Instruction: Generate impression based on medical findings.

Input: 59 year old man with history of anterior mediastinal neuroendocrine tumor with metastatic disease, found to have a right atrial mass on previous imaging, referred for cardiac MRI to better evaluate for etiology. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 58%, the LV end diastolic volume index is 44 ml/m2 (normal range: 74+/-15), the LVEDV is 85 ml (normal range 142+/-34), the LV end systolic volume index is 18 ml/m2 (normal range 25+/-9), the LVESV is 35 ml (normal range 47+/-19), the LV mass index is 36 g/m2 (normal range 85+/-15), and the LV mass is 68 g (normal range 164+/-36). There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is mildly dilated. The interatrial septum is aneurysmal.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 60%, the RV end diastolic volume index is 60 ml/m2 (normal range 82+/-16), the RVEDV is 115 ml (normal range 142+/-31), the RV end systolic volume index is 24 ml/m2 (normal range 31+/-9), and the RVESV is 46 ml (normal range 54+/-17).Right AtriumThe right atrium is at least mildly dilated. There is thickening which appears to be contiguous with the RA free wall which takes up contrast on first-pass perfusion, suggesting some component of vascularity. On late gadolinium enhancement imaging, there is partial contrast uptake, the appearance of which is not consistent with thrombus. Native T1 time in the region of this mass is 1280ms (normal myocardium was 1090ms). Of note, this was seen on previous CT Chest performed in March 2015. In the right atrial appendage, however, there is a more rounded density which does not exhibit late gadolinium uptake; this is suggestive of thrombus.Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are drain normally into the right atrium. There is compression of the SVC.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is a 30 x 30 mm nodule in the right lower lobe adjacent to the right costophrenic angle. There is right pleural thickening and nodularity. There is significant mediastinal soft tissue mass present, the largest of which measures 33 x 22mm with compression of the superior vena cava. There are changes consistent with previous sternotomy. There are numerous vertebral body lesions. There are cystic appearing lesions in the liver. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. Suggest review of previous CT imaging for more detailed description.

Output: 1. Normal sized left ventricle with normal systolic function (EF 58%).2. Normal sized right ventricle with normal systolic function (EF 60%).3. There is thickening which appears to be contiguous with the RA free wall which takes up contrast with first-pass perfusion, suggesting some component of vascularity. On late gadolinium enhancement imaging, there is partial contrast uptake, the appearance of which is not consistent with thrombus but the etiology of the mass is otherwise difficult to discern. Native T1 time in the region of this mass is 1280ms (normal myocardium was 1090ms). 4. In the right atrial appendage there is a more rounded density which does not exhibit late gadolinium uptake; this is suggestive of thrombus.5. Mild aortic regurgitation. 6. Mild biatrial dilation. 7. This constellation of findings suggest thrombus within the right atrial appendage. Given the clinical history of metastatic neuroendocrine disease, as well as evidence of partial vascularity of the mass and differential tissue characteristics from myocardium, differential diagnosis for the RA free wall finding includes malignant invasion of the RA wall versus thickening of the RA wall. 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: Evaluate for progression; stenosis History: neck pain; paresthesias The cervical vertebral bodies are appropriate in overall alignment and height. There is some signal change within the upper thoracic spinal cord and lower cervical spine spinal cord which was also present on the prior exam. It predominantly involves the central portion of the spinal cord.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a disk bulge present at this level associated with small uncovertebral osteophytes.At C5-6 there is no significant compromise to the spinal canal. There is a minor disk bulge present at this level associated with some small endplate and uncovertebral osteophytes and some narrowing of the neural foramina bilaterally with mild encroachment of the exiting nerve roots. Overall there is no significant change when compared to prior exam.At C6-7 there is no significant compromise to the spinal canal . There is a minor disk bulge present at this level associated with some small endplate and uncovertebral osteophytes.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.Single changes within the central portion of the lower cervical spinal cord and upper thoracic spinal cord are stable when compared to the prior exam.2.There some mild degenerative changes present in the cervical spine without significant compromise of the spinal canal or exiting nerve roots. There only mild encroachment of the exiting nerve roots at C5-6 due to degenerative changes.


Instruction: Generate impression based on medical findings.

Input: Reason: Left arm weakness History: Left arm weakness The exam is limited by patient motion.The cervical vertebral bodies are appropriate in overall alignment and height. The patient is status post recent laminectomies and posterior fusion with facet screws and at C2, C3 and C4. Previously noted spinal stenosis at C2-3, C3-4 and C4-5 has been alleviated.The patient has a focal signal hyperintensity at the C3-4 involving predominantly the spinal cord centrally - left more than right. Comparing to the prior exam it appears to have been previously present to some degree (see images 11 on series #4 and #7 of the prior exam) but may have been obscured by the severe spinal stenosis.Detailed evaluation of he neural foramina is partly obscured by patient motion. There are disk bulges present at C3-4, C4-5 , C5-6 associated with loss of disk space height and disk dessication. Bilateral neural foramen encroachment of exiting nerve roots is present at C3-4.The vertebral artery flow voids appear to be intact.

Output: 1.Since the prior exam the patient has undergone multilevel laminectomies and posterior fusion in the upper cervical spine.2.A central spinal cord abnormality at C3-4 eccentric to the left hemicord is more obvious on the current exam. The possibility of progression of edema cannot be excluded. Most likely this is related to spondylitic myelopathy status post decompression. It is conceivable that there is new superimposed injury. Please correlate with clinical exam findings.3.Exam is limited by patient motion which can obscure more subtle abnormalities and changes. The patient was not able to tolerate more imaging.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Evaluate syrinx, structural lesion. Signs and symptoms: Myoclonus and dystonia. Pre and post enhanced brain MRI:No acute intracranial process and negative diffusion weighted series.Examination demonstrates normal anatomical development and morphology of the brain parenchyma and with normal signal intensity on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.No detectable abnormal parenchymal, leptomeningeal, calvarial, or soft tissues of the scalp or retro-orbital enhancement.Normal visualization of signal void of major intracranial arterial branches.Normal signal intensity of the intracranial venous sinuses and with normal pattern of enhancement.Unremarkable orbits, paranasal sinuses and mastoid air cells.Nonenhanced cervical MRI:There is normal anatomical alignment of the vertebral column however with straightening of cervical lordosis.There is generalized uniform smaller than expected caliber of the spinal canal believed to represent a congenital anatomical variation of short pedicles.Foramen magnum is unremarkable.There is normal signal intensity and caliber of cervical and upper most visualized thoracic cord without evidence of syrinx.CSF flow study demonstrate normal biphasic flow through the foramen magnum both anterior and posterior to the cord. There is also detectable biphasic flow through the fourth ventricle.Axial images are degraded due to motion artifact which makes precise assessment for subtle findings including neural foraminal compromise difficult.C2-C3 is unremarkable.C3-C4 demonstrate mild degenerative changes and unremarkable otherwise.C4-C5 demonstrate mild degenerative changes and unremarkable otherwise.C5-C6 demonstrate moderate disc disease with loss of disc height and moderate right neural foraminal compromise.C7 is unremarkable.C7-T1 is unremarkable.

Output: 1.Negative pre and post enhanced brain MRI.2.Nonenhanced cervical MRI demonstrate congenitally small spinal canal. Unremarkable foramen magnum. Normal signal intensity and caliber of the cervical and upper most visualized thoracic cord to T2 level. Mild degenerative changes and unremarkable exam otherwise.3.CSF flow demonstrate biphasic flow through the foramen magnum both anteriorly and posteriorly and through the fourth ventricle.


Instruction: Generate impression based on medical findings.

Input: Unspecified cerebral artery occlusion with cerebral infarctionClinical question: strokeSigns and Symptoms: slurred speech The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There is a small focus of encephalomalacia present along the isthmus of the right cingulate gyrus.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.No evidence for acute ischemic cerebral infarction.2.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 3.Continued evolution of a small infarction involving the isthmus of the right cingulate gyrus


Instruction: Generate impression based on medical findings.

Input: Headache. There are unchanged low-lying cerebellar tonsils, right more than left, with associated pointed morphologies. There is unchanged asymmetric enlargement of the left Meckel's cave, which measures up to 10 mm in width. There is a partially-empty sella. There is prominence of the bilateral optic nerve sheaths and flattening of the optic nerve heads. There is no evidence of intracranial hemorrhage or acute infarct. There is unchanged protrusion of the right posterior cingulate gyrus across the right tentorial leaflet. There is also protrusion of a portion of the inferior right temporal gyrus into an arachnoid granulation along the right transverse sinus. In addition, the bilateral transverses sinuses appear to be constricted. There is minimal nonspecific white matter T2 hyperintensity. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift.

