Instruction: Generate impression based on medical findings.

Input: Six-year-old male with history of hydronephrosis BLADDER  Wall Thickness: Irregular bladder wall without significant thickening.  Contents: Debris is again seen with in the bladder appearing similar to the prior exam. Distal Ureter -- SFU Grade**  Right: 3  Left: 0   Ureteral Jets Right: Not observed  Left: Not observedKIDNEYS  Cortical Echogenicity: Poor corticomedullary differentiation, appearing similar to the prior exam   Medullary Echogenicity: Poor corticomedullary differentiation, appearing similar to the prior exam  Pelvicaliceal System -- SFU Grade*  Right: 3 Left: 0  Length*** Right: 10.0 cm Left: 4.6 cm   Mean for age: 7.8 cm  Range for age: 6.5 - 9.3 cmADDITIONAL OBSERVATIONS: Small atrophic left kidney is visualized with a hypoechoic structure measuring 1.1 x 0.8 x 0.6, which appears multicystic. This may represent an involuted multicystic dysplastic kidney. Atrophic kidney with cystic structures is seen on MRI dated 7/28/11.

Output: 1.Persisting right grade 3 pelvicaliceal dilatation with increasing hydroureter. 2.Small atrophic left kidney with a small multicystic structure. This may represent an involuted multicystic dysplastic kidney.*SFU grading system: Grade 0: No hydronephrosis. Grade 1: The renal pelvis is visualized. Grade 2: A few but not all of the calices are identified in addition to the renal pelvis. Grade 3: Virtually all the calices are seen. Grade 4: Grade 3 and parenchymal thinning. **SFU grading system retrovesical ureter: Grade 0: No ureteral dilatation. Grade 1: Ureter less than 7 mm. Grade 2: Ureter is 7-10 mm. Grade 3: Ureter is over 10 mm. Fernbach SK, Maizels M, Conway JJ. Ultrasound Grading of Hydronephrosis: Introduction to the System used by the Society for Fetal Urology. Pediatric Radiology (1993) 23: 478-480.***Rosenbaum DM, Korngold E, Teele RL. Sonographic Assessment of Renal Length in Normal Children. AJR Am J. Roentgenol (1984) 142:467-469


Instruction: Generate impression based on medical findings.

Input: 4-year-old female patient with cyclic vomiting and precocious puberty. Evaluate pituitary. Pituitary: The pituitary enhances homogeneously and is normal in size. There is no evidence of pituitary tumors. The posterior pituitary bright spot and infundibulum are intact. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain, brainstem, and cerebellum appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No gross evidence of pituitary or brainstem lesions.


Instruction: Generate impression based on medical findings.

Input: Low grade astrocytoma. There are postoperative findings related to biopsy of a heterogenously enhancing stellate-shaped mass in centered in the left peritrigonal white matter extending to left pre and postcentral gyri and left thalamus that measures up to approximately 4 cm. The mass also contains areas of susceptibility effect that correspond to calcifications and is surrounded by confluent areas of high T2 signal. Some portions of the mass appear to have gradually increased in size. Furthermore, there is now a small patchy area of enhancement in the right paracentral lobule with surrounding high T2 signal, as well as a punctate focus of enhancement in the left splenium of the corpus callosum in an area of increased high T2 signal and swelling. There are otherwise unchanged T2 hyperintense lesion in the periventricular and subcortical white matter and in the brainstem, which are nonspecific. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Findings suggestive of gradual progression of the mass centered in the left peritrigonal white matter extending to left pre and postcentral gyri and left thalamus , as well as development of what appears to be additional enhancing tumor in the left paracentral lobule and splenium of the corpus callosum.


Instruction: Generate impression based on medical findings.

Input: There is a near contiguous intermediate T1 and high T2 signal intensity material, when compared to the paraspinal musculature, which diffusely and avidly enhances within the anterior epidural space, the neural foramina, and prevertebral spaces extending from the inferior aspect of C4 to the T6/T7 level. Along the upper spine, this appears to be centered at the C7 level where there is mild lordosis of the cervicothoracic junction and edema type signal within the posterior elements of C7, as well as scattered elsewhere throughout the cervical and thoracic vertebrae.This process effaces/invades the bilateral neural foramina from C4 to C7, the right neural foramina from T1-T7/T9, the left neural foramina from T1 to T10/11. There is moderate spinal canal stenosis at the cervicothoracic junction and scattered mild stenosis of the upper to mid thoracic spinal canal. There are more focal regions of heterogeneity within this material at C7/T1 extending into the right T1/T2 neural foramina and within the epidural space of T5 extending into the left neural foramina of T5/T6, without defined collections measurable. There is no abnormal signal abnormality within the cord. Furthermore, the right cervical vessels are displaced anteriorly from mass effect. The vertebral arteries, right greater than left, are also encased, however, flow voids appear preserved. There is a near continuous peripherally enhancing, central low intensity collection in the prevertebral soft tissues extending from the level of T1 to T11/T12 with loculated/complex components in areas. The collection at its maximal thickness measures 10 mm along the right anterior aspect of the T6/T7 vertebral bodies. There is low T1 signal intensity within the C4-T1 vertebral bodies and posterior elements of C7 with associated abnormal T2 signal and enhancement which is more prominent within the vertebral bodies of C4 and C5 and the spinous process of C7. There is additional patchy low T1 signal, high T2 signal, and enhancement within the posterior aspect of the T2-T7 vertebral bodies and throughout the T8-T11 vertebral bodies. There is no significant signal abnormality within the interposed disc spaces of the cervical or thoracic spine. There is irregular opacity within the posterior right upper lobe as well as focal pleural thickening and enhancement medially, adjacent to the paraspinal inflammatory change. Fluid is noted within the esophagus.

Output: 1. Extensive enhancing paravertebral and epidural material extending from the C4 to T6/T7 which appears to be centered at the level of C7 along the upper spine, with isolated signal abnormality within the posterior elements at this level and a loculated prevertebral peripherally enhancing collection extending from T1 to T12. Epidural material nearly completes effaces the neural foramina of the mid cervical spine to the lower thoracic spine and there is scattered up to moderate central spinal canal stenosis without intrinsic cord signal abnormality. There is also bone marrow signal abnormality within the mid cervical to lower thoracic vertebral bodies without evidence of disk abnormality. Given the patient's history, the differential diagnosis primarily includes TB spondylitis with abscess formation, although atypical infectious or fungal etiologies are possible. Lymphoma or metastatic disease are also a consideration.2. Posterior right upper lobe nonspecific irregular opacity with adjacent pleural thickening, incompletely evaluated; dedicated chest radiograph is recommended for further evaluation, especially with the consideration for possible TB involvement. Findings communicated via telephone to Nathan Frogge at 1117 hrs on 1/27/2016.


Instruction: Generate impression based on medical findings.

Input: 55-year-old female with history of right hip pain. ACETABULAR LABRUM: There is a cleft within the anterior, superior acetabular labrum best seen on radial views and likely represents a labral tear.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Anterior, superior labral tear.


Instruction: Generate impression based on medical findings.

Input: 67 year old woman with cardiomyopathy, who is referred to assess for etiology.MEDICATIONS: furosemide, glipizide, aspirin, warfarin First Pass PerfusionThere is a global subendocardial perfusion defect present both during hyperemia and during resting conditions.Viability/ Myocardial ScarThere is no evidence of underlying myocardial infarction; however, there is an atypical pattern of late gadolinium enhancement which involves the basal to mid inferior wall and spares the endocardial border. This suggests the presence of underlying myocardial fibrosis.Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. There is global hypokinesis with regional variation. The overall LV ejection fraction is 23%, the LV end diastolic volume index is 134 ml/m2 (normal range: 65+/-11), the LVEDV is 245 ml (normal range 109+/-23), the LV end systolic volume index is 104 ml/m2 (normal range 18+/-5), the LVESV is 190 ml (normal range 31+/-10), the LV mass index is 67 g/m2, and the LV mass is 123 g. No LV thrombus is noted.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 31%, the RV end diastolic volume index is 93 ml/m2 (normal range 69+/-14), the RVEDV is 170 ml (normal range 110+/-24), the RV end systolic volume index is 64 ml/m2 (normal range 22+/-8), and the RVESV is 118 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is moderate tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drains normally into the right atrium. PericardiumThere is a small pericardial effusion.Extracardiac FindingsThere are large bilateral pleural effusions. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. There is a global circumferential perfusion defect present during hyperemia and resting conditions. This finding could be secondary to severe multi-vessel coronary disease or due to significant congestive heart failure/ increased LVEDP.2. Severe LV dilation with severely reduced systolic function (LVEF 23%) with an atypical (non-myocardial infarction) pattern of late gadolinium enhancement involving the basal and mid inferior walls suggesting the presence of underlying myocardial fibrosis. This finding favors the diagnosis of non-ischemic cardiomyopathy.3. Normal RV size with moderately reduced systolic function (RVEF 31%).4. Severe left atrial dilation. 5. Small pericardial effusion.6. Large bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: 56-year-old male status post syncope. There is no evidence of intracranial hemorrhage, mass or edema. Periventricular and deep white matter diffuse hypodensities consistent with small vessel ischemic disease, age indeterminate. If there is clinical concern for stroke, an MRI may be considered.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Periventricular and deep white matter diffuse hypodensities consistent with small vessel ischemic disease, age indeterminate. If there is clinical concern for stroke, an MRI may be considered.


