus abscess. Further evaluation with MRI may be helpful.Bilateral renal calcifications, most of the more vascular, however, small stones cannot be excluded.Dr. Anveroy (3123) was notified and acknowledged about these findings at the time of dictation.


Instruction: Generate impression based on medical findings.

Input: Shoulder pain There is widening of the acromioclavicular joint with deformity of the distal clavicle, likely result of prior surgery. The shoulder otherwise is unremarkable. There is mild leftward curvature the upper thoracic spine.

Output: Widening of the acromioclavicular joint likely related to prior surgery. Otherwise no specific findings to account for the patient's pain.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Metastatic lung cancer, prostate cancer, rule out brain metastases. Signs and symptoms: Cough. Pre- and post enhanced brain MRI:Unremarkable diffusion-weighted images.Examination demonstrates no detectable abnormal parenchymal, meningeal or calvarium enhancement to suggest metastatic disease.There are scattered punctate foci of FLAIR/T2 hyperintensity in bilateral subcortical and periventricular white matter and minimally in the bilateral basal ganglia and pons highly suggestive of mild chronic small vessel ischemic strokes.Unremarkable cerebral cortex, cortical sulci, ventricular system and CSF spaces otherwise.Examination demonstrates a focus of T2 hyperintense and T1 hypointense enhancing lesion in the left pterygoid muscle measuring at 12 x 17 mm in transaxial dimensions (axial enhanced series 1/4/2001 image 8 and sagittal post enhanced series 1/5/2001 image 9. Considering patient's history of malignancy finding is highly suspicious for focus of metastatic lesion.

Output: 1.No acute intracranial process.2.No detectable calvarium, leptomeningeal or parenchymal enhancement.3.Focus of signal abnormality and enhancement in the left pterygoid muscle measuring at 12-17 mm in transaxial dimensions with evidence of increased muscle size/edema which is suspected of a metastatic lesion. No prior exams for comparison.4.Negative diffusion weighted image and findings suggestive of mild chronic small vessel ischemic strokes as detailed.


Instruction: Generate impression based on medical findings.

Input: Infection skin. Check subcutaneous tissues and bones Extensive atherosclerotic changes with mild stranding of the subcutaneous soft tissues more pronounced proximally. No discrete soft tissue abnormality or evidence to suggest mass or fluid collection and appearance suggest mild cellulitis. The osseous structures are also grossly intact without overt findings to suggest osteomyelitis, however mild periosteal reaction cannot entirely be excluded along the distal fibula. If specific site of concern was identified this would increase sensitivity and serial imaging may be indicated. Specifically three-phase bone scan or possibly MRI if suspicion remains high.Moderate to more pronounced tricompartmental osteophytic changes of the knee are observed incompletely. Specifically a small loose body in the anterior aspect cannot be excluded. Consider dedicated plain film imaging.

Output: Nonspecific changes without overt findings to suggest osteomyelitis. Please see detail and recommendations provided


Instruction: Generate impression based on medical findings.

Input: 68-year-old female with right knee pain and swelling for 6 months. MENISCI: There is increased signal abnormality within the posterior horn of the lateral meniscus which extends to the tibial articular surface consistent with a complex degenerative tear that extends to the body of the meniscus. There is blunting of the anterior horn of the meniscus suggestive of degeneration/tearing with a longitudinal component through the anterior horn of the lateral meniscus. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is full-thickness articular cartilage degeneration along the lateral femoral condyle above the posterior horn of the meniscus as well as along the lateral tibial plateau underlying the posterior horn and body of the meniscus with underlying subchondral signal abnormality which is likely degenerative in etiology. There is a partial-thickness articular cartilage fissure along the lateral facet of the femoral trochlea.Note is made of curvilinear serpentine increased signal abnormality within the distal femoral metadiaphysis and epiphysis as well as within the proximal tibial metadiaphysis and epiphysis consistent with osteonecrosis/bone infarcts. There is apparent subchondral collapse/fracture along the weight bearing surface of the medial and lateral tibial plateau. LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Osteonecrosis of the femur and tibia with apparent focal areas of subchondral collapse/fracture along the medial and lateral femoral condyles.2. Degenerative osteoarthritic changes of the right knee.3. Large joint effusion.4. Tearing of the lateral meniscus as described above.


Instruction: Generate impression based on medical findings.

