Instruction: Generate impression based on medical findings.

Input: Rule out structural abnormalities, 2 year-old nonverbal, oral aversion, hypotonia.. There is mild hypoplasias of the inferior cerebellar vermis. Remainder of the posterior fossa structures are unremarkable. Corpus callosum appears within normal limits. Remainder of the brain is also unremarkable. Sulcation and myelination are age-appropriate. No evidence of infarct, intracranial mass, or mass effect. No extra-axial collections or subdural hematomas. Flow voids are present in the major vessels indicating patency. There is nonspecific opacification of the partially pneumatized maxillary sinuses. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: There is mild hypoplasia involving the inferior cerebellar vermis, which can be a normal variant. MRI of the brain is otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Male 26 years old Reason: eval for loose bodies; chondromalacia; lateral meniscal tear History: knee pain for 2-3 years s/p dislocation; now more pain; clicking and posterior lateral joint line pain MENISCI: The anterior and posterior horns of both the medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: Focal decreased signal in the substance of the articular cartilage at the junction the medial and lateral patellar facets may represent chondromalacia, but there is no evidence of a full-thickness defect.LIGAMENTS: The medial collateral and lateral collateral ligament complexes are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Focal decreased signal in the substance of the articular cartilage at the junction the medial and lateral patellar facets may represent chondromalacia. No evidence of meniscal tear or loose bodies as clinically questioned.


Instruction: Generate impression based on medical findings.

Input: Note that examination is limited by metal artifact from anterior fusion hardware. Postsurgical changes are noted from anterior fusion of the C4-C6 vertebral bodies. A known left cerebellopontine angle mass is again noted on sagittal images and measures 15 mm in AP dimension, unchanged. A 12 mm midline nasopharyngeal cyst is unchanged and likely presents a Thornwaldt cyst. There is uniform narrowing of the cervical spinal canal, measuring approximately 8 mm in diameter, compatible with congenital narrowing. The cervical and upper thoracic cord is normal in signal without abnormal enhancement. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. C1/2: No significant spinal canal or neuroforaminal narrowing.C2/3: Mild spinal canal narrowing. No significant neuroforaminal narrowing.C3/4: Mild spinal canal narrowing. Mild left neural foraminal narrowing.C4/5: Mild spinal canal narrowing. No significant neuroforaminal narrowing.C5/6: Mild spinal canal narrowing. No significant neuroforaminal narrowing.C6/7: Mild spinal canal narrowing. No significant neuroforaminal narrowing.C7/T1: There is central and leftward disc extrusion with mild superior displacement. This causes complete effacement of the thecal sac and flattening of the spinal cord, compatible with moderate spinal stenosis. There is no signal abnormality at this level within the cord. The visualized thoracic spine up to the level of T4 does not have significant spinal canal narrowing.

Output: 1.Congenital narrowing of the cervical spinal canal with moderate spinal canal narrowing at the C7-T1 level secondary to disc extrusion. Please see above comments.2.Postsurgical changes from anterior fusion of C4-C6 without evidence of spinal cord signal abnormality.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Patient presents with AMS, global dysfunction without focal deficits. History of renal dysfunction and cannot use IV contrast. Evaluate for potential etiology of AMS. Signs and symptoms: As above. Nonenhanced brain MRI:Examination is severely limited and incomplete due to extensive motion artifacts, repeat exam is recommended.Negative diffusion weighted images.Ventricular system remains within normal size and maintained midline.There is slight prominence of cortical sulci.There are subtle periventricular and subcortical foci of flair/T2 hyperintensity which are nonspecific all are in proper clinical setting could represent chronic changes of microvascular ischemic process.There is no detectable intracranial hemorrhage, mass effect or midline shift. No convincing evidence of a mass on this nonenhanced exam. Calvarium and orbits are unremarkable.Mastoid air cells, middle ear cavities and all paranasal sinuses demonstrate normal pneumatization signal pattern.

Output: 1.Suboptimal and limited exam due to extensive motion artifact.2.Within this limitation no acute intracranial process is detected.3.Minute subcortical and periventricular foci of flair hyperintensity is a nonspecific finding however in proper clinical setting could represent chronic small vessel ischemic strokes.


Instruction: Generate impression based on medical findings.

Input: Redemonstration of left intracranial/cisternal optic nerve and optic chiasm mass. The mass demonstrate regions of solid and enhancing tumor, foci of solid and partially enhancing tumor as well as cystic component. The tumor extends from the cisternal component of left optic nerve superiorly along the anterior aspect of supraclinoid internal carotid artery, superiorly into the basal cistern/hypothalamic region and posteriorly into the interpeduncular cistern and laterally into the proximal horizontal segment of left sylvian fissure. The tumor also has a small subfrontal component similar to prior exam. There is intrinsic T1 hyperintensity at the region of hypothalamus compatible with calcification. There is stable to minimal decrease in the size of the left paraclinoid enhancing component now measuring 13 x 14 x 13 mm in AP, transverse, and CC dimensions. It previously measured 13 x 17 x 16 mm. There is slight increase in the size of the cystic components just anterior to the interpeduncular cistern measuring 8 x 9 mm in AP and CC dimensions, previously 6 x 7 mm. Separate adjacent enhancing nodular component is without significant change from prior study.There is cystic collection in the middle cranial fossa, which follows near CSF characteristics. This collection has minimally decreased in size.No diffusion-weighted abnormalities are identified. There is no evidence for intracranial hemorrhage. The ventricles and sulci are normal in size. Flow voids re present within the major vessels indicating patency. Left maxillary mucous retention cyst.

Output: 1.Redemonstration of mixed signal intensity and pattern of enhancement of an irregular mass arising from the cisternal component of the left optic nerve and with involvement of the optic chiasm, extension into the interpeduncular cistern/hypothalamic region and minimally into the left subfrontal region and laterally into the proximal sylvian fissure. Left paraclinoid enhancing component is slightly decreased in size. Slight increase in the size of the cystic component anterior to the interpeduncular cistern. Adjacent nodular enhancing component is stable in size. 2.Cystic collection in the left medial middle cranial fossa follows near CSF characteristics and slightly decreased in size.3.No evidence of any additional new lesions since prior exam.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Secondary malignant neoplasm of brain and spinal cord Secondary and unspecified malignant neoplasm of lymph nodes, site unspecified Squamous cell carcinoma of skin, site unspecified Secondary malignant neoplasm of brain and spinal cord Secondary and unspecified malignant neoplasm of lymph nodes, site unspecified Squamous cell carcinoma of skin, site unspecifiedClinical question: Hx of metastatic HNSCCa with single L occipital metastasis s/p SRS, surveillance scanSigns and Symptoms: HA, poor balance The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There is redemonstration of 2 foci of susceptibility effect in the left cerebellar hemisphere 1 laterally and one medially which are only seen on the susceptibility weighted images. The one located on the lateral aspect has been identified as an enhancing nodule on the 8/12/2014 exam and could also be seen on the recent 3/21/2015 exam. On the current exam it is a punctate focus some enhancement only not significantly different than on the prior exam. The one on the medial aspect of the left cerebellar hemisphere is not readily identified on the postcontrast images on the current exam nor on prior exams. It can be identified as far back as 10/22/2014 on susceptibility weighted images.A couple punctate foci of susceptibility weighted image signal loss in the periventricular white matter were also present on the prior exam. In isolation these are of uncertain significance.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some minor mucosal thickening in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.

Output: 1.Findings suggest hemorrhagic lesions in the left cerebellar hemisphere which have been identified on prior exams and are stable since the March 2015 exam. The more lateral one of the two was larger on prior exams and has decreased in size over time and likely represented metastasis. The more medial lesion is only identified on susceptibility imaging. The possibility that this represents another metastatic focus cannot be excluded.2.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on medical findings.

Input: 79-year-old female with pain and swelling. Evaluate for osteomyelitis. Severe osteoarthritis affects the first MTP joint and mild osteoarthritis affects the interphalangeal joints.There is edema type signal seen within the middle phalanx of the third toe on T2 fat suppressed images, although the marrow maintains a normal fatty signal on T1 weighted images. The constellation of findings suggests reactive osteitis, with acute osteomyelitis considered less likely. There is mild edema along the dorsum of the foot as well as atrophy of the foot musculature. We see no discrete fluid collections.

Output: 1.Edema-type signal within the middle phalanx of the third toe is thought to represent reactive osteitis as opposed to osteomyelitis. This can be followed with dedicated toe radiographs if clinically warranted.2.Osteoarthritis and other findings as above.


Instruction: Generate impression based on medical findings.

