Instruction: Generate impression based on medical findings.

Input: Reason: Evaluate progression of hepatic and pancreatic cysts History: history of large cysts, abdominal pain, early satiety ABDOMEN:LIVER, BILIARY TRACT: Multiple simple cysts are seen throughout the liver, the largest of which measures 15.1 x 15 .3 cm, previously 15.1 x 14.4 cm (image 24, series 8). This largest cyst is again filled with debris with intrinsic T1 hyperintensity and T2 hypointense rim suggesting prior hemorrhage. No mural nodule or enhancing solid component is seen within this cyst. This is again causes mass effect on the right kidney, IVC, common duct, pancreas, and duodenum without evidence of obstruction, appearing similar to the prior study.No intrahepatic or extrahepatic biliary duct dilation. The portal vein is patent.SPLEEN: No significant abnormality noted.PANCREAS: Reference, multiloculated cystic lesion in the pancreatic tail measures 5.8 x 3.3 cm, previously 5.4 x 2.6 cm (image 17; series 10). There is again some enhancement of the septations, however no mural nodular enhancement. Differential considerations include a serous cystadenoma as well as a branch-type IPMN. No pancreatic duct dilation is seen.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Mass effect on the right kidney from the previously described hepatic cysts, appearing similar to the prior study. No significant abnormalities noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.No significant change in multiple benign appearing liver cysts, the largest of which again contains internal debris and causes mass effect on the surrounding structures without obstruction.2.Slight interval increase in size of reference cystic lesion in the pancreatic tail which may represent a serous cystadenoma or IPMN.


Instruction: Generate impression based on medical findings.

Input: History of HCV cirrhosis. Presents for hepatocellular carcinoma screening. ABDOMEN:LIVER, BILIARY TRACT: The liver contour is mildly lobular. No focal suspicious lesion, biliary ductal dilatation or vascular abnormality.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No suspicious liver lesion.


Instruction: Generate impression based on medical findings.

Input: 9-year-old female with purulent congestion for two weeks. Mucoperiosteal thickening is seen in the maxillary sinuses, ethmoid sinuses, and sphenoid sinuses. The right ostiomeatal unit is occluded. A defect in the medial wall of the left maxillary sinus likely represents the sequela of previous antrostomy, and less likely may represent a focal erosion.The ventricles and basal cisterns are symmetrically increased in volume. These findings likely represent volume loss, however, increased intraventricular pressure cannot be excluded. Please correlate clinically. MRI examination may be considered if clinically indicated.The calvaria and skull base are radiographically normal.

Output: Sinus disease as described above.1.Symmetrically enlarged ventricles and basal cisterns. These findings likely represent volume loss, however, increased intraventricular pressure cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: 50 year old woman with history of HFpEF who presents for cardiac MRI to evaluate for restrictive cardiomyopathy Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 65%, the LV end diastolic volume index is 64 ml/m2 (normal range: 65+/-11), the LVEDV is 90 ml (normal range 109+/-23), the LV end systolic volume index is 23 ml/m2 (normal range 18+/-5), the LVESV is 32 ml (normal range 31+/-10), the LV mass index is 79 g/m2 (normal range 67+/-11), and the LV mass is 111 g (normal range 114+/-24). There is mild systolic flattening of the interventricular septum suggesting increased RV systolic pressure.Aside form the mild late gadolinium enhancement of the anterior and inferior RV insertion points, which is well described and common in patients with pulmonary hypertension, there is no other late gadolinium enhancement of the myocardium or pericardium to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. No evidence of myocardial iron overload.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size and systolic function. It is moderately hypertrophied. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 86 ml/m2 (normal range 69+/-14), the RVEDV is 120 ml (normal range 110+/-24), the RV end systolic volume index is 43 ml/m2 (normal range 22+/-8), and the RVESV is 60 ml (normal range 35+/-13). Right AtriumThe right atrium is severely dilated. Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is moderate tricuspid regurgitation. There is aliasing of the tricuspid regurgitation jet suggesting increased TR velocity.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 mild to moderately dilated (34 mm). Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is moderate sized pericardial effusion. There is no enhancement of the pericardium on late gadolinium imaging.Extracardiac FindingsThere is moderate sized right pleural effusion with evidence of septation and some complex features raising the possibility that it may be exudative in nature. This effusion was not present on the prior study. There is a trace left pleural effusion. 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. Normal LV size and systolic function (LVEF 65%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.2. Normal RV size and systolic function (RVEF 50%) with significant hypertrophy and evidence of mild systolic flattening of the interventricular septum and late gadolinium enhancement of the anterior and inferior RV insertion points. All of these findings are consistent with the patients known history of pulmonary hypertension. 4. Severe biatrial dilation5. Moderate tricuspid regurgitation6. Mild aortic regurgitation7. Moderate sized pericardial effusion (slightly larger than on the prior study)8. Mild to moderately dilated main pulmonary artery (34 mm)9. In comparison to the cardiac mri done on 7/8/10, there is now a complex appearing right pleural effusion. The cardiac structures are essentially unchanged with the exception of mild late gadolinium enhancement involving the RV insertion points.