Input: The left superior parietal lobule enhancing lesion is persistently larger now measuring 7 x 7 mm, previously measured 5 x 4 mm The susceptibility abnormality seen previously is not as conspicuous on this exam which may be due to differences in slice selection. However, the FLAIR hyperintensity is more prominent. An additional punctate enhancing lesion is visualized just posteriorly within the left inferior parietal lobule, which is unchanged. The susceptibility abnormality in this lesion is also unchanged.The left middle frontal gyrus enhancing lesion is stable measuring 3 x 2 mm. This lesion also demonstrates mild susceptibility effect which is unchanged. The punctate focus of enhancement within the left lateral post central gyrus is also unchanged.The left anterior temporal lobe enhancing lesion is stable measuring 6 x 5 mm, but there is now less central enhancement. The susceptibility abnormality is increased compared to the prior exam.The right anterior inferior frontal gyrus enhancing lesion is similar in size measuring 6 x 5 mm. The surrounding FLAIR signal abnormality is also similar to the prior exam. An additional punctate enhancing lesion is noted in the right middle frontal gyrus that was less conspicuous previously and is unchanged.The lesion along the lateral aspect of the junction between the body and frontal horn of the right lateral ventricle, which was less conspicuous on the prior exam, now measures 6 x 6 mm compared to 4 x 5 mm previously.No new lesions. No significant mass effect, midline shift or herniation. There is no diffusion abnormality. There are no extraaxial fluid collections or subdural hematomas. Incidental note is made of a partially empty sella which is a normal variant. Moderate left frontal and anterior ethmoid sinus opacification. Bilateral maxillary retention cysts.

Output: 1.Interval increase in the size of the left superior parietal lobule metastatic lesion with mild increase in the surrounding FLAIR signal abnormality. 2.Interval increase in the size of a right lateral ventricle lesion, and likely represents an additional metastasis.3.Stable size of the remaining six lesions, several of which are punctate. No definite new lesions.


Instruction: Generate impression based on medical findings.

Input: 64 years Male (DOB:7/12/1952)Reason: r/o posterior fossa infarct/lesion History: gait imbalancePROVIDER/ATTENDING NAME: HELENE G. RUBEIZ HELENE G. RUBEIZ There is patchy and T2 and FLAIR signal hyperintensity present within the brainstem.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There are 10-15 punctate foci of signal loss and susceptibility imaging is present in the right centrum semiovale. In isolation this is of unknown clinical significance.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.Periventricular and subcortical white matter lesions of a mild degree and patchy lesions in the brainstem are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on medical findings.

Input: 11-year-old female with chronic right hip pain in the setting of neuroblastoma. Evaluate for right hip pathology. Bone marrow signal intensity is normal. No osseous masses are evident. The femoral head is well-positioned within the acetabulum with no joint space narrowing or effusion.The surrounding soft tissues appear normal. No areas of abnormal enhancement are evident.

Output: No osseous or soft tissue abnormality affect the right hip.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old, with worsening back pain and gait abnormality, and right leg weakness. History of back surgery. Findings compatible with prior surgery are again seen at the L4-5 level where evidence of right-sided laminectomy and facetectomy is demonstrated.The lumbar lordosis is straightened similar to prior. A trace anterolisthesis of L4 relative to L5 has slightly progressed.Vertebral body marrow signal is mildly heterogeneous which likely represents a combination of inhomogeneous fat and superimposed degenerative endplate signal change.Degenerative disc disease has progressed at L4-5 with further loss of disc height. The remaining disc levels appear similar to the prior exam. Level specific findings are as follows below.The visualized spinal cord, conus and nerve roots of the cauda equina are unremarkable except as discussed by level below.T12-L1: Facet hypertrophy. Minimal bulging disc. No significant spinal canal or neuroforaminal stenosis. No significant interval changes.L1-2: Moderate facet hypertrophy and ligamentum flavum thickening. Left anterior disc osteophyte. No significant spinal canal or neuroforaminal stenosis. No significant interval changes. L2-3: Moderate facet hypertrophy and ligamentum flavum thickening. Left anterior disc osteophyte, increased in size. Minimal bulging disc. Prominence of the epidural fat. Slight narrowing of the thecal sac without change. Mild left foraminal narrowing without change. L3-4: Moderate facet hypertrophy and ligamentum flavum thickening. Left anterior disc osteophyte, increased in size. Mild bulging disc. Mild generalized narrowing of the spinal canal without change. Mild left foraminal narrowing without change. L4-5: Advanced left facet hypertrophy. Postoperative findings at the level of the right facet. Left anterior disc osteophyte slightly increased. Disc bulging and disc uncovering. Mild to moderate generalized spinal canal narrowing with medial displacement of the left-sided cauda equina nerve roots. Moderate right and severe left foraminal narrowing. No significant interval changes. L5-S1: Mild facet hypertrophy. No significant spinal canal or neuroforaminal stenosis.

Output: 1.Postoperative findings compatible with right-sided laminectomy and facetectomy at L4-5.2.Progressive disc degeneration at L4-5 with further loss of disc height. The combination of disc degeneration and posterior element hypertrophy results in a mild to moderate generalized spinal canal narrowing asymmetric to the left without significant interval change. The L4-5 neural foramina are both significantly narrowed but without noticeable interval change.3.Degenerative findings at other levels are relatively mild and unchanged with the exception of multilevel anterior osteophytosis which has progressed but which does not affect the spinal canal or neural foramina.


Instruction: Generate impression based on medical findings.

Input: 71 year old female with acute change in mental status. Evaluate for bleed. Extensive vasogenic edema of right cerebral hemisphere is again identified. There is significant midline shift to the left secondary to mass effect. In comparison with prior MRI the midline shift on the current exam has increased and measures 10.5-mm. Minimal increase in the size of lateral ventricles is also suspected. There is however no evidence of hemorrhage as clinically is questioned.