Instruction: Generate impression based on medical findings.

Input: Comatose, intracranial hemorrhage, evaluate for structural lesions. MRI brain: Again seen is intra-parenchymal hematoma centered within the pons measuring approximately 32 x 37 x 47 mm. There is surrounding edema and partial effacement of the fourth ventricle. Again seen is tiny amount of hemorrhage within the ventricular system, layering within the occipital horns. Small foci of susceptibility within the bilateral basal ganglia are compatible with mineralization versus chronic hemorrhage. Minimal extra-axial blood products are noted along the right parietal convexity. Tiny focus of susceptibility seen within the left cerebellar hemisphere, image 33/212, left thalamus, image 118/212, and medial temporal lobes.There is no significant change in mild ventriculomegaly compared to CT. Right transfrontal EVD catheter is in place with small amount of edema as well as small subarachnoid hemorrhage along the catheter tract. There is periventricular FLAIR hyperintensity compatible with transependymal flow. Small perivascular spaces in the basal ganglia. Minimal scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild age related white matter changes. Brain parenchyma is otherwise unremarkable for age. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. There is diffuse opacification of the bilateral mastoid air cells. Mucosal thickening involving the maxillary sinuses and patchy opacification of the ethmoid and sphenoid sinuses again seen. Bone marrow signal and extracranial soft tissues are within normal limits. MRA head: Examination is slightly motion degraded. The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. Incidentally seen is a hypoplastic left A1. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. Intracranial right vertebral artery is hypoplastic. No evidence of aneurysms or vascular malformations.

Output: 1. Large hematoma centered within the pons is again seen. No associated masses or abnormal enhancement is appreciated. Follow-up evaluation once hematoma resolves may be helpful to exclude possibility of underlying lesion if clinically indicated.2. Few tiny foci of susceptibility as detailed above including the left cerebellar hemisphere and left thalamus which are nonspecific but may represent chronic microhemorrhages; correlate for history of chronic hypertension. Additional foci in the bilateral basal ganglia may represent additional foci of chronic hemorrhages versus mineralization which is not evident on CT.2. MRA demonstrates no aneurysms or vascular malformations. No significant stenosis is appreciated.3. Unchanged mild ventriculomegaly with right transfrontal EVD in place.


Instruction: Generate impression based on medical findings.

Input: 24 years Female (DOB:12/23/1991)Reason: hx hydrocephalus. VPS removed. Eval for vent sizes History: headachesPROVIDER/ATTENDING NAME: DAVID M. FRIM DAVID M. FRIM There is asymmetry in the size of the lateral ventricles with the left being slightly larger than the right but unchanged compared to prior exam. The septum pellucidum is bowed towards the right side. There is redemonstration of T2 and FLAIR signal hyperintense tracts along the right parietal lobe and left frontal lobe.The patient is status post burr hole placement adjacent to the left coronal suture. The patient is status post burr hole along the right parietal bone. A ventriculostomy tube is not currently identified.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. The vein of Galen appears small as does the straight sinus. There is obtained of the venous structures at the region of the vena Galen. The middle cerebral artery vasculature also appears tortuous at the sylvian fissures.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 cerebellar tonsils extend approximate 5 mm below the level of the foramen magnum.

Output: 1.The patient is status post previous ventriculostomy tube placement. There is no ventriculomegaly at this time.2.Low-lying cerebellar tonsils.3.Tortuous intracranial vasculature is a nonspecific finding.


Instruction: Generate impression based on medical findings.

Input: History of hepatitis C cirrhosis presents for HCC screening. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic fibrotic liver morphology. No focal suspicious lesion, biliary ductal dilatation or vascular abnormality.Normally distended gallbladder.SPLEEN: Splenomegaly measuring 19.9 cm in the craniocaudal dimension.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: Gastroesophageal varices.BONES, SOFT TISSUES: Susceptibility artifact from lower lumbar spinal fusion hardware.OTHER: No significant abnormality noted.

Output: Cirrhosis without a suspicious lesion. Gastroesophageal varices and splenomegaly.


Instruction: Generate impression based on medical findings.

Input: 70 year old man with history of recent diagnosis of cardiomyopathy with EF of 20% and no obstructive coronary disease by angiography, now referred for cardiac MRI to assess for possible etiologies as part of an advanced HF therapies evaluation. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 16%, the LV end diastolic volume index is 194 ml/m2 (normal range: 74+/-15), the LVEDV is 438 ml (normal range 142+/-34), the LV end systolic volume index is 163 ml/m2 (normal range 25+/-9), the LVESV is 368 ml (normal range 47+/-19), the LV mass index is 99 g/m2 (normal range 85+/-15), and the LV mass is 224 g (normal range 164+/-36). There is global hypokinesis with regional variation. There is transmural late gadolinium enhancement in the inferoapical, anteroapical and true apex with thinning suggestive of previous infarction. There is transmural late gadolinium enhancement in the basal inferolateral wall. There is no LV thrombus. In a 4-chamber view there outpouching at the apex compatible with apical aneurysm. Left AtriumThe left atrium is severely dilated. The interatrial septum is thickened.Right VentricleThe right ventricle is severely dilated with severely reduced systolic function. There is severe hypokinesia of the apical one half of the right ventricle. The basal one half demonstrates moderate to severe hypokinesia. The overall RV ejection fraction is 13%, the RV end diastolic volume index is 157 ml/m2 (normal range 82+/-16), the RVEDV is 355 ml (normal range 142+/-31), the RV end systolic volume index is 136 ml/m2 (normal range 31+/-9), and the RVESV is 307 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 leaflets are tethered. There is at least moderate mitral regurgitation which appears eccentric. Pulmonic ValveThe pulmonic valve opens widely. There is pulmonary regurgitation, visually this appears trace or mild.Tricuspid ValveThe tricuspid valve opens widely. There is trace tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size. The ascending aorta measures 37mm at the level of pulmonary artery bifurcation. Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is dilated (38mm). Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no pericardial effusion.Extracardiac FindingsThere are bilateral shoulder prostheses present. A portion of the splenic flexure is visualized. There is evidence of diverticulosis without diverticulitis.

Output: 1. Severely dilated left ventricle with severely reduced systolic function (EF = 16%). 2. There is thinning of the apex with transmural late gadolinium enhancement suggestive of previous infarction. This speaks to an ischemic component to his cardiomyopathy. 3. Suspected left ventricular apical aneurysm. 4. Severely dilated right ventricle with severely reduced systolic function (EF = 13%).5. Mitral leaflet tethering with at least moderate mitral regurgitation. 6. Dilated pulmonary artery. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Reason: Chiari malformation status post decompression. VP shunt, Syrinx. Weakness, headaches, difficulty walking , increase in syrinx size on recent MRI , repeat in 3 months History: expanding syrinx, shunt, chiari , worsening symptoms Again seen are postsurgical changes of prior Chiari decompression with suboccipital craniectomy and resection of the posterior arch of C1. Left cerebellar encephalomalacia is partially visualized and present previously. Fourth ventricular stent partially visualized.There is no significant change in extensive cervical syrinx with septations compared to 4/30/2015. For example at the C1 level, syrinx measures 17 x 13 mm similar to prior. Inferiorly syrinx extends to the C7 level similar to prior with additional T2 hyperintensity extending down to the T1 level appearing slightly less prominent in the interval.Abnormal T2 signal in the thoracic cord bilaterally is again seen from T6 to T7 and appears similar on the sagittal sequences. Axial T2 sequence of the thoracic cord were not obtained as patient could not tolerate further imaging. There is mild prominence of the central canal slightly more inferiorly from T7 to T8 which also appears similar to prior based on the sagittal sequences. Again noted is mild deformity of the thoracic cord with asymmetric flattening of the left ventrolateral aspect of the cord at the T5 level better appreciated on prior axial thoracic images.Mild multilevel degenerative changes are again seen in the cervical spine. Schmorl's nodes with mild depression of the superior endplates involving the thoracic spine are also again noted involving the superior endplates at T7, T8, T9, and T10. Alignment is maintained. Bone marrow signal is benign.

Output: Compared to 4/30/2015 there is overall no significant change in size or extent of large cervical syrinx extending from the cervicomedullary junction to the C7 level. Adjacent T2 signal abnormality extending more inferiorly from C7 to the T1 level however appears slightly decreased than before. Additional T2 signal abnormality involving the mid thoracic cord from T6 to T7 is also unchanged based on the sagittal sequences with patient not being able to tolerate further axial thoracic imaging. Contour deformity of the mid thoracic cord also remains unchanged which may be related to adhesions in the thecal sac from remote inflammation or surgical manipulation. No new cord signal abnormality.


Instruction: Generate impression based on medical findings.

Input: Unable to perform physical therapy. Left shoulder pain. Specifically difficulty with abduction and flexion ROTATOR CUFF: Only minimal signal abnormality along the undersurface of the distal supraspinatus near the insertion is observed compatible with mild fraying. Intact fibers are observed throughout and changes are only observed in the distalmost centimeter just prior to attachment. Remaining rotator cuff is otherwise intact.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: Minimal degenerative changes of the AC joint and the remaining shoulder is otherwise grossly intact. Marrow signal unremarkable. Labrum remains grossly intact given limitations of the technique.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Minimal tendinopathy with mild changes at the distal most supraspinatus tendon compatible with undersurface fraying. See detail provided


Instruction: Generate impression based on medical findings.

