Instruction: Generate impression based on medical findings.

Input: 40 year-old male with right knee pain and swelling, history of ACL repair MENISCI: A vertically oriented band of increased signal intensity extending through the anterior horn of the medial meniscus is consistent with a tear. We cannot tell on this single exam whether this is old or new, but we see no fluid signal intensity entering the meniscal substance. The body and posterior horn are intact. There is a small focus of increased signal intensity within the free edge of the lateral meniscal body, which could represent a tiny radial tear or postoperative changes; this may not be of any current clinical significance.ARTICULAR CARTILAGE AND BONE: While there are no focal defects within the articular cartilage of the patella, there is increased signal intensity within the deeper cartilage at the medial patellar eminence and medial patella facet likely representing early delamination. Focal increased signal intensity within the central femoral trochlea inferiorly suggests full-thickness degeneration with degenerative signal abnormality within the underlying marrow.There is thinning of the articular cartilage of the weight-bearing portion of the medial femoral condyle and a tiny near full-thickness defect of articular cartilage overlying the posterior horn of the medial meniscus. Regularly spaced foci of low signal intensity along the subchondral bone may represent prior microfracture. Slight depression of the articular cartilage along the lateral femoral condyle is consistent with old impaction fracture from prior ACL injury, with a small focus of full thickness cartilage loss noted within the overlying articular cartilage.LIGAMENTS: Status post ACL reconstruction. The graft appears intact. Mild edema within the marrow along the tibial tunnel is of questionable significance. The PCL is intact. The MCL, and LCL are intact.EXTENSOR MECHANISM: There is expected deformity of the patella and patellar tendon from ACL harvest. The patella tendon is otherwise intact. The quadriceps tendon is intact.ADDITIONAL

Output: 1. Intact ACL graft.2. Foci of articular cartilage degeneration as described above.3. Tear of the anterior horn of the medial meniscus, which may be old or new; we see no fluid signal intensity to confirm an unstable tear.


Instruction: Generate impression based on medical findings.

Input: Female 12 years old with a history of neuroblastoma status post autologous stem cell transplant. She also has venoocclusive disease with involvement of the portal vein, as well as thrombus seen in the splenic vein on recent ultrasound, on anticoagulation. Now with acute mental status, evaluate for PRES. There is no evidence of acute infarct. There are multiple areas of abnormal increased T2/FLAIR signal in the cortex and subcortical white matter, in the bilateral parietal and occipital lobes with additional small areas in the frontal lobes, the parasagittal anterior parietal areas near the vertex (greater on the left), right posterior temporal lobe and smaller foci in bilateral cerebellar hemispheres (greater on the right). The brainstem and basal ganglia are spared. There is associated mild sulcal effacement and patchy gyriform enhancement, more conspicuous on the delayed post-contrast images. There is no intraparenchymal hemorrhage at this time.The ventricles and basal cisterns are normal in size and configuration with the left temporal horn of the lateral ventricle slightly smaller than the right as seen on CT, likely a normal variant. There is no midline shift or herniation. There is no extraaxial abnormality or osseous mass. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Multiple areas of bilateral supratentorial and cerebellar cortical/subcortical FLAIR abnormality with mild sulcal effacement and without diffusion restriction or susceptibility are favored to represent PRES, with mild associated patchy enhancement. Differential diagnosis would also include encephalitis, although felt to be much less likely, given lack of basal ganglia and brainstem involvement.


Instruction: Generate impression based on medical findings.

Input: History of renal carcinoma status post partial nephrectomy. Evaluate renal cyst and for metastatic disease. ABDOMEN:LIVER, BILIARY TRACT: Steatosis. No focal suspicious lesion, biliary ductal dilatation or vascular abnormality. Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Stable enhancing left adrenal nodule with signal loss on out of phase images measuring 1.6 cm (series 10 image 23), consistent with a lipid rich adrenal adenoma.KIDNEYS, URETERS: Postsurgical changes from a right renal inferior pole partial nephrectomy with adjacent susceptibility artifact. There is no evidence of recurrent or residual tumor locally. No regional lymphadenopathy. The right renal vein is patent. There is a subcentimeter right renal interpolar cyst with a thin septation, unchanged.Minimally complex cyst with several enhancing septations in the left renal upper pole measuring 2.2 x 2.0 cm (series 7 image 17), unchanged. Additional left renal simple cysts are again noted.RETROPERITONEUM, LYMPH NODES: A few nonspecific subcentimeter retroperitoneal lymph nodes are unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stable left upper pole renal cyst with enhancing septations.2.Postsurgical changes from a right renal inferior pole partial nephrectomy without evidence of residual/recurrent or metastatic disease.


Instruction: Generate impression based on medical findings.

Input: History of metastatic gallbladder cancer with rising bilirubin, jaundice and ascites. Evaluate for intraductal obstruction. ABDOMEN:LIVER, BILIARY TRACT: T2-weighted moderately hyperintense liver masses extending from the gallbladder fossa and involving the right hepatic lobe. Tumor/lymphadenopathy extends through the porta hepatis. These findings have progressed from the prior study. There is severe narrowing at Klatskin's point (series 501/27) and decompression of the common hepatic and common bile duct. This results in severe intrahepatic biliary ductal dilatation. The dominant lesion measures approximately 6.0 x 5.2 cm (series 501/26) at the junction of the anterior and posterior segment.Large gallstone in a decompressed gallbladder. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Mild right-sided hydroureteronephrosis to the level of the pelvic mass likely related to mass effect, increased from the prior study.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The bowel is normal in caliber. Large volume ascites. The large heterogeneous pelvic mass with central cystic component is partially evaluated and is best seen on the coronal images. It measures approximately 12.2 x 11.7 cm (series 401/12).BONES, SOFT TISSUES: Anasarca.OTHER: Large bilateral pleural effusions with adjacent consolidation/atelectasis.

Output: 1.Findings compatible with gallbladder carcinoma invading the hepatic parenchyma with tumor/lymphadenopathy infiltrating the porta hepatis resulting in severe intrahepatic biliary ductal dilatation centered about Klatskin's point.2.Large volume ascites and bilateral pleural effusions.3.Pelvic mass is partially imaged.


Instruction: Generate impression based on medical findings.

Input: Reason: assess for medial meniscal tear s/p twisting injury History: pain and swelling MENISCI: There is deformity of the posterior horn of the medial meniscus which may represent degeneration and superficial fraying. There is no fluid-filled unstable tear identified. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is a full-thickness articular cartilage defect along the weightbearing surface of the medial femoral condyle above the body of the meniscus. There is also full-thickness articular cartilage degeneration along the weightbearing surface of the medial femoral condyle above the posterior horn of the meniscus. The lateral tibiofemoral articular cartilage appears relatively spared. There is a full-thickness articular cartilage cleft along the lateral facet of the femoral trochlea, centrally. There is subjective thinning of the patellofemoral articular cartilage.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Full-thickness articular cartilage degeneration and defects most pronounced along the medial tibiofemoral compartment.2. Deformity of the posterior horn of the medial meniscus likely represents a combination of degeneration and superficial fraying. No fluid-filled unstable tear is identified.3. Moderate size joint effusion. Other findings as described.


Instruction: Generate impression based on medical findings.

Input: 61-year-old male with shoulder pain and symptoms of rotator cuff tear. ROTATOR CUFF: There is a partial-thickness undersurface tear of the anterior fibers of the infraspinatus tendon at the level of its insertion on the greater tuberosity, measuring approximately 6 mm in the AP dimension, involving less than 50% of the tendon width. There is no significant retraction. The supraspinatus tendon and muscle appear intact. The teres minor and subscapularis muscles and tendons appear intact.SUPRASPINATUS OUTLET: Moderate degenerative changes affect the acromioclavicular joint. There is a small amount of fluid within the subacromial subdeltoid bursa which may reflect a mild bursitis.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. No articular cartilage defects are identified. Although this examination was not protocoled for evaluation of the glenoid labrum, there is heterogeneity and increased signal abnormality affecting the anterior inferior glenoid labrum suggestive of degenerative tearing.BICEPS TENDON: There is a small amount of fluid within the tendon sheath of the long head of the biceps which may reflect fluid extension from the glenohumeral joint versus a mild tenosynovitis.ADDITIONAL

Output: Small partial thickness tear of the infraspinatus tendon without evidence of a full-thickness rotator cuff tear. Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old, with metastatic breast cancer to the lungs, presenting with pain in the neck up into the bottom of the skull. Assess for metastatic disease. Extensive metastatic infiltration of the C3 and C4 vertebral bodies and posterior elements is noted with minimal infiltration of C5. Extraosseous extension is also seen into the left lateral paraspinal soft tissues.The affected vertebral bodies are mildly expanded and along with nearly circumferential involvement of the neural arch, there is a resulting severe spinal canal stenosis with cord impingement but no definite cord signal abnormality. Tumor extensively infiltrates the left C2-3, C3-4 and C4-5 neural foramina. The left vertebral artery is encased by tumor but the flow void appears to be preserved throughout indicating patency.Elsewhere, the vertebral bodies demonstrate normal signal characteristics and pattern of enhancement. Spinal alignment is straightened. Vertebral body heights are grossly preserved, even those affected by metastatic disease.C2-3: Posterior disc-osteophyte complex formation with a superimposed right paraspinal osteophyte or disc protrusion causing minimal impingement upon the spinal cord. At the disc space, only a mild generalized spinal canal stenosis is seen, though below the disc space, canal stenosis related to metastatic disease begins and is severe. No significant right foraminal narrowing. Tumor infiltration of the left neural foramen is seen. C3-4: Severe spinal canal stenosis and cord impingement secondary to a combination of circumferential tumor with osseous expansion and superimposed degenerative disc disease. The left neural foramen is extensively tumor infiltrated. The right neural foramen is moderately narrowed by degenerative disease. C4-5: Moderate spinal canal stenosis due to a combination of expansile tumor and some superimposed disc degeneration. The cord is impinged to a mild degree. The left neural foramen is tumor infiltrated. The right neural foramen is mildly narrowed by degenerative disease. C5-6: Posterior disc-osteophyte complex formation. Effacement of the ventral thecal sac with a mild generalized spinal canal stenosis but no significant cord deformation. Moderate to severe bilateral foraminal narrowing. C6-7: Minimal posterior disc-osteophyte complex formation. No significant generalized spinal canal or foraminal stenosis. C7-T1: Left facet hypertrophy. Minimal posterior disc-osteophyte complex formation. No significant spinal canal or neuroforaminal stenosis. Left supraclavicular adenopathy is partially imaged on this examination. Abnormal signal within the posterior sphenoid bone extending to involve the clivus may simply represent chronic sphenoid sinus mucosal thickening or a mucous retention cyst, but it is nonspecific.