Input: Weakness deconditioning. Suspicion for MCA infarct. MRI BRAIN: There is mild diffuse global volume loss. The gray-white matter differentiation is preserved. There are a few scattered foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter which are unchanged. There is mineralization of the bilateral globus pallidus. There is no evidence for acute intracranial hemorrhage. No midline shift or mass effect is appreciated.MRA BRAIN: The intracranial carotids and vertebrobasilar arteries are grossly patent, however additional examination is nondiagnostic due to extensive motion artifact.

Output: 1. No acute infarct.2. Stable mild white matter changes likely related to chronic microvascular ischemic disease.3. The intracranial carotids and vertebrobasilar arteries are grossly patent, however detailed evaluation is nondiagnostic due to extensive motion artifact.


Instruction: Generate impression based on medical findings.

Input: 69 year old female with retropharyngeal abscess. Worsening clinical symptoms. Increasing neurological symptoms. Evaluate for spread. CT of the soft tissues of the neck.Images through the skull base including cavernous sinuses remain within normal limits.Images through the soft tissues of the neck demonstrate a prevertebral edema enhancing fluid collection which also contains air and is consistent with patient's diagnosis of prevertebral abscess in comparison with the prior exam no definitive evidence of interval change is noted however on this the study extension of the abscess to the level of left neural foramina at C6- C7 is better visualized. Prior MRI of cervical spine also demonstrate ventral epidural spread of infection at this level. There may be slight increase in the size of prevertebral abscess. Images through the apices of the lungs demonstrate significant bilateral pleural effusions that appears more pronounced (on the right side) since prior examination.CT of brain with infusion.No evidence of any abnormal enhancement of brain parenchymal or the leptomeninges is identified to suggest intracranial spread of infection. No evidence of edema, mass effect, midline shift, hydrocephalus is detected. Cortical sulci, ventricular system and all CSF cisterns remain within normal limits.If worsening of neurological symptoms are relevant to the spine repeat MRI examination of cervical and thoracic spine is recommended.

Output: 1.Negative CT of brain with infusion.2.Redemonstration of prevertebral abscess with possible slight interval increase in its size.


Instruction: Generate impression based on medical findings.

Input: 53-year-old male with left knee pain MENISCI: There is an oblique flap tear involving the body and posterior horn of the medial meniscus extending to the tibial articular surface. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: No abnormal marrow signal. Mild partial thickness (greater than 50%) fissuring along the lateral patellar facet without underlying marrow changes. The trochlear cartilage is intact. The cartilage in the medial and lateral compartments is intact. Small tricompartmental osteophytes are present.LIGAMENTS: The ACL and PCL is intact. Lateral collateral ligament complex is intact. There is small amount of fluid surrounding the MCL which may suggest a grade 1 sprain.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Medial meniscal tear.2.Grade 1 sprain of the MCL.


Instruction: Generate impression based on medical findings.

Input: Clinical question: History of metastatic lung cancer with brain metastases. Surveillance scan. Signs and symptoms: None. Pre and post enhanced brain MRI:No diffusion-weighted abnormalities.Compared to prior MRI exam from February 2015 there is near complete resolution of vasogenic edema surrounding a small right parietal metastatic lesion. Minute residual gliosis is identified. The enhancing metastatic focus however is again identified and measuring approximately at 5 x 6 mm in transaxial dimensions (axial post enhanced series 12 image 7). There is a slight interval decreased size of metastatic focus since prior MRI exam however when compared with postenhancement on the study from 3-10-15 lesion demonstrate interval increased size and intensity of enhancement since prior exam.A punctate focus of enhancement in the right frontal subcortical white matter consistent with metastatic lesion demonstrate interval significant decreased size since prior exam which measured approximately 5 mm in size. A small metastatic lesion noted in the right basal ganglia on prior exam cannot be identified on current study.Multiple small metastatic lesions in bilateral cerebellar hemispheres demonstrate decreased number since prior exam and remaining visualized metastatic foci are tiny and smaller than prior exam. Calvarium demonstrate no abnormal enhancement.Unremarkable images through the orbits including axial fat sat post enhanced series.

Output: 1.There is interval improvement of metastatic brain lesions since prior exam and with a few of the smaller previously seen metastatic lesions no longer identified on the current study.2.The largest remaining metastatic lesion in the right postcentral gyrus measures at 5 mm in transaxial dimensions. Compared to post enhanced only study from 3-10-15 there is subtle interval increased size of this lesion however when compared with earlier MRI exam from 2-13-15 there is interval decreased size of the lesion.


Instruction: Generate impression based on medical findings.

Input: 38 year old woman with BRCA mutation and family history of breast cancer in mother and sister. There is scattered fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on medical findings.

Input: Clinical question:? Intracranial hemorrhage. Signs and symptoms: Seizures. CT of brain without infusion:Large area of vasogenic edema is noted in the right frontal lobe causing significant effacement of adjacent cortical sulci. A subtle mass effect on the right lateral ventricle. Within the area of vasogenic edema a partially cystic and partially solid mass is present. The larger cystic component of the mass measures 28 mm x 32-mm in transaxial dimensions (axial image 14. This finding is highly suspect of a neoplasm. There is no evidence of hemorrhage associated with this finding. There is a single small focus of low attenuation in the subcortical white matter of left posterior frontal (axial image 18). This finding is nonspecific and may represent an additional foci of neoplasm/metastases or a small foci of ischemic change. Further evaluation with an infused MRI examination is recommended. There is no evidence of hemorrhage, midline shift or hydrocephalus.Calvarium, limited paranasal sinuses and mastoid air cells are unremarkable.

Output: 1.Large area of vasogenic edema containing a partially cystic and partially solid mass highly concerning for malignancy. Follow-up with an MRI examination with infusion is recommended.2.Small foci of subcortical low attenuation is nonspecific however it may represent a second foci of malignancy or small vessel disease.3.No areas of hemorrhage, midline shift or hydrocephalus.4.Calvarium is intact.


Instruction: Generate impression based on medical findings.

Input: Reason: eval RT shoulder History: pain There is no evidence of acute fracture or malalignment. There is moderate degenerative change of the AC joint. There is mild degenerative change of the glenohumeral joint. There is redemonstration of mildly decreased acromiohumeral interval, consistent with rotator cuff tear seen on prior MRI. Bones appear demineralized.

Output: Moderate osteoarthritis of the AC joint and mild osteoarthritis of the glenohumeral joint appearing similar to prior study, other findings as above.


Instruction: Generate impression based on medical findings.

Input: evaluate for c-spine injury after trauma The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is straightening of the normal cervical curvature.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Minor opacity is present in the sphenoid sinus which is better seen on the recent CT of the maxillofacial bones.

Output: 1.Straightening of the normal cervical curvature could be related to muscle spasm or patient positioning. It is nonspecific.2.There is no evidence for spinal cord injury.


Instruction: Generate impression based on medical findings.

Input: 48 year old with cardiomyopathy, hypertension, diabetes and daily illicit drug use presenting for evaluation of cardiomyopathy. MEDICATIONS: carvedilol, furosemide, lisinopril, simvastatin First Pass PerfusionDuring hyperemia, no perfusion defects were present. A prominent dark rim artifact was noted at rest and stress.Viability/ Myocardial ScarThere is an area of transmural late gadolinium enhancement noted in the basal inferior and inferolateral walls. The pattern is most consistent with prior myocardial infarction; however, because the late gadolinium enhancement is associated with preserved myocardial wall thickness, the possibility of an infiltrative process can not be excluded, especially given the presence of mediastinal lymph nodes as described below. These segments of myocardium with late gadolinium enhancement are not likely to be viable. The remaining myocardium is without late gadolinium enhancement and likely to be viable. Left VentricleThe left ventricle is severely dilated with mildly reduced systolic function. The overall LV ejection fraction is 45%, the LV end diastolic volume index is 166 ml/m2 (normal range: 74+/-15), the LVEDV is ml (normal range 142+/-34), the LV end systolic volume index is 327 ml/m2 (normal range 25+/-9), the LVESV is 166 ml (normal range 47+/-19), the LV mass index is 85 g/m2, and the LV mass is 168 g. The systolic dysfunction is global. . Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is mildly dilated with moderately reduced systolic function. The overall RV ejection fraction is 37%, the RV end diastolic volume index is 115 ml/m2 (normal range 82+/-16), the RVEDV is ml (normal range 142+/-31), the RV end systolic volume index is 73 ml/m2 (normal range 31+/-9), and the RVESV is 144 ml (normal range 54+/-17).Right AtriumThe right atrium is mild to moderately dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is severe mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is trace pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size (28mm).Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsA large mediastinal lymph node is noted. Emphysematous changes noted in lung apices. 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. There is an area of transmural late gadolinium enhancement noted in the basal inferior and inferolateral walls, most likely consistent with prior myocardial infarction; however, because the late gadolinium enhancement is associated with preserved myocardial wall thickness, the possibility of an infiltrative process can not be excluded, especially given the presence of a mediastinal lymph node. The segments of myocardium with late gadolinium enhancement are not likely to be viable. The remaining myocardium is without late gadolinium enhancement and likely to be viable.3. Severely dilated LV with mildly reduced systolic function (LVEF 45%).4. Mildly dilated RV with moderately reduced systolic function (RVEF 37%).5. Severe left atrial dilation.6. Severe mitral regurgitation.7. See extra-cardiac findings.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: There is increased T2/STIR signal involving the thoracic cord from the T9 to T10 levels, without associated enhancement. This finding was present on the prior exams, though the most recent study was severely motion degraded. On sagittal T2 counting image including the cervical spine, there is subtle increased T2 signal from C3 to C5, grossly similar to the prior study but significantly improved from 7/14/2010.The thoracic spine is in normal alignment, with a normal thoracic kyphosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine.