Input: Right lower occipital weakness. Progressive back pain L3 fracture, stable L1 fracture, severe L3-L4 stenosis. Five lumbar type vertebral bodies are presumed to be present. There is a transitional anatomy at the L5 level with pseudoarticulation involving the left L5 transverse process with the sacrum with superimposed degenerative changes. Again seen is compression fracture involving the L1 vertebral body with approximately 50% loss of height. There is a severe compression fracture involving the L3 vertebral body with particular height loss in its mid aspect as seen on recent CT from 11/1/2016 and progressed since prior MRI from 6/5/2016. There is mild osseous retropulsion at both of these levels. Edema involving the L3 vertebral body is decreased compared to prior. There is a mild compression fracture involving the superior endplate of the L4 vertebral body with 20% loss of height which is new since prior from 6/5/2016 and grossly similar from recent CT. There is mild edema involving the superior L4 endplate. There is T1 shortening involving the L1 vertebral body as well as the pelvis which may be related to prior radiation.There is moderate to severe spinal canal stenosis at the L3-L4 level which is progressed since prior. There is fairly mild spinal canal narrowing at the L2-L3 and L4-L5 levels.Additional details as described below:L1-L2: No spinal canal stenosis. There is mild bilateral neural foraminal narrowing related to minimal disc bulge and bilateral facet arthropathy.L2-L3: There is mild spinal canal narrowing. There is mild right neural foraminal stenosis related to prominent right-sided facet arthropathy. Left neural foramen is patent.L3-L4: There is moderate to severe spinal canal stenosis related to combination of osseous retropulsion, disc bulge, ligamentum flavum thickening, and facet arthropathy. There is also severe right and moderate left neural foraminal stenosis, which have also progressed. L4-L5: Mild disc bulge and advanced facet arthropathy. There is mild narrowing of the spinal canal. There is moderate left and mild right neural foraminal stenosis similar to prior.L5-S1: There is a disc bulge and bilateral facet arthropathy, worse on the left. There is no spinal canal stenosis. There is mild to moderate, left relatively greater than right, neural foraminal stenosis which is similar to prior.No definite evidence of metastatic disease is evident within the limits of noncontrast study.

Output: 1. Compared to prior MRI from 6/5/2016, there is progression of a severe compression fracture of L3, new mild compression fracture of the L4 vertebral body, and unchanged moderate L1 compression fracture. These findings are similar to recent CT from 11/1/2016.2. At L3-L4, there is moderate to severe spinal canal stenosis, severe right neural foraminal stenosis, and moderate left neural foraminal stenosis. These findings have all significantly progressed since prior MRI from 6/5/2016.3. No definite evidence of metastatic disease is evident within the limits of noncontrast study. Additional levels as above.


Instruction: Generate impression based on medical findings.

Input: 75-year-old female with history of multiple CVAs now presents with increased altered mental status and muscle twitches. Please evaluate for new bleed, mass effect or shift. Compared to previous to evaluate progression of CVA. There is no evidence of intracranial hemorrhage, mass or edema. The previously described there is low attenuation throughout the MCA vascular territory the left consistent with a subacute infarct but remains overall unchanged from the previous examination. Multiple other areas of hypodensity in the periventricular and subcortical white matter distribution is consistent with small vessel disease, age indeterminant. Multiple lacunar infarcts redemonstrated within the bilateral basal ganglia and cerebellum. If there is clinical concern for acute ischemia, an MRI may be considered.The ventricles and basal cisterns are stable in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Stable right frontoparietal subacute infarct. 2. Small vessel disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.


Instruction: Generate impression based on medical findings.

Input: Male, 43 years old,spinal cord syrinx, follow-up. Thoracic: There is significant volume loss involving the thoracic cord at the level of the syrinx as well as of the mid thoracic cord above the syrinx. Again demonstrated is a syrinx extending from the T8 to T10 levels which is overall not significantly changed since 8/20/2015. At the T8 level there is a locule in the right aspect of the syrinx previously measuring 7.5 x 6.6 mm, now 7.1 x 8.0 mm. At the T9 level a locule measures 6.7 x 7.1 mm, previously 5.6 x 5.9 mm.Exaggerated thoracic kyphosis is redemonstrated with small Schmorl's nodes suggestive of Scheuermann's. Again seen are multilevel laminectomies. Syrinx shunt catheter is poorly visualized. Fatty endplate signal change is seen at the superior endplate of T7, unchanged. No areas of high-grade spinal canal or neuroforaminal stenosis are appreciated.Lumbar:The conus and cauda equina are within normal limits. The conus tip terminates at the upper margin of L2 which is within normal limits.Vertebral body heights are normal. Bone marrow signal is benign. Grade 1 retrolisthesis of L4 relative to L5 is again seen. Alignment is otherwise unremarkable. Edematous endplate marrow signal changes at L5-S1 appear slightly decreased. Disc desiccation at L3-L4, L4-L5, and L5-S1 is again seen with particular loss of disc height at the L5-S1 level. Individual levels as below: L1-2: No spinal canal stenosis or neuroforaminal narrowing. L2-3: No spinal canal stenosis or neuroforaminal narrowing. L3-4: Facet hypertrophy. Mild bulging disk. No significant spinal canal or neuroforaminal stenosis. No interval changes.L4-5: Facet hypertrophy. Disc bulge. No significant spinal canal stenosis. Mild bilateral foraminal narrowing.L5-S1: Facet hypertrophy. Diffuse disc bulge again seen including involvement of the neural foramina. No significant spinal canal stenosis. Mild to moderate bilateral neural foraminal stenosis.

Output: 1. Overall no significant change in size and extent of septated lower thoracic syrinx. There are small loculated areas which demonstrates subtle changes in morphology and perhaps minimal enlargement as detailed above compared to 8/20/2015. 2. Significant parenchymal volume loss involving the thoracic cord at the level of the syrinx as well as above it involving the mid thoracic cord. 3. Mild degenerative changes in the lumbar spine.


Instruction: Generate impression based on medical findings.

Input: Clinical question: 65 year-old female with left tonsillar squamous cell carcinoma. Now presenting with seizure episode. Rule out hemorrhagic CVA, etc. Signs and symptoms: Seizures Non-infused CT of brain:A new area of low-attenuation involving the cortex and subcortical white matter of the left frontal lobe (axial images 19 and 20) is noted. There is subtle mass effect with this finding. There is no evidence of hemorrhage associated with this finding. This finding is believed to represent a small acute cortical stroke. Considering patient's history possibility of a metastatic lesion should also be considered. Further study with an infused head CT or an MRI is recommended.No evidence of hemorrhage, mass effect, midline shift or hydrocephalus. Calvarium is intact. Very extensive degenerative changes of cervical spine at C1 -- C2 level is noted.

Output: 1.New foci of low-attenuation in the left frontal lobe as detailed. Finding is concerning for ischemic stroke and considering patient's history possibility of a metastatic lesion cannot be entirely ruled out. Follow-up study would be effusion is recommended.2.No evidence of hemorrhage a standard but is questioned or any additional findings.


Instruction: Generate impression based on medical findings.

Input: 9-year-old male with history of right lateral ventricular tumor (low grade astrocytoma) complains of occipital head pain more to touch and not headache. Evaluate for infection or abnormality. CSF-density cyst is again seen in the right parietal lobe. It measures approximately 4.7 x 5 cm in greatest axial dimension; measuring approximately 4.4 x 4 cm on prior MRI from 2008. The size and configuration of the ventricles and basal cisterns are unchanged. There is no evidence of intracranial hemorrhage, mass or edema. Right intracranial catheter is again seen in the extra-axial space on the right with tip at the level of the right sylvian fissure. Thinning of the right parietal skull reflects old craniotomy. The calvaria and skull base are otherwise radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Slight enlargement of CSF-density cyst in the right parietal lobe. Otherwise, stable postsurgical changes as above. Please note that lack of IV contrast limits evaluation for infection.


Instruction: Generate impression based on medical findings.

Input: Low back pain, left lower extremity neuropathic pain Five lumbar type vertebral bodies are present. Bilateral 12th ribs are hypoplastic. There is lumbar levoscoliosis with apex at the L2-L3 level. There is severe compression deformity involving the L4 vertebral body with approximately 70 to 80% loss of height. No edema seen within the vertebral body. There is also mild wedging involving the left superior endplate of the L3 vertebral body, which also remains unchanged since 2007.Round enhancing lesion is seen within the L4 vertebral body corresponding to focus with sclerotic rim on prior CT from 12/2013 and while nonspecific is favored to be benign. There is a larger focus of T1 hyperintensity involving the L3 vertebral body likely representing a hemangioma.Multilevel degenerative changes are seen, as described below:L1-L2: Diminished disk height with vacuum disk phenomena. There is mild bulge without significant spinal canal or left neural foramina stenosis. There is mild right neural foraminal narrowing.L2-L3: There is loss of disk height with vacuum disk phenomenon. There is mild disk bulge and mild to moderate right neural foraminal narrowing. No significant spinal canal or left neural foraminal narrowing.L3-L4: There is disk bulge and mild osseous retropulsion related to the chronic compression fracture. There is also ligamentum flavum thickening. There is resulting moderate spinal canal stenosis including the left lateral recess and the central canal. There is severe right neural foraminal narrowing. There is also moderate left neural foraminal narrowing.L4-L5: There is loss of disk height and vacuum disk phenomena. There is mild disk bulge. No significant central spinal canal narrowing. There is moderate left neural foraminal stenosis and mild right neural foramina stenosis.L5-S1: There is loss of disk height and vacuum disk phenomena. There is bilateral facet arthropathy. There is moderate to severe left and mild right neural foramina stenosis. No significant spinal canal stenosis.Again seen is chronic dissection involving the abdominal aorta, better assessed on prior CT angiogram. Visualized conus imaged on the axial images from from the lower T12 level is unremarkable. There is questionable T2 signal at the T11 level dorsally on the sagittal sequence, which may be artifactual or related to reported cord infarct.

