Instruction: Generate impression based on medical findings.

Input: MRI BRAIN: There is gyriform restricted diffusion and T2 hyperintensity involving the left middle and inferior frontal gyri with mild swelling. There are two additional punctate foci of restricted diffusion and T2 hyperintensity in the left inferior cerebellar hemisphere. There are scattered punctate foci of susceptibility effect in the left superior cerebellar hemisphere, and right frontal periventricular white matter and left middle frontal gyrus, which may represent chronic microhemorrhages. There is periventricular and subcortical nonspecific white matter T2 signal abnormality with additional patchy T2 signal abnormality in the central pons. There is a defect in left basal ganglia. The ventricles and sulci are diffusely prominent suggesting cerebral volume loss. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. MRA BRAIN: The anterior and posterior circulations show no evidence of high-grade steno-occlusive disease or aneurysm. MRA NECK: There is suboptimal depiction of the great vessel origins due to technical factors. Otherwise, the bilateral common carotid arteries, cervical internal carotid arteries, and vertebral arteries are without evidence of high grade stenosis.

Output: 1.Acute nonhemorrhagic cortical infarction involving the left middle and inferior frontal gyri, as well as punctate acute left inferior cerebellar hemispheric infarcts.2.No evidence of significant steno-occlusive disease in the head or neck].3.Chronic left basal ganglia infarct.4.Chronic microvascular ischemic changes as described above.Findings were discussed with Dr. Andrew Beaser (CCU Fellow) over the telephone at 4:06 PM today.


Instruction: Generate impression based on medical findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The right hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 12 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 35 seconds

Output: Successful fluoroscopic injection of dilute gadolinium into the right hip for subsequent MRI arthrogram.


Instruction: Generate impression based on medical findings.

Input: Reason: 64 YO male with hx of pancreas mass; please evaluate for changes and or abnormalities History: pancreas mass. ABDOMEN:LIVER, BILIARY TRACT: Hepatic steatosis. No focal hepatic lesion.SPLEEN: No significant abnormality noted.PANCREAS: Complex multiloculated cystic lesion with enhancing septations in the pancreatic head measures approximately 3.8 x 2.3 cm (series 4 image 30), previously 3.6 x 1.7 cm. This lesion again communicates with the pancreatic duct, which is mildly dilated measuring 5 mm, previously 4 mm. No new lesion.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: 3.5 cm solid nonenhancing lesion within the gastric body which follows fat on all sequences and compatible with an intramural lipoma has slightly increased in size, previously measuring 2.8 cm.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Slight interval increase in size of multiloculated cystic lesion in the pancreatic head that communicates with the mildly dilated pancreatic duct, these characteristics suggestive of a mixed main duct and side branch IPMN. Gastric lipoma.


Instruction: Generate impression based on medical findings.

Input: There are again stable postoperative findings from prior right frontal craniotomy for right frontal lobe ganglioglioma resection. There are a few foci of postoperative susceptibility. There is minimal persistent T2/FLAIR hyperintensity along the resection margins extending towards the right lateral ventricle margin, without associated nodular enhancement.There is no evidence of diffusion weighted abnormality. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are patent.

Output: Continued stable postoperative changes from prior right frontal craniotomy for right frontal lobe ganglioglioma resection, without evidence of tumor recurrence.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old, with fever and lethargy. Evaluate for etiology of fever and altered mental status. No restricted diffusion is seen. No evidence of parenchymal edema or mass effect is detected. There are no intracranial enhancing lesions. No evidence of acute or chronic intracranial hemorrhage is seen. Mild prominence of the CSF along the superior surface of the cerebral hemispheres is unchanged and may reflect underlying cerebellar volume loss or subdural effusions. The ventricular system is normal in size and morphology. Minimal left frontal periventricular white matter T2 hyperintensity is seen, a nonspecific finding. Patchy opacification of the mastoid air cells is seen, right more than left. Opacification of the right frontal sinus and the ethmoid air cells is seen with mucosal thickening and minimal fluid in the left sphenoid sinus.

Output: 1.No acute intracranial abnormality.2.No intracranial findings to account for the patient's symptoms.3.Evidence of mucosal inflammation is seen in the paranasal sinuses and mastoid air cells. Correlation with clinical signs of sinus or mastoid infection is suggested.


Instruction: Generate impression based on medical findings.

Input: 52-year-old female with history of adrenal lesions. ABDOMEN:LIVER, BILIARY TRACT: Bilateral T2 hyperintense lesions likely represent cysts.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Nodular left adrenal gland with internal fat density appearing similar to the study from 2014.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: Stable findings of nodular adrenal hyperplasia without suspicious features.


Instruction: Generate impression based on medical findings.

Input: 36-year-old male with history of Crohn's disease presents with fevers, chills, pain; evaluate for abscess. Status post recent fistula repair (on 2/5/2010) with abdominal pain. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Stable hypodense lesions within the liver.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Marked thickening of the terminal ileum and multiple loops of bowel appearing have resolved since the prior exam. The ileosigmoid fistula seen on the prior exam has been resected. There are post-op changes in the right lower quadrant from recent endocsopic procedure. Small amount of intraperitoneal fluid and subcutaneous / intraperitoneal gas are attributed to post-op changes. Contrast is present in the terminal ileum, but not the sigmoid, suggesting that the fistula has been repaired. BONES, SOFT TISSUES: No significant abnormality notedOTHER: New fluid collections with gas bubbles in the rectus muscles near the midline bilaterally, seen best on axial image 93/163 of series 12 and coronal image 67 have enhancing rims, compatible with abscess. These are new since the prior exam. PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Prominent bladder.LYMPH NODES: Borderline enlarged inguinal nodes. No other significant abnormality.BOWEL, MESENTERY: Rectal intramural fistula tract extending to the scrotum is reidentified and is subtle; however, this is incompletely evaluated by CT and may be better seen with MRI, if indicated.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1. Ileitis with narrowing of the terminal ileum and fistula between the ileum and the sigmoid colon have resolved since the prior exam. 2. A rectal intramural fistula to the scrotum is less prominent on this exam; however, it is incompletely evaluated on CT and MRI is recommended, if indicated.3. New abscess in the rectal sheath bilaterally.


Instruction: Generate impression based on medical findings.

Input: 43-year-old male with neurogenic claudication. Assess stenosis. There are defects in the bilateral pars interarticularis at L4 with minimal anterolisthesis of L4 on L5. The vertebral bone marrow signal is otherwise unremarkable. The imaged portions of the spinal cord and cauda equina are unremarkable. At L1-2, there is mild ligamentum flavum hypertrophy and facet hypertrophy with no significant spinal canal stenosis or neural foramen narrowing. At L2-3 there mild ligamentum flavum and facet hypertrophy without significant spinal canal stenosis or neuroforaminal narrowing. At L3-4, there is mild disc bulge and disc desiccation with annular fissuring, as well as mild ligamentum flavum and facet hypertrophy with minimal effacement of the ventral thecal sac and mild bilateral neuroforaminal narrowing. At L4-5, there is a disc bulge and disc desiccation with mild loss of disc height, ligamentum flavum hypertrophy, and facet hypertrophy, resulting in mild spinal canal stenosis as well as moderate to severe bilateral neural foramen narrowing. At L5-S1, there is a disc bulge, moderate facet and ligamentum flavum hypertrophy, resulting in mild spinal canal stenosis, as well as minimal to mild right and mild left neural foramen stenosis. The paravertebral soft tissues are unremarkable.

Output: 1. Multilevel degenerative spondylosis most prominent at L4-5, with mild central canal stenosis and moderate to severe bilateral neural foramen narrowing at this level.2. Bilateral pars interarticularis defects at L4, which are more conspicuous on the prior radiographs.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: Reason: assess infarct size History: Patient s/p mechanical thrombectomy on 2/22/2016 There is restricted diffusion in the left MCA territory particularly in the cortex of left frontal and parietal lobes, basal ganglia, and insula. There is surrounding edema and hemorrhage with mass effect on the anterior horn of the left lateral ventricle. There is trace rightward midline shift at the level of the foramen of Monro. There is also focus of restricted diffusion in the left cerebellar hemisphere. There are additional foci of FLAIR hyperintensities in the right cerebellum and left cerebral peduncle without restricted diffusion suggestive of chronic ischemia. There is volume loss involving the left occipital lobe with mild FLAIR hyperintensity suggestive of chronic infarct with ex vacuo dilatation of the occipital horn of the left lateral ventricle. There are suspected acute subarachnoid blood products in the left sylvian fissure as seen on recent CT.Major flow voids are maintained. There is nonspecific opacification of the ethmoid air cells, left maxillary sinus, and bilateral sphenoid sinuses with air-fluid level. Mastoid air cells are clear. Imaged orbits are intact.