Output: Unchanged enlargement of the left Meckel's cave, low-lying cerebellar tonsils, partially-empty sella, as well as optic nerve sheath prominence. The constellation of findings may indicate pseudotumor cerebri perhaps superimposed upon Chiari I malformation.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Evaluate for stroke, edema. Signs and symptoms: Worsened hypertension and bradycardia. Nonenhanced brain MRI:There is no detectable acute intracranial process and diffusion weighted images are negative.Extensive confluent periventricular and mildly subcortical nonspecific FLAIR hyperintensity of the white matter is noted. There is resultant mild ex vacuo dilatation of the lateral ventricles.Minimal similar signal changes in bilateral basal ganglia and pons is also noted. Findings are nonspecific however at this age group off and represent microvascular ischemic changes.No detectable cortical signal abnormality and unremarkable bilateral cerebellum and vermis.The signal void of major intracranial arterial branches are identified.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells.

Output: 1.No acute intracranial process and negative diffusion-weighted images.2.Extensive periventricular and to a lesser degree bilateral basal ganglia and pontine FLAIR hyperintensity suggestive of advanced chronic nonhemorrhagic small vessel ischemic strokes as detailed.


Instruction: Generate impression based on medical findings.

Input: 39 year old male with a history of left ventricular hypertrophy, syncope, SVT, atypical chest pain. Negative coronary angiogram. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 58%. There is mild concentric hypertrophy(IVSd=11 mm). The LV end diastolic volume index is 80 ml/m2 (normal range: 74+/-15), the LVEDV is 187 ml (normal range 142+/-34), the LV end systolic volume index is 34 ml/m2 (normal range 25+/-9), the LVESV is 79 ml (normal range 47+/-19), the LV mass index is 48 g/m2 (normal range 85+/-15), and the LV mass is 115 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Native pre-contrast myocardial T1 relaxation time ranges between 950-1050 ms (normal), extra-cellular volume fraction is normal (27%), T2-ratio is 1.6 (normal), global relative enhancement ration is 1.1 (normal). No evidence of myocardial iron overload based on normal T2-star relaxation time. All of these suggest that there is no underlying myocardial fibrosis, inflammation, or infiltration. Left AtriumThe left atrium is normal in size (75ml). Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 46%, the RV end diastolic volume index is 110 ml/m2 (normal range 82+/-16), the RVEDV is 258 ml (normal range 142+/-31), the RV end systolic volume index is 60 ml/m2 (normal range 31+/-9), and the RVESV is 140 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal left ventricular size and normal systolic function (LVEF 58%) with mild concentric left ventricular hypertrophy. No evidence of underlying myocardial fibrosis inflammation or infiltration based on multiple quantitative myocardial tissue characterization parameters.2. Normal right ventricular size with mildly reduced systolic function (RVEF 46%). 3. Mild right atrial dilationI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: 75 years Male (DOB:3/3/1940)Reason: cognitive decline, h/o diabetes - assess for cerebrovascular disease History: memory declinePROVIDER/ATTENDING NAME: JAMES A. MASTRIANNI JAMES A. MASTRIANNI The right basal vein of Rosenthal is markedly dilated along its junction with the deep middle cerebral vein. There is no associated aneurysm present involving the right basal vein of Rosenthal immediately adjacent to the right middle cerebral artery M1 segment origin. This aneurysm measures approximately 11 mm in size. There is some suggestion of some dilated left ventricular striate arteries at the right M1 segment.The CSF spaces are appropriate for the patient's stated age with no midline shift. The Excel note is made of cavum septum pellucidum and cavum vergae.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.A dilated the right basal vein of Rosenthal, an aneurysm and dilated contiguous right arteries suggest arteriovenous malformation with aneurysm formation. An MRA of the brain will be helpful to further evaluate this. This finding was communicated to Dr. Mastrianni at the time the exam. The patient was recalled before the left the MRI area so that the MR angiogram could be performed.2.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on medical findings.

Input: Male 60 years old Reason: r/o internal derangement History: pain and swelling in the knees, worse on the left. Hx of left Baker's cyst on the left MENISCI: There is extensive intermediate to high signal within the posterior horn of the medial meniscus, which extends to the articular surface consistent with complex/degenerative tearing. The lateral meniscus appears intact, although there are several parameniscal cysts at the origin of the anterior horn of the lateral meniscus, as well as mild fraying along its medial surface.ARTICULAR CARTILAGE AND BONE: There is focal full-thickness cartilage loss along the weightbearing surface of the medial femoral condyle, with adjacent irregular cartilage thinning anterior and posterior to this focal full-thickness defect. There is mild irregularity of the patellar articular cartilage.LIGAMENTS: The anterior cruciate and posterior cruciate ligaments are intact. The medial and lateral collateral ligament complexes are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Extensive complex/degenerative tearing of the posterior horn of the medial meniscus.2.Focal full-thickness cartilage loss as well as adjacent cartilage thinning of the weightbearing surface of the medial femoral condyle.3.Small joint effusion and large Baker's cyst.


Instruction: Generate impression based on medical findings.

Input: History of infertility and possibly uni-cornuate uterus on hysterosalpingogram. PELVIS:UTERUS, ADNEXA: Anteverted anteflexed uterus. It demonstrates a normal bicornuate morphology.The uterus measures 9.0 x 4.3 cm in the sagittal plane.The endometrial cavity is normal in thickness measuring 8 mm and demonstrates normal homogeneously hyperintense T2-weighted signal intensity.The majority of the inner myometrium/junctional zone measures up to 9 mm in thickness, above normal within the indeterminate range. There are regions of the inner-outer myometrial junction which are indistinct. Adjacent to the right anterior fundal/body aspect of the inner myometrium/junctional zone there is a poorly marginated T2 hypointense focus with small T2-weighted hyperintense cystic components measuring 2.4 x 1.7 cm (series 901/29) which may represent focal adenomyosis. There are no definite T1-weighted hyperintense foci to confirm hemorrhage from small ectopic endometrial glands.Additional 9 mm probable fibroid at the right fundus (series 701/24).Multiple cervical nabothian cysts are noted. The cervix, vaginal canal and parametrial soft tissues are otherwise unremarkable.The right ovary measures 3.0 x 2.4 cm it contains numerous follicles. The left ovary measures 3.4 x 3.1 cm and contains numerous follicles.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Trace simple appearing free pelvic fluid is within physiologic limits. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No evidence of a congenital mullerian duct abnormality.2.Suspected diffuse adenomyosis with focal adenomyomata 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: 65 year-old man with ischemic cardiomyopathy referred for EF assessment. Left VentricleThe left ventricle is moderate-severely dilated with severely reduced systolic function. The overall LV ejection fraction is 20%, the LV end diastolic volume index is 141 ml/m2 (normal range: 74+/-15), the LVEDV is 341 ml (normal range 142+/-34), the LV end systolic volume index is 112 ml/m2 (normal range 25+/-9), the LVESV is 271 ml (normal range 47+/-19), the LV mass index is 117 g/m2 (normal range 85+/-15), and the LV mass is 282 g (normal range 164+/-36). There is global hypokinesis with regional variation. The interventricular septum is dyssynchronous. Left AtriumThe left atrium is moderate-severely dilated. Right VentricleThe right ventricle is visually mildly dilated with a moderately reduced systolic function. The overall RV ejection fraction is 28%, the RV end diastolic volume index is 95 ml/m2 (normal range 82+/-16), the RVEDV is 231 ml (normal range 142+/-31), the RV end systolic volume index is 69 ml/m2 (normal range 31+/-9), and the RVESV is 167 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation, but the severity of aortic regurgitation can be underestimated by the MRI pulse sequence used in this study.Mitral ValveThe mitral valve opens widely and there is at least mild-moderate mitral regurgitation which could be underestimated. Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation, but the severity of pulmonic regurgitation can be underestimated by the MRI pulse sequence used in this study.Tricuspid ValveThe tricuspid valve opens widely. There is at least mild-moderate tricuspid regurgitation which could be underestimated.AortaThe ascending aorta is dilated. The maximum diameter is 41mm. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is dilated and has a diameter of 33mm.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSternal wires are noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Moderate-severe LV dilatation with a severely reduced systolic function (LVEF 20%).2. Visually mild RV dilatation with a moderately reduced systolic function (RVEF 28%).3. Biatrial dilatation.5. At least mild-moderate mitral amd tricuspid regurgitation.6. Ascending aorta is 41mm in maximum diameter.


Instruction: Generate impression based on medical findings.

Input: 64 years Male (DOB:5/29/1952)Reason: GBM s/p chemo XRT. Please eval History: headache.PROVIDER/ATTENDING NAME: STEVEN J. CHMURA RIMAS V. LUKAS There is redemonstration of a T2 and FLAIR hyperintense lesion involving gray and white matter located the anterior aspect of the left temporal lobe which currently measures 52 x 33 mm axial dimensions and on the prior exam the same location measured the same dimensions. The patient is status post left-sided temporal lobe surgery with a hemosiderin tract in the middle of the patient's left temporal lobe lesion. There is some associated mass effect with some mild uncal herniation.Is a cystic lesion present in the right pharyngeal mucosal space measuring 10 x 17 mm in axial dimensionsNormal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are opacified. The visualized portions of the orbits are intact.