Output: 1. Again seen is T2 signal abnormality in the thoracic cord from the T9 to T10 levels without associated abnormal enhancement and compatible with transverse myelitis. Finding is not significantly changed since 1/19/2016. No earlier thoracic comparison study is available.2. Partially imaged abnormal signal in the cervical cord is grossly similar to prior but significantly improved from 7/14/2010, when it also demonstrated enhancement. Finding is consistent with sequela of remote cervical transverse myelitis.


Instruction: Generate impression based on medical findings.

Input: 48 year-old female anterior thigh numbness 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.Mild degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: There is disk desiccation and mild height loss. No spinal canal or neural foraminal stenosis.L4-L5: There is mild disk bulge and mild facet arthropathy with resultant mild narrowing of the bilateral neural foramina, relatively worse on the right. Small dorsal annular fissure. No spinal canal stenosis. L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild bilateral facet arthropathy.Paraspinous soft tissues are within normal limits.

Output: Mild degenerative changes in the lumbar spine with mild neural foraminal narrowing bilaterally at L4-L5 related to mild disk bulge and facet arthropathy. Otherwise no significant spinal canal or neural foramina stenosis is seen in the lumbar spine.


Instruction: Generate impression based on medical findings.

Input: History of pancreatic tail cyst. Evaluate for any interval change. ABDOMEN:LIVER, BILIARY TRACT: Stable bilobar simple cysts. Normally distended gallbladder. No focal suspicious lesion. No biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Stable pancreatic tail unilocular cyst measuring 1.1 x 1.1 cm (series 901/28), unchanged. No suspicious enhancement. The main pancreatic duct is normal in caliber. Pancreas divisum.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No significant change in the is unilocular cystic pancreatic tail lesion.


Instruction: Generate impression based on medical findings.

Input: Left sensorineural hearing loss. Right: There is a 3 mm diameter lesion in the fundus of the right internal auditory canal, along the course of the inferior vestibular nerve. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable. Left: The cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable.Miscellaneous: There are bilateral maxillary sinus retention cysts, right larger than left.

Output: 1. A 3 mm diameter lesion in the fundus of the right internal auditory canal likely represents a schwannoma. 2. No evidence of left retrocochlear or inner ear lesions.


Instruction: Generate impression based on medical findings.

Input: 41 years Female (DOB:9/27/1975)Reason: Yearly surveillance for previously operated pituitary microadenoma History: SurveillancePROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD MRI pituitary:The patient is status post pituitary surgery. The infundibulum of the pituitary is shifted towards the left and is mildly thickened but unchanged since the previous exam. The general configuration of the pituitary gland is stable.There is a 2mm hyperintense T1 focus present within the infundibulum and mid portion of the pituitary gland which is stable compared with prior exams and may represent a Rathke's cleft cyst.A small nonenhancing focus along the superior aspect of the left pituitary gland is approximately 3 mm in size and is stable.The cavernous sinuses are intact bilaterally.

Output: 1.Status post pituitary surgery. The appearance of the pituitary gland is stable when compared to prior exams. Small nodule along the superior aspect of the left pituitary gland remains stable.2.Findings are consistent with a Rathke's cleft cyst which appears stable when compared to prior exams.


Instruction: Generate impression based on medical findings.

Input: 72 year old female with a history of heart failure with reduced LV function, hypertension, s/p PVC ablation 10/18/16 of the basal anteroseptum. Referred for cardiac MRI for further evaluation Left VentricleThe left ventricle is moderately dilated and has mildly reduced systolic function. The overall LV ejection fraction is 49%, the LV end diastolic volume index is 121 ml/m2 (normal range: 65+/-11), the LVEDV is 191 ml (normal range 109+/-23), the LV end systolic volume index is 62 ml/m2 (normal range 18+/-5), the LVESV is 98 ml (normal range 31+/-10), the LV mass index is 43 g/m2 (normal range 67+/-11), and the LV mass is 68 g (normal range 114+/-24). There is mild hypokinesis of the basal anteroseptum. Previously demonstrated basal subendocardial delayed hyperenhancement has improved since last study. There is new focus of delayed hyperenhancement involving the basal anteroseptal portion of the LV, likely related to recent ablation procedure. The pre-contrast native myocardial T1 relaxation time is normal (~1000 ms). Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is mildly dilated and has low-normal reduced systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 101 ml/m2 (normal range 69+/-14), the RVEDV is 159 ml (normal range 110+/-24), the RV end systolic volume index is 50 ml/m2 (normal range 22+/-8), and the RVESV is 78 ml (normal range 35+/-13). 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 are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSmall pleural effusions and basilar atelectasis. 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 moderately dilated and has mildly reduced systolic function (LVEF 49%). There is mild hypokinesis of the basal anteroseptum. Previously demonstrated basal subendocardial delayed hyperenhancement has improved since last study. There is new focus of delayed hyperenhancement involving the basal anteroseptal portion of the LV, likely related to recent ablation procedure.2. The right ventricle is mildly dilated and has mildly reduced systolic function (RVEF 51%). 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 changes from last MRI, osteoarthritis, joint or ligamentous or meniscal abnormalities History: h/o HIV, car accident; R knee pain/swelling. MENISCI: The menisci are within normal limits.ARTICULAR CARTILAGE AND BONE: The previously noted minor focal marrow edema type signal within the far medial aspect of the medial tibial plateau is no longer visualized. Focal cartilage degeneration involving the anterolateral to the medial femoral trochlea appears unchanged, without significant underlying marrow abnormality.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is within normal limits.ADDITIONAL

Output: 1.Interval resolution of marrow signal abnormalities in the medial aspect of the tibial plateau.2.Focal cartilage degeneration anterolateral to the medial femoral trochlea, unchanged.3.Ligaments and menisci are intact.


Instruction: Generate impression based on medical findings.

Input: 34 years Female (DOB: 10/17/1981)Reason: ? subacute stroke vs intracranial process History: new onset L sided weaknessPROVIDER NAME: MICHAEL A WARD MICHAEL A WARD MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate an air-fluid level in the left maxillary sinus. There is partial desiccation of the left frontal sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.No intracranial mass lesion or other explanation for the patient's generalized weakness is appreciated.2.There is no compromise of the cervical spinal canal and no abnormal enhancing lesion within the cervical spine.3.There is an air-fluid level in the left maxillary sinus. The possibility of an acute sinusitis cannot be excluded. Please correlate with patient's clinical evaluation.


Instruction: Generate impression based on medical findings.

Input: 29-year-old male patient with cystic focus medially adjacent to and continuous with the bulbous urethra on ultrasound. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There is an oblong nonenhancing T2 hyperintense midline structure within the region of the bulbous urethra which measures approximately 4.0 x 1.3 x 1.2 cm in the AP by craniocaudal by transverse dimensions (image 27, series 6 and image 52, series 5). This cystic structure appears to be in continuity with the urethra posteriorly. Furthermore, there is the suggestion of a lip of tissue separating this structure from the urethra anteriorly (image 28, series 6). The bladder is nondistended. The prostatic urethra is decompressed.

Output: Midline cystic structure which appears to be in continuity with the bulbous urethra; this could represent an anterior urethral valve, anterior urethral diverticulum, or less likely a Cowper's syringocele given location. Retrograde urethrogram may be considered for further evaluation.