Output: 1.There is restricted diffusion consistent with acute infarct predominantly in the left MCA territory as described above. There is hemorrhagic transformation involving the left basal ganglia component of the infarct with surrounding edema and mass effect on the lateral ventricle with trace midline shift.2.There is tiny left cerebellar acute infarction.3.Suspected subarachnoid blood products in the left sylvian fissure which were also seen on recent CT.4.Chronic left occipital infarct.


Instruction: Generate impression based on medical findings.

Input: Pain. Question of rotator cuff pathology. ROTATOR CUFF: There is partial thickness bursal surface tearing of the posterior fibers of the supraspinatus tendon. No full-thickness tear is identified. There is no atrophy of the supraspinatus muscle. The infraspinatus, teres minor, and subscapularis muscles/tendons are intact.SUPRASPINATUS OUTLET: There is a small amount of fluid within the subacromial/subdeltoid bursa. The acromioclavicular joint appears normal.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. The articular cartilage is preserved. There is no joint effusion.The labrum appears grossly intact.BICEPS TENDON: The biceps tendon is intact. ADDITIONAL

Output: Partial thickness tear of the supraspinatus tendon.


Instruction: Generate impression based on medical findings.

Input: 56 years Male (DOB:2/7/1960)Reason: stroke versus right parietal mass History: left hand numbnessPROVIDER/ATTENDING NAME: KOUROSH J REZANIA KOUROSH J REZANIA There are patchy T2 and FLAIR hyperintense lesions present in the parietal subcortical white matter involving the right parietal subcortical white matter more than the left. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There is no associated contrast enhancement with these lesions.There is a subgaleal focus of soft tissue thickening present adjacent to the parietal bones bilaterally along the midline measuring approximately 23 x 10 mm axial dimensions. It is associated with susceptibility effect on the susceptibility weighted imaging.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate minor mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Periventricular and subcortical white matter lesions of a mild to moderate degree are nonspecific. Most likely these are vascular related. 2.There is no evidence for acute ischemic cerebral infarction.3.Findings are suspicious for hematoma along the subgaleal scalp tissues at the level of the parietal bones at the midline.


Instruction: Generate impression based on medical findings.

Input: 61 year old female with a family history of breast cancer in her mother at age 49 and maternal aunt at age 75. History of benign right breast biopsy. There is scattered fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.Stable non-enhancing benign masses are again seen in the lower aspect of both breasts.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on medical findings.

Input: Reason: syrinx spine, yearly follow up History: yearly follow up. Untethered 2/2009. There are again extensive multi-level segmentation anomalies involving virtually the entire spine and rotatory scoliosis with thoracic curve to the left. There is a stable low-lying conus, which is again at the L3 vertebral level. No prone imaging was performed. There is a persistent syrinx most conspicuous in the lower thoracic cord, which measures 6 x 8 mm in greatest axial dimensions. There is also a stable thickened filum measuring up to 3 x 4 mm along the distal thecal sac, although discontinuous, consistent with prior untethering surgery.There is no significant spinal canal stenosis. Marrow signal is unremarkable. Sagittal alignment is unremarkable.

Output: 1. Stable syrinx most prominent in the lower thoracic cord.2. Low-lying conus medullaris remains at L3 level. Prone imaging not available. 3. Extensive multi-level segmentation anomalies and scoliosis.


Instruction: Generate impression based on medical findings.

Input: Neoplasm related pain (acute) (chronic) [G89.3], Reason for Study: ^Reason: metastatic prostate cancer with bone lesions History: metastatic prostate cancer with bone lesions 68 years Male (DOB:6/9/1948)Reason: metastatic prostate cancer with bone lesions History: metastatic prostate cancer with bone lesionsPROVIDER/ATTENDING NAME: MAGDALENA ANITESCU MAGDALENA ANITESCU For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There are multifocal mixed lytic and sclerotic metastatic lesions involving thoracolumbar spine, sacrum as well as bilateral ilium.In particular, there is about 5% compression fracture of L3 vertebral body with the bone marrow edema.In addition, soft tissue extension through the anterior epidural space from T12 vertebral body is also seen which suggest possible tumor extension.The spine alignment is anatomic. The signal of the visualized cord is normal. The conus medullaris terminates at the T12.Degenerative changes are specified by the intervertebral level as follows: T12-L1: Complete replacement of normal fatty marrow of T12 vertebral body indicate metastatic lesion. Anterior epidural space extension of soft tissue lesion from the T12 vertebral body metastasis. The soft tissues about the thecal sac and extends through bilateral neural foramen results minimal to mild neural foraminal stenosis. L1-L2: There is a sclerotic metastatic lesion on the right anterior aspect of the L1 vertebral body, however, other portion of the vertebral bodies are osteophytic lesion. No neuroforaminal narrowing or spinal stenosis. L2-L3: Diffuse metastasis lesion involvement of L2 vertebral body. No neuroforaminal narrowing or spinal stenosis. L3-L4: There is relatively well circumscribed metastatic lesion on the left anterior aspect of L3 vertebral body with a sclerotic margin. Diffuse bulging of disc with bilateral ligamentum flavum thickening results minimal to mild spinal canal stenosis. L4-L5: May new sclerotic metastatic lesion on the left side of vertebral body of L4 with associated osteolytic lesion. Diffuse bulging of disc. No neuroforaminal narrowing or spinal stenosis. L5-S1: Several nodular osteolytic metastatic lesion involving L5 vertebral body as well as left posterior lamina. Diffuse bulging of disc. No neuroforaminal narrowing or spinal stenosis.

Output: 1. Multifocal vertebral body metastatic lesions including thoracic, lumbar and sacral vertebrae, as well as bilateral iliac bones.2. Epidural extension of metastatic lesion is seen at the level of T12 vertebral body.3. Minimal to mild spinal canal stenosis due to degenerative changes of lumbar spine.4. Spinal cord signal intensity is normal.


Instruction: Generate impression based on medical findings.

Input: Right hemiparesis, pseudobulbar palsy. Stroke history, declining mobility, right leg weakness. There is diffuse global parenchymal volume loss supratentorially as well as infratentorially including the brainstem and cerebellum, which is advanced for age. Diffuse thinning of the corpus callosum is also noted, likely related to Wallerian degeneration. Confluent areas as well as scattered of foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic disease. Multiple areas of cavitation are noted in the bilateral basal ganglia and to a lesser degree bilateral frontal corona radiata consistent with lacunar infarcts. Lacunar infarcts are also noted in the pons bilaterally. No restricted diffusion to suggest acute ischemia. Multiple foci of susceptibility are noted within the pons, left posterior frontal periventricular white matter, and at the thalamus midbrain junction compatible with chronic microhemorrhages. No intracranial mass or mass-effect. Major flow-voids are preserved. Sella and orbits are grossly within normal limits. There is moderate mucosal thickening involving the left maxillary sinus and to a lesser degree right maxillary sinus. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. Advanced chronic small vessel ischemic disease with multiple supratentorial and infratentorial lacunar infarcts. Some of these lacunar infarcts demonstrate hemosiderin staining compatible with prior hemorrhage. 2. Advanced supratentorial and infratentorial parenchymal volume loss. 3. No acute infarct or intracranial mass effect.


Instruction: Generate impression based on medical findings.

Input: 28 year-old female with pain and swelling, evaluate for meniscal tear Evaluation is markedly limited due to metallic artifact from hardware within the proximal tibia, despite changes in exam parameters.MENISCI: Evaluation of the medial meniscus is extremely limited with the anterior horn rendered essentially invisible due to metallic susceptibility artifact. The visualized portion of the posterior horn of the medial meniscus appears intact, although the posterior horn near its root is distorted, presumably due to metallic artifact. The visualized portion of the body appears intact given the aforementioned limitations.The lateral meniscus is slightly better visualized than the medial meniscus and appears intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage of the patellofemoral joint appears grossly intact. No fluid filled cartilage defects are visualized, although evaluation of the tibiofemoral cartilage is markedly limited due to metallic artifact.LIGAMENTS: The cruciate ligaments are intact. The lateral collateral ligament is intact. The medial collateral ligament is not fully visualized, but the visualized portions appear intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Limited exam as detailed above due to metallic artifact from hardware within the proximal tibia. Given these limitations, no specific findings are identified to account for the patient's pain.


Instruction: Generate impression based on medical findings.

Input: History of noncontact injury of left ankle TENDONS: The peroneal, extensor, flexor, and Achilles tendon are intact.LIGAMENTS: The medial and lateral ligament complexes are intact.ARTICULAR SURFACES AND BONE: No fractures are identified. There is a small' cylindrical focus of bone marrow signal abnormality within the distal tibia within an additional similar focus of signal abnormality within the posterior calcaneus compatible with osseous defect from prior external fixation device. Small subchondral cysts are present within the posterior aspect of the distal tibia with associated reactive bone marrow edema. There is ossification of the distal tibiofibular syndesmosis which may reflect old injury. There is mild cartilaginous thinning along the posterior aspect of the tibiotalar joint. Visualized cartilage is otherwise grossly intact.ADDITIONAL

Output: 1.Mild-moderate osteoarthritis of the tibiotalar joint.2.Sequela of prior ankle injury as described above.