Output: 1. Advanced degenerative changes in the lumbar spine with levoscoliosis with apex at the L2-L3 level similar to priors.2. Severe chronic compression fracture involving the L4 vertebral body and mild depression of the superior endplate involving the L3 vertebral body, which remain unchanged. No vertebral body edema.3. Moderate spinal canal stenosis at L3-L4 which is not significantly changed since 2007. Otherwise no significant spinal canal stenosis in the lumbar spine.4. Moderate to severe neural foraminal stenosis at multiple levels as detailed above including right greater than left at L3-L4, and on the left at L4-L5 and L5-S1 levels. 5. Visualized conus imaged on the axial images below the lower T12 level is unremarkable. There is questionable T2 signal abnormality at the T11 level dorsally which is not imaged on the axial lumbar sequence. Prior lower thoracic cord infarct was seen on prior MRI from 2004. If clinically warranted thoracic MRI can be obtained.


Instruction: Generate impression based on medical findings.

Input: Female 55 years old; Evaluate for bursitis or gluteal muscle tears around the right hip. Severe pain for years (since 2005) near the greater trochanter, with acute worsening in the past 4 months. The examination is limited by lack of complete series of sequences as the patient was not able to tolerate positioning. Moderate osteoarthritis affects the right hip. There is diffuse thinning of the articular cartilage superiorly and focal full thickness degeneration anteriorly with associated cyst formation at the anterior acetabular dome. Additional edema type signal within the acetabular dome is likely reactive though the possibility of a stress reaction is also considered. We see no discrete fracture line. There is suspicion of an incomplete tear of the anterior superior labrum; however, the labrum is not fully visualized due to the aforementioned limitations of the study. The ligamentum teres is intact. Small amount of fluid and/or synovitis is present in the right hip. The gluteal musculature appears normal, as does the remaining musculature of the right hip. We see no gluteal muscle tear. Minimal edema type signal is present along the posterior aspect of the greater trochanter at the gluteus medius insertion, which is of questionable clinical significance and may be seen in asymptomatic patients. Similar, if not more prominent, edema type signal is present on the left, which is also of questionable clinical significance. A small focus of increased signal at the ischium along the origin of the right hamstring muscles may indicate a small tear, however, this may also be seen in asymptomatic patients. More prominent signal abnormality is present on the left at the hamstring origin and may also reflect prior tearing, not necessarily of any current clinical significance.Moderate osteoarthritis affects the pubic symphysis. Mild osteoarthritis affects the left hip. A small amount of fluid signal at the anterior aspect of the left acetabulum may perhaps be in the iliopsoas bursa, though a paralabral cyst is also a possibility. Severe degenerative disk disease affects the L4/5 level. Sacralization of L5 is again seen. Moderate facet joint hypertrophy is present in the lower lumbar spine with spinal stenosis, which may be better evaluated with dedicated lumbar spine MRI, if clinically warranted.

Output: 1. Osteoarthritis of the right hip, as above. Edema within the acetabular dome is probably degenerative in etiology, although a stress reaction is also considered. Degenerative changes of the left hip, pubic symphysis, and lower lumbar spine.2. No findings suggestive of gluteal muscle tear or frank bursitis. Minimal edema type signal along the greater trochanters bilaterally is not necessarily of any clinical significance. 3. Additional findings, as above.


Instruction: Generate impression based on medical findings.

Input: Ms. Caddell is a 61-year-old female with recently diagnosed DCIS of the left breast. She presents today for MRI evaluation for staging purposes There is heterogeneous amount of fibroglandular tissue in both breasts. Moderate background parenchymal enhancement is noted bilaterally, which limits the sensitivity of this examination.Left breast - In the left upper outer breast, there is a segmental distribution of clumped nonmass enhancement identified measuring approximately 4.6 x 2.6 cm in the AP x ML dimension, and 4.8 cm in the AP oblique dimension. This corresponds in location to the mammographically detected calcifications in the left upper outer breast, which are biopsy proven to be malignant. Susceptibility artifact from biopsy marker clip is seen centrally within this clumped nonmass enhancement.Seen approximately 2 cm inferior to this is an additional segmental distribution of clumped nonmass enhancement measuring approximately 2.0 cm in the AP dimension. Susceptibility artifact from biopsy marker clip with associated benign enhancing focus is seen in the left medial breast, at site of prior benign biopsy.Right breast - There is no abnormal enhancement seen in the right breast. Axillae - No abnormal lymph nodes are identified in either axillary or internal mammary region.Extra-mammary findings - Incidental note is made of a peripherally enhancing lesion in the manubrium, measuring approximately 3.5 x 2.4 cm. This lesion is associated with high internal T2 signal intensity and is partially visualized on prior MRI cardiac exam from 2012. Imaging findings favor a benign hemangioma.

Output: (1) 4.8 cm clumped nonmass enhancement in a segmental distribution in the left upper outer breast, corresponding in distribution to the mammographically detected calcifications which are biopsy proven to be malignant.(2) 2.0 cm segmentally distributed clumped nonmass enhancement in the left inferior breast. An MR guided biopsy with clip placement is recommended for further evaluation.(3) No MRI evidence for malignancy in the right breast.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: History of meningioma status post resection and radiation therapy now with new headache. There is evidence of prior left-sided craniotomy for biopsy or partial resection of tumor. There is redemonstration of a homogeneously enhancing extra-axial mass in the left superior cerebellopontine angle cistern measuring 22 x 22 x 28 mm (AP x TR x CC), previously 22 x 21 x 29 mm. The lesion abuts the dorsal aspect of petrous bone with resultant hyperostosis, with mass effect on the left aspect of superior pons. There is mass effect with effacement of the left Meckel's cave at this level. The enhancing dural tail of tumor extends along the left cerebellopontine angle inferiorly to the level of foramen magnum. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with chronic small vessel ischemic changes. There is unchanged extensive T2/FLAIR hyperintensity of the left middle cerebellar peduncle, which could represent a combination of edema and encephalomalacia from tumor and surgery. There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There is a partially empty sella. The skull and extracranial soft tissues are otherwise unremarkable. There is mild scattered mucosal thickening of the paranasal sinuses.

Output: 1. No significant interval change in size of a homogeneously enhancing extra-axial mass in the upper left cerebellopontine angle cistern, consistent with known petrous apex meningioma. There is unchanged mass effect on the left aspect of the pons. Unchanged diffuse T2/FLAIR hyperintensity of left middle cerebellar peduncle with volume loss.2. No acute infarct. Mild to moderate chronic small vessel ischemic changes. 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: Male, 61 years old, with weakness in the left quadriceps muscle, evaluate lumbar spondylosis, specifically the left L3 nerve root. Trace retrolisthesis of L4 relative to L5 is unchanged. Spinal alignment is otherwise unremarkable.Mild anterior wedging of the T11 and T12 vertebral body is unchanged. Vertebral body heights are otherwise preserved. Marrow signal characteristics are slightly heterogeneous which in part represents endplate degenerative signal abnormality. No focal worrisome marrow replacement or marrow edema is seen.Mild focal myomalacia of the spinal cord at the T11-12 level is unchanged. Elsewhere, the visualized distal spinal cord, conus and nerve roots of the cauda equina are normal in signal characteristics.Diffuse loss of disc height is seen with the exception of L5-S1 which demonstrates relatively preserved disc height. The discs show uniformly T2 signal. Additional level specific findings are as follows:T11-12: Evidence of prior posterior element surgery. Left facet arthropathy. Disc bulging with a small left foraminal protrusion. Mild generalized spinal canal stenosis. Moderate bilateral foraminal narrowing. No interval changes. T12-L1: Facet arthropathy. Ligamentum flavum thickening. Minimal disc bulge. Mild spinal canal stenosis. Mild bilateral foraminal narrowing. No interval changes.L1-2: Facet arthropathy. Ligamentum flavum thickening. Moderate generalized spinal canal stenosis with some crowding of the cauda equina. Mild bilateral foraminal narrowing.L2-3: Facet arthropathy. Ligamentum flavum thickening. Disc bulging. Mild generalized spinal canal stenosis. Moderate bilateral foraminal narrowing. No interval changes. L3-4: Facet arthropathy, left worse than right. Minimal disc bulging. Mild generalized spinal canal stenosis. Severe left and moderate right foraminal narrowing. No interval changes. L4-5: Facet arthropathy. Ligamentum flavum thickening. Bulging disc with a small right paracentral protrusion. Mild generalized spinal canal stenosis. Moderate bilateral foraminal narrowing. No interval changes. L5-S1: Facet arthropathy. Ligamentum flavum thickening. Bulging disc with a small central protrusion. Mild generalized spinal canal stenosis. Severe left and mild right foraminal narrowing. No interval changes.