Instruction: Generate impression based on medical findings.

Input: Li Fraumeni Syndrome: surveillance. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is an 8 mm wide left temporomandibular joint synovial cyst.

Output: No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on medical findings.

Input: 75-year-old male with right arm weakness and slurred speech. Evaluate for acute stroke. Reidentified is a focal area of hypoattenuation involving the left temporoparietal region compatible with encephalomalacia secondary to prior infarct. No new hemorrhage identified. There is mild ex vacuo dilation of the left occipital horn secondary to adjacent volume loss. No evidence of hydrocephalus.No evidence of acute ischemia, however, CT is insensitive for the evaluation of early ischemic change; if there is clinical concern for acute ischemia, an MRI may be considered.There is no evidence of intracranial hemorrhage, mass or edema. The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. No acute intracranial abnormalities are present including hemorrhage, mass-effect, or edema.2. No evidence of acute ischemia, however, CT is insensitive for the evaluation of early ischemic change; if there is clinical concern for acute ischemia, an MRI may be considered.


Instruction: Generate impression based on medical findings.

Input: 56 year old man with elevated cardiac biomarkers but no evidence of obstructive coronary artery disease. He is referred to evaluate for myocarditis. Left VentricleThe left ventricle is normal in size with low normal systolic function. The overall LV ejection fraction is 53%, the LV end diastolic volume index is 89 ml/m2 (normal range: 74+/-15), the LVEDV is 200 ml (normal range 142+/-34), the LV end systolic volume index is 42 ml/m2 (normal range 25+/-9), the LVESV is 95 ml (normal range 47+/-19), the LV mass index is 63 g/m2 (normal range 85+/-15), and the LV mass is 141 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is epicardial late gadolinium enhancement in a pattern atypical for prior myocardial infarction. It involves the mid anterolateral and inferolateral walls and the apical lateral wall. The finding most likely represents myocarditis. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 58%, the RV end diastolic volume index is 92 ml/m2 (normal range 82+/-16), the RVEDV is 207 ml (normal range 142+/-31), the RV end systolic volume index is 38 ml/m2 (normal range 31+/-9), and the RVESV is 87 ml (normal range 54+/-17).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 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 mildly dilated (32mm).Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal LV size with low normal systolic function (LVEF 53%). There is epicardial late gadolinium enhancement in a pattern atypical for prior myocardial infarction. It involves the mid anterolateral and inferolateral walls and the apical lateral wall. The finding most likely represents acute/ subacute myocarditis. 2. Normal RV size and systolic function (RVEF 58%). 3. Mild mitral regurgitation.4. Mild dilation of the main pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old, with transient right arm and right leg weakness and numbness. MRI brain:Mild striated restricted diffusion is seen within the left aspect of the pons (image 112 series 506). There may be very subtle corresponding FLAIR hyperintensity though this is equivocal.Elsewhere no restricted diffusion or other significant parenchymal signal abnormality is detected. No parenchymal edema or generalized mass effect is seen. No intracranial hemorrhage or abnormal extra-axial fluid is detected. The ventricular system is normal in size and morphology.MRA brain:No significant intracranial stenosis is seen. In particular, the posterior circulation is within normal limits. Fetal origin of the right PCA is noted. No aneurysms are detected.MRA neck:Conventional aortic branching. No significant vascular stenosis is detected in the carotid circulation by NASCET criteria. Likewise, the vertebral arteries are free of significant stenosis or occlusion.

