Instruction: Generate impression based on medical findings.

Input: Reason: Pt is a 57 y/o male with RCC, evaluate for recurrence, attention to L2 vertebrae History: RCC Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment. There is anterior compression fracture present at L1. This is unchanged since the prior exam The conus medullaris on sagittal imaging is grossly intact. No enhancing lesions are appreciated within the lumbar spinal canal.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is disk desiccation, loss of disk space height and a diffuse disk bulge present at this level. There is mild facet hypertrophy at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is disk desiccation, loss of disk space height and a diffuse disk bulge present at this level. There is mild facet hypertrophy at this level right more than left. There is a left paramedian disk protrusion at this level. There is mild encroachment of the nerve roots of the right lateral recess at this level. This is unchanged compared to the previous examAt L3-4 there is a left lateral recess disk protrusion at this level which encroaches on the nerve roots of the left lateral recess and is unchanged since prior exam. There is bilateral facet hypertrophy at this level as well as some ligamentum flavum hypertrophy. There is loss of disk space height, disk desiccation and diffuse disk bulge at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There is a compression fracture present at L1 which is stable compared to the prior exam.2.Multilevel degenerative changes are present in the lumbar spine with encroachment of the nerve roots at the left lateral recess at L3-4 due to a disk protrusion. This is stable compared to the prior exam.3.No evidence for lumbar spine metastases


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old, unspecified disturbances of skin sensation/pure sensory syndrome for evaluation of possible spinal cord mass. There is straightening of the normal cervical lordosis, without subluxation. Vertebral body heights are maintained. There is multilevel disc desiccation with mild loss of intervertebral disc height from C3-4 through C6-7. There are associated endplate degenerative marrow signal changes. A small round area of increased T1 and T2 signal in the superior aspect of the T3 vertebral body, likely relates to a intraosseous hemangioma or focal fatty marrow. Bone marrow signal intensity is otherwise within normal limits. There is no abnormal cord signal. There is no abnormal intrathecal enhancement.Additional level specific findings are as follows:C2-3: Small posterior disc osteophyte complex. Left greater than right facet arthropathy and uncovertebral hypertrophy. No significant spinal canal stenosis. Mild left neural foraminal narrowing.C3-4: Axial images degraded by motion. A small posterior disc osteophyte complexes suggested with right greater than left facet arthropathy. No significant spinal canal stenosis is evident. Neural foraminal stenoses are not able to be evaluated.C4-5: Axial images degraded by motion. Posterior disc osteophyte complex. Right greater than left facet arthropathy and uncinate hypertrophy. No significant spinal canal stenosis. Mild right neural foraminal narrowing.C5-6: Posterior disc osteophyte complex with a prominent right paracentral disc protrusion, which causes mild spinal canal stenosis, effacing the ventral thecal sac and flattening the spinal cord. Right greater than left facet arthropathy and uncinate hypertrophy. Mild to moderate right and mild left neural foraminal narrowing.C6-7: Small posterior disc osteophyte complex. Bilateral facet arthropathy and uncinate hypertrophy. Mild bilateral neural foraminal narrowing.C7-T1: No disc herniation. No significant spinal canal or neural foraminal stenoses.

Output: No abnormal cord signal or enhancement.Multilevel moderate degenerative changes throughout the cervical spine, most prominent at the C5-6 level with mild spinal canal stenosis and mass effect on the spinal cord.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old, with left cervical radiculopathy in the C8 distribution. The cervical lordosis is mildly reversed centered at C5-C7. Sagittal alignment is unremarkable.Vertebral body heights are not significantly compromised. There is mild degenerative anterior wedging of C5-C7.Severe loss of disc height and degenerative endplate signal abnormality is noted at C5-6 and C6-7. Elsewhere, marrow signal characteristics are unremarkable.The visualized spinal cord demonstrates normal signal intensity throughout. No epidural abnormalities are suspected.C2-3: Severe right facet hypertrophy. No significant spinal canal or neuroforaminal stenosis. C3-4: Moderate bilateral facet hypertrophy. Minimal posterior disc-osteophyte complex formation. No significant spinal canal or foraminal stenosis. C4-5: Right greater than left moderate facet hypertrophy. Mild posterior disc-osteophyte complex formation with a small central protruding component. No significant spinal canal or foraminal stenosis. C5-6: Moderate bilateral facet hypertrophy. Loss of disc height and disc osteophyte formation. Mild generalized spinal canal narrowing. Mild bilateral foraminal narrowing. C6-7: Moderate facet hypertrophy. Loss of disc height and disc osteophyte formation. Moderate generalized spinal canal narrowing. Moderate to severe bilateral foraminal narrowing. C7-T1: Moderate right greater than left facet hypertrophy. No significant spinal canal or foraminal stenosis.

Output: Degenerative disc disease is seen most conspicuously affecting C5-6 and C6-7. At C5-6, there is a mild spinal canal stenosis and mild bilateral foraminal narrowing. At C6-7, there is a moderate spinal canal stenosis and moderate to severe bilateral foraminal narrowing. Facet arthropathy is noted at all levels.


Instruction: Generate impression based on medical findings.

Input: Drainage, pain. Known osteomyelitis. Orthopedic evaluation. There is thickening and sclerosis of the diaphysis of the third metatarsal, compatible with chronic osteomyelitis. The head of the third metatarsal appears separated from the diaphysis with erosion suggesting acute osteomyelitis (likely corresponding to the "abscess" seen on the recent MRI examination). Osteolysis of the proximal phalanx of the third toe also indicates acute osteomyelitis, and poor definition of the proximal margin of the middle phalanx of the third toe is suggestive of acute osteomyelitis as well. Deformity of the second metatarsal head and bases of the first, second and fourth proximal phalanges may reflect prior infection or trauma, but I see no osteolysis these bones on the current study. Moderate osteoarthritis affects the first metatarsophalangeal joint. Deformity of the head of the fourth proximal phalanx likely reflects prior surgery. Deformity of the neck of the fifth metatarsal likely reflects an old healed fracture.

Output: Osteomyelitis of the third metatarsal, third proximal phalanx, and third middle phalanx, with other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for spinal canal stenosis History: bilateral LE weakness Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. No abnormal enhancing lesions are appreciated in the lumbar spine.There is mild superior compression of the T11 vertebral body which is not present on the prior exam and is associated with high signal on T1 suggesting that this is chronic.At L5-S1 there is bilateral facet and ligamentum flavum hypertrophy of moderate degree associated with a minor disk bulge. There is no significant compromise to spinal canal or neural foramina at this level. There is no substantial change compare the prior exam.At L4-5 there is bilateral facet and ligamentum flavum hypertrophy of moderate degree associated with a minor disk bulge. There is no significant compromise to spinal canal or neural foramina at this level. Since the prior exam the patient has developed lobe with more endplate reaction.At L3-4 there is no significant compromise to spinal canal or neural foramina. Since the prior exam the patient has developed a left paramedian disk protrusion which mildly impresses on the thecal sac at the left lateral recess and minimally encroaches on the nerve roots of the left lateral recess.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is a mild disk bulge present this level associate with some ligamentum flavum hypertrophy.At L1-2 there is no significant compromise to spinal canal or neural foramina. There is T2 signal hyperintensity within the disk space at this level associated with Schmorl's nodes. The endplates are preserved and there is no perivertebral soft tissue swelling appreciated. Since the prior exam the only difference is appreciated is the T2 signal hyperintensity. There is subtle adjacent endplate contrast enhancement following gadolinium administration but no disk enhancement. Since the prior exam the patient's right renal pelvis and ureter have an enlarged. The kidneys are atrophic. There is a large cyst associated with the left kidney which was not present on the prior exam. The cyst measures 32 x 40 mm axial dimensions. There is partial visualization of a kidney in the right pelvis.

Output: 1.Degenerative changes are present in the lumbar spine which have mildly progressed since the prior exam. At L3-4 there is a new left lateral recess and paramedian disk protrusion which mildly encroaches on the nerve roots at the left lateral recess at this level. 2.T2 signal hyperintensity within the L1-2 disk space is suspected to be degenerative in nature. There are no specific stigmata for diskitis appreciated. Please correlate with patient's clinical symptoms. A CT scan demonstrating vacuum disk phenomenon similar to the CT of the abdomen from 2011 may help confirm likely DJD.3.There is a mild (<10%) chronic superior endplate compression of the T11 vertebral body which is new since 2007.4.Dr Laura Carlson pager 9903 was paged to discuss the above findings and the findings were discussed.


Instruction: Generate impression based on medical findings.