Instruction: Generate impression based on medical findings.

Input: There is stable minimal thickening and enhancement of the left tentorial leaflet without adjacent mass effect or vasogenic edema. There is no other suspicious intracranial enhancement, acute infarct, mass effect or midline shift. The ventricles are sulci are unchanged. There is no hydrocephalus. The cerebellar tonsils remain above the foramen magnum. There is a mucus retention cyst in the left maxillary sinus.

Output: Stable minimal nonspecific thickening and enhancement of the left tentorial leaflet without mass-effect. Otherwise, unremarkable examination.


Instruction: Generate impression based on medical findings.

Input: Ms. Snow is a 45 year old female with a personal history of left breast lumpectomy in 2015 for IDC/DCIS treated with radiation therapy. Family history of breast cancer in maternal grandmother and maternal aunt. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Expected postsurgical changes are identified in the left breast and axilla. No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on medical findings.

Input: 60 years Male (DOB:10/19/1955)Reason: MRI with (wo already done) History: Eval source of L occipital bleedPROVIDER/ATTENDING NAME: CHRISTOPHER L KRAMER CHRISTOPHER L KRAMER There is a hematoma measuring approximately 3 cm located in the left cuneus and precuneus. It is not associated with any significant degree of contrast enhancement.There is a moderate degree of periventricular and subcortical punctate hypointense white matter lesions present identified on the T1 weighted images. These correspond to T2 hyperintense foci in the prior MR.There is a hypointense focus present in the right thalamus corresponding to T2 hyperintense focus in the prior MR.Incidental note is made of a developmental venous anomaly located in the right cerebellar hemisphere.There is a mucous retention cyst in the left maxillary sinus.

Output: 1.There is no associated enhancing lesion related the patient's left occipital and parietal lobe hematoma. There is no evidence for brain metastases.2.Exam is limited to pre and postcontrast T1-weighted imaging. There is a prior MRI from 1/31/2016. Please refer to that for further comments.3.Old lacunar infarct is redemonstrated in the right thalamus4.Periventricular and subcortical white matter lesions of a moderate degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on medical findings.

Input: Reason: fracture History: pain There is soft tissue swelling along the dorsal aspect of the wrist no acute fracture is evident. There is subtle cortical irregularity about the radial aspect of the triquetrum likely representing a nondisplaced fracture corresponding to the findings on recent MRI examination. The scapholunate interval is in the upper limits of normal which may represent ligamentous laxity. There is negative ulnar variance.

Output: Findings indicating a nondisplaced fracture of the triquetrum, better visualized on recent MRI examination. Soft tissue swelling. Widening of the scapholunate interval which may represent ligamentous laxity and is unchanged.


Instruction: Generate impression based on medical findings.

Input: 51 years Male (DOB:12/3/1964)Reason: h/o meningoencephalitis - evaluate History: confusionPROVIDER/ATTENDING NAME: JESSICA PENTZ RIDGWAY JESSICA PENTZ RIDGWAY The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Since the prior exam leptomeningeal enhancement predominantly involving posterior fossa structures has regressed and is not visible. There are several subtle enhancing nodules present adjacent to the quadrigeminal plate which demonstrate enhancement. Another small nodule is present adjacent to the left trigeminal nerve root origin. To have a ring-enhancing appearance and measure 4 mm diameter and one is more solid in appearance and measures 4 mm in diameter. These were not present on the prior exam. There are some subtle leptomeningeal enhancement present surrounding the upper brainstem. FLAIR signal hyperintensity is present along the surface of the entire brainstem.No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma. Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is some residual/persistent nodules present adjacent to the quadrigeminal plate and the left trigeminal nerve root origin which were not present on the prior exam representing some residual meningitis. The amount of the leptomeningeal enhancement in the posterior fossa has significantly regressed but not completely resolved.2.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific.


Instruction: Generate impression based on medical findings.

Input: Hyperprolactinemia. There is a possible hypoenhancing focus in the left lobe of the pituitary gland that measures up to 3 mm. Otherwise, the pituitary gland is not enlarged and there is no mass effect upon the optic apparatus or cavernous sinuses. The infundibulum are posterior pituitary bright spot are intact.

Output: Candidate pituitary microadenoma in the left lobe of the pituitary gland that measures up to 3 mm.


Instruction: Generate impression based on medical findings.

Input: 33 years Female (DOB:12/15/1982)Reason: STEALTH MRI, IN CCD at 6:00am pre-operative, PLEASE PAGE NEUROSURGERY RESIDENT TO PLACE FIDUCIALS History: Pituitary macroadenomaPROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD The CSF spaces are appropriate for the patient's stated age with no midline shift. The pituitary gland is large and heterogeneous in signal intensity. It measures approximately 11 mm in height. It is unchanged compared to the prior exam from 4/18/2016No 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 some mucous retention cysts. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.The pituitary gland is large and heterogeneous. One possibility is that this represents sequela of necrosis.2.This examination was performed the purpose of stereotactic guidance


Instruction: Generate impression based on medical findings.

Input: Status post right frontal craniotomy for recurrent brain neoplasm. There are postoperative findings related to recent right craniotomy for resection of a larger portion of the right frontal lobe air and fluid with in the resection cavity and deep to the craniotomy flap. There are also multiple areas of restricted diffusion and susceptibility effect along the surgical margins. There is also susceptibility effect within the ventricular system. There are residual areas of confluent high T2 signal surrounding the resection cavity, with extension into the left cerebral hemisphere. There are mildly prominent vessels and dural enhancement in the vicinity of the resection cavity, as well as patchy mild enhancement in the right basal ganglia that may attributable to hyperemia. Otherwise there is no evidence of residual enhancing tumor components. The ventricles are unchanged in size and configuration and there is unchanged slight midline shift to the right.

Output: Recent postoperative findings with scattered areas of intracranial hemorrhage, but no definite evidence of residual enhancing tumor components.


Instruction: Generate impression based on medical findings.

Input: The cranium is large but the brain parenchyma is in general atrophic or underdeveloped. Both cerebral hemispheres are affected symmetrically and diffusely, though the frontal and temporal lobes appear to be slightly more affected. As such, the sylvian fissures are quite wide. The cerebellum and brainstem show relatively normal volume.The periventricular white matter of the cerebral hemispheres is symmetrically T2 hyperintense. This affects the deep white matter with sparing of the subcortical U-fibers. The subinsular white matter is questionably T2 hyperintense, as is the junction of the basal ganglia and thalami. The genu and splenium of the corpus callosum are T2 hyperintense, and furthermore, the posterior corpus callosum body and splenium are thinned. Striated T2 hyperintensity is seen in the pons, and there is patchy T2 hyperintensity at the dentate nuclei of the cerebellum.The degree of white matter myelination is difficult to assess on T2 weighted images due to the extensive signal abnormality as above. However, on T1 weighted images, the white matter signal pattern is commensurate with age at least in some areas, for example distally in the cerebral hemispheres. Symmetric bilateral expansion of the subarachnoid spaces is seen along the cerebral hemispheres. In addition, there are bilateral symmetric subdural collections which do not fully suppress on FLAIR images indicating the possibility of proteinaceous debris or old blood product. The ventricular system is mildly prominent, but not to the degree of the subarachnoid spaces.No restricted diffusion is seen. No evidence of acute intracranial hemorrhage is detected. No definite evidence of any migrational anomaly is seen. There is no evidence of an intracranial tumor or mass effect.

Output: Multiple pathologic findings are seen, including symmetric bilateral signal abnormality affecting predominantly the deep cerebral white matter, the corpus callosum, the junction of the basal ganglia and thalami, the pons, and the cerebellum in the area of the dentate nuclei.Brain volume is significantly lower than normal suggesting either atrophy or underdevelopment. The cerebral hemispheres are affected diffusely, with perhaps mild preference for the frontal and temporal lobes. The sylvian fissures in particular are widened.Symmetric bilateral expansion of the subarachnoid spaces is seen. In addition, there are symmetric bilateral subdural collections suggesting prior subdural hemorrhage.The constellation of findings is most suggestive of an inborn error of metabolism or leukodystrophy. Several of the observed findings, including widened sylvian fissures and bilateral subdural collections, can be seen in glutaric aciduria type 1. However, other metabolic conditions must also be considered.


Instruction: Generate impression based on medical findings.