Output: 1.No evidence of hemorrhage as clinically is questioned.2.Increase in the amount of midline shift and slight increase in the size of ventricular system since prior MRI exam.


Instruction: Generate impression based on medical findings.

Input: Female 44 years old Reason: cervical cancer, needed for brachytherapy planning History: cervical cancer, MRI needed for brachy planning PELVIS:UTERUS, ADNEXA: Interval decreased size of peripherally enhancing, centrally necrotic cervical mass, which now measures up to 3.3 x 4.4 cm cm in greatest axial dimension (series 801/19), previously 4 x 5.4 cm. Again, the mass is seen arising from the cervix and extending into the left lower uterine segment. Decreased rectal and adjacent small bowel invasion. Bilateral vesicoureteral junction invasion is similar to prior study. BLADDER: No significant abnormality noted.LYMPH NODES: No significant pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval decreased size of cervical mass as detailed above.


Instruction: Generate impression based on medical findings.

Input: Change in pituitary lesion? Pituitary microadenoma. The previously demonstrated punctate pituitary lesion is much less conspicuous. The pituitary gland is not enlarged. The infundibulum is intact. There is no compromise of the optic apparatus or cavernous sinuses.

Output: The previously demonstrated punctate pituitary lesion is much less conspicuous.


Instruction: Generate impression based on medical findings.

Input: 64 year old female with Wolf-Parkinson-White syndrome, and recent development of left ventricular dysfunction. Presents for cardiovascular MRI to evaluate for cardiomyopathy Left VentricleThe left ventricle is severely enlarged with severe global hypokinesis. The overall LV ejection fraction is 35%, the LV end diastolic volume index is 122 ml/m2 (normal range: 65+/-11), the LVEDV is 268 ml (normal range 109+/-23), the LV end systolic volume index is 79 ml/m2 (normal range 18+/-5), the LVESV is 174 ml (normal range 31+/-10), the LV mass index is 61 g/m2 (normal range 67+/-11), and the LV mass is 133 g (normal range 114+/-24). There is mid-myocardial late gadolinium enhancement in the basal and mid- septum. Left AtriumThe left atrium is moderately enlarged.Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 80 ml/m2 (normal range 69+/-14), the RVEDV is 177 ml (normal range 110+/-24), the RV end systolic volume index is 63 ml/m2 (normal range 22+/-8), and the RVESV is 79 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is trace aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is trace mitral regurgitation by visual estimation; dedicated imaging was not performed.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. The leaflets are thickened. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal 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 no pericardial effusion.

Output: 1. The left ventricle is severely enlarged with severe global hypokinesis (LVEF 35%). There is mid-myocardial late gadolinium enhancement in the basal and mid- septum which can be seen with dilated cardiomyopathy. 2. Normal right ventricular size and systolic function (RVEF 55%).3. Trace mitral and aortic regurgitation.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 57 years old asymptomatic patient with a lipoma in the head of the pancreas. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in size and smooth in contour. There is a subcentimeter cyst in left hepatic lobe. No suspicious hepatic lesion. The hepatic vasculature is patent.There is thickening of the gallbladder wall at the fundus as well as multiple multiple T2 hyperintense, nonenhancing foci within the wall consistent with adenomyomatosis. No intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic tail is slightly foreshortened, normal variant. There is a 1 hyperintense focus in the head of the pancreas loses signal on out of phase images. The pancreatic parenchyma enhances normally and the duct is not dilated. There is no suspicious pancreatic lesion.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is a 6.6 cm T2 hyperintense, circumscribed, nonenhancing left upper pole renal lesion consistent with a cyst. Additional smaller bilateral renal cysts are also seen. There is no hydronephrosis.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Presumed subcentimeter lipoma in the head of the pancreas.2.Gallbladder adenomyomatosis.


Instruction: Generate impression based on medical findings.

Input: Patient is 17 month old female with history of intractable seizure disorder. Status post right frontal lobectomy. Now with right subdural hematoma and 4 minute generalized seizure o/n Large area of low density in the right frontal lobe with minimal air is believed to represent postoperative changes of patient's given history of right frontal lobectomy. Large frontal craniotomy on the right which extends across the midline is also noted. The bony flap appears fragmented and may represent associated fracture. Please correlate with surgical history. This examination is compared with prior MRI examination which makes evaluation of bony structures difficult however no definitive evidence of similar findings of fragmented bony flap was detected. The comparison CT examination is a pre- surgical study.Extra-axial fluid collection under the craniotomy flap has mixed density and is consistent with epidural hematoma.There is evidence of mass-effect by the above findings however no definitive evidence of midline shift is detected.

Output: 1.Changes in the right frontal lobe with no hemorrhage are believed to represent postoperative change.2.Large epidural collection under the craniotomy flap consistent with hemorrhage.3.The bony flap is fragmented which may be postsurgical change however I cannot entirely rule out fracture.


Instruction: Generate impression based on medical findings.

Input: Multifocal bilateral subtle high signal foci are seen in FLAIR and in T2 sequences in the white matter of the trigone bilaterally, less prominent than in the previous study. Note is made that this subtle difference may be due to difference in technical imaging factors.The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.