Input: There has been anterior cervical fusion from C4 through C7.There are no fractures. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: UnremarkableC3/4: Posterior osteophyte disc complex and bilateral uncinate hypertrophy. There is mild anterior cord flattening without intrinsic cord signal abnormality. There is moderate left and mild-to-moderate right neural foraminal stenosis.C4/5: Posterior osteophyte disc complex, bilateral facet hypertrophy, and left facet hypertrophy. There is T2 abnormality within the cord at this level which demonstrates associated focal cord atrophy. There is severe left and moderate right neural foraminal stenosis.C5/6: Posterior osteophyte disc complex and bilateral uncinate hypertrophy. T2 hyperintensity is noted within the cord at this level with associated slight focal cord atrophy. There is moderate to severe left and mild-to-moderate right neural foraminal stenosis.C6/7: Posterior osteophyte disc complex and bilateral uncinate hypertrophy. There is a suggestion of cord T2 hyperintensity and minimal focal cord atrophy. There is moderate to severe left neural foraminal and moderate right neural foraminal stenosis.C7/T1: Posterior osteophyte disc complex and uncinate hypertrophy. There is severe bilateral neural foraminal stenosis.Degenerative changes throughout all the visualized thoracic levels from T1 through T5 demonstrate central canal and bilateral neural foraminal encroachment.

Output: 1.C3/4: Moderate left and mild-to-moderate right neural foraminal stenosis.2.C4/5: There are is T2 abnormality within the cord at this level which demonstrates associated focal cord atrophy. There is severe left and moderate right neural foraminal stenosis.3.C5/6: T2 hyperintensity is noted within the cord at this level with associated slight focal cord atrophy. There is moderate to severe left and mild-to-moderate right neural foraminal stenosis.4.C6/7: There are is a suggestion of cord T2 hyperintensity and minimal focal cord atrophy. There is moderate to severe left neural foraminal and moderate right neural foraminal stenosis.5.C7/T1: Severe bilateral neural foraminal stenosis.6.Degenerative changes throughout all the visualized thoracic levels from T1 through T5 demonstrate central canal and bilateral neural foraminal encroachment. If the patient has symptoms referable to the thoracic spine, a dedicated MRI of the thoracic spine could be obtained if the clinically beneficial.


Instruction: Generate impression based on medical findings.

Input: History of prostate cancer (Gleason 8). 11/12 cores with prostate cancer, Gl 8 in 1, Gl 4+3 in 2, Gl 3+4 in 6, Gl 3+3 in 2 cores PELVIS:PROSTATE:Prostate Size: 5.7 x 4.4 x 5.3 cm.Peripheral Zone: There are several areas of decreased T2 and ADC signal within the bilateral apex, mid gland, and base, suspicious for neoplasm. The largest discrete area of signal abnormality is in the left apex (series 401, image 29) measuring 1.1 x 1.3 cm.Central Gland: No significant abnormality noted.Seminal Vesicles: No frank invasion of the seminal vesicles is identified.Extracapsular Extension: There is extracapsular extension on the left at the level of the mid gland (series 801, image 12) without definite involvement of the adjacent neurovascular bundle.BLADDER: No significant abnormality noted.LYMPH NODES: No frank lymphadenopathy is identified.BONES, SOFT TISSUES: There is a 1.6 x 1.6 cm lesion within the left femoral head which demonstrates sclerotic borders, heterogeneously increased T2 signal, intermediate T1 signal, and enhancement. Elsewhere, bone marrow signal intensity is mildly heterogeneous.OTHER: No significant abnormality noted.

Output: 1.Diffuse prostate cancer involving the bilateral peripheral zones with extracapsular extension at the left mid gland without definite associated involvement of the adjacent neurovascular bundle.2.Lesion within the left femoral head, nonspecific but favor benign given imaging characteristics. However, correlation with nuclear medicine bone scan is recommended.


Instruction: Generate impression based on medical findings.

Input: MRI brain: There is no evidence of discernible mass in the visualized portions of the nasopharynx. There is redemonstration of heterogeneous marrow signal involving the central skull base including clivus with ill-defined enhancement which extends along bilateral left more than the right expanded pterygopalatine fossa, unchanged from the prior exam. There is mild diffuse enhancement extending to the right more than the left masticator space, grossly similar to prior exam. There is no new enhancement in the nasopharynx.There are scattered patchy foci of T2/FLAIR signal throughout the cerebral white matter which are nonspecific, most likely representing mild chronic small vessel disease, unchanged. There is a small focus of T2/FLAIR hyperintense lesion involving the left cingulate gyrus with associated punctate focus of susceptibility which may represent prior ischemic injury and associated chronic hemosiderin deposition, unchanged.There is an ill-defined apparent focus of enhancement along the right paramedian genu of the corpus callosum seen only on the coronal post contrast images of the brain (series 20, image 19), which was also suggested on coronal post-contrast images on the prior exam, however, not demonstrated on any other post-contrast sequences including post axial 3-D T1 weighted imaging and coronal postcontrast images through the orbits (although these are not as delayed). Hence this focus of enhancement is favored to be artifactual. Otherwise, there is no evidence of parenchymal enhancement or meningeal enhancement.The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is unchanged opacification of the anterior and posterior ethmoid air cells as well as mucosal thickening in the bilateral maxillary sinuses, similar to the prior exam. There are stable diffuse opacification of the bilateral mastoid air cells, similar to prior.MRI ORBITS: There is mild nonspecific non-mass-like enhancement in the right orbital apex corresponding to the site of previous tumor, unchanged from prior. Previously demonstrated intraorbital extension of tumor with mass effect on the medial rectus and right optic canal is completely resolved. No definite abnormal mass or abnormal enhancement is seen in the intraconal or extraconal compartment. No abnormal enhancement along the foramen rotundum or inferior orbital fissure. The optic nerves are normal in size and signal intensity, and are symmetric bilaterally. No retrobulbar mass, chiasmatic mass, or parasellar abnormality is seen. Extraocular muscles are unremarkable.

Output: 1. Stable posttreatment changes related to treated nasopharyngeal carcinoma with ill-defined enhancement involving the base of skull as well as pterygopalatine fossa extending to the right more than the left maxillary space without significant interval change compared to the prior exam. No evidence of tumor recurrence.2. Ill-defined apparent punctate focus of enhancement along the right paramedian genu of corpus callosum, which was not present on any other sequences, with similar focus of enhancement present on same sequence on the previous exam is felt to be artifactual. Attention on follow-up exam.3. No evidence of intraorbital mass or tumor extension.4. Scattered cerebral white matter T2/FLAIR hyperintense foci, may relate to chronic small vessel ischemic changes, similar to prior.5. Stable extensive opacification of the bilateral ethmoid air cells and bilateral maxillary sinuses as well as opacification of the bilateral mastoid air cells.


Instruction: Generate impression based on medical findings.

Input: Ms. Childers is a 43 year old female with BRCA2 mutation and known left breast fibroadenoma. Family history of breast cancer in mother and paternal grandmother. Family history of ovarian cancer maternal aunt. There is scattered fibroglandular tissue in both breasts. Mild background parenchymal enhancement is noted bilaterally.Few scattered foci of enhancement are re-visualized in the left breast, all of which appear similar in distribution and appearance when compared to multiple prior MRI's. There is no new abnormal enhancement seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on medical findings.

Input: Left trigeminal neuralgia. BRAIN MRI:Brain parenchyma appears within normal limits. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. Focal susceptibility along the left side of the posterior falx demonstrates no associated enhancement and compatible with a nonspecific dural calcification. T1-hyperintense, centrally T2-hyperintense material in the left lateral sphenoid sinus is compatible with a mucus retention cyst with inspissated secretions and was present previously on MRI/19/2009. This focus is medial to the foramen rotundum. There is trace mucosal thickening in the paranasal sinuses, elsewhere. There is asymmetric prominence of the right palatine tonsillar tissue, possibly related to left-sided tonsillectomy, but can be correlated with direct examination. There is also nonspecific prominence of the nasopharyngeal tonsillar tissue without suspicious masses.MRI OF THE CRANIAL NERVES:The cavernous sinuses and Meckel's caves are symmetric and preserved. There is no abnormal contrast enhancement along the trigeminal nerve cisternal segments or the other imaged cranial nerves. There is also no brainstem or root entry zoon lesion. No abnormal vasculature structure is appreciated at the origin of the left trigeminal nerve. There is no abnormal signal or contrast enhancement in the foramina rotunda and ovale. The orbital floors show no gross abnormality.