Output: 1.There is a left temporal lobe mass present which is stable compared to the prior exam. This is known to represent a glioblastoma. No contrast enhanced imaging was performed due to the patient's inability to cooperate further with the exam. The mass associated with mass effect and mild uncal herniation.2.Motion artifact is present which may obscure more subtle abnormalities.


Instruction: Generate impression based on medical findings.

Input: anoxic brain injury, posterior circulation stroke, unresponsive There is no evidence of acute ischemic or hemorrhagic lesion on this scan.FLAIR images show patchy bilateral high signal intensity lesion on periventricular white matter indicating non specific small vessel disease. Gradient echo images show various sized susceptibility lesions on bilateral hemispheres white matter. Differential diagnosis include amyloid angiopathy, small chronic hemorrhagic lesions, parenchymal calcifications or cavernomas less likely. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal bilateral ICAs, MCAs and ACAs. Bilateral PCAs are fetal origin. Vertebrobasilar system appears to be normal. No aneurysm. No intracranial arterial luminal stenosis.3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. Bilateral vertebral artery origins are not shown but source image analysis revealed no significant luminal stenosis.

Output: 1. No evidence of acute ischemic stroke. No evidence of acute hemorrhagic lesion.2. Non specific small vessel ischemic disease.3. Multiple lesions on bilateral hemispheres demonstrating susceptibility artifacts, possibilities include amyloid angiopathy, multiple chronic hemorrhagic lesions, multiple calcifications or cavernomas less likely.4. No intracranial aneurysm. No intracranial arterial stenosis. Normal extracranial cervicocarotid arterial system.


Instruction: Generate impression based on medical findings.

Input: 74 years Female (DOB:2/22/1942)Reason: new lung cancer diagnosis, initial staging History: n/aPROVIDER/ATTENDING NAME: JYOTI D PATEL JYOTI D PATEL There is susceptibility effect along the surface of the right frontal lobe representing siderosis. There is encephalomalacia involving the right inferior parietal lobule and the posterior aspect of the right temporal lobe and posterior lateral aspect of the right occipital lobe. There is associated ex vacuo effect along the right lateral ventricle.There are numerous serpiginous flow-voids centered in the right cerebellar hemisphere associated with a large draining vein. The serpiginous flow-voids encompasses an area measuring approximately 11 x 7 mm axial dimensions.The right middle cerebral artery is not readily identified. The left middle cerebral artery appears attenuated distal to the mid M1 segment. The left anterior cerebral artery appears attenuated proximally. Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal right anterior and left posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. Findings suggest fetal origin of the right posterior cerebral artery with a small right P1 segment and stenosis or occlusion at the p2 segment and a fairly large left posterior cerebral artery with a large left posterior communicating artery. Findings also suggest leptomeningeal collateral reconstitution of the left anterior cerebral artery.The visualized portions of the paranasal sinuses demonstrate small 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.Findings are suggestive of occlusion of the right middle cerebral artery and high-grade stenoses along the proximal left anterior cerebral artery and stenosis along the left middle cerebral artery as well as stenosis or occlusion of the right posterior cerebral artery at the P2 segment. If clinically appropriate an MR angiogram or CT angiogram may be helpful to further evaluate this. Leptomeningeal reconstitution of the anterior cerebral artery territory and possibly left middle cerebral artery territory are suggestive of misery perfusion.2.Findings raise the question of small arteriovenous malformation versus developmental venous anomaly located in the right cerebellar hemisphere. An MRA or a CTA may be helpful to further evaluate this.3.There is encephalomalacia involving much of the right cerebral hemisphere predominantly along the right middle and posterior cerebral artery territories.4.Siderosis along the right frontal lobe implies prior subarachnoid hemorrhage.5.Findings were discussed with Dr Jyoti Patel at the time of this interpretation.


Instruction: Generate impression based on medical findings.

Input: Metastatic base of tongue squamous cell carcinoma, treated with pembrolizumab, palliative RT to left orbit, and started palliative carbo/paclitaxel/cetuximab. The left cerebellar tonsil lesion is now intrinsically T1 hyperintense with associated susceptibility effect and measures up to 5 mm in diameter. There is no evidence of other infratentorial or supratentorial lesions. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is interval decrease in size of the enhancing left posterior globe lesion, measuring up to 3 mm in thickness, previously 7 mm. The left lateral retinal detachment has resolved. There is mild diffuse conjunctival and lacrimal gland enhancement, likely related to radiation therapy effects. The skull and scalp soft tissues are grossly unremarkable. There is a small left maxillary sinus retention cyst. There are left mastoid air cell effusions.

Output: 1. Interval evolution of the appearance of the subcentimeter left cerebellar tonsil metastasis, likely due to treatment effects. 2. Interval decrease in size of the left ocular metastasis with improvement of the associated retinal detachment.


Instruction: Generate impression based on medical findings.

Input: Lung cancer with new headaches. There is a new widely diffuse left calvarial lesion with irregular, enhancing left holocerebral convexity extra-axial tumor extension that measures up to 10 mm in thickness along the inferior left temporal lobe. There are foci of susceptibility effect associated with portions of the tumor, which may represent hemorrhage and/or calcification. There is also a fluid collection in the left frontal convexity subdural space that measures up to 8 mm in thickness. There is overall mild mass effect upon the underlying brain parenchyma and slight midline shift to the right. In addition, the tumor appears to compress or perhaps invade the left sigmoid sinus. The left calvarial tumor also extends into the overlying subgaleal space, measuring up to 7 mm in thickness. There are smaller enhancing lesions within the right and mid frontal calvarium without epidural or subgaleal extension. There is no evidence of intraparenchymal brain tumors or acute infarct. There is no herniation. The major cerebral flow voids are intact. There is scattered mucosal thickening within the left mastoid air cells, which may be related to compromise of the regional venous drainage. The orbits and paranasal sinuses are grossly unremarkable.

Output: New widely diffuse left calvarial metastasis with epidural tumor extension that measures up to 10 mm in thickness, with foci of susceptibility effect associated with portions of the tumor, which may represent hemorrhage and/or calcification. A fluid collection in the left frontal convexity subdural space that measures up to 8 mm in thickness may represent an epitumoral cyst. There is overall mild mass effect upon the underlying brain parenchyma and slight midline shift to the right. The left calvarial tumor also extends into the overlying subgaleal space, measuring up to 7 mm in thickness. There are smaller metastatic lesions within the right and mid frontal calvarium without epidural or subgaleal extension.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o meniscal tear or injury History: knee pain MENISCI: The medial and lateral meniscus appear intact.ARTICULAR CARTILAGE AND BONE: No full-thickness or near full-thickness articular cartilage defects are identified.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Edema within the superolateral aspect of Hoffa's fat pad is nonspecific but can be seen in patellar tendon-lateral femoral condyle friction syndrome, particularly if there is anterior knee pain.


Instruction: Generate impression based on medical findings.

Input: Unspecified epilepsy without mention of intractable epilepsy [345.90], Reason for Study: ^Reason: focal lesion History: right abd pain Brain MRINo evidence of acute ischemic or hemorrhagic lesion.There is about 7 mm sized focal patchy enhancing lesion on the right cerebellar hemisphere (series 3801, image 27/80). Possibility of this lesion include capillary telangiectasia, small developmental venous anomaly or an artifact. The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.C-spine MRIThe cranial-cervical junction is normal. There is normal cervical lordosis. The cervical spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The intervertebral discs demonstrate normal T2 intensity and height with no evidence of disc herniation. There are 12 mm x 15 mm sized right thyroid gland mixed intensity lesion as well as about 4 mm sized multiple centimeters nodular lesions on the left thyroid gland. Further investigations using ultrasound examination may need to be considered.There is no evidence of abnormal enhancement, cord compression or mass. Minimal bulging of disc C5-6 and C6-7 were seen without evidence of spinal canal stenosis or neuroforaminal stenosis.T-Spine MRIThere is normal thoracic kyphosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing, cord compression, or myelopathy. The intervertebral discs demonstrate normal T2 intensity and height with no evidence of disc herniation. The paraspinal soft tissues are unremarkable.There is no evidence of abnormal enhancement, cord compression or mass.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Right cerebellar hemisphere patchy enhancing lesion diagnostic possibilities include capillary telangiectasia, developmental venous anomaly or an artifact.3. Normal cervical and thoracic MRI.4. Multiple variable sized thyroid nodules as described above, further imaging evaluation using ultrasound can be considered if clinically indicated.


Instruction: Generate impression based on medical findings.