Input: History of multiple sclerosis presenting with lower extremity weakness. Extensive increased T2 white matter signal centered in the periventricular white matter with a radiating morphology compatible with the history of multiple sclerosis. Similar to prior, the lesions have variable mild to marked low T1 signal. Compared to prior this is more extensive and confluent compatible with mild disease progression. Discrete new lesions are identified in the left precentral gyrus, right superior frontal gyrus, and mesial left temporal lobe. No definite lesional enhancement is present on the postcontrast images.There is no evidence of intracranial hemorrhage or mass. Mild generalized cerebral volume loss similar to prior. The expected intracranial vascular flow voids are present. The paranasal sinuses are clear. The visualized mastoid air cells are clear. The orbits are unremarkable.

Output: White matter signal abnormality primarily within the periventricular white matter compatible with the history of multiple sclerosis. Compared to 2011, there has been slight interval progression of disease burden with scattered small new lesions and increase in size of the prior lesions.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old, with cord compression. Image quality is significantly degraded by motion artifact. Within this limitation, the following observations are made. A retropharyngeal fluid collection is partially visualized. Adjacent to the collection, the paraspinal soft tissues demonstrate evidence of edema. The C3, C4 and C5 vertebral bodies, and the intervening discs, are edematous with perhaps a small amount of fluid in the disc spaces. The ventral epidural space from C3 through C5 is thickened. Image quality does not allow for the discrimination between edema, phlegmon or frank abscess. However, this process, along with superimposed degenerative disease of the disks and posterior elements, does result in significant narrowing of the spinal canal and likely some degree of cord impingement at the disc levels. Image quality is not adequate to exclude the possibility of cord edema.

Output: In the context of a presumed retropharyngeal abscess and paraspinal edema, abnormal edematous signal within the C3-C5 vertebral bodies, and fluid like signal within the C3-4 and C4-5 disc spaces, are concerning for the possibility of discitis osteomyelitis.Thickening of the ventral epidural space is noted from C3 through C5 which is concerning for infectious involvement. Image quality does not allow for the distinction between epidural edema, phlegmon or abscess.


Instruction: Generate impression based on medical findings.

Input: Multiple enhancing lesions are again identified. A right post central gyrus lesion (series 401, image 142) appears smaller than the prior examination with decreased enhancement and internal signal compatible with necrosis. The degree of surrounding vasogenic edema also appears decreased on the current examination. Small enhancing nodules in the right frontal lobe, right basal ganglia, and left cerebellum appear smaller. The ventricles and sulci are normal in size. There is no susceptibility artifact to indicate intracranial hemorrhage. Flow voids are present within the major vessels indicating patency.

Output: Multiple intracranial metastases as described above appearing smaller than the prior examination with slightly decreased edema.


Instruction: Generate impression based on medical findings.

Input: 51 years Male (DOB:3/26/1964)Reason: Evaluate for worsening headaches that are bifrontal and radiate to back of head with associated nausea and vomiting. Please compare to previous study that is uploaded to PACS, possible Dandy-walker malformation. PROVIDER/ATTENDING NAME: RIMAS V. LUKAS RIMAS V. LUKAS The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma. There is a perivascular space present in the right basal ganglia is probably of significance.There are several periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. 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.There is an arachnoid cyst present located just above the cerebellar vermis which measures approximately 14 x 19 mm sagittal dimensions. The cerebellar vermis appears to be displaced and deformed but not hypoplastic. The cerebellar tonsils extend approximately 3 mm below the level of foramen magnumThe visualized portions of the paranasal sinuses demonstrate some mild mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is small arachnoid cyst present posterior fossa. 2.Low-lying cerebellar tonsils.3.Several periventricular and subcortical punctate lesions at this age are frequently seen, likely of little clinical significance and are nonspecific. There is no evidence for Dandy-Walker malformation4.Some minor opacities in the paranasal sinuses are likely inflammatory in nature.


Instruction: Generate impression based on medical findings.

Input: 48 years Female (DOB:4/1/1967)Reason: hydrocephalous History: haPROVIDER/ATTENDING NAME: PETER C WARNKE PETER C WARNKE There is ventriculomegaly present prior exams and has not changed. There is redemonstration of bilateral ventriculostomy tubes coursing to the frontal lobes bilaterally extending respectively right and left frontal horns of the lateral ventricles.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Examination performed for stereotactic guidance during surgery. There is ventriculomegaly present associated with bilateral ventriculostomy tubes..


Instruction: Generate impression based on medical findings.

Input: 87 years Female (DOB:2/17/1929)Reason: 87F with h/o brain aneurysm and optic neuropathy with sudden loss of color vision left eye History: sudden loss of color vision left eyePROVIDER/ATTENDING NAME: SUSAN M KSIAZEK SUSAN M KSIAZEK MRI orbits:The eyeballs are intact. No intraconal or extraconal space mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. There is no optic nerve enhancement appreciated. The suprasellar cistern is intact There is a punctate focus of enhancement present along the posterior aspect of the pons which corresponds to a microhemorrhage identified on the 9/11/2014 MRI of the brain in can be identified on the echo planar images as a signal void..No foci of diffusion restriction are appreciated within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.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. The ophthalmic arteries are also identifiedThere is a 2.5 mm infundibulum present at the origin of the left posterior communicating artery. The posterior communicating arteries are very small.There appears to be obtaining infundibulum at the origin of the left ophthalmic artery. There is redemonstration of a slight bulge of the left internal carotid artery at the proximal ophthalmic segment and its lateral wall which is likely related to minor atherosclerosis.There is extracranial origin of the right posterior inferior cerebellar artery present.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is small. The vertebral arteries are similar in size.

Output: 1.There is no evidence for an intraorbital mass or other explanation for the patient's visual loss involving the left eye.2.There is a 2.5mm infundibulum present at the origin of the left posterior communicating artery.


Instruction: Generate impression based on medical findings.

Input: 60 year-old male history of left ureteral reimplant with cholelithiasis and right upper quadrant ultrasound, rising bilirubin and now with epigastric pain ABDOMEN:LIVER, BILIARY TRACT: No focal enhancing hepatic lesion is identified. Cholelithiasis with mild gallbladder wall thickening and trace pericholecystic fluid. No evidence of intra or extrahepatic biliary ductal dilatation. No choledocholithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No evidence of pancreatic ductal dilatation. The pancreas is normal in morphology, T1 intrinsic hyperintensity, and enhancement. No abnormal T2 signal to suggest edema or inflammation.ADRENAL GLANDS: The adrenal glands are normal in size and morphology bilaterally.KIDNEYS, URETERS: Atrophic kidneys. Again noted is mild perinephric T2 hyperintensity consistent with inflammatory changes bilaterally, not changed compared to the CT examination. Mild to moderate left hydroureteronephrosis with partially visualized left nephroureteral stent.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Minimal free air predominantly around the liver is better appreciated on the CT examination. There is mild edema around the second portion of the duodenum.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cholelithiasis with mild gallbladder wall thickening and small amount of pericholecystic fluid. Findings may represent early cholecystitis in the appropriate clinical setting versus may be related to recently passed stone. No choledocholithiasis.2.Mild edema around the second portion of the duodenum may be related to gallbladder pathology.3.Minimal pneumoperitoneum is better appreciated on the CT examination.Findings text paged to Dr. Aizen at 1100 hours.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Cord compression? Signs and symptoms: PRCA, BLE weakness. Nonenhanced complete spine MRI:Examination demonstrates an expected finding the morning problem.Examination demonstrates no evidence of compromise of spinal canal or any foci of mass effect on the cord.The alignment of vertebral or common remains anatomical.There is a tiny focus of T2 hyperintensity in the vertebral body of T2 which is nonspecific and the signal intensity of the rest of the vertebral column is unremarkable.There is no detectable paraspinal soft tissue abnormality.Moderate degenerative disc disease at L4-L5 and L5-S1 levels as well as C6/C7 is noted.

Output: No evidence of cord compression.


Instruction: Generate impression based on medical findings.

Input: Male; 68 years old. Reason: 67 yo male with hx of pancreas cyst; please do MRCP to evaluate for abnormalities History: pancreas cyst ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis without evidence of cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: Cystic lesion in inferior aspect of uncinate process abutting third portion of duodenum is not significantly changed, measuring 2.3 x 2 .2 cm, previously 2.5 x 2.5 cm (series 6, image 35). No enhancing or nodular component. No clear connection with the pancreatic duct is evident.The largest of these is located in uncinate process and measures 1.3 x 1 .1 cm, previously 1.1 x 1.1 cm (image 40; series 8). There is an additional fluid signal intensity lesion in the body of the pancreas, which measures 11 x 8 mm, which appears unchanged when compared to the most recent MRI examination dated 1/14/2014, however, when compared to a earlier MRI dated 7/30/2010, this appears slightly increased in size, previously measuring approximately 4 x 5 mm. Additional smaller cystic lesions are also not significantly changed. No pancreatic ductal dilation. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable small bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Status post median sternotomy.