Output: 1.Extensive tumor infiltration is seen affecting the C3 and C4 vertebral bodies and posterior elements, and to a lesser degree the C5 vertebral body. There is substantial left lateral extraosseous tumor spread as well which engulfs the left vertebral artery. 2.The above findings result in a severe stenosis of the spinal canal at the C3 and C4 levels with cord impingement, as well as tumor infiltration of the left-sided neural foramina from C2 through C5.3.Relatively mild degeneration of the disks and posterior elements is seen at the remaining cervical levels.4.Signal abnormality within the posterior sphenoid bone and clivus, partially imaged on this examination, is nonspecific. Dedicated imaging of the head, at least by CT, would likely help to clarify the nature of this finding.


Instruction: Generate impression based on medical findings.

Input: Male, 33 years old, with essential tremor status post unilateral deep brain stimulator, now planning for implantation on the other side. Since the prior examination, a left frontal approach deep brain stimulator lead has been placed coursing posteriorly and inferiorly to terminate within or just below the left thalamus. No unexpected or acute findings are identified on this limited examination. Brain parenchymal morphology and signal characteristics are otherwise unremarkable.

Output: Findings compatible with interval placement of a left-sided deep brain stimulator.


Instruction: Generate impression based on medical findings.

Input: 65 years Male (DOB:10/28/1950)Reason: assess for cervical radiculopathy and progression of cervical spinal stenosis History: radicular pain in the RUEPROVIDER/ATTENDING NAME: KOUROSH REZANIA KOUROSH REZANIA The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal mass lesions are identified in the cervical spine. The patient status anterior fusion from C4 through C6 using anterior plate and screws.At C2-3 there is a diffuse disc bulge present associated with ligamentum flavum hypertrophy. There is associated effacement of spinal fluid ventral and posterior the spinal cord. This has not changed substantially compared to the previous exam.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. There is a disc bulge present at this level which narrows the neural foramina. It is associated with small uncovertebral osteophytes. Overall there is mild encroachment of the exiting nerve roots within the neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this level mildly narrowing the neural foramina at this level.The vertebral artery flow voids appear to be intact.

Output: The patient is status post anterior fusion from C4 through C6. There is redemonstration of degenerative changes of the cervical spine associated with spinal stenosis at C2-3 and some narrowing of neural foramina at other levels. These findings are stable compared to the previous exam from 10/17/2015.


Instruction: Generate impression based on medical findings.

Input: 29-year-old female with liver lesions in the left lobe and caudate lobe. ABDOMEN:LIVER, BILIARY TRACT: The liver is mildly prominent in size, though of normal parenchymal appearance otherwise. There is no biliary ductal dilation. Two masses are seen in the liver. A caudate lobe mass measures 3.8 x 3.1 cm. A left hepatic lobe mass measures 2.9 x 1.8 cm. The masses are homogeneously isointense to the background liver on T2 sequences and hyperintense on T1 sequences, without signal dropout on out of phase images. The masses are gently lobulated. The masses demonstrate arterial enhancement on e-THRIVE sequences, with continued enhancement on delayed images. There is a question of a focal linear T2 hyperintensity in the caudate lobe mass, which demonstrates delayed enhancement suggestive of a scar.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 abdominal fluid collections are noted.

Output: Two enhancing masses seen in the liver, most likely representing focal nodular hyperplasia.


Instruction: Generate impression based on medical findings.

Input: 65 years Male (DOB:6/30/1951)Reason: Follow up of two 2mm brain lesions suspicious for metastatic disease History: NonePROVIDER/ATTENDING NAME: RENUKA MALIK RENUKA MALIK The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a punctate enhancing nodule in the right precuneus associated with susceptibility effect. Another punctate enhancing nodule is present in the left cerebellar hemisphere medially. It is also associated with a low but susceptibility effectThere are several punctate foci of susceptibility effect in the right periventricular white matter, right parietal lobe, left parietal lobe and right temporal lobe which are not associated with abnormal enhancement.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There are couple punctate lesions which are suspicious for metastatic disease which are now associated with microhemorrhage. Previously they are not associated with a microhemorrhage2.There are several microhemorrhages in the supratentorial brain which were not readily identified on the prior exam. It is possible these are treatment related


Instruction: Generate impression based on medical findings.

Input: 62 years old Male. Reason: h/o metastatic prostate CA, spinal pain History: as above. C7 is incompletely imaged. And there is a suggestion of loss of height of the C7 vertebral body. Suggest further evaluation with CT or MRI if clinically indicated.There is no evidence of acute fracture or dislocation in the C1-C6 vertebrae. Degenerative changes are seen in the cervical spine.

Output: Probable loss of height of C7 vertebral body which is incomplete imaged. Suggest further evaluation with CT or MRI if clinically indicated.


Instruction: Generate impression based on medical findings.

Input: a 36 year old male with hypertension, atrial fibrillation, gout and heart failure suspected to be non-ischemic. The patient is now hospitalized due to decompensated heart failure and referred to cardiac MRI for further evaluation of function and etiology. Left VentricleThe left ventricle is severe dilated with significant systolic dysfunction. The lateral wall demonstrates severe hypokinesis with akinesia of the sepum, inferior and anterior walls.The overall LV ejection fraction is 13%, the LV end diastolic volume index is 259 ml/m2 (normal range: 74+/-15), the LVEDV is 584 ml (normal range 142+/-34), the LV end systolic volume index is 224 ml/m2 (normal range 25+/-9), the LVESV is 506 ml (normal range 47+/-19), the LV mass index is 82 g/m2 (normal range 85+/-15), and the LV mass is 185 g (normal range 164+/-36). The myocardium is globally thinned. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.No LV cavity thrombus. No iron overload. No findings to suggest amyloid in the myocardium. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is severely dilated with severe systolic dysfunction. The overall RV ejection fraction is 20%, the RV end diastolic volume index is 172 ml/m2 (normal range 82+/-16), the RVEDV is 387 ml (normal range 142+/-31), the RV end systolic volume index is 137 ml/m2 (normal range 31+/-9), and the RVESV is 309 ml (normal range 54+/-17).Right AtriumThe right atrium is severely dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely. Visually, there is moderate to severe mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. Visually, there is moderate tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC drains normally into the right atrium. There is azygous continuation of the IVC.PericardiumThere is trace pericardial effusion.

Output: 1. The left ventricle is severe dilated with extreme systolic dysfunction, the LVEF is 13%. The myocardium is globally thinned. There is global hypo/akinesis with regional wall motion variation. 2. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. No LV cavity thrombus. No iron overload. No findings to suggest amyloid in the myocardium. 3. The right ventricle is severely dilated with severe systolic dysfunction, the RVEF is 20%. 4. The left and right atrium are severely dilated. 5. Azygous continuation of the IVC.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: Wrist pain following injury, multiple prior surgical interventions Despite multiple attempts at metal reduction, evaluation of the wrist, including the triangular fibrocartilage complex, is extremely limited due to susceptibility artifact from an orthopedic screw affixing the scaphoid and lunate. There are new surgical changes relating to prior TFCC repair with the small areas of signal void within the soft tissues overlying the ulna. Additionally, there are small foci of low T1 signal seen between the triquetrum and ulnar styloid which are thought to represent areas of suture material. The triangular fibrocartilage complex is not well visualized on the fluid sensitive sequences on account of the aforementioned metallic susceptibility artifact. There is low T1 signal intensity within the region of the TFCC thought to represent the area of repair. Within this structure are areas of ill-defined signal abnormality (best appreciated on series 9 images 10 and 11 and series 3 images 7 and 8) suspicious for areas of tearing. Evaluation of the intrinsic ligaments is limited due to metallic susceptibility artifact. A mild amount of increased marrow signal is seen along the ulnar styloid which may be reactive in nature.The median nerve is normal in caliber.

Output: 1. Markedly limited study due to extensive metallic susceptibility artifact. 2. Postsurgical changes of TFCC repair. What is seen of the TFCC demonstrates areas of ill-defined signal abnormality suspicious for partial tears with or without scarring.3. Normal appearance of the median nerve.


Instruction: Generate impression based on medical findings.

Input: Female 49 years old Reason: Right achilles tendinopathy vs tear - evaluate achilles tendon and calcaneous. History: Right achilles pain, chronic TENDONS: No significant abnormality noted. In particular, the Achilles tendon appears normal.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: Punctate focus of T2 hyperintense signal within the subchondral tibia which likely represents a small subchondral cyst. T1 hypointense/T2 hyperintense signal focus within the posterior talus likely represents a synovial herniation. There is no edema within the surrounding bone.ADDITIONAL

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


Instruction: Generate impression based on medical findings.