Instruction: Generate impression based on medical findings.

Input: 16 year old female with syndromic enchondroma. BONE MARROW: There are numerous intermediate T1 and high T2 lesions especially medially along the proximal left femoral neck that appear similar to recent radiographs and increased when compared to prior MRI. One lesion extends from the femoral neck into the head, crossing the physis. Many similar lesions are noted in the femoral diaphysis, where they become confluent and expand the diaphysis and thin the cortical margin of the bone. These lesions also demonstrate a low T2 rim. No fracture line is identified.These lesions demonstrate peripheral and septal enhancement while centrally intermediate T1 signal remains.SOFT TISSUES: There are a few prominent subcentimeter lymph nodes in the left inguinal region. No soft tissue masses. JOINTS: Joint spaces are well-maintained. No joint effusion present.ADDITIONAL

Output: Multiple areas of marrow replacement by a nonaggressive appearing lesions. There is peripheral and septal enhancement with areas of endosteal scalloping. The differentiation between enchondroma and low-grade chondrosarcoma is difficult by imaging. This is favored to represent enchondroma given lack of radiographic changes from 2011.


Instruction: Generate impression based on medical findings.

Input: MRI brain: There are numerous punctate to small supratentorial and infratentorial areas of diffusion restriction with corresponding T2/FLAIR hyperintensity, with most centered in the bilateral cerebellar hemispheres posteriorly where there is effacement of sulci. There are foci of diffusion restriction in the central portion of the superior pons and cerebellar vermis. There are multiple small punctate punctate foci involving the bilateral parahippocampal gyri, left greater than right temporal and occipital lobes, bilateral parietal and frontal lobes. There is also involvement of the bilateral basal ganglia and right thalamus. There are innumerable punctate foci of susceptibility effect in the bilateral frontal, parietal and anterior temporal lobes, splenium of the corpus callosum, most of which do not definitively cross-reference with the areas of acute infarction. These are nonspecific and may represent chronic microhemorrhages.There is diffuse mild volume loss. There is mild periventricular white matter T2 signal abnormality which is nonspecific, likely representing chronic microvascular ischemic change. There is moderate left and trace right maxillary sinus mucosal thickening. There is mild to moderate ethmoid sinus and trace bilateral sphenoid mucosal thickening. There is left greater than right mastoid opacification. There is fluid in the posterior nasal cavity with a nasogastric tube partly imaged. The left V4 vertebral artery segment is diminutive with indistinct flow void.MRA brain: There is mild motion artifact degrading image quality. Within this limitation, the anterior and posterior circulation are intact with the exception of the left V4 vertebral artery segment which shows only minimal flow related enhancement and is much smaller compared to the right.MRA neck: The left subclavian artery origin is not well seen. The remaining great vessel origins are grossly intact. There is no flow related enhancement in the left subclavian artery approximately at the location of the expected left vertebral artery origin. The entire left vertebral artery is not seen except distally intracranially, compatible with occlusion with probable minimal retrograde flow. There is mild focal irregularity without significant stenosis at the origin of the right internal carotid artery suspected, best seen on the 3-D vessel images (series 505 image 13). There is mild asymmetric fullness of the left thyroid lobe with suspected decreased signal possibly representing a nodule (series 501 image 103).

Output: 1.Innumerable punctate to small acute foci of diffusion restriction in the supratentorial and infratentorial brain. Given recent history of cardiac arrest, these most likely represent numerous tiny infarcts which may be secondary cardiac embolic etiologies. Differential diagnosis also includes hypotension and/or hypoxic/anoxic injury, although the pattern seen on the study is atypical for these entities.2.Occlusion of the entire left vertebral artery with minimal retrograde flow intracranially, likely chronic.3.Occlusion of the left subclavian artery at the level of the expected left vertebral artery origin, extending distally, also likely chronic.4.Fullness and asymmetric decreased signal intensity in the left thyroid lobe suspicious for a thyroid nodule. Further dedicated thyroid sonogram can be helpful for further evaluation if clinically indicated.Findings were discussed with Dr. Ali Mansour over the telephone at 2:45 p.m. today by Dr. Uppuluri.


Instruction: Generate impression based on medical findings.

Input: Reason: ascending cholangitis? History: GNR sepsis, fever, tachycardia, pancreatitis ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. 1.2 cm right hepatic T2 hyperintensity corresponds to ill-defined hypodense lesion seen on prior CT (701/27). No new lesion was identified to correspond to left hepatic hypodensity seen previously.Gallbladder is mildly dilated containing sludge. No evidence of cholelithiasis or choledocholithiasis. Common bile duct measures 7 mm, likely within normal limits for ageSPLEEN: No significant abnormality noted.PANCREAS: Dilated main pancreatic duct with diffuse atrophy, suggestive of chronic pancreatitis.. Multiple dilated tubular structures in the pancreatic head are favored to represent dilated side branches.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral T2 hyperintensities, likely cystsRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Concentric bowel wall thickening in the cecum appears grossly similar to the prior CT.BONES, SOFT TISSUES: Diffuse anasarca.OTHER: Moderate ascites.

Output: 1.Exam was terminated due to patient discomfort and postcontrast images were not obtained.2.No evidence of ascending cholangitis.3.Findings of chronic pancreatitis.4.Cirrhotic liver morphology with right hepatic T2 hyperintensity which is nonspecific without intravenous contrast.5.Moderate abdominal ascites.6.Diffuse circumferential cecal wall thickening is nonspecific but appears similar to the prior exam, possibly a portal colopathy or nonspecific colitis.


Instruction: Generate impression based on medical findings.

Input: 3-year-old female in status epilepticus 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: Normal brain CT.


Instruction: Generate impression based on medical findings.

Input: Male 63 years old Reason: staging exam History: prostate cancer PELVIS:PROSTATE:Prostate Size: 3.2 x 5.4 x 4.1 cmPeripheral Zone: Dominant focus of signal abnormality within the prostate gland posteromedially at the left base. This measures approximately 1.3 x 0.8 cm (series 901, image 20). This abuts the prostatic capsule. Additional smaller subcentimeter foci identified throughout the gland. For example in the right base posteriorly measuring 0.9 x 0.7 cm (series 804, image 324) and within the left mid gland and left apex. Central Gland: Enlarged and heterogeneous.Seminal Vesicles: No significant abnormality.Extracapsular Extension: The above described lesion in the left base abuts the prostatic capsule. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.1.3-cm dominant focus of signal abnormality within the left prostate gland at the base which abuts the capsule with additional subcentimeter foci as detailed above. These are suspicious for foci of prostatic adenocarcinoma. No evidence of seminal vesicle invasion or lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: Negative MRI of the brain including gadolinium enhancement. Specifically, there are no MRI evident stigmata of neurofibromatosis.


Instruction: Generate impression based on medical findings.

Input: 55-year-old male with history of cirrhosis and elevated bilirubin. Evaluate for obstruction. ABDOMEN: Lack of contrast enhancement, dielectric artifact, and suboptimal MRCP images limits evaluation.LIVER, BILIARY TRACT: Cirrhotic liver morphology with evidence of an umbilical vein. Incompletely evaluated left hepatic lobe subcentimeter T2 hyperintense focus.Within the aforementioned limitations, no evidence of intra or extrahepatic biliary ductal dilatation. The bladder wall is thickened, most likely secondary to the ascites. Cholelithiasis.SPLEEN: Splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right T2 hyperintense renal focus, measuring up to 2 cm; findings most compatible with a cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Large volume ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Lack of contrast enhancement, dielectric artifact, and suboptimal MRCP images limits evaluation. Within this limitation, no evidence of biliary ductal dilatation. 2.Cirrhosis with large volume ascites. Draining ascites prior to MRI imaging decreases chance of dielectric artifact.


Instruction: Generate impression based on medical findings.

Input: 53 year old male patient with detectable PSA after prostatectomy in 2015. PELVIS:PROSTATE: The patient is status post prostatectomy without evidence of residual tissue. Foci of low T2 signal within the inferior prostatectomy bed likely reflect susceptibility artifact/sequela of surgery.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: There is asymmetric enhancement about the tendinous insertion of the left gluteus medius tendon on the left greater trochanter. OTHER: No significant abnormality noted.

Output: 1.Status post prostatectomy without evidence of residual tissue or lymphadenopathy.2.Enhancement about the left gluteus medius tendon insertion is compatible with tendinopathy and can be further evaluated with dedicated MR imaging if clinically warranted.