Output: Multifocal bilateral subtle high signal foci in the FLAIR and in T2 sequences in bilateral periventricular white matter including trigone area. These are less prominent than in the previous study of 7/8/2014; however, difference in technical imaging factors should be taken into account.


Instruction: Generate impression based on medical findings.

Input: Female, 82 years old, with left facial twitching and left face numbness, history of left CP angle meningioma. A solidly enhancing extra-axial mass is redemonstrated centered at the left CP angle measuring 28 x 22 mm in the axial plane, unchanged from prior examinations. This lesion impinges on the adjacent brainstem and middle cerebellar peduncle, deviating the brainstem to the right and partially effacing the fourth ventricle. The degree of mass effect is not significantly changed from prior. Mild T2 hyperintensity within the impinged parenchyma is unchanged.No new intracranial lesions are suspected. Scattered small foci of T2 hyperintensity through the cerebral hemispheres are nonspecific and unchanged. A probable small chronic lacunar infarct in the right caudate head is unchanged. The lateral ventricles remain mildly prominent but are similar in caliber and morphology to prior exams. No intracranial hemorrhage or any abnormal extra-axial fluid collection is seen.

Output: Stable left CP angle tumor with stable associated mass effect on the brainstem and cerebellum.


Instruction: Generate impression based on medical findings.

Input: Male; 37 years old. Reason: 37 yo M hx of severe ETOH induced necrotizing pancreatitis, follow up MRI/MRCP is ordered to evaluate the pancreatic parenchyma and pancreatic duct History: hx of severe acute necrotizing pancreatitis ABDOMEN:LIVER, BILIARY TRACT: Mild diffuse hepatic steatosis. No focal hepatic lesions.SPLEEN: No focal splenic lesions. There is attenuation of the splenic vein, which is patent. Perisplenic varices are seen. Together, the findings are suspicious for prior splenic vein thrombosis with recanalization.PANCREAS: No focal pancreatic mass. Normal T1 signal and volume of the pancreas. Homogeneous enhancement of the pancreas on postcontrast images without evidence of pancreatic necrosis. No peripancreatic fluid collections. Pancreas divisum anatomy is with a dorsal pancreatic duct draining most of the pancreas via a superiorly located minor papilla and a ventral duct draining via the major ampulla. No pancreaticobiliary tree dilation. Normal physiologic response to secretin.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.No evidence of acute or chronic pancreatitis.2.Pancreas divisum anatomy. No pancreaticobiliary tree dilation.3.Hepatic steatosis.4.Perisplenic varices, likely due to prior splenic vein thrombosis with recanalization.


Instruction: Generate impression based on medical findings.

Input: Altered mental status There is a focal restricted diffusion on the right deep parietal white matter indicating small ischemic infarct.There is no evidence of acute hemorrhage lesion.On FLAIR images, patch bilateral periventricular white matter high signal intensity lesions with a some scattered white matter high signal intensities indicate nonspecific small vessel ischemic disease.There is focal volume loss with surrounding patch high signal intensity on FLAIR on the left mesial aspect of cerebellar hemisphere indicate chronic ischemic infarct.Previously shown restricted diffusion lesions show focal increased signal intensity lesions on FLAIR imaging, however, do not show evidence of restricted diffusion anymore indicating chronic ischemic infarct.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. A new focal restricted diffusion on the right deep parietal lobe white matter indicating focal acute ischemic infarct without hemorrhagic transformation.2. Moderate degree nonspecific small vessel ischemic disease, no change since prior exam.


Instruction: Generate impression based on medical findings.

Input: New focal right upper extremity weakness, concern for stroke 2 weeks ago. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mils scattered cerebral and pontine white matter T2 hyperintensity. There is no abnormal intracranial enhancement. The ventricles and sulci are mildly prominent diffusely due to cerebral volume loss. 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 are small right maxillary sinus retention cysts and trace secretions in a right anterior ethmoid sinus.

Output: Findings suggestive of chronic small vessel ischemic disease, but no evidence of acute infarct.


Instruction: Generate impression based on medical findings.

Input: Clinical question: 7-year-old ex-34 week infant with ALTE requiring CPR at home. Nonenhanced head CT:There are questionable patchy areas of cortical low-attenuation in the bilateral posterior temporal and parietal lobes which considering patient's age may not be an abnormal finding however possibility of ischemic changes cannot be entirely ruled out. Please correlate with clinical exam and follow-up with an MRI study. There is no evidence of hemorrhage, mass effect, midline shift or hydrocephalus. There is no evidence of any crowding of the fontanelles. Mastoid air cells and middle ear cavities are pneumatized and unremarkable. Calvarium is intact.

Output: No definitive evidence of pathology. Questionable areas of low attenuation of the cortex and bilateral temporal and parietal lobes may be related to patient's premature brain however possibility of ischemic change cannot be entirely from out. Correlate with history and follow-up with an MRI.


Instruction: Generate impression based on medical findings.

