Instruction: Generate impression based on medical findings.

Input: Focal left hand dystonia. Asymmetric reflexes. There are multiple punctate T2-hyperintense, non-diffusion restricted foci in the frontoparietal white-matter that are nonspecific but most probably reflect chronic microvascular ischemia. There is no mass effect or space-occupying brain lesion. There is no midline shift. Gray-white differentiation is preserved. There is mild brain volume loss manifested by expansion of the ventricles and CSF-containing spaces above and below the tentorium. There is no intracranial hemorrhage by susceptibility weighted imaging. The intradural right vertebral artery does not show the expected flow-void which may reflect slow flow or thrombosis. Major intracranial vascular flow voids are preserved, otherwise.The mastoid air cells are clear. There is mild mucosal thickening in the paranasal sinuses. There is no gross orbital abnormality. There is incidental finding of torus mandibularis.

Output: 1.Brain shows volume loss and cerebral white-matter findings of chronic microvascular ischemia. There is no focal brain abnormality.2.The intradural right vertebral artery does not show the expected flow-void which may reflect slow/decreased flow or thrombosis. However, there is no acute infarct and this is unchanged since the previous cervical spine MRI from October 8, 2015, therefore perhaps a chronic finding.


Instruction: Generate impression based on medical findings.

Input: Male, 41 years old, with history of medulloblastoma presenting with worsening back pain and lower extremity weakness. Cervical:Postoperative findings are demonstrated in the posterior fossa including evidence of suboccipital craniotomy, encephalomalacia of the cerebellum and prominence of the fourth ventricle. A small pseudomeningocele in the posterior midline operative bed is unchanged measuring up to 7 mm in thickness.The visualized spinal cord demonstrates normal signal intensity and morphology. No evidence of pathologic intracanalicular enhancement is seen.Spinal alignment is anatomic. Vertebral body morphology and signal characteristics are within normal limits. Minimal disk bulging at C6-7 is seen. Otherwise, no evidence of significant degenerative disk disease, spinal canal stenosis or neuroforaminal narrowing is detected.Thoracic:The visualized spinal cord demonstrates normal signal intensity and morphology. No evidence of pathologic intracanalicular enhancement is seen.As before, a T2 hyperintense oval structure along the left second rib is unchanged and may represent a nerve root sleeve cyst or schwannoma.Spinal alignment is anatomic. Vertebral body morphology and signal characteristics are within normal limits. Small paracentral protrusions are redemonstrated on the left T6-7, bilaterally at T7-8 and on the right at T9-10, unchanged. No significant spinal canal or neuroforaminal stenosis is demonstrated.Lumbar:The conus and cauda equina are unremarkable. No pathologic intracanalicular enhancement is seen.Grade 1 anterolisthesis of L5 relative to S1, and bilateral L5 pars interarticularis defects, are redemonstrated. Otherwise, vertebral body morphology and signal characteristics are within normal limits. Disk uncovering and disk bulging at L5-S1 is unchanged. No significant spinal canal stenosis is seen. The L5-S1 neural foramen are mildly narrowed.

Output: 1. No evidence of metastatic disease in the spine.2. No significant spinal canal stenosis or other findings are seen which would account for the patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: 24-year-old female with a prior episode of right hip osteomyelitis in 2012 with new right hip pain and fever for 2 days. The right hip appears normal. There is a trace amount of fluid seen within the joint, appearing similar to the other side, but no joint effusion is evident. There is no enhancement to suggest a synovitis nor is there edema/enhancement of the surrounding soft tissues of the right hip. The bone marrow signal intensity of the right hip is normal. There is decreased signal intensity along the right sacroiliac joint corresponding to sclerosis seen on radiographs which may be degenerative in etiology or reflect prior inflammatory arthritis, but currently there is no fluid within the sacroiliac joint or within the adjacent soft tissues. There is edema within the paraspinal musculature, left greater than right, which is nonspecific. We see no fracture or intramuscular fluid collections. There is also edema within the subcutaneous fat, posteriorly, which is not necessarily of any current clinical significance. There is a right adnexal cyst which is likely physiologic in a patient of this age.

Output: 1. No evidence of septic arthritis or osteomyelitis of the right hip.2. Osteoarthritis of the right sacroiliac joint which may reflect prior inflammatory arthritis, but this is equivocal. Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: 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 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. MRA Brain: There is antegrade flow within the distal bilateral vertebral arteries, within the basilar artery, distal bilateral internal carotid arteries and carotid siphons and bilateral anterior, middle and posterior cerebral arteries. A 2 mm saccular aneurysm is seen in the left cavernous carotid artery (image 59, series 301). No arterial stenoses or occlusions are identified. No arteriovenous malformations are identified and there is no evidence for cerebral vasculitis. Cervical spine: Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cervical cord is normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable. No central canal or neural foraminal stenoses.Thoracic spine: There is a smooth, physiologic thoracic kyphotic curve. The vertebral body heights and disc spaces are maintained. Marrow signal intensity is benign throughout.The spinal cord has a smooth contour and is without focal atrophy, edema, or myelomalacia. There are no masses. No significant central canal or neural foraminal stenoses.Lumbar spine: There is abnormal signal intensity within the CSF space and appears hypointense on T2 images. This is likely due to pulsation artifact. Widening of the anterior epidural space is seen along the L4-L5 levels. This measures up to 6 mm in thickness and is not fat signal intensity. This is believed to be secondary to engorged venous plexus. Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. The visualized intra-abdominal and paraspinal contents are unremarkable. No significant central canal or neural foraminal stenoses.

Output: 1.Widening of the anterior epidural space is seen along the L4-L5 levels. While this is believed to be secondary to an engorged venous plexus, repeat imaging of the lumbar spine with intravenous contrast is recommended to exclude blood products.2.T2 hypointense CSF only on lumbar images is likely secondary to pulsation artifact.3.2mm left cavernous carotid artery aneurysm. No intracranial arteriovascular malformation identified.


Instruction: Generate impression based on medical findings.

Input: 77-year-old male with history of stroke. Now with mental status changes. Evaluate for bleed/mass Large low attenuation area involving the left cortical and subcortical temporoparietal lobe in the territory of the left MCA consistent with encephalomalacia. MRI recommended for further evaluation if clinical concern remains for acute stroke. There is no evidence for mass or hemorrhage. There is associated ex vacuo dilatation of the left lateral ventricle.The basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Chronic left MCA infarct. MRI recommended for further evaluation if clinical concern remains for acute stroke.


Instruction: Generate impression based on medical findings.

Input: Altered mental status, multiple myeloma. The images are degraded by patient motion. There is a mass centered within the clivus with extension into the left cavernous sinus. There is no gross mass effect upon the pons. There is no evidence of intracranial hemorrhage or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The orbits and scalp soft tissues are grossly unremarkable. There is mild right maxillary and bilateral sphenoid sinus mucosal thickening and fluid in the left maxillary sinus.

Output: 1. A lesion in the central skull base with extension into the left cavernous sinus is likely related to multiple myeloma, but assessment of the previously demonstrated epidural extension is limited by patient motion and the lack of intravenous contrast.2. No evidence of acute intracranial hemorrhage or acute infarct.3. Findings suggestive of acute sinusitis.


Instruction: Generate impression based on medical findings.

Input: Female 23 years old with history of septic shock, unknown source, evaluate for abscess versus tissue necrosis in gluteal region, PET scan demonstrates bilateral right greater than left decreased activity within the gluteal musculature with peripheral increased activity Diffuse edema with increased T2 signal throughout the gluteal musculature and soft tissues bilaterally. A fluid collection is noted measuring up to 14 x 48 mm in the area of the right gluteus minimus/maximus muscles (601/29).Bilateral iliacus and iliopsoas muscle enhancement as well as diffuse and heterogeneous enhancement of the gluteal muscles, which appears more severe on the right, with central areas of decreased enhancement measuring up to 47 x 99 mm on the right (901/20) and 36 x 61 mm on the left (901/22). These regions correspond to areas of decreased FDG uptake on recent PET and are consistent with necrosis. Surrounding subcentimeter necrotic areas with rim enhancement are also noted within the gluteal musculature and to a lesser extent along the coccyx.Decreased T1 signal within the marrow of the iliac bones, right greater than left, with corresponding increased T2 signal. Additional areas of decreased T1 signal along the greater trochanters and lateral aspects of the bilateral femoral heads are also noted.Small bilateral hip effusions noted. Rectal tube in place. Distended bladder containing foci of gas.

Output: 1. Diffuse soft tissue edema with heterogeneous enhancement of the bilateral gluteal, iliacus, and iliopsoas muscles. Large central areas of necrosis within the gluteal muscles are noted bilaterally with multiple surrounding subcentimeter abscesses. An additional 1.5 x 5 cm fluid collection is also noted within the right gluteal musculature.2. Underlying osseous involvement of the iliac bones, right greater than left, suspicious for osteomyelitis. The greater trochanters and lateral aspects of the femoral heads are also involved to a lesser extent.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Evaluate IACs left unilateral hearing loss. Signs and symptoms: 46-year-old female with left unilateral hearing loss. Pre and post enhanced MRI of the IACs:Bilateral internal auditory canals are symmetrical and normal anatomical morphology and size.The signal intensity and overall anatomical morphology of the inner ears structures are within normal limits.The signal intensity of bilateral petrous bones and skull base is within normal.There is normal visualization of bilateral cerebellopontine angle cisterns and bilateral neurovascular bundles traversing through the cerebellopontine angles and within the internal auditory canals.There is normal signal intensity and morphology of pons, medulla and bilateral cerebellar hemispheres.Postcontrast images demonstrate no detectable abnormal enhancement of the pons, cerebellar pontine angles, neurovascular bundles or enhancement of the internal auditory canals or the inner ear structures.There is normal signal intensity and enhancement of bilateral cavernous sinuses. There is normal signal intensity, morphology and size of pituitary stock and with normal pattern of enhancement.

