Instruction: Generate impression based on medical findings.

Input: Female, 53 years old, with left lower extremity weakness and dizziness. A 5-mm focus of T2 hyperintensity is seen within the centrum semiovale just below the right pre-central gyrus. Although this lesion is bright on the diffusion images, there is no ADC correlate indicating likely T2-shine-through artifact. This lesion produces no mass effect. Approximately three additional punctate T2 hyperintense, non-diffusion restricting lesions are also seen in the periventricular white matter. No pathologic enhancement is seen. No intracranial hemorrhage or abnormal extra-axial fluid is seen. Ventricular size and morphology are normal.

Output: A 5-mm lesion is seen in the right centrum semiovale, just below the pre-central gyrus. The location of this lesion could potentially account for the patient's left lower extremity weakness. Several additional punctate periventricular lesions are also seen. The differential diagnosis would include demyelinating disease among other inflammatory processes. A vascular etiology such as vasculitis or ischemic disease if felt to be less likely.


Instruction: Generate impression based on medical findings.

Input: 51 year old woman with history of HCV and segment 7 HCC status post resection 10/2015. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in signal. Postsurgical changes from segment 7 wedge resection noted. No abnormal enhancement surrounding the surgical cavity (10/304) and no additional suspicious hepatic foci.The patient is status post cholecystectomy. There is stable extrahepatic biliary ductal dilatation, expected in the postcholecystectomy setting.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Postsurgical changes without evidence of recurrent or metastatic disease.


Instruction: Generate impression based on medical findings.

Input: 90 year-old female with past medical history of ESRD on hemodialysis, end hypertension. Presents with new, right lid ptosis and concern for TIA. There is no evidence of intracranial hemorrhage, mass or edema. Multiple patchy areas of hypodensity in a periventricular and subcortical distribution consistent with small vessel disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

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


Instruction: Generate impression based on medical findings.

Input: Ms. Hall is a 37-year-old female with strong family history of breast cancer in mother and maternal aunt. She presents for MRI high risk screening evaluation. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally. Numerous non-enhancing subcentimeter cysts are identified bilaterally. Few scattered foci of enhancement are seen bilaterally, none of which are more suspicious than the rest. There is no abnormal enhancement seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.Incidental note is made of a thoracic cord syringomyelia.

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


Instruction: Generate impression based on medical findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.he patient was placed supine on the fluoroscopy table. The right hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 10 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of Marcaine, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 1:03

Output: Successful right hip injection. MRI arthrogram to follow.


Instruction: Generate impression based on medical findings.

Input: 49 years Female (DOB:3/18/1967)Reason: evaluate and stage brain mets History: brain mets seen on CT-HeadPROVIDER/ATTENDING NAME: RITA NANDA RITA NANDA There are multiple ring-enhancing lesions scattered throughout the brain parenchyma which have associated susceptibility effect and a vasogenic pattern of edema.. One in the left precentral gyrus is hyperdense and measures 14 x 11 mm axial dimensions. Another one is present in the right precentral gyrus and measures 13 x 13 mm. Another in the right postcentral gyrus measures 6 x 6 mm axial dimensions. Another ringlike enhancing lesion associated with fluid fluid level is present in the right frontal lobe measuring 16 x 15 mm axial dimensions involves the anterior aspect of the right middle frontal gyrus and is also associated with subcortical white matter hypodensity. Another couple are present in the left cuneus one measuring 8 mm in adjacent 1 measuring 5 mm. Couple punctate 1's are present in the left occipital lobe.There is associated sulcal effacement with the above described lesions.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There are multiple hemorrhagic lesions associated with the vasogenic edema scattered throughout the brain. These are suspicious for hemorrhagic metastases.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Memory loss for 2 years. Signs and symptoms: As above. Nonenhanced brain MRI:No diffusion-weighted abnormalities.Examination demonstrate patchy periventricular and to a lesser degree subcortical confluent foci of FLAIR hyperintensity in bilateral cerebral hemispheres. Minimal similar signal changes in bilateral basal ganglia and pons is detected. There is no associated susceptibility signal changes with the findings which are highly suggestive of chronic small vessel ischemic strokes of mild degree.There is also mild generalized prominence of cortical sulci and the supratentorial ventricular system for patient's stated age of 61.The signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses are within normal.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.

Output: 1.No acute intracranial findings.2.Findings suggestive of mild chronic nonhemorrhagic small vessel ischemic strokes.3.Generalized mild prominence of cortical sulci and supratentorial ventricles for stated age of 61.


Instruction: Generate impression based on medical findings.

Input: Clinical question: rule out METs. Signs and symptoms: Right eye pain and vision loss. Examination demonstrates a large destructive bony metastasis of the right frontal bone involving the floor of the right anterior cranial fossa and with a significant extracranial component which measures 80-mm in AP axis and 40-mm in transverse axis (axial image 6 of 50). Although not as well-visualized on this exam as it was noted on MRI of brain dated 10 -- 10 -- 2009 there is a large intracranial extension of tumor into the right anterior and middle cranial fossas. Extensive destructive changes of the frontal bone along the floor of the right anterior cranial fossa, lateral orbital ridge and greater wing of the sphenoid on the right is noted. There is a large extraconal retro-orbital spread of tumor which does not extend to the apex of the orbit. This component of the mass measures 53-mm times 26-mm in transaxial dimensions (axial image 50). There is significant mass effect on the retro-orbital content, including lateral rectus, superior rectus, right optic nerve and globe which is significantly deformed. There is also suggestion of extension of tumor into the right frontal sinus. This component of tumor within the right frontal sinus may be a second smaller metastatic lesion. There is no apparent involvement of the cavernous sinus. No extension of tumor into the apex of the orbit, no involvement of the lamina papyracea. The extracranial component of the tumor appears to extend inferiorly into the right infratemporal fossa. The paranasal sinuses are well pneumatized and demonstrate only minimal opacification of right anterior ethmoid air cells. Mastoid air cells and middle ear cavities are unremarkable.

Output: 1.Large destructive mass involving the right frontal bone along the floor of right anterior cranial fossa with extension into the right orbit, right frontal sinus, right anterior and middle cranial fossas, right frontal temporal extracranial region and right infratemporal fossa. Please see above detailed report.2.Paranasal sinuses are well pneumatized. Please see above comments.


Instruction: Generate impression based on medical findings.

Input: Crohn's disease status post ileocecectomy x2. Evaluate for stricture or adhesions and active inflammation. ABDOMEN:LIVER, BILIARY TRACT: Right hepatic lobe cyst. Otherwise unremarkable liver.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The small bowel is adequately distended with oral contrast. The small bowel fold pattern is unremarkable.There are postsurgical changes from an ileocecectomy. The small bowel including the terminal ileum is normal in caliber, wall thickness and demonstrates normal postcontrast enhancement without restricted diffusion or adjacent inflammatory changes. No free or loculated fluid. No evidence of sinus tract or fistula formation. No fixed stricture or prestenotic dilatation.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Left adnexal bilobed cystic lesion measuring 5.4 x 2.6 cm without suspicious imaging features.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The small bowel is adequately distended with oral contrast. The small bowel fold pattern is unremarkable.There are postsurgical changes from an ileocecectomy. The small bowel including the terminal ileum is normal in caliber, wall thickness and demonstrates normal postcontrast enhancement without restricted diffusion or adjacent inflammatory changes. No free or loculated fluid. No evidence of sinus tract or fistula formation. No fixed stricture or prestenotic dilatation.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No specific findings of active small bowel inflammation or fibro-stenotic disease.2.5.4 cm left adnexal cystic lesion. Follow-up ultrasound in 4-6 weeks is recommended to document resolution.


Instruction: Generate impression based on medical findings.