Output: Multilevel degenerative disease of the discs and posterior elements is redemonstrated without significant interval change. As on the prior examination, severe foraminal narrowing is demonstrated on the left at L3-4 and on the left at L5-S1. Moderate spinal canal stenosis is seen at L1-2 with some crowding of the cauda equina. Mild spinal canal narrowing is also evident at additional levels as above.


Instruction: Generate impression based on medical findings.

Input: 50-year-old female with medial knee pain. MENISCI: The medial and lateral meniscus appear intact.ARTICULAR CARTILAGE AND BONE: Note is made of linear increased signal abnormality within the medial facet of the patella consistent with a focal full-thickness articular cartilage fissure/cleft with delamination. The remainder of the cartilage of the patellofemoral joint appears spared. No bone marrow signal abnormality is identified.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Articular cartilage fissure/cleft along the medial facet of the patella as described above. Otherwise, no findings to account for the patient's pain.


Instruction: Generate impression based on medical findings.

Input: Episodic tension-type headache, intractable [G44.211], Reason for Study: ^Reason: r/o structural lesion History: HA associated with right side weakness Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion on this scan.There is no evidence of abnormal enhancement.Multiple small high signal intensities on subcortical white matter and periventricular white matter are non specific likely represent non specific small vessel ischemic disease.There are however multiple small susceptibility lesions at the right anterior temporal lobe and right posterior inferior temporal lobe without associated with surrounding edema. In particular, the left cerebellar hemisphere lesion is associated with developmental venous anomaly. A small susceptibility lesion just mesial to the DVA is likely to be adjacent venous structure instead of parenchymal lesion. Constellation of these findings suggest differential diagnosis of possibility of cavernous malformation, chronic petechial hemorrhages and calcifications. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. The mastoid air cells are clear. Retention cyst on the left side of sphenoid sinus.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate subtle luminal irregularities of intracranial arterial system without evidence of significant (more than 50%) luminal stenosis. Note is made that distal basilar artery shows about 20-30% luminal narrowing in conjunction with luminal irregularities of bilateral PCAs indicating atherosclerotic changes. No aneurysm is seen. Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The left vertebral artery originates from the aortic arch directly. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement.2. 2-3 susceptibility lesions on the right temporal lobe with DVA on the left cerebellar hemisphere. Differential diagnosis include cavernous malformation, chronic petechial hemorrhage and calcifications.3. Atherosclerotic changes of intracranial arterial system without evidence of significant luminal narrowings. No aneurysm.4. Normal Neck MRA.


Instruction: Generate impression based on medical findings.

Input: Female, 84 years old, gait problems. The thoracic kyphosis is slightly exaggerated. Otherwise, sagittal alignment is within normal limits. Vertebral body heights are preserved. No evidence of marrow edema or marrow replacement is seen.Loss of disc height and disc bulging is evident at almost every level in the thoracic spine. At most levels, this results in mild to moderate spinal canal stenosis without significant cord deformation. At T8-9, however, disc bulging in combination with posterior element hypertrophy results in a moderate to severe stenosis with complete effacement of CSF and mild impingement of the spinal cord. The cord at this level demonstrates mild T2 hyperintensity. Elsewhere, no spinal cord signal abnormality is detected. No epidural collections are seen. The paraspinal soft tissues are within normal limits.The neural foramina are are narrowed on the right at T4-5 and bilaterally from T8-9 through T10-11. Perineural root sleeve cysts are noted incidentally in several of the foramina.

Output: Degenerative disc disease is seen at almost every level in the thoracic spine with loss of disc height and disc bulging. At T8-9, disc bulging in combination with posterior element hypertrophy results in a moderate to severe spinal canal stenosis with mild impingement of the spinal cord. Subtle cord signal abnormally at this location could indicate either edema or myelomalacia. At most other levels, degenerative disease results in mild to moderate spinal canal stenosis without significant cord impingement.


Instruction: Generate impression based on medical findings.

Input: History of distal esophageal cancer and chronic pancreatitis. PET CT demonstrated a hypermetabolic focus in the pancreatic head/neck. Evaluate this lesion. ABDOMEN:LIVER, BILIARY TRACT: Demonstrate again is marked intrahepatic and extrahepatic biliary ductal dilatation. A biliary stent is noted.No suspicious liver lesion. The liver is normal in morphology. The hilar portal vein is patent. At the level of the pancreatic head is markedly attenuated. The hepatic veins are patent.Cholelithiasis.SPLEEN: Normal splenic size.PANCREAS: The pancreas is prominent with marked irregular pancreatic ductal dilatation/ectasia with multiple signal voids compatible with calcifications as seen on recent CT. These findings are consistent with severe chronic pancreatitis, although a main duct intrapancreatic mucinous neoplasm cannot be excluded.There is soft tissue enhancement of the pancreatic head/uncinate process which may represent residual pancreatic parenchyma although underlying neoplasm cannot be excluded given the marked parenchymal abnormality.There is a enhancing thick-walled focus along the anterior caudal aspect of the pancreatic head measuring 1.4 x 0.7 cm (series 12/179), which may represent a small pseudocyst or necrotic lymphadenopathy.A 1.8 cm lesion near the pancreatic tail may represent the mobile rim calcified pseudoaneurysm as seen on recent CT.There is no significant peripancreatic acute inflammatory changes/fluid.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Renal simple appearing cysts and too small to characterize hypointensities.RETROPERITONEUM, LYMPH NODES: Prominent gastrohepatic adenopathy is better characterized on recent CT.BOWEL, MESENTERY: The stomach is distended with heterogeneous debris to the level of the transverse duodenum without a discrete mass lesion seen.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Markedly distended main pancreatic duct may reflect stigmata of severe chronic pancreatitis although a main duct intrapancreatic mucinous neoplasm cannot be entirely excluded. Heterogeneous soft tissue enhancement of the pancreatic head may represent residual parenchyma although an underlying neoplasm cannot be excluded. ERCP/US correlation is recommended.2.Thick rim enhancing small lesion anterior and caudal to the pancreatic body may represent a pseudocyst versus necrotic lymphadenopathy.3.Probable mobile arterial pseudoaneurysm measuring 1.8 cm, better seen on the recent CT.


Instruction: Generate impression based on medical findings.

Input: Dizziness. Neck pain. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.Trace amount of low attenuation are present in the periventricular and subcortical white matter. Gray-white differentiation is preserved. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No acute intracranial abnormality.


Instruction: Generate impression based on medical findings.

Input: 43-year-old male with history of chronic bilateral back pain and leg pain. Evaluate for possible abscess versus disc disease. Please note this study is technically limited. Five lumbar type vertebral bodies are presumed to be present for the purposes of numbering. Vertebral body heights are within normal limits. There is loss of disc height at L3-4, L4-5, and most severely at L5-S1. There is abnormal T2 signal within the L4-5 and L5-S1 disc space. There are suspected inflammatory changes in the paraspinous soft tissues at L4-5 and L5-S1 raising suspicion for infection. There is a tiny T2 hyperintense lesion in the right psoas muscle which could represent a small abscess. There are endplate marrow signal changes at L4-5 and L5-S1 which are difficult to evaluate due to artifact. There is diffuse low T1 signal in the marrow which may be related to chronic anemia. The conus medullaris is normal in position terminating at L1. Alignment is within normal limits. Innumerable bilateral renal cysts are present compatible with end-stage renal disease.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Mild disc bulge with no significant spinal canal or neuroforaminal stenosis. Moderate facet hypertrophy.L3-L4: Mild disc bulge with left paracentral disc protrusion which results in mild to moderate left neuroforaminal narrowing. No significant spinal canal stenosis. Moderate facet hypertrophy.L4-L5: There is near complete loss of disc height especially along the right aspect of the disc. There is a mild left paracentral disc protrusion resulting in mild to moderate left neuroforaminal stenosis and mild right foraminal stenosis. No significant spinal canal stenosis. Moderate facet hypertrophy.L5-S1: There is near complete diffuse loss of disc height. Mild bilateral neuroforaminal narrowing. No significant spinal canal stenosis. Moderate facet hypertrophy. Bilateral facet effusions.

Output: 1. Study is technically degraded due to artifacts and poor signal. There is abnormal T2 hyperintense signal within the L4-5 and L5-S1 disc space. There are mild inflammatory changes suspected in the paraspinous soft tissues at L4-5 and L5-S1 raising suspicion for infection. There is a tiny T2 hyperintense lesion in the right psoas muscle (axial T2 image 7/50 series 601) which could represent a small abscess. No epidural collections. As patient can not receive gadolinium, recommend repeat MRI spine study with conventional sequences, axial T2 fatsat, and diffusion. CT lumbar spine with contrast can also be considered.2. Multilevel degenerative disc disease with near complete loss of disc height at L4-5 and L5-S1 which may be related to degenerative disease versus infection. There are endplate marrow changes which are difficult to evaluate due to artifact. 3. No significant spinal canal stenosis. Mild to moderate left L4-5 and L5-S1 neural foraminal stenosis.4. Multilevel facet arthropathy especially at L5-S1.5. Diffuse low T1 marrow signal which is nonspecific and can be seen in conditions such as chronic anemia.Findings including recommendation for repeat study were discussed with Dr. Garza at 1600 hrs on 2/28/2015.