Output: 1. No significant interval change in size of the reference cystic lesions within the uncinate process abutting the duodenum, which may represent a side branch IPMNs.2. No significant interval change in size of the additional smaller cystic lesions throughout the pancreas, when compared to the most recent study dated 1/14/14. However, a cystic lesion in the body of the pancreas appears slightly increased in size when compared to a more remote study dated 7/30/2010, with measurements provided above.3. Cholelithiasis without evidence of cholecystitis.


Instruction: Generate impression based on medical findings.

Input: Hearing loss and developmental delay. Brain: 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, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Interval Auditory Canals: The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable.

Output: 1. No evidence of intracranial hemorrhage, mass, or ventriculomegaly. 2. No evidence of cochlear nerve deficiency or internal auditory canal tumors.


Instruction: Generate impression based on medical findings.

Input: 23 year old man with dTGA s/p arterial switch operation presents with atypical chest pain and arrhythmia. He is referred for further evaluation. Left VentricleThe left ventricle is mildly dilated with mildly reduced systolic function. The overall LV ejection fraction is 46%, the LV end diastolic volume index is 115 ml/m2 (normal range: 74+/-15), the LVEDV is 219 ml (normal range 142+/-34), the LV end systolic volume index is 63 ml/m2 (normal range 25+/-9), the LVESV is 119 ml (normal range 47+/-19), the LV mass index is 72 g/m2 (normal range 85+/-15), and the LV mass is 136 g (normal range 164+/-36). There are no regional wall motion abnormalities present; however, the LV shape is elongated. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is mildly dilated with mildly reduced systolic function. The overall RV ejection fraction is 47%, the RV end diastolic volume index is 121 ml/m2 (normal range 82+/-16), the RVEDV is 230 ml (normal range 142+/-31), the RV end systolic volume index is 65 ml/m2 (normal range 31+/-9), and the RVESV is 123 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 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 severely dilated. The remainder of the thoracic aorta is normal in size. Measurements as below. No aortic dissection is noted.Sinus of Valsalva: 50x52mmST Junction: 37x39mmAscending Aorta: 30x28mmPulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. It is located anteriorly and to the left of the aorta. The left and right pulmonary arteries straddle over the ascending aorta. The LPA is 20mm in diameter and the RPA is 16mm in diameter. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Coronary OriginsThe left anterior descending artery originates from the left sinus. The right coronary artery originates from the right sinus. The left circumflex originates anomalously from the proximal RCA and takes the retroaortic course to the left AV groove.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. D-TGA s/p arterial switch operation.2. Mild LV dilation with mildly reduced systolic function (LVEF 46%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration. 3. Mild RV dilation with mildly reduced systolic function (RVEF 47%).4. The pulmonary artery is located anteriorly and to the left of the aorta. The left and right pulmonary arteries straddle over the ascending aorta. 5. Severely dilated aortic root without evidence of thoracic aortic dissection. 6. Anomalous origin of the left circumflex artery with a retro-aortic course.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old. Reason: asymptomatic goiter found on exam, eval for nodules RIGHT LOBE MEASUREMENTS: 6.1 x 3.2 x 2.0 cmLEFT LOBE MEASUREMENTS: 5.7 x 2.6 x 2.6 cmISTHMUS MEASUREMENTS: 0.7 cmRIGHT LOBE: Heterogeneous echotexture, with multiple nodules of varying sizes. A right upper pole nodule measures 1.9 x 1.6 x 1 .2 cm, predominantly solid with cystic component a, noncalcified, without significant internal vascularity. An right lower pole nodule measures 1.2 x 1.0 x 1.1 cm, predominately cystic, noncalcified, nonvascular.LEFT LOBE: Heterogeneous echotexture, with multiple nodules of varying sizes. A dominant lower pole nodule measures 2.8 x 2.4 by 1.3 cm, heterogeneous, hypoechoic, predominantly solid with cystic components, and suggestion of peripheral calcification.ISTHMUS: Heterogeneous echotexture. A nodule at the left aspect of the isthmus measures 3.0 by 3.3 x 1.9 cm, heterogeneous and hypoechoic, with mild internal vascularity, noncalcified.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Heterogeneous thyroid with multiple nodules of varying size and character, as detailed above. A dominant left thyroid nodule is amenable to biopsy.


Instruction: Generate impression based on medical findings.

Input: 66 years Female (DOB:1/12/1950)Reason: stroke work up History: perioral numbness and body weaknessPROVIDER/ATTENDING NAME: JAMES R. BRORSON JAMES R. BRORSON MRI of the brainThere are 2 subcentimeter foci of diffusion restriction present in the right precentral gyrus along its lateral aspect. These display some contrast enhancement suggests an air in the subacute phase.There are punctate foci of signal loss on susceptibility imaging one located in the right temporal lobe subcortical white matter and one in the right basal ganglia no 1's located in the right occipital lobe subcortical white matter while another couple are located along the left superior frontal gyrus left and right orbital gyri as well as the left temporal lobe.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. 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.A couple small nodules adjacent to the parotid gland probably represent lymph nodes.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 posterior communicating arteries are intact. 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.

Output: 1.Foci of diffusion restriction are present in the right precentral gyrus laterally compatible with subacute foci of infarction.2.There multiple subcortical punctate foci of susceptibility effect which correspond to calcifications on a CT of the head. They are nonspecific suggestive of cysticercosis in the appropriate clinical setting. Please note that punctate calcifications can also be seen with other entities as well3.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on medical findings.

Input: 80 year-old woman with right leg numbness x 2 days and headache. There is no evidence of intracranial hemorrhage, mass or edema. In the left, high convex frontal lobe there is a region of dystrophic, cortical calcification. This finding is present on the MRI dated 8/25/2007.The ventricles are normal in size and configuration. There is a mega cisterna magna, a non-pathological finding, noted.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No CT findings of acute process. If stroke is a clinical concern, recommend MRI.


Instruction: Generate impression based on medical findings.

Input: Pain in right knee status post PCL rupture. MENISCI: The medial and lateral menisci appear intact.ARTICULAR CARTILAGE AND BONE: There is a full-thickness defect of the articular cartilage of the anterior medial condyle of the femur with mild progression. There is a small amount of internal signal of the lateral facet of the patella, indicating chondromalacia, similar to the prior study.LIGAMENTS: The collateral ligaments and the ACL appear intact. The previously observed suspected strain of the PCL has resolved on today's exam. PCL appears continuous without surrounding edema. EXTENSOR MECHANISM: The extensor mechanism appears intact. ADDITIONAL

Output: Interval resolution of PCL disruption and articular cartilage degeneration of the medial condyle of the femur with chondromalacia of the patella.


Instruction: Generate impression based on medical findings.

Input: Radicular low back pain, lumbosacral spondylosis without myelopathy. 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. There is mild disc desiccation at L2-L3 and L3-L4 levels and moderate desiccation at L5-S1 level. The conus medullaris is normal in position. There is prominent epidural fat at various levels resulting in moderate developmental narrowing of the distal spinal canal. There is mild grade I retrolisthesis of L5 on S1, approximately 3 mm. Minimal retrolisthesis as well as prominent epidural fat was demonstrated on previous CT dated 9/19/2014.Mild to moderate multilevel degenerative changes are seen, as described below:T11-T12: On sagittal imaging there is prominent ligamentum flavum thickening with moderate central spinal canal stenosis.L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: There is mild ligamentum flavum hypertrophy. There is facet arthropathy with joint effusion on the right. No spinal canal or neural foraminal stenosis.L3-L4: There is annular disc bulge with left-sided prominence causing mild left foraminal narrowing. There is mild to moderate spinal canal stenosis.L4-L5: There is diffuse disc bulge causing mild to moderate bilateral neural foraminal narrowing. There is mild hypertrophy of ligamentum flavum and bilateral facet hypertrophy and bilateral joint effusion. There is mild to moderate spinal canal stenosis.L5-S1: There is uncovering of the disc with superimposed mild disc bulge, left more than right, causing causing moderate to severe bilateral neural foraminal narrowing. There is ligamentum flavum hypertrophy and mild to moderate bilateral facet arthropathy. There is mild to moderate spinal canal stenosis. Paraspinous soft tissues are within normal limits.