Output: Mild striated apparent restricted diffusion is seen within the left aspect of the pons. Given the clinical history, this could potentially represent mild pontine ischemia. However, the transverse pontine fibers sometimes produce an artifact which looks similar to this on DWI images. Considering the otherwise normal appearance of the brain, and the normal MRA examinations of the head and neck, the possibility of an artifact should be considered. If clinical suspicion remains high, a follow-up examination can be considered at 1.5T which may decrease the potential for artifact.


Instruction: Generate impression based on medical findings.

Input: 50-year-old female with left foot drop and acute onset left-sided pain with decreased pin and light touch sensation; rule out stroke or other lesion. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few scattered foci of T2/FLAIR hyperintensities in the supratentorial subcortical white matter which are nonspecific. The brain parenchyma appears otherwise 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: Scattered foci of T2/FLAIR hyperintensities in the supratentorial subcortical white matter which are nonspecific but compatible with mild chronic small vessel ischemic changes. Examination is otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: 70 year old BRCA 2 mutation carrier. Personal history of stage III ovarian cancer diagnosed at the age of 41. History of breast carcinoma in paternal grandmother, uncle and cousins. There is heterogeneous amount of fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on medical findings.

Input: 49-year-old male with recurrent left paresthesias. Rule out thrombosis which was possibly seen on MRI/MRA.IMAGE ACQUISITIONS: Brain CTA with contrast, neck CTA with contrast. 120 cc nonionic Omnipaque 350 at 4.5 cc/sec. Left carotid artery: Mild noncalcified stenosis at the origin of the internal carotid artery. There is calcifications of the cavernous portion of the internal carotid artery.Right carotid artery: Calcifications of the cavernous portion of the internal carotid artery. No significant stenosis or septations elsewhere.Left are two artery:Left vertebral artery: Severe narrowing of the left vertebral artery from its origin to the basilar artery with only faint wisps of contrast seen. This is either due to marked hypoplasia or intrinsic disease.Right vertebral artery: No significant stenosis or calcification.BRAIN

Output: 1. Left vertebral artery is severely narrowed, either due to hypoplasia or intrinsic disease.2. P1 segments of the PCAs are not well visualized, either due to absence or hypoplasia3. Mild stenosis of the origin of the left internal carotid artery4. Noncontrast brain CT shows small vessel ischemic disease of indeterminate age and multiple bilateral lacunar infarcts


Instruction: Generate impression based on medical findings.

Input: 66-year-old male patient with liver lesion and portal vein thrombosis. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology with macronodular changes. No intra or extrahepatic biliary ductal dilatation. The portal vein is diminutive in appearance and remains patent. The hepatic veins and hepatic arteries are patent. No suspicious lesions are identified. Perigastric and esophageal varices are again noted.SPLEEN: Splenomegaly, measuring up to 16 cm in craniocaudal dimension. Subcentimeter hypervascular lesion in the spleen is nonspecific and is unchanged compared to prior and compatible with a hemangioma.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Perihepatic and perisplenic ascites appears slightly increased compared to prior examination.