Input: Breast cancer metastasized to central nervous system. Since the brain MRI from November 2015, there are has been interval progression of supratentorial and infratentorial metastatic disease consisting of increase in size of existing lesions and interval appearance of several new lesions, with a total of approximately 20 intra-axial lesions. For example, a right cerebellar hemisphere lesion measures 8 mm in diameter, previously 4 mm, and there is a new 5 mm diameter right thalamus lesion. There is vasogenic edema associated with the lesions, but otherwise an unchanged background of mild periventricular white matter T2 hyperintensity, which may represent chronic small vessel ischemic disease. There are postoperative findings related to left parieto-occipital craniotomy without evidence of nodular enhancement to suggest tumor recurrence in this location. There is unchanged confluent white matter T2 hyperintensity in the treatment bed region. There is an unchanged subcentimeter enhancing lesion within the fundus of the right internal auditory canal. There is an unchanged developmental venous anomaly in the brainstem associated with punctate foci of susceptibility effect that likely represent cavernous malformations. There is unchanged mild encephalomalacia in the left cerebellar hemisphere. There is no evidence of acute infarct. The ventricles and basal cisterns are stable in size and configuration, with ex vacuo dilatation of the left lateral ventricle. There is minimal midline shift to the left. There is minimal fluid signal within the left mastoid air cells. There is mild mucosal thickening in the paranasal sinuses. The skull and extracranial soft tissues are unchanged.

Output: 1. Overall progression of intracranial metastatic disease since November 2015.2. An unchanged subcentimeter right internal auditory canal lesion may represent a vestibular schwannoma versus less likely a metastasis.3. Unchanged developmental venous anomaly in the brainstem associated with punctate foci of susceptibility effect that likely represent cavernous malformations.


Instruction: Generate impression based on medical findings.

Input: Enlarged orbital muscles: proptosis. Orbits: There is interval decreased enlargement of the extraocular muscles, with mild residual prominence of the right superior rectus muscle. There is mild protosis bilaterally, right more than left, which appears to be attributable to diffuse prominence of the orbital fat. Otherwise, the bilateral globes, lacrimal glands, and optic nerves bilaterally are intact. There is no evidence of orbital mass lesions.Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are nonspecific punctate foci of T2 hyperintensity in the right parietal lobe white matter. The brain, brainstem, and cerebellum otherwise appear unremarkable. There is no abnormal meningeal enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Interval decreased enlargement of the extraocular muscles, with mild residual prominence of the right superior rectus muscle, which may be related to evolution of an inflammatory process, such as sarcoidosis. Otherwise, mild protosis bilaterally, right more than left, appears to be attributable to diffuse prominence of the orbital fat.2. Mild thickening of the pituitary infundibulum may represent an inflammatory process as well, such as sarcoidosis.3. No evidence of intracranial hemorrhage, mass, or acute infarct. Punctate foci of T2 hyperintensity in the right parietal lobe white matter are nonspecific, but may represent chronic small vessel ischemic disease, for example.


Instruction: Generate impression based on medical findings.

Input: Primary CNS lymphoma status post treatment. There are postoperative findings related to left transfrontal biopsy. There is unchanged patchy T2 hyperintensity in the left corona radiata, basal ganglia, and insula, with minimal faint enhancement in this region. There is also unchanged patchy intrinsic T1 hyperintensity and susceptibility effect in the left basal ganglia enhancement at the biopsy site. There is unchanged patchy high T2 signal in the left cerebral peduncle without associated enhancement. There is no residual midline shift or herniation. There is diffuse cerebral volume loss with superimposed ex vacuo dilatation of the left lateral ventricle and Wallerian degeneration of the left brainstem. There is no acute infarct. There is an unchanged nonspecific enhancing lesion in the left parietal skull.

Output: 1. Treated CNS lymphoma centered in the left basal ganglia and left cerebral peduncle without evidence of tumor recurrence.2. Unchanged nonspecific enhancing lesion in the left parietal skull.


Instruction: Generate impression based on medical findings.

Input: 71 year old man with previous wide complex tachycardia who underwent EP ablation, with right atrial enlargement noted during procedure, now referred for cardiac MRI. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 87 ml/m2 (normal range: 74+/-15), the LVEDV is 181 ml (normal range 142+/-34), the LV end systolic volume index is 39 ml/m2 (normal range 25+/-9), the LVESV is 81 ml (normal range 47+/-19), the LV mass index is 34 g/m2 (normal range 85+/-15), and the LV mass is 71 g (normal range 164+/-36). There is a small area of late gadolinium enhancement in the basal inferolateral which is nearly transmural, and suggestive of prior infarction. There are no wall motion abnormalities. There is no evidence of myocardial iron overload or intracardiac thrombus.Left AtriumThe left atrium is moderately enlarged. The interatrial septum appears aneurysmal.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 56%, the RV end diastolic volume index is 87 ml/m2 (normal range 82+/-16), the RVEDV is 181 ml (normal range 142+/-31), the RV end systolic volume index is 38 ml/m2 (normal range 31+/-9), and the RVESV is 80 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly enlarged.Aortic ValveThe aortic valve is trileaflet. The aortic valve opens widely and there is mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is trivial 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. The thoracic aorta is tortuous.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no pericardial effusion.Extracardiac FindingsDextroscoliosis. Hepatic and renal cysts.

Output: 1. Normal size LV with normal systolic function (EF 55%).2. Small area of late gadolinium enhancement in the basal inferolateral wall which is transmural and consistent with infarction.3. Normal size RV with normal systolic function (EF =56%).4. Biatrial dilation. 5. Mild aortic regurgitation.


Instruction: Generate impression based on medical findings.

Input: Neoplasm of unspecified behavior of brain [D49.6], Reason for Study: ^Reason: brain lesion. Preop planning for biopsy History: headaches Extra-axial mass likely represent meningioma on the anterior aspect of falx do not show any significant interval change in terms of MR characteristics as well its size (T:24.4 mm x CC:27.2 mm x AP:30.7 mm).Dural sinuses specialist superior sagittal sinus appears to be intact.Subtle high signal intensity on the left frontal lobe on T2 and FLAIR imaging, does not show any significant interval change since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No change of anterior falx meningioma in terms of size and MR characteristics as well as left inferior frontal lobe white matter lesion since prior scan.


Instruction: Generate impression based on medical findings.

Input: Clinical question: History of left acoustic neuroma status post radiosurgery; please evaluate for response. Signs and symptoms: As above. Pre- and post enhanced brain MRI:Examination is performed utilizing the standard pre and post enhanced brain MRI and without dedicated by IAC images.Negative diffusion weighted series.Examination demonstrates an enhancing left-sided acoustic neuroma occupying the entire left internal auditory canal and the slight bulge into the cerebellopontine angle cistern. The lesion measures 13.3 mm in transverse axis which is identical to prior study. It measures approximately 7.7 mm in AP axis at the level of the left internal auditory meatus is similar to prior exam.Examination otherwise demonstrate normal anatomical morphology of the brain and with normal signal intensity on all MRI sequences. No detectable abnormal parenchymal or leptomeningeal enhancement. Unremarkable calvarium and soft tissues of the scalp. Unremarkable images through the orbits including axial fat sat post enhanced series. Normal signal intensity of bilateral mastoid air cells, middle ear cavities and visualized paranasal sinuses.

Output: 1.No appreciable interval change in the size, morphology or enhancement of a 13.3 x 7.7 mm left acoustic neuroma since prior exam.2.Unremarkable pre and post enhanced brain MRI otherwise. Please see above comments.


Instruction: Generate impression based on medical findings.

Input: Radiculopathy, cervical region [M54.12], Reason for Study: ^Reason: eval for radiculopathy, myelopathy History: neck pain and left sided radicular pain There is straightening of cervical spine. The cranial-cervical junction is normal. There is minimal fluid collections on the atlanto axial joint indicating inflammatory changes including osteoarthritic changes. There is no evidence of atlanto axial subluxation.The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The cord signal is normal. Degenerative changes are specified by the intervertebral level as follows: C2-C3: disc dessication, no neuroforaminal narrowing or spinal stenosis. C3-C4: disc dessication, no neuroforaminal narrowing or spinal stenosis. C4-C5: there is broad based central to left disc protrusion which abuts thecal sac, no neuroforaminal narrowing or spinal stenosis. C5-C6: disc dessication,, diffuse bulging of disc which abuts thecal sac, no neuroforaminal narrowing or spinal stenosis. C6-C7: disc dessication, broad based disc protrusion which abuts thecal sac and minimal obliteration of the left lateral recess, no neuroforaminal narrowing or spinal stenosis. C7-T1: no neuroforaminal narrowing or spinal stenosis.

Output: 1. Multi-level various degree disc degenerations as described above.2. Disc herniations at the level of C45 and C67 as described above. Disc bulging at the level of C56.


Instruction: Generate impression based on medical findings.