Input: History of tethered cord release with syringomyelia Again seen is dilatation of the central spinal canal that extends from approximately T4-T5 level to the conus medullaris, which terminates at the level of L1-L2. There are 2 components with maximal dilatation noted at the T7 level measuring proximally 10 x 11 mm similar to prior and a more inferior component with maximal dilatation at the T12 level measuring 5 x 4 mm. Allowing for differences in measurement technique, there is no significant change. There is also no significant change in the craniocaudal extent. Enlargement of the cord caliber at these levels is also unchanged.There is appropriate ventral motion of the cord with prone positioning. There is no evidence of filar lipoma or other masses along the filum terminale and cauda equina nerve roots.The vertebral column alignment is within normal limits. The vertebral body and disk space heights are preserved. There is no worrisome bone marrow signal. There is no significant spinal canal stenosis, disc herniation, or neural foraminal narrowing. There is evidence of prior surgery in the lumbar spine for release of presumed tethered cord.

Output: 1. No significant change in size and extent of the thoracolumbar syrinx. 2. No MR evidence of cord tethering.


Instruction: Generate impression based on medical findings.

Input: History of prostate cancer. Pathology dated 1/15/2016 right mid medial 3+ 3 2-mm 15%, right mid lateral 3+3 less than 1 mm 5%, right Apex medial 3+ 3 7-mm 7%, right Apex lateral 3+4 10 mm 70%, left base medial 3+4 less than 1 mm 5%, left apex medial 3+ 3 1-mm. PELVIS:PROSTATE:Prostate Size: 4.0 x 5.8 x 5.6 cmPeripheral Zone: In the medial right apex there is a poorly marginated 1.4 x 1.1 cm T2-weighted hypointense lesion (series 501/7) with associated restricted diffusion (series 703/124). The lesion demonstrates avid early enhancement (series 1901/1214) and washout.Otherwise the peripheral zone is heterogeneous onT2-weighted imaging without an additional dominant lesion.Central Gland: Changes of benign prostatic hyperplasia.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: The right apical lesion appears to extend beyond the expected prostate boundary on diffusion weighted imaging and bulges the capsule on DCE imaging suspicious for extraprostatic extension.BLADDER: No significant abnormality noted.LYMPH NODES: Nonspecific mildly prominent right external iliac lymph node.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Dominant 1.3 cm right apical lesion is suspicious for prostatic adenocarcinoma with local extraprostatic extension.


Instruction: Generate impression based on medical findings.

Input: Female 53 years old right shoulder pain, instability and history of a slip and fall. ROTATOR CUFF: Severe atrophy is noted of the infraspinatus muscle. The remaining rotator cuff muscles are intact. No full thickness tear of the rotator cuff tendons.SUPRASPINATUS OUTLET: Degenerative changes are noted about the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: Cystic degenerative changes are noted about the anterosuperior aspect of the humeral head. A tear is noted of the posterior labrum.BICEPS TENDON: The biceps tendon is intact. ADDITIONAL

Output: 1.Severe atrophy of the infraspinatus muscle without a tear of the rotator cuff.2.Posterior labral tear.


Instruction: Generate impression based on medical findings.

Input: 51-year-old female for evaluation of breast and lymph nodes. History of IDC with 3/3 LN positive on Bx. Scattered fibroglandular parenchyma noted in both breast. On postcontrast images, moderate parenchymal enhancement is seen bilaterally.There are postsurgical changes in the left lower axilla and left upper outer quadrant without suspicious enhancement to suggest residual or recurrent tumor. No residual postsurgical fluid collections. There is small enhancing lymph node identified 1.3 cm posterior to the postsurgical change. No abnormal enhancement is seen in the right breast or bilateral axillary regions.There is a benign morphology focus in the left central breast at the 9:00 position with an internal septation which likely represents a fibroadenoma.Right chest port is identified.

Output: 1.Postsurgical change in the left upper outer quadrant. No residual enhancement identified.2.Benign enhancing focus in the left central breast likely represents a fibroadenoma.3.No abnormal enhancement in the right breast or bilateral axillary region.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: Female, 22 years old, with multiple sclerosis and paresthesias. Follow-up for progression. Allowing for difference in technique between today's examination and the comparison study, no definite change is seen in the size and morphology of multiple T2 hyperintense white lesions. No new lesions are detected. There is no evidence of significant parenchymal edema or mass effect. No acute intracranial hemorrhage or any abnormal extra-axial fluid collection is observed. There is mild prominence of the lateral ventricular atria which may reflect underlying white matter volume loss, unchanged from prior.

Output: No significant change in size or number of multiple white matter lesions compatible with demyelinating disease.


Instruction: Generate impression based on medical findings.

Input: 20 years, Female, Reason: History of Crohn's, assess for small bowel inflammation History: abdominal pain. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No bowel wall thickening or dilatation. No abnormal enhancement or diffusion restriction. No abscesses or fistulaes identified.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: FemaleUTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No evidence of active inflammation or complications of Crohn's disease.


Instruction: Generate impression based on medical findings.