Input: 67 year old woman with possible sarcoidosis, referred for evaluation of cardiac involvement and interval changes since prior CMR. Left VentricleThe left ventricle is normal in size with low normal systolic function. The overall LV ejection fraction is 51%, the LV end diastolic volume index is 77 ml/m2 (normal range: 65+/-11), the LVEDV is 146 ml (normal range 109+/-23), the LV end systolic volume index is 37 ml/m2 (normal range 18+/-5), the LVESV is 71 ml (normal range 31+/-10), the LV mass index is 65 g/m2 (normal range 67+/-11), and the LV mass is 124 g (normal range 114+/-24). There is moderate concentric left ventricular hypertrophy (13mm). There is hypokinesis of the apical inferior wall and the mid anterior wall. There is late gadolinium enhancement that is multifocal and patchy, that is atypical for an infarct pattern. It is present in the apical inferior and lateral walls, basal inferior, inferoseptal, and inferolateral walls, and basal to mid antero wall. There is additionally evidence of early gadolinium enhancement involving the apical inferior and lateral walls. Together these findings support the presence of acute or subacute myocardial inflammation. The overall LGE burden since prior MRI in 2013 has increased. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 72 ml/m2 (normal range 69+/-14), the RVEDV is 137 ml (normal range 110+/-24), the RV end systolic volume index is 35 ml/m2 (normal range 22+/-8), and the RVESV is 67 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild 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 mildly dilated. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumSmall pericardial effusion is noted.Extracardiac FindingsPulmonary opacities noted, please see dedicated chest CT imaging for further description. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with low normal systolic function. Regional wall motion abnormalities as described above are noted. The overall LV ejection fraction is 51%.2. There is extensive late gadolinium enhancement which is associated with early gadolinium enhancement. These findings support the presence of acute or subacute myocardial inflammation. The pattern of late gadolinium enhancement is not typical for prior myocardial infarction. The extent of late gadolinium enhancement has increased when compared to the prior study from 2013. Given the associated lung findings, the diagnosis of cardiac sarcoidosis should be considered. 3. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%.4. Small pericardial effusion. 5. See extra-cardiac findings. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Severe back pain radiating down right leg Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is minimal anterolisthesis of L3 on L4 and L4 on L5. Alignment is otherwise grossly maintained. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen including multilevel disc desiccation. Individual levels as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Mild disc bulge with foraminal components. There is no significant spinal canal or right neural foraminal narrowing. There is minimal left neural foraminal narrowing.L3-L4: There is a disc bulge with a small central extrusion. There is also ligamentum flavum thickening and bilateral facet arthropathy at this level contributing to mild spinal canal stenosis. There is mild bilateral, left worse than right, neural foraminal stenosis. L4-L5: Disc bulge with a small central extrusion, facet arthropathy and ligamentum flavum thickening. No significant spinal canal stenosis. There is up to moderate left neural foraminal stenosis and mild right neural foraminal narrowing.L5-S1: Minimal disc bulge without significant spinal canal stenosis. There is mild bilateral neural foraminal stenosis. There is right-sided facet arthropathy.Paraspinous soft tissues are within normal limits.

Output: Multilevel degenerative changes in the lumbar spine, relatively worse at the L3-L4 and L4-L5 levels. There is mild spinal canal stenosis at L3-L4. There is moderate left L4-L5 neural foraminal stenosis. Additional details as above.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Is there evidence of occult bleed. Signs and symptoms: Headaches Nonenhanced CT of brain:Examination demonstrates a focal area of increased signal intensity in the right periventricular white matter of frontal lobe. This finding measures 6.2-mm x 8.9-mm on axial image 15. This finding was not reported on prior exam and likely represent a new finding. Differentials for this lesion includes a small area of hemorrhage or a hemorrhagic tumor. There is no evidence of any surrounding vasogenic edema but this finding. Follow-up with an MRI is recommended. This nonenhanced CT of brain is otherwise entirely within normal limits.

Output: 1.6.2 x 8.9-mm hemorrhage in the right periventricular white matter of frontal lobe with no surrounding edema as detailed above.2.Follow-up with an MRI is recommended.3.Negative nonenhanced CT brain otherwise.


Instruction: Generate impression based on medical findings.

Input: Reason: seizure focus? History: first time seizure 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 mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. These are more in the left hemisphere compared to the rightThe hippocampi are similar in size and signal characteristics.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 and demonstrates 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.

Output: 1.No evidence for acute cerebral infarction.2.No evidence for intracranial mass lesion or intracranial hemorrhage.3.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific but preferentially involve the left hemisphere. They are likely of little clinical significance but are nonspecific and their origin cannot be ascertained on this exam.4.No evidence for mesial temporal sclerosis.


Instruction: Generate impression based on medical findings.

Input: Right forearm mass. Suspect lipoma. Evaluate for nature of mass. A marker was placed along the radial aspect of the proximal forearm. Deep to this marker is a fatty mass centered in the mid forearm between the brachioradialis and extensor carpi radialis longus muscles. The mass is approximately 4.7 x 2.4 cm in transverse dimension and approximately 10 cm in longitudinal dimension. It displaces the brachioradialis muscle laterally. The radial artery and what I believe to be the superficial branch of the radial nerve course along the anterior margin of the mass. A couple of thin septations traverse the mass but I see no dominant nonadipose element. Osteoarthritis affects the elbow and wrist.

Output: Forearm lipoma as above.


Instruction: Generate impression based on medical findings.

Input: Aneurysm and cavernous malformation: headache, light flashes. MRI: There is a punctate focus of susceptibility effect in the left parietal lobe white matter with an adjacent developmental venous anomaly. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA: There is a medially-directed outpouching from the right internal carotid artery adjacent to the opthalmic artery origin that measures up to 5 mm, with a 2 mm wide neck. There is no evidence of significant steno-occlusive lesions.

Output: 1. A punctate focus of susceptibility effect in the left parietal lobe white matter with an adjacent developmental venous anomaly likely represents a cavernous malformation. 2. A right opthalmic artery saccular aneurysm measures up to 5 mm.


Instruction: Generate impression based on medical findings.

Input: There is redemonstration of postoperative and treatment findings of the left mid and posterior temporal lobe without interval change since prior exam. The resection cavity with surrounding T2 signal abnormality are unchanged. Minimal enhancement within the cavity is unchanged and likely post-operative in nature. There is dilatation of the trigone of the left lateral ventricle similar to prior exam. There is no significant enhancement elsewhere. The signal intensity in the brain parenchyma otherwise is within normal limits on all MRI sequences. There are no diffusion weighted abnormalities.

Output: Stable post-treatment changes with no evidence of recurrence or new lesions.


Instruction: Generate impression based on medical findings.

Input: CNS lymphoma and lymphoplasmacytic lymphoma/Waldenstrom macroglobulinemia status post 4 cycles of MTR chemotherapy, now with new blindness. There has been interval progression of infiltrative abnormal enhancement involving the optic apparatus. In particular, there is now swelling and enhancement involving the intraorbital, canalicular, and prechiasmatic segments of the left optic nerve, as well as the canalicular and prechiasmatic segments of the right optic nerve and optic chiasm, right greater than left, with extension into the adjacent optic pathway. There is persistent swelling, but decreased enhancement of the left trigeminal nerve and persistent T2 hyperintensity in the left lateral pons along the course of the trigeminal nerve fibers, also without residual enhancement. There are also new subcentimeter areas of leptomeningeal enhancement along the right cerebellar tonsil and left cerebellomedullary junction region, as well as ependymal and subependymal enhancement in the right frontal horn. There are unchanged nonspecific foci of T2 hyperintensity without corresponding enhancement in the cerebral white matter. There is no evidence of acute infarction or intracranial hemorrhage. There is no significant interval change in the size of the ventricular system. There is no midline shift or herniation. The skull and scalp soft tissues are unremarkable. There is diffuse moderate paranasal sinus mucosal thickening. There is mild fluid signal within the mastoid air cells.

Output: 1. Interval progression of infiltrative abnormal enhancement involving the optic apparatus likely related to involvement by lymphoplasmacytic lymphoma. 2. New areas of leptomeningeal enhancement along the right cerebellar tonsil and left cerebellomedullary junction region, as well as ependymal and subependymal enhancement in the right frontal horn also likely represent involvement by lymphoplasmacytic lymphoma. 3. Persistent swelling, but decreased enhancement of the left trigeminal nerve also likely related to lymphoplasmacytic lymphoma. 4. Findings suggestive of sinusitis.


Instruction: Generate impression based on medical findings.

Input: 70 year-old male with the history of recent CVA in the right MCA found unresponsive. Right frontal cortical hypoattenuation consistent with infarction noted on MRI of 2/21/2008. Periventricular hypoattenuation consistent with microangiopathic vascular disease demonstrated on prior MRI. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Right frontal infarction and white matter hypoattenuation compatible with microangiopathic vascular disease as demonstrated on prior MRI.


Instruction: Generate impression based on medical findings.