Output: Unremarkable pre and post enhanced MRI of the internal auditory canals as detailed.


Instruction: Generate impression based on medical findings.

Input: 27-year-old female with knee pain. Evaluate for knee avascular necrosis. MENISCI: The medial and lateral menisci appear intact.ARTICULAR CARTILAGE AND BONE: There is poorly defined intermediate to low signal intensity within the subchondral marrow of the distal femoral epiphysis, likely corresponding to the subchondral sclerosis seen on recent radiographs, although we do not see a pathognomonic double line sign. We see no associated edema, subchondral fracture or articular surface collapse. There is patchy intermediate signal intensity within the distal femoral metadiaphysis and proximal tibial metadiaphysis which may reflect the sequela of end-stage renal disease. We see no focal articular cartilage defects. Chronic periosteal reaction along the distal femur and proximal tibia is again noted, which may reflect renal osteodystrophy, but we cannot exclude hypertrophic osteoarthropathy.LIGAMENTS: There is increased signal intensity and thickening of the lateral collateral ligament proper, suggesting degeneration. The MCL appears intact. The cruciate ligaments appear intact. EXTENSOR MECHANISM: There is diffuse thickening of the patellar tendon compatible with tendinosis, without a discrete tear. There is also thickening of the quadriceps tendon compatible with tendinosis. There is more focal signal abnormality within the lateral fibers of the quadriceps tendon at its insertion, which may represent focal tendinosis or perhaps a small insertional tear.ADDITIONAL

Output: 1. Poorly defined subchondral low signal intensity within the distal femur may reflect avascular necrosis, although we do not see a double line sign. There is no associated edema, subchondral fracture, or articular surface collapse.2. Patellar and quadriceps tendon tendinosis.


Instruction: Generate impression based on medical findings.

Input: Ulcerated/chronic proctitis, recurrent abdominal pain on thiopurines with nausea and vomiting in background of UC, r/o pancreatitis, if possible, assess small bowel for evidence of IBD Evaluation suboptimal without IV contrast.ABDOMEN:LIVER, BILIARY TRACT: Mild intrahepatic biliary duct dilatation and minimal contour irregularity. For example, focal left hepatic duct dilatation (image 21 series 9), concerning for underlying stricture near confluence. Mild prominence of common hepatic duct, measuring up to 5 mm, with distal tapering seen. Findings may also be due in part to patient's postcholecystectomy state. No focus of restricted diffusion seen to suggest underlying lesion. Tiny T2 hyperintense hepatic foci, likely benign. SPLEEN: T2 hyperintense focus in superior aspect of spleen, measuring 1.5 x 1.2 cm on image 30 series 9, likely a cyst or hemangioma.PANCREAS: Decreased intrinsic T1 signal of pancreas. No evidence of peripancreatic edema. Nondilated pancreatic duct.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Apparent circumferential narrowing of rectosigmoid colon on image 23 series 17 more likely related to collapsed state as improved distensibility seen on other sequences, for example, series 23. No evidence of submucosal fat deposition to suggest chronic inflammation. Visualized terminal ileum unremarkable. No significant fibrofatty proliferation seen.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Nonvisualization of uterus, presumably related to prior hysterectomy.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Evaluation suboptimal without IV contrast.2. Mild intrahepatic biliary duct dilatation and minimal contour irregularity, focal left hepatic duct dilatation, concerning for underlying stricture near confluence in setting of sclerosing cholangitis. Mild prominence of common hepatic duct, measuring up to 5 mm, with distal tapering seen. Findings may also be due in part to patient's postcholecystectomy state. No focus of restricted diffusion seen to suggest underlying lesion.3. Decreased intrinsic T1 signal of pancreas, suggestive of chronic pancreatitis. Nondilated pancreatic duct. No evidence of acute pancreatitis.4. Apparent circumferential narrowing of rectosigmoid colon more likely related to collapsed state as improved distensibility seen on other sequences. No evidence of submucosal fat deposition to suggest chronic inflammation. Please note that assessment not optimal secondary to absence of IV contrast.


Instruction: Generate impression based on medical findings.

Input: 54-year-old female with strong family history of breast cancer. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on medical findings.

Input: Reason: Evaluate for acl tear History: knee pain and swelling and instability for weeks post injury MENISCI: There is a complex tear through the posterior horn of the medial meniscus with vertical and horizontal components extending to the inferior and superior articular surfaces. The lateral meniscus appears grossly intact, however there is mild edema of the fibers at the anterior root.ARTICULAR CARTILAGE AND BONE: There is focal discontinuity of the cortex of the lateral tibial plateau with adjacent edema, consistent with a small avulsion fracture. There is increased T2 signal intensity in the lateral femoral condyle and posterior medial and lateral tibial plateau, consistent with bone contusion. The articular cartilage is intact.LIGAMENTS: There is focal discontinuity in the ACL fibers with increased T2 signal intensity, consistent with complete ACL tendon rupture. The PCL is intact. The LCL and MCL are also intact. EXTENSOR MECHANISM: The Achilles and quadriceps tendons are intact.ADDITIONAL

Output: 1. Complete ACL tendon rupture.2. Complex tear through the posterior horn of the medial meniscus.3. Segond fracture with lipohemarthrosis.


Instruction: Generate impression based on medical findings.

Input: Evaluate for early signs of avascular necrosis. Severe osteoarthritis affects the right hip with severe cartilage loss and bone-on-bone apposition anteriorly and superiorly. There is edema-type signal within the acetabular dome that we suspect is degenerative in etiology. We see no specific imaging features of avascular necrosis. Small right hip joint effusion containing intermediate signal intensity likely representing synovitis and debris. There is degeneration and tearing of the anterior labrum.On the large field-of-view images, moderate osteoarthritis affects the right hip.The musculature appears intact. There is metallic susceptibility artifact from tubal ligation clips.

Output: Severe osteoarthritis of the right hip and other findings as described above without evidence of avascular necrosis.


Instruction: Generate impression based on medical findings.

Input: Hereditary hemorrhagic telangiectasia [I78.0] / Cerebral aneurysm, nonruptured [I67.1], Reason for Study: ^Reason: 3T scanner, please evaluate for AVMs, HHT, and evaluate known aneurysm (please compare to outside images uploaded to PACS) Brain MRINo evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement.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, or abnormal contrast enhancement. 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. There is a retention cyst on the right maxillary sinus.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate left Pcom origin infundibulum which demonstrated patent left Pcom artery and smooth luminal bulge at the right Pcom area. The bulge at the right Pcom area is measured about 0.8mm x 2.6mm which most likely represent right Pcom infundibulum. Comparing to prior scan performed at outside hospital, there is no significant interval change.Otherwise bilateral ICAs, MCAs and ACAs appear to be normal. Vertebrobasilar system appears to be normal.

Output: 1. No evidence of abnormal enhancement. No acute ischemic or hemorrhagic lesion.2. Right Pcom area luminal bulging most likely represent infundibulum, the left pcom origin infundibulum. No change since prior scan.3. No evidence of intracranial arterial aneurysm. No evidence of unusual vascularity or evidence of arteriovenous shunt.


Instruction: Generate impression based on medical findings.

Input: L4 lytic lesion. please provide biopsy Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the vertebral lesion. Following the procedures no significant hematomas was identified.

Output: L4vertebral bone biopsy under CT guidance. A total of nine samples were delivered to surgical pathology for analysis.


Instruction: Generate impression based on medical findings.

Input: 55 year old female with fever and old brain mass; evaluate state of intracranial mass There is no evidence of intracranial hemorrhage or edema. No obvious mass or fluid collection is seen on this noncontrast CT. If further evaluation is warranted, MRI or CT with contrast may be obtained.Diffuse areas of hypoattenuation are noted in the periventricular and subcortical white matter, most prominent in the right frontal lobe, which most likely represents gliosis or post-treatment demyelination, versus small vessel ischemic disease of indeterminate age. Presence of vasogenic edema is difficult to be completely excluded in the absence of a prior study for comparison.There is mild asymmetric dilatation of the right lateral ventricle with the remaining ventricles and basal cisterns appearing normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No acute intracranial abnormality or obvious mass is seen on this noncontrast CT. However, this study has limited sensitivity for small intracranial neoplasm or infection. If further evaluation is warranted, MRI or CT with contrast of the brain may be obtained.


Instruction: Generate impression based on medical findings.