Input: Patient with worsening confusion and headaches. History of metastatic renal cell cancer with brain metastases. Undergoing whole brain radiation. Rule out bleed, edema, increased intracranial pressure. Nonenhanced CT of brain:Examination demonstrate a slightly high density mass in the basal cistern measuring 13 mm x 16.6-mm in transaxial dimension. There is evidence of edema in the hypothalamic and bilateral basal ganglia. Considering patient's provided clinical history of malignancy this finding could represent a metastatic focus. Further follow-up with an MRI is recommended to exclude other lesions in this location.Shunted lateral ventricles with complete collapse of right lateral ventricle and normal appearing third ventricle and left lateral ventricle.Foci of encephalomalacia in the right frontal lobe under a right frontal craniectomy may represent site of prior surgical intervention for removal of tumor. There is no evidence of hemorrhage or midline shift.Calvarium demonstrates right high convexity frontal craniotomy and is otherwise negative.Limited view of paranasal sinuses and mastoid air cells are unremarkable. Limited view of orbits are negative.

Output: 1.High density mass in the basal cistern/hypothalamic region with surrounding edema highly concerning for metastatic lesion considering provided history of renal cell cancer.2.No evidence of any additional metastatic foci and no evidence of midline shift or hydrocephalus.3.High convexity right posterior frontal encephalomalacia under a right frontal craniectomy.4.Calvarium, paranasal sinuses and mastoid air cells are intact.


Instruction: Generate impression based on medical findings.

Input: Metastatic NSCLC to the brain. Status post stereotactic radiosurgery to the left frontal and left occipital regions and subsequently to right frontal and left occipital lesions.Additional clinical history from electronic medical records:L frontal and L occipital regions SRS 20 Gy x 1 on 7/8/15R frontal and L occipital regions SRS 20 Gy x 1 on 11/18/15 The ringlike contrast enhancing lesion in the left occipital lobe has increased in size, now measures up to 15 mm transaxially, compared to 5 mm previously. The contrast-enhancing rim is associated with susceptibility effect. There is also surrounding confluent T2-hyperintensity, consistent with edema.The small left frontal lesion with associated susceptibility effect is not significantly changed in size but shows more pronounced peripheral contrast enhancement, especially posteriorly, on axial imaging. However, the axial imaging on today's examination was obtained in a slightly more delayed fashion compared to on the previous examination, which may account for the apparent increase in contrast enhancement. The surrounding confluent T2-hyperintensity is unchanged to very minimally increased.The tiny right frontal lesion with associated susceptibility effect remains unchanged, without associated contrast enhancement or surrounding edema. Other similar small lesions in the deep posterior left parietal lobe and the superficial right middle frontal gyrus remain unchanged, also without associated contrast enhancement or surrounding edema.There is no acute infarct or acute intracranial hemorrhage. Tiny CSF intensity focus in the left midbrain is unchanged, and may represent a tiny chronic lacunar infarct or atypical dilated perivascular space. The left frontal developmental venous anomaly is unchanged. Major intracranial vascular flow voids are preserved. There is incidental finding of a small defect involving the anterior aspect of the falx.Orbits show findings of previous bilateral lens replacement. The mastoid air cells are clear. There is trace mucosal thickening in the ethmoid sinuses.

Output: 1.Since February 9, 2016, there has been increase in the size of the ring-enhancing lesion in the left occipital lobe with increased associated edema, which may reflect evolving post stereotactic radiosurgery change. However, progression of the metastasis can also appear similar. Continued follow-up is recommended.2.The small left frontal lesion shows apparent minimal increase in the peripheral contrast enhancement but this might be artifactual, from differences in technique as described above. The associated surrounding T2-hyperintensity is unchanged or very minimally increased.3.The other 2 right frontal and 1 left parietal lesions remain unchanged, without associated contrast enhancement or surrounding edema.


Instruction: Generate impression based on medical findings.

Input: Pituitary gland is normal in size and demonstrates normal homogeneous enhancement. There is no evidence for pituitary or suprasellar mass. The optic chiasm, cavernous sinuses and intracranial portions of the optic nerves are normal in appearance.There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are no areas of abnormal parenchymal signal. 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 skull, paranasal sinuses, and scalp soft tissues are unremarkable. The midline structures and craniocervical junction are within normal limits.

Output: No evidence of pituitary abnormality.


Instruction: Generate impression based on medical findings.

Input: There are no diffusion-weighted abnormalities to suggest acute ischemia. There is a subtle, small focus of increased T1 signal and enhancement within the cortex of the left postcentral gyrus (image 12, series 301 and image 137, series 12 one) with associated minimal increased FLAIR signal. This region appears to correlate to an area of hypoattenuation seen on a prior outside hospital CT. There is no other identifiable area of abnormal T2 signal or enhancement within the brain. 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. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear.

Output: Small focus of abnormal T1 & T2 signal with subtle enhancement within the cortex of the left postcentral gyrus may represent laminar necrosis secondary to a resolving subacute infarct. A follow up MRI of the brain with contrast is recommended in 6 months to evaluate for resolution.


Instruction: Generate impression based on medical findings.

Input: History of retroperitoneal liposarcoma. Follow-up exam. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology. There is minimal diffuse parenchymal signal loss in the out of phase images which suggest mild hepatic steatosis. No focal lesion. No intrahepatic or extra hepatic biliary ductal dilatation.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: Throughout the retroperitoneum and there is abnormal curvilinear increased T2 signal and postcontrast enhancement extending from the level of the duodenal sweep down into the pelvis, right greater than left. There are more focal nodular/masslike components. This includes a mass immediately anterior to the infrarenal aorta which measures 6.4 x 2.7 cm (series 1705 image 165). There is an additional large enhancing mass lesion anterior to the left psoas muscle (series 1/9/2001 image 145), which measures 7.5 x 3.8 cm. There is a smaller nodule anterolateral to the right psoas muscle measuring 1.9 x 2.0 cm (series 1704 image 29). The abnormal signal and enhancement extends down into the right hemipelvis compatible with additional tumor involvement.BOWEL, MESENTERY: Postoperative changes from an end to side anastomosis in the descending colon.BONES, SOFT TISSUES: Diastases of the rectus muscles.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: Post surgical changes in the rectosigmoid colon and tumor extension into the pelvis as described above.BONES, SOFT TISSUES: Fat-containing right inguinal hernia.OTHER: No significant abnormality noted.

Output: Extensive retroperitoneal tumor involvement extending from the level of the duodenal sweep into the right and left hemipelvis as described. This includes both masslike lesions as well as poorly defined, sheet-like stranding and enhancement throughout the retroperitoneal fat compatible with more infiltrative tumor.


Instruction: Generate impression based on medical findings.

Input: Male; 74 years old. Reason: intermediate risk prostate cancer with cT2a disease (palpable nodule in right lobe). Please evaluate History: prostate cancer PELVIS:PROSTATE:Prostate Size: 5 x 6.6 x 5.9 cm. Peripheral Zone: 1 x 0.9 cm lesion in the right mid prostate gland peripheral zone medially with low T2 signal and restricted diffusion, compatible with prostate cancer (series 904/244).Central Gland: Heterogeneous.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Right mid prostate gland peripheral zone in prostate cancer as detailed above.


Instruction: Generate impression based on medical findings.

Input: Reason: rule out renal recurrence History: hx of renal cell carcinoma sp nephrectomy ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post left nephrectomy. No evidence of recurrent disease in the operative bed.Stable small right renal lower pole cyst. No right hydronephrosis or suspicious lesion.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

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


Instruction: Generate impression based on medical findings.

Input: Chronic alcoholic pancreatitis. Pancreatic pseudocyst post drainage and stent removal. Evaluate pancreatic parenchyma ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: There is interval removal of a cystogastrostomy. There is a focal area of necrosis and main pancreatic duct stricture at the site of prior cystogastrostomy. There is discontinuity of the pancreatic duct, with upstream ductal dilatation. There is increased size of a pancreatic tail collection measuring 4.0 x 1.6 cm, which extends superiorly and is contiguous with the main pancreatic duct. ADRENAL GLANDS: There is a small left adrenal nodule measuring 1.0 cm. Normal right adrenal gland. KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Progression of chronic pancreatitis with focal pacreatic necrosis and pancreatic stricture at site of prior cystogastrostomy and increased size of pancreatic tail collection.


Instruction: Generate impression based on medical findings.

Input: There is a diffusely anomalous gyration pattern of the bilateral posterior perisylvian regions, which is compatible with polymicrogyria. There are also more focal areas of grey matter that extend toward the margins of the lateral ventricles bilaterally, which are compatible with transmantle dysplasia. There is an absent septum pellucidum and mild focal prominence of the temporal horn of the right lateral ventricle associated with mild malrotation of the right hippocampus. The ventricular system is otherwise not significantly enlarged. The corpus callosum, posterior pituitary bright spot, as well as the optic nerves and optic chiasm are grossly intact. There is a small focus of encephalomalacia in the lateral aspect of the inferior right cerebellar hemisphere and perhaps mild hypoplasia of the inferior cerebellar vermis. However, the brainstem appears to be intact. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are unremarkable. There is ethmoid sinus mucosal thickening and fluid within the mastoid air cells bilaterally.

Output: 1. Congenital bilateral perisylvian syndrome. 2. Nonspecific ethmoid sinus mucosal thickening and fluid within the mastoid air cells bilaterally.