Input: Chronic ulceration. Question of osteomyelitis. There is complete destruction of the third metatarsal head with abnormal low T1, high T2 signal, and enhancement extending to the base compatible with osteomyelitis. Additionally, there is destruction of the third digit proximal phalanx. Abnormal signal within the third digit middle phalanx is compatible with osteomyelitis. There is low T1 signal along the lateral aspect of the second metatarsophalangeal joint, however, no definitive T2 signal abnormality or enhancement. Bone marrow signal within the remaining bones appears within normal limits. There is a 1.5 cm collection in the location of the third metatarsal head with peripheral enhancement and central low signal compatible with an abscess. An enhancing tract is seen communicating from the plantar skin surface to this collection.

Output: Osteomyelitis with abscess formation as described above.


Instruction: Generate impression based on medical findings.

Input: Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.Lumbar Spine: There is diffuse thickening of most of the cauda equina nerve roots, generally to a mild degree. Otherwise, the imaged spinal cord displays normal signal and morphology. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. At L3-4, there is mild facet hypertrophy and ligamentum flavum thickening, without no significant spinal canal stenosis, but mild bilateral neural foramen narrowing. At L4-5, there is a based disc bulge with mild bilateral neural foramen narrowing, but no significant spinal canal. At L5-S1, there is disc desiccation and small central disc protrusion with no significant neural foramen or spinal canal stenosis. There paraspinal soft tissues are unremarkable.

Output: 1. No evidence of acute cerebral infarction, intracranial mass, or intracranial hemorrhage.2. Diffuse thickening of the cauda equina nerve roots. Differential include an inflammatory or neoplastic process, or perhaps a hereditary motor sensory neuropathy. Further evaluation via MRI with contrast and DRIVE/FIESTA sequence may be useful. 3. Mild degenerative spondylosis of the lumbar spine with small central disc protrusion at the L5-S1 level, but no significant spinal canal stenosis.


Instruction: Generate impression based on medical findings.

Input: A patient submitted outside study for review. Submitted for review are bilateral diagnostic mammogram dated 9/12/2015Bilateral breast MRI dated 11/7/2015MR directed ultrasound dated 11/11/2015Bilateral breast MR guided biopsy dated 11/16/2015 with postprocedure mammogram performed at Midwest Center for Advanced Imaging. For comparison,mammogram 9/6/2014 are available. Patient has history of left breast DCIS with excision in 2008, diagnosed with Cowden syndrome 1. Bilateral diagnostic mammogram dated 9/12/2015: 2 standard views of both breasts were obtained. Tomo synthesis cannot be interpreted. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. Scar marker overlies the left lower inner quadrant. Multiple scattered benign calcifications seen in both breast.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in either breast. Benign appearing lymph nodes are projected over the left axillae.2. Bilateral breast MRI:Images were uploaded on Dyna CAD workstation for final interpretation.Linear area of non mass enhancement identified in the right breast 10:00 position approximately measuring 16 x 2 x 10 mm in the AP X ML x CC dimension.In the left breast 7:00 position there is a circumscribed oval mass is intensely enhancing that measures 8 x 5 x 7 mm (AP X ML x CC) with most likely benign morphology.Outside hospital report mentions an enhancing nodule measuring 8 x 7 x 5 mm at 12:00 position of the left breast which appears to represent parenchymal enhancementNo abnormality noted in the axillary region.3. MR directed ultrasound: No correlate was identified to the lesions identified in the outside hospital.4. Bilateral breast MRI biopsy: Right breast 10:00 and 2 sites in the left breast (7:00 and 12:00) were biopsied under MRI guidance. Targeting appears adequate. Clips were placed. A dumble-shaped clip is identified in the right upper-outer quadrant at appropriate location. A rod-shaped clip is identified in the left upper inner quadrant. A dumble-shaped clip is identified in the left lower inner quadrant.Pathology: Right breast 10:00 MR biopsy: DCIS high-grade, malignant and concordantLeft breast 7:00 MR biopsy: Benign breast tissue showing evidence of dense fibrosis suggestive of scarLeft breast 12:00 MRI guided biopsy: Benign breast tissue showing evidence of patchy fibrosis with duct ectasia and apocrine metaplasia with radiation type changes.Both left breast results are benign and concordant

Output: MRI guided biopsy right breast 10:00 linear non mass enhancement shows DCIS.2 sites left breast MRI guided biopsy results are benign and concordant.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: Reason: Chiari decompression , cerebellar T2 signal changes, new symptoms , follow up evaluation for changes, new numbness tingling and pain to her feet and hands up to thighs History: new numbness Operative changes from suboccipital craniectomy related to Chiari decompression are again seen. The cerebellar tonsils extend to the upper margin of C1 through the neo-foramen magnum, unchanged. Patchy symmetric T2/FLAIR hyperintensity involving the pons is again seen and appears similar to prior examination. The cortical sulci and ventricles are in proportion. There is redemonstration of nonspecific linear T1 hyperintensity involving the inferior aspect of the pituitary gland, slightly better visualized compared to prior examination. The more posterior portion may represent an atypical posterior pituitary bright spot. The abnormal pituitary gland morphology appears grossly similar to prior examinations. No midline shift or mass effect is appreciated. The gray-white matter junction is preserved. There is no evidence for acute ischemia or intracranial hemorrhage.CERVICAL SPINE:There is mild straightening of the cervical lordosis which may be positional. The cervical vertebral body heights and intervertebral disc spaces are maintained. No significant disc herniation, neuroforaminal stenosis, or spinal stenosis is noted. The spinal cord demonstrate normal signal and morphology.THORACIC SPINE:Thoracic kyphosis is preserved. The vertebral body heights are maintained. A few scattered T1 hyperintense lesions visualized throughout the thoracic spine appears similar to prior examination and likely related to hemangiomas. Schmorl's node involving the superior and inferior endplate of the T7 vertebral body are again seen. There is redemonstration of a right paracentral T11-12 disc protrusion resulting in mild spinal stenosis. The thoracic spinal cord demonstrates normal caliber and signal intensity.LUMBAR SPINE:For the purposes of numbering, the inferior most fully formed intervertebral disc space is considered to be L5-S1. The lumbar lordosis is preserved. T1 hyperintense lesion in the L3 vertebral body likely relates to a hemangioma. The vertebral bodies and intervertebral disc spaces are preserved. No significant disc herniation, neuroforaminal stenosis, or spinal stenosis is noted. The conus terminates at L1. The cauda equina appear unremarkable.Small left greater than right pleural effusion. There is fluid present within the somewhat distended esophagus. Trace fluid is also seen along the dependent tracheal wall.

Output: 1. Redemonstrated postoperative changes from Chiari decompression without significant interval change of cerebellar tonsil morphology or position.2. No evidence of syringohydromyelia.3. Nonspecific patchy symmetric T2/FLAIR hyperintensity involving the pons appears similar to multiple prior examinations, possibly relating to previous osmotic demyelination.4. Small left greater than right pleural effusion. Please correlate clinically, and dedicated chest x-ray should be considered.5. The esophagus is distended with fluid and there is trace fluid present within the trachea, possibly related to reflux. Recommend correlation with symptoms.


Instruction: Generate impression based on medical findings.

Input: Reason: right achilles tendon strain vs. tear History: right ankle pain TENDONS: There is thickening of the Achilles tendon at its insertion, which is consistent with tendinopathy. Additionally, there is increased signal in the retrocalcaneal bursa on the T2 weighted images, which is consistent with bursitis.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: No significant abnormality noted. ADDITIONAL

Output: Findings consistent with achilles tendinopathy and retrocalcaneal bursitis.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Is there change in cerebellum or ?olivary lesionSigns and Symptoms: ataxia MRI brain:There is redemonstration of cystic lesions in the medulla bilaterally at the expected location of the all of which is larger on the left compared to the right side. There is no associated diffusion restriction. There is no associated susceptibility effect. There is no associated contrast enhancement on the prior exam. The one on the left measures 4 x 5 mm axial dimensions and 4 x 9 mm coronal dimensions whereas the one on the right measures 3 x 3 mm axial dimensions and 3 x 3 mm coronal dimensions. These cystic lesions are slightly more prominent on the current prior exam though this appearance of a larger on the current versus the prior exam may be due to difference in slice thickness and gap on the prior MR acquisition and therefore may not be valid. This there is no convincing evidence for interval change in size of these lesions.There is associated cerebellar atrophy present. This is also present on the prior exam. The degree of cerebellar atrophy appears similar compared to the prior exam.There are no associated lesions appreciated in the dentate nuclei nor in the right nuclei.The supratentorial CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is multilevel disc desiccation present.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this level.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this level.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this level.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There are cystic lesions centered in olivary nuclei bilaterally (left larger than right) - suspected to represent cystic degeneration - associated with relatively symmetric cerebellar atrophy.2.No intrinsic spinal cord lesions are appreciated3.There are mild degenerative changes present in the cervical spine mainly in the form of disk degeneration without significant compromise to the spinal canal or neural foramina. At age 22 this is more disk dessication than usually expected.


