Instruction: Generate impression based on medical findings.

Input: 60-year-old female with popping, locking and catching. Mild osteoarthritis on recent radiographs. Evaluate medial meniscus. MENISCI: Note is made of increased branching linear signal abnormality within the posterior of the medial meniscus which extends to the tibial and femoral articular surface consistent with a complex tear with both a radial and horizontal component. There is also linear increased signal abnormality within the posterior horn and body of the medial meniscus which does not definitively extend to either articular surface. The anterior horn of the medial meniscus appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is bone marrow signal abnormality within the medial aspect of the tibial plateau and to a lesser degree within the medial femoral condyle consistent with bone contusion. No full-thickness or near full-thickness articular cartilage defects are identified. There is a partial-thickness articular cartilage fissure along the lateral facet of the patella, centrally.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Tearing of the medial meniscus as described above.2. Partial-thickness articular cartilage fissure along the patella and bone contusions as described above. 3. Small joint effusion. Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Ms. Thompson is a 66-year-old female presenting for imaging evaluation of a suspicious cluster of calcifications in the left upper inner breast. Patient is to have a stereotactic guided biopsy following this Breast MRI. There is scattered fibroglandular tissue in both breasts. Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. Specifically, there is no abnormal enhancement seen at the site of mammographically detected calcifications in the left breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. Specifically, no abnormal enhancement seen at the site of mammographically detected calcifications in the left breast. A stereotactic biopsy continues to be the recommendation for sampling of these calcifications.BIRADS: 1 - Negative.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: Cerebral cysts [G93.0], Reason for Study: ^Reason: hx of colloid cyst s/p endoscopic removal. eval for recurrence History: none- surveillance No evidence of acute ischemic or hemorrhagic lesion.Susceptibility lesions along the ventriculostomy track through the right frontal lobe as well as at the level of right foramen of Monro are again seen, unchanged since prior scan.On gadolinium enhanced scan, the right hemispheric dura shows diffuse thin enhancement which corresponds to postoperative status. There is no evidence of abnormal brain parenchymal enhancement.Previously seen craniotomy site soft tissue swelling has been completely resolved.The ventricles, sulci and cisterns are 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 mastoid air cells are clear. Retention cyst is seen on the right maxillary sinus and in mucosal thickening was seen on the right frontal sinus, ethmoid sinus and sphenoid sinus.

Output: 1. Postoperative status of colloid cyst, postoperative no unusual finding.2. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Neoplasm of uncertain behavior of brain, unspecified. Unspecified convulsionsClinical question: Eval for growth of low grade glioma. No prior RT.Signs and Symptoms: low grade glioma.Comments: Low grade glioma. S/p surgery in 2008. | There is redemonstration of a 17 x 36 mm axial dimension extra-axial cyst adjacent to the left inferior and middle frontal gyri as well as the left temporal pole. There is associated calvarial scalloping present.There is redemonstration of cystic encephalomalacia of the right temporal lobe anteriorly associated with 26 x 35 mm cyst. This has not changed since the prior exam. There is signal change present along the right temporal lobe adjacent to the cyst. This likely represents gliosis. The patient is status post right-sided craniotomy for removal of a right temporal lobe mass.There is redemonstration of a small T2 and FLAIR hyperintense lesion the left thalamus. This is stable compared to prior examsNo abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucous retention cyst in the right maxillary sinus as well as mucosal thickening in the ethmoid air cells, frontal sinuses sphenoid sinuses and left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.No evidence for tumor recurrence in the right temporal lobe.2.Left-sided arachnoid cyst this is stable3.Stable lesion in the left thalamus


Instruction: Generate impression based on medical findings.

Input: 59-year-old female with biopsy proven invasive lobular carcinoma in the left breast presents for breast MRI. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.In the left breast, there is an irregularly shaped enhancing mass with a marker clip at 2:00 position, consistent with biopsy-proven carcinoma. The lesion measures 12 x 12 x 12 mm (AP x LR x CC).There is an enhancing focus with irregular margins at retroareolar 4:00 position in the left breast, measuring 5 x 4 x 5 mm. This enhancing focus is located 46 mm anterior and inferior to the index cancer.No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in either axillary region.

Output: 1. Biopsy proven carcinoma at 2:00 position in the left breast.2. Indeterminate enhancing focus at retroareolar 4:00 position in the left breast. MR directed ultrasound study is recommended. If the lesion is not detected on ultrasound study, MR guided biopsy should be considered.3. No MRI evidence for malignancy in the right breast.4. No abnormal lymph nodes in either axilla.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required.


Instruction: Generate impression based on medical findings.

Input: There is no evidence of acute infarct. The ventricles and sulci are prominent, consistent with mild age-related volume loss. In addition, the ventricular prominence appears somewhat disproportionate to sulcal prominence. There is no midline shift or mass effect. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the basal ganglia as well as the periventricular and subcortical white matter, consistent with moderate chronic small vessel ischemic changes. Chronic lacunar infarcts are present within the right head of the caudate. Scattered punctate foci of susceptibility are present most prominent in the bilateral basal ganglia. There is no abnormal intracranial enhancement. The midline structures and craniocervical junction are within normal limits. The major cerebral flow voids are intact. There is minimal mucosal thickening in the right frontoethmoidal recess. The remainder of the visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear.

Output: 1.No evidence of acute ischemic infarction. Moderate chronic small vessel ischemic changes.2.No evidence of mass lesion to account for patient's seizures.3.Scattered presumed chronic microhemorrhages most prominent in the basal ganglia which may be related to hypertension, with peripheral findings also possibly related to amyloid angiopathy.4.Disproportionate ventricular dilatation with respect to sulci. While this simply may be related to preferential periventricular white matter volume loss from chronic small vessel ischemic changes, correlate for symptoms of normal pressure hydrocephalus.


Instruction: Generate impression based on medical findings.

Input: 55-year-old male with history of recent lumbar surgery. There are postsurgical changes at L1 and L2. There is mild facet osteoarthritis of the lower lumbar spine.

Output: Postsurgical changes as above.


Instruction: Generate impression based on medical findings.

Input: Metastatic melanoma on Temodar. The intrinsically T1 hyperintense lesions in the bilateral cerebral hemisphere are stable to slightly decreased in size. For example, a lesion in the left occipital lobe measures 4 mm in diameter, previously also 4 mm, while a lesion in the right anterior cingulate gyrus measures 3 mm in diameter, previously 5 mm. There is no appreciable vasogenic edema associated with the lesions. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Stable to slight interval decrease in size of the brain metastases.


Instruction: Generate impression based on medical findings.

Input: Reason: Assess for lateral meniscal tear; assess ligament integrity History: Lateral knee pain on deep flexion, positive McMurray test MENISCI: There is a large fluid-filled complete longitudinal tear of the posterior horn of the medial meniscus extending into the body of the medial meniscus seen on 6 consecutive sagittal images. The anterior horn of the medial meniscus is intact. There is a thin band of linear intermediate signal intensity within the peripheral fibers of the posterior horn of the lateral meniscus extending to the femoral articular surface. Although the signal is continuous with the interface of the meniscofemoral ligament of Wrisberg and the posterior horn of the lateral meniscus, its lateral extension through the meniscus is suggestive of a true longitudinal tear (Wrisberg rip). Of note, the suspected tear is of intermediate signal intensity and may be healed. The anterior horn and body of the lateral meniscus appears normal.ARTICULAR CARTILAGE AND BONE: We see no articular cartilage defects.LIGAMENTS: The proximal fibers of the ACL are indistinct, which may represent an old tear; however there are no bone contusions to indicate a recent tear. The PCL and LCL complex are intact. EXTENSOR MECHANISM: The quadriceps and patellar tendons appear intact.ADDITIONAL

Output: 1. Large and likely unstable complete longitudinal tear of the medial meniscus.2. Poor definition of the proximal fibers of the ACL suggests prior injury/tear although we see no bone contusion on the current study to suggest recent injury.3. Findings suggestive of a partial thickness peripheral tear of the posterior horn of the lateral meniscus (Wrisberg rip). This tear is not fluid-filled and may be healed.


Instruction: Generate impression based on medical findings.