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old, with MRSA endocarditis and continued positive blood cultures despite appropriate therapy. Evaluate for epidural abscess. Cervical:Alignment is anatomic. Vertebral body height and morphology are within normal limits. No evidence of marrow replacement, edema or pathologic enhancement is seen. The visualized spinal cord shows normal signal intensity and morphology. No epidural abnormalities are suspected. The intervertebral discs are preserved with no significant spinal canal or foraminal stenosis seen.Thoracic:Alignment is anatomic. Vertebral body height and morphology are within normal limits. Degenerative fatty endplate signal change is seen anteriorly from the T8 level to the T12 level. At T11, there is also small focus of enhancement at the anterior superior endplate but no osseous destruction and no involvement of the intervertebral disc. A clustering of mildly prominent retrocrural lymph nodes is seen adjacent to T11. The visualized spinal cord demonstrates normal signal intensity and morphology. No epidural abnormalities are seen. Intervertebral discs are preserved with no spinal canal or foraminal stenosis. Small bilateral pleural effusions and scattered airspace opacities are noted in the lungs.Lumbar:Alignment is anatomic. Vertebral body height and morphology are within normal limits. Fatty endplate signal change is seen along the inferior endplate of L1 and minimally along the superior endplate of L3. No pathologic marrow enhancement is observed. The distal spinal cord, conus and nerve roots of the cauda equina are within normal limits. No epidural abnormalities are suspected. The intervertebral discs are preserved with no evidence of spinal canal or foraminal stenosis.

Output: 1.No evidence of an epidural abscess is seen.2.No definite findings of discitis osteomyelitis are noted.3.Fatty endplate signal alteration is demonstrated at multiple levels in the lower thoracic and upper lumbar spine. Such findings are likely chronic and degenerative in nature.4.Only one small focus of abnormal marrow enhancement is seen along the anterior superior endplate of T11. In the context of chronic endplate degenerative signal at multiple additional levels, this finding is favored to represent a more inflammatory phase of the degeneration. Adjacent slightly prominent lymph nodes are, however, seen. If clinical concern for spine infection persists, a follow-up examination can be considered in one to two weeks.


Instruction: Generate impression based on medical findings.

Input: History of renal cancer. Evaluate for metastatic disease. ABDOMEN:LIVER, BILIARY TRACT: Normal hepatic morphology and size without a focal suspicious lesion. Stable punctate benign hepatic cysts. Cholelithiasis within a normally distended gallbladder. No biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Mild fatty atrophy without a focal lesion.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post right nephrectomy. No evidence of tumor recurrence in the nephrectomy bed. No local regional lymphadenopathy. The right adrenal gland is unremarkable.Postsurgical changes from a left partial nephrectomy of the lateral interpolar region. No evidence of recurrence in the surgical bed. Stable small left renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted. Susceptibility artifact from lymph node dissection in the retroperitoneum.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diverticulosis without diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Postsurgical changes from right nephrectomy and partial left nephrectomy without evidence of recurrent or metastatic disease.


Instruction: Generate impression based on medical findings.

Input: 15-year-old male status post blunt head trauma with loss of consciousness. Evaluate for intracranial hemorrhage. Preseptal and periorbital soft tissue swelling on the left. Minimal fat stranding of the retro-orbital fat on the left appear stable. If further evaluation is clinically warranted, an MRI is suggested. The globe appears normal in morphology and density in the anterior and posterior chambers. Extraocular muscles appear intact. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.There is soft tissue swelling overlying the left orbit. There is minimal opacification of bilateral maxillary sinuses. The calvaria and skull base are radiographically normal. The remaining visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Preseptal and periorbital soft tissue edema on the left with minimal fat stranding a left retro-orbital fat unchanged from prior exam. If further evaluation is clinically warranted, an MRI may be obtained.


Instruction: Generate impression based on medical findings.

Input: Clinical question: History of lung cancer, evaluate for metastases, compared to prior. Signs and symptoms: None. Pre- and post enhanced brain MRI:No diffusion-weighted abnormalities.Post enhanced images are degraded due to artifact which precludes precise assessment for detection of very small lesions. Within this limitation however there is no convincing evidence of any residual parenchymal or leptomeningeal enhancement to suggest metastatic disease. This is an improvement compared to prior study.Patchy foci of FLAIR hyperintensity in the periventricular and subcortical white matter of cerebral hemispheres remain grossly similar to prior exam and suggestive of chronic small vessel ischemic strokes as well as overlapping postradiation changes. Mildly dilated supratentorial ventricular system with maintained midline remain similar to prior exams.No detectable abnormal enhancement of calvarium.Unremarkable images through the orbits including axial fat sat post enhanced series.All paranasal sinuses demonstrate normal pneumatization signal patterns.

Output: 1.No detectable residual metastatic disease. Note however should be made that post enhanced images are degraded due to artifacts which preclude detection of tiny metastatic lesions.2.Periventricular and subcortical FLAIR hyperintensity grossly similar to prior exam and likely representing a combination of chronic small vessel ischemic strokes and post treatment/radiation changes.3.Unremarkable calvarium, paranasal sinuses and orbits.


Instruction: Generate impression based on medical findings.

Input: 45-year-old female with history of liver mass. LIVER: Echogenic hepatic parenchyma. The liver measures 20.2 cm in craniocaudal length. Portal vein with normal direction and flow measuring 29.8 cm/s.Stable echogenic lesion in the posterior right hepatic lobe measuring 3.4 x 3.1 x 2.1 cm (prior 3.3 x 2 x 2.6 cm). This region correlates with the previously described segment 6 lesion with MRI characteristics suggestive of a hepatic adenoma.BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation. No gallstones or gallbladder wall thickening.PANCREAS: Unremarkable appearance of the visualized pancreas parenchyma. Incomplete visualization of the pancreatic body and tail due to overlying bowel gas.SPLEEN: The spleen measures 10.3 cm in length. Normal echogenicity.RIGHT KIDNEY: The right kidney measures 13 cm in length. No hydronephrosis. Normal echogenicity of the renal parenchyma. OTHER: The left kidney measures 13 cm in length. No hydronephrosis. Normal echogenicity of the renal parenchyma.

Output: Stable echogenic lesion of the posterior right hepatic lobe. On the 2/17/2016 MRI abdomen exam, this lesion demonstrated MRI characteristics compatible with a hepatic adenoma.


Instruction: Generate impression based on medical findings.

Input: Left knee pain MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There are multiple foci partial and full-thickness cartilage degeneration scattered throughout all 3 compartments with degenerative subchondral signal abnormality within the medial facet of the femoral trochlea. The bone marrow signal is otherwise normal.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. No evidence of meniscal tear.2. Tricompartmental cartilage defects with probable loose body as described above.3. Faint edema of the popliteus muscle which may reflect a mild strain.


Instruction: Generate impression based on medical findings.

Input: This exam is degraded by motion artifact.There are postoperative findings related to prior left pterional craniotomy. The left sphenoid wing post treatment changes are not well assessed on this exam. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are no areas of abnormal parenchymal signal. There is an unchanged left cerebellar developmental venous anomaly. There is otherwise 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 midline structures and craniocervical junction are within normal limits.

Output: 1.No evidence of intracranial metastases. 2.The left sphenoid wing post treatment changes are not well assessed on this exam but appear grossly unchanged.


Instruction: Generate impression based on medical findings.

Input: Reason: rule out rotator cuff pathology History: pain and weakness with forward flexion and abduction ROTATOR CUFF: There is intermediate signal intensity within the supraspinatus indicating mild tendinosis and perhaps minimal superficial fraying at its insertion on the greater tuberosity. There is cyst formation within the underlying greater tuberosity. The supraspinatus muscle appears intact. The infraspinatus muscle and tendon appear intact. There is focal intermediate signal intensity within the distal fibers of the subscapularis likely representing mild insertional tendinosis, but we see no fluid-filled tear. The subscapularis muscle appears intact. The teres minor muscle and tendon appear intact.SUPRASPINATUS OUTLET: Small amount of fluid within subacromial subdeltoid bursa of questionable significance. There is minimal, if any, osteoarthritis affecting the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. Linear signal abnormality traverses the anterior superior labrum from the 2 to 3 o'clock position. While we cannot entirely exclude the possibility of a labral tear, this may represent a normal variant sublabral foramen. The remainder of the labrum appears normal given the limitations of a non arthrogram study.BICEPS TENDON: The tendon to long head of the biceps appears intact ADDITIONAL

Output: Mild rotator cuff tendinosis and other findings as described above.


Instruction: Generate impression based on medical findings.

Input: 53yo F w/ complicated rheum history, CKD, recurrent UTI and multiple hospitalizations with several months of AMS. Septic despite broad spectrum antibiotics. ?Tumor, autoimmune.Signs and Symptoms: AMS: confusion, word recall, weakness, emotional labilityComments: No contrast for this patient. | The CSF spaces are appropriate for the patient's stated age with no midline shift. There is relatively low signal present within the visualized marrow elements of the cervical spine and calvarium and skull base.Exam is degraded due to motion artifact.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 a minor opacity in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Examination is somewhat compromised due to patient motion. This may obscure subtle abnormalities.2.There is no evidence for acute ischemic cerebral infarction.3.The marrow signal is diffusely low. There is a nonspecific finding. This can be explained on the basis of anemia, lymphoproliferative disorder, chronic disease or renal osteodystrophy.