Instruction: Generate impression based on medical findings.

Input: Several sequences are motion degraded. Given this caveat:T2 hyperintense foci are present throughout the white matter, basal ganglia, and pons, confluent in some locations. This is not associated with restricted diffusion, susceptibility abnormality, or enhancement. There is diffuse volume loss, slightly more affecting the bilateral mesial temporal lobes. 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. Note is made of dolichoectasia and elongation of the posterior circulation. Mucosal thickening is present within a single right ethmoid air cell. Otherwise the paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: 1.Several sequences are motion degraded.2.Advanced chronic small vessel ischemic disease.3.There is diffuse volume loss, slightly more affecting the bilateral mesial temporal lobes which is a pattern that can be seen in the clinical setting of Alzheimer dementia.


Instruction: Generate impression based on medical findings.

Input: New diagnosis of lung cancer. Evaluate for brain metastasis. There is a well-circumscribed 11 mm pineal region mass which shows solid contrast enhancement. There is minimal cerebral white matter T2 hyperintensity. The brain parenchyma and pituitary gland appear unremarkable. Otherwise, there is no evidence of brain parenchymal enhancing lesions, intracranial hemorrhage, or acute infarct. 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 minimal maxillary sinus mucosal thickening. There is also minimal fluid within the left mastoid air cells.

Output: 1.A pineal mass with solid enhancement that measures up to 11 mm may represent a perineal parenchymal tumor versus an isolated lung cancer metastatic lesion. Follow-up imaging is recommended to confirm stability.2.Minimal cerebral white-matter T2 hyperintensity is nonspecific, but may reflect chronic microvascular ischemia.3.No evidence of intracranial hemorrhage or acute infarct.


Instruction: Generate impression based on medical findings.

Input: Male, 4 years old, with history of generalized tonic-clonic seizure in 7/2016, recurrent on two other occasions and on current admission. No evidence of parenchymal edema, mass effect or restricted diffusion is seen. No structural defects are identified. Slight asymmetric prominence of the right temporal horn is seen. The mesial temporal structures are normally formed, symmetric and free of abnormal signal intensity. No evidence of intracranial hemorrhage or any abnormal extra-axial collection is seen. Ventricular size and morphology are otherwise within normal limits.

Output: Slight asymmetric prominence of the right temporal horn may represent a developmental variant. The mesial temporal structures are otherwise unremarkable. No specific findings are seen which would account for the patient's seizures.


Instruction: Generate impression based on medical findings.

Input: 72 year old with history of hypertension, diabetes, chronic kidney disease, valvular heart disease, coronary artery disease (CABG 2014) and diastolic heart failure presenting from OSH with acute decompensated heart failureTechnical: The quality is poor, due to inability to perform breath hold and motion artifact Left VentricleThe left ventricle is mildly dilated with normal systolic function. The overall LV ejection fraction is 59%, the LV end diastolic volume index is 106 ml/m2 (normal range: 74+/-15), the LVEDV is 252 ml (normal range 142+/-34), the LV end systolic volume index is 43 ml/m2 (normal range 25+/-9), the LVESV is 103 ml (normal range 47+/-19), the LV mass index is 87 g/m2 (normal range 85+/-15), and the LV mass is 208 g (normal range 164+/-36). There is septal flattening at inspiration and expiration consistent with RV pressure and volume overload. There is no obvious late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process, however LGE imaging significantly limited by motion artifact.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is severely dilated with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 145 ml/m2 (normal range 82+/-16), the RVEDV is 346 ml (normal range 142+/-31), the RV end systolic volume index is 72 ml/m2 (normal range 31+/-9), and the RVESV is 171 ml (normal range 54+/-17).Right AtriumThe right atrium is severely dilated.Aortic ValveThere is a prosthetic valve in the aortic position. Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is moderate-severe eccentric 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 is normal in size and drain normally into the right atrium. The IVC is dilated.PericardiumThe pericardium is borderline thickened in some regions (the maximum measured thickness is only 4mm). Based on tagging, the myocardium does not appear adherent to the pericardium. Free breathing does not show significant interventricular dependence to support constrictive physiology. Extracardiac FindingsSternotomy wires present. Bilateral interstitial markings, left greater than right. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. This is a technically difficult study because of patient inability to cooperate with breath-holds. Within the limitations of image quality, it can be noted that the pericardium is at most borderline thickened. There is no obvious evidence of pericardial tethering to the myocardium or respiratory variation in the septal position. There is also no significant late gadolinium enhancement of the pericardium. Taken together there is no strong evidence for pericardial constriction.2. Mild LV dilation with normal systolic function (LVEF 59%) with septal flattening which seems to occur more often during systole suggesting the presence of increased RV systolic pressures. There is no obvious late gadolinium enhancement to suggest the presence of underlying myocardial fibrosis, inflammation, or infiltration; however, image quality is somewhat limited. 3. Severe RV dilation with normal systolic function (RVEF 51%).4. Moderate to severe tricuspid regurgitation. 5. Severe RA dilation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old. Left tibial pain The left tibia and fibula appear normal. The soft tissues of the leg appear normal. We see no findings to account for the patient's tibial pain.Abnormal signal intensity in the right tibial plateau as seen on the large field-of-view images is presumably degenerative in etiology.

Output: Normal-appearing left tibia without findings to account for the patient's pain.


Instruction: Generate impression based on medical findings.

Input: Unspecified cerebral artery occlusion with cerebral infarction. Dysarthria There are several punctate foci of diffusion restriction present in the left middle frontal gyrus adjacent to the precentral sulcus as well as in the left precentral gyrus lateral to the hand motor area.There is encephalomalacia present involving the left superior frontal gyrus and left cingulate gyrus anteriorly in an area of a prior infarction. There is associated susceptibility effect within this focus of encephalomalacia. On the 4/7/2013 exam there is diffusion restriction within this focus of encephalomalacia.There is a moderate degree of periventricular and subcortical confluent hyperintense white matter lesions present identified on the FLAIR and T2 images.T2 and FLAIR hyperintense punctate lesions are present in the brainstem and thalami.Punctate foci of signal loss on susceptibility imaging are present in the pons, midbrain and basal ganglia.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There are several microinfarcts present in the left frontal lobe at the posterior most aspect of the left middle frontal gyrus and in the left precentral gyrus. The location could account for dysarthria based on the location of the motor tongue area.2.There is encephalomalacia involving the left superior frontal gyrus and left cingulate gyrus where there was previously cerebral infarction in the subacute stage in April3.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. 4.Punctate lesions in the thalami and brainstem are compatible with lacunar infarcts.5.Findings are compatible with a few microhemorrhages in the brainstem and basal ganglia which is a distribution suggestive of hypertension


Instruction: Generate impression based on medical findings.

Input: Dementia. Assess for stroke or atrophy. The brain shows diffuse, fairly symmetric and proportionate expansion of the CSF-containing spaces reflecting mild cerebral and cerebellar volume loss. Volume loss in the mesial temporal lobes is proportionate as well. There is relatively minimal confluent periventricular cerebral white matter T2 hyperintensity that is most pronounced in the frontal and occipital lobes. In addition, there are scattered punctate foci of T2 hyperintensity in the frontal deep white matter. These findings are nonspecific but may reflect microvascular ischemia. There is a 7 mm left cerebellar white matter T1-hypointense, T2 hyperintense focus that may reflect a small chronic infarct. None of the lesions is associated with diffusion restriction. There is no intraparenchymal hemorrhage. Flow voids of the major vessels are preserved.There is a 1.5 cm extraaxial mass based on the right side of the anterior aspect of the falx that is isointense to gray matter on both T1 and T2. This is most suggestive of a falcine meningioma. A smaller 10 mm similar mass is present along the posterior aspect of the cribriform plate is most compatible with olfactory groove meningioma.There is minimal ethmoidal mucosal thickening. The orbits are unremarkable accounting for bilateral eye lens replacement.A 1.5 cm focal expansion of the right frontal bone that is bright on both T1 and T2 with tiny foci of T1/T2 hypointensity is compatible with a hemangioma. Deeply T1/T2 hypointense foci in the scalp near the vertex may represent small calcifications.

Output: 1.Global brain volume loss without specific lobar involvement, age-appropriate.2.Relatively mild white matter involvement by chronic microvascular ischemia.3.Left cerebellar nonenhancing lesion may represent a tiny nonacute focal infarct. 4.Incidental small parafalcine and olfactory groove presumed meningiomas, within limitations of this noncontrast exam.


Instruction: Generate impression based on medical findings.

Input: Reason: pt with left knee pain, no known injury, now with popping History: left knee pain MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: The articular cartilage appears slightly thinned diffusely, without focal defect.LIGAMENTS: The anterior collateral and posterior collateral ligaments are within normal limits.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Essentially unremarkable appearance of the left knee.


Instruction: Generate impression based on medical findings.