Input: Right thalamus glioblastoma status post recent partial resection. There has been partial resection of the right thalamic mass via a right parietal approach. The residual tumor measures up to approximately 6 cm. There are blood products along the surgical tract and in the occipital horn of the right lateral ventricle, as well as within the right thalamic mass. There is a right parietal ventriculostomy catheter that traverses the right lateral ventricle and indents the anterior corpus callosum. There is perhaps a small amount of restricted diffusion related to ischemic tissue along the surgical approach, but no evidence of territorial infarction. There is also a small amount of linear enhancement along the surgical approach, which may represent granulation tissue. There is decreased dilatation of the right lateral ventricle, while the left lateral ventricle remains dilated and the third ventricle is partially effaced. The cortical swelling and high T2 signal in the inferior right parietal lobule has diminished. There is minimal extra-axial fluid underlying right parietal craniotomy flap and swelling and fluid in the overlying scalp. There is a maxillary retention cyst and sphenoethmoidal mucosal thickening. The orbits are unremarkable.

Output: 1.Interval partial resection of the large right thalamic glioblastoma with intratumor hemorrhage and a small amount of hemorrhage along the surgical path and ventricular system. The residual tumor measures up to approximately 6 cm.2.Decreased dilatation of the shunted right lateral ventricle.3.Decreased right parietal cortical edema, which may represent transient seizure-related effects.


Instruction: Generate impression based on medical findings.

Input: 19-year-old female runner with right leg pain. Bone marrow signal intensity within the right tibia and fibula is normal. No periosteal edema to suggest a stress reaction. The musculature of the right leg is normal. Tiny focus of increased signal intensity is noted within the proximal left tibial diaphysis on the large field-of-view images. This is nonspecific although could conceivably represent a stress reaction but may represent normal vascular blush.

Output: 1.No evidence of stress fracture or stress reaction of the right leg.2.Tiny focus of increased signal within the proximal left tibial diaphysis is nonspecific and may represent normal vascular blush although could conceivably represent a stress reaction.


Instruction: Generate impression based on medical findings.

Input: New thoracic and lumbar spine pain. History of heart transplant in 2012. Thoracic:Thoracic vertebral body heights are maintained. Alignment is maintained. Bone marrow signal is benign with no suspicious lesions. There are minimal degenerative changes including mild facet arthropathy in the lower thoracic spine.Thoracic cord is normal in signal and contour. No significant spinal canal or neural foraminal stenosis is seen. Lumbar:Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.Minimal degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Minimal disk bulge. No spinal canal or neural foraminal stenosis.L3-L4: Minimal disk bulge eccentric to the right with minimal right neural foraminal stenosis. No spinal canal or left neural foraminal stenosis.L4-L5: Minimal disk bulge. No spinal canal or neural foraminal stenosis.L5-S1: Minimal disk bulge. No spinal canal or neural foraminal stenosis. Minimal facet arthropathy in the lumbar spine. Paraspinous soft tissues are within normal limits.

Output: Minimal degenerative changes in the thoracic and lumbar spine as described above within normal limits for age. Examination is otherwise unremarkable. No significant spinal canal or neural foramina stenosis. No compression fractures.


Instruction: Generate impression based on medical findings.

Input: Suspicious for osteomyelitis on foot xray, probe to bone, diabetic foot infection. Question of osteomyelitis. There is heterogeneous T1 signal and increased STIR signal within the head to midshaft of the first metatarsal. This region also enhances on post-contrast imaging and is compatible with osteomyelitis. There is destruction of the head of the first metatarsal.There is hypointense T1/hyperintense STIR signal within the fourth digit proximal phalanx with associated enhancement and cortical destruction, which is also compatible with osteomyelitis. There is a soft tissue defect dorsal to this as well. There is mild increased STIR signal and enhancement of the head of the third metatarsal with slightly decreased T1 signal which is also highly suspicious for osteomyelitis. There is a chronic fracture of the midshaft of the second metatarsal with surrounding intermediate signal. There is a 8 x 28 mm T1 hypointense/T2 hyperintense collection adjacent to the head of the first metatarsal with rim enhancement which likely represents an infected fluid collection. There is diffuse soft tissue edema/inflammatory changes of the forefoot.

Output: 1. Osteomyelitis of the first metatarsal, fourth digit proximal phalanx, and third metatarsal as described above with surrounding inflammation.2. Infected fluid collection adjacent to the first metatarsal head. 3. Fracture of the second metatarsal.


Instruction: Generate impression based on medical findings.

Input: Cystectomy for bladder cancer with transient episodes of blurred vision and left eye facial droop; please evaluate for TIA. There is no evidence of intracranial hemorrhage or acute infarct. There is mild diffuse predominantly periventricular cerebral white matter T2 hyperintensity. The ventricles and basal cisterns are normal in size and configuration. A 3 mm wide right parafalcine structure may represent a meningioma. 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 bilateral maxillary sinus retention cysts.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Mild diffuse predominantly periventricular cerebral white matter T2 hyperintensity is nonspecific, but may represent chronic small vessel ischemic disease.


Instruction: Generate impression based on medical findings.

Input: 16 year old male with knee pain and instability. Evaluate meniscus and ACL MENISCI: There is a vertical tear with blunting of the posterior horn of the lateral meniscus. The medial meniscus is intact with no significant abnormality noted.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: No significant abnormality noted. Specifically the ACL is intact with no abnormal signal noted.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Findings compatible with a tear of the posterior horn of the lateral meniscus.


Instruction: Generate impression based on medical findings.

Input: Redemonstrated is an approximately 6 mm craniocaudal x 3 mm AP dimension T1 hypointense, T2 hyperintense, nonenhancing focus involving the posterior aspect of the pituitary. The posterior pituitary lobe appears to be flattened posteroinferiorly. The pituitary gland anteriorly is normal in size and shape without other discrete mass lesion. There is no macroadenoma. The pituitary infundibulum inserts on the midline of the gland. There are no suprasellar or parasellar masses and the cavernous sinuses are symmetric bilaterally. Limited views of the other intracranial structures are unremarkable. A 7 mm enhancing excrescence is noted of the skin just superior and anterior to the ear.

Output: 1.Redemonstrated is an approximately 6 mm craniocaudal x 3 mm AP dimension T1 hypointense, T2 hyperintense, nonenhancing focus involving the posterior aspect of the pituitary. The posterior pituitary lobe appears to be flattened posteroinferiorly. This constellation of findings is most suggestive of a Rathke's cleft cyst.2.A 7 mm enhancing excrescence is noted of the skin just superior and anterior to the ear.


Instruction: Generate impression based on medical findings.

Input: Female, 41 years old, with L5-S1 herniated nucleus pulposus. Assess preoperative change and morphology. Loss of disc height and T2 signal is seen at L5-S1. The previously demonstrated right foraminal disc extrusion with extension superiorly into the right lateral recess has significantly diminished in size with only trace residual herniated disc material. There is mild disc bulging at this level but without significant spinal canal or foraminal stenosis.The remaining intervertebral discs are preserved with no areas of significant spinal canal or foraminal stenosis. Facet arthropathy is seen at L4-5 and L5-S1. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No evidence of marrow replacement or marrow edema is seen. The visualized distal spinal cord, conus and nerve roots of the cauda equina are within normal limits. No epidural abnormalities are suspected.

Output: Interval significant decrease in the size of a right foraminal/lateral recess disc extrusion at L5-S1.


Instruction: Generate impression based on medical findings.

Input: 46-year-old male with history of seminoma. Evaluate for recurrence. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted. LYMPH NODES: New pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: 75 year old male with a history of PVCs, syncope and cardiomyopathy. First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarMotion artifacts on this study limit image interpretation. There was no clear areas of late gadolinium enhancement noted suggesting no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. Left VentricleThe left ventricle is normal in size with low normal systolic function. The overall LV ejection fraction is 52%. The LVEDV is 249 ml (normal range 142+/-34), the LV end diastolic volume index is 104 ml/m2 (normal range: 74+/-15), the LVESV is 119 ml (normal range 47+/-19) and the LV end systolic volume index is 50 ml/m2 (normal range 25+/-9). The LV mass is 120 g (normal range 164+/-36) and the LV mass index is 50 g/m2 (normal range 85+/-15). There are no regional wall motion abnormalities present. The native T1 myocardial relaxation time is <1100 ms suggestive of absence of underlying diffuse fibrosis or infiltration.Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 59%. The RVEDV is 189 ml (normal range 142+/-31), RV end diastolic volume index is 79 ml/m2 (normal range 82+/-16), the RVESV is 77 ml (normal range 54+/-17), and the RV end systolic volume index is 32 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is mild-moderately dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is trivial to mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery measures 37 mmVenous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere are 2 cyst-like lesions in the liver; one in the superior mid right lobe and one in the posterior aspect of the right lobe. Imaging artifact is noted in the left chest from the implantable loop recorder. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1.No perfusion defects/ "ischemia" present during hyperemia.2.No prior myocardial infarction. Motion artifacts limited interpretation of late gadolinium enhancement images. No definitive areas of late gadlinium enhancement. The entire myocardium is viable.3.Normal LV size with low normal systolic function (LVEF 52%).4.Normal RV size with normal systolic function (RVEF 59%).5.Biatrial dilation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: 51-year-old female patient with cramping pain in pelvis. ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas is mildly atrophic with pancreatic divisum noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Stomach remained distended during the entirety of the examination, raising question of delayed gastric emptying.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Junctional zone thickness measures 9 mm, within normal limits. No significant abnormality is seen in the uterus or adnexa.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small Nabothian cyst is noted.OTHER: No free fluid in the pelvis.