Instruction: Generate impression based on medical findings.

Input: Metastatic breast cancer. There is a heterogeneously enhancing, low T1 and T2 signal intensity left temporal region calvarium lesion that measures up to 5 cm in length with epidural extension that measures up to 7 mm in thickness. There is mild mass effect upon the underlying brain parenchyma. There also appears to be mild subgaleal extension of tumor. There is no evidence of intracranial hemorrhage or acute infarct. There is mild nonspecific periventricular cerebral white matter T2 hyperintensity, but no evidence of intraparenchymal enhancing lesions. 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 are grossly unremarkable.

Output: Left temporal calvarium region metastasis with epidural extension measuring up to 7 mm in width.


Instruction: Generate impression based on medical findings.

Input: Clinical question: hx transphenoidal. f/u 3 months post op eval for change. Signs and Symptoms: surveillance imaging. Pre and post enhanced pituitary MRI:Examination demonstrate stable post operative changes of pituitary without change or residual or recurrence of tumor.Mild thickening of the pituitary stalk with normal pattern of enhancement similar to prior study.Stable residual atrophic pituitary or post operative scar on the left which the pituitary stock terminates into and similar to prior exam.Unremarkable bilateral cavernous sinuses. Basal cistern is unremarkable.Orbits, visualized paranasal sinus and mastoid air cells are unremarkable.

Output: Stable post operative changes of transphenoidal pituitary hypophysectomy without residual or recurrence of tumor.


Instruction: Generate impression based on medical findings.

Input: Female 47 years old Reason: 47F h/o fascioscapulohumerol dystrophy p/w numbness/tingling/weakness of right thumb, forefinger. Pain originates at shoulder and goes doesn through forearm. Eval for plexopathy/nerve impingement at level of shoulder. Some sequences are degraded by motion.ROTATOR CUFF: Mild supraspinatus tendinopathy is present. No tear or retraction of the supraspinatus tendon. Remainder of the rotator cuff is intact.SUPRASPINATUS OUTLET: There is a type I acromion. Mild osteoarthritis at the AC joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: Small subchondral cysts are present in the humeral head indicating osteoarthritis. The glenoid labrum is intact. Irregularity in the anterior superior labrum is likely normal variant.BICEPS TENDON: Biceps tendon is intact and situated in the bicipital groove. ADDITIONAL

Output: 1.No evidence of nerve impingement as clinically questioned.2.Mild supraspinatus tendinopathy without rotator cuff tear or retraction. Mild osteoarthritis of the acromioclavicular and glenohumeral joints.


Instruction: Generate impression based on medical findings.

Input: Axial T2 precontrast and axial T1 postcontrast images were acquired for treatment planning purposes. Multiple fiducial markers are in place. Multiple abnormal brain lesions are identified. There is a round enhancing lesion within the right posterior frontal lobe involving the hand motor area of the precentral gyrus extending anteriorly abutting the junction with the right superior frontal gyrus measuring 16 x 17 mm in the axial plane with surrounding vasogenic edema. There is an additional enhancing lesion within the posterior right temporal lobe which measures 9 x 10 mm in the axial plane which lacks significant surrounding edema. There are additional subcentimeter foci of punctate enhancement within the left superior frontal gyrus, right putamen, and left insula. There are several punctate foci of susceptibility artifact within the right posterior temporal lobe. There are multiple foci of abnormal enhancement within the bilateral cerebellar hemispheres with associated susceptibility artifact suggesting associated microhemorrhage. Fluid is present within the right greater than left mastoid air cells. Mild mucosal thickening is present within the paranasal sinuses.The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are grossly intact.

Output: 1.Multiple supratentorial and infratentorial brain metastases with the largest in the right posterior frontal lobe.2.Paranasal sinus mucosal thickening and fluid within the right greater than left mastoid air cells.


Instruction: Generate impression based on medical findings.

Input: Neck pain, tingling, pain upper extremities Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is mild grade 1 retrolisthesis of C3 on C4 and minimally of C5 on C6; alignment is otherwise maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Disc osteophyte complex and ligamentum flavum thickening result in mild to moderate spinal canal stenosis. There is mild narrowing of the bilateral neural foramina, right relatively worse than left.C4-5: Small disc osteophyte complex and ligamentum flavum thickening result in mild spinal canal stenosis. There is mild bilateral neural foraminal stenosis related to uncovertebral hypertrophy, left relatively worse than right.C5-6: Small disc osteophyte complex with mild spinal canal stenosis. There is mild to moderate left neural foraminal stenosis. Minimal right neural foraminal narrowing.C6-7: Small disc osteophyte complex including a central disc extrusion. Dorsal thecal sac is patent with at most mild spinal canal stenosis at this level. Neural foramina are patent.C7-T1: No significant compromise to the spinal canal or neural foramina.There is also mild generalized facet arthropathy. There is opacification of the right mastoid air cells, which are partially imaged. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Multilevel degenerative changes in the cervical spine. There is mild to moderate spinal canal stenosis at the C3-C4 level without cord signal abnormality. Mild spinal canal stenosis is present at additional levels as described above.2. Multilevel neural foraminal narrowing is relatively worst at the left C5-C6 level. Please see additional details above.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Evaluate spinal anatomy for possible fusion. Signs and symptoms: Pain and weakness. Non-enhanced CT of lumbar spine:Examination redemonstrates destructive changes of the L1 vertebral body with collapse of more than 50% of one. There is fragmentation of the body of L1 vertebrae with expansion into the spinal canal posteriorly. These findings are similar to what was noted on prior MRI of lumbar spine. There is compromise of the AP diameter of thecal sac secondary to retropulsion of fragments into the canal. There is widening of the articulating facets space between T12 -- L1 and L1 -- L2 levels.There is evidence of minimal lytic changes of the inferior endplate of T12 vertebrae as well. This is result of patient's known diskitis/osteomyelitis. The T12 vertebral body and its pedicles are otherwise unremarkable.Very advanced degenerative disk disease throughout the rest of the lumbar spine with significant loss of disk height and sclerotic changes of the adjacent endplates as well as vacuum phenomenon. The alignment of vertebral column is otherwise unremarkable. There is no evidence of any abnormality of the pedicles of the lumbar spine except for partial involvement of pedicles of L1 with technique changes. Very extensive hypertrophic changes of articulating facets bilaterally are noted throughout the lumbar spine. Multilevel mild neural foramina compromise secondary to degenerative changes are suspected.Nonenhanced CT of thoracic spine:A small leak change along the inferior endplate of T12 is consistent with patient's known osteomyelitis/diskitis noted on multiple prior MRI exams. The density of vertebral column in the thoracic spine is otherwise unremarkable. There is no evidence of sclerotic or lytic changes of the rest of thoracic spine. Could the exception of hypertrophic changes no additional abnormality of the facets or the pedicles are detected.The alignment the vertebral column is within normal limits.Mild-to-moderate degenerative disk disease and hypertrophic changes of posterior elements throughout the thoracic spine is noted.

Output: 1.Lytic/destructive changes of L1 vertebrae with retropulsion of fracture body of L1 into the spinal canal and resultant central spinal stenosis. There is also lytic changes involving the anterior aspect of L1 pedicles bilaterally which is also result the patient's osteomyelitis.2.Extensive degenerative changes of lumbar spine of both disks and posterior elements and with multilevel neural frontal compromise as detailed. There is no evidence of any bony defect in the rest of lumber spine other than L1 level.3.Degenerative changes of disk and posterior elements in thoracic spine. Minimal lytic changes of the inferior endplate of T12 related to patient's known osteomyelitis. Unremarkable CT of thoracic spine otherwise.


Instruction: Generate impression based on medical findings.

Input: 18-year-old female with hip pain sports for a year, evaluate for labral tear.. ACETABULAR LABRUM: Curvilinear intermediate signal intensity is present between the anterosuperior acetabular labrum and adjacent cartilage compatible with an anterosuperior labral tear. Otherwise the remaining acetabular labrum appears normal.ARTICULAR CARTILAGE AND BONE: The articular cartilage appears normal. Bone marrow signal is normal.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Findings compatible with an anterosuperior acetabular labral tear.


Instruction: Generate impression based on medical findings.

Input: Male, 36 years old, with history of GBM, off all therapy now, follow-up exam. Redemonstrated is evidence of right-sided craniotomy and resection of a tumor from the right frontal lobe. The resection cavity is stable in size and morphology. Minimal T2 hyperintensity surrounding cavity is unchanged. Minimal extra-axial thickening and enhancement along the posterior lateral craniotomy margin is unchanged and likely postoperative in nature. No new or masslike areas of enhancement are seen. Elsewhere, the cerebral parenchyma demonstrates normal signal characteristics. The ventricular system is stable in size and morphology.

Output: Stable postoperative findings with no evidence of tumor recurrence.


Instruction: Generate impression based on medical findings.