Output: 1.No suspicious hepatic lesions identified in a cirrhotic liver.2.Diminutive portal vein, remains patent.3.Slight interval increase in perihepatic and peristaltic ascites.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Status post lumbar decompression with fusion. Assess for spine stability and assess for postop bleeding. Signs and symptoms: Back pain. Nonenhanced CT of lumbar spine:Routine non-infused axial 3-mm CT images of the entire lumbar spine were obtained. Sagittal and coronal 2-D reformatted images were also acquired.Examination again demonstrates with no interval change extensive patchy sclerotic changes of the L5 vertebral body which extends into the bilateral pedicles.There is also evidence of mild compression fracture of L5 with slight bulge into the spinal canal similar to prior study.There is evidence of interval bilateral laminectomies at this level for spinal decompression. There is a drainage catheter extending from the canal at this level on the left (likely within the left epidural space) extending posteriorly and exiting the canal on the right side of the spinous process of L4.The alignment of vertebral column is similar to prior study an unremarkable.There is evidence of posterior fusion with placement of fixating rods extending from L4 to S1 and bilateral transpedicular screw placement in L4 and S1. There is no evidence of any detectable hardware abnormalities. There is extensive soft tissue thickening and and soft tissue emphysema posterior to the spinal canal in the soft tissues of lower back which appears to be within the expected range of. Findings. There is no detectable perispinal or prevertebral soft tissue abnormality or hemorrhage. Soft tissue densities there is thickening of the epidural space at the L4 level and suspected central spinal stenosis of approximately 6.5 mm. Follow-up with an MRI examination is recommended.

Output: 1.Stable patchy sclerotic changes of L4 vertebrae which extends into bilateral pedicles. There is also mild compression fracture of L4 similar to prior study. No appreciable interval change since prior study. Findings is suspected for a metastatic focus.2.Interval bilateral laminectomies at L4 vertebrae for decompression of the spinal canal. There is thickening of the lateral epidural spaces at L4 level contiguous with extensive increased soft tissue density posterior to the laminectomy site. This finding results in suspected central spinal stenosis at this level. Recommend further follow-up with an MRI to exclude hemorrhage.3.The alignment of vertebral column is unremarkable and stable since prior study.4.Postoperative changes of posterior fusion and bilateral transpedicular screw placement at L4 and S1 levels. No hardware abnormality.5.A drainage catheter extends from the right lateral epidural space at the L4 level posteriorly and exits the spinal canal as described above.


Instruction: Generate impression based on medical findings.