Input: Sarcoidosis, systemic lupus erythematosus, low back pain Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign with T1 hyperintense foci scattered within the vertebral bodies compatible with focal fat or hemangiomas. The conus medullaris is normal in position.Mild degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: Disc desiccation, mild disc bulge, and dorsal annular fissure. No spinal canal or neural foraminal stenosis. Mild facet arthropathy.L5-S1: Disc desiccation. No spinal canal or neural foraminal stenosis. Moderate facet arthropathy.Paraspinous soft tissues are within normal limits.

Output: Mild degenerative changes in the lumbar spine without significant spinal canal stenosis or neural foraminal stenosis at any level. There is facet arthropathy at L5-S1 bilaterally and to a lesser degree at L4-L5, which may be contributing to patient's low back pain.


Instruction: Generate impression based on medical findings.

Input: Dizziness and giddiness [R42], Reason for Study: ^Reason: Evaluate for new stroke History: Multiple episodes of lightheadedness w behavioral change, loss of bowels. History of stroke and TIA There is a small focus of diffusion restriction in the left peritrigonal white matter. There is prominence of the cortical sulci in proportion to cerebral ventricles consistent with global volume loss. There are numerous foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter. Several scattered lacunar infarcts are demonstrated in the bilateral centrum semiovale. There is a punctate focus of gradient susceptibility in the left thalamus likely relating to mineralization or chronic hemosiderin deposition. No midline shift or mass effect is appreciated. No intracranial fluid collections are visualized.

Output: 1. There is a punctate area of acute ischemia in the left peritrigonal white matter.2. Global volume loss and white matter changes consistent with advanced small vessel ischemic disease, progressed since 3/7/2010.


Instruction: Generate impression based on medical findings.

Input: 50 year old male patient with restaging appendiceal cancer. ABDOMEN:LIVER, BILIARY TRACT: The patient is status post cholecystectomy. Scattered punctate T2 hyperintense foci are too small to characterize, but likely cysts. No suspicious hepatic lesion is identified. The hepatic vasculature is patent. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral percutaneous nephrostomy tubes with stable mild hydronephrosis. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post right hemicolectomy. Mild peritoneal surface thickening without discrete nodular enhancement.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No measurable solid disease seen in the abdomen or pelvis.2.Decrease in size of a fluid pocket within the rectovesical pouch with wall enhancement; this is favored to represent continued evolution of a postoperative collection.3.Redemonstration of peritoneal surface and serosal bowel wall surface thickening and pelvic small bowel mesentery haziness but no discrete nodular enhancement. Differential includes postsurgical changes from extensive peritoneal surface stripping although residual tumor is not excluded.


Instruction: Generate impression based on medical findings.

Input: 63 year old female with history of compression fracture and kyphoplasty. Recent fall. Evaluate for compression fracture. Additional history per EMR: Bilateral lower extremity weakness. Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.There has been interval kyphoplasty at T12, L1, and L3. There is new L2 superior endplate depression as well as compression deformity seen at L4 with approximately 40% loss of height. No associated retropulsed fragments are identified.At L1-2 there is no significant compromise to spinal canal or neural foramina, unchanged.At L2-3 there is no significant compromise to spinal canal or neural foramina, unchanged.At L3-4 there is mild facet hypertrophy, ligamentum flavum hypertrophy and minimal disk bulge with minimal central canal stenosis and no significant neuroforaminal narrowing, unchanged.At L4-5 there is moderate facet hypertrophy, ligamentum flavum hypertrophy and mild disk bulge with mild central canal stenosis and mild bilateral neuroforaminal narrowing, unchanged.At L5-S1 there is eccentric, left greater than right disk bulge, mild facet hypertrophy and ligamentum flavum hypertrophy. These findings result in mild central canal stenosis, as well as mild right and moderate left neuroforaminal narrowing, unchanged.

Output: 1.New L2 and L4 compression deformities.2.Interval kyphoplasty of T12, L1, and L3 vertebrae.3.Degenerative changes of the lumbar spine, with mild central canal stenosis at L4-5 and moderate left L5-S1 neuroforaminal narrowing, not significantly changed.


Instruction: Generate impression based on medical findings.

Input: Images of the internal auditory canals demonstrate the seventh and eighth nerves to be normal in size and symmetric bilaterally without masses or enhancing lesions along the course of these nerves or in the cerebellopontine angle cisterns bilaterally. The inner ear structures are normal in appearance and symmetric bilaterally without congenital inner ear anomalies identified on either side. There are no vascular anomalies. There is slight asymmetric increase in enhancement of the left facial nerve from the geniculate ganglion to the level of stylomastoid foramen consistent with provided history of previous left facial paralysis and Ramsey Hunt.

Output: 1.Negative MRI of the internal auditory canals including gadolinium enhancement. Specifically, there are no findings to explain the patient's left are pulsatile tinnitus.2.There is slight asymmetric increase in enhancement of the left facial nerve from the geniculate ganglion to the level of stylomastoid foramen consistent with provided history of previous left facial paralysis and Ramsey Hunt.


Instruction: Generate impression based on medical findings.

Input: Reason: prior sustentaculum tali fracture now with recurrent pain History: prior sustentaculum tali fracture now with recurrent pain TENDONS: The flexor and extensor tendons appear intact. The peroneal tendons appear intact. The achilles tendon is normal in appearance. LIGAMENTS: The lateral collateral ligament complex appears intact. The visualized portions of the deltoid ligament appear intact. ARTICULAR SURFACES AND BONE: There is a fracture line through the sustentaculum tali of the calcaneus, extending to the middle facet of the subtalar joint. The previously noted edema at this region has decreased.ADDITIONAL

Output: Fracture of the sustentaculum tali of the calcaneus again noted but the edema at this region has decreased compared to prior exam.


Instruction: Generate impression based on medical findings.

Input: Note the left sagittal oblique images could not be acquired as the patient requested the study be terminated.Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. Heterogeneous foci are noted within bilateral thyroid lobes, with a left left focus demonstrating a mixture of both T2 hyperintense and hypointense contents measuring up to 14 mm.C2/3: Mild degenerative changes without stenosisC3/4: Posterior osteophyte disc complex with a central extruded component which causes anterior cord flattening without intrinsic cord signal abnormality. There is also bilateral uncinate hypertrophy and ligamentum flavum thickening. There is mild central, severe left neural foraminal, and moderate right neural foraminal stenosis.C4/5: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, and ligamentum flavum thickening. There is mild central and severe bilateral neural foraminal stenosis.C5/6: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, and ligamentum flavum thickening. There is mild central and severe bilateral neural foraminal stenosis.C6/7: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, and ligamentum flavum thickening. There is severe bilateral neural foraminal stenosis.C7/T1: Bilateral facet hypertrophy without stenosis.T1/2: Bilateral facet hypertrophy and endplate spurring causes mild bilateral neural foraminal stenosis.T2/3: Right facet hypertrophy and endplate spurring causes mild bilateral neural foraminal stenosis.T3/4: Right facet hypertrophy and endplate spurring causes moderate right neural foraminal stenosis.T4/5: Right facet hypertrophy and endplate spurring causes mild right neural foraminal stenosis.

Output: 1.Heterogeneous foci are noted within bilateral thyroid lobes, with a left left focus demonstrating a mixture of both T2 hyperintense and hypointense contents measuring up to 14 mm. A dedicated thyroid ultrasound is recommended for further characterization, especially of the more heterogeneous, greater than 1 cm left thyroid nodule.2.C3/4: Mild central, severe left neural foraminal, and moderate right neural foraminal stenosis.3.C4/5: Mild central and severe bilateral neural foraminal stenosis.4.C5/6: Mild central and severe bilateral neural foraminal stenosis.5.C6/7: Severe bilateral neural foraminal stenosis.6.T1/2: Mild bilateral neural foraminal stenosis.7.T2/3: Mild bilateral neural foraminal stenosis.8.T3/4: Moderate right neural foraminal stenosis.9.T4/5: Mild right neural foraminal stenosis.


Instruction: Generate impression based on medical findings.

Input: Progressive and congenital hearing loss. Internal Auditory Canal: The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. There is scattered fluid signal in the right mastoid air cells and middle ear. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are terminal zones of myelination in the bilateral parietal lobes. The brain parenchyma otherwise appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. No evidence of cochlear nerve deficiency of gross inner ear anomalies.2. No evidence of acute intracranial hemorrhage, mass, or acute infarct.3. Scattered fluid signal in the right mastoid air cells and middle ear likely represents sequela of recent otomastoiditis.


Instruction: Generate impression based on medical findings.

Input: Male, 42 years old, with neck pain, left arm to hands. Image quality is degraded by motion artifact. Within this limitation, the following observations are made.Mild straightening of the cervical is seen. Alignment is otherwise unremarkable. Vertebral body morphology and signal characteristics are within normal limits.Except as discussed below, the spinal cord demonstrates normal signal intensity and morphology.C2-3: Unremarkable. C3-4: Mild facet hypertrophy. Otherwise unremarkable. No interval changes.C4-5: Mild facet hypertrophy. Mild left neuroforaminal narrowing. Otherwise unremarkable. No interval changes.C5-6: Mild facet hypertrophy. Posterior disk osteophyte formation with a left central/paracentral disk protrusion. Resultant mild flattening of the left ventral aspect of the cord without cord signal abnormality. Moderate left neuroforaminal narrowing. No significant interval changes. C6-7: Facet hypertrophy. Mild posterior disk osteophyte formation. Moderate left and mild right foraminal narrowing. No significant interval changes. C7-T1: Facet hypertrophy. Otherwise unremarkable. No significant interval changes.