Instruction: Generate impression based on medical findings.

Input: Possible arachnoid cyst and abnormal vessel: right side headache, abnormal CT. MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and brainstem appear unremarkable. There is focal prominence of cerebrospinal fluid spaces along the inferior aspect of the left cerebellar hemisphere, measuring 10 mm in width, 2 mm in height, and 10 mm anteroposteriorly. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA: The vertebrobasilar system is tortuous, but there is no evidence of significant steno-occlusive lesions or cerebral aneurysms.

Output: 1. No evidence of arachnoid cyst in the premedullary space. However, a small area of focal prominence of the cerebrospinal fluid spaces along the inferior aspect of the left cerebellar hemisphere may be attributable to an arachnoid cyst.2. No evidence of cerebral aneurysms.


Instruction: Generate impression based on medical findings.

Input: Ms. Weiner is a 45-year-old woman with a personal history of right breast IDC/DCIS status post lumpectomy in November 20, 2012. Patient received adjuvant radiation and chemotherapy. No current breast related complaints. There is extreme amount of fibroglandular tissue in both breasts with minimal background parenchymal enhancement.Stable postsurgical changes are present within the right lower outer breast. In addition, there is a stable benign morphology mass in the left lower outer breast. No abnormal enhancement is identified in either breast. No abnormal axillary lymph nodes are identified. Postsurgical changes are noted within the right axilla.

Output: No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Other specified disorders of muscleClinical question: stroke, Demyelinating disease.Signs and Symptoms: complicated neuro symptoms x 1 month, right sided weakness, vertiginous symptoms, R pronator drift 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 some mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: MRI of the brain is within normal limits


Instruction: Generate impression based on medical findings.

Input: Unspecified dementia without behavioral disturbance [F03.90], Reason for Study: ^Reason: Patient with progressive cognitive decline - assess for signs of CJD and/or cerebrovascular disease. History: progressive decline in memory and behavior. Significant motion artifact degraded image quality.There are subtle diffusion image high signal intensities on bilateral superior parietal lobules and right side inferior parietal lobule. Corresponding FLAIR images show subtle high signal intensities but T2 weighted images do not demonstrate those lesions. Thus, above described lesions could be artifactual or subacute ischemic lesions.Gradient echo images do not show definitive focus of susceptibility lesion, however, again due to significant motion artifact, thorough evaluation is not possible.There are patchy FLAIR high signal intensity lesions on bilateral periventricular white matter and centrum semiovale indicating possible small vessel ischemic disease.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, or midline shift. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses are clear.Left mastoid air cells show opacifications.

Output: 1. Significant motion artifacts degraded image quality.2. Subtle FLAIR high signal intensity lesions on bilateral parietal lobes are seen which could be artifacts or subacute ischemic lesions.3. No evidence of mass, mass effects or definitive hemorrhagic focus on this scan.Comment: the imaging request includes DTI scan as well as post contrast MR scans. However, considering significant motion artifacts, it was decided not to proceed for the DTI and post contrast scan today. Instead, it might need to be rescheduled for more detailed examination. This was discussed with Dr.Dellaria who is a resident of Dr Mastrianni at the time of this dictation.


Instruction: Generate impression based on medical findings.

Input: 67-year-old male patient with T2a prostate cancer, Gleason 4+3, PSA 15. Evaluate for extent of disease in prostate and pelvis.Right side prostate biopsiesSpecimen: Date: 11/10/14Prostate adenocarcinoma, Gleason score 3+4=7 involving Four biopsy cores and 10% of entire tissueLeft side prostate biopsy- Focal prostatic adenocarcinoma, Gleason score 3+3=6 involving <5 % of tissue PELVIS:PROSTATE:Prostate Size: 5.4 x 3.4 x 3.9 cm (ML x AP X CC).Peripheral Zone: There is a 1.5 x 0.7 cm (series 604 image 264) focus of decreased T2 and ADC signal in the mid right peripheral zone extending towards the apex.There is a 1.5 x 0.6 cm (series 604 image 324) focus of decreased T2 and ADC signal in the mid left peripheral zone.Central Gland: No suspicious lesions.Seminal Vesicles: No evidence of seminal vesicle involvement.Extracapsular Extension: Lesion in the right peripheral zone abuts the capsule without evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: Scattered small subcentimeter lymph nodes bilaterally in the pelvis.BONES, SOFT TISSUES: Patchy enhancement is noted in the bones the pelvis.OTHER: No significant abnormality noted.

Output: 1.Likely neoplastic foci in the mid right peripheral zone extending towards the apex as well as in the left peripheral zone without evidence of extracapsular extension or significant pelvic lymphadenopath as described above.2.Mottled, patchy enhancement of the bones in the pelvis. When correlated with outside hospital CT and recent bone scan, favor Paget's disease over metastatic disease.


Instruction: Generate impression based on medical findings.

Input: 49-year-old female with lower back pain.. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.L1-L2: No significant disc disease, spinal canal, or neural foraminal narrowing.L2-L3: No significant disc disease, spinal canal, or neural foraminal narrowing.L3-L4: Mild bilateral facet arthropathy. No significant disc disease, spinal canal, or neural foraminal narrowing.L4-L5: Moderate bilateral facet arthropathy. Loss of disc T2 signal and bulging disc with superimposed left foraminal annular fissure. Mild to moderate generalized spinal canal stenosis. Mild bilateral foraminal narrowing.L5-S1: Mild facet arthropathy. No significant disc disease, spinal canal, or neural foraminal narrowing.

Output: Mild degenerative findings at the L4-5 level, including facet arthropathy and bulging disc. These result in mild to moderate generalized spinal canal and mild bilateral neural foraminal narrowing.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Rule out bleed. Signs and symptoms: Fall. Unenhanced head CT:There is no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.The cortical sulci, ventricular system, CSF cisterns and gray -- white matter that initiation is well preserved.There is higher density of left supraclinoid internal carotid artery compared to the right lower compared to any of the other visualized intracranial large vessels. Recommend follow-up with an MRI to entirely exclude possibility of thrombus. The calvarium is intact. There is no detectable abnormality of the soft tissues of the scalp. Limited real paranasal sinuses and mastoid air cells are unremarkable.Above findings were discussed with the physician in the emergency room at the time of interpretation on the phone number 45968.

Output: Negative head CT.


Instruction: Generate impression based on medical findings.

Input: 47-year-old male with elevated PSA. PELVIS:PROSTATE:Prostate Size: 3.9 x 5 x 4.8 cm.Peripheral Zone: Mild heterogeneous T2 signal in the right mid gland may reflect an area of prior inflammation or correlate with biopsy proven PIN. However, no dominant focal lesion is evident.Central Gland: Heterogeneous.Seminal Vesicles: No significant abnormality.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No dominant focal lesion is evident.


Instruction: Generate impression based on medical findings.

Input: Evaluate mass of right brachial plexus and shoulder: discomfort and small mass on right side just below the clavicle and far lateral. There are innumerable tumors involving multiple bilateral cervical and upper thoracic nerve roots, as well more peripheral nerves, including what may correspond to the lesion of clinical concern located inferior to the right clavicle, which measures up to 27 mm. Of note, a mass along the right C6 nerve root is heterogeneous and has increased in size, measuring 28 mm in width, previously 19 mm. While some of the tumors enlarge the neural foramina, there is no evidence of spinal cord compression. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable.

Output: Innumerable peripheral nerve sheath tumors involving multiple bilateral cervical and upper thoracic nerve roots, as well more peripheral nerves, including what may correspond to the lesion of clinical concern located inferior to the right clavicle, which measures up to 27 mm. Of note, a mass along the right C6 nerve root is heterogeneous and has increased in size, which may indicate malignant transformation.


Instruction: Generate impression based on medical findings.

Input: There is a redemonstration of the diffusion restriction along the lateral aspect of the posterior right dorsal medulla with associated T2 hyperintensity. There is no evidence of intracranial hemorrhage. The ventricles and sulci are unchanged in size and configuration. The basal cisterns remain patent. There is no midline shift or mass effect. The distal right vertebral artery flow-void appears to be markedly narrowed. There is mild mucosal thickening in the right maxillary sinus with suggestion of chronic inflammatory changes.