Output: 1.No significant findings to account for patient's pelvic pain.2.Distended stomach raises question of delayed gastric emptying, which may be associated with patient's pain medication use.


Instruction: Generate impression based on medical findings.

Input: Lung cancer with bone metastases and fracture: pain, surveillance. There are postoperative findings related to upper thoracic laminectomy. There is a persistent pathological fracture of the T1 vertebral body with near complete loss of height and retropulsion of bone and tumor posterior into the spinal canal measuring 7 mm in width, which results in mild spinal cord impingement. There is no definite spinal cord edema. There is also approximately 9 mm of anterior subluxation of the cervical vertebral column. The rest of the thoracic spinal column alignment is intact. There is marked interval decrease in size of the soft tissue tumor arising from the left T1 posterior elements that projects into the paraspinal soft tissues. There is also decrease in size of a mass situated alongside the right T11-12 level that projects into the paraspinal soft tissues. The previously demonstrated pulmonary nodules are better depicted on the prior chest CT.

Output: 1. Pathological fracture of the T1 vertebral body with near complete loss of height and retropulsion of bone and tumor posterior into the spinal canal with mild indentation upon the spinal cord, as well as persistent 9 mm of anterior subluxation of the cervical vertebral column. Soft tissue tumor arising from the left T1 posterior elements projecting into the paraspinal soft tissues has diminished. 2. A metastasis situated alongside the right T11-12 level that projects into the paraspinal soft tissues has also markedly diminished.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Evaluate arachnoid cyst for change. Compare with previousSigns and Symptoms: Arachnoid cyst The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of an 11 x 9 mm axial dimension cystic lesion in the left middle cranial fossa anteriorly which has not changed in dimensions when compared to the previous exam. It is associated with some scalloping of the adjacent sphenoid bone.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Stable small left middle cranial fossa arachnoid cyst.


Instruction: Generate impression based on medical findings.

Input: Male, 18 years old, left lower leg pain since 8/2014, positive left straight- leg exam, concern for radiculopathy. Spinal alignment is anatomic. Vertebral body morphology is within normal limits. No evidence of marrow replacement or marrow edema is seen.The visualized spinal cord, conus and cauda equina are unremarkable.The L5-S1 disk demonstrates loss of T2 signal. There is, in addition, a left paracentral disk protrusion which narrows the left ventral thecal sac and probably impinges upon the transiting left S1 nerve root.Mild facet hypertrophy is seen at L5-S1 which, along with the disk herniation, contributes to a mild left neuroforaminal narrowing. No significant degenerative disease is seen at the remaining levels and there are no other areas of spinal canal or foraminal stenosis.

Output: Left paracentral L5-S1 disk herniation with probable impingement of the left S1 nerve root.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Neck and arm pain. Pain across mid back. Signs and symptoms: Neck and arm pain. Pain across mid back. Non-enhanced cervical MRI:There is normal anatomical alignment the vertebral column.There is unremarkable signal intensity of vertebral column.Foramen magnum is unremarkable. C2 -- C3 is unremarkable.C3 -- C4 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.C4 -- C5 demonstrate mild degenerative disk disease and mild asymmetric left facet hypertrophic changes and mild bilateral ligamentum flavum hypertrophy. There is a tiny annular fissure in the midline and to the left best appreciated on sagittal T2 stir. Mild central spinal stenosis and mild left neural foraminal compromise.C5 -- C6 demonstrate prior corpectomy and anterior fusion without evidence of spinal stenosis or neural foraminal compromise.C6 -- C7 demonstrate mild degenerative disk disease, uncovertebral hypertrophy on the left a mild left facet hypertrophy changes are noted. There is mild to moderate left neural foraminal compromise and mild central spinal stenosis.C7 -- T1 demonstrate minimal disk disease, moderate right-sided asymmetric uncovertebral hypertrophic changes resulting in significant right neural foraminal compromise. No spinal stenosis and patent left neural foramina.The signal intensity of the cord remains ".Fluid signal intensity along the left aspect of C6 spinous process is believed to represent post operative change. No prior exams for comparison. The fluid collection measures approximately 6 mm in transverse axis and 23-mm in AP axis.Nonenhanced thoracic MRI:There is normal anatomical alignment of the column. The signal intensity of vertebral column is unremarkable.There is normal signal intensity and caliber of thoracic cord.There is no significant degenerative disease, no evidence of spinal stenosis or neural foraminal compromise at any level.

Output: 1.Postoperative changes of anterior corpectomy and fusion at C5 -- C6 without evidence of spinal stenosis or neural foraminal compromise.2.Degenerative changes at C4 -- C5 and including a tiny annular fissure is noted. Mild central spinal stenosis and left neural foraminal compromise.3.Degenerative changes at C6 -- C7 and asymmetrical left uncovertebral hypertrophy results in left neural foraminal compromise and mild central spinal stenosis.4.Loculated fluid collection along the left side of C6 spinous process as detailed.5.Asymmetric right sided moderate uncovertebral hypertrophy results in significant right neural foraminal compromise at C7 -- T1 level.6.Unremarkable nonenhanced thoracic spine MRI.


Instruction: Generate impression based on medical findings.

Input: There are multiple unchanged supratentorial cortical and subcortical regions of T2 hyperintensity. There is an unchanged 5 mm focus of T2 hyperintensity and susceptibility effect within one of these regions in the right superior parietal lobule that may represent mineralization or old hemorrhage. There are numerous subependymal mildly enhancing masses. Exact comparison is difficult due to differences in technique, however, the largest of these located within the atrium of the right lateral ventricle has mildly increased in size, measuring 17 x 17 mm, previously 15 x 15 mm. The second largest located within the left lateral ventricular body near the foramen of Monro has also mildly grown, measuring 9 x 9 mm, previously 8 x 8 mm. A previously measured subependymal mass within the right lateral ventricular body near the foramen of Monro is unchanged, measuring 4 x 4 mm. The ventricles and basal cisterns are unchanged in size and configuration. There is no evidence of acute intracranial hemorrhage or acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: Stigmata of tuberous sclerosis including unchanged cortical/subcortical tubers and multiple subependymal masses, the largest of which have mildly increased in size (about 1mm).


Instruction: Generate impression based on medical findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The right hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 15 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 22 seconds

Output: Successful right hip arthrogram prior to MRI.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Patient with spinal metastases, neck pain. Signs and symptoms: Neck pain Nonenhanced CT of the cervical spine:Previously described on prior MRI of the cervical spine with the study the lesion to the vertebral body of C5 is not identified on this study. There is subtle low attenuation of C7 vertebral body consistent with patient's known metastatic lesion. There is no evidence of fracture of this vertebrae and the alignment of vertebral column is unremarkable.Nonenhanced CT of thoracic spine:The alignment the vertebral column is within normal limits. Examination identifies previously detected metastatic lesion to T1 with mild compression deformity and minimal bulge of vertebrae into the spinal canal. There is no involvement of the pedicle of T1. The alignment remains intact. Mild compression deformity of vertebral body of T5 along its superior aspect and the internal lytic changes. There is no definitive involvement of the pedicles of T5. No definitive evidence of any additional lytic changes of vertebral column is detected.No definitive metastatic lesion to the facets of the pedicles of vertebral column.Nonenhanced CT of the lumber spine:The alignment of vertebral column is unremarkable. No definitive for the study kidneys to the lumber spine is detected.No evidence of central spinal stenosis or neural foramina compromise.There is very subtle low-attenuation involving S2 vertebral body however been no distinct destruction of the cortex or any perispinal soft tissue abnormality. Possibility of metastatic disease cannot be entirely ruled out.