Output: MRI of the brain appears within normal limits. Specifically no lesion to explain trigeminal neuralgia is appreciated. Please see additional findings above.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: eval chordoma, eval for pathology History: weakness.. Brain MRIThere is multifocal patchy periventricular white matter hyperintensity on FLAIR images, which likely represents small vessel ischemic disease of indeterminate age and is unchanged compared to prior MRI. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.C SpineThe high signal prevertebral mass that was previously seen anterior to the C3 vertebral body and extending along the anterior longitudinal ligament demonstrate interval decrease in size. There is again demonstration of high signal intensity of the C3, C4, and C5 vertebral bodies, not significantly changed compared to prior MRI. The vertebral bodies of C3, C4, and C5 are again seen to enhance with contrast. The cervical and thoracic spinal cord demonstrates diffuse high intensity on T2 weighted images compared to prior exam, which is consistent with post-radiation spinal cord edema. There is new enhancement of the spinal cord at the C4-C5-C6 level, which is favored to represent postradiation myelopathy, with metastasis less likely. Thoracic SpineThere is no evidence of compression of the thoracic spine. There is diffuse high signal intensity on T2-weighted images of the thoracic spinal cord extending to the T5 level. Lumbar SpineThere is mild foraminal narrowing bilaterally at the L1-L2, L2-L3, and L3-L4 levels with mild foraminal stenosis bilaterally. There is diffuse intervertebral disc bulge at the L3-L4 level. There is diffuse intervertebral disc bulge also at level L5-S1. There is spondylolisthesis at the L4-L5 level and severe central canal stenosis at the L4-L5 level. The conus medullaris is normal at the L1-L2 level, with normal signal intensity. There is evidence of diffuse disc desiccation.The bladder is distended with fluid. The paraspinal soft tissues are unremarkable.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. Nonspecific chronic small vessel ischemic disease of indeterminate age.2. Interval decrease in size of the previously identified extracorporeal mass anterior to vertebral body C3. However, no significant change in MR characteristics of the vertebral bodies compared to prior exam.3. There is new spinal cord enhancement at the C4-C5-C6 level, which favors radiation-induced myelopathy, cannot exclude metastatic lesion.4. Diffuse increased signal of the cervical and thoracic spinal cord extending from C1 to T5 on T2-weighted and STIR images, which is suggestive of postradiation spinal cord edema.5. Severe central canal stenosis at the L4-L5 level secondary to vertebral spondylolisthesis.


Instruction: Generate impression based on medical findings.

Input: Plexiform tumor of left side of neck with facial involvement and left sided weakness History: large plexiform tumor of left side of face and neck and facial weakness. There is an infiltrative mass centered in the right pterygopalatine fossa with extension into the foramen ovale, foramen rotundum, Vidian canal, right cavernous sinus, posterior right nasal cavity, buccal space, and protrudes slightly into the right orbit via the inferior orbital fissure. Overall, the tumor measures up to approximately 7 cm. There is right tympanomastoid fluid. There is a partially-imaged transpatial mass centered in the posterior triangle of the left lower neck, which measures at least up to 10 mm. Furthermore, tumor extends into the left C5 though at least the T2 neural foramina, but there does not appear to be spinal cord compression. There are postoperative findings related to laminotomies from C5 to T1. There is kyphotic deformity at the cervical thoracic junction, but no spondylolisthesis. There is a punctate T2 hyperintense lesion in the left upper lip. There is diffuse moderate paranasal sinus mucosal thickening. There is no significant cervical lymphadenopathy. There is mild prominence of the Waldeyer ring structures, which is a common finding for the age of the patient.

Output: 1. A plexiform neurofibroma centered in the right pterygopalatine fossa with extension into the foramen ovale, foramen rotundum, Vidian canal, right cavernous sinus, posterior right nasal cavity, and buccal space. Overall, the tumor measures up to approximately 7 cm. Right tympanomastoid fluid may represent retained effusions due to mass effect upon the Eustachian tube. 2. A partially-imaged transpatial plexiform neurofibroma centered in the posterior triangle of the left lower neck measures at least up to 10 mm. Furthermore, tumor extends into the left C5 though at least the T2 neural foramina, but there does not appear to be spinal cord compression. Please refer to the separate chest MRI report for additional details.3. Kyphotic deformity at the cervical thoracic junction, but no spondylolisthesis. 4. A punctate T2 hyperintense lesion in the left upper lip may represent a neurofibroma.


Instruction: Generate impression based on medical findings.

Input: Clinical question: 73-year-old female with memory loss in the last 6 months. History of hypertension, diabetes, intubation in fall. Evaluate for CVA, mass or others. Signs and symptoms: Memory loss. Pre and post enhanced brain MRI:No acute intracranial process and negative diffusion weighted images.Examination demonstrates few tiny foci of FLAIR hyperintensity only in the subcortical and periventricular white matter of bilateral cerebral hemispheres. Findings are nonspecific and demonstrate no evidence of hemorrhagic changes or abnormal enhancement. Considering patient's age findings likely representing chronic minimal microvascular ischemic changes.There is slight prominence of cortical sulci and mild prominence of lateral ventricles which could still be within normal range for patient's stated age of 73. The signal void of major intracranial arterial branches are identified. The signal intensity of intracranial venous sinuses are within normal angles with normal pattern of enhancement.Post enhanced images demonstrate no detectable abnormal parenchymal, meningeal or calvarial enhancement.Paranasal sinuses demonstrate partial opacification of left frontal sinus with mucosal enhancement suggestive of sinus disease. The rest of paranasal sinuses and bilateral mastoid air cells are unremarkable.

Output: 1.No acute intracranial process and negative diffusion-weighted images.2.Few tiny foci of FLAIR hyperintensity only in the subcortical and periventricular white matter could represent minute chronic small vessel ischemic strokes.3.Mild prominence of cerebral cortical sulci and supratentorial ventricular system which could be still within normal for patient's stated age of 73.4.No abnormal parenchymal, leptomeningeal or calvarial/retro-orbital enhancement.


Instruction: Generate impression based on medical findings.

Input: 3 month follow up from ETV for aqueductal stenosis. There are postoperative findings related to right transfrontal endoscopic thrid ventriculostomy, with what appears to be a faint jet of cerebrospinal fluid across the ventriculostomy, although no defect is discernible otherwise. There is decreased dilatation of the third and lateral ventricles. However, there is no evidence of aqueductal stenosis. There is deficiency of surrounding cerebral white matter, particularly in the right peritrigonal region. There is interval evolution of the intraventricular hemorrhage, with residual diffuse susceptibility effect along the margins of the ventricular system and choroid plexus. There is also susceptibility effect along the surfaces of some of the posterior fossa structures. There is paucity of cerebral white matter, particularly in the right peritrigonal region. Furthermore, the degree of myelination appears to be delayed. There is mild prominence of the subarachnoid spaces in the frontal convexities. There is a mega cisterna magna. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable.

Output: Postoperative findings related to right transfrontal endoscopic thrid ventriculostomy, with what appears to be a faint jet of cerebrospinal fluid across the ventriculostomy, indicating patency, although no defect is discernible otherwise. Interval decrease in the degree of hydrocephalus and interval evolution of the prior intraventricular hemorrhage with superimposed superficial siderosis in the posterior fossa. In addition, there appears to be periventricular leukomalacia and delayed myelination.


Instruction: Generate impression based on medical findings.

Input: History of suprasellar meningioma status post resection. There are post-surgical changes related to a right frontotemporal craniotomy for suprasellar meningioma resection. There is redemonstration of encephalomalacia in the right inferior frontal lobe at the site of previously resected meningioma as well as laminar necrosis along the cortex similar to prior exam. There is faint enhancement in the sella with decreased band of enhancement along the superior aspect of planum sphenoid extending along the floor of the right anterior cranial fossa laterally to the craniotomy flap in the right temporal region, likely reflecting post-operative change.There are subtle subcentimeter areas of heterogeneous enhancement at the medial aspect of the left cavernous sinus as well as the right aspect of the suprasellar cistern. There is unchanged increased T1 hyperintensity in the right inferior basal ganglia. There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: Evolution of postoperative changes related to a right frontotemporal craniotomy for suprasellar meningioma removal. Subcentimeter heterogeneous areas of enhancement at the medial aspect of the left cavernous sinus as well as the right aspect of the suprasellar cistern, may represent minimal residual tumor, but are not significantly changed from prior exam. No evidence of tumor progression.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old, with toxoplasmosis, follow-up examination. Currently asymptomatic. A lobulated lesion with diffusion restriction and moderate local edema is unchanged in the right occipital lobe. An oval lesion in the right corona radiata with ring restricted diffusion demonstrates slightly reduced FLAIR signal abnormality. Numerous additional small foci of FLAIR hyperintensity are redemonstrated in both cerebral hemispheres without significant interval change. As on the prior examinations, several of the intracranial lesions are associated with susceptibility effect but this is unchanged.No new lesions are seen. No significant generalized mass effect is detected. There are no abnormal extra-axial collections. The ventricular system is stable in size. Redemonstrated is ill-defined non-specific T2 hyperintense signal in the posterior medulla and pons showing no interval change. Opacification of the left ethmoid air cells and perhaps the adjacent nasal cavity is unchanged.

Output: 1.A lesion in the right occipital lobe which induces moderate local edema has not significantly changed.2.A small lesion in the right corona radiata has become smaller. Numerous additional scattered nonspecific lesions show no significant interval change. No new lesions are detected.3.Stable soft tissue opacification of the left ethmoid air cells.


Instruction: Generate impression based on medical findings.

Input: There is no acute cord compression. Degenerative stenosis are noted involving the cervical spine with varying degrees of probable mild central stenosis. There are bilateral pleural effusions.

Output: No acute cord compression.


Instruction: Generate impression based on medical findings.