Output: Right dorsolateral medulla recent infarct without evidence of hemorrhagic transformation associated with steno-occlusive disease of the distal right vertebral artery, which is better depicted on the recent CTA. 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 minimal scattered areas of subcortical white matter T2 hyperintensity. There is no evidence of acute infarct or intracranial hemorrhage. There are no abnormal intracranial enhancement. There is no intracranial mass or mass effect. Specifically, the cerebellum and the cerebellopontine angle appear normal. The major intracranial vascular structures enhance normally. The ventricles and sulci appear normal in size and configuration.There are scattered paranasal sinus secretions and mucosal thickening.

Output: 1. No evidence of cerebellar lesions.2. Minimal nonspecific cerebral white matter T2 hyperintensity.3. Mild inflammatory paranasal sinus disease. 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: Acute on chronic left sciatica. There are disc bulges with associated annular fissures are L3-4 through L5-S1, with up to moderate spinal canal stenosis at L4-5 and bilateral facet hypertrophy with at least moderate neural foraminal stenosis at L5-S1 bilaterally. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: Degenerative spondylosis at L3-4 through L5-S1, with up to moderate spinal canal stenosis at L4-5 and at least moderate neural foraminal stenosis at L5-S1 bilaterally.


Instruction: Generate impression based on medical findings.

Input: There is bilateral, nearly symmetric, T2 hyperintensity localized to the anterior aspect of the medulla without restricted diffusion, susceptibility abnormality, or enhancement.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: There is bilateral, nearly symmetric, T2 hyperintensity localized to the anterior aspect of the medulla without restricted diffusion, susceptibility abnormality, or enhancement. This is nonspecific in appearance and has been described in entities such as demyelination, infectious/inflammatory processes, hypertrophic olivary degeneration (although there is no definite primary lesion as the source), and subacute combined immunodeficiency.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old, with multiple sclerosis and bowel incontinence. Assess for new MS lesion. Alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement, edema or enhancement is seen.The visualized spinal cord demonstrates normal signal intensity and morphology. No focal signal abnormality or pathologic enhancement is detected. No epidural abnormalities are seen.The intervertebral discs are preserved. No significant disc bulging or herniation is seen. The spinal canal and neural foramina are patent.

Output: No evidence of demyelinating disease or any other specific thoracic spine abnormality.


Instruction: Generate impression based on medical findings.

Input: Ms. Denise Johnson is a 61 year old female with a personal history of a newly diagnosed cancer in her right breast, 10:00 position, 8 cm from the nipple. She presents today for ultrasound and possible ultrasound-guided biopsy of the additional enhancement demonstrated on the recent breast MRI. A targeted right ultrasound was performed for the area of concern on the MRI. In the right breast, 10:00 position, 8 cm from the nipple, there is an 1.3 x 1.7 cm hypoechoic mass with irregular margin and a biopsy clip, compatible with the biopsy proven malignancy. There is no suspicious finding anterior to this index mass in the upper outer right breast to correlate with the additional enhancement demonstrated on the MRI breast dated 5/13/2016. Therefore, ultrasound-guided biopsy is not performed today.

Output: No sonographic correlate for the additional enhancement anterior to the index cancer demonstrated on the MRI breast. Patient will be scheduled for MRI guided biopsy of the additional enhancement demonstrated only on the MRI. Results and recommendations were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: Clinical question : History of lung cancer, base of toque cancer, status post CRT. Evaluate for disease, compared with prior. Signs and symptoms: As above. Enhanced CT of soft tissues of neck: 80 cc of Omnipaque 350 is administered for this exam.Images through the skull base and including cavernous sinuses are unremarkable with the exception of extensive vascular calcification of cavernous carotid.Images through the neck demonstrate very extensive post therapy/surgical changes of the neck and including a large anterior flap. There is however no detectable tumor or any pathologic adenopathy neck.Limited images through the apices of the lungs demonstrate complete opacification of right upper lung field similar to what was noted on prior exam. Pleural effusion bilaterally is also noted (left greater than right). This is a new finding since prior exam. Please review dedicated report of CT of the chest performed the same date which he upper lung fields with better advantage.Enhanced head CT:Examination demonstrates extensive findings suspect for a mass to small vessel disease of indeterminate age. There is a small focal area of low cortical enhancement in the right frontal lobe (axial image 15 and coronal reformatted image 48). This finding was present on prior exam however it appears more prominent on the current study. Recommend further follow with an MRI exam to exclude the possibility of metastatic disease. The finding could represent a small enhancing cortical stroke as well. This examination is otherwise unremarkable and there are no additional foci of abnormal enhancement brain parenchyma or leptomeninges.

Output: 1.No evidence of recurrence of disease in neck and the stable exam since prior study.2.CT examination of brain demonstrates small focus of cortical enhancement in the right frontal lobe (axial image 15 & coronal reformatted image 48). This finding was present on prior study however appears slightly more pronounced on the current study and recommend further follow-up with an MRI to exclude metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Intra-articular contrast does not traverse the expected location of the scapholunate ligament or the lunotriquetral ligament. Please refer to the subsequent MRI report for further information.Exposure time: 1 minute and 58 seconds.

Output: Fluoroscopic guided injection of dilute gadolinium into the mid carpal joint of the left wrist for subsequent MR arthrogram examination without evidence of ligamentous disruption on fluoroscopic evaluation. Please refer to the MRI report examination for further details.


Instruction: Generate impression based on medical findings.

Input: There are 2 punctate foci of subtle diffusion restriction and T1 hyperintensity within the deep right frontal white matter and an additional punctate focus within the right inferior parietal lobule. There is no additional evidence of intracranial hemorrhage or acute infarct and no additional areas of abnormal parenchymal signal. The ventricles and basal cisterns are normal in size and configuration. The midline structures and craniocervical junction are within normal limits. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are unremarkable.

Output: Three punctate foci of diffusion restriction and T1 hyperintensity within the right cerebral deep white matter, which may represent foci of subacute petechial hemorrhage with possible underlying minimal ischemia, of unlikely clinical significance. Otherwise unremarkable MRI.


Instruction: Generate impression based on medical findings.

Input: Altered mental status, unspecified [R41.82], Reason for Study: ^Reason: meningitis History: encephalopathy Subtle focal restricted diffusion on the left side of the mid Pons unchanged since prior scan indicating acute ischemic infarct. There is no evidence of acute hemorrhagic lesion.There is evidence of tissue loss on the left basal ganglia thalamus as well as caudate head indicating prior ischemic infarct evidence of hemorrhage, unchanged.Patchy T2/flair high signal intensity lesions on bilateral periventricular white matter indicating small vessel ischemic disease, unchanged.There is no evidence of abnormal enhancement on the scan.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Left mid pontine acute ischemic infarct without evidence of hemorrhagic transformation, unchanged since prior scan.2. No evidence of acute hemorrhagic lesion. 3. No evidence of abnormal enhancement.3. Chronic ischemic lesion on the left basal ganglia, caudate head and thalamus with the tissue loss, unchanged since prior scan.4. Nonspecific small vessel ischemic disease, unchanged since prior scan.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old, with tracheomalacia, status post substernal goiter removal, vocal cord paresis, neck arthritis. Motion artifact decreases image quality on most sequences. Within this limitation, the following observations are made.Sequelae of left hemithyroidectomy is seen with no evidence of any masslike soft tissue in the operative bed. The right thyroid lobe is slightly heterogeneous and nodular, similar to prior CTs.Two T2 hyperintense, possibly cystic lesions are evident within the nasopharyngeal mucosa, both measuring less than a centimeter in diameter. No other significant aerodigestive abnormalities are seen though please note that subtle lesions of the larynx will not be adequately assessed on this examination due to artifact. The visualized salivary glands are within normal limits. No pathologic adenopathy is detected.A septated T2 hyperintense, T1 hypointense lesion is evident in the right paraspinal region adjacent to the first rib which appears to involve the neural foramina and which measures up to 24 mm in diameter. Similar but smaller appearing lesions are evident within the neural foramina of the adjacent low cervical and upper thoracic levels.