Output: 1.Multiple metastatic disease to the thoracic spine and a suspected metastatic lesion to as to as detailed.2.There is mild compression fracture of T1 and T5 and mid no involvement of the pedicles of T1 or T5.3.The alignment of the vertebral column throughout the spine remains normal.


Instruction: Generate impression based on medical findings.

Input: Evaluate for cerebellar CVA: vertigo, uvular deviation, dysmetria. Brain MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. However, there is a heterogeneous mass along the inferior portion of the left parotid gland that measures up to approximately 5 cm. There are bilateral maxillary sinus retention cysts, right larger than left.Brain MRA: There is no evidence of significant steno-occlusive lesions or aneurysm.Neck MRA: There is no evidence of significant steno-occlusive lesions.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. No evidence of significant steno-occlusive lesions in the head and neck arteries.3. Heterogeneous mass along the inferior portion of the left parotid gland that measures up to approximately 5 cm, which may represent a salivary gland neoplasm.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Syncope and collapseClinical question: syncopal episode; h/o prior ischemic strokeSigns and Symptoms: passing out episodes x 2 MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is multilevel disc desiccation present.At C2-3 there is no significant compromise to the spinal canal. There is bilateral facet hypertrophy present at this level - right more than left - with encroachment of right-sided exiting nerve roots.At C3-4 there is no significant compromise to the spinal canal. There is bilateral facet hypertrophy present at this level with encroachment of left-sided exiting nerve roots.At C4-5 there is no significant compromise to the spinal canal. There is a left paramedian disc protrusion present at this level as well as bilateral facet hypertrophy and encroachment of the exiting nerve roots bilaterally left worse than rightAt C5-6 there is no significant compromise to the spinal canal. There is a diffuse disc bulge present at this level associated with small uncovertebral osteophytes and narrowing of the neural foramina bilaterally with encroachment of exiting nerve roots. There is partial effacement of spinal fluid ventral to the spinal cord at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There are some small endplate and uncovertebral osteophytes present at this level with mild encroachment of the exiting nerve roots within the neural foramina on the right side.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There are T2 and FLAIR hyperintense lesions present in the internal capsules and basal ganglia as well as the brainstem and thalami. On susceptibility weighted imaging there are punctate foci of low signal in the thalami bilaterally as well as the pons and cerebellum and to a lesser degree basal ganglia. This has not changed substantially since the prior exam.The CSF spaces are appropriate for the patient's stated age with no midline shift. 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 mucosal thickening in the paranasal sinuses.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The right posterior communicating artery is relatively small but can be identified. The left posterior cerebral artery has fetal origin. The vertebral arteries are similar in size.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries identified to the extent of visualization. The origins of the vertebral arteries are partially obscured due to artifacts..

Output: 1.No evidence for intracranial aneurysm.2.No evidence for intracranial or extracranial cervicocerebral vascular occlusive disease.3.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 4.There are multiple microhemorrhages present predominantly distributed in the thalami and brainstem and cerebellum which are in a pattern compatible with hypertension. This has not changed substantially since the prior exam.5.There are multilevel degenerative changes present in the cervical spine without evidence for spinal stenosis. There is encroachment of exiting nerve roots within the neural foramina at multiple levels as detailed above


Instruction: Generate impression based on medical findings.

Input: Brain: Again seen are post-operative findings related to a suboccipital craniectomy and resection of the posterior arch of C1 for decompression of Chiari malformation. There is evidence of tonsillar cauterization/resection. There remains some crowding of the remaining cerebellar tonsils at the level of the foramen magnum, which is unchanged. A fluid collection at the surgical bed measures approximately 23 x 33 x 36 mm (AP x TR x CC) compared to 10 x 35 x 36 mm previously and extends inferiorly to the level of the mid C2 vertebral body. Although the collection appears larger in the AP dimension, this may simply represent conformational changes due to patient positioning rather than true increase in size. Even if there has been an increase, it has not increased dramatically. The dura or duraplasty is somewhat irregular in places but we see no obvious defects or gaps. There continues to be no significant edema around the fluid collection. The ventricles and sulci are normal in size. 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. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain. C-spine: Normal cervical lordosis. The vertebral body heights are well-maintained. No focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber. There is a persistent thin syrinx at the right lateral aspect of the cervical cord, which, along with a prominent central canal of the cord, extends inferiorly to the thoracic region but is unchanged. There is no pathological intrathecal enhancement.There is no significant disc bulge, herniation, spinal canal or foraminal stenosis within the cervical spine.

Output: 1. Post-operative findings related to Chiari decompression. 2. Mild apparent change in the size of the fluid collection in the surgical bed may simply be related to changes in patient position. Even if there were an increase in size, the collection is not significantly larger. Persistent pseudomeningocele is favored as the diagnosis. Infection is less likely given lack of edema and no change in the enhancement pattern compared to the prior exam.3. Unchanged, mild syringohydromyelia.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old, history of multiple myeloma, status post stem cell transplant with worsening back and leg pain. Outside hospital imaging in November 2015 showed lesions at T12 with no compression. Cervical:Grade 1 retrolisthesis of C3 relative to C4 is seen. Vertebral body height and morphology are within normal limits. No concerning marrow replacement is seen. No pathologic marrow enhancement is evident.The spinal cord demonstrates normal signal intensity throughout. No abnormal intramedullary or leptomeningeal enhancement is seen. No epidural abnormalities are suspected.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Posterior disc-osteophyte complex formation. Moderate spinal canal stenosis with slight flattening of the ventral cord. Moderate left foraminal narrowing. No interval changes.C4-5: Posterior disc-osteophyte complex formation. Mild spinal canal narrowing. No significant foraminal narrowing. No interval changes.C5-6: No spinal canal stenosis or neuroforaminal narrowing. C6-7: Posterior disc-osteophyte complex formation. Mild spinal canal stenosis. Mild right foraminal narrowing. No interval changes.C7-T1: No spinal canal stenosis or neuroforaminal narrowing.  Thoracic:Alignment is anatomic. Vertebral body heights are preserved. T1 isointense and T2 hyperintense signal within the left T3 vertebral body is unchanged and probably represents an atypical hemangioma.The spinal cord demonstrates normal signal intensity throughout. No pathologic intramedullary or leptomeningeal enhancement is seen. No epidural abnormalities are suspected.Scattered facet arthropathy and minimal disc degeneration is seen through the thoracic spine. No areas of high-grade spinal canal or foraminal stenosis are detected.An enhancing nodule in the right retrocrural space at T12 measures up to 28 x 11 mm in the axial plane. The lesion is relatively dark on T2-weighted images which would suggest chronic blood products, mineralization or a fibrous component. There has been no significant interval change.Lumbar:A transitional L5 vertebral body is seen. Vertebral body morphology is otherwise unremarkable. Marrow signal is generally somewhat heterogeneous but there are no suspicious areas of marrow replacement or enhancement.The distal spinal cord, conus and cauda equina are unremarkable except as discussed below. No epidural abnormalities are suspected. No leptomeningeal enhancement is seen.L1-2: Facet arthropathy. Minimal disc bulging. Mild generalized spinal canal stenosis with slight crowding of the cauda equina. No significant foraminal narrowing. No interval changes. L2-3: Facet arthropathy. Mild disc bulging. Moderate generalized spinal canal stenosis with crowding of the cauda equina. Mild bilateral foraminal narrowing. No interval changes. L3-4: Facet arthropathy. Minimal bulging disc. Moderate generalized spinal canal stenosis with crowding of the cauda equina. Moderate bilateral foraminal narrowing. No interval changes. L4-5: Facet arthropathy. Minimal bulging disc. No significant spinal canal stenosis. Moderate left and mild right foraminal narrowing. No interval changes. L5-S1: No significant spinal canal stenosis or neuroforaminal narrowing.