Instruction: Generate impression based on medical findings.

Input: 54-year-old female presents with right knee pain. MENISCI: There is a radial tear near the posterior root of the medial meniscus. Lateral meniscus is normal in appearance.ARTICULAR CARTILAGE AND BONE: Full-thickness cartilage loss in the weightbearing zone of the medial compartment as well as full-thickness loss particularly along the medial facet of the patellofemoral cartilage.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Posterior root radial tear of the medial meniscus with full-thickness cartilage loss in the medial tibiofemoral compartment and medial facet of the patellofemoral cartilage.


Instruction: Generate impression based on medical findings.

Input: NSCLC with brain metastases status post WBRT. There is essentially resolved vasogenic edema in the anterior right frontal lobe with minimal associated residual tumor. There is interval decrease in size of a mass centered in the right posterior cingulate gyrus with extensive persistent surrounding vasogenic edema. There is no significant interval change in the subcentimeter lesion in the right inferior temporal gyrus. There is a new punctate lesion with vasogenic edema in the right superior temporal gyrus. There is minimal midline shift to the right. There is no evidence of an acute infarct. There is diffuse prominence of the right cerebellar hemisphere folia with associated diffuse T2 hyperintensity.

Output: 1.Evidence of mixed treatment response of the intracranial metastases.2. Unchanged right cerebellar hemisphere encephalomalacia.


Instruction: Generate impression based on medical findings.

Input: Thoracic spine:Marrow signal abnormality is noted throughout all osseous elements providing MRI evidence for diffuse metastatic disease.Osseous expansion causes left T6/7, bilateral T7/8, and left T8/9, foraminal narrowing.There has been collapse of the T11 vertebral body with retropulsion of fragments 5 mm posteriorly in a right paramedian direction causing slight flattening of the anterior right hemicord, however without cord signal abnormality or compression. Associated osseous expansion results in T10/11 and T11/12 foraminal narrowing bilaterally, worse on the right. Associated soft tissue extends beyond the vertebral body cortices anteriorly from T9 through T12.There are bilateral pleural effusions as demonstrated previously, right much greater than left.Lumbar spine:Marrow signal abnormality is noted throughout all osseous elements providing MRI evidence for diffuse metastatic disease.There has been near complete central collapse of L4, with MRI findings consistent with prior vertebroplasty as better demonstrated on the x-ray dated 4/24/2014. This is associated with approximately 4 mm retropulsion of fragments in the left paramedian direction which results in moderate left lateral recess and neural foraminal stenosis.At L3/4 there is mild bilateral neural foraminal stenosis from diffuse annular disc bulge. Degenerative changes are noted elsewhere in the lumbar spine, however without significant resulting associated stenosis.

Output: 1.Marrow signal abnormality is noted throughout the thoracic spine, lumbar spine, and visualized pelvis, providing MRI evidence for diffuse metastatic disease.2.Osseous expansion causes left T6/7, bilateral T7/8, and left T8/9, foraminal narrowing.3.There has been collapse of the T11 vertebral body with retropulsion of fragments 5 mm posteriorly in a right paramedian direction causing slight flattening of the anterior right hemicord, however without cord signal abnormality or compression. Associated osseous expansion results in T10/11 and T11/12 foraminal narrowing bilaterally, worse on the right. Associated soft tissue extends beyond the vertebral body cortices anteriorly from T9 through T12.4.There has been near complete central collapse of L4, with MRI findings consistent with prior vertebroplasty as better demonstrated on the x-ray dated 4/24/2014. This is associated with approximately 4 mm retropulsion of fragments in the left paramedian direction which results in moderate left lateral recess and neural foraminal stenosis.5.At L3/4 there is mild bilateral neural foraminal stenosis from diffuse annular disc bulge.6.There are bilateral pleural effusions as demonstrated previously, right much greater than left.


Instruction: Generate impression based on medical findings.

Input: Female 28 years old Reason: eval for sacral fracture History: tailbone pain for months hurts to sit BONE MARROW:There is an abundance of red marrow in the lower lumbar spine.SOFT TISSUES: No significant abnormality noted. JOINTS: No significant abnormality noted.ADDITIONAL

Output: No evidence of sacral fracture. No specific findings to account for patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Evaluate for etiology of breakthrough seizure. Signs and symptoms: Breakthrough seizures, patient has known metastatic esophageal cancer with left brain met. Pre-and post-enhanced brain MRI:Examination demonstrates no evidence of an acute intracranial hemorrhage, midline shift or hydrocephalus.A necrotic rim enhancing tumor in the left post central gyrus is again identified. It measures at 13.8 x 14.4 x 16.7-mm and demonstrates very subtle interval increased size since prior study measurement of 13 x 14.8 X 15.6-mm. Large focus of surrounding vasogenic edema demonstrates no significant change since prior exam and results in regional mass-effect without mass effect on the lateral ventricle or midline shift.There is no detectable additional foci of parenchymal or leptomeningeal enhancement.Finding suggestive of mild chronic non-hemorrhagic small vessel ischemic strokes are again noted and diffusion-weighted images are negative.Calvarium and soft tissues of the scalp are unremarkable and without abnormal enhancement.Unremarkable images through the orbits and included axial fat sat post enhanced series. Excellent all paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal patterns.

Output: 1.No detectable acute intracranial process. 2.Left post central gyrus rim enhancing metastatic lesion demonstrates subtle interval increased size (likely as result of treatment) however with stable surrounding vasogenic edema with resultant regional mass-effect and no midline shift.3.Negative diffusion weighted images and finding suggestive of mild chronic small vessel ischemic strokes


Instruction: Generate impression based on medical findings.

Input: 15 year old with cerebral palsy, fever, septic shock, sinusitis, and osteomyelitis of the frontal bone. Evaluate for intracranial extension. MRI Face/Sinus:Redemonstration of extensive mucosal thickening and hyperenhancement of the left frontal sinus with a defect in the anterior left frontal sinus. The large left lobulated mixed T2/flair fluid intensity peripherally enhancing subgaleal collection in the supraorbital region containing foci of air is not significantly changed. There is mild restricted diffusion in the subgaleal lesion, left frontoethmoidal sinuses and left maxillary sinus. There are surrounding inflammatory changes and phlegmonous enhancement in the adjacent subcutaneous tissues around the left subgaleal abscess. The right frontal sinus again demonstrates moderate mucosal enhancement and thickening which is unchanged. The left frontoethmoidal recess demonstrates mucosal thickening and hyperenhancement with mixed fluid intensity on T2/flair and the right appears patent. There is moderate-severe left and mild-moderate right patchy ethmoidal air cell involvement. The sphenoid sinuses demonstrate moderate mucosal thickening bilaterally with opacification of the sphenoethmoidal recesses. There is lobulated mucosal thickening and hyperenhancement of the maxillary sinuses with near complete opacification. The right mastoid air cells and middle ear are essentially completely opacified with suggestion of possible chronic inflammatory changes. There is thickening of the outer table of the frontal calvarium.MRI Brain:Redemonstrated is a left parietal approach ventriculostomy catheter with the tip unchanged in position just anterior to the left foramen of Monro. There is thinning of the cortical mantle and the ventricular enlargement is stable. There is no midline shift or mass effect. There is no intracranial hemorrhage. There are no areas of abnormal enhancement intracranially. However, the cranium along the posterior aspect of the left frontal sinus demonstrates marrow replacement best seen on T1 axial series 701, image 9, and is compatible with osteomyelitis. There is no abnormal intracranial enhancement or intracranial extension of the sinus disease. The major cerebral flow voids are intact. MRI Orbits:No abnormal mass or abnormal enhancement is seen. No abnormal signal intensity is evident. 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.Findings are again consistent with Potts puffy tumor involving the left frontal sinus associated with adjacent osteomyelitis as well as overlying subcutaneous abscess. There is no convincing evidence for intracranial or intraorbital extension.2.Findings compatible with osteomyelitis involving the outer cranium along the posterior aspect of the left frontal sinus. There is no evidence of intracranial extension. 3.Left parietal approach ventriculostomy catheter with stable moderate dilatation of the ventricles4.Additional diffuse paranasal sinus, right mastoid air cell and right middle ear opacification has not significantly changed.


Instruction: Generate impression based on medical findings.

Input: No intracranial mass or mass effect. No evidence of infarct or hemorrhage. No extra-axial collections. No hydrocephalus. Sulcation and myelination are within normal limits. Midline structures including the corpus callosum are within normal limits. Bilateral hippocampi are symmetric in size and signal characteristics with preserved internal architecture. No findings to suggest cortical dysplasia, gray matter heterotopia, or other abnormalities to suggest seizure focus are appreciated. Major flow-voids are preserved. Cerebellar tonsils are in normal position without evidence of Chiari malformation, as questioned. CSF flow sequence demonstrates good biphasic flow at the foramen magnum ventrally and dorsally.CERVICAL SPINE

Output: 1. MRI of the brain is within normal limits. No findings to suggest seizure focus. Cerebellar tonsils are in normal position without evidence of Chiari malformation.2. Unremarkable exam of the spine with no evidence of tethered cord.3. Urinary bladder is distended with prominence of the ureters and renal collecting system. Findings are nonspecific. Correlate with post voiding ultrasound as clinically indicated.