Output: 1.Sequelae of left hemithyroidectomy without suspicious or masslike tissue in the operative bed.2.Two subcentimeter probable nasopharyngeal mucosal cysts are seen.3.Multiple presumably cystic lesions are evident in association with the neural foramina of the low cervical and upper thoracic levels. These most likely reflect prominent perineural root sleeve cysts.


Instruction: Generate impression based on medical findings.

Input: 74 years Male (DOB:1/21/1942)Reason: Dr. Christoforidis acute stroke protocol to evaluate if candidate for IR intervention with MR perfusion History: rt sided weaknessPROVIDER/ATTENDING NAME: DAVID A HARTER DAVID G. BEISER MRI of the brainThere are multiple foci of diffusion restriction present. One in the right cerebellar hemisphere measures 33 x 28 mm axial dimensions. There are several smaller 1's scattered in both cerebellar hemispheres. There is a focus of diffusion restriction involving the left lingual and fusiform gyri as well as the left hippocampus measuring approximately 75 x 22 mm axial dimensions. Another focus of diffusion restriction is present in the left thalamus which measures 11 x 9 mm axial dimensions. Another one present in the left cuneus measures 5 mm in size. Many of these are associated with FLAIR signal hyperintensity with the exception of the left thalamic lesion.Perfusion imaging is suboptimal due to early triggering.There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucous retention cysts. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and right posterior cerebral arteries.There is occlusion of the left posterior cerebral artery at the proximal P2 segment. There is focal narrowing of the mid basilar artery with approximately 50% stenosis.The right vertebral artery is larger than the left vertebral artery. The left posterior inferior cerebellar artery is not readily identified though the right posterior inferior cerebellar artery is relatively larger.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The right A1 segment is hypoplastic. The posterior communicating arteries are small to medium sized.

Output: 1.There are multiple foci of cerebral infarction manifested there is diffusion restriction in the posterior circulation involving left medial temporal lobe, left occipital lobe and the cerebellar hemispheres.2.There is occlusion of left posterior cerebral artery at the proximal P2 segment.3.50% focal stenosis at the mid basilar artery.4.Periventricular and subcortical white matter lesions of a moderate degree are nonspecific. At this age they are most likely vascular related. 5.Perfusion imaging is suboptimal due to early triggering.Findings were reported to Dr ALSHAIKH, JUMANA TARIQ


Instruction: Generate impression based on medical findings.

Input: Axial images are motion greater. Given this caveat:Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: UnremarkableC3/4: UnremarkableC4/5: UnremarkableC5/6: Ligamentum flavum thickening without stenosis.C6/7: Minimal posterior osteophyte disc complex and uncinate hypertrophy as well as ligamentum flavum thickening. There are no significant stenoses.C7/T1: Unremarkable

Output: Minimal cervical spine spondylosis without significant stenosis.


Instruction: Generate impression based on medical findings.

Input: Again seen are postoperative changes related to resection of two right parietal meningiomas. Compared to 6/26/2015, there is been decrease in size of the resection cavity in the right paramedian parietal region. More inferiorly irregular areas of enhancement in the right parieto-occipital region and are not significantly changed. Unchanged nodular areas of enhancement along the right parietal convexity. No new or enlarging mass is seen to suggest tumor recurrence. Minimal parieto-occipital extra-axial collection is again seen. Chronic segmental occlusion of the posterior superior sagittal sinus is again seen with patency more anteriorly and posteriorly.The T2/FLAIR signal abnormality within the brain parenchyma surrounding all of these areas is similar to prior study. The remaining brain parenchyma is otherwise unremarkable. There are no other intracranial lesions identified.

Output: Compared to 6/26/2015, there is evolution of postsurgical changes related to resection of two right parietal meningiomas. Minimal areas of nodular dural thickening and enhancement in the right parieto-occipital region have not significantly changed. No findings to definitively suggest tumor recurrence.


Instruction: Generate impression based on medical findings.

Input: 82 years Female (DOB:1/3/1934)Reason: meningioma growth History: dizzinessPROVIDER/ATTENDING NAME: JAMES R. BRORSON JAMES R. BRORSON 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 are multiple punctate-sized foci of signal loss on susceptibility weighted imaging located along subcortical white matter predominantly in the right hemisphere. This has not changed significantly compared to the previous exam. In addition there is a punctate focus of signal loss on susceptibility imaging in the left cerebellar hemisphere just lateral to the left dentate nucleus. This is also stable.There is a gyriform linear signal hypointensity on susceptibility imaging along the surface of the brain adjacent to the right precentral sulcus.There is an extra-axial nodule present adjacent to the right postcentral sulcus measuring 7 mm in size with a broad-based the dura which is unchanged in size compared to the prior exam. It is bright on T1-weighted imaging and is associated with susceptibility effect. It is also identified on the CT from 4/9/2014 where it is calcified.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 right vertebral artery appears to be hypoplastic and not readily visualized intracraniallyThe visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.

Output: 1.Since the prior exam there does not appear to be any significant change. There is redemonstration of multiple microhemorrhages within the subcortical white matter of the supratentorial brain bilaterally but predominantly in the right hemisphere and also in the left cerebellar hemisphere. This asymmetry is of uncertain significance.2.There appears to be hemosiderin deposition along the left precentral sulcus which was also identified on the prior exam and most likely indicates that prior subarachnoid blood was present at this location.3.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 4.There is a stable 7 mm calcified extra-axial lesion present adjacent to the right postcentral sulcus most likely represent a burnt out meningioma.


Instruction: Generate impression based on medical findings.

Input: 43 year-old with history of ALH, LCIS and dense breasts. Family history of breast cancer in her mother at age 54 and sister at age 50. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Multiple cysts are present in both breasts, right greater than left.An enhancing focus at posterior left upper outer quadrant is stable.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on medical findings.

Input: 66-year-old man with history of clear cell renal carcinoma status post right nephrectomy. ABDOMEN:LIVER, BILIARY TRACT: There is a subcentimeter cyst in segment 6 of the liver. The liver and gallbladder are otherwise unremarkable. There is no intra or extra hepatic biliary duct dilatation.SPLEEN: The spleen appears normal. PANCREAS: A punctate cystic focus in the body of the pancreas (series 5/25) is unchanged from prior exams and likely an ectatic sidebranch or IPMN. The pancreas is otherwise normal.ADRENAL GLANDS: Bilateral adrenal myelolipomas, right larger than left.KIDNEYS, URETERS: There is a left superior for renal cyst, otherwise the left kidney is normal. The patient is status post right nephrectomy.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: Partially visualized small bowel and colon are normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Status post right nephrectomy without evidence of recurrent disease.


Instruction: Generate impression based on medical findings.

Input: Brain: Postsurgical changes are present related to decompression including suboccipital craniectomy and C1 laminectomy. The CSF spaces at the foramen magnum ventrally and dorsally have significantly increased in size, and the cerebellar tonsils are no longer flattened. There is persistent mild cerebellar tonsillar ectopia with the left cerebellar tonsil extending to the C1 level. There is no evidence of intracranial hemorrhage or acute infarct. A small pineal cyst is unchanged in size. There are no areas of abnormal parenchymal signal. 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 skull, paranasal sinuses, and scalp soft tissues are unremarkable. 3-D T2 Fiesta and CSF flow images are severely degraded due to technical limitations. Cervical Spine: Postsurgical changes are present including C1 laminectomy. There is mild straightening of the normal cervical lordosis which may be due to positioning. The vertebral body heights and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. There is no evidence of syrinx of the cervical or upper most visualized thoracic cord. The paravertebral soft tissues are unremarkable.Mild disc protrusions are present at C3-C4, C4-C5, and C5-C6 without significant central canal stenosis or foraminal stenosis.

Output: Interval postsurgical changes related to Chiari decompression with significant enlargement of CSF spaces ventrally and dorsally at the foramen magnum.


Instruction: Generate impression based on medical findings.

Input: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are no areas of abnormal parenchymal signal. The hippocampi are symmetric and normal in appearance. The midline structures and craniocervical junction are within normal limits. 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 skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: Normal MRI without evidence for mass, structural abnormality, or mesial temporal sclerosis.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old. Patient with hearing loss and gait disturbance. Prior MRI findings of an acoustic neuroma. History of cardiac defibrillator. Review of patient's chart indicates history of right intracanalicular acoustic neuroma measuring approximately 7 mm. A subtle area of asymmetric intracanalicular enhancement identified in the right IAC that likely corresponds to small schwannoma referenced patient's clinical history. The lesion measures approximately 4 x 9 mm (image 72, axial series 80832; image 105, coronal series 80833).Nonspecific white matter hypoattenuating foci are seen in bilateral cerebral white matter and the brainstem likely secondary to chronic small vessel disease. No other areas of abnormal enhancement are identified. Mucosal thickening identified in the ethmoid air cells and frontoethmoid recess. The ventricles and basal cisterns are normal in size and configuration.