Input: Malignant neoplasm of unspecified part of unspecified bronchus or lung [C34.90], Reason for Study: ^Reason: Cancer eval for mets History: Cancer eval for mets Previously seen right precentral gyrus (6mm was 2mm) and at least 3 left cerebellar enhancing lesions are again seen but appear to be more conspicuous and slightly increased in size since prior scan.There is no evidence of new abnormal enhancing lesion on the scan.There is no evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are unremarkable. About 5mm sized downward tonsilar displacement through the foramen magnum are again seen, unchanged.The midline structures are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. More conspicuous and slightly increased in size of right frontal lobe pre central gyrus and left cerebellar hemispheric enhancing nodular lesions since prior scan.2. No new abnormal enhancement is seen.3. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Status post brain tumor resection. Signs and symptoms: Status post brain tumor resection. Pre- and post enhanced brain MRI:Indication is status post left posterior temporal-frontoparietal craniotomy with expected postoperative changes.There is a surgical resection cavity at the site of removed tumor in the left frontal lobe measuring approximately 32 x 37 mm in transaxial dimensions. There is serosanguineous fluid as well as a small amount of air within the surgical cavity which is within expected postoperative finding. Very extensive surrounding vasogenic edema demonstrate no significant change since prior exam.On post enhanced images there is an ill-defined focus of enhancement along the anterior and superior aspect of surgical cavity measuring 10 x 20 mm in transaxial dimensions (axial post enhanced series 1001 image 20) and approximately 14 x 13 mm size measured on sagittal post enhanced series 1/1/2001 image 9. Region of enhancement is believed to represent a focus of residual tumor and further follow-up is recommended.Increased mass effect on the left results in rightward deviation of midline of approximately 4 mm which has a slightly decreased since prior exam. The ventricular system however remain within normal size.Multiple additional necrotic rim enhancing metastatic lesions in bilateral cerebral hemispheres and right cerebellum are again identified without significant change since prior exam from 6-5-15.

Output: 1.Expected postoperative changes of a left-sided craniotomy for removal of tumor as detailed.2.Focus of enhancement along the anterior superior aspect of surgical cavity measuring at 10 x 20 mm in transaxial and 14 x 13 mm on sagittal post enhanced images is highly suspected of residual tumor.3.Slight interval decreased rightward deviation of the midline since prior exam and with stable normal size of ventricles.4.Stable multiple bilateral hemispheric and right cerebellar metastatic lesion since prior exam.5.Extensive vasogenic edema in bilateral hemispheres (left greater than right) remains fairly similar to preoperative study.


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old, with left-sided stroke presenting with slowed response, concern for worsening mental status. Barely detectable diffusion restriction is seen corresponding to the areas of hypoattenuation noted on prior CTA involving the left insula, opercular tissues and inferior parietal lobule. No significant edema, mass effect or volume loss is evident as of yet. Trace scattered sulcal FLAIR hyperintensity within the infarct region may reflect vascular engorgement or slow flow.Scattered small foci of cortical and white matter T2 hyperintensity are seen which may reflect prior episodes of ischemia. No acute intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. Several scattered foci of susceptibility are seen which may reflect chronic microhemorrhage. The ventricles are normal in size and morphology.

Output: 1.Diffusion restriction corresponding to the known left MCA infarct is barely detectable suggesting a subacute time course. 2.No evidence of associated edema, mass effect or significant tissue loss is detected.3.No other acute findings are seen to account for the patient's apparent worsening mental status.


Instruction: Generate impression based on medical findings.

Input: cT4N1Mx left tongue squamous cell carcinoma, status post treatment. There is no measurable residual tumor in the left tongue or surrounding structure. There is no significant lymphadenopathy in the neck. The thyroid and major salivary glands are unchanged. The osseous structures and paranasal sinuses are unremarkable. The imaged intracranial structures and orbits are unremarkable.

Output: No evidence of gross measurable tumor or significant lymphadenopathy in the neck.


Instruction: Generate impression based on medical findings.

Input: 72 years Female (DOB:8/9/1944)Reason: s/p crani for tumor History: s/p crani for tumorPROVIDER/ATTENDING NAME: KRUPA G ANDALKAR PETER C. WARNKE Since the prior examination patient is undergone parietal craniotomy for removal of an extra-axial mass involving the superior sagittal sinus. The lobulated enhancing component remaining along the anterior aspect of the mass measuring 33 x 19 mm in axial dimensions the superior sagittal sinus appears to be patent adjacent to it.Within the brain parenchyma adjacent to the craniotomy site there is signal change within the subcortical white matter in a contiguous fashion which has not changed substantially since the prior preoperative exam.There are are some small foci of diffusion restriction adjacent to the surgical site within the brain parenchyma. There are some blood products which are hyperintense on T1 at the surgical site. There is soft tissue swelling present involving the scalp tissues.Incidental note is made of partial empty sella.There is mild anterior subluxation of C1 on C2.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells demonstrate opacification of the right mastoid air cells. The visualized portions of the orbits are intact.

Output: 1.Since the prior examination the patient is undergone partial removal of an extra-axial mass adjacent to the falx and superior sagittal sinus. There are associated postoperative changes present.2.There is mild anterior subluxation of C1 on C2 which appears unchanged since the prior exam


Instruction: Generate impression based on medical findings.

Input: Clinical question: NSCLC restaging. Signs and symptoms: As above. Pre-and post-enhanced brain MRI:No diffusion weighted abnormalities.Examination demonstrates interval further decreased size of metastatic lesions since prior study. On the current exam there is only a single detectable metastatic lesion in the subcortical white matter of right frontal lobe measuring approximately 2.6 mm in size (axial post enhanced series 12 image 175) which previously measured at 4-mm. A 1 mm punctate focus of enhancement in the left cerebellum consistent with residual metastatic lesion which previously measured at 3.3-mm.there is no convincing evidence of any additional detectable metastatic lesions. Multiple small foci of flair hyperintensity in periventricular and subcortical white matter of bilateral cerebral hemispheres demonstrate no change. The findings could represent posttreatment/radiation changes.Unremarkable calvarium and orbits without evidence of abnormal enhancement.All paranasal sinuses demonstrate normal pneumatization signal pattern.

Output: 1.Negative diffusion weighted images.2.Further improvement of metastatic disease since prior exam as detailed. Some of the smaller lesions are no longer identified. Visualized remaining metastatic lesions are smaller than prior exam. Please see above comments as/measurements.3.Stable nonspecific periventricular and subcortical flair hyperintensity which could represent post treatment/radiation change.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old, with aphasia and right-sided weakness. Findings are seen compatible with a very large AV malformation involving the left posterior frontal, parietal, and perhaps temporal lobes. This includes numerous convoluted and serpentine flow voids, several of which are markedly dilated. The left MCA vessels are generally enlarged indicating the likely primary source of supply. Numerous dilated draining veins are noted including surface veins which drain to the dural venous sinuses and veins which drain to the deep system. Accounting for differences in technique, the overall morphology and size of the lesion seem to be unchanged relative to prior CTs.No restricted diffusion is seen. No definite evidence of parenchymal edema is seen. Mild T2 hyperintensity within the AVM may represent gliosis. The lesion does cause generalized left cerebral mass effect with effacement of sulci, partial effacement of the left lateral ventricle, and a relatively mild 5 mm midline shift to the right. These findings do not appear to have changed significantly. Within the lesion, there is a 10 mm T1 hyperintense lobule which could represent a small hemorrhagic collection or perhaps a thrombosed vascular channel.

Output: Findings are seen compatible with a large left sided AV malformation involving the posterior frontal lobe, parietal lobe and perhaps a small portion of the temporal lobe. The overall size of the lesion does not seem to have changed significantly. It appears that the left MCA serves as a major source of supply for the lesion with venous drainage to both superficial and deep systems. The degree of associated mass effect does not appear to have changed. No definite acute abnormalities are seen.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Assess for sinus disease/infection. Signs and symptoms: 55-year-old female with MDS and severe facial pain. Concern for invasive sinusitis. Non-enhanced CT of paranasal sinuses:Frontal sinuses, worsening of frontal sinus disease since prior study.Sphenoid sinus, worsening of sinusitis since prior exam.Ethmoid sinuses, significant worsening of the left ethmoid sinus disease since prior exam. Minimal new right posterior ethmoid sinus disease.Maxillary sinuses demonstrate significant interval worsening of left maxillary sinus disease with near complete opacification on the current exam. Complete occlusion of left ostiomeatal unit. Unremarkable right maxillary sinus and with patent right ostiomeatal unit which has remained stable since prior exam.There is thinning of the posterolateral wall of left maxillary sinus with a suspect a small area of bony defect. There is also effacement of fracture plane in the left infratemporal fossa and including the left retromaxillary fat pad. There is also effacement of fascial planes between the masticator muscles at this site. There is edematous changes of the musculature. Comment a follow-up with an enhanced MRI exam for further evaluation.There is no detectable retro-orbital space abnormality on the left however the edematous changes of the left infratemporal fossa extends into the left inferior orbital fissure.Images through nasal cavity demonstrate increased soft tissue density in the posterior aspect of left nasal cavity.Visualized mastoid air cells and middle ear cavities are unremarkable.Above findings were discussed at the time of interpretation with Dr. Scott Siglin pager number 2953.

Output: Interval worsening of sinusitis in particular on the left with extension of edema/inflammatory changes into the left infratemporal fossa with effacement of fascial plane which also extends into the left inferior orbital fissure. Follow up with an MRI is recommended.


Instruction: Generate impression based on medical findings.