Instruction: Generate impression based on medical findings.

Input: Male 9 years old Reason: concern for splenic vein thrombus; please evaluate splenic vein with MRV History: grade 2 esophageal varices on EGD, past evidence of splenic infarct on imaging ABDOMEN:Motion artifact limits sensitivity of examination.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: The spleen is markedly enlarged, with multiple small, subcentimeter foci of decreased signal intensity.PANCREAS: Pancreas is normal in appearance.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of bowel obstruction.BONES, SOFT TISSUES: No significant abnormality noted.MRV: The portal vein, splenic vein, hepatic veins, and IVC are patent with no evidence of thrombus.OTHER: Small to moderate amount of ascites is present.

Output: 1.Patent vasculature with no evidence of thrombus, specifically no splenic vein thrombus.2.Splenomegaly.3.Small to moderate ascites.


Instruction: Generate impression based on medical findings.

Input: Left hip femoral acetabular impingement. ACETABULAR LABRUM: The labrum appears intact without discrete tears.ARTICULAR CARTILAGE AND BONE: Bone marrow signal is within normal limits. The articular cartilage is grossly unremarkable.SOFT TISSUES: The visualized musculature and soft tissues are within normal limits. ADDITIONAL

Output: 1.No labral tear identified.2.Please see CT 6/16/2015 for details regarding femoral acetabular impingement.


Instruction: Generate impression based on medical findings.

Input: 16 years Female (DOB:5/3/2000)Reason: 16yo F with h/o nonruptured cerebral aneurysm coiled and stented 8/2015 and 7/2016 with 2 days of nausea and lightheadedness, new headache today History: 2 days of nausea and lightheadedness, new headache todayPROVIDER/ATTENDING NAME: DAVID HOWES DAVID HOWES MRI of the brainNo diffusion weighted abnormalities are appreciated. Comparing CSF flow artifacts in the fossa present. The change compared to 10/13/2015 overall pattern. Differences signal intensity arterial wall to differences in imaging parameters there is no change in the susceptibility artifacts adjacent to the aneurysm. Outside the confines of the appearing aneurysmal space is no convincing evidence for subarachnoid hemorrhage either. The aneurysm is known to have a calcified wall.There is a 42x33x36mm sagittal dimension premedullary and prepontine mass (thrombosed aneurysm with coils distally and proximally) with heterogenous signal on T1 and T2 associated with flow voids. Much of the signal is hyperintense on T1WI.The brainstem is displaced and compressed posteriorly by the mass and drapes over the mass. The inferior aspect of the 4th ventricle is narrowed and the foramina of Luschka are distorted. There is mixed signal along the periphery of the mass on SWI phase imaging with some bright signal and some dark signal some of which is opposite in signal on the corresponding magnitude SWI images (suggesting peripheral calcification). The vertebral arteries and basilar artery are contiguous with this mass.A similar signal characteristic well-circumscribe mass is present in the left upper carotid space measuring 16x22xmm. It is stable compared to the prior exam.The temporal horns of the lateral ventricles are dilated. Biventricular diameter on coronal imaging at the level of foramen of Monro is currently 38 mm October 40 1/3 ventricular diameter is currently 9 mm and was previously 11 mm.There are several supratentorial periventricular and subcortical white matter T2 and FLAIR hyperintense lesions without diffusion restriction.Normal vascular flow voids are present in the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal right vertebral artery, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.The patient is status post embolic coil occlusion of a 46x36x35mm giant vertebrobasilar aneurysm and occlusion of the LVA intracranially. Stents are present in the RVA across the origin of the aneurysm. There is minimal opacification at the base of the aneurysmThere is a 26x26x16 mm LICA cervical segment aneurysm redemonstrated which has a different opacification pattern on the current exam relative to the prior exam.The anterior communicating artery is identified. The posterior communicating arteries are identified. There is extracranial origin of the right PICA. The LVA is diminutive distally. The left PICA has extracranial origin.

Output: 1.Status post stent assisted embolic coil occlusion of a vertebrobasilar junction giant aneurysm and embolic occlusion of the left vertebral artery (LVA) distal to the PICA. Since the prior exam there is no change. There is only minimal filling at the base of the aneurysm.2.The overall dimensions of the aneurysm and the mass effect remain stable compared to the prior exam. The ventricles are stable.3.Stable size of LICA cervical segment dissecting aneurysm.4.The lateral ventricles although mildly dilated are slightly smaller on the current exam when compared to the October exam.5.There is no convincing evidence for subarachnoid hemorrhage.6.A preliminary report was provided via text message to Anita Bhansali around midnight following the exam.


Instruction: Generate impression based on medical findings.

Input: 9 years Female (DOB:3/24/2006)Reason: patient with chronic headaches, holocephalic with visual changes with the HA History: holocephalic headaches at times waking patient up in the middle of the nightPROVIDER/ATTENDING NAME: CHALONGCHAI PHITSANUWONG CHALONGCHAI PHITSANUWONG The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a small mucous retention cyst in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: No abnormal intracranial mass lesion is appreciated to explain the patient's headaches associated with visual changes.


Instruction: Generate impression based on medical findings.

Input: 51 year old female status post lumpectomy and XRT for DCIS, here for screening.Family history of breast cancer diagnosed in sister at age of 35. Breast parenchyma is almost entirely fat in both breasts.Minimal parenchymal enhancement is noted bilaterally. Despite a partial contrast extravasation, there is still contrast visualized within breast blood vessels and tissues. Postsurgical changes seen in the left upper outer breast compatible with history of lumpectomy. No suspicious nodular enhancement near the lumpectomy site. In the right 10 o'clock position there is a small intramammary lymph node, also present on prior mammograms.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: Postsurgical changes of the left breast. No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on medical findings.

Input: 75-year-old male with history of colon cancer, metastatic to the liver. Patient status post liver resection now with elevated alkaline phosphatase. Evaluate for etiology. ABDOMEN:LUNG BASES: Bilateral small pleural effusions with the right decreased in size compared to previous examination.LIVER, BILIARY TRACT: Postoperative changes of right hepatectomy. There is thrombus in the hepatic vein in the medial hepatic segment 4A/4B. The thrombus occludes the segment 4 hepatic vein; this is due to narrowing at the confluence of the veins near the dome. This causes perfusion changes in segment 4 of the liver. The segment 2 vein is also narrowed but patent. The IVC is narrowed at the intrahepatic portion. Additionally, there is a fluid collection near the resection margin measuring 3.8 x 1.2 cm (series 6, image 22). Right subdiaphragmatic drain is present.No significant change in T2 hyperintense segment 4 lesion consistent with a cyst measuring 1.3 x 1.3 cm (series 6, image 29), previously measuring 1.5 x 1.2 cm. An additional smaller T2 hyperintense lesion in segment 2 of the liver consistent with a cyst is stable (series 6, image 30).SPLEEN: No significant abnormality noted.PANCREAS: Pancreas is atrophic but otherwise appears normal.ADRENAL GLANDS: Adrenal glands are normal in size and morphology bilaterally.KIDNEYS, URETERS: Kidneys enhance symmetrically without evidence of hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Visualized bowel is moderately distended measuring up to 3.5 cm with transition point likely in the right lower quadrant. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Thrombus in the hepatic vein in the medial hepatic segment 4A/4B.2.Segment 2 vein is also narrowed but patent.3.Fluid collection near the resection margin measuring up to 3.8 cm.4.Postoperative changes of right hepatectomy without suspicious hepatic lesions. 5.Findings consistent with small bowel obstruction.6.Bilateral small pleural effusions.Findings relayed to Dr. Xue over the phone at approximately 5:05 PM.


Instruction: Generate impression based on medical findings.

Input: Left optic neuritis with scotoma. Orbits: The globes and optic nerves appears unremarkable. The ocular adnexa are intact. There is no evidence of mass lesions or abnormal intraorbital enhancement.Brain: There is a T2 hyperintense enhancing lesion in the right pituitary lobe that measures up to 6 mm. There is also a non-enhancing focus in the right lateral pituitary lobe that measures up to 4 mm. There is no mass effect upon the optic apparatus. There is no evidence of intracranial hemorrhage or acute infarct. There are a few punctate foci of T2 hyperintensity in the cerebral white matter, without associated 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 skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: 1. An enhancing lesion in the right pituitary lobe that measures up to 6 mm may represent a microadenoma. A non-enhancing focus in the right lateral pituitary lobe that measures up to 4 mm may represent a cystic microadenoma.2. A few punctate foci of T2 hyperintensity in the cerebral white matter are nonspecific.3. The orbits are unremarkable.Discussed with Dr. Reder at 8:40 AM on 1/9/15.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: Unspecified dementia without behavioral disturbance [F03.90], Reason for Study: ^Reason: memory loss, r/o vascular dementia History: memory loss. There is no evidence of acute ischemic or hemorrhagic lesion.Multifocal patchy scattered FLAIR high signal intensities on bilateral periventricular white matter and centrum semiovale indicate nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. Opacification on the left ethmoid sinus and frontal sinus are seen.