Output: Subtle area of intracanicular enhancement in the right internal auditory canal likely corresponding to patient's schwannoma per the clinical history.


Instruction: Generate impression based on medical findings.

Input: 50-year-old male with history of urothelial cancer. Status post right nephroureterectomy and right adrenalectomy in 2014. Please assess for disease progression. ABDOMEN:LIVER, BILIARY TRACT: Loss of signal intensity of the hepatic parenchyma between the in and out of phase sequences compatible with hepatic steatosis.SPLEEN: Splenomegaly measuring 15 cm in length.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Status post right adrenalectomy. Normal left adrenal gland.KIDNEYS, URETERS: Status post right nephrectomy. No recurrent lesion identified in the surgical bed. Normal enhancement of the left renal parenchyma. No hydronephrosis. No filling defect of the left collecting system or left ureter.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Tiny hiatal hernia. Mild colonic diverticulosis without evidence for acute diverticulitis.BONES, SOFT TISSUES: Small fat-containing umbilical hernia.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No abnormal filling defects or asymmetric wall thickening.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Status post right nephrectomy. No evidence of local tumor recurrence or metastatic disease.2.Hepatic steatosis.


Instruction: Generate impression based on medical findings.

Input: 68-year-old male with abdominal pain, vomiting ABDOMEN:LUNG BASES: Calcified granuloma in the right lung baseLIVER, BILIARY TRACT: Subcentimeter hypodensity at the dome of the liver may represent a hemangioma, suggested on prior MRI.SPLEEN: The spleen is mildly enlargedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Multiple mildly enlarged mesenteric and retroperitoneal lymph nodes are identified, stable. A left paraaortic lymph node (series 2; image 66) is unchanged, measuring 1.4 cm.Scattered calcified lymph nodes are identified.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: The prostate gland is enlarged.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No acute abnormality. Stable scattered adenopathy.


Instruction: Generate impression based on medical findings.

Input: Multiple sclerosis: pain and paresthesias legs. There are persistent T2 hyperintense lesions in the spinal cord, particularly at the T1-2 and T12 levels. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There are multilevel upper thoracic subcentimeter neural foraminal perineural cysts. There are disc protrusions at L4-5 and L-S1 with mild bilateral neural foraminal narrowing, but no significant spinal canal stenosis. There are multilevel degenerative changes in the cervical spinal cord, which are depicted only on the limited localizer images. The paravertebral soft tissues are unremarkable. There are multiple adnexal lesions, perhaps including hemorrhagic cysts.

Output: 1. Persistent demyelinating lesions in the spinal cord.2. Multiple adnexal lesions, perhaps including hemorrhagic cysts. A pelvic ultrasound may be useful for further evaluation.


Instruction: Generate impression based on medical findings.

Input: 62-year-old male patient with neck pain and bilateral shoulder pain. Evaluate for cord compression. The vertebral bodies are appropriate in the overall alignment and height. The spinal cord has normal signal characteristics and overall morphology. There is no compromise of the spinal cord. There are mild multilevel degenerative changes of the cervical, including a posterior disc-osteophyte complex at C4/C5. There are partially imaged lung masses and a left thyroid nodule, which are better evaluated on prior CT soft tissue neck and chest.

Output: 1. 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. No cord compression is identified.Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine.2. Mild degenerative changes of the cervical spine.3. Partially imaged lung masses are better evaluated on prior chest CT.


Instruction: Generate impression based on medical findings.

Input: Abdominal pain with history of abdominal schwannoma ABDOMEN:LIVER, BILIARY TRACT: Small bilobar hepatic cysts. Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No lymphadenopathy. See pelvis report.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Lobulated peripherally enhancing T2 hyperintense mass anterior to the L5 vertebral body measures approximately 3.2 x 5.7 x 5.6 cm (AP x TR x CC). The mass arises at the level of the aortic bifurcation and surrounds the right common iliac artery and vein.

Output: 1. Peripherally enhancing cystic mass anterior to the L5 vertebral body surrounds the right common iliac artery and vein. Given the time course, a postoperative collection should be considered although residual and/or recurrent schwannoma can not be excluded.


Instruction: Generate impression based on medical findings.

Input: Medial knee pain MENISCI: There is a horizontal cleavage type tear of the body and posterior horn of the medial meniscus with additional fraying/degenerative tearing of the free edge of the posterior horn. The anterior horn of the medial meniscus is intact. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is edema within the medial femoral condyle that surrounds a small focus of low signal intensity in the subchondral bone just above the body of the medial meniscus. This edema type signal may be degenerative in etiology but could also represent a small subchondral insufficiency fracture. There is relatively mild edema within the medial tibial plateau. Subjectively, the articular cartilage of the weightbearing portion of the medial compartment appears thinned particularly along the medial tibial plateau but we see no fluid-filled articular cartilage defects. A tiny superficial defect is noted along the articular cartilage of the lateral tibial plateau. The articular cartilage of the patellofemoral compartment is relatively spared.LIGAMENTS: There is edema along the superficial band of the MCL. This is nonspecific in nature and could represent a sprain in the appropriate clinical context but may also be secondary to the underlying medial compartment pathology described above. The remaining cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Horizontal cleavage type tear of the medial meniscus with other findings described above.


Instruction: Generate impression based on medical findings.

Input: Reason: sarcoid with worsening pain, want to assess for progression History: sarcoid with worsening pain, want to assess for progression Again seen are multiple lesions within the innominate bones, sacrum, and proximal femora compatible with the stated history of osseous sarcoid. Many of these lesions now show high signal intensity on T1-weighted images indicating fatty replacement and healing. For example, the reference right intertrochanteric lesion measures approximately 2 cm in its greatest dimension which previously demonstrated homogeneous signal abnormality now appears predominantly fatty on the T1-weighted images. Other lesions appear slightly larger on the current study than on the prior examination. For example, a lesion within the proximal left femur measures approximately 1.5 cm in its greatest transverse dimension, previously measuring 1 cm. New lesions are also identified, for example, in the left anterior column of the left acetabulum. Many of these lesions show enhancement following gadolinium administration. There is osteonecrosis of both femoral heads with progression of flattening of the anterior surface of the left femoral head. Osteoarthritic changes of the hips have also progressed slightly on the left as well. There is slight enlargement of the bilateral inguinal lymph nodes which still retain their normal fatty hilum. Degenerative disc disease affects the imaged lumbar spine. Please refer to the dedicated lumbar spine MRI report for additional details. Note is made of left hip synovitis appearing similar to the prior study.

Output: Osseous sarcoid as described above with a mixed pattern of response, with some lesions showing fatty replacement and others showing slight enlargement. A few new lesions are also identified.


Instruction: Generate impression based on medical findings.

Input: Multiple sclerosis or NMO: fatigue. Brain: There are multiple, grater than 10, scattered cerebral white matter T2 hyperintense lesions. Some of the lesions are also T1 hypointense. There is no evidence of intracranial hemorrhage, mass, or acute infarct. 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.Spine: The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable, aside from scattered areas of focal fat. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. There are small left renal cysts.

Output: 1. Findings suggestive of intracranial multiple sclerosis.2. No evidence of spinal cord lesions.


Instruction: Generate impression based on medical findings.

Input: Malignant neoplasm of unspecified kidney, except renal pelvis [C64.9], Reason for Study: ^Reason: s/p nephrectomy for RCC. R flank pain, L thigh numbness, ?periportal LN on OSH scans on PACS. Abd AND Lumbar MRI together please History: R flank pain, s/p For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is about 17.8mm x 15.4mm sized lesion on the L3 vertebral body which shows low signal intensity on T1 and high signal intensity on T2 with intense enhancement on Gad infusion.The lesion shows lamellated appearance on T1 and T2 weighted images indicating central soft tissue layer, surrounding sclerotic bone area and bone marrow edema which show enhancement. In addition, there is evidence of focal endplate defect which is associated with the lesion. Constellation of these findings are suggestive of acute Schmorl's node, however, single vertebral body metastasis cannot be completely excluded. Since bone scan may not differentiate two diagnostic possibilities, follow up imaging about 1-2 months with MRI with and without contrast is recommended. There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance except L3 vertebral body. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing. The conus medullaris terminates at the L1-L2 level.The paraspinal soft tissues are unremarkable.Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: diffuse bulging of disc, no neuroforaminal narrowing or spinal stenosis. L4-L5: diffuse bulging of disc, no neuroforaminal narrowing or spinal stenosis. L5-S1: no neuroforaminal narrowing or spinal stenosis.