Output: Stable degenerative findings including a disk protrusion at C5-6 which mildly impinges upon the left ventral aspect of the cord.


Instruction: Generate impression based on medical findings.

Input: Male 59 years old Reason: HCV, Cirrhosis, elevated AFP, US negative for HCC, eval for HCC in light of elevated AFP History: HCV, Cirrhosis ABDOMEN:LIVER, BILIARY TRACT: Liver has a cirrhotic morphology. There are several hypervascular right hepatic lobe lesions. The largest measuring 1.0 x 1.0 cm on (image 532/series 1102). This lesion has washout to background liver on the delayed phase of imaging. (Image 545/series 1105). The lesions are also hyperintense on T2-weighted imaging.The hepatic and portal veins are patent.Particular enhancement of the hepatic parenchyma suggests fibrosis. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No ascites.

Output: Multiple hypervascular right hepatic lobe lesions. There are at least 2 hepatic lesions that meet the criteria for HCC.


Instruction: Generate impression based on medical findings.

Input: 75 years, Male, altered mental status, posterior reversible encephalopathy syndrome. Neck pain, rule out stenosis. Brain: There is a focus of restricted diffusion involving the right post central gyrus and right parietal centrum semiovale. There is extensive T2/FLAIR hyperintensity in the bilateral cerebral hemispheres predominantly involving the periventricular and subcortical white matter of the bilateral frontal, parietal, and to a lesser degree temporal and occipital lobes. Small foci of FLAIR hyperintensity within the cortex also noted in the bilateral frontal lobes. Patchy FLAIR hyperintensity is also evident in the brainstem and bilateral cerebellar hemispheres. Multiple lacunar infarcts are also noted within the left greater than right basal ganglia and thalami. There is global parenchymal volume loss. No intracranial mass or mass effect. No midline shift or herniation. No hydrocephalus. There are multiple foci of susceptibility effect involving the basal ganglia, thalami, brainstem, and cerebellum with a distribution favored to be related to chronic hypertension. Additional scattered foci in the lobar distribution such as in the right frontal lobe and left parietal and occipital lobes may be related to amyloid angiopathy.Cervical spine:There is reversal of cervical lordosis centered at the C3-C4 level. Vertebral body heights are maintained. Bone marrow signal is benign. No obvious cord signal abnormality is evident although STIR sequence could not be obtained due to significant patient motion, there by limiting sensitivity for cord signal abnormality. Multilevel degenerative changes are seen which are suboptimally evaluated, individual levels as below:C2-3: No significant compromise to the spinal canal or right neural foramen. Mild left neural foraminal stenosis. C3-4: Disc osteophyte complex with moderate spinal canal stenosis. There is moderate to severe bilateral neural foraminal stenosis.C4-5: Disc osteophyte complex and ligamentum flavum thickening with moderate spinal canal stenosis and moderate bilateral neural foraminal stenosis, left worse in right.C5-6: Disc osteophyte complex and ligamentum flavum thickening. There is moderate spinal canal stenosis. There is moderate bilateral neural foraminal stenosis.C6-7: Small disc extrusion with mild spinal canal stenosis at this level. There is mild bilateral neural foraminal narrowing.C7-T1: Disc bulge without significant spinal canal stenosis at this level. There is mild left greater than right neural foraminal narrowing.

Output: 1. Small focus of acute infarct in the right parietal lobe.2. Extensive patchy supratentorial and infratentorial T2/FLAIR hyperintensity which is nonspecific and much of which may represent advanced chronic small vessel ischemic disease. Some of these areas (such as in the posterior fossa) may be reversible/indicative of PRES and can be confirmed with follow-up imaging.3. Multiple chronic microhemorrhages involving the basal ganglia, thalami, brainstem, and cerebellum likely related to chronic hypertension. Additional scattered foci of microhemorrhage in the lobar distribution such as in the right frontal lobe and left parietal and occipital lobes may be related to amyloid angiopathy.4. Cervical spine study is motion degraded but demonstrates moderate spinal canal stenosis at the C3-C4, C4-C5, C5-C6 levels. 5. Please note post contrast brain imaging could not be obtained due to significant patient motion. STIR sequence of the cervical spine could also not be obtained, thereby limiting evaluation for cord signal body. No cord signal abnormality is evident within these limitations.Dr. Ali discussed findings with Dr. Sheikh 1120 hrs on 12/8/2015.


Instruction: Generate impression based on medical findings.

Input: 44 year old female with personal history of right invasive ductal carcinoma status post right mastectomy in 8/2015 as well as radiation, hormonal therapy, and chemotherapy. Left breast benign biopsy in 2015 for PASH/stromal fibrosis. No family history of breast cancer. There is extreme amount of fibroglandular tissue in the left breast.Mild parenchymal enhancement is noted in the left breast.The patient is status post right mastectomy. Multiple scattered benign enhancing foci are present within the left breast, appearing less conspicuous than prior studies. No suspicious enhancement is identified in the left breast. No abnormal lymph nodes are identified in the left axillary region.

Output: Scattered benign enhancing foci in the left breast which appear less conspicuous than on prior studies. No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on medical findings.

Input: ORBITS: There is normal appearance of the globes, and extraocular muscles with no signal abnormality appreciated. The optic nerves are symmetric in caliber and signal intensity without mass or discrete abnormality. However, evaluation is limited due to lack of IV contrast.BRAIN: Evaluation is limited due to lack of IV contrast. There are remote postoperative findings related to right anterior temporal lobectomy. There is no acute infarct, mass effect or midline shift. There is increased T2 signal at the margin of the right temporal lobe resection and regional which may be postsurgical. The right fornix is small than the left which may be chronic and secondary to surgery. There is no definite abnormal T2 signal or volume loss in the left hippocampus, although evaluation is limited due to right temporal resection and lack of the contralateral comparison. There are no gray matter heterotopia or gross evidence for cortical dysplasia. The pituitary gland is not enlarged. There mass effect on the optic chiasm.

Output: 1.No intraorbital mass or significant abnormality, although evaluation is limited without IV contrast.2.No gray matter heterotopia or evidence for cortical dysplasia.3.No appreciable volume loss or signal abnormality in the left hippocampus, slightly limited due to lack of contralateral comparison.4.Remote postoperative findings related to right anterior temporal lobectomy.


Instruction: Generate impression based on medical findings.

Input: Alignment is anatomic. Vertebral body heights and disc are intact. Normal marrow signal. No abnormal signal within the cord or conus. No significant neural foraminal or spinal canal narrowing. Soft tissue edema is identified in the superficial subcutaneous tissues of posterior midline as well as right suboccipital region. No MRI findings to indicate ligamentous injury. No epidural hematoma or fluid collection. Airspace disease is seen in the right apex.

Output: 1.Soft tissue edema is identified in the superficial subcutaneous tissues of posterior midline as well as right suboccipital region. No MRI findings to indicate ligamentous injury. 2.Airspace disease is seen in the right apex.


Instruction: Generate impression based on medical findings.

Input: Reason: Concern for AVN on recent Xray History: Has been on steroids for radiation pneumonitis Bone marrow signal intensity of the imaged proximal right femur is within normal limits. Similarly, bone marrow signal intensity of the imaged left proximal femur is within normal limits. Bone marrow of the bony pelvis is also normal in appearance. Mild osteoarthritis affects both hips. The musculature of the lower abdomen, hips and proximal legs is unremarkable.

Output: No evidence of avascular necrosis.


Instruction: Generate impression based on medical findings.

Input: 50 year old man with heart/kidney transplant on 10/22/15, referredfor serial MRI as part screening for cardiac allograft rejection Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 57%, the LV end diastolic volume index is 78 ml/m2 (normal range: 74+/-15), the LVEDV is 152 ml (normal range 142+/-34), the LV end systolic volume index is 34 ml/m2 (normal range 25+/-9), the LVESV is 66 ml (normal range 47+/-19), the LV mass index is 32 g/m2 (normal range 85+/-15), and the LV mass is 63 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.Left AtriumThe left atrium is consistent with cardiac transplant. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 85 ml/m2 (normal range 82+/-16), the RVEDV is 167 ml (normal range 142+/-31), the RV end systolic volume index is 42 ml/m2 (normal range 31+/-9), and the RVESV is 82 ml (normal range 54+/-17).Right AtriumThe right atrium is consistent with cardiac transplant.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. Evidence of aortic anastomosis at approximately 6 cm above the aortic valve. Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated (30 mm).Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is a small pericardial effusion. There is no apparent hemodynamic compromise from pericardial effusion. Extracardiac FindingsSternotomy wires are present consistent with previous cardiac surgeries. Bilateral gynecomastia is present.

Output: 1. The left ventricle is normal in size and systolic function. The overall LV ejection fraction is 57%. This LVEF is slightly lower than previous study, however, still within normal range. 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.2. The right ventricle is normal in size and systolic function. The overall RV ejection fraction is 51%3. Small pericardial effusionAddendum to follow with calculations of ECV and T1 times


Instruction: Generate impression based on medical findings.