Output: 1. Nonspecific small vessel ischemic disease.2. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on medical findings.

Input: Tongue pain and burning. The tongue and other oral cavity structures appear unremarkable. There is no evidence of mass lesions. There is no evidence of measurable mass lesions or significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable. The osseous structures are unremarkable. The airways are patent. The imaged intracranial structures and orbits are unremarkable. There is a small retention cyst in the left maxillary sinus.

Output: No evidence of mass lesions in the tongue.


Instruction: Generate impression based on medical findings.

Input: posterolateral ankle pain and swelling. Assess peroneal tendons, posterior subtalar joint and achilles tendon TENDONS: The Achilles is normal. The remaining tendons of the ankle are also normal in appearance. No evidence of tenosynovitis.LIGAMENTS: The anterior talofibular ligament and lateral collateral complex is intact. No abnormality of the ligaments.ARTICULAR SURFACES AND BONE: Edema is present within the posterior calcaneus with a T1 and T2 hypointense stress fracture line through the body of the calcaneus extending from the superior surface, inferiorly to the mid body. The stress fracture is nondisplaced and in anatomic alignment. In the inferior lateral portion of the talus there is bone marrow edema without evidence of fracture. No additional areas of bone marrow edema or fracture.ADDITIONAL

Output: Nondisplaced linear stress fracture through the posterior calcaneus.


Instruction: Generate impression based on medical findings.

Input: Neck and arm pain, C6 distribution weakness, left upper extremity. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is mild reversal of cervical lordosis with apex at the C4-C5 level. Alignment is otherwise maintained. There is nonspecific subcentimeter focus of low T1 and T2 signal involving the anterior inferior aspect of the C6 vertebral body with adjacent T2 hyperintensity which may be on a degenerative basis but not well evaluated by MRI.The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Small disc osteophyte complex with mild effacement of the ventral thecal sac. There is moderate narrowing of the left neural foramen related to uncovertebral hypertrophy and facet arthropathy. Overall no significant spinal canal or right neural foraminal stenosis.C4-5: Small disc osteophyte complex with effacement of the ventral thecal sac. There is mild left neural foraminal narrowing related to uncovertebral hypertrophy and facet arthropathy. Overall no significant stenosis of the spinal canal or right neural foramen.C5-6: Small disc osteophyte complex with effacement of the ventral thecal sac. There is mild to moderate left neural foraminal narrowing related to uncovertebral hypertrophy and minimal right neural foraminal narrowing. Overall no significant spinal canal stenosis.C6-7: Small disc osteophyte complex with partial effacement of the ventral thecal sac. There is mild to moderate left neural foraminal narrowing related to uncovertebral hypertrophy. Overall no significant spinal canal stenosis or right neural foraminal narrowing. C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Multilevel degenerative changes in the cervical spine. There is varying mild to moderate degrees of neural foraminal narrowing on the left as detailed above.2. There is partial effacement of the ventral thecal sac related to small disc osteophyte complexes and reversal of cervical lordosis. Dorsal thecal sac remains patent without significant spinal canal stenosis overall at any level.


Instruction: Generate impression based on medical findings.

Input: 51-year-old female with a history of multiple sclerosis presents with paresthesias, evaluate for progression. Please note that differences in technique and magnet strength slightly limits comparison with the prior study.MRI brain: There is a moderate degree of periventricular and subcortical white matter lesions as well as minimal corpus callosum lesions with some lesions perpendicularly oriented to the lateral ventricles. A prominent left cerebellar lesion is again identified. Overall the previously described lesions are stable, with slight increased size and conspicuity of some lesions. There is corresponding T1 hypointensity. There is no significant contrast enhancement associated with these lesions. No new lesions are identified.Normal vascular flow is present in the distal carotid and vertebral arteries, basilar artery, and the proximal anterior, middle, and posterior cerebral arteries. There is also normal vascular flow voids in the internal cerebral veins and superior sagittal sinus.There is a bony excrescence arising from inner table of the right parietal bone which is hyperintense on T1 and T2 and may represent a benign bony lesion such as an osteoma.MRI cervical spine: The cervical spine is in normal alignment, with a normal cervical lordosis. The vertebral body and disk heights are well-maintained. Minimal central disc protrusions are again noted in the mid-cervical spine. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There is no pathological enhancement. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the cervical spine. MRI thoracic spine: The thoracic spine is in normal alignment, with a normal thoracic kyphosis. The vertebral body and disk heights are well-maintained. Again seen is a subtle area of T2 hyperintensity within the dorsal cord at the T6-T7 level. There is no pathological enhancement. No additional lesions are identified. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine.

Output: 1. Mild T1 burden and moderate T2 burden of demyelinating disease within the brain, including involvement of infratentorial structures. Overall, findings are stable with only minimal progression of a few lesions.2. Stable appearance of nonenhancing T2 hyperintense demyelinating cord lesion at T6-T7 without new spinal cord lesions identified.


Instruction: Generate impression based on medical findings.

Input: Lumbosacral radiculitis with radiation down left leg. Re-assess lumbar degenerative disk disease. 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 redemonstration of loss of disc space height, disc desiccation and a diffuse disc bulge associated with effacement of the fat at the left lateral recess and extension of disc material into the neural foramina bilaterally. There are associated endplate osteophytes as well. There is redemonstration of mild facet and ligamentum flavum hypertrophy at this level. Overall there is no significant interval change when compared to the previous exam.At L4-5 there is redemonstration of bilateral facet hypertrophy and ligamentum flavum hypertrophy which has mildly progressed since the prior exam. There is no significant compromise to spinal canal or exiting nerve roots at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is mild facet hypertrophy present at this level which has not changed substantially compared to the previous examAt L2-3 there is no significant compromise to spinal canal or neural foramina. There is mild ligamentum flavum hypertrophy at this level which has not changed substantially compared to the previous. There are new endplate reactive changes present at this level associated with a disc bulge and some mild narrowing of th neural foramina. The endplate reactive changes are heterogeneous signal on T2 and low signal on T1.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is a new Schmorl's node present at T12-L1 associated with some adjacent marrow signal changes which are low signal on T1 and high signal on T2There is a left renal lesion which is bright on T2 and low signal on T1 which suspect was present on the prior exam but is only included on the very top image of this exam as well as a prior exam. Most likely this represents a renal cyst but is incompletely evaluated on this exam.

Output: 1.There is mild encroachment of the nerve roots at the left lateral recess at L5-S1 due to degenerative changes which is stable compared to the previous exam. 2.There is redemonstration of multilevel degenerative changes present in the lumbar spine which are not associated with compromise to spinal canal or exiting nerve roots. There is some progression of facet hypertrophy at L4-5 but otherwise no substantial change. There is also endplate reactive change at L2-3 as well as Schmorl's node at T12-L1 which has progressed since the prior exam and appears to be in a somewhat subacute stage.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old, with right-sided lumbar back pain. A mild scoliotic curvature of the thoracic lumbar spine is seen. Alignment is otherwise unremarkable. Vertebral body height and morphology are normal.Hemangiomas are present within the T10 and L1 vertebral bodies. There may be mild fatty degenerative signal abnormality along the superior L4 endplate. Note is made, however, of STIR hyperintense signal within the right L4 pedicle (see image 17 series 4) compatible with edema. This is seen in the context of marked facet arthropathy at L4-5.The visualized spinal cord and conus are unremarkable. Additional details pertaining to the spinal canal are as follows:T12-L1: L1-2: Facet hypertrophy with small effusions. No significant spinal canal stenosis. Moderate left and mild right foraminal narrowing. L2-3: Facet hypertrophy and ligamentum flavum thickening. No significant spinal canal stenosis. Mild left foraminal narrowing.L3-4: Facet hypertrophy, worse on the left, and ligamentum flavum thickening. Mild bulging disc. Mild generalized spinal canal stenosis. Severe left and moderate right foraminal narrowing. L4-5: Marked bilateral facet hypertrophy. Ligamentum flavum thickening. Mild bulging disc. Mild generalized spinal canal stenosis. Severe right and moderate left foraminal narrowing. L5-S1: Marked bilateral facet hypertrophy. Mild bulging disc. No significant generalized spinal canal stenosis. Moderate bilateral foraminal narrowing.

Output: 1.Marked facet arthropathy is evident at L4-5. Edema within the right L4 pedicle may be reactive to this arthropathy.2.Moderate to severe posterior element hypertrophy is seen at additional levels as above.3.Relatively mild degenerative disc disease is seen without evidence of high-grade spinal canal stenosis.