Output: 1.An enhancing nodule in the right retrocrural space at T12 is redemonstrated showing no significant interval change. This lesion could represent a pathologic lymph node, or given the history of multiple myeloma, a plasmocytoma.2.No definite pathologic marrow space lesions are seen. Signal abnormality within the T3 vertebral body is favored to represent an atypical hemangioma. Vertebral body morphology is within normal limits. There are no compression deformities.3.Scattered degenerative findings are noted as discussed above. Areas of mild to moderate spinal canal stenosis are seen. No significant interval change is noted.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Brain tumor. Signs and symptoms: Brain tumor. Pre-and post-enhanced brain MRI:Examination redemonstrate previously known cluster of extra axial dural based rim enhancing lesion in the left subfrontal and left anterior middle cranial fossa at the site of previous meningioma resection. Compared to prior exam there is noticeable interval decreased size of this finding which is highly suggestive of postoperative change and likely loculated hemorrhage. The focus of rim enhancement in the left subfrontal region measures at 10 x 14-mm in size compared to prior study measurement of 14.5 x 18.5-mm.The largest focus of enhancement along the anterior left middle cranial fossa measures at approximately 12.5 x 21 mm compared to prior study measurement of 14 x 26.Additional well-demarcated focus of rim enhancement in the left anterior middle cranial fossa measures at 7.3 x 7-mm compared to prior study measurement of 11.5 x 11.6mm. The findings in left anterior up fossa and left subfrontal region are highly suggestive of postoperative change and very unlikely to represent tumor.Flair hyperintensity of the left anterior temporal lobe demonstrate interval decreased size and extent and consistent with gliosis.There is no convincing evidence of residual or recurrence of tumor however further follow-up is recommended considering presence of residual postoperative enhancement which could obscure small tumor recurrence. There is a tiny focus of nonspecific flair hyperintensity in the cingulate gyrus of the right frontal lobe is again identified and without change.

Output: 1.Internal improvement with decreased size of cluster of extra axial rim enhancing lesions in the left anterior middle cranial fossa and left subfrontal region consistent with postsurgical change as detailed/measured above.2.Interval decrease left anterior temporal tip flair hyperintensity suggesting improvement of residual vasogenic edema at the surgical site.3.Stable tiny focus of nonspecific flair hyperintensity in the right frontal single he gyrus and with minimal enhancement.


Instruction: Generate impression based on medical findings.

Input: Other abnormal findings on diagnostic imaging of central nervous system [R90.89], Reason for Study: ^Reason: interval change MS vs. post gastric bypass nutritional mayhem History: weak legs Multifocal scattered various size T2/FLAIR high signal intensity lesions are seen on bilateral periventricular and subcortical white matter, unchanged since prior scan.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. The midline structures and cranial-cervical junction are normal.

Output: Stable multifocal scattered bihemispheric white matter FLAIR/T2 high signal intensity lesions since prior scan.


Instruction: Generate impression based on medical findings.

Input: An 82 year old male with personal history of coronary artery disease and persistent atrial fibrillation s/p ablation, referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 44%, the LV end diastolic volume index is 76 ml/m2 (normal range: 74+/-15), the LVEDV is 185 ml (normal range 142+/-34), the LV end systolic volume index is 43 ml/m2 (normal range 25+/-9), the LVESV is 104 ml (normal range 47+/-19), the LV mass index is 49 g/m2 (normal range 85+/-15), and the LV mass is 119 g (normal range 164+/-36). There is global hypokinesis. There is late gadolinium enhancement at the basal segment of the inferior and infero-lateral walls in a pattern that spares the endocardium. The pattern is atypical for prior myocardial infarction and suggests the presence of underlying myocardial fibrosis, inflammation, or infiltration. Left AtriumThe left atrium is severely dilated (166ml). Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 48%, the RV end diastolic volume index is 78 ml/m2 (normal range 82+/-16), the RVEDV is 189 ml (normal range 142+/-31), the RV end systolic volume index is 41 ml/m2 (normal range 31+/-9), and the RVESV is 99 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with mildly reduced systolic function, the LVEF is 44%. 2. There is late gadolinium enhancement at the basal segment of the inferior and infero-lateral walls in a pattern that spares the endocardium. The pattern is atypical for prior myocardial infarction and suggests the presence of underlying myocardial fibrosis, inflammation, or infiltration. 3. The left atrium is severely dilated. 4. The right ventricle is normal in size with mildly reduced systolic function, the RVEF is 48%. 5. The right atrium is mildly dilated. 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: 73-year-old female with transient alteration of awareness. Rule out CVA/bleed. There is no evidence of intracranial hemorrhage, mass or edema. Multiple areas of diffuse periventricular and subcortical white matter hypoattenuation consistent with small vessel ischemic disease, age undetermined. If there is clinical concern for acute ischemia, MRI may be considered.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

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


Instruction: Generate impression based on medical findings.

Input: 39-year-old male with significant ankle pain for 2 years and associated inflammation. TENDONS: No significant abnormality noted.LIGAMENTS: The anterior talofibular ligament appears slightly elongated and thin. The calcaneofibular ligament appears thickened. There are small foci of near-fluid signal intensity along the posterior talofibular ligament. This constellation of findings may represent prior injury to the lateral collateral ligament complex. The distal tibiofibular syndesmotic complex appears intact. There is loss of the normal fatty striation of the deep component of the deltoid ligament which may reflect prior trauma. There is a 1 cm ossicle along the anterior inferior margin of the medial malleolus likely reflects old trauma as well.ARTICULAR SURFACES AND BONE: There are 1.5-2 cm ossicles along the dorsal aspect of the talonavicular joint which may reflect old trauma. There is severe osteoarthritis of the talonavicular joint. Relatively mild osteoarthritis affects the tibiotalar joint. ADDITIONAL

Output: Findings suggestive of prior trauma to the ankle as described above with severe osteoarthritis of the talonavicular joint and relatively mild osteoarthritis of the tibiotalar joint.


Instruction: Generate impression based on medical findings.

Input: Seizure. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are small areas of encephalomalacia in the right pons, right basal ganglia, and left thalamus. There are several scattered foci of cerebral white matter T2 hyperintensity bilaterally. There is bilateral basal ganglia mineralization. Otherwise, the hippocampi appear to be unremarkable and there is no evidence of heterotopia or hamartomas. There is no abnormal intracranial enhancement. There is mild diffuse cerebral volume loss, with superimposed ex vacuo dilatation of the right anterior lateral ventricle. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are bilateral lens implants.

Output: Multiple chronic lacunar infarcts in the right pons, right basal ganglia, and left thalamus, superimposed upon mild chronic small vessel ischemic white matter disease, but no evidence of acute infarction or other evidence of potential seizure foci.


Instruction: Generate impression based on medical findings.

Input: 82 year old with history of hypothyroidism, T2DM, ?amyloid (hyperglobulinemia) who presents from OSH for workup heart failure. Left VentricleThe left ventricle is normal in size with moderately reduced systolic function. There is LV hypertrophy (14-17 mm). The overall LV ejection fraction is 36%, the LV end diastolic volume index is 72 ml/m2 (normal range: 74+/-15), the LVEDV is 115 ml (normal range 142+/-34), the LV end systolic volume index is 46 ml/m2 (normal range 25+/-9), the LVESV is 74 ml (normal range 47+/-19). The left ventricular dysfunction is global. The late gadolinium enhancement images reveal diffuse transmural Gd enhancement. This is a finding that is typical for amyloidosis. Additional supportive findings include: Inability to completely null the myocardium on LL series. Elevated native T1 times at 1174 ms (normal < 1050 ms). MArked delayed enhancement of the atrial wall. Delayed enhancement in the RV wall.Left AtriumThe left atrium is moderate-severely dilated. Right VentricleThe right ventricle is normal in size with moderately reduced systolic function . There is right ventricular hypertrophy. The overall RV ejection fraction is 31%, the RV end diastolic volume index is 86 ml/m2 (normal range 82+/-16), the RVEDV is 138 ml (normal range 142+/-31), the RV end systolic volume index is 59 ml/m2 (normal range 31+/-9), and the RVESV is 95 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary Veins3 pulmonary veins drain normally into the left atrium (LUPV not well seen)Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is a small pericardial effusion.Extracardiac FindingsBilateral interstitial markings at lung bases. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with moderately reduced systolic function and severe LVH (LVEF 36%) The left ventricular dysfunction is global. The late gadolinium enhancement images reveal diffuse transmural Gd enhancement. This is a finding that is typical for amyloidosis. Additional supportive findings include: Inability to completely null the myocardium on LL series. Elevated native T1 times at 1174 ms (normal < 1050 ms). MArked delayed enhancement of the atrial wall. Delayed enhancement in the RV wall.2. The right ventricle is normal in size with moderately reduced systolic function . There is right ventricular hypertrophy. The overall RV ejection fraction is 31%. 3. There is a small pericardial effusion


Instruction: Generate impression based on medical findings.

Input: Evaluate right internal carotid artery for aneurysm as mentioned in previous MRI brain report. There is no evidence of significant steno-occlusive lesions in the cervical arteries. The study is not optimized to assess the intracranial arteries, although no aneurysm at the origin of the mildly tortuous right ophthalmic artery is apparent.