Input: 63-year-old female with worsening left hip pain, radiograph with evidence of osteonecrosis, history of steroid use ACETABULAR LABRUM: The acetabular labrum appears within normal limits for nonarthrographic technique.ARTICULAR CARTILAGE AND BONE: Mixed T2 signal in the superior aspect of the left femoral head with marked decreased T1 signal in a serpentine pattern compatible with avascular necrosis. No collapse of the cortex or articular cartilage. The geographic territory of the affected area appears similar to the sclerotic region seen on prior radiograph.Susceptibility artifact from metallic right total hip arthroplasty device is noted.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Avascular necrosis of the left femoral head without evidence of advanced collapse as described above.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old, with refractory epilepsy, imaging for guidance during laser ablation. Limited imaging sequences were obtained for guidance during the laser ablation procedure. The laser probe tip has been placed in the anterior medial left temporal lobe via a left occipital approach. Postcontrast images demonstrate a ring of enhancement surrounding the tip of the laser probe. These findings occur in a background of volume loss within the left medial temporal lobe from prior laser ablation. No additional enhancing lesions are seen.

Output: Expected findings are seen compatible with laser ablation of the anterior medial left temporal lobe.


Instruction: Generate impression based on medical findings.

Input: Right knee right pain. Evaluate right knee for medial meniscus tear versus DJD. MENISCI: There is a small inner margin tear of the posterior horn of the medial meniscus. The lateral meniscus is intact. ARTICULAR CARTILAGE AND BONE: There is full thickness loss of cartilage of the weight-bearing portion of the medial femoral condyle. Additionally, there is full thickness loss of articular cartilage of the posterior medial tibial plateau with an underlying high T2 focus within the bone compatible with a subchondral cyst. There is thinning of the articular cartilage of the anterior lateral femoral condyle.There is denuding of the articular cartilage of the lateral 75% of the medial patellar facet along with a small portion of the medial patellar ridge. There is denuding of at least 50% of the articular cartilage of the medial femoral trochlea along the inner margin.LIGAMENTS: The collateral and cruciate ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Small inner margin tear of the posterior horn of the medial meniscus. 2. Cartilage loss in the medial and extensor compartments with subchondral cyst formation in the posterior medial tibial plateau.


Instruction: Generate impression based on medical findings.

Input: Female, 31 years old, with left arm and leg weakness. Suspected mild dating disease. Small foci of spinal cord T2 signal abnormality are demonstrated along the left dorsal cord at C2 and again at C3 (see image 11 and image 16 of series 8). No definite additional spinal cord lesions are seen. The spinal cord is otherwise unremarkable with the conus tip terminating at the L1-2 level. The nerve roots of the cauda equina are unremarkable.Spinal alignment is anatomic. Vertebral body morphology is within normal limits. No marrow replacement or marrow edema is observed.A few scattered Schmorl's nodes are seen in the lower thoracic spine. No significant disc bulging or disc herniation is seen. No compromise of the spinal canal or neural foramina is suspected.

Output: Two small foci of signal abnormality are evident within the cervical cord at the C2 and C3 levels. These would be compatible with demyelinating disease.No additional spinal cord lesions are seen, and the evaluation of the spine is otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: 37-year-old male with history of right nephrectomy complains of diffuse back pain. Urinalysis shows moderate blood. Fever. Rule out infected stone. ABDOMEN: This examination is limited by the absence of oral and intravenous contrast.LUNG BASES: Mild bibasilar dependent atelectatic changes. No acute infiltrates or effusions.LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: The left adrenal mass has increased in size and currently measures 4.6 x 6 cm and axial image 56/181.KIDNEYS, URETERS: Status post right nephrectomy. Minimal left perinephric fat stranding. No renal calculus. No hydronephrosis. There is a left posterior mid pole circumscribed hyper density at axial image 65/21 which measures approximately 2.7 cm in diameter. This was seen on the prior examination and may represent a hemorrhagic cyst or solid neoplasm. Characterization with intravenous contrast-enhanced CT or MRI exam may be helpful for further evaluation, if indicated.RETROPERITONEUM, LYMPH NODES: The retroperitoneal mass seen in the prior examination has increased in size and now measures 6.6 x 8.8 cm and axial image 93/181. There is extensive retroperitoneal lymphadenopathy, which was present on the prior examination, but has diffusely increased in size.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There has been interval development of numerous retroperitoneal mass and left adrenal mass consistent with metastases.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Interval increase in the retroperitoneal mass, lymphadenopathy, left adrenal mass. These findings are compatible with progression of known metastatic disease. No hydronephrosis. No nephrolithiasis.


Instruction: Generate impression based on medical findings.

Input: Thoracic spine: There has been interval approximately 50% height loss T8 vertebral body, which demonstrates abnormal bone marrow signal. There is also 4 mm of retropulsion with partial effacement of the ventral thecal sac. However, there is no evidence of spinal cord compression or abnormal spinal cord signal. There is mild overall spinal canal stenosis at the T8 level. There is moderate narrowing of the left neural foramen at T8-T9. Lumbar spine: There is normal alignment of the lumbar spine, with a normal lumbar lordosis. The vertebral body heights are well-maintained. There is no abnormal bone marrow signal. There is moderate loss of intervertebral disc height at L4-L5 and mild loss of intervertebral disc height at the remaining levels of the lumbar spine. There are disc bulges at L2-L3, L3-L4, L4-L5 and L5-S1. There is bilateral facet arthropathy and mild ligamentum flavum thickening from L2-L3 to L5-S1. There is resultant moderate spinal canal stenosis at L3-L4 and L4-L5. There is mild bilateral neural foraminal narrowing at L3-L4 through L5-S1. There is unchanged nodularity of the left adrenal gland. There is a left renal cyst.