Input: 59-year-old female with diffuse large B cell of the sinus status post 4 cycles of chemotherapy. There is redemonstration of soft tissue density within the maxillary sinus immediately posterior to the anterior wall of the left maxillary sinus. This soft tissue prominence again extends posteriorly and posterior laterally to the left maxillary sinus and along the enlarged infraorbital nerve groove. The osseous involvement of the anterior aspect of the maxillary sinus, including a mixed sclerotic and lucent area, appears unchanged. There is increased mucosal thickening and opacification of both maxillary sinuses. This appearance may be due to chronic sinus disease, although lymphomatous involvement cannot be excluded. MRI may be more helpful in delineating tumor from inflammatory disease. Opacification of the left frontal and bilateral ethmoid sinuses, as well as mucosal thickening of the right sphenoid sinus is also noted. The retro-orbital fat remains within normal limits. Extraocular musculature and globe remain within normal limits. No definitive abnormality of cavernous sinus or Meckel's cave on this exam is detected. Limited view of nasopharynx demonstrates no abnormality.

Output: Persistent abnormal soft tissue within the left maxillary sinus with associated osseous changes as detailed. Increased pan-sinus opacification. MRI may be more helpful in delineating tumor involvement from inflammatory disease.


Instruction: Generate impression based on medical findings.

Input: New diagnosis of cholangioadenocarcinoma and gallbladder carcinoma, abdominal pain and elevated LFTs Suboptimal exam due to extensive patient motion artifact.ABDOMEN:LIVER, BILIARY TRACT: Improved biliary duct dilatation, likely related to placement of biliary stent. Thick walled gallbladder, likely combination of inflammation from adjacent ascites and reported gallbladder carcinoma, small sludge/hemorrhagic or proteinaceous material and cholelithiasis in gallbladder, nonspecific rounded restricted diffusion seen in the gallbladder lumen, may also reflect reported gallbladder malignancy. Nodular liver contour. New from prior study are multiple hepatic lesions (examples include located in hepatic dome and hepatic segment 8/5 and hepatic segment 6, see images 524, 396 and 300 series 607) demonstrating mildly increased T2 signal and restricted diffusion, with ill-defined borders and minimal to no internal enhancement seen, appearance suspicious for hypoenhancing metastatic disease. Lesion near gallbladder fossa may reflect metastatic disease or direct tumor invasion. Submitted for reference is a hepatic segment 5 lesion measuring 1.3 x 1.2 cm, image 372 series 1502. Left portal vein and splenic vein not well seen, suspicious for occlusion, heterogeneous left lateral hepatic parenchymal enhancement.SPLEEN: No significant abnormality noted.PANCREAS: Nonspecific peripancreatic soft tissue attenuation and stranding.ADRENAL GLANDS: Diffusely enlarged adrenal glands.KIDNEYS, URETERS: Bilateral renal cortical thinning.RETROPERITONEUM, LYMPH NODES: Again visualized retroperitoneal soft tissue thickening, with associated flattened configuration of the IVC, assessment including patency suboptimal secondary to extensive patient motion artifact. Small inguinal lymph nodes.BOWEL, MESENTERY: Wall thickening, likely reactive in setting of ascites.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Right greater than left small pleural effusions and moderate to large ascites visualized.

Output: 1. Suboptimal exam due to extensive patient motion artifact and presence of ascites, contrast-enhanced CT abdomen and pelvic imaging for improved assessment should be considered.2. Hepatic metastatic disease, new. Left portal vein and splenic vein not well seen, suspicious for occlusion, heterogeneous left lateral hepatic parenchymal enhancement.3. Improved biliary duct dilatation, likely related to placement of biliary stent. Thick walled gallbladder, likely combination of inflammation from adjacent ascites and reported gallbladder carcinoma, small sludge/hemorrhagic or proteinaceous material and cholelithiasis in gallbladder, nonspecific rounded restricted diffusion seen in the gallbladder lumen, may also reflect reported gallbladder malignancy. 4. Nonspecific peripancreatic soft tissue attenuation and stranding. Again visualized retroperitoneal soft tissue thickening,5. Right greater than left small pleural effusions and moderate to large ascites visualized.


Instruction: Generate impression based on medical findings.

Input: Osteomyelitis There is diffuse soft tissue edema and inflammation of the radial portion of the hand and entirety of the thumb. There is T1/high T2 signal of the distal phalanx of the thumb consistent with osteomyelitis. Additional areas of increased T2 signal are noted within the proximal phalanx without corresponding T1 signal and this is likely reactive in nature. Although no discrete fluid collection is identified, there is ill-defined peripheral enhancement on the volar portion of the distal phalanx likely representing phlegmonous change. The distal attachment of the flexor tendon is not well seen which may be the result of partial tearing/rupture. The remaining fingers demonstrate normal marrow signal. A small amount of fluid is noted within the first MCP joint.Diffuse edema affects the thenar musculature. The median nerve is also enlarged.

Output: Osteomyelitis of the distal phalanx of the thumb. Although there is no discrete fluid collection, surrounding phlegmonous change tracks into the thenar eminence.


Instruction: Generate impression based on medical findings.

Input: 2-year-old male with pancreatitis. Evaluate for structural abnormalities.EXAMINATION: MRI MRCP without and with intravenous contrast 12/16/2016 10:00 The pancreatic head, body and majority of the tail is normal demonstrating normal homogeneous enhancement. The distal aspect of the pancreatic tail is indistinct with adjacent intermediate signal intensity, stranding and free fluid. A complex rim-enhancing structure is present in the region of the distal pancreatic tail measuring 3 cm x 2 cm (series 1601, image 38). There are enhancing septations within the fluid collection in the left upper quadrant. There are adjacent smaller loculated fluid collections in the left lower quadrant (for example series 1601, image 29). No pancreatic ductal dilatation. Moderate amount of fluid is present in the upper abdomen. Stranding of the perinephric fat on the left is noted. No intra or extrahepatic biliary ductal dilatation. The liver, spleen and gallbladder are normal.The kidneys demonstrate normal enhancement with symmetric excretion of contrast. The bladder is moderately distended.The adrenal glands are normal.Bilateral small pleural effusions.

Output: 1. Focal pancreatitis of the pancreatic tail with adjacent peripancreatic fluid collection demonstrating complex features likely representing a peripancreatic fluid collection transitioning into a pseudocyst. There are adjacent smaller loculated fluid collections.2. No biliary or pancreatic ductal dilatation.3. Moderate amount of fluid in the upper abdomen with multiple septations in the left upper quadrant. This extends inferiorly and posteriorly involve the left perinephric space.4. Bilateral small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: 53 year old female with alcoholic cirrhosis and HCC status post resection presenting with right upper quadrant pain. Evaluate for recurrence. ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Liver has nodular contours consistent with cirrhosis. New hyperattenuating focus seen only on arterial phase measures 1 x 1 cm on image 39 series 9. Although no definite washout is identified which favors benignity, continued follow up or MRI is suggested for further characterization of this lesion. The patient has undergone interval resection of a portion of the left lateral segment. There is a small perihepatic fluid collection which is likely postsurgical in etiology. No new lesions are identified.Cholelithiasis and pericholecystic fluid. If there is clinical concern for acute cholecystitis, a right upper quadrant ultrasound may be obtained. 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: Borderline enlarged retroperitoneal lymph nodes are stable.BOWEL, MESENTERY: Appearance of intussusception in the duodenum may be transient and is of uncertain clinical significance. Multiple colonic diverticula with retained hyperattenuating foci likely represent retained contrast. No evidence of obstruction, intra-abdominal free air, or abscess is identified.BONES, SOFT TISSUES: Postsurgical changes are identified in the right anterior abdominal wall from the incision.OTHER: Extensive collateral vessels inferior to the spleen at the splenic hilum consistent with portal hypertension.

Output: 1.New 1 cm enhancing focus in the right lobe of liver seen only on arterial phase without definite washout for which continued follow-up or MRI for further characterization is suggested. 2.Cirrhosis and portal hypertension as described above.3.Cholelithiasis and pericholecystic fluid. If there is clinical concern for acute cholecystitis, a right upper quadrant no may be obtained.4.Postoperative and other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Assess for cervical spondylosis. Neck pain and stiffness. There is partial fusion of the C6 and C7 vertebrae. Otherwise, the vertebral column alignment is within normal limits and the vertebral body heights are preserved. There are multilevel degenerative changes in the cervical spine with endplate edema and small posterior disc-osteophyte complexes. There is associated mild neural foramen stenosis at C2-3 and C3-4, eccentric to the left. There also appears to be mild left C3-4, right C4-5, and right C5-6 neural foramen stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1. Multilevel degenerative changes in the cervical spine with endplate edema and small posterior disc-osteophyte complexes with associated mild neural foramen stenosis at C2-3 and C3-4 and what appears to be mild left C3-4, right C4-5, and right C5-6 neural foramen stenosis. 2. Partial fusion of the C6 and C7 vertebrae may be congenital in nature.


Instruction: Generate impression based on medical findings.

Input: Abnormality of gait [781.2], Reason for Study: ^Reason: r/o stenosis History: gait difficulties Extensive confluent high signal intensity lesions on bilateral periventricular white matter on FLAIR images indicating nonspecific ischemic lesions, comparing to prior scan, the extent of those lesions have aggravated.On Gradient echo images, there are multiple bihemispheric supra and infratentorial various sized susceptibility artifacts, these lesions could represent amyloid angiopathy. Possibility of cavernous malformation or calcifications are less likely. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.C-Spine:The cranial-cervical junction is normal. There is exaggerated cervical lordosis. The cervical spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. Degenerative changes were as follows:C23: within normal limitsC34: within normal limitsC45: diffuse bulging of disc, no spinal stenosis, no neural foraminal stenosis.C56: diffuse bulging of disc, no spinal stenosis, no neural foraminal stenosis.C67: within normal limits.C7T1: within normal limits.L Spine:For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow demonstrate a normal MR appearance. The signal of the visualized cord is normal. The conus medullaris terminates at the L1-L2 level. There is no evidence of cord compression or mass. Degenerative changes are as follows:T12L1: within normal limitsL12: within normal limitsL23: diffuse bulging of disc with osteophyte especially on the right side of neural foramen resulting mild neural foraminal stenosis. L34: diffuse bulging of disc with bilateral ligamentum flavum thickening results mild bilateral neural foraminal narrowing. Modic 2 endplate changes are also seen.L45: disc dessication, Modic type 2 endplate changes. Diffuse disc bulging. No neural foraminal or spinal canal stenosis.L5S1: within normal limits

Output: 1. Interval progression of confluent patchy periventricular white matter changes since prior exam performed on Jun 5 2008.2. Multifocal various sized susceptibility artifacts indicate possibility of amyloid angiopathy. Clinical correlation is indicated.3. Degenerative changes of C and L spine as described above. Multilevel various sized disc degenerations. Mild neural foraminal stenosis at the levels of L23 and L34 were seen.