Input: There is extensive abnormality throughout the right frontal and anterior parietal lobes with areas of cortical thickening, polymicrogyria, and numerous foci of heterotopic gray matter extending from the cortex to the right lateral ventricle ependymal surface. There is extension of polymicrogyria along the superior aspect of the right sylvian fissure. The right lateral ventricle is dysmorphic and dilated. Although no definite cleft is visualized, there is suggestion of mild dimpling of a small portion of the lateral margin of the right lateral ventricle towards a confluent area of abnormal grey matter, and therefore it is possible that this could be on the spectrum of closed lip schizencephaly.The hippocampi are symmetric and normal in appearance. There is no evidence of mass or acute infarct. There are no areas of abnormal parenchymal signal. There is no abnormal intracranial enhancement. There is no midline shift or herniation. The major cerebral flow voids are intact. The midline structures and craniocervical junction are within normal limits.

Output: Extensive right frontal and anterior parietal polymicrogyria and heterotopic gray matter extending to the right lateral ventricle ependymal surface.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old, with history of thoracic laminectomy, evaluate decompression. Postoperative changes are redemonstrated compatible with complete laminectomy at T7 with partial laminectomy at T6 and T8. The spinal canal is congenitally slender. At the operative levels, the caliber of the spinal canal is similar to or slightly wider than the remained of the thoracic spine. There is minimal T2 hyperintensity in the cord at T7/8 likely representing myelomalacia from prior stenosis. Spinal alignment is adequate. Vertebral body heights are preserved allowing for minimal degenerative loss of height at lower levels. Fatty marrow change is seen in the mid thoracic vertebral bodies compatible with endplate degeneration. At T4-5, there is a left paracentral protrusion causing mild canal stenosis and left foraminal narrowing. At T8-9, there is a bulky right anterior osteophyte.At T10-11, a disc bulge and facet arthropathy result in moderate canal stenosis and moderate bilateral foraminal narrowing. At T11-12, a disc bulge and facet arthropathy result in mild canal stenosis, moderate right and mild left foraminal narrowing.

Output: Findings are seen indicating surgical decompression of the spinal canal from T6 through T8. The caliber of the canal at these levels is at least as wide if not wider than the rest of the thoracic region. Minimal cord signal abnormality at T7/8 likely reflects myelomalacia from prior stenosis.


Instruction: Generate impression based on medical findings.

Input: Assess for neuropathy/radiculopathy versus inflammation versus less likely spinal involvement: neck pain with extension. There has been near-interval resolution of findings related to pharyngitis with minimal residual retropharyngeal edema. There is no evidence of significant cervical lymphadenopathy in the neck. The thyroid and major salivary glands are unremarkable. The osseous structures and cervical spinal are unremarkable. The imaged intracranial structures are also unremarkable. There is a subcentimeter left maxillary sinus retention cyst.

Output: 1. Near-interval resolution of findings related to pharyngitis with minimal residual retropharyngeal edema.2. The osseous structures and cervical spinal are unremarkable. Please refer to the separate shoulder MRI report for additional details.


Instruction: Generate impression based on medical findings.

Input: Clinical question: 51-year-old female with metastatic renal cell cancer status post S RSto Right cerebellum, evaluate for progression. Signs and symptoms: None Pre and post enhanced brain MRI:Examination demonstrate slight interval increased size of a hemorrhagic metastatic lesion in the right cerebellum. It measures 16.5 x 20 mm in transaxial dimensions which is slightly larger than prior study. Measurement of 14.7 x 18.3 mm. There is also interval increased surrounding vasogenic edema with resultant regional mass effect.A tiny focus of hemorrhagic enhancement in the right cerebellar cortex also demonstrates subtle interval increase in the edema and enhancement since prior study. Finding is consistent with additional small metastatic lesion measuring approximately at 5.5 x 6 mm (axial fat-sat post enhanced series 12 image 16) in transaxial dimensions compared to prior study remeasurement of approximately 3 x 4 mm.Diffusion-weighted images are negative and there are stable few nonspecific, nonhemorrhagic and nonenhancing foci of FLAIR/T2 hyperintensity in the subcortical white matter of bilateral cerebral hemispheres. Findings in proper clinical setting could represent minimal chronic small vessel ischemic strokes.Calvarium demonstrate normal signal intensity and without abnormal enhancement.Unremarkable images through the orbits.Unremarkable visualized paranasal sinuses.

Output: 1.Mild interval increased size and surrounding vasogenic edema of a right cerebellar hemorrhagic metastatic lesion as detailed/measured above.2.Mild interval increased edema and size of a hemorrhagic metastatic lesion in the right subinsular white matter as detailed/measure above.3.Negative diffusion weighted series.4.Stable few nonspecific foci of subcortical FLAIR hyperintensity.5.Unremarkable calvarium and all visualized paranasal sinuses.


Instruction: Generate impression based on medical findings.

Input: Headache. There is no evidence of acute intracranial hemorrhage, mass-effect, or shift. No abnormal extra-axial fluid collections are identified. The ventricles and cortical sulci are within normal limits. There is an abnormal soft tissue lesion identified intraconally with the left orbit measuring approximately 1.5 cm. This examination was not tailored for evaluation of the orbits. If further imaging is warranted dedicated orbital CT or MRI may be helpful.

Output: No evidence of acute hemorrhage or shift. Intraconal mass lesion involving left orbit. This was also identified on prior MR imaging from March 16, 2009.


Instruction: Generate impression based on medical findings.

Input: History of prostate cancer with PSA of 22. Recent biopsy with Gleason 3+3 left mid and apex. PELVIS:PROSTATE:Prostate Size: 4.4 x 2.9 x 3.9 cmPeripheral Zone: There are scattered areas of increased T1 signal most prominent in the left peripheral zone compatible with blood products from recent biopsy which somewhat limits evaluation of enhancement. Within the lateral aspect of the left mid peripheral zone, there is a 3 x 3 mm focus of decreased T2 and ADC (series 704, image 364) signal suspicious for neoplasm. No additional focal suspicious lesions are identified within the peripheral zone.Central Gland: No significant abnormality.Seminal Vesicles: No significant abnormality.Extracapsular Extension: No significant abnormality.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Single 3 x 3 mm focus of signal abnormality in the lateral aspect of the left mid peripheral zone suspicious for neoplasm.2.Intraprostatic blood products likely from recent biopsy which somewhat limits evaluation of enhancement.


Instruction: Generate impression based on medical findings.

Input: Reason: stage IVb lung adenocarcinoma EGFR exon 21 L858R mutation, on Tarceva, evaluate response. History: h/o small brain mets There are subcentimeter foci of subtle enhancement in the right superior frontal gyrus (series 11 image 26), right posterior cingulate sulcus (series 11 image 23), and right sylvian fissure (series 12 image 9). These lesions have mild intrinsic T1 hyperintensity and questionable susceptibility artifact. There is no associated edema of the adjacent brain parenchyma, which may suggest that these lesions are leptomeningeal in location. Nonspecific scattered punctate FLAIR hyperattenuation is noted in the subcortical and periventricular white matter.There is a round, intrinsically T1 hyperintense, 7 mm lesion in the anterior sella situated above the pituitary gland. The lesion does not enhance beyond its intrinsic T1 hyperintensity. The native pituitary gland is evident inferior to this lesion.No abnormal diffusion restriction. No gross intracranial hemorrhage is identified. No evidence of intracranial mass, mass-effect, or midline shift. No extra-axial fluid collections. The ventricles, sulci, and cisterns are normal in size without evidence of hydrocephalus. Gray-white matter differentiation is preserved. Nonspecific mucosal thickening of the left ethmoid air cells. Otherwise paranasal sinuses and mastoid air cells are clear. The imaged orbits are intact. The osseous structures are unremarkable.

Output: There are subcentimeter foci of subtle enhancement in the right superior frontal gyrus, right posterior cingulate sulcus, and right sylvian fissure. These lesions have mild intrinsic T1 hyperintensity and questionable susceptibility artifact. There is no associated edema of the adjacent brain parenchyma. Findings are suspicious for the presence of intracranial metastases, potentially leptomeningeal in nature.Incidental note is made of an intrinsically T1 hyperintense lesion within the anterior sella situated above the native pituitary gland. This could represent a Rathke cleft cyst, or perhaps an adenoma which has undergone proteinaceous or hemorrhagic degeneration.


Instruction: Generate impression based on medical findings.

Input: 55 year old male s/p lung transplant, on immunosuppressive medication who is found to have pericardial effusion and septal bounce on recent echo - MRI to evaluate for pericardial disease, specifically constrictive pericarditis. Left VentricleThe left ventricle is normal sized with normal function. The overall LV ejection fraction is 57%. The LVEDV is 113 ml (normal range 142+/-34), the LV end diastolic volume index is 53 ml/m2 (normal range: 74+/-15), the LVESV is 49 ml (normal range 47+/-19) and the LV end systolic volume index is 23 ml/m2 (normal range 25+/-9). The LV mass is 92 g (normal range 164+/-36) and the LV mass index is 43 g/m2 (normal range 85+/-15). There are no regional wall motion abnormalities present. . There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.There is septal bounce during diastole during breath-hold with leftward intraventricular septal straightening during inspiration consistent with interventricular dependence.Left AtriumThe left atrium is normal. Right VentricleThe right ventricle is normal sized with mildly decreased ejection fraction. The overall RV ejection fraction is 53%. The RVEDV is 90 ml (normal range 142+/-31), RV end diastolic volume index is 42 ml/m2 (normal range 82+/-16), the RVESV is 48 ml (normal range 54+/-17), and the RV end systolic volume index is 22 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is normal sized.Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is a moderate sized pericardial effusion, likely loculated in the inferior aspect of the pericardium. There is likely pericardial enhancement with associated mild thickening. Probable adhesions are noted at least within the anterior and left lateral aspects of the pericardium.Extracardiac FindingsLarge bilateral pleural effusions. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Findings suggestive of pericardial constriction: Mild pericardial thickening and enhancement, likely loculated inferior pericardial effusion, intraventricular dependence, and probable pericardial adhesions. 2. Normal Left ventricle size and function at 57%. Normal RV size with low normal ejection fraction.3. Large bilateral pleural effusions. 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: 71-year-old female with history of COPD, hundred pack year smoker infiltrate on CXR. Assess for infiltrate versus oncologic process. Limited examination due to lack of contrast. MRI may be considered for further evaluation.BRAIN: Limited intracranial images demonstrate no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.NECK:Limited value of the exam due to lack of contrast. With this limitation, imaging through the skull base and the cavernous sinus is unremarkable. Examination demonstrates no evidence of mass or pathologic lymphadenopathy in the neck. The airway and vasculature are patent. The osseous structures are intact. Effacement of the pyriform sinus is stable when compared to previous examinations dating back as far as one year ago 05/20/07.Limited view of the chest shows bilateral apical scarring.