Output: 1.No convincing right ophthalmic artery aneurysm. Finding on previous examination may have been attributable to mild tortuosity of vessel or enhancement in the adjacent cavernous sinus.2. No significant steno-occlusive disease in the neck.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: Alignment is anatomic. No loss of vertebral body height. The osseous structures are unremarkable. The marrow signal is benign. The cervical cord signal is normal. The imaged paraspinal contents are unremarkable without evidence of soft tissue injury. No evidence of neuroforamina or central canal stenosis.

Output: No evidence of osseous or soft tissue injury.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Intracranial hemorrhage? Signs and symptoms: Headaches. Non-enhanced MRI of brain:Extensive postoperative changes of large bifrontal craniotomy. Significant widening of the epidural space containing serosanguineous fluid and air. This is a postoperative findings. Epidural collection causes mass effect and posterior displacement of frontal lobes. Residual air within the subarachnoid space from patient's surgery. No evidence of parenchymal hemorrhage. Interval reduction in the low density cyst in the basal cistern. On the current exam the cyst measures approximately 19 mm in AP and 27-mm in transverse diameter. This is a smaller than prior examination which measured 25 mm x 36-mm. no evidence of hemorrhage within the cyst.

Output: 1.Reduction in the size of cyst within the basal cistern consistent with patient's past history of craniopharyngioma.2.Extensive postoperative changes all bifrontal craniotomy as detailed above.3.No evidence of acute hemorrhage within the brain parenchymal or cyst within the basal cistern.


Instruction: Generate impression based on medical findings.

Input: Recent biopsy of a low grade glioma involving the brainstem, with new right 6th nerve palsy and dysphagia. There are postoperative findings related to right transfrontal biopsy of the medullary lesion. There is a small amount of susceptibility effect along the biopsy track, which traverses the lateral margin of the right red nucleus and the posterior right pons, in the region of the abducens nucleus and the root of the abducens nerve, as well as the medulla, in the region of the right hypoglossal nucleus. There is no evidence of acute infarct. There is a small amount of pneumoventricle, but the ventricles are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are grossly intact. The paranasal sinuses and orbits are unremarkable.

Output: Postoperative findings related to right transfrontal biopsy of the medullary glioma. There is a small amount of susceptibility effect along the biopsy track, which traverses the posterior right pons, in the region of the abducens nucleus and the root of the abducens nerve, as well as the medulla, in the region of the right hypoglossal nucleus.


Instruction: Generate impression based on medical findings.

Input: 20 year-old male with history of osteosarcoma. There are postsurgical changes from left proximal fibular resection with adjacent scarring and mildly increased T2 signal within the surgical bed and soft tissues likely representing edema. There are foci of signal void artifact within the lateral proximal tibia and soft tissues of the surgical bed related to orthopedic hardware and clips. On postcontrast imaging there is no evidence of abnormal enhancing mass to suggest residual tumor or tumor recurrence. There is mild edema-like signal about the medial femoral condyle which is nonspecific. There are periosteal changes at the resection margin of the fibular as well as increased marrow signal which is favored to be postoperative in etiology. There is no lymphadenopathy. The remainder of the visualized tibia, fibula, and femur are unremarkable.

Output: Postsurgical changes without definitive evidence of residual tumor or tumor recurrence.


Instruction: Generate impression based on medical findings.

Input: 58 years Female (DOB:2/8/1958)Reason: h/o R acoustic neuroma History: tinnitusPROVIDER/ATTENDING NAME: STEVEN J CHMURA STEVEN J CHMURA The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mass present in the right internal auditory canal measuring 15 x 6 mm axial dimensions which is also identified on prior examsNo 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: Right internal auditory canal mass is stable since the February exam. Examination is obtained for stereotactic guidance during surgery.


Instruction: Generate impression based on medical findings.

Input: H/o breast cancer. Examination demonstrates a focal hypodensity lateral to the left insular fissure, corresponding a metastatic lesion on the previous MRI. The brain is otherwise normal in attenuation and morphology. There is no intracranial hemorrhage, mass effect, edema, midline shift or abnormal extra-axial fluid collection.There is a focal area of lytic change in the left frontal bone. The visualized paranasal sinuses are well cells are normally pneumatized.

Output: 1. Left temporal metastatic lesion. An infused exam is suggested for further evaluation. 2. Metastatic lesion in the left frontal bone.


Instruction: Generate impression based on medical findings.

Input: Lumbago with sciatica, left side [M54.42] / Muscle weakness (generalized) [M62.81] / Pain, unspecified [R52], Reason for Study: ^Reason: eval for lumbar spine pathology History: lower back pain and bilat leg pain For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The conus medullaris terminates at the L1-L2 level. Degenerative changes are specified by the intervertebral level as follows: T12-L1: There is central to right broad based disc protrusion, unchanged since prior scan. Disc dessication is seen, unchanged. No spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: no neuroforaminal narrowing or spinal stenosis. L4-L5: no neuroforaminal narrowing or spinal stenosis. L5-S1: no neuroforaminal narrowing or spinal stenosis.

Output: 1. Unchanged central to right broad based disc protrusion with disc dessication at the level of T12-L1.2. Otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: 44M uncontrolled IDDM with recent dog scratch now presents with sepsis presumed secondary to infection of left upper due to left subscapular abscess seen on imaging status post left shoulder open anterior I&D and posterior arthroscopic I&D. Back pain. Evaluate for infection in the spine. There is mild dextro thoracic and mild levo lumbar curvature. There is straightening of the lumbar lordosis in the sagittal plane. The vertebral body heights are preserved. There is mild loss of height of the L4-L5 disc space with endplate degenerative changes. There is diffuse low signal of the bone marrow. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.T12-L1: No significant disc bulge, spinal canal or foraminal stenosis. L1-L2: No significant disc bulge, spinal canal or foraminal stenosis.L2-L3: Mild bilateral facet degeneration. No significant disc bulge, spinal canal or foraminal stenosis. L3-L4: Mild bilateral facet degeneration. No significant disc bulge, spinal canal or foraminal stenosis. L4-L5: Disc bulge with superimposed large central/right paracentral disc extrusion with cranial and caudal migration and measuring approximately 20 mm, contributing to moderate spinal canal stenosis and possible impingement of the descending nerve roots, and mild bilateral foraminal stenosis. Mild bilateral facet degeneration. L5-S1: Mild bilateral facet degeneration. No significant disc bulge, spinal canal or foraminal stenosis.

Output: 1. Central/right paracentral disc extrusion at L4-L5 with cranial and caudal migration and measuring approximately 20 mm in length. There is resulting moderate central canal stenosis as well as and right lateral recess stenosis. 2. No evidence of discitis-osteomyelitis, inflammatory changes, or fluid collections in the lumbar spine to suggest infection.3. Diffusely low marrow signal, which is nonspecific but can be seen in conditions such as chronic anemia or marrow proliferative disorders. 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: 40 year old man with cutaneous amyloidosis, hypertension referred for cardiac MRI to evaluate for potential amyloid involvement of the heart. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 69%, the LV end diastolic volume index is 64 ml/m2 (normal range: 74+/-15), the LVEDV is 130 ml (normal range 142+/-34), the LV end systolic volume index is 20 ml/m2 (normal range 25+/-9), the LVESV is 40 ml (normal range 47+/-19), the LV mass index is 55 g/m2 (normal range 85+/-15), and the LV mass is 111 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Gadolinium kinetics appear normal. The native T1 myocardial relaxation time in the basal, mid and apical septum is within normal limits (920-940ms).Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 60%, the RV end diastolic volume index is 69 ml/m2 (normal range 82+/-16), the RVEDV is 140 ml (normal range 142+/-31), the RV end systolic volume index is 28 ml/m2 (normal range 31+/-9), and the RVESV is 56 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsRight hemidiaphragm elevation noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function (EF 69%). The left ventricular function is more vigorous on today's study. There is no abnormal late gadolinium enhancement to suggest the presence of cardiac amyloidosis. Furthermore, the native T1 myocardial relaxation times are within normal limits. 2. Normal size right ventricle with normal systolic function (EF 60%).3. Unusually elevated right hemidiaphragm. Correlate with concern for diaphragmatic dysfunction.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: Evaluate for PSC. Elevated alkaline phosphatase. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Retroaortic left renal vein, a normal variant. No hydronephrosis or suspicious renal lesion.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Unremarkable MRCP. No biliary ductal dilatation. No evidence of dominant or flow-limiting biliary stricture.


Instruction: Generate impression based on medical findings.