Input: Mass in forearm Note that a marker was placed along the volar aspect of the midforearm in the region of the patient's mass. There is an irregularly-marginated mass within the underlying subcutaneous fat of the volar forearm that contacts the underlying deep peripheral fascia of the anterior compartment musculature. This mass extends to the skin with the overlying skin appearing thickened. It measures approximately 3 x 1 cm in the transverse dimensions and just over 5 cm in the longitudinal dimension. The mass demonstrates irregular and spiculated margins and is slightly hyperintense to muscle on T1, hyperintense to muscle on T2, and shows diffuse enhancement following gadolinium administration. There is subcutaneous edema extending along the fascia both proximal and distal from the mass over the majority of the length of the forearm. The mass does not infiltrate the underlying musculature. The muscles of the forearm are normal in caliber and signal and the marrow signal of the radius and ulna is also normal. There is mild edema and enhancement of the subcutaneous fat posterior to the olecranon which may reflect mild inflammation.

Output: Irregularly-marginated mass within the volar subcutaneous fat of the forearm. While a specific histologic diagnosis cannot be ascertained, the location and characteristics are suggestive of nodular fasciitis. Referral to orthopedic oncology is recommended.


Instruction: Generate impression based on medical findings.

Input: Obstructive jaundice, evaluate bile duct obstruction ABDOMEN: LIVER, BILIARY TRACT: T2 hyperintense hepatic lesions consistent with metastases increasing in size and number. Dominant hilar mass measures 5.6 x 3.2 cm (series 701, image 21), previously 4.2 x 3.5 cm. Increasing and now severe bilobar intrahepatic biliary ductal dilation.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.

Output: 1.Dominant obstructive hilar mass with increasing and now severe bilobar intrahepatic biliary ductal dilation.2.Hepatic metastases increasing in size and number.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old, with multiple myeloma of the CNS. On limited visualization of the brain, a right frontal approach ventricular catheter is in place with its tip in the right frontal horn. There appears to be a small amount of enhancement along the catheter tract. Patchy enhancement is also seen along the left superior frontal sulcus which is difficult to compare to the immediate prior noncontrast examination. However, there was similar patchy enhancement in this area on the older study from 4/16. The previously demonstrated large nodule of enhancement seen in the posterior left frontal lobe does not appear to be present on the current study. Ventricular size remains within normal limits. Susceptibility effect and minimal enhancement in the pineal region may reflect treatment effect from the prior lesion in that location. The globes, optic nerves and extraocular muscles are within normal limits. No intraorbital masses are seen. No pathologic orbital enhancement is detected. Note is made of generalized paranasal sinus mucosal inflammation with fluid levels in the maxillary sinuses.

Output: 1.Please note that this examination only partially assesses the brain as it was ordered and protocoled as an MRI of the orbits.2.Mild enhancement along the right frontal catheter tract, and patchy enhancement along the left superior frontal sulcus, are nonspecific findings which could represent mild residual disease or treated disease.3.The previously seen large lesions in the left posterior frontal lobe and in the pineal region are not appreciated on this examination.


Instruction: Generate impression based on medical findings.

Input: 30 years Female (DOB:11/22/1985)Reason: headache History: migraine headachePROVIDER/ATTENDING NAME: ADIL JAVED ADIL JAVED 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 are clear. 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 to the extent of the exam. Please note that this is a limited exam relative to the typical University of Chicago protocol. No susceptibility weighted imaging was acquired, no axial T1 imaging was acquired and no coronal T2 imaging was acquired.


Instruction: Generate impression based on medical findings.

Input: Benign neoplasm of meninges, unspecified [D32.9], Reason for Study: ^Reason: Eval for growth of meningioma. Please compare back to oldest MRI as well. History: meningioma. Redemonstration of left anterior temporal extra-axial mass (most likely meningioma), unchanged in terms of size, configuration and MR signal characteristics since prior scan.There is no other abnormal enhancement.There is no evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Fluid levels are seen within the left sphenoid sinus and a small right maxillary sinus retention cyst, unchanged since prior scan.

Output: Unchanged left anterior temporal meningioma in terms of size, configuration and MR characteristics since prior scan.


Instruction: Generate impression based on medical findings.

Input: Please note, the postcontrast 3-D T1 images were inadvertently not acquired. There is unchanged extra-axial dural based mass along the greater right sphenoid wing with enhancement measuring 44 ML x 36 CC x 42 AP mm on series 1201 image 14 and series 1101 image 12. There is central heterogeneity. The predominant portion of the mass is centered along the skull base of the right middle cranial fossa, although some portion extends along the anterior clinoid process into the right anterior cranial fossa. The mass intimately abuts the right cavernous sinus and the right supraclinoid internal carotid artery, as well as the right M1 segment causing superior deviation of the right M1 segment which appears to be draping over the mass, as noted on the prior exams. There are also unchanged serpiginous linear flow voids posteriorly along the border of the mass best seen on axial T2 images, which probably represent displaced vascular structures which are outlined due to presence of edema.The mass shows T1 isointense and mild T1 hyperintense signal relative to white matter with mild increased DWI signal. As noted on the prior exam, there may be mild thickening of the right anterior clinoid process and greater sphenoid wing suggesting hyperostosis. There is a thin cleft of CSF signal separating this lesion from the adjacent temporal lobe which is again compressed with persistent leftward uncal herniation causing compression and leftward deviation of the mid brain, unchanged. There is vasogenic edema within the right temporal lobe tracking superiorly into the right parietal lobe and basal ganglia. There is persistent mass effect with near effacement of the right lateral ventricle, and midline shift to the left of 9 mm without change. There is an enlarged left lateral ventricle again seen with a prominent left occipital horn, suggesting entrapment. The third and fourth ventricles are unchanged in caliber and not dilated. There is no acute infarct.

Output: 1. Stable enhancing extra-axial mass centered at the right greater sphenoid wing and right anterior clinoid process causing extensive right temporal lobe vasogenic edema, mass effect with midline shift, right uncal herniation, effacement of the right lateral ventricle, as well as stable dilation of the left lateral ventricle suggesting entrapment. This most likely represents a meningioma.2. Mass abuts the right cavernous sinus, and is in close proximity with the right distal internal carotid artery and M1 segment.


Instruction: Generate impression based on medical findings.

Input: 64-year-old male with confusion on Coumadin found down at bedside with no neurologic findings. There is no evidence of intracranial hemorrhage, mass or edema. Diffuse hypodense region within the subcortical and periventricular white matter consistent with small vessel disease, age indeterminate. Well defined hypodense region within the left MCA territory and left cerebellum consistent with previous strokes. No acute cortical stroke is seen, however, if there is clinical concern for acute ischemia, an MRI may be considered. Dense atherosclerotic calcifications noted throughout the large vessels.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 ischemic disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.


Instruction: Generate impression based on medical findings.

Input: Acute on chronic back pain x3 weeks after "snap" in lower back, bilateral, w/ bilateral sciatica. There is mild disc bulging at L5-S1, but no significant spinal canal or neural foramen stenosis. 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: Mild disc bulging at L5-S1, but no significant spinal canal or neural foramen stenosis.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Evaluate for spinal stenosis, history of T12 compression fracture signs and symptoms: Neurogenic claudication Nonenhanced lumbar MRI:T10-T11 is unremarkable.T11-T12 demonstrate mild compression deformity of the superior endplate of T12 which is new since prior lumbar MRI exam from 2012. This finding is associated with subtle T2/T2 stir hyperintensity of the adjacent bone marrow suggestive of edema and suggesting of acute process. There is no evidence of expansion of mildly compressed vertebra into the spinal canal. Hypertrophic changes of the ligamentum flavum posteriorly as well as degenerative changes of the disc at this level results in mild central spinal stenosis with significant left and moderate right neural foraminal compromise. There are no axial images acquired through this level and findings are assess based on sagittal images only.T12-L1 demonstrate moderate disc disease and loss of disc height, moderate bilateral ligamentum flavum hypertrophy and mild facet disease. There is no central spinal stenosis however moderate left and mild right neural foraminal compromise is detected.L1-L2 demonstrate mild disc disease and loss of disc height, moderate bilateral ligamentum flavum hypertrophy and mild facet disease without central spinal stenosis. There is no significant neural foraminal compromise. Degenerative changes at this level demonstrate interval progression since prior exam.L2-L3 demonstrate mild disc disease and loss of disc height, moderate to significant bilateral ligamentum flavum hypertrophy and mild bilateral facet disease without significant hypertrophic changes. Constellation of findings results in moderate central spinal stenosis, moderate left and mild right neural foraminal compromise. Degenerative changes at this level and including central spinal stenosis demonstrate mild interval progression.L3-L4 demonstrate mild disc desiccation, severe bilateral ligamentum flavum hypertrophy and mild (L>R) facet degenerative disease without significant hypertrophy. Constellation of findings results in moderate central spinal stenosis, moderate to severe right and mild to moderate left neural foraminal compromise. Degenerative changes at this level demonstrate subtle interval progression.L4-L5 demonstrate mild disc disease without significant loss of disc height, significant bilateral ligamentum flavum hypertrophy and mild left and moderate right facet degenerative changes and hypertrophy. Constellation of changes results in significant central spinal stenosis with interval progression since prior exam from 2012. Mild to moderate bilateral neural foraminal compromise demonstrate no significant change.L5-S1 demonstrates moderate disc disease, loss of disc height, significant bilateral ligamentum flavum and facet hypertrophic changes and evidence of mild grade 1 anterolisthesis. There is interval progression of degenerative changes at this level however without convincing evidence of central spinal stenosis. Moderate bilateral foraminal compromise with mild interval progression.