Input: 44 year old man with recent diagnosis of severe multivessel CAD, bicuspid aortic valve and reduced ejection fraction who was referred for cardiac MRI to evaluate for viability. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 14%, the LV end diastolic volume index is 256 ml/m2 (normal range: 74+/-15), the LVEDV is 465 ml (normal range 142+/-34), the LV end systolic volume index is 219 ml/m2 (normal range 25+/-9), the LVESV is 399 ml (normal range 47+/-19), the LV mass index is elevated at 121 g/m2 (normal range 85+/-15), and the LV mass is 220 g (normal range 164+/-36). There is global hypokinesis with regional variation; notably the inferior wall is thinned and akinetic. There is no apical thrombus noted. There is late gadolinium enhancement which is predominately transmural, suggestive of previous myocardial infarction, which involves the extent of the inferior and inferolateral walls, suggesting non-viability. There is additionally an atypical pattern (mid-wall stripe) of late gadolinium enhancement involving the basal to septum. This pattern is not consistent with prior myocardial infarction and suggests the presence of a concomitant non-ischemic/ dilated cardiomyopathy. The remainder of the myocardium (left anterior descending) is free of late gadolinium enhancement and likely to be viable. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size with severely reduced systolic function. The overall RV ejection fraction is 27%, the RV end diastolic volume index is 102 ml/m2 (normal range 82+/-16), the RVEDV is 186 ml (normal range 142+/-31), the RV end systolic volume index is 75 ml/m2 (normal range 31+/-9), and the RVESV is 136 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve is bicuspid with fusion of the left and right coronary cusps. There is at least moderate aortic regurgitation, which appears eccentric. The regurgitant fraction is 35%.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 mildly dilated The sinus of valsalva is dilated (44x43mm). The ascending aorta measures 37x37mm, and the proximal transverse arch measures 29mm. There is no evidence of coarctation or aortic dissection.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated (34mm at the level of the ascending aorta).Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is severely dilated with severely reduced systolic function (EF 14%). 2. There is a transmural myocardial infarction in the usual territory of the left circumflex or a large right coronary artery. This territory is not viable. The LAD territory is free of myocardial infarction and is likely to be viable. 3. There is additionally evidence of myocardial fibrosis involving the mid-wall of the basal to mid septum which is not due to a myocardial infarction and suggests that there is also a concomitant non-ischemic cardiomyopathy present.4. Normal size RV with severely reduced function (RVEF 27%). 5. Bicuspid aortic valve with at least moderate aortic regurgitation. 6. Mildly dilated aortic root without evidence of thoracic aortic dissection or coarctation.7. Biatrial dilatation. 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: H/o cervical cancer. The lumbar lordosis is present. The lumbar spine alignment appears within normal limits. Abnormal hyperdensity is seen in the L2, L4, L5 and S1 vertebral bodies, in which there are 30% loss of height in the L2 vertebral body and depression of the right superior endplate of the L5 vertebral body. T12/L1: disc bulge and bilateral facet hypertrophy; no neuroforaminal compromise or spinal canal stenosis. L1/L2: disc bulge, vacuum phenomena and bilateral facet hypertrophy; no neuroforaminal compromise or spinal canal stenosis. L2/L3: disc bulge and bilateral facet hypertrophy; no neuroforaminal compromise or spinal canal stenosis. L3/L4: disc bulge and bilateral facet hypertrophy; no neuroforaminal compromise or spinal canal stenosis. L4/L5: disc bulge, vacuum phenomena and bilateral facet hypertrophy; left neuroforaminal compromise; no spinal canal stenosis. L5/S1: disc bulge, vacuum phenomena with small amount of air in the epidural space and bilateral facet hypertrophy; bilateral neuroforaminal compromise; no spinal canal stenosis. These findings have been stable since prior MRI.

Output: 1. Metastases likely involving the L2, L4, L5 and S1 vertebral bodies with the L2 and L5 compression or pathologic fractures. 2. Degenerative disease of the lumbar spine as detailed above.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Unspecified fall. Muscle weakness (generalized). Dizziness and giddinessClinical question: Please eval for stroke, posterior circulationSigns and Symptoms: 63 yo M with HTN, Hyperthyroidism uncontrolled, presents with left sided weakness and overall dysequilibrium, several fallsComments: Has tolerated Gadolinium on prior MRI in 2014 here. | The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. This is stable compared to the prior exam .No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.No foci of signal loss on susceptibility imaging are appreciated.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a mucous retention cyst in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. This is stable compared to the prior exam 2.There is no evidence for intracranial mass lesion and no evidence for acute ischemic cerebral infarction.


Instruction: Generate impression based on medical findings.

Input: 60-year-old with strong family history of breast cancer There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on medical findings.

Input: Right locked jaw, muscle spasms of right jaw muscles. Abnormality of right TMJ, hypertrophy of right facial/mastication muscles? The right mandibular condyle is appropriately situated within the mandibular fossa on the closed mouth sequences. There is appropriate anterior translation of the mandibular condyle on the open mouth sequences. The articular disc is unremarkable, situated between the mandibular condyle and articular eminence on all sequences. I see no frank arthritic changes such as synovitis or erosion.The left mandibular condyle is appropriately situated within the mandibular fossa on the closed mouth sequences. There is appropriate anterior translation of the mandibular condyle on the open mouth sequences. The articular disc is unremarkable, situated between the mandibular condyle and articular eminence on all sequences. I see no frank arthritic changes such as synovitis or erosion.The musculature in the vicinity of the temporomandibular joints appears symmetric.

Output: Normal-appearing temporomandibular joints bilaterally, without findings to account for the patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: Stabbing right-sided headache, worse in life. Assess for vascular dissection or subarachnoid hemorrhage. The study is limited by patient motion. Also, immediately following gadolinium injection, the patient reported warm sensation in her chest and significant nausea. The examination was halted. Symptoms resolved within 2 minutes without treatment but no postcontrast images were obtained for the MRA of the neck or MRV of the cranium.MRI BRAIN WITHOUT CONTRAST:The brain demonstrates normal morphology and signal characteristics. There is no space-occupying lesion, midline shift or brain herniation. The ventricles and the other CSF-containing spaces are normal accounting for predominantly CSF filled sella, compatible with partially empty sella. There is no abnormal diffusion restriction or susceptibility effect to indicate acute stroke or intracranial hemorrhage.There is no gross orbital abnormality. There is no destructive skull lesion. Thickening of the subcutaneous fat along the scalp likely relates to patient body habitus. There is mild prominence of the optic nerve sheath although remaining within normal limits. No definite posterior scleral flattening is identified.CRANIAL MR VENOGRAPHY WITHOUT AND WITH CONTRAST:As discussed above, no postcontrast MR venography was performed. Motion also limits the examination.There is no sign of significant dural venous thromboses on the noncontrast MR venography. Attenuation of the flow-related signal at the junction of the transverse and sigmoid sinuses is a common imaging finding of no clinical significance.CRANIAL MR ANGIOGRAPHY WITHOUT CONTRAST:Flow-related signal in the intracranial internal carotid arteries and the paired anterior and middle cerebral arteries and their major branches is preserved as well as the vessel caliber. Similarly, the vertebrobasilar system shows no significant stenosis or aneurysm.NECK MR ANGIOGRAPHY WITHOUT AND WITH CONTRAST:As discussed above, only noncontrast enhanced images are available. There is bilateral attenuation of flow-related signal in the carotid bulbs which likely relates to turbulent flow. Otherwise, the cervical carotid arteries show preserved flow-related signal and caliber. Similarly, the cervical vertebral arteries are also preserved except for suboptimal visualization of the origin of the left vertebral artery which may reflect technical limitation of noncontrast enhanced cervical MR angiography. Aortic arch branching pattern is conventional.The fat saturated precontrast axial images of the neck show no sign of intramural hematoma/vessel dissection. There is asymmetric enlargement and lobulation of thyroid gland, more pronounced on the left, probably reflecting the presence of thyroid nodules.

Output: 1.The examination is limited as described above because of inability to complete the examination following the contrast injection as well as patient motion throughout the remainder of the examination.2.There is no definitive intracranial abnormality.3.There is no definite cervical or intracranial artery stenosis accounting for the above described limitations. There is also no sign of vessel dissection.4.No gross evidence dural venous thrombosis.5.Partially empty sella is nonspecific and may represent a normal variant. However, given the incidental note of increased fat within the scalp suggestive of patient's body habitus, as well as history of headaches and relatively young age, clinical correlation should be made for idiopathic intracranial hypertension.6.Asymmetric thyroid gland enlargement and lobulation probably reflect multinodular goiter.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Evaluate grade 3 oligodendroglioma status post RT and TMZ. Signs and symptoms: As above. Pre and post enhanced brain MRI:Examination redemonstrates extensive postoperative changes of right anterior temporal lobectomy since prior study. There is stable FLAIR and T2 hyperintensity of the right temporal lobe immediately posterior to the surgical resection site which extends into the left basal ganglia consistent with encephalomalacia/gliosis and postoperative changes. There is no detectable focus of abnormal enhancement at the surgical site or remote to the surgical site. This is a similar observation is prior exam.Moderate to be enlarged supratentorial ventricular system with maintained midline remain similar to prior study.Focus of encephalomalacia in the left anterior frontal lobe without abnormal enhancement or interval change since prior study.Scattered periventricular and subcortical FLAIR and T2 hyperintensity foci suggestive of chronic small vessel ischemic strokes are again noted without interval change. Possibility of overlapping post treatment/radiation changes cannot be excluded. Correlate with clinical history.Diffusely prominent cortical sulci and CSF spaces also remains identical to prior exam.