Instruction: Generate impression based on medical findings.

Input: Evaluate for septic embolic infarction, subacute: subtle right face, arm motor deficit, and MSSA mitral valve endocarditis. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is encephalomalacia in the left anterior frontal lobe. There are also subcentimeter foci of T2 hyperintensity in the left basal ganglia and right corona radiata. In addition, there are a few nonspecific scattered foci of t2 hyperintensity in the cerebral white matter. 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, and scalp soft tissues are grossly unremarkable. There is a right sphenoid sinus retention cyst. There is nonspecific scattered fluid signal in the left mastoid air cells.

Output: Chronic left anterior frontal lobe infarct. Subcentimeter lesions in the left basal ganglia and right corona radiata also likely represent chronic lacunar infarct. No evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on medical findings.

Input: Clinical question: New parietal brain lesion, history of metastases. Signs and symptoms: AMS. Pre- and post enhanced brain MRI: Examination demonstrates a focus of restricted diffusion consistent with a subacute ischemic stroke in the left posterior temporal-parietal region. It demonstrate subtle gyriform enhancement which is unexpected finding in a subacute stroke. The finding results in effacement of adjacent cortical sulci.This examination demonstrate no convincing evidence of any metastatic lesion.Chronic postoperative changes (large area of encephalomalacia) of a right frontal parietal craniotomy is noted without detectable abnormal enhancement.Diffuse uniform FLAIR hyperintensity of bilateral hemispheric white matter highly suggestive of posttreatment/radiation changes. There is ex vacuo dilatation of supratentorial ventricular system however maintained midline. Diffuse patchy foci of FLAIR hyperintensity in the pons could also represent posttreatment changes or chronic small vessel ischemic strokes.Unremarkable calvarium and soft tissues of the scalp as well as orbits and without abnormal enhancement.

Output: 1.Subacute left MCA ischemic stroke with expected gyriform cortical enhancement in the left posterior temporal and parietal with regional mass effect.2.No evidence of residual or recurrence of metastatic disease.3.Extensive chronic postoperative changes of the right sided craniotomy.4.Diffuse FLAIR hyperintensity of bilateral hemispheric white matter and pons representing post treatment/radiation change however overlapping chronic small vessel ischemic strokes cannot be excluded.5.Ex vacuo dilatation of supratentorial ventricular system secondary to underlying parenchymal volume loss.


Instruction: Generate impression based on medical findings.

Input: Re-evaluate suspected ischemic changes in occipital area: migraine. The subcentimeter non-enhancing T2 hyperintense cortical and subcortical lesion in the right superior parietal lobule appears slightly smaller. There is no evidence of intracranial hemorrhage, mass-effect, or acute infarct. The occipital lobes appear to be intact. 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: The tiny cortical and subcortical lesion in the right superior parietal lobule has slightly decreased in size and may once again represent a prior ischemic event, but is otherwise nonspecific. The occipital lobes appear to be intact.


Instruction: Generate impression based on medical findings.

Input: History of HCC status post TACE/RFA of 3 hepatic lesions. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology with a nodular contour, left hepatic lobe hypertrophy and fissural widening.Segment 5 ablation cavity measures 3.9 x 1.9 cm) (series 9/249). Adjacent to the anterolateral cranial aspect of this ablation cavity is a residual focus of arterial enhancement measuring 1.7 x 1.4 cm (series 9/35). This associated with restricted diffusion without definite washout.Segment 6 ablation cavity measures 2.8 x 1.0 cm (series 9/247). Adjacent to the medial cranial aspect of this ablation cavity is a 1.3 x 1.2 cm residual focus of arterial enhancement (series 9/30), increased in size from the prior where it measured 1.1 x 1.0 cm (series 10/44). This is associated with restricted diffusion without definite washout.Additional punctate subcentimeter enhancing focus in segment 8 (series 9/29) is unchanged, measuring 7 x 6 mm.Segment 3 ablation cavity measures 2.6 x 1.1 cm (series 9/242). SPLEEN: Splenomegaly measuring 18 cm in craniocaudal dimension. Numerous siderotic nodules.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: Post-ablation changes of the liver. There are residual arterially enhancing lesions adjacent to the segment 5 and segment 6 ablation cavities. The segment 6 enhancing focus demonstrates interval mild increase in size. Stable non-specific enhancing subcentimeter focus in segment 8.


Instruction: Generate impression based on medical findings.

Input: 17 year-old female status post trauma. Images through posterior fossa are unremarkable.Images through the supratentorial brain parenchyma demonstrates a subtle area of low attenuation in the periventricular white matter of the left parietal lobe. This is not associated with any additional areas of edema, hemorrhage, mass-effect, midline shift or hydrocephalus. This finding is not believed to be secondary to trauma. The exact nature of the finding is not clear and further evaluation with an MRI is highly recommended. This finding is best demonstrated on axial images 15 through 19. To exclude the possibility of a mass and MRI is recommended.Calvarium, soft tissues of the scalp, mastoid air cells and visualized portions of the paranasal sinuses are unremarkable.The above findings were relayed to Dr. Jeff Frank at the time of interpretation.

Output: 1.No definitive evidence of post traumatic findings.2.Focal area of low-attenuation in the periventricular white matter of the left parietal lobe which is non specific and nonhemorrhagic and does not appear to be a post traumatic finding. Further evaluation with an MRI is highly recommended.


Instruction: Generate impression based on medical findings.

Input: Shoulder pain. Check for impingement syndrome ROTATOR CUFF: Full-thickness tearing to the supraspinatus along the anterior aspect is observed with associated thickening, abnormal signal and minimal fluid underlying the deltoid and acromion. Undersurface fraying of the infraspinatus and minimal tendinopathy of the subscapularis are also observed. Teres minor appears intactSUPRASPINATUS OUTLET: Mild downward sloping acromion is again observed with associated mild to moderate degenerative changes of the AC joint. Persistent moderate narrowing of the outlet is again observed correlating with plain filmGLENOHUMERAL JOINT AND GLENOID LABRUM: Similar mild to moderate degenerative changes of the glenohumeral articulation is preserved. Marrow signal is intact other than underlying degenerative changes and subchondral cysts. The labrum is grossly intact for techniqueBICEPS TENDON: Grossly intact ADDITIONAL

Output: Associated chronic appearing rotator cuff injury with full thickness tearing of the supraspinatus with more mild changes involving the infraspinatus and subscapularis. See detailed provided


Instruction: Generate impression based on medical findings.

Input: Altered mental status and possible malignancy. Some of the images are degraded by patient motion. There is a T2 hyperintense lesion in the splenium of the corpus callosum that measures up to 20 mm and multiple scattered punctate foci of high T2 signal in the bilateral cerebral hemisphere white matter. Many of the lesions demonstrate mild restricted diffusion. There is no definite evidence of gross intracranial hemorrhage. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Multiple scattered white matter lesions, including within the splenium of the corpus callosum and in the bilateral cerebral hemispheres may represent late subacute infarcts perhaps superimposed upon chronic small vessel ischemia, or possibly form of infectious process, versus less likely metastatic disease given the atypical distribution. However, the assessment is limited by the lack of intravenous contrast. 2. No evidence of gross acute intracranial hemorrhage, although the images are somewhat degraded by patient motion.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old, history of ganglioglioma. Surveillance imaging. A small surgical cavity within the inferior left parietal lobe is stable in size and morphology. Mild T2 hyperintensity within the surrounding parenchyma is also unchanged. Likewise, a small curvilinear region of enhancement along the lateral and superior edge of the cavity is unchanged.No new intracranial lesions are detected. Findings compatible with a Chiari I malformation are redemonstrated similar to prior. Brain parenchymal morphology is otherwise unremarkable. A few very small scattered foci of T2 hyperintensity are seen in the periventricular white matter, a nonspecific finding.No evidence of significant intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricles are normal in size and morphology.

Output: A small resection cavity within the left inferior parietal lobe is unchanged in size and morphology. This includes mild enhancement along the cavity margin which may simply represent postoperative granulation.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Patient with spinal metastases, neck pain. Signs and symptoms: Neck pain Nonenhanced CT of the cervical spine:Previously described on prior MRI of the cervical spine with the study the lesion to the vertebral body of C5 is not identified on this study. There is subtle low attenuation of C7 vertebral body consistent with patient's known metastatic lesion. There is no evidence of fracture of this vertebrae and the alignment of vertebral column is unremarkable.Nonenhanced CT of thoracic spine:The alignment the vertebral column is within normal limits. Examination identifies previously detected metastatic lesion to T1 with mild compression deformity and minimal bulge of vertebrae into the spinal canal. There is no involvement of the pedicle of T1. The alignment remains intact. Mild compression deformity of vertebral body of T5 along its superior aspect and the internal lytic changes. There is no definitive involvement of the pedicles of T5. No definitive evidence of any additional lytic changes of vertebral column is detected.No definitive metastatic lesion to the facets of the pedicles of vertebral column.Nonenhanced CT of the lumber spine:The alignment of vertebral column is unremarkable. No definitive for the study kidneys to the lumber spine is detected.No evidence of central spinal stenosis or neural foramina compromise.There is very subtle low-attenuation involving S2 vertebral body however been no distinct destruction of the cortex or any perispinal soft tissue abnormality. Possibility of metastatic disease cannot be entirely ruled out.