Input: 67 year old male with hepatitis C and alcoholic cirrhosis referred for CMR as part of liver transplant evaluation. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 65%, the LV end diastolic volume index is 74 ml/m2 (normal range: 74+/-15), the LVEDV is 147 ml (normal range 142+/-34), the LV end systolic volume index is 26 ml/m2 (normal range 25+/-9), the LVESV is 52 ml (normal range 47+/-19), the LV mass index is 28 g/m2 (normal range 85+/-15), and the LV mass is 56 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement present to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Native pre-contrast myocardial T1 relaxation time = 973 ms which is normal. No evidence of myocardial iron overload. Hemodynamics:Based on cine imaging, the cardiac output is 6.32L/min and cardiac index is 3.2L/min/m2.Base on velocity encoded imaging, the cardiac output is 4.13L/min and cardiac index is 2.07L/min/m2.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 58%, the RV end diastolic volume index is 89 ml/m2 (normal range 82+/-16), the RVEDV is 177 ml (normal range 142+/-31), the RV end systolic volume index is 37 ml/m2 (normal range 31+/-9), and the RVESV is 74 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation. The aortic valve is trileaflet. 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. The ascending aorta is mildly dilated (41mm). Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size and systolic function (LVEF 65%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration. 2. The right ventricle is normal in size and systolic function (RVEF 58%).3. Cardiac output and cardiac index are reduced but without evidence of any associated structure heart disease. 4. Mild ascending aorta 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: New back pain. Thoracic spine: At the T7 and T8 vertebral bodies, there are changes of previous augmented vertebroplasty, where central vertebral body height loss remain not significantly changed nor the minimal T8 retropulsion. The compression fracture along the anterior inferior endplate of T6 is unchanged but there are anterior and central compression fractures at T9, T11 and T12, which are new since October 2015 though without associated marrow edema. There is unchanged focal fat in the left T5 lamina. There is mildly exaggerated kyphosis from the multilevel compression fractures. Multilevel disc desiccation is present. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The distal arch/proximal descending aorta is prominent and there is a small left pleural effusion. The paravertebral soft tissues are unremarkable.Lumbar spine: New central compression fractures involve all the lumbar vertebral bodies, which is most pronounced at L2 with up to 50% height loss in addition to fluid subjacent to the superior endplate and adjacent marrow edema, as well as linear hypointense signal in the posterior aspect of the vertebral body. Mild marrow edema is present superiorly at L1, L3 and L4. Sagittal alignment remains anatomic. There is no retropulsion or osseous expansion. Multilevel degenerative disc disease is not significantly changed and results in shallow ventral indentations of the thecal sac but no significant spinal canal stenosis. Facet arthropathy contributes to mild bilateral neural foraminal stenoses in the mid/lower lumbar spine, most pronounced on the left at L3-L4 and on the right at L4-L5 levels, where it is moderate. The conus medullaris displays normal signal and morphology with its tip lying at upper L2 level. The paraspinal muscles are atrophic. The paravertebral soft tissues are unremarkable otherwise.

Output: 1.Thoracic spine: New insufficiency compression fractures are present at T9, T11 and T12 without marrow edema, marrow replacement or retropulsion. T6-T8 compression fractures are unchanged since October 2015 except for changes of augmented vertebroplasty at T7 and T8. No thoracic spinal canal stenosis or cord abnormality. Incidental small left pleural effusion.2.Lumbar spine: New, since October 2015, insufficiency compression fractures at L1-L5, most pronounced at L2, where there is also fluid subjacent to the superior endplate, which may reflect unstable endplate fragment. There is mild marrow edema at the other levels but no retropulsion or osseous expansion. Multilevel degenerative disease has not changed, causing neural foraminal stenoses most on the left at L3-4 and on the right at L4-L5, but no significant spinal canal stenosis. Unremarkable conus medullaris.


Instruction: Generate impression based on medical findings.

Input: Transient vision loss. MRI Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a right cerebellar hemisphere developmental venous anomaly. The brain parenchyma otherwise appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and paranasal sinuses are grossly unremarkable. There is a well-circumscribed mass in the right parotid gland that measures up to 18 mm.MRA Brain: There is apparent focal stenosis of the left vertebral artery just distal to the origin of the left PICA. The right vertebral artery is diffusely hypoplastic. Otherwise, there is no evidence of significant other cerebral steno-occlusive lesions or aneurysms.MRA Neck: The right vertebral artery is diffusely hypoplastic. Otherwise, there is no evidence of significant steno-occlusive lesions.