Input: 52-year-old female. Pain. Evaluate for ulnar styloid impaction. LIGAMENTS: The scapholunate and lunotriquetral ligaments are grossly intact.TRIANGULAR FIBROCARTILAGE COMPLEX: Grossly intact.TENDONS: The extensor carpi ulnaris tendon is perched along the medial edge of the ulnar groove suggesting extensor carpi ulnaris subsheath injury. There is trace fluid around the tendon suggestive of tenosynovitis. Mild increased signal intensity within the tendon consistent with tendinosis.BONES: There is bone marrow edema in the distal ulna, likely reactive to the aforementioned ECU tendinosis. Foci of fluid signal abnormality within the carpal bones, including the radial aspect of the lunate, likely represent small degenerative cysts. Mild edema in the medial edge of the scaphoid, likely degenerative in etiology.ADDITIONAL

Output: 1. Extensor carpi ulnaris tendinosis and subsheath injury.2. Subcentimeter ganglion cyst volar to the triquetrum.


Instruction: Generate impression based on medical findings.

Input: Dizziness and giddiness [R42], Reason for Study: ^Reason: Are there brain metastases? History: Hearing loss. Left sided ear fullness. Vertigo. Dysequilibrium. Metastatic cancer There is single restricted diffusion lesion on the left cerebellar hemisphere without evidence of hemorrhagic conversion (series 4, image 8) indicating acute ischemic infarction.Underlying brain shows non specific small vessel ischemic disease. There is no evidence of abnormal enhancement.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.Mucosal thickenings on bilateral ethmoid sinuses, frontal sinus and left maxillary sinus.

Output: 1. Acute ischemic infarction on the left cerebellar hemisphere without evidence of hemorrhagic conversion.2. Non specific small vessel ischemic disease.3. No evidence of abnormal enhancement.


Instruction: Generate impression based on medical findings.

Input: Altered mental status; agitation. Also dysphagia and abnormal gait prior to admission. Rule out brain infarct. There is no diffusion restriction to indicate recent infarct. There are multiple tiny CSF intensity foci with T2 FLAIR rim involving the basal ganglia reflecting chronic lacunar infarcts. There is also mild prominence of the perivesical spaces. There is extensive confluent and patchy bilateral cerebral hemispheric white-matter T2 FLAIR hyperintensity along with similar finding in the pons which is nonspecific but most compatible with chronic small vessel ischemic disease. There are foci of susceptibility artifact underlying the posterior right frontal craniotomy flap near the vertex in addition to focal mild dural thickening and underlying minimal encephalomalacia. Otherwise, there is no intracranial hemorrhage. There is no midline shift or brain herniation. The ventricles along with the other CSF-containing spaces are enlarged, reflecting moderate global brain volume loss. Though ventricular enlargement is more pronounced than sulcal enlargement, this is still most probably related to brain volume loss. The flow voids of the major intracranial vessels are preserved, reflecting gross patency. Following contrast injection, there is no abnormal brain or leptomeningeal contrast enhancement. Contrast enhancement in the mildly thickened right frontoparietal dura underlying the craniotomy flap near the vertex is probably postoperative in nature. Asymmetric contrast enhancement in the pterygoid muscles is probably related to asymmetry of the pterygoid venous plexus.There is partial opacification of the bilateral mastoid air cells, partial opacification of the paranasal sinuses, and fluid in the nasopharynx. These findings are likely, at least in part, related to presence of endotracheal tube.

Output: 1.Moderate to severe chronic small vessel ischemic disease. No evidence of acute infarct.2.Prior right frontal craniotomy.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Multiple sclerosisClinical question: hx of MS, new right arm paresthesias, electric shock sensationSigns and Symptoms: as above MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There are periventricular white matter lesions present which are perpendicularly oriented to the lateral ventricles as well as some corpus callosum lesions especially at the colossal cingulate junction and to some degree some subcortical white matter lesions. These are hyperintense on FLAIR and T2 imaging. There is no associated contrast enhancement. Additionally there are punctate lesions present in the cerebellar hemispheres bilaterally. These also do not enhance following gadolinium administration and they are hyperintense on FLAIR and T2 images. These lesions have not changed since the prior exam of 2/14/2014Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:There is a patchy T2 and FLAIR hyperintense lesion present along the posterior aspect of the cervical spinal cord extending from the C1-2 level down to the C7 vertebral level which has not changed substantially when compared to the prior exam. There is no associated enhancement of this lesion following gadolinium administration. There is no associated mass effect.The cervical vertebral bodies are appropriate in overall alignment and height. No abnormal enhancing lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There are periventricular and subcortical white matter lesions present as well as lesions in the corpus callosum and cerebellum which are compatible patient's diagnosis of demyelinating disorder. These are stable compared to the prior exam.2.There is redemonstration and no significant change of extensive lesion within the cervical spinal cord. This is compatible with the patient's clinical diagnosis of demyelinating disorder. It is stable compared to the prior exam.


Instruction: Generate impression based on medical findings.

Input: 17-year-old male with left knee pain, evaluate for possible patellar dislocation MENISCI: We see no meniscal tears. Globular increased signal within the posterior horn of the medial meniscus likely represents artifact or perhaps a meniscal contusion.ARTICULAR CARTILAGE AND BONE: Marrow edema is seen within the anterolateral aspect of the lateral femoral condyle. This may reflect prior dislocation, although we see no corresponding kissing contusion in the medial aspect of the patella. There is also edema within the anterior aspect of the lateral tibial plateau with an associated subchondral focus of curvilinear T1 signal intensity which may represent a nondisplaced subchondral fracture. The femoral trochlea is abnormally shallow, indicating dysplasia. The tibial tubercle to trochlear groove distance is 19 mm which is borderline abnormal. The Insalata-Salvati ratio is 1.35 suggesting mild patella alta.LIGAMENTS: The medial and lateral collateral ligament complexes are intact. The ACL and PCL are intact. There is mild edema along the abductor tubercle, and the medial patellofemoral ligament is not well visualized at its femoral attachment, perhaps representing a tear.EXTENSOR MECHANISM: The extensor mechanism is intact. ADDITIONAL

Output: 1.Edema within the anterolateral femoral condyle suggests prior lateral dislocation of the patella. Although we see no edema within the medial patella, there is edema along the abductor tubercle and incomplete visualization of the medial patellofemoral ligament at its femoral attachment as well as morphologic abnormalities which may predispose to patellofemoral instability as described above.2.Additional edema as well as a probable nondisplaced subchondral fracture along the anterior tibial plateau suggesting a hyperextension/valgus component to the mechanism of injury.


Instruction: Generate impression based on medical findings.

Input: Clinical question: DBS planning. Signs and symptoms: DBS planning Pre and post enhanced brain MRI:Examination is limited and performed utilizing surgical planning protocol and is not a true diagnostic exam.There are also no prior exams for comparison.Examination demonstrates uniform prominence of cortical sulci and supratentorial ventricular system without radiation of midline.There is no detectable abnormal enhancement of parenchyma or the leptomeninges.The signal void of major intracranial arterial branches are identified and there is normal enhancement of intracranial venous sinuses. There is no detectable abnormal signal intensity on T2 or susceptibility MRI sequences.

Output: Pre- and post enhanced surgical planning MRI study as detailed.


Instruction: Generate impression based on medical findings.

Input: Complex partial epilepsy, neuropathic pain, and new prolonged confusion state. There has been interval resolution of the subcentimeter lesion with high T2 signal and restricted diffusion in the midline of the splenium of the corpus callosum. The rest of the brain parenchyma also appears unremarkable. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Interval resolution of the lesion in the splenium of the corpus callosum. No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on medical findings.

Input: Male 30 years old Reason: US shows new 1.7 cm segment 2 lesion History: hep B, hemangiomas ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. There are at least 3 T2 hyperintense lesions involving the right hepatic lobe the largest measuring 1.3 x 1.3 cm on image 47 of series 8. The lesions show peripheral nodular discontinuous enhancement which fill-in over time, compatible with hemangiomas. A subcentimeter lesion near the anterior aspect of the right hepatic lobe in segment 8 as seen on image 227/series 9 is too small to characterize. No suspicious hepatic lesions are identified. Multiple small polypoid lesions within the gallbladder adherent to the wall likely represent small gallbladder wall polyps.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.3 right hepatic lobe lesions with imaging features compatible with small hemangiomas. No suspicious hepatic lesions.


Instruction: Generate impression based on medical findings.

Input: Female, 40 years old, history of lung cancer with brain metastases, follow-up examination. Ill-defined T2 hyperintensity within the bilateral periventricular white matter is unchanged. No mass effect or edema is seen. No pathologic parenchymal enhancement is detected. No evidence to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricles are normal in size and morphology. A subcentimeter nonspecific focus of enhancement within the left occipital bone is unchanged.

Output: Treatment effects are seen with no evidence of any active intracranial metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Pain in the right knee. Exam limited with only 2 projections provided.There is mild osteoarthritis, as demonstrated by mild medial joint space narrowing and osteophyte. Additionally, the lateral projection mild flattening of the anterior aspect of the medial condyle raising concern for a questionable underlying cartilage abnormality. An MRI would be helpful if further characterization is needed clinically.There is a 4 mm round calcific density in the posterior aspect of the joint. A loose body ossicle in this limited two-view study.Lastly, there are no lytic or blastic lesions in this limited two-view study given the relayed history.