Output: 1.Multiple metastatic disease to the thoracic spine and a suspected metastatic lesion to as to as detailed.2.There is mild compression fracture of T1 and T5 and mid no involvement of the pedicles of T1 or T5.The alignment of the vertebral column throughout the spine remains normal.


Instruction: Generate impression based on medical findings.

Input: Status post endoscopic third ventriculocisternostomy for hydrocephalus due to aqueduct stenosis. Scoliosis and lipomyelomeningocele status post L4 and L5 osteoplastic laminoplasty, repair, and subtotal resection of intradural lipoma causing spinal cord tethering. Brain: There are postoperative findings related to endoscopic third ventriculostomy. There is no discernible CSF flow across the third ventriculostomy. There is no significant interval change in the marked dilatation of the lateral and third ventricles with mild mass effect upon the brainstem and cerebellum. There is no evidence of acute infarction, hemorrhage, or tumors. There is no midline shift. The major cerebral flow voids are grossly intact. The skull and scalp soft tissues are unchanged. There is persistent fluid within the bilateral middle ears and mastoid air cells.Spine: There is unchanged cervicothoracic scoliosis and postoperative findings related to lipomeningocele surgery in the lumbar spine. There is persistent fluid signal within the central spinal cord diffusely, which measures up to 2 mm in width. The conus medullaris terminates at the L3-4 level. There is an unchanged fatty signal intensity of the filum terminalis and fat within the spinal canal extending from L5 to S3. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is a distended urinary bladder.

Output: 1. No significant interval change in the hydrocephalus associated with the aqueductal stenosis.2. No discernible CSF flow across the third ventriculostomy.3. Unchanged cervicothoracic scoliosis.4. The conus medullaris terminates at the L4 level and there is an unchanged fibrofatty filum terminalis and fat within the spinal canal that extends from L5 to S3. 5. Unchanged long-segment syrinx.


Instruction: Generate impression based on medical findings.

Input: Newly diagnosed lung cancer, left side focal neurological deficit. Multifocal bihemispheric restricted diffusion lesions indicating acute ischemic infarctions involving right frontal lobe, left frontal lobe, left parietal lobe, caudate nucleus splenium, left occipital lobe, left temporal lobe and right cerebellar hemisphere.On Gradient echo images, there are focal signal voids on the right frontal lobe (junction of right superior frontal gyrus and pre central gyrus), left parietal lobe (inferior parietal lobule adjacent to the left parieto-occipital sulcus), and corpus callosum splenium. These lesions may indicate focal hemorrhagic transformation.On Gad enhanced images, there are multifocal nodular and ring enhancing lesions involving left frontal lobe middle frontal gyrus, left side of midbrain, right cerebellar hemisphere and possibly right posterior medullar (marked on series 1001) indicating possible metastatic nodules.In addition, gyriform enhancement of left temporo-occipital lobe cortex and left frontal lobe pre central gyrus hand motor center indicate subacute ischemic infarctions. The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Multifocal acute and subacute ischemic infarctions with suspicious petechial hemorrhagic conversions as described above.2. Multifocal supra and infratentorial bihemispheric enhancing lesions indicating metastatic lesions as described above.


Instruction: Generate impression based on medical findings.

Input: Metastatic sarcoma. There are postsurgical changes with spinal rods extending from T2 to T8 affixed by laminar hooks and transpedicular screws. There are significant streak artifacts secondary to the presence of hardware, limiting evaluation. Lytic lesion involving T6 is again seen correlating with the lesion seen on prior MRI study. There is a significant paraspinal component. There is extension of tumor to the posterior elements. There is suspicion of extension into the spinal canal, but this is difficult to assess due to the presence of streak artifacts.There is a compression fracture, with wedging deformity of T8 vertebral level, also seen on prior x-ray study of 7/6/2011. This results in kyphotic angulation, which is unchanged. There is posterior disk protrusion, with calcification, causing spinal canal stenosis, and likely spinal cord impingementRight lung mass is seen. Please correlate with chest x-ray and CT chest.

Output: 1. Compression fracture of T8, not significantly changed compared to prior x-ray.2. Lytic lesion involving T6, with significant paraspinal and epidural component. There is likely extension into the spinal canal, with impingement of spinal cord which is difficult to assess due to streak artifacts.3. Posterior calcified disk protrusion at T7 -- T8 level, likely resulting in spinal cord impingement.4. Right lung mass. Please correlate with chest x-ray and CT chest.


Instruction: Generate impression based on medical findings.

Input: The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. Incidental note is made of a developmental venous anomaly within the inferior left frontal lobe, without MRI evidence of associated cavernous malformation. There is no abnormal enhancement within the brain.

Output: Negative MRI of the brain including gadolinium enhancement. Specifically, there are no MRI findings to explain the patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: Reason: Evaluate for degenerative vs. Inflammatory changes as source of back pain History: Low back pain. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The discs appear desiccated. Scattered foci of increased T1 and T2 signal within the bone marrow are compatible with benign hemangiomas and/or focal fat deposition. No suspicious bone marrow replacing lesions are identified. The spinal cord displays normal signal and morphology. The tip of the conus is located at L1-L2. No pathological enhancement is identified. The paravertebral soft tissues are unremarkable.T12-L1: No significant stenosis.L1-L2: Minimal disc bulge without significant stenosis.L2-L3: Minimal disc bulge without significant stenosis.L3-L4: Minimal disc bulge eccentric to the left without significant stenosis.L4-L5: Mild facet hypertrophy. No significant stenosis.L5-S1: Mild facet hypertrophy. No significant stenosis.

Output: Minimal to mild degenerative changes without significant central canal or foraminal stenosis.


Instruction: Generate impression based on medical findings.

Input: Male, 14 years old. Hip pain for weeks to months with football ; reinjured with limp. Evaluate for avulsion versus stress fracture. BONE MARROW: Cortical irregularity and marrow edema at the left anterior superior iliac spine with surrounding soft tissue T2 hyperintensity, compatible with an avulsion injury at this location. Cortex and marrow signal is normal elsewhere.SOFT TISSUES: No significant abnormality noted. JOINTS: No significant abnormality noted.ADDITIONAL

Output: Findings compatible with avulsion injury of the left anterior superior iliac spine.


Instruction: Generate impression based on medical findings.

Input: Other visual disturbances [H53.8], Reason for Study: ^Reason: vasculitis? History: neuro deficit Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion.Left side basal ganglia including external capsule shows encephalomalacia with gliotic changes indicating chronic ischemic infarct, unchanged since prior scan.The left lateral ventricle shows ex vacuo changes, otherwise unremarkable.There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRAMotion artifact degraded exam quality. 3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate irregular and small diameter of the left internal carotid artery with nonvisualization of left ACA A1 segment. Normal appearance of right ICA, MCA and ACA. Vertebrobasilar system appears to be normal. Comparing to prior scan obtained on Dec 26 2014, the intracranial portion of the left ICA especially from the level of the carotid canal appear to be recanalized. Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate non visualization of the left CCA. Extracranial left carotid system is visualized at the level of carotid bifurcation with demonstration of small caliber both ICA and ECA branches.Left subclavian artery proximal portion is not demonstrated either but reconstituted at the level of left vertebral artery origin.The brachiocephalic artery also shows significant luminal stenosis.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Chronic ischemic infarction on the left basal ganglia and external capsule.3. Multifocal both intra and extracranial arterial luminal stenosis involving brachiocephalic artery and left intracranial ICA especially cavernous sinus segment. There is also complete occlusion of the left CCA and left subclavian artery origin. These findings may suggest idiopathic arteritis such as Takayasu's disease or vasculitis. 4. Interval recanalization of the left ICA intracranial portion.Rec: Considering the feature of both extracranial and intracranial arterial system which suggest possibility of vasculitis, brain MRI with and without contrast enhancement to assess any intracranial inflammatory foci can be considered if clinically indicated.


Instruction: Generate impression based on medical findings.

Input: Female, 15 years old, with headache. Artifact presumably arising from orthodontic braces degrades image quality particularly on the diffusion-weighted, susceptibility weighted, and FLAIR images. Given this limitation, the following observations are made.Brain parenchymal morphology is within normal limits. No definite evidence of restricted diffusion or other significant parenchymal signal abnormality is seen. No edema or mass effect is detected. No intracranial hemorrhage or abnormal extra-axial fluid is observed. The ventricular system is normal in size and morphology.On MRA imaging of the head, an apparent 4 mm outpouching is seen along the anterior genu of the left ICA. While it is possible that this represents artifact or vascular tortuosity, it is observed again on the MRV sequence. The intracranial arterial structures are otherwise within normal limits. No significant stenosis or vascular occlusion is identified.On MRV imaging of the head, again a small vascular outpouching is suspected at the level of the anterior genu of the left ICA. The dural venous sinuses and deep venous structures of the brain are well visualized and patent.On MRA imaging of the neck, no significant vascular abnormalities are detected.