Output: 1. Pathologic compression fracture of the T8 vertebral body with 50% loss of vertebral body height and mild retropulsion with mild resultant spinal canal stenosis, but no spinal cord compression or abnormal signal.2. Multilevel lumbar spondylosis with up to moderate spinal canal stenosis at L3-4 and L4-L5.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: 36-year-old with history of palpable left breast mass and family history of breast cancer in her mother at age 40. FNA of the left breast in November 2014 was consistent with fibroadenoma. There is extreme amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally. Multiple high T2 signal cysts are scattered in each breast. No suspicious enhancement is seen in either breast. This includes no distinct enhancing mass in the left breast 12:00 position. The degree of enhancement at that site is similar to the background parenchyma. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. If there is clinical concern for change of the left breast 12:00 mass since the prior imaging studies, I would suggest a follow up ultrasound to evaluate for stability. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on medical findings.

Input: Subdural hemorrhage MRI of the brainThere are bilateral subdural effusions present adjacent to both hemispheres. The right one is larger than the left lung. The one on the right measures approximately 17 mm in thickness along the left measures approximately 17 mm in thickness. The subdural collections are hyperintense on T2 and FLAIR sequences and somewhat homogeneous. There is no evidence for any significant restriction of diffusion. There is associated diffuse pachymeningeal enhancement.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No diffusion weighted abnormalities are appreciated.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.The patient is status post a drainage tube placement which courses through the left cerebellar hemisphere into the lateral aspect of the fourth ventricle and left foramen of Luschka. It appears be in stable position compared to prior CT exam. There is a focus of enhancing tissue at the anterior tip of the ventriculostomy tube adjacent to the 4th ventricle - along its left posterior inferior aspect - and adjacent to the left foramen of Luschka within the cerebellum. There is associated T2/FLAIR signal hyperintensity which is unchanged since the prior exam but larger than on 8/28/14. On August it measured 8mm whereas now it measures 12mm.MRA brain:Antegrade flow is present in the distal left internal carotid artery, the distal vertebral arteries, the basilar artery and the proximal left middle and bilateral posterior cerebral arteries. Artifact from aneurysm clips in the right middle cerebral artery region obscures visualization of the distal right internal carotid artery and the right middle cerebral artery as well as the right anterior cerebral artery and the anterior communicating artery region.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is obscured by artifact. There is fetal origin of the left posterior cerebral artery. The right posterior communicating artery is obscured by artifact. The vertebral arteries are similar in size.

Output: 1.There are bilateral subdural collections present which also been identified in the recent CT of the head and are associated with mass effect and compression of the underlying brain.2.There is a small lesion present at the tip of the ventriculostomy tube adjacent to the 4th ventricle and left foramen of Luschka in the left cerebellar hemisphere. This is not obviously changed since the prior exam from 12/30/14 (a non contrast exam) but larger than on the August exam. The possibility of progression cannot be excluded. DDX includes metastasis and radiation change/necrosis.3.There is diffuse pachymeningeal enhancement present which is non-specific. Possibilities include that this could be a reaction to prior surgery or the subdural hematomas. 4.Artifact from aneurysm clip significantly diminishes visualization of intracranial vasculature. No obvious aneurysms in the visualized vasculature are appreciated.5.Findings were discussed with Dr Awad.


Instruction: Generate impression based on medical findings.

Input: Stage III C melanoma status post re-do right radical axillary lymph node dissection with excision of separate subcutaneous nodule of the right proximal upper extremity on 10/26/15 for metastatic melanoma, rule out brain metastasis. There is no evidence of intracranial mass, hemorrhage or acute infarct. There is no abnormal intracranial enhancement. There is patchy and confluent and intracerebral white matter T2 hyperintensity which may be nonspecific, but most compatible with small vessel ischemic changes. There is mild global parenchymal loss. There is no midline shift or herniation. The major cerebral flow voids are intact. There is mild mucosal thickening in the bilateral maxillary sinuses. There is trace fluid in the bilateral mastoid air cells. The orbits, skull and scalp soft tissues are grossly unremarkable.

Output: 1. No evidence of intracranial metastasis.2. Chronic small vessel ischemic changes, but no evidence of acute infarction.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: 47 years Male (DOB:12/19/1968)Reason: please do dr javed MS protocol History: MS worsening gaitPROVIDER/ATTENDING NAME: JACQUELINE T BERNARD SERVICES ANCILLARY The thoracic vertebral bodies are appropriate in the overall alignment and height. There is CSF flow artifact, phase encoding artifact and breathing artifact which is superimposed on the spinal cord and may obscure underlying lesions. Example and distal spinal cord there is signal hyperintensity superimposed on the T2 sagittal images which are not readily appreciated on the axial T2 images. There is no compromise of thoracic spinal canal or exiting nerve roots. No abnormal enhancing lesions are identified in the thoracic spine.