Output: 1.No evidence of an acute or definitive new finding since prior exam.2.Stable postoperative/therapy changes of the right anterior temporal lobectomy without abnormal enhancement to suggest recurrence of tumor.3.Stable scattered foci of FLAIR hyperintensity in the subcortical and periventricular white matter and a focus of encephalomalacia in the left anterior and inferior frontal lobe similar to prior exam.4.Stable scattered foci of FLAIR hyperintensity and localized focus of encephalomalacia in the left frontal lobe since prior study.5.Stable moderately enlarged supratentorial ventricular system and generalized prominence of cerebral cortical sulci likely representing ex vacuo dilatation.


Instruction: Generate impression based on medical findings.

Input: Multiple sclerosis: ataxia and dysphagia. There are extensive, largely confluent, T2 hyperintense and T1 hypointense lesions involving the supratentorial and infratentorial white matter. In particular, there is a new enhancing lesion in the midline medulla. There are several newly enhancing lesions, including within the left superior frontal gyrus, parietal lobe, posterior right frontal corona radiata, and right occipital lobe. On the other hand, previously demonstrated abnormal enhancement in the right parietal lobe has resolved. There is a developmental venous anomaly in the right frontal lobe. The ventricles are stable in size and configuration, including diffuse cerebral volume loss as well as cavum septum pellucidum and vergae. The skull, orbits, and extracranial soft tissues are unremarkable.

Output: Extensive demyelinating lesions in the supratentorial and infratentorial brain parenchyma with several new enhancing lesions and interval resolution of previously demonstrated abnormal enhancement in other areas.


Instruction: Generate impression based on medical findings.

Input: 25 years Male (DOB:4/14/1991)Reason: low back pain History: low back pain leg painPROVIDER/ATTENDING NAME: JAVAD HEKMATPANAH HILLARY M HECKTMAN Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is minimal disc bulge present at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: No compromise to lumbar spinal canal or neural foramina. There are minimal degenerative changes present in the lumbar spine.


Instruction: Generate impression based on medical findings.

Input: The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Mucosal thickening is present within the single posterior left ethmoid air cell. Minimal fluid signal is noted within left mastoid air cells. The remaining paranasal sinuses and right mastoid air cells are clear. There is no abnormal enhancement within the brain. Degenerative changes of the upper cervical spine from C2 through the superior-most visualized aspect of C5 demonstrate spondylitic changes resulting in degrees of central stenosis and cord deformation.

Output: 1.Mucosal thickening is present within the single posterior left ethmoid air cell. 2.Minimal fluid signal is noted within left mastoid air cells. 3.Degenerative changes of the upper cervical spine from C2 through the superior-most visualized aspect of C5 demonstrate spondylitic changes resulting in degrees of central stenosis and cord deformation. If the patient has symptoms referable to the cervical spine, dedicated cervical spine MRI could better characterize central and foraminal stenoses.4.There are no MRI findings to explain the patient's chronic dizziness.


Instruction: Generate impression based on medical findings.

Input: Acute lymphoid leukemia. Altered mental status and right-sided tremor. The study is limited by patient motion. There are patchy areas of FLAIR hyperintensity involving the bilateral subcortical and periventricular white matter. Relatively more prominent of these is seen involving the left posterior frontal centrum semiovale and corona radiata. There are punctate foci of mild restricted diffusion within this area of FLAIR hyperintensity with subtle enhancement. There is also a subtle focus of enhancement in the right cerebellar hemisphere which also shows mild diffusion restriction (better seen on the ADC, then on the limited DWI).The other scattered foci of cerebral white matter abnormality show no diffusion restriction or contrast enhancement and are nonspecific. There is no intracranial mass or mass effect. Ventricles are within normal limits without evidence of hydrocephalus. Mild global parenchymal volume loss is commensurate with age. Bone marrow signal and extracranial soft tissues are unremarkable.

Output: 1.Study is limited by patient motion as described above.2.There are punctate foci of mild restricted diffusion in the left frontal lobe and right cerebellum with enhancement. These are favored to represent subacute infarcts or posttreatment-related injury. There are patchy areas of FLAIR hyperintensity in the left frontal centrum semiovale and corona radiata as well as scattered elsewhere in the white matter which may represent posttreatment and/or chronic ischemic change. Given history of systemic infection, it is also possible the foci of FLAIR hyperintensity and foci of enhancement and restricted diffusion are infection-related (cerebritis); however there is no evidence of intracranial abscess, empyema, or abnormal meningeal enhancement to support this differential. Follow-up MRI to evaluate for evolution and CSF evaluation may be considered as clinically indicated.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: 32 years Female (DOB:1/1/1984)Reason: Chiari with new vision changes and headaches/dizziness, sp decompression, please do with csf flow History: headache, dizziness and vision changesPROVIDER/ATTENDING NAME: DAVID M FRIM DAVID M FRIM MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There appears to be some bidirectional flow at the level of foramen magnum.The patient status post suboccipital craniotomy and C1 posterior arch surgery for Chiari decompressionNo abnormal enhancing mass lesions are appreciated within the brain parenchyma. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a small mucous retention cyst. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI orbits:The eyeballs are intact. No intraconal or extraconal space mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. The suprasellar cistern is intact .

Output: 1.There is no evidence for an intraorbital mass.2.Some bidirectional flow present at the level of the foramen magnum which may suggest that there is some mild impedance to CSF flow at the level of the foramen magnum. There is no evidence for ventriculomegaly on this exam.3.Status post Chiari I decompression.


Instruction: Generate impression based on medical findings.

Input: lumbar radiculopathy (left) with persistent pain; any change from 2011 MIRSigns and Symptoms: lumbar radiculopathy (left) with persistent pain; any change from 20 Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is multilevel disc desiccation present.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge present at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge present at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is a left paramedian broad-based disc protrusion present at this level. There is a a small T2 hyperintensity along the posterior aspect of the annulus on this exam which is unchanged since the prior examAt L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is a cortical cyst present along the medial and superior aspect of the right kidney measuring 2.5 cm in diameterThe uterus appears somewhat heterogeneous in appearance but unchanged since the prior exam

Output: 1.There are multilevel degenerative changes present in the lumbar spine without significant compromise to spinal canal or neural foramina. Overall there is no significant change when compared to the prior exam.


Instruction: Generate impression based on medical findings.

Input: There is slight reversal of normal cervical curvature centered at C5. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: Left facet hypertrophy and slight ligamentum flavum thickening. There is mild left neural foraminal stenosis.C3/4: Mild posterior osteophyte disc complex, slight ligamentum flavum thickening, and mild bilateral facet hypertrophy. There are no significant stenoses.C4/5: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, ligamentum flavum thickening, and minimal bilateral facet hypertrophy. There is mild anterior cord flattening without intrinsic cord signal abnormality. There is mild central, mild left neural foraminal, and mild to moderate right neural foraminal stenosis.C5/6: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, and ligamentum flavum thickening. There is mild anterior cord flattening without intrinsic cord signal abnormality. There is mild central and mild bilateral neural foraminal stenosis.C6/7: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, and ligamentum flavum thickening. There is mild central and mild bilateral neural foraminal stenosis.C7/T1: Unremarkable

Output: 1.C2/3: Mild left neural foraminal stenosis.2.C4/5: Mild central, mild left neural foraminal, and mild to moderate right neural foraminal stenosis.3.C5/6: Mild central and mild bilateral neural foraminal stenosis.4.C6/7: Mild central and mild bilateral neural foraminal stenosis.


Instruction: Generate impression based on medical findings.

Input: Left supraclavicular lymph node metastasis. There is persistent left level 4 lymphadenopathy, which measures 13 x 14 mm in axial cross-section. There is also a prominent left supraclavicular lymph node, which measures 7 x 11 mm in axial cross-section. The other cervical lymph nodes and other neck soft tissues are unremarkable. There is mild multilevel degenerative cervical spondylosis. The images portions of the intracranial structures and orbits are unremarkable.

Output: Persistent left level 4 and supraclavicular lymphadenopathy with corresponding hypermetabolism on PET are compatible with metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old, with numbness, tingling and visual disturbance. History of meningioma. Sequelae of right parietal craniotomy are redemonstrated. There remains mildly thickened subjacent craniotomy defect, but no suspicious or nodular enhancing tissue is evident in the operative region. The underlying right parietal parenchyma shows evidence of mild hemosiderin staining and very slight anatomic distortion and encephalomalacia likely related to surgery.Elsewhere in the brain, no pathologic enhancement is seen. A developmental venous anomaly is suspected within the right superior frontal gyrus. No evidence of edema or mass effect is detected. No abnormal extra-axial fluid collections are seen. Ventricles are within normal limits for size. Incidental note is made of prominent choroid plexus cysts at the level of the atria.

Output: Postoperative findings are redemonstrated compatible with right parietal craniotomy. No findings are seen to suggest recurrent tumor. No new intracranial lesions are detected.


Instruction: Generate impression based on medical findings.