Output: Mild osteoarthritis and possible loose body of the right knee with a questionable anterior defect of the medial condyle, MRI would be helpful for characterization.


Instruction: Generate impression based on medical findings.

Input: History of myelofibrosis. ABDOMEN:LIVER, BILIARY TRACT: A few hepatic cysts are noted. No focal suspicious lesion or biliary ductal dilatation.Status post cholecystectomy with postsurgical susceptibility artifact in the gallbladder fossa.Poor visualization of the portal vein with several small caliber collateral vessels in the porta hepatis suspicious for portal vein thrombosis. SPLEEN: Marked splenomegaly with the spleen measuring 29 cm in the craniocaudal dimension. At the level of the celiac artery origin the spleen measures 19 x 12.7 cm in cross-section. No focal splenic lesion. Numerous perisplenic collateral vessels are present the appearance of which is suspicious for splenorenal shunting. The largest varix measures up to 1.6 cm. Minimal perisplenic fluid. Small peripheral irregularly-shaped parenchymal signal abnormality likely reflects a prior small infarct.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Several right renal simple cysts. Subcentimeter right renal hemorrhagic cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Heterogeneous bone marrow signal intensity.OTHER: No significant abnormality noted.

Output: 1.Marked splenomegaly with perisplenic collateral vessels and appearance suspicious for splenorenal shunting.2.Poor visualization of the portal vein which appears replaced with several porta hepatis small caliber vessels, suspicious for portal vein thrombosis. Color Doppler ultrasound may be considered to confirm patency as clinically warranted.


Instruction: Generate impression based on medical findings.

Input: 54 year old female with history of right mastectomy in 2006 for invasive lobular carcinoma. Status post autologous right reconstruction. No current breast complaints. Status post right mastectomy and reconstruction.There is heterogeneous amount of fibroglandular tissue in the left breast.Mild parenchymal enhancement is noted in the left breast.No abnormal enhancement is seen in left breast or reconstructed right breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on medical findings.

Input: 49-year-old male with AML and neutropenic fever. Status post SCT. Now with recent seizure and fevers Suboptimal exam secondary to extensive motion artifact.No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus is detected. Further follow-up with an MRI recommended.The paranasal sinuses are unremarkable and no pneumatized.Mastoid air cells demonstrates opacification bilaterally which was present on the prior exam.

Output: Poor quality exam and no definitive evidence of an acute findings.


Instruction: Generate impression based on medical findings.

Input: 57-year-old female with right lower quadrant abdominal pain ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Several hypodense lesions in the liver are incompletely evaluated with this single phase contrast enhanced CT. ultrasound or liver MRI may be helpful for further evaluation. An index lesion in the left lobe measures two by 1.2-cm image number 25 of series number 3.SPLEEN: 1.2-cm cyst in the spleen.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral benign-appearing renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The appendix is dilated with thick walls and periappendiceal fat stranding consistent with acute appendicitis. No evidence of abscess.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: 4.6 x 3 cm cystic lesion involving the right ovary. Pelvic ultrasound is recommended for further evaluation. Left ovary contains at 1.4 cm cyst.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Acute appendicitis.Right ovarian cystic mass . further evaluation with transvaginal ultrasound is recommended.Several hypodense lesions within the liver. Their etiology is unknown. Ultrasound or MRI of the liver may be helpful for further evaluation and characterization of these lesions.


Instruction: Generate impression based on medical findings.

Input: History of pancreatic adenocarcinoma. Staging MRI. ABDOMEN:LIVER, BILIARY TRACT: No focal suspicious liver lesion. Probable cyst in the left hepatic lobe. Moderate intra and extrahepatic biliary ductal dilatation to the level of the pancreatic head.SPLEEN: No significant abnormality noted.PANCREAS: 2.7 x 2.4 cm pancreatic head hypoenhancing mass (series 1 302/36) with associated pancreatic ductal dilatation and parenchymal atrophy. The lesion abuts and mildly deforms the adjacent superior mesenteric vein involving less than 180 degrees of the vessel. There may be focal non-occlusive marginal thrombus in the SMV. There is loss of fat plane with the adjacent superior mesenteric artery with less than 180 degrees of involvement.1.4 x 1.1 cm periportal heterogeneously enhancing lymph node (series 1 302/49).ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral small renal cysts.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: 2.7 x 2.4 cm pancreatic head hypoenhancing mass with associated pancreatic and biliary ductal dilatation is compatible with FNA proven adenocarcinoma. Periportal adenopathy. The mass abuts less than 180 degrees of the superior mesenteric vein and artery as described above.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Chiari and tethered cord, history of decompression and cord repair OSH. Still with symptoms. Signs and symptoms: Unexplained cognitive and growths delay, headaches and back pain. Nonenhanced total spine MRI:Examination demonstrates expected post operative changes of Chiari decompression with resultant expansion of subarachnoid space at the level of surgery. There is no detectable herniation of cerebellar tonsils or tonsillar deformity identified.The signal intensity and the caliber of the entire cord remains within normal and in particular without evidence of syrinx. The cord terminates at L1 -- L2 disk level. The morphology and the signal intensity of the cauda equina is within normal and in particular no evidence of fatty filum present.Sagittal T2 prone images demonstrate distinct anterior movement of the lower thoracic cord, conus and proximal cauda equina compared to sagittal T2 supine images.There is subtle postoperative changes of prior surgical approach for untethering of the cord at S1 level.Unremarkable nonenhanced total spine MRI otherwise.3-D fiesta sequence demonstrate patency of the aqueduct however there is mild narrowing of the lumen of the aqueduct in its most cephalad aspect.CSF flow study demonstrate presence of biphasic flow anteriorly through the foramen magnum.The biphasic flow pulsation posteriorly to the cord terminates at the level of foramen magnum and there is no detectable biphasic flow posterior to the cerebellar tonsils, ventricle or in the aqueduct.

Output: 1.Expected postoperative changes of Chiari decompression and without evidence of tonsillar herniation or deformity.2.Normal signal intensity and caliber of cor and with normal termination at L1 -- L2 disk level.3.Distinct anterior movement of the conus and proximal cauda equina on prone sagittal T2-weighted series.4.Very subtle postoperative changes of cord untethering at S1 level as detailed above.5.Normal signal intensity of cauda equina and in particular without evidence of any fatty deposition of the filum.6.CSF flow study demonstrate presence of a normal appearing biphasic flow through the foramen magnum anterior to the cord. The biphasic flow of CSF posterior to the cord however terminates at the level of the foramen magnum. There is no detectable flow posterior to the cerebellum, fourth ventricle or the aqueduct.


Instruction: Generate impression based on medical findings.

Input: There are multiple supratentorial and infratentorial lesions with variable enhancement, many showing susceptibility effect consistent with hemorrhagic products, which are compatible with metastases. Aside from the calcified right hippocampus lesion, a peripherally enhancing left superior frontal gyrus lesion, and the dominant peripherally enhancing lesion in the inferior right parietal lobe, which are not significantly changed, the other lesions have decreased in size and display less prominent enhancement. For example, a left cerebellar hemisphere lesion measures up to 4 mm, previously6 mm, a left medial temporal lobe lesion measures up to 6 mm, previously 9 mm, a left temporal lobe lesion measures up to 7 mm, previously 12 mm, and a right cuneus lesion measures up to 3 mm, previously 14 mm. In addition, there has been interval decrease in the degree of associated vasogenic edema overall. There is consequent decreased mass effect on the posterior horn and atrium of the lateral ventricles, right greater than left and there is no significant midline shift. There is a background of punctate T2 hyperintense signal abnormality scattered in the supratentorial periventricular and subcortical white matter, which is nonspecific. There is no evidence of acute infarct. The orbits, skull, and scalp soft tissues appear unremarkable.

Output: Stable to decreased size of the intracranial metastases and overall reduced associated vasogenic edema.


Instruction: Generate impression based on medical findings.

Input: Increased left-sided DT reflexes with intermittent weakness/falls. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position. Apparent focus of T2 hyperintensity in the partially imaged lower thoracic cord on the sagittal T2 sequence is favored to be artifactual.Individual levels described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits. Nonspecific focus of T1 and T2 hypointensity involving the partially imaged right iliac bone which may represent a bone island.