Output: 1.New since prior lumbar MRI there is mild compression deformity of superior endplate of T12 without retropulsion into the spinal canal. Degenerative changes at T11-T12 however results in mild central spinal stenosis as detailed above.2.Interval mild progression of degenerative changes of lumbar spine and including multilevel central spinal stenosis at L2-L3, L3-L4 and more significantly at the L4-L5 levels as detailed.3.Multilevel neural foraminal compromise as detailed per level above.


Instruction: Generate impression based on medical findings.

Input: 76 year-old female history of pelvic carcinomatosis. PELVIS:UTERUS, ADNEXA: Heterogeneous and thickened endometrial cavity measuring up to 14mm. Multiple small intramural uterine fibroids.10 mm calcified right ovarian lesion. The right ovary is slightly abnormal appearing measuring 2.8 x 1.4 cm and corresponds to an area of increased FDG uptake on recent PET CT. The left ovary measures 1.7 x 1.5 cm and appears unremarkable..BLADDER: The bladder is collapsed.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is mild thickening of the visualized bowel, likely related to ascites.BONES, SOFT TISSUES: Diffuse sclerotic osseous metastases.OTHER: Moderate volume ascites.

Output: 1. Thickened and heterogeneous endometrial canal measuring up to 14 mm concerning for endometrial neoplasm.2. Slightly abnormal-appearing left ovary with internal calcified cystic lesion which corresponds to an area of increased FDG uptake on recent PET. This is nonspecific and should be evaluated with dedicated ultrasound.3. Moderate volume ascites.


Instruction: Generate impression based on medical findings.

Input: 41-year-old male with right shoulder pain and weakness with a history of fall. Evaluate for cuff tear. ROTATOR CUFF: There is a full thickness tear of the supraspinatus tendon at the level of its insertion on the greater tuberosity, measuring approximately 17 mm in the AP dimension, which extends proximally along it's undersurface fibers resulting in delamination and mild retraction of the undersurface fibers to the level of the humeral head. The supraspinatus muscle appears intact. There is partial thickness tearing of the undersurface fibers of the anterior infraspinatus tendon at the level of its insertion on the greater tuberosity. The infraspinatus muscle appears intact. The subscapularis tendon and muscle appear intact. The teres minor muscle and tendon appear intact.SUPRASPINATUS OUTLET: There is no fluid within the subacromial subdeltoid bursa. Mild degenerative changes affect the acromioclavicular joint with subchondral cyst formation within the distal clavicle and small inferior osteophyte formation.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. The glenoid labrum appears intact within the limitations of a non arthrogram study.BICEPS TENDON: The tendon of the long head of the biceps appears intact. ADDITIONAL

Output: Full-thickness tearing of the rotator cuff with mild retraction as described above.


Instruction: Generate impression based on medical findings.

Input: Clinical question: CVA. Signs and symptoms: Headaches and hypertension Nonenhanced CT of brain:There is no definitive evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation is within normal. Follow-up with an MRI is recommended if clinical concern for stroke in our system. Non-infused CT can this area also the small strokes.Calvarium is intact. Limited view of paranasal sinuses and mastoid air cells are unremarkable.

Output: No definitive evidence of abnormality. Follow-up with an MRI is recommended if clinical concern for stroke persists.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Cervicalgia Other chronic painClinical question: evaluate for persistent neck pain with scalp, shoulder radiculopathySigns and Symptoms: neck pain, radiculopathy The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is a 7 mm well-circumscribed lesion within the odontoid at its junction with the C2 vertebral body which is bright on T2 and low signal on T1. It is adjacent to the C2 fusion plate. It is associated with marrow replacement within the right aspect of the C2 vertebral bodyAt C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is loss of disc space height at this level as well as small endplate osteophytes and a minor disc bulge.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There are small uncovertebral osteophytes present at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a diffuse disc bulge present at this level associated with some mild posterior ligamentous hypertrophy. There is effacement of spinal fluid ventral but not posterior to the spinal cord at this level. There are uncovertebral osteophytes present associated with disc material bilaterally which mildly narrow the neural foramina but do not significantly compromise the exiting nerve roots.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.

Output: 1.There are some degenerative changes present in the cervical spine without significant compromise to the cervical spinal canal or exiting nerve roots.2.There is a C2 vertebral body cystic appearing lesion present. If clinically appropriate a CT of the cervical spine may be of benefit to further evaluate this as her is some infiltration of the adjacent bone marrow. It is suspected to be degenerative in nature. Alternatively it could represent a solitary bone cyst.


Instruction: Generate impression based on medical findings.

Input: 48-year-old male with medial ankle pain and pain with bearing weight since crushing injury. Evaluate for posterior tibial tendon rupture/injury. TENDONS: There is a circumferential fluid about the posterior tibialis tendon which is suspicious for tenosynovitis. There is also fluid about the flexor digitorum longus tendon also suggestive of tenosynovitis. The flexor and extensor tendons appear intact. The peroneal tendons appear intact. The Achilles tendon is within normal limits.LIGAMENTS: The lateral collateral ligament complex appears intact. The distal tibiofibular syndesmotic complex appears intact. There is increased signal abnormality and thickening of the deep layer of the deltoid ligament.ARTICULAR SURFACES AND BONE: There is increase signal abnormality in the medial malleolus and medial aspect of the talar dome likely representing reactive osteitis secondary to the aforementioned tenosynovitis. There is mild narrowing of the medial aspect of the tibiotalar joint with associated subchondral cyst formation in the medial malleolus suggestive of degenerative changes. There is a benign appearing focal lesion in the posterior aspect of the distal tibial metadiaphysis, incompletely imaged, most consistent with a healing nonossifying fibroma.ADDITIONAL

Output: 1. Findings suggestive of posterior tibialis tendon tenosynovitis and associated reactive osteitis of the underlying bone.2. Chronic appearing changes of the deep layer of the deltoid ligament which may represent prior trauma. Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: 47-year-old female with history of knee pain. MENISCI: There is poorly defined signal abnormality within the body and posterior horn of the medial meniscus which may reflect intrasubstance degeneration, however no discrete tear is appreciated.ARTICULAR CARTILAGE AND BONE: Mild osteoarthritis affects the knee with tiny tricompartmental osteophytes and focal articular cartilage defects centrally and along the medial facet of the femoral trochlea.LIGAMENTS: There is mucoid degeneration of the ACL with small intrasubstance ganglia proximally and intraosseous ganglion within the intercondylar eminence of the tibia.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Mild osteoarthritis of the knee with focal articular cartilage degeneration along the femoral trochlea.2. Mucoid degeneration of the ACL.3. Mild degeneration of the medial meniscus without discrete tear.


Instruction: Generate impression based on medical findings.

Input: The ventricles and sulci are prominent, consistent with mild age-related volume loss, commensurate with age. The basal cisterns remain patent. There is no midline shift or mass effect. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with moderate chronic small vessel ischemic changes. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is mild, right greater than left, opacification of the mastoid air cells.

Output: No evidence of acute infarct. Moderate chronic small vessel ischemic changes.


Instruction: Generate impression based on medical findings.

Input: Patient with stooped posture, memory decline. Concern for normal pressure hydrocephalus. No evidence of hemorrhage, edema, mass effect or midline shift is detected. Cortical sulci and ventricular system are proportionately enlarged and unchanged since prior MRI examination from 2007. Findings although may be at the upper limits of normal for age however they may represent underlying parenchymal volume loss. Calvarium is intact. Mastoid air cells and paranasal sinuses are unremarkable.

Output: No evidence of acute findings. Please see above comments.


Instruction: Generate impression based on medical findings.

Input: 50 year-old female with seizures. There are transtemporal depth electrodes positioned in the various portions of the right temporal lobe region. There is no evidence of any substantial intracranial hemorrhage. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. Cerebellar tonsillar ectopia is again noted.

Output: 1.There are transtemporal depth electrodes positioned in the various portions of the right temporal lobe region. 2.Cerebellar tonsillar ectopia is again noted.


Instruction: Generate impression based on medical findings.