Output: 1. Moderate degenerative disc disease predominantly involving L5-S1 causing moderate to severe bilateral neural foraminal stenosis.2. There is mild to moderate spinal canal stenosis at various levels predominantly due to prominent epidural fat.3. Unchanged minimal grade I retrolisthesis of L5 on S1.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Subdural hematoma. Signs and symptoms: Subdural hematoma. Nonenhanced CT of brain:There is no evidence of new bleed since prior exam. There is revisualization of patient's known right frontal and parietal subdural collection. This results in subtle mass effect and buckling of the cortex of right frontal and parietal lobes. In greatest dimension of subdural measures approximately 14 mm which is fairly similar to prior examination. Minimal discrepancy in measurements however could be secondary to slice positioning.No abnormality of brain parenchyma is detected. Cortical sulci and ventricular system are within normal range for patient's stated age. Burr hole is in the left frontal bone secondary to prior surgical intervention for drainage of subdural is again identified. A small left frontal -- temporal subdural is again identified. There is no evidence of interval change in the size or the extent of this lesion since prior study.Revisualization of bilateral extra conal well-demarcated high density lesions with no interval change. Findings could represent metastatic lesions. On prior examination the clinical date no included metastatic carcinoma. He above extraconal findings are not associated with any bony changes. Further evaluation with an MRI examination is recommended.

Output: 1.No evidence of new hemorrhage.2.Stable bilateral subdurals as detailed above.3.Stable bilateral extraconal retro-orbital masses as described.4.No detectable parenchymal abnormality on this non-infused CT of brain.


Instruction: Generate impression based on medical findings.

Input: 67-year-old female with complex right renal cyst 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: Multiple T2 hyperintense nonenhancing renal cysts are noted in bilateral kidneys. In particular, the septated right inferior pole cyst measuring 6 cm in question has no nodularity or abnormal enhancement.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Thinly septated right inferior pole cyst measuring up to 6 cm without nodularity or abnormal enhancement. If Bosniak classification applied, consistent with Bosniak category 2.


Instruction: Generate impression based on medical findings.

Input: 43 years, Female, multiple sclerosis, evaluate for progression. Compared to 8/20/2014, no new lesions are seen within the brain to suggest disease progression. Again seen are multiple abnormal foci of increased T2/FLAIR hyperintensity involving the corpus callosum and periventricular white matter bilaterally consistent with known demyelinating disease. No appreciable change in extensive, confluent abnormal signal involving the posterior periventricular white matter, particularly the periatrial region. Several these lesions again demonstrate T1 hypointensity. There are no new lesions. No abnormal enhancement. Brain parenchymal volume appears within normal limits for age.

Output: No new lesions to suggest progression of demyelinating disease. No abnormal enhancement.


Instruction: Generate impression based on medical findings.

Input: Shoulder instability ROTATOR CUFF: No significant abnormality noted.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a type II SLAP tear of the labrum which extends posterior to anterior.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Type II SLAP tear of the labrum. Otherwise no internal derangement of the left shoulder.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old, with right leg weakness. Assess for hemispheric lesion. A small wedge-shaped region of encephalomalacia is evident along the inferior right cerebellar hemisphere, unchanged from prior. A few scattered punctate foci of white matter T2 hyperintensity are also evident in the cerebral hemispheres, not significantly changed.No evidence of restricted diffusion is seen. No parenchymal edema or mass effect is detected. There are no findings to suggest intracranial hemorrhage or any other abnormal extra-axial fluid collection. The ventricular system is patent and normal in size.

Output: 1.Evidence of a small chronic right PICA distribution infarct.2.Several scattered punctate foci of white matter T2 hyperintensity are nonspecific and probably not significantly changed.3.No evidence of acute ischemia, mass or mass effect, or other acute intracranial abnormality to account for the patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: There is a T2 hyperintense focus involving the right pedicle and immediately adjacent osseous structures of C6. This demonstrates minimal T1 hyperintensity, persistent T2 hyperintensity with STIR technique, and enhancement. This is not associated with medullary expansion or MRI evident cortical erosion. There is no adjacent soft tissue component. There is a similar-appearing focus within the left posterolateral vertebral body of C7.Alignment is normal. The marrow signal is benign. The cervical and upper thoracic cord is normal in signal without abnormal enhancement. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable. There is no significant degenerative disease, and there are no stenoses.

Output: 1.There is a T2 hyperintense focus involving the right pedicle and immediately adjacent osseous structures of C6. This demonstrates minimal T1 hyperintensity, persistent T2 hyperintensity with STIR technique, and enhancement. This is not associated with medullary expansion or MRI evident cortical erosion. There is no adjacent soft tissue component. There is a similar-appearing focus within the left posterolateral vertebral body of C7. The constellation of these MRI features is most suggestive of the atypical appearance of a benign hemangioma. This could be confirmed with CT.2.Otherwise negative contrast enhanced cervical spine MRI.


Instruction: Generate impression based on medical findings.

Input: 54 year old male with EKG with ST elevations, normal coronary arteries on recent coronary angiogram, concern for myocarditis. Left VentricleThe left ventricle is normal in size and function. The overall LV ejection fraction is 55%. The LVEDV is 206.8 ml (normal range 142+/-34), the LV end diastolic volume index is 86.8 ml/m2 (normal range: 74+/-15), the LVESV is 94 ml (normal range 47+/-19) and the LV end systolic volume index is 39.4 ml/m2 (normal range 25+/-9). The LV mass is 177 g (normal range 164+/-36) and the LV mass index is 74.3 g/m2 (normal range 85+/-15). There are no regional wall motion abnormalities present. . There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.The native T1 myocardial relaxation time not obtainable as image sequences for measurement are not present due to MRI software issues. Left AtriumThe left atrium is normal in size. Right VentricleRV function is qualitatively normal. However,the right ventricle is normal in size with mildly reduced function quantitatively. The overall RV ejection fraction is 30%. The RVEDV is 209 ml (normal range 142+/-31), RV end diastolic volume index is 87.7 ml/m2 (normal range 82+/-16), the RVESV is 146.6 ml (normal range 54+/-17), and the RV end systolic volume index is 61.5 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is normal.Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely; 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 is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal left ventricular systolic function at 55%.2. Qualitatively normal RV ejection fraction. Quantitatively, right ventricular ejection fraction is mildly reduced.3. No late gadolinium enhancement noted in myocardium. 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: Diffuse osseous metastases involving the cervical, thoracic and lumbar spine, as well as the sacrum are again noted. There is no evidence of acute cord compression. Mild loss of height of the T12 and T7 vertebral bodies again noted.Moderate degenerative disease affects the lower cervical spine with disk osteophyte complexes, but there is no evidence of acute cord compression. Small disk bulges along the lower thoracic and lumbar spine without acute cord compression.

Output: This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. Diffuse osseous metastasis is again seen with no evidence of acute cord compression. Mild epidural extension of sacral metastasis is again seen.Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine.


Instruction: Generate impression based on medical findings.

Input: 36 years Female (DOB:2/10/1980)Reason: eval for osteo vs neoplasm History: Chronic osteo on CT, persistent CRP elevation patient is status post recent tooth extraction.PROVIDER/ATTENDING NAME: REASHEAL M LEHMANN MADHU C YARLAGADDA There is an infiltrating and contrast enhancing lesion which involves the right alveolar ridge centered along the right-sided maxillary premolar which extends up into the inferior aspect of the right maxillary sinus including the inferior aspects of the lateral wall of the right maxillary sinus. Additionally there is extension into the adjacent soft tissues surrounding the right alveolar ridge. There is infiltration of fat planes and muscles of mastication associated with some contrast enhancement.The visualized intracranial structures which include the posterior fossa are intact. The visualized orbits appear to be intact.The parotid and the submandibular glands appear intact.The carotid and vertebral vasculature visualized on this exam appears intact. There are mild disc bulges present in the cervical spine.The cervical vertebral bodies in general are intact with no evidence for canal stenosis.

Output: There is an infiltrating lesion present centered in the right alveolar ridge which extends into the surrounding soft tissues including the right masticator space in the soft tissues superficial to the right maxillary sinus including the subcutaneous fat. It also involves the lateral wall of the right maxillary sinus. This is suspected to represent osteomyelitis and cellulitis.


Instruction: Generate impression based on medical findings.