Input: The ventricles and sulci are prominent, consistent with mild age-related volume loss. However, there is enlargement of the lateral and third ventricles, out of proportion to the degree of sulcal prominence; this is grossly stable when compared to remote MRI from 2006. The basal cisterns remain patent. There is no midline shift or mass effect. There are scattered punctate foci of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, which are nonspecific, slightly progressed from prior MRI. There is no pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified.There is a multilobulated structure of CSF-signal extending medially and inferiorly from the medial right middle cranial fossa, immediately posterior to Meckel's cave, which was not seen on the previous study, measuring up to 1 cm (series 901, image 17). This structure appears contiguous with the adjacent subarachnoid space. No significant CT abnormality is seen in this location previously.Normal flow-voids are demonstrated in the major intracranial vascular structures. There is a partially empty sella. There is horizontal angulation of the clivus, resulting in flattening of the skull base, likely developmental.

Output: 1.No intracranial metastatic lesions are identified.2.Subcentimeter, multilobulated, CSF-signal intensity structure inferomedially adjacent to the right middle cranial fossa, not seen on prior MRI and without significant prior CT correlate. Given apparent contiguity with the adjacent subarachnoid space, this may represent an encephalocele. Consider MRI brain with thin cuts or CT through the skull base if further evaluation is warranted.3.Stable chronic disproportionate enlargement of the lateral and third ventricles, of uncertain clinical significance.


Instruction: Generate impression based on medical findings.

Input: 50-year-old female with left hip and groin painPOST-PROCEDURAL DIAGNOSIS: Left hip pain.PHYSICIANS AND ASSISTANTS: Drs. Sanchez and Dixon. The attending physician, Dr. Dixon, was present for the critical portions of the procedure. 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 left hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 10 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of 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. Subsequently, a mixture of 1 cc of Kenalog and 2 cc's of 1% lidocaine were injected into the joint. 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: 13 seconds.

Output: Successful fluoroscopic guided corticosteroid injection as well as injection of dilute gadolinium into the left hip for subsequent MRI arthrogram examination.


Instruction: Generate impression based on medical findings.

Input: 73 year old male patient with bilateral renal masses and previous left RFA. ABDOMEN:LIVER, BILIARY TRACT: A heterogeneously hyperintense T2 lesion within the superior pole of the left kidney which demonstrates enhancement has slightly increased in size measuring 2.3 x 2.3 cm (image 43, series 12), previously 1.8 x 1.6 cm. This remains concerning for malignancy.A T2 hypointense lesion in the right kidney with equivocal enhancement has not significantly changed in size measuring 1.6 x 1.3 cm (image 52, series 12), previously 1.6 x 1.4 cm. A T2 hypointense nonenhancing lesion in the posterior upper pole of the left kidney appears stable in size measuring 2.0 x 2.0 cm (image 42, series 12), previously 2.1 x 2 cm. This presumably represents the site of prior ablation. A left interpolar T2 isointense lesion with T1 hyperintensity may represent a proteinaceous or hemorrhagic cyst. Additional scattered subcentimeter T2 hyperintense lesions are too small to characterize.There is dilatation of the inferior left renal collecting system with renal cortical thinning. 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: A small retrocrural lymph node is not significantly changed in size measuring 1.1 cm. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Left upper pole enhancing renal lesion is slightly increased in size; this is concerning for malignancy.2.Stable T2 hypointense lesion within the right kidney with indeterminate enhancement; continued attention should be paid on subsequent imaging.3.Stable dilatation of the left inferior pole collecting system.


Instruction: Generate impression based on medical findings.

Input: 74-year-old male with right renal mass seen on prior ultrasound ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter T2 hyperintensity in segment six likely reflects a benign cyst.SPLEEN: No significant abnormality noted.PANCREAS: A 4 mm T2 hyperintensity in the pancreatic head without clear connection to the main pancreatic duct may represent a sidebranch cyst versus sidebranch IMPN.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple T2 hyperintense cysts in bilateral kidneys, right greater than left. In particular, the posterior interpolar lesion seen on prior ultrasounds is T2 hyperintense with mild septation and no nodularity on this limited noncontrast study.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: T2 hypointense lesion in the L4 vertebral body. Mild leftward curvature of the lumbar spine.OTHER: No significant abnormality noted.

Output: 1.Mildly complex cyst corresponding to the interpolar right kidney lesion seen on prior US on this limited noncontrast study.2.Probable 4 mm cyst versus sidebranch IPMN in the pancreatic head.


Instruction: Generate impression based on medical findings.

Input: Oligoastrocytoma treated with chemotherapy and prior resection. The images are degraded by patient motion. There are postoperative findings related to left parietal craniotomy. There is unchanged confluent T2 hyperintensity surrounding the left parietal lobe resection cavity consistent. There is also unchanged scattered cerebral white matter T2 hyperintensity, particularly in the right peritrigonal region, which is nonspecific. There is no evidence of abnormal enhancement. The ventricles are stable in size and configuration. There is no acute territorial infarct. There is no significant midline shift or herniation. The major cerebral flow voids are grossly intact. The skull and extracranial soft tissues are unchanged.

Output: No evidence of tumor progression amidst post-treatment findings.


Instruction: Generate impression based on medical findings.

Input: 75-year-old male with cavernous malformation. Redemonstrated is hemosiderin staining associated with the site of prior intraparenchymal hemorrhage involving the left postcentral gyrus. This is unchanged in configuration with a prior examination, as is the closely associated smaller focus of hemosiderin staining and high T2/FLAIR signal within the left precentral gyrus. A left cerebellar hemispheric lesion has also been stable. There are multiple stable foci of high T2/FLAIR scattered within subcortical/ventricular white matter without associated susceptibility abnormality. There are no new lesions including mass, foci of acute hemorrhage, hydrocephalus, enhancement or acute ischemia. The midline is intact. Normal flow-voids are demonstrated within major intracranial vessels. Orbits, sinuses and mastoid air cells are unremarkable.

Output: 1.Stable encephalomalacia and hemosiderin staining involving the left precentral gyrus possibly related to an underlying cavernoma.2.Two other hemosiderin-stained lesions within the left frontal lobe and cerebellar hemisphere are also stable.3.Stable chronic small vessel ischemic disease.


Instruction: Generate impression based on medical findings.

Input: 14 year old female patient with recurrent severe localized right upper quadrant pain and nausea. Question of any anatomic abnormality in the liver, gallbladder, biliary tract, and pancreatic duct. Motion limits evaluation. LIVER, BILIARY TRACT: No focal hepatic lesion is identified. No gallstones are identified. No intra- or extrahepatic biliary ductal dilatation. No filling defect is identified within the common bile duct.SPLEEN: The spleen is normal in appearance.PANCREAS: The pancrease is normal in appearance. The pancreatic duct is non-dilated. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The kidneys are normal in appearance. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No specific findings to account for the patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: Reason: MRI liver to r/o HCC History: post TACE/RFA. ABDOMEN:LIVER, BILIARY TRACT: Ablation cavity in the right lobe of the liver measures 3.1 x 1.6 cm (series 10 image 47), unchanged.New ablation cavity from interval ablation of previous HCC inferiorly measures 3.8 x 2.5 cm. No nodular arterial enhancement or washout to suggest residual disease. Intrinsic T1 signal compatible with blood products.No new lesions.Cirrhotic morphology. Patent hepatic vasculature. No biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Cystic lesion in the pancreatic head is unchanged, measuring 1.3 x 0.9 cm (series 9 image 22), likely a side branch IPMN. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: Prominent periportal and gastric hepatic lymph nodes, unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.New RFA ablation cavity with no specific evidence of residual disease.2.Stable additional RFA patient cavity with no specific evidence of recurrence.3.Stable probable IPMN.


Instruction: Generate impression based on medical findings.

Input: 24 year-old female with swelling and pain, evaluate for injury TENDONS: The extensor and flexor tendons are intact. The Achilles tendon appears within normal limits.LIGAMENTS: The lateral collateral ligaments, including the ATFL and PTFL are intact. The medial collateral ligaments appear within normal limits.ARTICULAR SURFACES AND BONE: Moderate tibiotalar joint effusion. The tibiotalar articular surface appears within normal limits.ADDITIONAL

Output: 1. Moderate tibiotalar joint effusion2. Mild soft tissue edema adjacent to the base of the fifth metatarsal without underlying osseous abnormality.


Instruction: Generate impression based on medical findings.