Output: 1. MRI of the lumbar spine is essentially unremarkable. No significant disc disease or spinal canal or neural foraminal stenosis at any level.2. Focus of T1 and T2 hypointensity involving the partially imaged right iliac bone is nonspecific but may represent a bone island.3. Apparent focus of T2 hyperintensity in the partially imaged lower thoracic cord on the sagittal T2 sequence is likely artifactual.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old, with altered mental status. Assess for swelling, radiation effect or tumor. Postoperative findings are seen compatible with right parietal craniotomy and paramedian parietal craniectomy with mesh cranioplasty. A small pocket of extra-axial fluid is seen subjacent to the craniectomy which is unchanged from prior.Since the prior examination, an irregularly enhancing nodule of presumed residual tumor along the left parietal lobe at the upper aspect of the resection cavity has increased in size from approximately 20 mm to 30 mm. This lesion is contiguous with nodular tumor at the inferior aspect of the resection cavity, spanning the midline, which has also substantially increased in size.Edema and T2 signal abnormality within the left parietal lobe have increased from prior. Edema and T2 signal abnormality within the right parietal lobe are relatively unchanged. Areas of cystic degeneration within the right parietal lobe are stable to slightly smaller.Redemonstrated are scattered nonspecific foci of brain parenchymal T2 hyperintensity. No restricted diffusion is seen. No acute intracranial hemorrhage is suspected. Apart from the residual and/or growing tumor, no new enhancing lesions are seen. The lateral and third ventricles are slightly more prominent than on the prior examination but are not frankly dilated.On MR imaging, no high-grade intracranial vascular stenosis or occlusion is suspected. No aneurysm or vascular malformation is observed. The right vertebral artery is congenitally small and primarily supplies the right PICA. Prominent bilateral PCOM arteries are present. The ACOM artery is small and unremarkable.

Output: 1.Findings are seen concerning for progression of tumor at the site of prior tumor resection in the high parietal regions.2.Slight progression of edema in the left parietal lobe. Stable edema and cystic encephalomalacia in the right parietal lobe.3.No acute intracranial abnormality.4.No intracranial vascular compromise.


Instruction: Generate impression based on medical findings.

Input: Unspecified visual disturbance [H53.9] / Dizziness and giddiness [R42], Reason for Study: ^Reason: 50M with recurrent episodes of visual disturbances initially with bilateral "wavy lines" but now with unilateral (left-sided) vision blurring/loss that res No evidence of acute ischemic or hemorrhagic lesion.Several nonspecific scattered punctate T-2/flair high signal intensity lesions on bilateral hemispheric white matter are seen. These lesions likely represent nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are 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 paranasal sinuses and mastoid air cells are clear.

Output: 1.No evidence of acute ischemic or hemorrhagic lesion.2. Nonspecific FLAIR/T2 high signal intensity lesions on white matter.


Instruction: Generate impression based on medical findings.

Input: New onset seizure. Evaluate for seizure focus. The bilateral hippocampi are symmetric and display normal signal characteristics. There is no evidence of cortical dysplasia and gray matter heterotopia. There is no evidence of acute intracranial hemorrhage or mass effect. The brain parenchyma appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is minimal mucosal thickening of the right maxillary sinus. The skull and extracranial soft tissues are unremarkable.

Output: 1. No evidence of seizure focus.2. No evidence of acute intracranial hemorrhage or mass effect.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: Female, 61 years old, with aneurysms. Chronic infarcts of the left parietal and occipital lobes are seen appearing similar to prior. Also noted is extensive patchy periventricular and subcortical T2 hyperintensity. No restricted diffusion is detected. No evidence of parenchymal edema or mass effect is noted. Two or three scattered small foci of susceptibility are seen, similar to prior and compatible with chronic microhemorrhage. No acute intracranial hemorrhage is seen. The ventricles are stable and normal in size. No abnormal extra-axial fluid collections are detected. Multiple known intracranial aneurysms are not well visualized on this study.

Output: 1.No acute intracranial abnormality.2.Chronic ischemic lesions of the left parietal and occipital lobes.3.Moderate chronic microvascular ischemic disease.


Instruction: Generate impression based on medical findings.

Input: 9-year-old male with history of thigh mass resected September 2015; per pathology report, the mass was determined to be myofibroblastic and histiocytic proliferation without evidence of malignancy Within the subcutaneous tissues of the lateral right thigh is a small focus of T2 hyperintensity which demonstrates enhancement following contrast administration. The area now measures 1.3 x 0.4 x 2 cm as compared to 1.7 x 0.6 x 2.7 cm previously. There is no evidence of a discrete enhancing mass. No additional lesions or abnormal enhancement is identified within the thigh. The underlying muscle signal and caliber is normal. The bone marrow signal of the femur is normal.

Output: Small focus of enhancement within the subcutaneous tissues of the lateral right thigh likely represents an area of scarring and has decreased from the prior exam. There is no discrete enhancing mass identified.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old, with progressive supranuclear palsy, IRB approved brain MRI. 2 repeat axial FLAIR sequences were obtained. Redemonstrated is thinning of the mid brain and volume loss.

Output: Repeat axial FLAIR sequences redemonstrate thinning of the midbrain and volume loss.


Instruction: Generate impression based on medical findings.

Input: The cervical spine is in normal alignment. The vertebral body and disk heights are well-maintained. No focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the cervical spine. THORACIC SPINE

Output: 1. Findings most consistent with a thin subacute epidural hematoma extending throughout the thoracic spine without significant mass effect on the thecal sac. Some of the signal abnormality in the dorsal epidural space in the thoracic spine likely corresponds to the epidural venous plexus which can be better assessed with postcontrast images, although end-stage renal disease contraindicates gadolinium administration. No cord compression or cord signal abnormality. Small layering subarachnoid hemorrhage is also questioned in the upper thoracic spine, possibly related to redistribution from the intracranial subarachnoid hemorrhage. 2. Small bilateral pleural effusions.3. Diffuse low T1 marrow signal which is nonspecific but can be seen in conditions such as chronic anemia.4. Small bilateral pleural effusions.Dr. Ali discussed findings with Dr. Kak at 1450 hrs on 1/20/2015.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old, with worsening back pain. Trace anterolisthesis of L3 relative to L4 and L4 relative to L5 is again seen without significant change. Alignment is otherwise unremarkable.A subcentimeter focus of nonspecific marrow replacement within the L1 vertebral body shows no significant interval change. Marrow signal characteristics remain diffusely heterogeneous.Concavity of the L2 inferior endplate is similar to the prior examination. No adjacent marrow edema is seen.Mild edema is evident within the L3 vertebral body without significant endplate concavity or loss of vertebral body height.Since the prior examination, the L4 and L5 vertebral bodies demonstrate a mild generalized loss of vertebral body height. The L5 vertebral body demonstrates mild associated edema as well.L1-2: No significant spinal canal stenosis or neuroforaminal narrowing. L2-3: Facet arthropathy and ligamentum flavum thickening. Mild disc bulging. Mild generalized spinal canal narrowing with slight crowding of the cauda equina. Moderate bilateral foraminal narrowing. No interval changes. L3-4: Facet arthropathy. Ligamentum flavum thickening. Bulging disc. Moderate generalized spinal canal narrowing which appears to be slightly progressed from the prior examination. Mild bilateral foraminal narrowing, unchanged. L4-5: Facet arthropathy. Ligamentum flavum thickening. Disc bulging. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. No interval changes. L5-S1: No significant spinal canal stenosis or neuroforaminal narrowing.

Output: 1.Since the prior examination, mild compression deformities have developed at L4 and L5. Also noted is new edema within the L3 vertebral body which could indicate an impending compression deformity.2.Chronic concavity of the L2 inferior endplate is seen without evidence of marrow edema.3.A subcentimeter focus of marrow replacement within the L1 vertebral body is unchanged and nonspecific. Likewise, diffuse marrow heterogeneity is again seen which, on its own, is nonspecific. However, given the development of multiple compression deformities over the prior examinations, the possibility of more widespread osseous myelomatous involvement should be considered.4.Degenerative disc disease is seen, most severely affecting the L2-3 and L3-4 levels where there is spinal canal narrowing and some degree of nerve root crowding.


Instruction: Generate impression based on medical findings.

Input: 25-year-old male with a history of sickle cell disease and left-sided AVN presents with decreased joint mobility and right hip pain. There is marked deformity of the right femoral head corresponding to findings seen on recent radiographs. Note is made of increased bone marrow signal abnormality within the right ischium, acetabulum, iliac bone, and femoral head on fluid sensitive sequences with associated decreased signal abnormality on T1-weighted images. There is also increased signal abnormality within the gluteal musculature bilaterally, right greater than left, as well as within the right iliopsoas muscle. These findings likely represent osteonecrosis/bone infarction with surrounding inflammatory change, although infection cannot be completely excluded by this examination. There is a small right-sided joint effusion likely related to the synovitis from the aforementioned osteonecrosis. There is also increased bone marrow signal abnormality on fluid sensitive sequences within the left iliac bone also suggesting osteonecrosis. Note is made of extensive metallic susceptibility artifact corresponding to the orthopedic fixation of the left hip.

Output: Findings most consistent with advanced osteonecrosis resulting in subchondral collapse and severe secondary degenerative changes affecting the right hip. There is inflammatory change in the surrounding musculature as well as synovitis affecting the right hip, also likely related to the aforementioned avascular necrosis, although infection cannot be completely excluded by this examination.


Instruction: Generate impression based on medical findings.

Input: 35-year-old female with right upper quadrant pain. ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis with pericholecystic fluid. No choledocholithiasis. Trace dependent perihepatic fluid. No intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The right kidney is surgically absent. Small cyst in the left kidney.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: 1.Findings suspicious for acute cholecystitis. No choledocholithiasis.


Instruction: Generate impression based on medical findings.