Input: Male; 58 years old. Reason: assess for excursion of drain History: bilious fluid in pancreatic cyst drain ABDOMEN:LUNG BASES: Moderate left pleural effusion with increased left basilar nonspecific atelectasis/consolidation, for which underlying aspiration or infection cannot be excluded. Small right pleural effusion with mild compressive right basilar subsegmental atelectasis. LIVER, BILIARY TRACT: Postsurgical changes from side-to-side choledochojejunostomy. The anastomosis is widely patent. Minimal biliary tree dilation is seen without evidence of obstructing lesion.SPLEEN: No significant abnormality noted.PANCREAS: Mild likely chronic dilation of the pancreatic duct. No evidence of obstructing mass, but correlation with most recent endoscopic findings is recommended.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post cyst gastrostomy and percutaneous catheter placement with two drainage catheters and appearance of left upper quadrant bilobed cystic structure grossly unchanged since prior CT. Mild to moderate nonspecific circumferential bowel wall thickening of the transverse duodenum, which may be at least partially attributable to underdistention.BONES, SOFT TISSUES: Body wall anasarca.

Output: 1.Postsurgical changes from choledochojejunostomy with widely patent anastomosis. Minimal biliary tree dilation without evidence of obstructing lesion.2.Nonspecific bowel wall thickening of the transverse duodenum, which may be causing partial obstruction with gastric reflux of bile, given the patient's clinical history of bilious fluid from gastrostomy tube.3.Catheter placement and essentially stable left upper quadrant bilobed cystic structure.4.Stable mild and likely chronic pancreatic ductal dilation without evidence of obstructing mass, but correlation with most recent endoscopic findings is recommended.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Evidence of herniation, please evaluate for brainstem and foramina magnum. Signs and symptoms: Status post PEA arrest, nonresponsive. Nonenhanced CT of brain:Portable CT at bedside is performed. Images through posterior fossa are severely obscured due to extensive artifact from patient's multiple bilateral dental fillings. The brainstem cannot be properly evaluated due to extensive artifact. Recommend follow-up with a standard nonportable CT. The fourth ventricle is identified in the midline. The prior portable CT did not include the fourth ventricle and comparison cannot be made.Images through supratentorial space demonstrate no gross evidence of hemorrhage, mass-effect, hydrocephalus or midline shift. Possibility of edema cannot be evaluated due to very poor quality of the study. There is however no visualization of cortical sulci this may indicate underlying diffuse cerebral edema. Follow-up exam with a dedicated nonportable CT or an MRI is recommended.

Output: Suboptimal study due to extensive artifact however no gross abnormality since prior exam. Possibility of cerebral edema cannot be evaluated.


Instruction: Generate impression based on medical findings.

Input: Dizziness, abnormal VNG, arm weakness. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is minimal nonspecific cerebral white matter T2 hyperintensity. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is fluid in the right maxillary sinus.

Output: No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on medical findings.

Input: 57 years Male (DOB:2/5/1959)Signs and Symptoms: left lateral neck pain and radiating left arm painPROVIDER/ATTENDING NAME: SERVICES ANCILLARY SERVICES ANCILLARY The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal. There is left-sided facet hypertrophy present associated with encroachment of left-sided exiting nerve roots within the neural foramen. There is disc desiccation present at this level. This has not changed significantly since the prior exam.At C3-4 there is a right paramedian disc protrusion present associated with uncovertebral osteophytes and narrowing of the right neural foramen. There is some effacement of spinal fluid ventral to the right hemicord at this. There is disc desiccation present at this level. This has not changed significantly since the prior exam.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is disc desiccation present at this level. There is a broad-based central disc protrusion at this level. This has not changed significantly since the prior exam.At C5-6 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with uncovertebral and endplate osteophytes. There is encroachment of the exiting nerve roots within the neural foramina bilaterally at this level there is partial effacement of spinal fluid ventral to the spinal cord with a mild degree of spinal stenosis at this level. This has not changed significantly since the prior exam.At C6-7 there is no significant compromise to the spinal canal. There is disc desiccation and a broad-based left paramedian disc protrusion at this level associated with mild encroachment of left-sided exiting nerve roots within the neural foramen. This has not changed significantly since the prior exam.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: There are multilevel degenerative changes present in the cervical spine associated with a mild degree of spinal stenosis at C5-6 and encroachment of exiting nerve roots within the neural foramina at C5-6 bilaterally, the left side at C2-3 and C6-7 and the left side at C3-4. These findings have not changed significantly since the prior exam.


Instruction: Generate impression based on medical findings.

Input: 79-year-old female with pain over the posterolateral aspect of the knee. Evaluate for meniscal tear versus Baker's cyst. MENISCI: There is globular increased signal abnormality within the medial meniscus consistent with intrasubstance degeneration. There is increased signal abnormality which extends to the tibial and femoral articular surfaces with associated deformity/maceration of the posterior horn and body of the medial meniscus consistent with degenerative tearing. There is medial extrusion of the body of the meniscus. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is full-thickness articular cartilage degeneration along the weightbearing surface of the medial femoral condyle and medial aspect of the tibial plateau with bone marrow edema type signal abnormality, likely degenerative in etiology. There is tricompartmental osteophyte formation. There is near full-thickness articular cartilage degeneration along the lateral facet of the patella. There is near full-thickness to full-thickness articular cartilage degeneration along the medial facet of the patella.LIGAMENTS: The cruciate and collateral ligaments appear intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Osteoarthritic changes including articular cartilage degeneration and degenerative tearing of the medial meniscus as described above.


Instruction: Generate impression based on medical findings.

Input: 62 years Male (DOB:12/29/1953)Reason: hx cervical stenosis. Eval for abnormality. History: Left arm pain/ hx ulnar nerve decomp. Claw handPROVIDER/ATTENDING NAME: EDWIN RAMOS EDWIN RAMOS Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. The patient status post anterior fusion at 3 C6-7 with anterior plate and screws.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is a broad-based central disc protrusion present this level which is unchanged compared to the prior examAt C3-4 there is redemonstration of a broad-based left lateral recess disc protrusion which encroaches on the left-sided exiting nerve roots within the neural foramen. There are some endplate and uncovertebral osteophytes at this level and There are some endplate reactive changes present which are bright on T2 STIR and dark on T1.At C4-5 there is loss of disc space height, disc desiccation and a disc bulge associated with endplate and uncovertebral osteophytes. There is partial effacement of spinal fluid ventral but not posterior the spinal cord at this level. There is narrowing of the neural foramina bilaterally with encroachment of the exiting nerve roots within the neural foramina bilaterally this was also present on the previous exam and has not changed substantially.At C5-6 there is some loss of disc space height, diffuse disc bulge and ligamentum flavum hypertrophy associated with some uncovertebral osteophytes bilaterally and encroachment of the exiting nerve roots within the neural foramina bilaterally due to disc material and uncovertebral osteophytes. These findings were also present on the previous exam and have not changed substantially. Overall there is a mild to moderate degree of spinal stenosis at this level which is also stable compared to the prior exam.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. There is a small central disc protrusion present at this levelThe vertebral artery flow voids appear to be intact.There is a disc bulge at T2-T3 associated with neural foramen encroachment of exiting nerve roots. This remains stable compared to the previous exam.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with the narrowing of the neural foramina more on the left than the right side. There is associated facet hypertrophy at this level. There are some encroachment of the left-sided exiting nerve roots within the neural foramen at this level. There are some endplate reactive changes at this level which are high signal on T1 and T2. There is a right lateral recess disc protrusion at this level which extrudes behind the adjacent S1 segment and encroaches on the nerve root at the right lateral recess.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is some loss of disc space height and a disc bulge at this level associated with facet and ligamentum flavum hypertrophy.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge present at this level and a right far lateral disc protrusion there is crowding of the nerve roots within the thecal sac at this level and overall a mild to moderate degree of spinal stenosis.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There are multilevel degenerative changes present in the cervical spine with mild to moderate spinal stenosis at C5-6 and mild spinal stenosis at C3-4 which has not progressed significantly since the previous exam. Associated encroachment of exiting nerve roots at C3-4, C4-5 , C5-6 and T2-3 has also not progressed significantly compared to the prior exam.2.Since prior exam some endplate reactive changes at C3-4 have entered acute or subacute phase. This would suggest some active inflammation predominantly on the left side at this level.3.There is a right lateral recess disc extrusion at L5-S1 which encroaches on the nerve roots at the right lateral recess (probably right S1 nerve roots).4.There are degenerative changes present lumbar spine with associated mild-to-moderate spinal stenosis at L2-3 and encroachment of the left-sided exiting nerve roots at L5-S1 (probably left L5 nerve roots).