Output: Stable examination without evidence of an oncologic process as clinically questioned.


Instruction: Generate impression based on medical findings.

Input: 61-year-old male with destructive bony lesion L5/S1. Evaluate unknown primary malignancy. History of hemachromatosis and diabetes. The recent PET examination demonstrates no pathologic foci of increased radiotracer accumulation to indicate FDG avid tumor in the neck, chest, abdomen or pelvis. Specifically, the region of L5/S1 is negative on FDG-PET.On the recent PET scan examination show moderate to markedly increased metabolic activity throughout the entire colon suggesting a nonspecific infectious or inflammatory colitis.CHEST:LUNGS AND PLEURA: Mild left lower lobe volume loss and atelectatic changeMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: There is hepatosplenomegaly. The liver measures 20 cm craniocaudally, and the spleen measures approximately 14 cm. The hepatic parenchyma is hypodense relative to the spleen suggesting fatty infiltration. There are small calcifications in the liver, probably due to old granulomatous disease. Cholelithiasis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple bilateral renal cortical hypodensities compatible with simple cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes in the spineOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diverticulosis, without evidence of diverticulitis. No specific abnormality was found in the colon to correspond with the area of increased uptake on the recent PET scan examination.BONES, SOFT TISSUES: Multilevel degenerative disk disease. Abnormal mass lesion infiltrates the spinal column at L5-S1, seen best at axial image 150/222. These findings are compatible with an aggressive process, such as infection or malignancy. No significant interval change since recent MRI and CT scans of the lumbosacral spine.OTHER: Prominent left varicocele at axial image 220/222.

Output: Hepatosplenomegaly. Probable fatty infiltration of the liver. No significant interval change in the L5-S1 aggressive process seen on recent CT and MRI examinations. No local neoplasm. Left varicocele. Findings are discordant with PET-CT exam regarding the colon, where no abnormality was found.


Instruction: Generate impression based on medical findings.

Input: 40 year old woman with history of post-operatively noted PVC with burden of 16% by Holter monitor, referred to evaluate for underlying cardiomyopathies including ARVC. Left VentricleThe left ventricle is moderately dilated with low-normal systolic function. The overall LV ejection fraction is 53%, the LV end diastolic volume index is 106 ml/m2 (normal range: 65+/-11), the LVEDV is 183 ml (normal range 109+/-23), the LV end systolic volume index is 50 ml/m2 (normal range 18+/-5), the LVESV is 86 ml (normal range 31+/-10), the LV mass index is 38 g/m2 (normal range 67+/-11), and the LV mass is 66 g (normal range 114+/-24). Wall motion is normal. Wall thickness is normal (mid septum ~8mm thickness). There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.The native T1 myocardial relaxation time is 1100-1150ms in the basal to mid septum, which is elevated. These values are mildly elevated, suggestive of underlying diffuse fibrosis or infiltration. There is no obvious evidence for non-compacted LV morphology. There is no LV thrombus. Left AtriumThe left atrium is mildly dilated.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 83 ml/m2 (normal range 69+/-14), the RVEDV is 142 ml (normal range 110+/-24), the RV end systolic volume index is 40 ml/m2 (normal range 22+/-8), and the RVESV is 68 ml (normal range 35+/-13). There are no regional wall motion abnormalities.Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is a trivial pericardial effusion.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. Moderately dilated left ventricle with low normal systolic function (EF 53%). There is no late gadolinium enhancement to suggest a focal infiltrative, inflammatory or fibrotic process. However, the native T1 myocardial relaxation time is mildly elevated, which could suggest a diffuse underlying fibrotic process. 2. Normal size right ventricle with normal systolic function (EF 52%) and no regional wall motion abnormalities. 3. Mild left atrial dilation.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: Male, 66 years old, with metastatic thyroid cancer to the brain, follow-up examination. Evidence is seen compatible with prior lesion resection from the left inferior parietal lobule. Mild T2 hyperintensity and hemosiderin staining at the resection site are unchanged. No pathologic enhancement is seen at this location.A 5 mm enhancing lesion with susceptibility effect in the left superior parietal lobule is unchanged. A 3 mm focus of enhancement in the left postcentral gyrus is unchanged. A vague 3 mm focus of enhancement in the right middle frontal gyrus is unchanged from prior. A nonenhancing focus of susceptibility along the right caudate head is unchanged.No areas of new pathologic enhancement or parenchymal signal abnormality are seen. No evidence of significant edema or mass effect is detected. The ventricles are stable and normal in size.

Output: 1.Stable postoperative findings in the left inferior parietal lobule with no evidence of residual or recurrent metastatic tumor.2.Small enhancing foci within the left superior parietal lobule, the left postcentral gyrus and the right middle frontal gyrus are unchanged. No new intracranial lesions are seen.


Instruction: Generate impression based on medical findings.

Input: 43-year-old woman with a history of a left mastectomy in 2010 for DCIS followed by reconstruction. History of benign right breast biopsy. Breast MRI of 12/3/2014 was unremarkable. No current symptoms. Left: Patient is status post left mastectomy and reconstruction. Left breast skin thickening and enhancement are compatible with postoperative changes. No suspicious enhancement is seen in the reconstructed breast or chest wall. Right: There is moderate background parenchymal enhancement in the right breast. Several benign foci are seen in the right breast which demonstrate rapid uptake and plateau kinetics, typically benign. No suspicious enhancement is seen in the right breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on medical findings.

Input: 67-year-old male with history of HCC on radiation presenting with lower back pain. Evaluate for metastases or abscess.ANDERSON, STANLEY (DOB: 3/2/1949)PROVIDER/ATTENDING NAME: CHRAPEK, KRISTINE Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is abnormal marrow signal consisting of decreased T1 and increased T2/STIR signal with enhancement completely replacing the L3 vertebral body as well as the pedicles and to a lesser extent S1 and along the inferior endplate of L2. There is infiltration of the surrounding soft tissues around L3 with thickening and enhancement of the adjacent epidural space causing compression of the thecal sac with associated spinal canal stenosis at this level. There is infiltration of the fat along the neural foramina at L3-L4. Similarly there is infiltration of the fat surrounding the left S1 exiting nerve root.There is similar abnormal bone marrow signal of the right iliac bone.On review of the prior CTs, in retrospect there was mild low attenuation of the above vertebral bodies on prior study dated 11/30/2016 however the lesions cannot be detected on the more remote CT studies from 11/18/16, August and June 2016 and April 2011 suggesting a rapidly developing process.At L5-S1 there is broad-based disc bulge, ligamentum flavum thickening and mild facet hypertrophy. No significant compromise to spinal canal or neural foramina.At L4-5 there is broad-based disc bulge, ligamentum flavum thickening and mild facet hypertrophy. There is mild spinal canal stenosis. No significant neural foraminal stenosis.At L3-4 there is moderate spinal canal stenosis. No significant neural foraminal stenosis.At L2-3 there is mild broad-based bulging of the disc, ligamentum flavum thickening and mild facet hypertrophy. There is no significant spinal canal or neural foraminal stenosis.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There are multiple infiltrating lesions the largest of which involves L3 which infiltrates and the surrounding musculature and into the adjacent L2 vertebral body along its left inferior aspect. There is extension into the spinal canal epidural space with associated narrowing of the spinal canal and moderate spinal canal stenosis. The lesion also infiltrates into the L3-4 neural foramina where it affects the exiting nerve roots. These appear to have rapidly progressed since the November 30 CT. These lesions could represent metastatic disease though the possibility the represent an infectious process such as tuberculosis cannot be excluded. Bone biopsy may be of further benefit if clinically indicated.2.There is an infiltrative lesion present in the left sacral alla which extends into the left S1 neural foramen. It is suspected to be of similar origin to the above described lesion.3.Another lesion is present within the right sacral alla and another one in the right iliac bone. These are also suspected to be of similar origin to the above described lesions.4.There is a lesion present within the liver which is not completely evaluated on this exam. Please refer to CT of the abdomen for further comments.5.Findings were discussed with the clinical service by phone on 12/29/2016 at 10:00 AM and the decision was made to proceed with bone biopsy which will be arranged today.Findings also discussed with the radiation oncology team Dr Haraf in person in the neuroradiology reading room.