Input: 71-year-old female with history of ovarian cancer. Known liver lesions causing biliary obstruction, stent placement on 11/10/08. Now has increased pain and worsening LFTs. Rule out pneumobilia. Evaluate for stent obstruction. ABDOMEN:LUNG BASES: There are small bilateral pleural effusions, unchanged.LIVER, BILIARY TRACT: Redemonstration of multiple solid hypodense lesions. Reference right hepatic lesion is stable measuring 3.5 x 3.2 cm on image 32/96. There an internal biliary stent but no pneumobilia. The intrahepatic portions of metallic stents are in the posterior segment of the right hepatic lobe and anterior segment of the right hepatic lobe. Distal metallic stents are in the duodenum. Contrast noted previously in the anterior segment of the right intrahepatic ducts is not seen. Persistent left intrahepatic ductal dilatation is unchanged. Interval increase in the right-sided intrahepatic ductal dilatation.Gallbladder is surgically absent. Tumor invasion in main portal vein as seen on MRI is redemonstrated (series 4, image 39/96)SPLEEN: Calcified splenic granulomata are unchanged. Large metastatic lesion in the spleen measuring 5.7 x 5 cm on image 25/96 is unchanged.PANCREAS: Mild pancreatic ductal dilatation in the pancreatic head is unchanged.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Reference lymphadenopathy encasing hepatic artery in the porta hepatis is grossly unchanged, measuring 2.5 x 1.7 cm image 39/96. There is new small amount of fluid in the hepatoduodenal ligament. There is thin, curvilinear fluid noted in medial segment of the second portion of duodenum. Adjacent inflammatory fat stranding in the second and third portions duodenum is noted. No free air is seen. Findings suggest inflammatory change from instrumentation without complete perforation.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1) Stable internal biliary stent location with interval increase in right intrahepatic biliary dilatation and persistent left intra-hepatic biliary dilatation and decreased pneuomobilia suggests stent occlusion. 2) Stable inflammatory change and wall edema in second portion of duodenum from recent ERCP, but no free air is seen to suggest duodenal perforation.3) Stable small bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: 72-year-old male with history of renal cell carcinoma with new lung lesions ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Numerous lesions in the liver are unchanged. Largest ones are cysts. Some of them are too small to accurately characterize but stable.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Nodular left adrenal gland is unchanged. Nodular right adrenal gland is also unchanged.KIDNEYS, URETERS: Status post right nephrectomy. Cysts involving the left kidney are unchanged. Punctate, nonobstructing stone in the lower pole of the left kidney is unchanged.RETROPERITONEUM, LYMPH NODES: Borderline enlarged retroperitoneal lymph nodes are unchanged. For reference purposes a left para-iliac node measures 1.2 by 0.9 cm on image number 91, series number 3.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate gland. Enhancement in the posterior peripheral zone is suspicious for prostate cancer. Correlation with PSA level and/or pelvic MRI is recommended.BLADDER: Diffuse wall thickening of the bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No significant change in the abdomen. Enhancement within the posterior peripheral zone although prostate, suspicious for prostate cancer. Correlation with PSA values and/or biopsy results is recommended.


Instruction: Generate impression based on medical findings.

Input: Reason: right shoulder tendinopathy and OA, now limited ROM, assess for rotator cuff tear History: as above. ROTATOR CUFF: Partial thickness bursal tearing of the distal supraspinatus tendon. Infraspinatus tendinosis without discrete tear. The teres minor and subscapularis tendons are intact. Diffuse fatty muscle atrophy. SUPRASPINATUS OUTLET: Mild AC joint osteoarthritis. Small amount of fluid within the subacromial subdeltoid bursa, similar to prior.GLENOHUMERAL JOINT AND GLENOID LABRUM: The labrum is small and irregular likely representing degeneration. Subcortical cysts along the superior humeral head.BICEPS TENDON: The long head of the biceps tendon is intact. ADDITIONAL

Output: 1.Partial thickness bursal surface tearing of the supraspinatus tendon.2.Mild AC joint osteoarthritis.


Instruction: Generate impression based on medical findings.

Input: 66-year-old male with urethral cancer at the meatus. PELVIS:PROSTATE/SEMINAL VESICLES: Prostatomegaly measuring 5.6 x 4.6 cm in transaxial dimension. T1 hyperintense focus in the region of the epididymis likely representing a epididymal cyst. Small hydroceles bilaterally.There is no gross abnormal focal or nodular enhancement of the urethra. The known cancer of the distal urethral meatus is not well visualized.BLADDER: No significant abnormality noted.LYMPH NODES: No significant inguinal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No inguinal lymphadenopathy. 2.The known cancer of the distal urethral meatus is not well visualized.


Instruction: Generate impression based on medical findings.

Input: Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: stroke workup History: left sided weakness, dysphagia, slurred speech The examination is limited secondary to extensive motion artifact. There is a confluent area of encephalomalacia and gliosis in the right paramedian parietal lobe, cingulate gyrus, medial temporal lobe, and occipital lobe. There is associated ex vacuo dilatation of the right lateral ventricle. There are also small areas of encephalomalacia in the left basal ganglia and corona radiata with ex vacuo dilatation of the frontal horn. There is a background of scattered cerebral white matter T2 hyperintensity. There is a new area of T2/FLAIR hyperintensity involving the right thalamus and paramedian right midbrain. There is no evidence of acute ischemia. There are no masses, mass effect or midline shift. The skull, paranasal sinuses, and mastoid air cells are unremarkable.

Output: 1. No evidence for acute ischemia.2. Right PCA territory encephalomalacia with chronic infarcts in the left basal ganglia and corona radiata superimposed upon a background of small vessel ischemic disease, similar to prior examination.3. A focus of T2/FLAIR hyperintensity involving the right thalamus and right paramedian midbrain appears new since prior examination and may relate to interval area of now subacute ischemia since prior MRI from 7/5/2016.3. MRA and MRV could not be obtained due to patient's inability to tolerate the examination.


Instruction: Generate impression based on medical findings.

Input: Reason: staging exam, biopsy scheduled History: Prostate cancer treated with cyberknife in 2010, rising PSAFrom Epic: Gleason 4+3=7 treated with Cyberknife radiotherapy without ADT in May 2010. His PSA did nadir at approximately 2 ng/mL and has had consecutive rising PSA values since October 2015. The most recent PSA is 7.95 ng/mL on 4/14/2016. PELVIS:PROSTATE:Prostate Size: 4.5 x 3.9 x 4.6 cmPeripheral Zone: T1 signal in the right mid peripheral zone associated with heterogeneous T2 signal likely represents hemorrhage. There is ill-defined hypointense T2/ADC signal in the mid to base peripheral zone, medial to the region of hemorrhage. No measurable lesion is identified.Central Gland: BPH nodules.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: Enhancement at the hamstring origins may reflect tendinosis. Enhancement within the sacrum adjacent to the right sacroiliac joint is likely degenerative.OTHER: No significant abnormality noted.

Output: 1.Limited exam due to therapy-related changes. There is ill-defined low T2/ADC signal in the central peripheral zone of the mid gland and base but no definite measurable lesion. However, given the pronounced therapy-related changes, cancer in this region cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: 63-year-old female patient with left medial knee pain. Evaluate for left medial meniscus tear. MENISCI: There is abnormal increased T2 intrasubstance signal within the medial meniscus that is compatible with degeneration. There is blunting of the free edge of the body of the medial meniscus, best seen on coronal images, likely due to a degenerative tear. The anterior horn of the lateral meniscus is diminutive and there is abnormal increased T2 intrasubstance signal within the lateral meniscus that is compatible with degeneration.ARTICULAR CARTILAGE AND BONE: There is tricompartmental osteophyte formation. There is marked chondral thinning of the medial and lateral facets of the patella with a full thickness chondral fissure in the lateral facet with underlying edema-like signal in the subchondral marrow. There is partial thickness chondral thinning of the weightbearing portions of the medial and lateral compartments. There is a full-thickness chondral defect in the lateral femoral trochlea, measuring 1.2 cm on sagittal images, with underlying reactive edema-like marrow signal abnormality.LIGAMENTS: There is fluid signal about the iliotibial band of the lateral collateral ligament complex that may represent inflammatory changes. Increased T2 signal within the anterior cruciate ligament is compatible with mucoid degeneration. The posterior collateral ligament, medial collateral ligament, and patellar retinacula are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Osteoarthritis with chondromalacia as described above. 2.Degeneration of the medial and lateral menisci with blunting of the free edge of the body of the medial meniscus, which may represent a degenerative tear.3.Fluid signal about the iliotibial band is suggestive of inflammatory changes.


Instruction: Generate impression based on medical findings.

Input: 57 year-old female with ataxia and cerebellar mass. Evaluate for evolution of cerebellar mass. Again noted is a posterior fossa space-occupying hypodense lesion measuring 3.5 x 2.6 cm and appears minimally decreased in size since the previous examination (Image 10; series 4). This previously measured 3.8 x 2.7 cm. There is an adjacent focus of hyperdensity in the right cerebellum measuring 1.9 x 0.8 cm which appears unchanged compared to previous study (Image 7; series 4). This previously measured 1.7 x 0.8 cm. Differential considerations include hematoma versus mass lesion with petechial hemorrhage. Contrast enhanced MRI could be considered for further evaluation of this finding. Again noted is effacement of the fourth ventricle associated with moderate supratentorial ventriculomegaly and transependymal edema which appears unchanged when compared to the previous study. These findings are likely related to obstructive noncommunicating hydrocephalus. The calvaria and skull base are radiographically normal. The visualized paranasal sinuses are normally pneumatized. There is opacification of the left mastoid air cells and thickening of the left external auditory canal which appears unchanged compared to previous study. Incidental noted is made of bilateral lens prosthesis. There is calcification within the left globe.