Output: 1.No evidence of acute intracranial hemorrhage or infarct.2.Apparent focal stenosis of the left vertebral artery just distal to the origin of the left PICA. The remaining major intracranial and cervical vessels are patent without aneurysm or significant stenosis.3.A well-circumscribed mass in the right parotid gland may represent a benign mixed tumor, but is incompletely characterized.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: Sickle-cell disease without crisis [D57.1] / Moyamoya disease [I67.5], Reason for Study: ^Reason: hx of pial synangiosis. Eval vasculature History: none- surveillance imaging Brain MRI:There is no evidence of acute ischemic or hemorrhagic lesion on this scan. The right hemispheric sulci appear to be more prominent and gyri appear to be atrophic comparing to those of left hemisphere. These findings do not show significant interval change since prior scan.On FLAIR imaging, there are patchy high signal intensity on the right frontal lobe superior frontal gyrus which indicate chronic ischemic infarction. As well, there are multiple scattered and a bit confluent high signal intensities on bilateral periventricular white matter indicating possible non specific small vessel ischemic disease. Comparing to prior scan, the extent and approximate number of those high signal intensity lesions do not show any significant interval change.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRA:3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate near total occlusion of the distal right ICA at the level of ICA terminus, without showing appreciable right MCA M1 segment. The left distal ICA also appears to be occluded with multiple small in-flow signals indicating collateral vessels. However, the left MCA M1 segment is reconstituted and the luminal diameter appears to be normal range. Comparing to prior scan, there is no significant interval change since prior scan.Bilateral posterior communicating arteries are patent and vertebrobasilar system appears to be normal

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Multifocal chronic ischemic lesions and non specific ischemic lesions as described above, no change since prior scan.3. No significant interval change of bilateral distal ICA occlusion/near total occlusion with collateral vessels including the reconstitution of the left MCA with reasonable lumen size and non visualization of the right MCA M1 segment. Vertebrobasilar system appears to be within normal range.


Instruction: Generate impression based on medical findings.

Input: Evaluate liver masses seen on CT. ABDOMEN:LIVER, BILIARY TRACT: There are multiple hepatic lesions demonstrating increased T2 signal. These include a segment 8 lesion measuring approximately 1.5 x 1.5 cm (series 6, image 7) and a segment 7 lesion measuring approximately 0.8 x 2.7 cm (series 6, image 8), which demonstrate progressive, gradual fill-in on postcontrast images and no evidence of washout on delayed phase images, compatible with hemangiomas. No other definite lesions demonstrating enhancement or washout. The remainder of the T2 hyperintense lesions are too small to further characterize though likely represent tiny cysts.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Partially imaged T2 hyperintense fluid collections in the right elbow, incompletely evaluated.OTHER: No significant abnormality noted.

Output: Findings compatible with two hemangiomas in the liver. Multiple other nonspecific T2 hyperintense hepatic lesions likely represent tiny cysts.


Instruction: Generate impression based on medical findings.

Input: Developmental delay and lack of expected normal physiological development in childhood. The cortical sulci are in proportion to the cerebral ventricles. Prominent perivascular spaces are demonstrated in the bilateral parietal lobes, right greater than left. No midline shift or mass effect is appreciated. The gray-white matter junction is preserved. There is no diffusion restriction to suggest acute ischemia. No abnormal gradient susceptibility is demonstrated. No intra-axial or extra axial fluid collections are visualized. Myelination appears appropriate for age.

Output: Prominent perivascular spaces in the bilateral parietal lobes, right greater than left, are nonspecific and may be an incidental finding. However rounded appearance of some especially can be associated with mucopolysaccharidosis. Please correlate clinically.


Instruction: Generate impression based on medical findings.

Input: 64-year-old male with cranial nerve III palsy. There is no evidence of intracranial hemorrhage, mass, or edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or mass effect. There is no diffusion abnormality to suggest acute ischemia. There is an unchanged punctate focus of susceptibility effect. There is a new small focus of susceptibility artifact just above the left cerebellar peduncle and 2 punctate foci in the left parietal lobe. Normal flow-voids are demonstrated in the major intracranial vascular structures. The paranasal sinuses and mastoid air cells are unremarkable. There are bilateral lens replacements. The orbits are otherwise unremarkable. There is a subcentimeter nodule in the right occipital scalp, which may represent an inclusion cyst. There is a posterior disc-osteophyte complex at C3-4, which slightly indents the spinal cord.