Instruction: Generate impression based on medical findings.

Input: Reason: fell on left knee History: has difficulty walking and swelling above the patella MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There is blistering and fraying of the articular cartilage of the medial patellar facet with edema-type signal in the underlying bone. Otherwise, the articular cartilage is unremarkable.LIGAMENTS: There is minimal edema along the superficial band of the MCL as well as the posterior oblique ligament which may represent sprain in the appropriate clinical context, but the medial collateral ligament is otherwise intact. The lateral collateral ligament is intact. EXTENSOR MECHANISM: The quadriceps and patellar tendons appear intact. There are enthesopathic changes affecting the anterior patella as seen on recent radiographs. There is edema in the soft tissues anterior to the patella as well as the patellar tendon, indicating inflammation, perhaps a bursitis. Furthermore, the fibers of the quadriceps continuation anterior to the patella appear focally disrupted, suggesting a partial tear.ADDITIONAL

Output: 1.Edema anterior to the patella and the patellar tendon suggests inflammation, perhaps a mild bursitis. Furthermore, the fibers of the quadriceps continuation anterior to the patella appear focally disrupted, suggesting a partial-thickness tear.2.Degeneration of the articular cartilage along the medial patellar facet with edema in the underlying bone.3.Moderate to large joint effusion and other findings as above.


Instruction: Generate impression based on medical findings.

Input: Low back pain, myeloma Lumbosacral spine: Mild degenerative disc disease affects L5-S1 and there is mild loss of height of the superior endplate of L1 which appears similar to the exam dated 11/20/2015. The marrow abnormalities as described on the comparison MRI are not well appreciated on this exam. The remaining vertebral body heights and alignment are preserved.Pelvis: The bones are demineralized. Evaluation of the sacrum is limited secondary to overlying bowel gas. There are deformities of the left superior and inferior pubic rami relating to healed fractures. A large lucency adjacent to the left sacroiliac joint represents an area of known myelomatous involvement. There is otherwise no evidence of an acute fracture or malalignment.

Output: 1. Lumbosacral spine: Mild loss of height of the superior endplate of L1 which is unchanged from prior exams. There is otherwise no acute osseous abnormality.2. Pelvis: Healing/healed fractures of the left inferior and superior rami with unchanged appearance of left iliac lesion.


Instruction: Generate impression based on medical findings.

Input: Migraine with aura There is a focal relatively well-circumscribed about 5 mm sized high signal intensity lesion on FLAIR and T2 weighted image on the right hippocampal gyrus. The lesion is not enhancing and does not show any evidence of local mass effect or surrounding edema. Comparing to prior scan, considering the difference of imaging acquisition technique, there is no significant interval change in terms of size, and MR characteristics.There is no evidence of acute ischemic or hemorrhagic lesion. There is no evidence of abnormal enhancement.There is no evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No interval change of right hippocampal gyrus high signal intensity lesion on FLAIR in terms of size and MR characteristics since prior scan.No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on medical findings.

Input: Male, 30 years old, history of Ewing's sarcoma, status post cryoablation in January of 2014, with findings concerning for progressive disease on a scan from July 2014, status post second cryoablation in August 2014, assess for progression of disease, recent cryoablation resulted in paralysis. Again seen is the sequelae of prior ablation and cement placement within the T10 vertebral body. This includes bilateral transpedicular access tracts and low signal centrally within the vertebral body likely related to the presence of cement. There is abnormal STIR signal and enhancement involving this vertebral body extending into the pedicles not significantly changed since 11/19/2014.Again seen is thinning of the spinal cord at the T10 level. The cord seems to be retracted anteriorly towards the vertebral body as seen before. There is slight decrease in enhancement along the anterior aspect of the cord at this level. Abnormal T2 signal involves the central cord bilaterally as well as ventrally slightly more inferiorly at T10.Interval increase in size of T12 vertebral body lesion, previously 6x6 mm, now 20 x 15 in the AP and craniocaudal dimensions in the sagittal plane. There is also a 9x11 mm lesion measured similarly which is new since 11/19/2014 MRI. These lesions are hypermetabolic on PET from same day.Elsewhere, there signal characteristics are unremarkable. There is minimal loss of height at T10 involving the superior endplate which is stable to minimally worse than prior. Vertebral body heights are otherwise preserved. Spinal alignment is anatomic. The remainder of the spinal cord shows normal signal intensity and morphology. No evidence of spinal canal stenosis or neuroforaminal narrowing is detected.

Output: 1. Compared to MRI 11/19/2014, there is progression of osseous metastatic disease in the thoracic spine with enlarging T12 lesion and new T3 lesion. These lesions are hypermetabolic on PET from same day.2. Previously treated enhancing T10 vertebral lesion is not significantly changed. There is minimal depression of the superior endplate which is slightly worse than prior. Otherwise no compression fractures. No epidural tumor. 3. Sequela of prior cryoablation related injury to the thoracic cord with mild cord atrophy and ventral cord enhancement at T10; enhancement is slightly decreased in the interval consistent with evolution of injury.


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. There are numerous bilateral foci of T2/FLAIR hyperintensity in the subcortical and periventricular white matter as well as in the bilateral basal ganglia and left cerebellum, suggestive of moderate age-indeterminate small vessel ischemic disease, appearing similar to slightly increased compared to prior examination. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: 1.No evidence of intracranial metastases.2.Moderate age-indeterminate small vessel ischemic disease appears similar to slightly increased compared to prior examination.


Instruction: Generate impression based on medical findings.

Input: 43 years Female (DOB:12/16/1973)Reason: evaluate for demyelinating disease History: abnormal non-contrast c-spine MRI; asymmetric hyper-reflexia PROVIDER/ATTENDING NAME: NAOUM ISSA SERVICES ANCILLARY Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. There is redemonstration of a globular appearing T2 signal hyperintensity along the posterior midline of the spinal cord extending from approximately C2-3 disc space down to the C6 vertebral level. No abnormal enhancing lesions are appreciated in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There are small uncovertebral osteophytes at this level.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There are small uncovertebral osteophytes at this level.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There are small uncovertebral osteophytes present associated disc material layering in some mild encroachment of the exiting nerve roots.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. There are small disc bulges present at T6-7 T7-8 without significant compromise spinal canal or neural foramina.No abnormal enhancing lesions are appreciated in the thoracic spine.

Output: 1.There is a T2 hyperintense lesion along the posterior midline of the cervical spinal cord. It has not changed since the prior exam. It does not extend into the thoracic spinal cord. There is no abnormal enhancement to suggest breakdown barrier at this time. The differential diagnosis has not changed. Differential considerations could include demyelination subacute combined degeneration possible cord ischemia post transverse myelitis and vacuolar myelopathy.


Instruction: Generate impression based on medical findings.

Input: Reason: assess for osteomyelitis History: skin infection, elevated CRP, immunosuppressed Right femur:There is a small amount of fluid within the right hip without evidence of a large effusion. There is no bone marrow signal abnormality within the right femur to suggest osteomyelitis. There is diffuse nonspecific subcutaneous edema about the right hip and thigh. There is fatty atrophy of the musculature of the thigh most pronounced within the posterior compartment musculature. There is also enhancing increased signal abnormality within the hamstring musculature which is nonspecific but may reflect a myositis. Although the edema becomes confluent along the posterior and lateral aspect of the distal femur no focal encapsulated fluid collection is identified to suggest abscess formation. Note is made of a large knee joint effusion with thickened enhancing synovium indicating a synovitis.Right tibia/fibula:Severe osteoarthritis affects the right knee. Again seen is the right knee joint effusion with foci of internal debris and synovial enhancement on postcontrast sequences indicating a synovitis. There is a lobulated focus of fluid signal intensity within the proximal fibula likely representing a benign enchondroma, although this could be further evaluated with dedicated radiographs. There is nonspecific enhancing subcutaneous edema along the anterior and medial aspect of the leg. There is associated skin thickening most pronounced along the anterior aspect of the leg. There is soft tissue irregularity in this area which may represent ulceration. There is no bone marrow signal abnormality in the surrounding area to suggest osteomyelitis. There is diffuse fatty atrophy of the imaged musculature of the right leg. There is no focal fluid collection to suggest abscess formation. There is mild increased signal abnormality and fluid sensitive sequences within the anterior tibialis muscle which may reflect a myositis.

Output: 1. Extensive nonspecific enhancing subcutaneous edema about the thigh and leg as described above consistent with the stated history of a cellulitis. There is also signal abnormality within the hamstring musculature and anterior tibialis muscle which may reflect a myositis. There is no bone marrow signal abnormality to suggest osteomyelitis. There is no focal fluid collection to suggest abscess formation.2. Note is made of large bilateral knee joint effusions with thick enhancing synovium indicating a synovitis.3. Lobulated lesion within the proximal right fibula may represent a benign enchondroma, however, this could be further evaluated with dedicated radiographs if clinically warranted.4. Osteoarthritis of the knees and other findings as described above.