Input: Brain:Asymmetry is noted of the lateral ventricles, right greater than left, which is most likely secondary to anatomic variation.There is a solitary, small, ovoid focus of susceptibility hypointensity within a peripheral posterior right temporal gyrus (series 9, image 46), without other associated signal abnormality.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. The paranasal sinuses and mastoid air cells are clear. There is lack of visualization within the distal left vertebral artery. Correlation with the cervical MRI portion of today's studies demonstrates the left-sided transversarium foramina to be small, consistent with a congenitally hypoplastic left vertebral artery. However, portions of the cervical left vertebral artery fail to demonstrate a flow void. It is uncertain if this is due to past dissection or from non-visualization of the tiny lumen.Cervical spine:There is slight reversal normal upper cervical curvature. There are no fractures or subluxations. The marrow signal is benign. The cervical cord is normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. Other than the aforementioned left vertebral artery findings, the visualized paraspinal contents are unremarkable.C2/3: UnremarkableC3/4: There is a tiny midline disc protrusion, partially effacing the anterior CSF, without associated cord deformation or central stenosis.C4/5: Minimal disc bulge without significant mass effect or stenosis.C5/6: There is a left paracentral disc protrusion which causes anterior left hemicord flattening without intrinsic cord signal abnormality. There is no resulting central stenosis.C6/7: UnremarkableC7/T1: UnremarkableBilateral facet hypertrophy with ligamentum flavum thickening at T2/3 encroachment bilateral neural foramina without significant resulting stenosis.Lumbar spine:Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. The visualized intra-abdominal and paraspinal contents are unremarkable.L1/2: UnremarkableL2/3: UnremarkableL3/4: There is a small left foraminal/lateral disc protrusion which abuts the adjacent L3 nerve roots. There is also mild left facet hypertrophy without resulting foraminal stenosis.L4/5: Mild bilateral facet hypertrophy without resulting foraminal stenosis.L5/S1:Disc desiccation, disc height loss, asymmetric bulge to the right, small superimposed right paracentral disc protrusion, endplate spurring eccentric to the left, and mild bilateral facet hypertrophy. There is abutment of the right S1 nerve root sheath origin without deformation. There is no central stenosis, although there is mild left neural foraminal and minimal right neural foraminal stenosis.

Output: 1.Asymmetry is noted of the lateral ventricles, right greater than left, which is most likely secondary to anatomic variation. Correlation with prior historical studies could help to determine if there has been interval change.2.There is a solitary, small, ovoid focus of susceptibility hypointensity within a peripheral posterior right temporal gyrus without other associated signal abnormality. This most likely represents a small focus of hemosiderin deposition, of uncertain etiology or clinical significance.3.There is lack of visualization within the distal left vertebral artery. Correlation with the cervical MRI portion of today's studies demonstrates the left-sided transversarium foramina to be small, consistent with a congenitally hypoplastic left vertebral artery. However, portions of the cervical left vertebral artery fail to demonstrate a flow void. It is uncertain if this is due to past dissection or from non-visualization of the tiny lumen.4.C3/4: There is a tiny midline disc protrusion, partially effacing the anterior CSF, without associated cord deformation or central stenosis.5.C5/6: There is a left paracentral disc protrusion which causes anterior left hemicord flattening without intrinsic cord signal abnormality. There is no resulting central stenosis.6.Bilateral facet hypertrophy with ligamentum flavum thickening at T2/3 encroachment bilateral neural foramina without significant resulting stenosis.7.L3/4: There is a small left foraminal/lateral disc protrusion which abuts the adjacent L3 nerve roots.8.L5/S1:Asymmetric bulge to the right with small superimposed right paracentral disc protrusion. There is abutment of the right S1 nerve root sheath origin without deformation. There is no central stenosis, although there is mild left neural foraminal and minimal right neural foraminal stenosis.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old, with sudden onset of ptosis. Brain:Scattered small foci of white matter T2 hyperintensity are seen without evidence of edema, mass effect or diffusion restriction. No pathologic parenchymal or extra-axial enhancement is detected. No evidence of intracranial hemorrhage or any abnormal extra axial fluid collection is seen. The ventricles are normal in size and morphology.Orbits:Mild bilateral proptosis is seen. However, the globes are symmetric and round. The lenses are normally positioned. The extraocular muscles demonstrate normal caliber and enhancement. The optic nerves are not thickened and are free of pathologic enhancement. The intraorbital fat is clean with no evidence of any mass, fluid collection or inflammatory stranding. The superior ophthalmic veins are not engorged. There is no asymmetric or abnormal orbital enhancement. The cavernous sinuses are within normal limits.

Output: 1.Mild bilateral proptosis is seen with no clear underlying etiology.2.No acute intracranial abnormality.


Instruction: Generate impression based on medical findings.

Input: 40 year old woman with history of orthotopic heart transplant in 2009, referred for annual evaluation of allograft vasculopathy. MEDICATIONS: Cellcept, Prograf, Pravastatin, Synthroid, Lyrica First Pass PerfusionDuring hyperemia, no definite perfusion defects were present. Apparent area of decreased enhancement during hyperemia and rest images within the interventricular septum in the mid and apical portions of the LV is likely artifactual.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 63%, the LV end diastolic volume index is 63 ml/m2 (normal range: 65+/-11), the LVEDV is 106 ml (normal range 109+/-23), the LV end systolic volume index is 23 ml/m2 (normal range 18+/-5), the LVESV is 39 ml (normal range 31+/-10), the LV mass index is 18 g/m2, and the LV mass is 31 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is consistent with transplant. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 69%, the RV end diastolic volume index is 65 ml/m2 (normal range 69+/-14), the RVEDV is 110 ml (normal range 110+/-24), the RV end systolic volume index is 20 ml/m2 (normal range 22+/-8), and the RVESV is 34 ml (normal range 35+/-13). Right AtriumThe right atrium is consistent with transplant. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveTrace mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSternal wires are present. Nonspecific renal hyperintense T2 lesions. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No convincing evidence of perfusion defects/ "ischemia" present during hyperemia. Apparent area of decreased enhancement during hyperemia and rest images within the interventricular septum in the mid and apical portions of the LV is likely artifactual. Consider MRI follow-up imaging in 6 months for reevaluation.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 63%).4. Normal RV size and systolic function (RVEF 69%).


Instruction: Generate impression based on medical findings.

Input: Male, 80 years old, restaging examination for metastatic lung cancer. No focal edema, mass effect or pathologic intracranial enhancement is seen. The previously mentioned focus of apparent enhancement in the left parietal lobe is clearly an artifact on today's examination. Extensive, nearly confluent periventricular white matter T2 hyperintensity is redemonstrated appearing similar to the prior examination. No restricted diffusion is seen. No acute intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. The ventricles remain normal in size and morphology. Bone marrow signal characteristics are within normal limits.

Output: 1.No evidence of active metastatic disease in the brain.2.Redemonstration of extensive white matter signal abnormality which may represent a combination of treatment effect and small vessel ischemic disease.


Instruction: Generate impression based on medical findings.

Input: 47 year old woman with non ischemic cardiomyopathy, referred for further evaluation of underlying etiology. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 28%, the LV end diastolic volume index is 137 ml/m2 (normal range: 65+/-11), the LVEDV is 307 ml (normal range 109+/-23), the LV end systolic volume index is 97 ml/m2 (normal range 18+/-5), the LVESV is 218 ml (normal range 31+/-10). There is regional variation in segmental contraction. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. There is no evidence of acute inflammation or edema on T1 or T2 imaging.Left AtriumThe left atrium is enlarged. Right VentricleThe right ventricle is normal in size with lower normal systolic function. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 54 ml/m2 (normal range 69+/-14), the RVEDV is 120 ml (normal range 110+/-24), the RV end systolic volume index is 25 ml/m2 (normal range 22+/-8), and the RVESV is 56 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 no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 28%. There is dyssynchronous contraction. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Additionally there is no evidence of acute inflammation or edema on T1 or T2 imaging.2. The right ventricle is normal in size with lower normal systolic function. The overall RV ejection fraction is 54%.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: 72-year-old with 3 to 4-cm left breast cancer, DCIS, MRI for staging and surgery planning There is scattered fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.Left Breast: Postprocedural hematoma is seen on the T1 precontrast images measures 13 x 16 x 13 mm in the left breast 8 o'clock position. The clip artifact is noted within the hematoma. Area of non-Mass enhancement is seen anterior and posterior to the hematoma with total extent of 37 x 34 x 17 mm (AP x ML x CC), which includes the hematoma as well. This approximately corresponds to the extent of suspicious calcifications seen on mammogram.Right breast: No abnormal enhancement is seen in right breast. Axillae: No abnormal lymph nodes are identified in either axillary region. The left low-lying axillary lymph node appears folded over itself, unchanged from prior mammograms dating back to 2012.

Output: 1. Area of non-Mass enhancement corresponding to DCIS in left breast 8 o'clock position with maximum extent of 3.7 cm in the AP dimension. This approximately corresponds to the extent of suspicious calcifications seen on mammogram.2. No abnormality in the right breast or bilateral axillary regions. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.