Instruction: Generate impression based on medical findings.

Input: Clinical question: Metastatic breast cancer, baseline prior to starting on clinical trial. Signs and symptoms: No clinical signs of brain metastases. Pre-and post enhanced brain MRI:Negative diffusion weighted images.Examination demonstrate normal anatomical morphology and signal intensity to brain parenchyma on all MRI sequences. Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.No detectable abnormal parenchymal or leptomeningeal enhancement.Normal signal intensity calvarial gland without detectable abnormal enhancement.Unremarkable images through the orbits and including axial fat sat post enhanced series.Normal signal intensity of paranasal sinuses and bilateral mastoid air cells and middle ear cavities.

Output: Negative pre-and post enhanced brain MRI.


Instruction: Generate impression based on medical findings.

Input: Left shoulder pain. Weakness. ROTATOR CUFF: No evidence is seen of any rotator cuff tears. There is some intermediate signal within the supraspinatus consistent with tendinopathy.No evidence is seen of any fatty atrophy or muscle edema in the rotator cuff. The spinoglenoid and suprascapular notches are within normal limits.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: No significant abnormality noted.

Output: Supraspinatus tendinopathy. Otherwise negative


Instruction: Generate impression based on medical findings.

Input: 51 year old female with known right triple negative breast cancer with right axillary lymph node metastasis, status post neoadjuvant chemotherapy. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Hydromark Clip is present at anterior 10 o'clock in the right breast. It is presumably placed in the proven carcinoma. There are no abnormal enhancement in the right breast, suggesting complete resolution of the right breast cancer.There is a small metallic artifact at the edge of a benign appearing lymph node located at superior anterior right axilla, suggesting a presence of marker clip. Thus, this lymph node is presumably a proven metastatic node. In addition, several benign appearing lymph nodes are present in the right axilla. No abnormal enhancement is seen in left breast. Port-A-Cath is seen in the upper inner left breast. No abnormal axillary lymph nodes are identified in left axillary region.

Output: 1. Complete imaging resolution of right breast cancer and right axillary lymph node.2. No MR evidence for malignancy in the left breast or left axilla.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old, history of thymoma resection, with giant arachnoid granulation versus venous lake seen on recent CT scan. An area of focal calvarial thinning in the right frontal bone is seen containing CSF signal fluid. The space is in fact contiguous with the adjacent CSF space. No concerning solid or nodular enhancement is demonstrated. This area demonstrates at most minimal peripheral enhancement.Elsewhere in the brain, no significant parenchymal edema or mass effect. No abnormal extra axial fluid collections are seen. Parenchymal enhancement is within normal limits.

Output: An area of focal thinning of the right frontal bone shows imaging features most compatible with a large arachnoid granulation.


Instruction: Generate impression based on medical findings.

Input: 63-year-old male with infected stump. Evaluate for osteomyelitis. RIGHT FOOT:Postsurgical changes of prior amputation through the first through fifth metatarsals. There is no bone marrow signal abnormality to suggest osteomyelitis of the right foot, as clinically questioned. No sinus tract or cortical destruction are identified. There is decreased signal abnormality in within the remnant of the 5th metatarsal which appears to correspond to sclerosis seen on recent radiographs. There is increased signal abnormality within the soft tissues along the plantar aspect of the calcaneus and proximal midfoot. There is also increase in signal abnormality within the flexor digitorum and flexor hallucis longus muscle bellies. No focal fluid collection is identified to suggest abscess formation.LEFT FOOT:The patient is status post transmetatarsal amputation through the first and fifth metatarsals. There is increased T2 and decreased T1 signal abnormality within the remnant of the fifth metatarsal base, suspicious for osteomyelitis. No sinus tract or cortical destruction are identified. There is increased signal abnormality within the soft tissues in the surrounding area. Additionally there is decreased T1 and T2 signal abnormality within the distal portions of the fourth and fifth metatarsal remnants which appears to correspond to sclerosis seen on recent foot radiographs. No focal fluid collection is identified to suggest abscess formation.

Output: 1. Findings suspicious for osteomyelitis of the 5th metatarsal remnant of the left foot, as described above.2. Findings suggestive of soft tissue inflammation/edema without evidence of osteomyelitis of the right foot.


Instruction: Generate impression based on medical findings.

Input: Patient is status post left craniotomy for tumor resection with small extra-axial collection beneath the craniotomy flap appearing unchanged. There is increased T2/FLAIR signal surrounding the resection cavity with linear enhancement along the medial border appearing unchanged from the previous study. No new FLAIR signal abnormality, new mass effect, or suspicious enhancement. Susceptibility effect related to chronic blood products again seen. No hydrocephalus, mass effect, midline shift or herniation. Paranasal sinuses and the osseous structures are within the normal limits.

Output: Unchanged posttreatment changes in the left frontoparietal lobes without evidence of tumor recurrence.


Instruction: Generate impression based on medical findings.

Input: History of low back pain. Evaluate for nerve impingement, vertebral compression. Examination is limited due to motion degradation. There is grade 1 anterolisthesis of L5 on S1. Vertebral body heights and disc heights are grossly maintained. There is nonspecific heterogeneous bone marrow signal. Conus medullaris is normal in appearance and terminates at the T12-L1 level. Fat at the L4-5 level is thought to be in the dorsal epidural space. Right renal cyst.T12-L1: There is no significant compromise to spinal canal or neural foramina.L1-L2: There is no significant compromise to spinal canal or neural foramina.L2-L3: There is no significant compromise to spinal canal or neural foramina.L3-L4: There is no significant compromise to spinal canal or neural foramina.L4-5: Advanced facet arthropathy with small amount of fluid in the joint. Small synovial cysts posterior to the facet joints. There is no significant compromise to spinal canal or neural foramina.L5-S1: Advanced facet arthropathy with small amount of fluid in the joint. Small synovial cysts posterior to the facet joints. Mild disc bulge. There is moderate to severe right and moderate left neural foraminal narrowing. There may be impingement of the exiting L5 nerve roots. There is no spinal canal stenosis.

Output: 1.Grade 1 anterolisthesis of L5 on S1 with advanced facet arthropathy at L4-5 and L5-S1.2.Moderate to severe right and moderate left neural foraminal narrowing at L5-S1, where there may be impingement of the exiting L5 nerve roots.


Instruction: Generate impression based on medical findings.

Input: Follow-up of mildly restricted diffusion lesion on prior MRI, numbness and tingling of the right upper extremity, possible demyelinating disease. There is no evidence o acute ischemic or hemorrhagic lesion on today's scan.There is no evidence of abnormal enhancement either.Previously recognized left inferior frontal area mildly restricted diffusion lesions are not demonstrated on today's scan. However, corresponding high signal intensity lesions on FLAIR images are seen and do not show any significant interval change since prior exam (series 5, image18/38).Previously seen focal high signal intensity on vermis on FLAIR imaging (series 8, image 21/30) appears to be much lessen signal intensity than prior scan.Above findings could represent evolution of small subacute ischemic lesions or could also represent evolving demyelinating lesion. Again there is no evidence that can suggest chronic demyelinating lesion on this scan.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. There is no evidence of acute ischemic or hemorrhagic lesion.2. Non visualization of previously recognized restricted diffusion lesions on the left inferior frontal lobe but can still recognizable on FLAIR images. Lessen signal intensity and smaller in size of the anterior vermis lesion on FLAIR images without evidence enhancement. Again diagnostic possibilities include evolving subacute ischemic lesions and demyelinating lesions. Follow up imaging study and clinical correlation might be valuable for the differential diagnosis.


Instruction: Generate impression based on medical findings.

Input: 33-year-old male with a history of synovial cell sarcoma with pain. The bone marrow signal intensity is normal. The left hip appears normal. We see no effusion. There is a small amount of fluid within the joint with minimal synovial enhancement. Please note that this examination was not protocoled for detailed evaluation of the acetabular labrum, however, no abnormalities of the labrum are identified. The musculature of the left hip appears normal. On the large field-of-view images, the right hip appears normal as do the sacroiliac joints. Degenerative disc disease affects the level of L5/S1. The remaining visualized soft tissue structures appear normal.

Output: Minimal synovial enhancement of the left hip which is not necessarily of any clinical significance. Degenerative disc disease at L5/S1. We otherwise see no findings to account for the patient's pain.