Output: There is no significant interval change since the previous examination. 3.5 cm space-occupying mass lesion within the left cerebellum with an associated hyperdensity which could represent blood product or mass lesion with mineralization. There is associated effacement of the fourth ventricle and moderate noncommunicating hydrocephalus unchanged since the previous examination. MRI examination for further characterization is recommended.


Instruction: Generate impression based on medical findings.

Input: Abdominal painEXAMINATION: MR enterography without and with IV contrast date ABDOMEN:LIVER, BILIARY TRACT: Normal hepatic size and enhancement without focal lesion. No intrahepatic or extrahepatic biliary ductal dilatation. The gallbladder is normal.SPLEEN: Normal size and enhancement.PANCREAS: Normal enhancement.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Symmetric enhancement without focal lesion or significant hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy.BOWEL, MESENTERY: Increased enhancement of the descending colon, without significant bowel wall thickening or abnormal motility. No surrounding fat stranding. No other areas of abnormal enhancement, wall thickening, dilation, or abnormal motility. No evidence of obstruction.BONES, SOFT TISSUES: No focal osseous lesion.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Distended and normalLYMPH NODES: No significant lymphadenopathy.BOWEL, MESENTERY: Increased enhancement of the descending colon, without significant bowel wall thickening or abnormal motility. No surrounding fat stranding. No other areas of abnormal enhancement, wall thickening, dilation, or abnormal motility. No evidence of obstruction.BONES, SOFT TISSUES: No focal osseous lesions.OTHER: No significant free pelvic fluid.

Output: Descending colonic wall enhancement, inflammatory in nature, without significant bowel wall thickening or surrounding fat stranding.


Instruction: Generate impression based on medical findings.

Input: 37 years Male (DOB:5/15/1978)Reason: pre-op for craniotomy History: pituitary lesionPROVIDER/ATTENDING NAME: DOROTA K HAVLIN CHRISTOPHER L KRAMER There is a 28 mm AP dimension x 38 mm with x 47 mm height sellar and suprasellar nonenhancing mass present associated with expansion of the sella and scalloping of the clivus. Since the prior exam signal characteristics within the mass of changed. It is more heterogeneous on T2 with some hemorrhagic foci on the current exam which were not present on the prior. The optic chiasm is displaced superiorly in the third ventricle is compressed superiorly. The patient is status post transsphenoidal surgery. There is fat packing present within the sphenoid sinus and nasopharynx narrowing the nasopharynx.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 partially opacified. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Large sellar and suprasellar mass displacing the optic chiasm, hypothalamus and third ventricle with associated scalloping of the clivus and bony remodeling of the sella..2.Status post recent transsphenoidal surgery. 3.Narrowing of the nasopharynx.4.Examination was performed for stereotactic guidance.


Instruction: Generate impression based on medical findings.

Input: History of sarcoidosis. Evaluate for biliary obstruction or other abnormality. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in size with a nodular contour compatible with chronic liver disease. Recanalized periumbilical vein.Note is made of bilateral percutaneous biliary drains with mild adjacent signal changes of the parenchyma. There is persistent irregular narrowing and moderate dilatation of the common bile duct and intrahepatic biliary tree. There is mild enhancement of the biliary tree centrally, unchanged and likely related to chronic mild inflammation. No new dominant stricture or discrete mass lesion. No suspicious arterial enhancing lesion.The main portal vein and intrahepatic portal branches are chronically occluded with extensive perigastric peripancreatic, intrapancreatic and splenic collaterals.SPLEEN: The spleen is normal in size morphology and signal intensity.PANCREAS: The main pancreatic duct appears to drain into the minor papilla compatible with pancreas divisum. No main pancreatic ductal dilatation or focal lesion. There are extensive intra and peri-pancreatic collateral vessels. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral cortical scarring is noted. Splenorenal shunt is again 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: Mild morphologic changes of cirrhosis, chronic portal vein occlusion and stable dilatation/stricturing of the common bile duct and intrahepatic biliary tree. No suspicious hepatic lesion.


Instruction: Generate impression based on medical findings.

Input: 58 year old female with syncope and history of TIA. Evaluate for any neurologic disease Non-enhanced CT of brain:No evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.Cortical sulci, ventricular system and all CSF cisterns remain within normal range for patient's stated age of 78. The gray -- white matter differentiation is preserved.Calvarium, visualized orbits, paranasal sinuses and mastoid air cells are unremarkable. Considering significant provided clinical data and unremarkable prior CT examination from 11 -- 27 -- 10 follow-up with an MRI is recommended.Minimal suspected a small vessel disease that was reported on prior study is not identified on this exam however the quality of this exam is suboptimal compared to prior study which may explain this difference.

Output: No evidence of acute intracranial process, mass effect, midline shift or hydrocephalus. Recommend follow-up with an MRI examination considering lack of any definitive finding on two CT examination of brain.


Instruction: Generate impression based on medical findings.

Input: 62 year-old female with altered mental status and history of multiple sclerosis. Evaluate for intracranial hemorrhage. There is no evidence of intracranial hemorrhage, mass or edema. Extensive white matter changes are stable when compared to previous examination. No evidence of cortical stroke. If there is clinical concern for acute ischemia an MRI may be considered. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Stable, extensive white matter changes. If there is clinical concern for acute ischemia an MRI may be considered.


Instruction: Generate impression based on medical findings.

Input: Patient with recurrent Ewing sarcoma and status post hemipelvectomy. Please reevaluate BONE AND BONE MARROW: Similar postsurgical changes are again observed involving the right internal hemipelvectomy 2011, including portion of the right iliac wing and ischium resection and superior displacement of the femoral head. Correlation of the osseous structures and prior exams are similar, including deformity of the femoral head. Scattered postsurgical changes including susceptibility artifact and soft tissue deformity appear unchanged in contour and gross appearance. Specifically the surgical incision scar is noted along the right paraspinal musculature extending anterolaterally.And irregular shaped focus of abnormal signal intensity involving the right ischium again appears similar to the prior study with an abnormal signal intensity seen in the right sacral wing. Suspected post treated tumor with mild heterogeneity of the remaining bone marrow appears similar compared to prior studies and again suggesting red marrow recruitment.SOFT TISSUES: Of special note is the abnormal enhancement and signal characteristics observed within the right adductors and piriformis anteriorly and gluteus maximus posteriorly. The edema like appearance remains similar to 11/28/14 and again without a discreet focal mass observed, yet there is a loss of muscle bundle distinction with mild enlargement/fullness without clear evidence of encapsulation. No clear distinct changes to suggest internal hemorrhage. The appearance remains most suggestive of post treatment changes and overall stability from past November.JOINTS: Status post hemipelvectomy and pseudoarticulation appears similar. Suspected reactive synovitis like changes involving the residual articulation. Left hemipelvis is intact.

Output: Extensive postoperative changes as described similar to prior exam. Surrounding edema and enhancement of right hip muscles remain uncertain but presumably related to prior treatment and possibly radiation. No new focal mass or discrete lesion/changes are observed.


Instruction: Generate impression based on medical findings.

Input: There is atlantooccipital assimilation primarily involving the bilateral lateral masses and the occipital condyles. There is crowding of the CSF spaces at the foramen magnum with mildly elongated appearance of the cerebellar tonsils. Measuring from the inferior aspect of the occipital bone, cerebellar tonsillar ectopia measures up to 4 mm, although measuring from the level of the posterior C1 arch which is fused to the occipital bone, cerebellar tonsils do not herniate inferior to it. CSF flow sequence demonstrates focally diminished biphasic flow at the foramen magnum ventrally and dorsally. Atlantodental interval is not well assessed with MRI with appears borderline widened measuring 2 to 3 mm. There is a syrinx in the cervical cord extending from C2 mid dens to the lower C4 level. Syrinx measures up to up to 3 x 4 mm at the mid C3 and upper C4 levels, measured in the AP and transverse dimensions. Vertebral body heights are maintained. There is loss of cervical lordosis. Multilevel degenerative changes are seen including small disc osteophyte complexes at the C3-C4, C5-C6, and C6-C7 levels. There is up to mild spinal canal stenosis and mild to moderate bilateral neural foraminal stenosis at the C5-C6 level. Mild to moderate left and mild right neural foraminal stenosis is present at the C6-C7 level. Spinal canal and neural foramina in the cervical spine are otherwise patent.THORACIC SPINE

Output: 1. Atlantooccipital assimilation with mildly elongated cerebellar tonsils extending to the C1 level. There is crowding of the CSF spaces at the foramen magnum with diminished CSF flow.2. Syrinx in the cervical cord extending from the C2 mid dens to the lower C4 level. There is also trace prominence of the central canal in the thoracic cord. Aforementioned findings are compatible with Chiari I.3. No evidence of tethered cord.4. Mild multilevel degenerative changes as detailed above including mild spinal canal stenosis and mild to moderate bilateral neural foraminal stenosis at the C5-C6 level.5. Borderline widening of the atlantodental interval which can be further assessed with dynamic radiographs as clinically indicated.