Output: 1. Allowing for artifact induced by orthodontic braces, no significant brain parenchymal abnormalities are detected.2. On MRA imaging of the head, a 4 mm vascular outpouching is suspected at the level of the anterior genu of the left ICA, also confirmed on MRV imaging. While this could reflect an artifact or vascular tortuosity, the possibility that this may represent a small aneurysm must be considered. Confirmation of this finding with CTA of the head is recommended.3. On MRV imaging of the head, no dural venous or deep venous thrombosis is suspected.4. On MRA imaging of the neck, no significant vascular abnormalities are detected.


Instruction: Generate impression based on medical findings.

Input: 64 years Female (DOB:12/30/1951)Reason: Treatment planning for SRS to L temporal lesion History: Treatment planning for SRS to L temporal lesionPROVIDER/ATTENDING NAME: STEVEN J CHMURA STEVEN J CHMURA There is a 18 x 15 mm axial dimension ring-enhancing lesion adjacent to the trigone of the right lateral ventricle which previously measured 10 x 11 mm axial dimensions. Currently the central component is hypointense on T2 and has a slightly hyperintense appearance on T1 scout images. There are some patchy susceptibility weighted imaging signal loss associated with the lesion. There is vasogenic edema associated with the lesion appears to be greater on the current exam versus the prior exam from July 5. There is a small enhancing tract anterior inferior to this periventricular lesion presumably related to the stereotactic needle tract.Since the prior exam a right middle frontal gyrus surgical site has remained stable.The patient is status post burr hole placement along the right parietal bone and right frontal craniotomy.There is a small ring-enhancing focus in the left temporal lobe measuring 6 mm in diameter associated with some surrounding T2 signal hyperintensity. This is also stableThere is redemonstration of an enhancing punctate focus adjacent to the frontal horn of the left lateral ventricle.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.

Output: 1.Multiple intracranial lesions present. One in the right periventricular white matter is enlarged however the rest are stable compared to prior exam. 2.The patient is status post recent stereotactic surgery for the right periventricular white matter lesion which now has a larger appearance. The change in size may potentially be accounted for on the basis of blood products within the lesion.


Instruction: Generate impression based on medical findings.

Input: Clinical question: 73-year-old male with bilateral arm pain and numbness, evaluate for cord compression. Signs and symptoms: Burning pain in both arms, syncope. Nonenhanced total spine MRI:Examination is performed utilizing cord compression protocol which does not include axial images.Examination demonstrates diffuse patchy foci of marrow signal replacement consistent with extensive osseous metastatic lesions throughout the cervical, thoracic and lumbosacral spine.Metastatic lesions at C6 and to a lesser degree C5 levels demonstrate extraosseous spread of tumor into the epidural space and resultant mass effect on the cord however without central spinal stenosis and no convincing evidence of cord edema.Mild extraosseous cyst. Of tumor from T8 vertebral body into the spinal canal is also noted without mass effect on the cord or central spinal stenosis. Minimal ventral epidural spread of tumor at T12 is also noted without spinal stenosis or mass effect on the cord.There is no evidence of fracture or malalignment. There is no detectable cord signal abnormality.The findings on this exam can be further and more accurately assessed if clinically deemed pertinent with pre and post enhanced dedicated spine MRI study.

Output: 1.Extensive osseous metastatic lesions throughout the spine as detailed.2.Small regions of epidural spread of tumor into the spinal canal more noticeably at C6 however without resultant central spinal stenosis or detectable cord signal abnormality as detailed.3.Normal signal intensity and caliber of the cord and cauda equina.


Instruction: Generate impression based on medical findings.

Input: Patellar instability MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: The articular cartilage of the medial and lateral compartments is preserved. There is slight depression of the lateral femoral condyle which may relate to prior injury. A small amount of marrow signal is seen along the lateral femoral condyle presumably from prior patellar subluxation.There is a obliquely oriented linear defect involving the medial portion of the patella representing a nondisplaced fracture. Marrow edema is seen along the fracture site although the underlying articular cartilage of the patellofemoral compartment is intact. The femoral trochlea appears slightly shallow and dysplastic. The MPFL is torn.LIGAMENTS: The ACL is absent. The PCL and remaining collateral ligaments are intact.EXTENSOR MECHANISM: There is patella alta although the patellar tendon is intact. A mild amount of edema-type signal surrounds the anterior soft tissues of the knee.ADDITIONAL

Output: 1. Ruptured ACL.2. Oblique, nondisplaced fracture of the patella.3. Findings consistent with prior patellar subluxation including bony contusions of the patella and lateral femoral condyle, shallow appearance of the femoral trochlea, and tearing of the MPFL.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old, with profound lower extremity weakness, hypotension without etiology, prior MRI with notable diskitis. Severe endplate irregularity, loss of disk height and some loss of vertebral body height is evident at T11-12. These findings are similar to those noted on the prior body CT but are new when compared to an older lumber spine MRI from 2012. The degenerated disk space, and likely the right anterior projecting disk osteophyte complex, demonstrate elevated STIR signal, but the remainder of the vertebral body marrow space does not. Please note that these findings are only assessed on sagittal images as the axial field of view does not extend to this level.Spinal alignment is grossly anatomic. Except as above, vertebral body heights are preserved. A Schmorl's node has progressed along the inferior L3 endplate. Marrow signal characteristics are heterogeneous but benign. The visualized spinal cord and conus demonstrate normal signal intensity. Additional level specific findings are as follows:T11-12: Facet hypertrophy and ligamentum flavum thickening. Progressive loss of disk height and disk bulging. Prominence of the dorsal epidural fat. Findings contributes to produce a moderate generalized spinal canal stenosis with possible slight impingement on the conus. Severe right and moderate left neuroforaminal narrowing. Findings are new relative to prior. T12-L1: No significant spinal canal stenosis or neuroforaminal narrowing. L1-2: Facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. No significant generalized spinal canal stenosis. No significant neuroforaminal narrowing. No interval changes.L2-3: Moderate facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. No significant generalized spinal canal stenosis. No significant neuroforaminal narrowing. No significant interval changes.L3-4: Moderate facet hypertrophy with a left facet effusion and ligamentum flavum thickening, progressed. Moderate bulging disk with a superimposed right paracentral protrusion. Moderate to severe generalized spinal canal stenosis with crowding of the cauda equina, unchanged. Moderate left and mild right foraminal narrowing, unchanged. L4-5: Marked facet hypertrophy with bilateral facet effusions and ligamentum flavum thickening. Moderate to severe generalized spinal canal stenosis with crowding of the cauda equina, unchanged. Moderate bilateral foraminal narrowing, unchanged. L5-S1: Marked facet hypertrophy with bilateral facet effusions and ligamentum flavum thickening. Moderate bulging disk, progressed. Moderate to severe generalized spinal canal stenosis. Severe right and moderate left foraminal narrowing, unchanged. The kidneys are atrophic.

Output: 1. Severe deformity involving the disk space and endplates at T11-12 is similar to that seen on a recent body CT but new when compared to a prior MRI from 2012. Findings are only partially images on the present exam. Abnormal signal is evident within the severely deformed disk space and perhaps also the associated disk osteophyte complex, but not necessarily within the adjacent vertebral body marrow. Differential diagnosis would include severe disk degeneration, sequela of prior trauma or sequela of prior infection. Ongoing active infection is considered a less likely possibility, but correlation with clinical and laboratory parameters should be made.2. Along with disk space deformity, there is a new bulging disk at T11-12 which results in a moderate generalized canal stenosis and perhaps slight impingement of the conus.3. Moderate to severe degenerative findings are seen at additional levels in the lumbar spine with areas of slight progression as indicated above. L3-4 through L5-S1 are the most severely affected levels where disk disease and posterior element hypertrophy contribute to causing moderate to severe spinal canal stenoses.


Instruction: Generate impression based on medical findings.

Input: 10 year old female with a history of Tetralogy of Fallot, s/p valve sparing repair. Referred for cardiovascular MRI to evaluate right ventricular size and function as part of a research study. Left VentricleThe left ventricle is moderately enlarged with mildly reduced systolic function. There is diastolic flattening of the interventricular septum. The overall LV ejection fraction is 54%, the LV end diastolic volume index is 105 ml/m2, the LVEDV is 132 ml (Z-score +3.5), the LV end systolic volume index is 48 ml/m2, the LVESV is 61 ml, the LV mass index is 43 g/m2, and the LV mass is 54 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is moderately enlarged with normal systolic function. The overall RV ejection fraction is 57%, the RV end diastolic volume index is 116 ml/m2, the RVEDV is 147 ml (Z-score +3.2), the RV end systolic volume index is 50 ml/m2, and the RVESV is 63 ml. Right AtriumThe right atrium is dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is moderate pulmonary valve regurgitation. Regurgitant fraction is 30%.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteriesThe main pulmonary artery is normal in size. There is discrete ostial stenosis of the left pulmonary artery. LPA receives 40% of pulmonary flow, and RPA receives 60% of pulmonary flow. MPA measures 26 x21 mm. Ostium of the LPA measures 11 x 9 mm. Distal LPA measures 14 x 13 mm. Venous AnatomyThe SVC and IVC drain normally into the right atrium. The coronary sinus appears dilated. Possible small left-sided SVC.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Moderate left ventricular enlargement with mildly reduced systolic function. (LVEF 54%)2. Moderate right ventricular enlargement with normal systolic function. (RVEF 57%, RVEDV 116 mL/m2)3. Moderate pulmonary valve insufficiency.4. Mild left pulmonary artery ostial stenosis.5. Possible small left-sided SVC.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.