Input: Uterine fibroids, abdominal pain PELVIS:UTERUS, ADNEXA: Multiple subserosal and intramural enhancing masses in the uterus some compatible with fibroids. The largest fibroid at the fundus measures 9.9 x 9.6 x 9.6 cm (AP x TR x CC; series 10, image 33). A fibroid in the posterior fundus demonstrates a region of nonenhancement compatible with necrosis (series 12, image 26).The ovaries are normal.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small amount of pelvic free fluid.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Uterine fibroids as described above.2.Small amount of pelvic free fluid; likely physiologic.


Instruction: Generate impression based on medical findings.

Input: Moyamoya disease [I67.5], Reason for Study: ^Reason: hx pial synangiosis: eval revascularization History: surveillance imaging Brain MRINo evidence of acute ischemic or hemorrhagic lesion on the scan.Focal encephalomalacia on the right basal ganglia and thalamus, hemosiderin deposition on the left mesial thalamus and right globus pallidus as well as encephalomalacia on the left inferior parietal lobule are again seen, unchanged since prior scan.Bilateral fronto-temporal craniectomy sites are redemonstrated, unchanged.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate obliteration of bilateral distal ICA supraclinoid segments which are consistent with known Moyamoya disease, unchanged since prior scan. Vertebrobasilar system appears to be normal. Reconstitution of bilateral MCAs and their branches are seen on source images, unchanged since prior scan.Vertebrobasilar system appears to be normal.Brain MR PerfusionAIF was measured from the distal basilar artery.The MTT appears to be delayed symmetrically on bilateral hemispheres comparing to posterior fossa.The rCBV and rCBF maps show approximately symmetric rCBV and rCBF but slightly decreased left hemispheric rCBV and rCBF.There is no focal significant increase or decreased area on either rCBV or rCBF maps. Above findings do not show any significant interval change since prior scan.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. No change of multifocal chronic ischemic and hemorrhagic lesions.3. No change of Moyamoya disease involving bilateral distal ICA with reconstitution of bilateral MCAs and their branches.4. No significant interval change of MR perfusion study.


Instruction: Generate impression based on medical findings.

Input: Ms. Ostroff is a 44-year-old female with a strong family history of breast cancer, including mother, maternal aunt, maternal cousin, and paternal grandmother. She has a personal history of benign right breast biopsy and bilateral breast reduction. There is scattered fibroglandular tissue in both breasts. Moderate background parenchymal enhancement is noted bilaterally, which limits the sensitivity of this examination.Multiple circumscribed homogeneously enhancing foci are identified in both breasts, but these lesions are stable over several prior studies and do not demonstrate suspicious morphology or kinetics. No suspicious enhancement is seen in either breast. Signal artifact from biopsy clip is redemonstrated in the right upper outer breast, at the site of benign MR guided biopsy. No abnormal lymph nodes are identified in either axillary region.T2 hyperintense focus in the left hepatic lobe, compatible with a benign cyst.

Output: Multiple stable benign enhancing foci in both breasts. No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on medical findings.

Input: 55-year-old male with elevated PSA. PELVIS:PROSTATE:Prostate Size: 4.4 x 2.6 x 3.5 cm (TR x AP x CC)Peripheral Zone: There is a focus of decreased T2 signal abnormality with apparent restricted diffusion in the right posterior mid body of the peripheral zone of the prostate gland. However, there is no convincing abnormal enhancement on the dynamic contrast enhanced sequences. These findings are indeterminant, however, prostate carcinoma is not excluded.Seminal Vesicles: No evidence of extension to involve the seminal vesicles.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: Mild concentric thickening of the wall of the bladder suggestive of chronic outlet obstruction.LYMPH NODES: No evidence of lymphadenopathy.BONES, SOFT TISSUES: No bone marrow signal abnormality is identified.OTHER: No significant abnormality noted.

Output: Focus of signal abnormality in the right posterior mid body of the peripheral zone of the prostate gland with indeterminate imaging characteristics. Prostate carcinoma is not completely excluded. These findings were discussed directly with the patient.


Instruction: Generate impression based on medical findings.

Input: 75-year-old female with jaundice ABDOMEN:LIVER, BILIARY TRACT: Innumerable lesions scattered throughout the liver highly suspicious for metastatic disease.Marked intrahepatic biliary ductal dilatation leading up to the Klatskin point. A mass at the Klatskin point extends into the common bile duct as well as infiltrates into the liver parenchyma. The common bile duct does not opacify.Enlarged periportal lymph node measuring 12 mm (series 11, image 341).The hepatic vasculature are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Nonenhancing fluid intensity left adrenal lesion may represent a cyst.KIDNEYS, URETERS: Left interpolar and inferior pole renal cyst. Additional subcentimeter T2 hyperintense lesions are likely cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Moderate hiatal hernia. Colonic diverticulosis without evidence of diverticulitis. No peritoneal carcinomatosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Mass invading the Klatskin point and common bile duct with intrahepatic extension and extension into the common bile duct. Innumerable lesions scattered throughout the liver are highly suspicious for metastatic disease. Findings are most concerning for cholangiocarcinoma.Findings discussed with Dr. Choi at 1704 on 7/14/16.


Instruction: Generate impression based on medical findings.

Input: Lung cancer with history of brain metastases status post SRS. There are multiple subcentimeter supratentorial and infratentorial enhancing lesions. A previously identified ring-enhancing lesion within the right cerebellum measures 0.4 x 0.3 cm, previously 0.6 x 0.5 cm. A ring-enhancing lesion within the left occipital lobe measures 0.4 x 0.3 cm, previously 0.5 x 0.5 cm. There is mild adjacent vasogenic edema. A new left posterior parietal enhancing lesion measures 0.3 x 0.3 cm. There is a new left superior frontal ring-enhancing lesion measuring 0.4 x 0.4 cm. There is new linear T2 hyperintensity along the right occipital lobe, best identified on series 6, image 14, with no associated enhancement. There is subcortical T2 hyperintensity within the posterior right parietal lobe, with no associated enhancement. A T2 hyperintense lesion within the right inferior frontal white matter is unchanged. There is encephalomalacia within the left gyrus rectus. There is also a chronic lacunar infarct in the left basal ganglia with hemosiderin deposition. There is no evidence of acute intracranial hemorrhage or acute infarction. The pituitary gland appears unremarkable. However, there is a subcentimeter enhancing extra-axial lesion along the left jugulum sphenoidale. The ventricles are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable.

Output: 1. Multiple subcentimeter supratentorial and infratentorial metastases. The lesions within the right cerebellum and left occipital lobes are decreased in size. However, at least two enhancing lesions within the left cerebral hemisphere appear to be new.2. A subcentimeter enhancing lesion along the left jugulum sphenoidale may represent a metastasis or meningioma.3. Encephalomalacia of the left gyrus rectus and new scattered areas of T2 hyperintensity, which are perhaps treatment related.


Instruction: Generate impression based on medical findings.

Input: 84-year-old female with constipation, unable to disimpact. Concern for mass or fecolith per ER. ABDOMEN: The exam is not sensitive detection of lesions in the solid organs due to the lack of intravenous contrast. Given that limitation, the following observations are made.LUNG BASES: Left mastectomy.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Atherosclerotic changes aorta no evidence of aneurysm.BOWEL, MESENTERY: Bilateral hypoattenuating foci in the kidneys likely cysts. Left lower pole lesion stable but does not have characteristics of simple cyst. See prior evaluation with ultrasound on MRI.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: Atrophic or surgically absent.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Moderate amount of stool in the colon and in the rectum. There is distinct rectal wall thickening to about .8 cm as seen on series 4 image 129. Correlate for possible stercoral colitis limited to the rectum. There is mild stranding of the perirectal fat. Ischio rectal fossa fat is normal.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Atherosclerotic disease.

Output: Possible proctitis. Moderate amount of stool in the rectum. Renal lesions likely cysts including one atypical lesion which is stable.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Sciatica, right side Radiculopathy, site unspecifiedClinical question: assess for causes of radicular back painSigns and Symptoms: back pain with radiculopathy Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation present at this level.At L4-5 there is loss of disc space height, diffuse disc bulge and endplate reactive changes associated with facet and ligamentum flavum hypertrophy. The endplate reactive changes are high signal on T2 and low signal on T1. The endplates are irregular. The loss of disc space height appears to be worse than a plain film exam of 3/24/2015. There is crowding of the nerve roots within the thecal sac at this level with near effacement of the spinal fluid surrounding the nerve roots. Overall there is a moderate degree of spinal stenosis present at this level. There is effacement of the fat at the lateral recess bilaterally at this level. There is narrowing of the neural foramina at this level associated with encroachment of the exiting nerve roots within the neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is a minor disc bulge at this level. At L2-3 there is no significant compromise to spinal canal or neural foramina. There is a Schmorl's node at this levelAt L1-2 there is no significant compromise to spinal canal or neural foramina.The kidneys appear relatively small.

Output: 1.There are degenerative changes present in the lumbar spine which are worse at L4-5 where there is moderate spinal stenosis and bilateral neural foramen encroachment due to degenerative change. The degenerative changes appear to have progressed significantly since the prior CT of the abdomen from 9/9/2014. There are acute endplate reactive changes at this level which are likely inflammatory in nature. Please correlate with clinical history.2.The kidneys appear atrophic.