Output: To the extent of visualization no abnormal lesions are clearly appreciated in the thoracic spine though there is a significant amount of artifact which may obscure some lesions. For example is not clear whether there is a distal spinal cord lesion present.


Instruction: Generate impression based on medical findings.

Input: History of left breast DCIS with microinvasion and status post left axillary lymph node biopsy with benign results. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Within the left breast extending from less than 1 cm anterior to the pectoralis up to the nipple is suspicious nonmass enhancement compatible with the diagnosis of DCIS with microinvasion. The overall span is approximately 13.8 x 7.1 x 5.0 cm. Note is made of a focus of enhancement immediately adjacent to the nipple.Within the right outer breast, a significantly less large but still somewhat suspicious area of nonmass enhancement is seen. This measures approximately 4.9 x 1.2 x 2.9 cm. The appearance is nonspecific, though DCIS is a possibility. Based on the appearance, it is felt to be unlikely that a correlate for this finding would be seen at an MRI directed ultrasound.There are mildly prominent but largely symmetric nodes in each axilla, including the node that contains biopsy clip artifact from the previous benign biopsy.

Output: 1. Extensive nonmass enhancement in the left breast correlating with extensive calcifications on mammography and the biopsy results at 2 sites.2. Area of nonmass enhancement in the right outer breast for which MRI guided biopsy is recommended.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: 74 years, Male, Reason: 74M with hx of pancreatic pseudocyst History: Pancreatic pseudocyst. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Cholelithiasis. Mild hepatic steatosis.There is narrowing of the distal common bile duct, however the proximal common bile duct itself is normal in caliber. There is mild intrahepatic biliary ductal dilatation.SPLEEN: Splenic vein thrombosis is unchanged.PANCREAS: Fluid collection along the body of the stomach has resolved. There is normal enhancement of the head, neck and proximal body of the pancreas with atrophy of the distal body and tail.There is a blunted response to secretin administration with multiple dilated side branches along the course of the main pancreatic duct. The main pancreatic duct has areas of narrowing and irregularity.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.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.Resolution of peripancreatic fluid collection.2.Findings of chronic pancreatitis with irregularity and dilated side branches along the pancreatic duct.3.Stenosis of the distal common bile duct with mild intrahepatic biliary ductal dilatation.4.Stable splenic vein thrombosis.5.Cholelithiasis.


Instruction: Generate impression based on medical findings.

Input: The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Mucosal thickening is present within the right maxillary sinuses. The remaining paranasal sinuses and mastoid air cells are clear. Images of the internal auditory canals demonstrate the seventh and eighth nerves to be normal in size and symmetric bilaterally without masses along the course of these nerves or in the cerebellopontine angle cisterns bilaterally. The inner ear structures are normal in appearance and symmetric bilaterally without congenital inner ear anomalies identified on either side. There are no vascular anomalies.

Output: Negative MRI of the brain and internal auditory canals.


Instruction: Generate impression based on medical findings.

Input: Reason: 70 with TBI, here with fevers, AMS. Has unstageable sacral wound w/eschar. Requesting MRI of sacrum to evaluate for abscess or osteo History: fevers with large sacral wound Intravenous contrast was not able to be administered due to a malfunctioning IV.There is diffuse nonspecific subcutaneous edema most pronounced along the anterior and lateral aspects of the pelvis. There is also increased signal abnormality within the gluteal musculature, right greater than left. There is increased signal abnormality within the iliacus and paraspinal muscles bilaterally which is nonspecific. There is also increased signal abnormality within the imaged musculature of the left hip with some of this inflammatory change/edema becoming confluent within the vastus lateralis musculature. Superimposed infection cannot be excluded. There is minimal soft tissue irregularity along the posterior aspect of the sacrum consistent with the stated history of ulceration. There is extension of this ulceration to the level of the left gluteal musculature. There is associated subcutaneous inflammatory change as well as inflammatory change within the left gluteus maximus musculature. There is a loculated focus of fluid signal intensity within the medial aspect of the left gluteus maximus muscle, measuring approximately 2.0 x 2.0 cm in transverse dimensions, as well as a fluid collection within the presacral space which may represent early abscess formation versus confluent inflammatory change/phlegmon.A Foley catheter is in place. Note is made of a 2.1 cm focus of fluid signal intensity along the right posterolateral aspect of the urethra which may represent a urethral diverticulum. There is a small amount of fluid identified within both hips which is not necessarily of any current clinical significance.

Output: Soft tissue ulceration along the posterior aspect of the sacrum with inflammatory change in the subcutaneous and surrounding soft tissues including a 2.0 cm loculated fluid collection in the left gluteus maximus muscle as well as a presacral fluid collection which may represent early abscess formation versus confluent inflammatory change/phlegmon, although these findings are incompletely characterized on this noncontrast examination. Diffuse nonspecific subcutaneous and soft tissue edema/inflammatory change about the pelvis. No evidence of osteomyelitis. Other findings as described.