Output: 1. Acute Schmorl's node, L3 vertebral body inferior end plate. Vertebral body metastatic lesion cannot be completely excluded considering the patient's history. Follow up MRI with and without contrast enhancement is recommended.2. Diffuse bulging of disc at the level of L34 and L45 as described above. Otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Pain in limbClinical question: LE painSigns and Symptoms: LE pain Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is straightening of the normal cervical curvature. There is multilevel disc desiccation present.No abnormal enhancing lesions are appreciated in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina. At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a minor disc bulge present at this level with very mild narrowing of the right neural foramenAt C4-5 there is no significant compromise to the spinal canal. There are endplate and uncovertebral osteophytes present this level associated with a disc bulge and partial effacement of spinal fluid ventral and posterior the spinal cord. There is narrowing of the neural foramina bilaterally with some encroachment of the right-sided exiting nerve roots. Overall there is a mild degree of spinal stenosis at this level. There are some endplate reactive changes present at this level.At C5-6 there is no significant compromise to the spinal canal. There are bilateral uncovertebral osteophytes present at this level with some mild narrowing of the neural foramina worse on the right than the left side. There is a disc bulge at this level. There are some endplate reactive changes present at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge and some endplate osteophytes at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. The right vertebral artery is very small.MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. No abnormal enhancing lesions are appreciated in the thoracic spine.There are some mild degenerative changes present in the cervical spine with multilevel disc desiccation and a minor disc bulge at T9-10 which affects the left neural foramen.

Output: 1.There are multilevel degenerative changes present in the cervical spine with encroachment of right-sided exiting nerve roots within the neural foramina at C4-5 and C5-6 as described above.2.There are minimal degenerative changes in the thoracic spine without compromise to spinal canal or exiting nerve roots.3.No abnormal lesion is appreciated within the cervical or thoracic spinal cords.


Instruction: Generate impression based on medical findings.

Input: 70-year-old woman w/ severe PAD w/ h/o right BKA p/w left foot infection/gangrene of left foot. Assess for osteomyelitis Please note that this study is slightly limited as the patient was unable to hold still during the examination, and as such it was terminated early. There is destruction and abnormal signal intensity within the entire distal phalanx of the great toe with complete destruction of the tuft, with a similar appearance within the distal half of the proximal phalanx of the great toe. There is soft tissue irregularity and abnormal signal intensity in this distribution. These findings are compatible with osteomyelitis.

Output: Osteomyelitis of left great toe


Instruction: Generate impression based on medical findings.

Input: 47-year-old male. Persistent pain in left hip and infragluteal area. Xray - ? mild deformity - ? cam deformity of femoral head/neck (mild), probably not enough to explain symptoms. Please note that due to insurance issues, only the pelvis was imaged despite the order for a pelvis and left hip MRI. As a result, evaluation of the left hip is limited.JOINTS: Mild osteoarthritis affects the left hip with small anterior acetabular osteophytes and mild edema in the adjacent bone that is presumably degenerative in etiology. Slightly more pronounced osteoarthritic changes affect the right hip including small subchondral cysts in the anterior aspect of the femoral head. Given the sequences used for this study, we cannot adequately comment on the articular cartilage of the hip or the acetabular labrum.SOFT TISSUES: There is a small focus of edema within the superolateral fibers of the left gluteus medius near their origin, which may represent a mild strain injury. The remaining musculature is unremarkable.ADDITIONAL

Output: 1. Mild hip osteoarthritis.2. Mild edema in the superolateral aspect of the left gluteus medius, which may represent a mild strain.3. Other findings, as described above.


Instruction: Generate impression based on medical findings.

Input: 66 years, Male, Reason: Study for upcoming prostate biopsy History: Elevated PSA. PELVIS:PROSTATE:Prostate Size: 5.7 x 3.9 x 3.4 cmPeripheral Zone: Lesion in the right base with low T2/ADC signal and invasion of the right seminal vesicle is suspicious for prostatic adenocarcinoma and measures 1.6 x 1.2 cm (804/364).Lesion in the left base with low T2/ADC signal and invasion of the left seminal vesicle is suspicious for prostatic adenocarcinoma and measures 1.5 x 1.9 cm (804/364).Central Gland: Multiple well-defined heterogeneous nodules likely represent benign prostatic hypertrophy.Seminal Vesicles: Bilateral invasion of the seminal vesicles.Extracapsular Extension: Bilateral extracapsular extension suggested posteriorly.BLADDER: No significant abnormality noted.LYMPH NODES: No lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Lesions described above in the bilateral bases are suspicious for prostatic adenocarcinoma.2.No lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old, with low back pain, radiculopathy, and lower leg weakness. A trace grade 1 anterolisthesis of L4 relative to L5 is not significantly changed. Sagittal alignment is otherwise unremarkable.Vertebral body height and morphology are within normal limits. Marrow signal characteristics are heterogeneous, but there are no areas of significant marrow edema or concerning marrow replacement.The visualized distal spinal cord, conus and nerve roots of the cauda equina are unremarkable except as discussed below. No epidural abnormalities are suspected.L1-2: No significant spinal canal stenosis or neuroforaminal narrowing. No interval changes. L2-3: Facet arthropathy and ligamentum flavum thickening, progressed from prior. No significant spinal canal stenosis. Mild bilateral foraminal narrowing, progressed from prior. L3-4: Facet arthropathy and ligamentum flavum thickening, progressed from prior. A previously seen synovial cyst projecting into the right lateral spinal canal has since resolved. Progressive loss of disc height and disc bulging is seen. A mild generalized spinal canal stenosis is detected along with moderate bilateral foraminal narrowing, progressed from prior. L4-5: Marked facet arthropathy and ligamentum flavum thickening, progressed from prior. There appears to be a new synovial cyst measuring up to 8 mm projecting into and effacing the left lateral recess (see image 8 series 501, and image 14 series 901). Disc bulging. Significant generalized spinal canal narrowing is seen with effacement of CSF and crowding of the cauda equina nerve roots. Both neural foramina are moderately narrowed. Findings have progressed from prior. L5-S1: Facet arthropathy and ligamentum flavum thickening. Mild disc bulging with a new small superimposed right paracentral protrusion. No significant generalized spinal canal stenosis. Moderate bilateral foraminal narrowing, unchanged.

Output: Progressive degenerative disease is seen at most levels in the lumbar spine. The most severely affected level is L4-5, where facet arthropathy and disc bulging result in a significant generalized spinal canal stenosis with crowding of the cauda equina. In addition, there appears to be a new synovial cyst projecting into the left L4-5 lateral recess. Both neural foramina are moderately narrowed.


Instruction: Generate impression based on medical findings.

Input: Low back and right hip pain radiating to groin. Long-term use of prednisone, concern for avascular necrosis versus tendon/ligament damage Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. No evidence of fracture. There is mild reversal of lumbar lordosis. Bone marrow signal is heterogeneous without discrete suspicious osseous lesions. The conus medullaris is normal in position.Multilevel degenerative changes are seen including multilevel disc desiccation and loss of height. Individual levels as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Minimal disc bulge eccentric to the right. Minimal right greater than left neural foraminal narrowing. No significant central canal stenosis.L3-L4: Disc bulge with left paracentral annular fissure and protrusion resulting in effacement of the left lateral recess. There is mild bilateral neural foraminal stenosis. No significant central canal stenosis.L4-L5: Diffuse disc bulge with right foraminal/extraforaminal disc protrusion and small posterior Schmorl's node involving the right inferior L4 endplate. There is moderate right-sided neural foraminal stenosis and minimal left neural foraminal narrowing. No significant spinal canal stenosis.L5-S1: Small central protrusion. No significant spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits. Atrophic native kidneys with small cysts noted.

Output: Overall relatively mild multilevel degenerative changes throughout the lumbar spine as detailed above. There is a right foraminal disc protrusion at the L4-L5 level with moderate right neural foraminal stenosis and possible impingement of the exiting right L4 nerve root. No findings to suggest avascular necrosis involving the lumbar vertebral bodies as questioned.