Input: 58-year-old with known right breast cancer status post chemotherapy with good response on conventional imaging. MRI performed in preparation for surgery. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There is clip artifact at the site of known malignancy, but no significant residual enhancement is seen near the biopsy clip. A several millimeter focus of enhancement in the right medial breast is stable and benign in appearance.No abnormal enhancement is seen in the left breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: No residual enhancement near the biopsy clip of the right breast malignancy that is been undergoing chemotherapy. Mammographic localization of the biopsy clip can be performed if clinically desired.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: History of grade 2 oligodendroglioma on PCV therapy. There are post-treatment findings in the left frontal lobe with unchanged patchy enhancement, susceptibility effect, and confluent high T2 signal surrounding the resection cavity. A few scattered punctate foci of increased T2 signal within the subcortical and periventricular white matter are also unchanged. There is no evidence of acute infarct. There is no midline shift or herniation. The ventricles are unchanged in size and configuration. The major cerebral flow voids are intact. The extracranial structures are unchanged.

Output: Stable post-treatment findings in the left frontal lobe without evidence of tumor progression.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Headache, structural brain lesion. Brain parenchyma appears within normal limits. No intracranial mass or mass-effect. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. The ventricles are within normal limits in size and configuration. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: Examination is within normal limits. Specifically, no intracranial mass or mass effect.


Instruction: Generate impression based on medical findings.

Input: There is nonspecific straightening of the normal cervical lordosis. There is mild loss of intervertebral disc space height and endplate degenerative changes noted at C5-6. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal and caliber. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C1/2: No significant spinal canal stenosis or neural foraminal narrowing.C2/3: No significant spinal canal stenosis or neural foraminal narrowing.C3/4: No significant spinal canal stenosis or neural foraminal narrowing.C4/5: No significant spinal canal stenosis or neural foraminal narrowing.C5/6: Uncovertebral joint hypertrophy and a posterior disc osteophyte complex results in flattening of the ventral thecal sac and mild/moderate bilateral neural foraminal narrowing, right greater than leftC6/7: No significant spinal canal stenosis or neural foraminal narrowing.C7/T1: No significant spinal canal stenosis or neural foraminal narrowing.

Output: Focal degenerative changes at C5-6 resulting in mild/moderate bilateral neural foraminal narrowing. Otherwise, no significant spinal canal stenosis or neural foraminal narrowing is evident.


Instruction: Generate impression based on medical findings.

Input: Evaluate for rotator cuff pathology, infraspinatus atrophy. ROTATOR CUFF: There is a full thickness, transverse tear of the supraspinatus tendon with retraction and atrophy of the muscle. There are questionable residual fibers anteriorly. There is a complete transverse tear of the infraspinatus tendon with retraction and atrophy of the muscle. The teres minor muscle and tendon are intact. There is marked thickening and increased T2 signal within the subscapularis tendon compatible with marked tendinosis. SUPRASPINATUS OUTLET: There is moderate osteoarthritis of the acromioclavicular joint with joint space narrowing and subchondral cyst formation.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is superior subluxation of the humeral head from the glenoid. There is a moderate glenohumeral joint effusion.There is diffuse degenerative changes of the labrum.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1. Full thickness tearing of the supraspinatus and infraspinatus tendons with retraction and associated muscle atrophy.2. Marked subscapularis tendinopathy.3 Diffuse degenerative changes of the labrum.


Instruction: Generate impression based on medical findings.

Input: 18 year old male with a history of hypoplastic right ventricle who under went BT shunt as infant followed by take down of BT anastomosis, creation of bidirectional Glenn shunt, enlargement of atrial septostomy, and followed by lateal tunnel Fontan with fenestrations who is referred for cardiac MRI for further evaluation to evaluate for hypoxia. Overall AnatomyHypoplastic right ventricle s/p bidirectional Glenn shunt and Fontan (lateral tunnel) procedure. The interatrial septum has been resected. There is tricuspid valve atresia with hypoplastic right ventricle. The left ventricle is dominant and is the systemic ventricle.Systemic Venous Return (Fontan)A Glenn shunt connects the SVC to the right pulmonary artery. There is a conduit connecting the IVC to the right pulmonary artery. There are no obstruction or leak noted in or around the Glenn shunt. The possibility of a stenosis or a Fontan leak in the distal part of the lateral tunnel can not be excluded due to imaging artifact in that territory. Systemic Ventricle (i.e. Left Ventricle)The left ventricle is normal in size with low normal systolic function. The overall LV ejection fraction is 50%, the LV end diastolic volume index is 92 ml/m2 (normal range: 74+/-15), the LVEDV is 156 ml (normal range 142+/-34), the LV end systolic volume index is 46 ml/m2 (normal range 25+/-9), the LVESV is 78 ml (normal range 47+/-19). 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.Pulmonary Venous ReturnThere are four pulmonary veins which seem to drain into the common atrium; unfortunately, the anatomy is not optimally defined due to large artifact related to surgical material posterior to the heart. Right VentricleThe right ventricle is hypoplastic.Common AtriumThe interatrial septum has been resected resulting in a common atrium. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve is not well seen due to the above described imaging artifact.Tricuspid ValveThe tricuspid valve is atretic.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. There is no thoracic aortic aneurysm or thoracic aortic dissection. Left and Right Pulmonary ArteryThe left pulmonary artery has a diameter of ~10mm. The right pulmonary artery has a diameter of ~9mm.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. Glenn shunt and lateral tunnel Fontan noted. The Glenn shunt is without obstruction or obvious other abnormality. The IVC is dilated and the possibility of a stenosis or leak in the distal portion of the Fontan can not be excluded due to imaging artifact. 2. Normal left ventricular size with low normal systolic function (LVEF 50%).3. Hypoplastic right ventricle/ tricuspid atresia4. Coronary sinus drains into the "common" atrium. 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: Slurred speech. Progressive neurological symptoms.Additional clinical history from electronic medical records: PMH of stroke, HTN, DM2, OSA, prostate cancer (s/p radioactive seed implantation), who presents for alternate opinion of chronic progressive blurry vision, dizziness, gait imbalance. Main differential consideration is demyelinating process. Less likely considerations are ischemic neoplastic. CSF protein elevated to 85.3 on 4/29/16. The study is overall at least mildly limited by patient motion. The postcontrast images are markedly limited by motion.Multifocal T2/FLAIR hyperintensity are present in the cerebral white-matter, many new since the prior outside exam. The lesions are predominantly frontal in distribution. Similar lesions are present also in the corpus callosum anteriorly. Some of the lesions are round and relatively well-defined. Similar signal abnormality lesions are present in the midbrain, middle cerebellar peduncles, left superior cerebellar peduncle, and the cerebellum. Some of the lesions are associated with expansion, for example the lesions involving the cerebellar peduncles, especially a the small lesion involving the medial aspect of the left middle cerebellar peduncle with mass effect upon the fourth ventricle, which is new since April 2016. Many of the supratentorial and infratentorial lesions are associated with patchy, non-masslike contrast enhancement, while some of the lesions show more nodular contrast enhancement. FLAIR imaging shows increased signal along the superior vermian interfolial spaces, which may reflect leptomeningeal involvement.A few of these lesions are new compared to the prior examination of April 2016; such as the lesions involving the left cerebellum, left anterior corpus callosum, and left frontal operculum. There is also a smaller right temporal lobe lesion. These new lesions are the ones that show more intense, nodular contrast enhancement. Many of these lesions are new compared to the more remote prior examination from January 2016 and June 2015. Over the same time course, few of the lesions have shown improvement. For example, in January 2016, there was extensive involvement in the occipital lobes and the splenium of the corpus callosum, which is now partially resolved. There is no acute infarct or intracranial hemorrhage. There is mild dilatation of the lateral and third ventricles, probably from volume loss. The sulci are also mildly enlarged. There is no midline shift or brain herniation.There is no destructive skull lesion. There is mild scattered mucosal thickening in the paranasal sinuses.

Output: 1.The examination is limited by motion, especially the postcontrast images.2.Relatively extensive white-matter lesions, predominantly in frontal, corpus callosal and brainstem/cerebellar peduncle distribution. The lesions show patchy and nodular contrast enhancement and no diffusion restriction. There is also suggestion of leptomeningeal involvement. While there has been an overall progressive course, compared to the previous MRIs as remote as March 2015, few of the lesions did actually improve, reflecting the waxing and waning but overall progressive nature of the disease. This pattern would be most compatible with an inflammatory/demyelinating disorder. Vasculitis/angiitis and demyelinating disorders are the more likely differential diagnoses. A neoplastic process would have a more progressive course. Within this vascular/inflammatory/demyelinating differential, the frontal involvement can be suggestive of CADASIL, however the lack of significant anterior temporal lobe involvement would be atypical. For Susac syndrome, clinical correlation to assess for retinal artery branch involvement and sensorineural hearing loss can be helpful.