Output: 1. No evidence of acute ischemia.2. A right pons lesion with susceptibility effect is compatible with a capillary telangectasia, as demonstrated on the prior MRI with contrast. Otherwise, several punctate foci of susceptibility effect elsewhere may represent chronic microhemorrhages.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: Possible hemorrhagic stroke. History of kidney disease as an adult. 50 sutural female Since the exam of 2008 the patient has developed hypodense foci in the medial anterior aspect of the left thalamus and the superior aspect of the right thalamus anteriorly and in the right caudate nucleus. These are identified on an MRI of 8/19/09 . There is redemonstration from that time of focus of encephalomalacia in the inferior aspect of the left cerebellar hemisphere also identified and exams dating back to 2006 and the identified during the acute stage on 11/12/05.A focus of encephalomalacia is also present along the left temporal lobe identified on an MRI of 8/19/09. A focus of encephalomalacia is present along the right thigh medial parietal lobe and on either side of the intra-parietal sulcus involving superior parietal lobule, small portion of the precuneus and a small portion of the right inferior parietal lobule. There is also involvement of a small focus along the left cuneus.There is atrophy of the brain a somewhat early for this age.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.No evidence for acute intracranial hemorrhage mass effect or edema.2.Multiple foci of encephalomalacia as indicated above most of which are in the posterior circulation however there are a few in the anterior circulation bilaterally. These have developed over time and appeared many of these were not present on 2/25.08 right MRI from 8/19/09 identified. The distribution of the anterior circulation lesions suggests watershed distribution.


Instruction: Generate impression based on medical findings.

Input: Patient is a 53-year-old man with end-stage hepatitis B liver cirrhosis and portal hypertension who presented with altered mental status, acute respiratory and renal failure and hypotension now with multiorgan failure status post intubation with unclear neurological prognosis. Please evaluate for ischemia, cerebral edema, and encephalopathic changes. There is no evidence of intracranial hemorrhage, mass or edema. There are no CT findings of stroke, however if stroke is of clinical concern recommend MRI.The ventricles and basal cisterns are normal in size and configuration. There are no CT findings of cerebral edema.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Normal brain CT.


Instruction: Generate impression based on medical findings.

Input: 65yr old male with history of DLBCL evolved from CLL s/p SCT and heart failure presenting for cardiac evaluation. MEDICATIONS: lisinopril, furosemide, carvedilol First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarNo evidence of myocardial infarction. There is no definitive late gadolinium enhancement noted to suggest that there is replacement fibrosis, inflammation, or infiltration. However, the native T1 times are significantly elevated at 1150-1225 ms (nl <1050ms) diffusely, which suggest the presence of diffuse interstitial myocardial fibrosis or edema. Left VentricleThe left ventricle is moderately dilated with mildly reduced systolic function. The overall LV ejection fraction is 48%, the LV end diastolic volume index is 131 ml/m2 (normal range: 74+/-15), the LVEDV is 213 ml (normal range 142+/-34), the LV end systolic volume index is 67 ml/m2 (normal range 25+/-9), the LVESV is 110 ml (normal range 47+/-19), the LV mass index is 91 g/m2, and the LV mass is 148 g. The LV dysfunction is global. 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 115 ml/m2 (normal range 82+/-16), the RVEDV is 187 ml (normal range 142+/-31), the RV end systolic volume index is 55 ml/m2 (normal range 31+/-9), and the RVESV is 89 ml (normal range 54+/-17).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.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 mildly dilated (30 mm).Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is a partially loculated pericardial effusion which is moderate in size along the mid to apical RV free wall. There is a much smaller circumferential 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. No perfusion defects/ "ischemia" present during hyperemia.2. No evidence of myocardial infarction. There is no late gadolinium enhancement noted to suggest the presence of replacement fibrosis, inflammation, or infiltration. However, the native T1 times are significantly elevated at 1150-1225 ms (nl <1050ms) diffusely, which would suggest the presence of diffuse interstitial fibrosis or edema. 3. Moderately dilated LV size and mildly reduced systolic function (LVEF 48%).4. Normal RV size and systolic function (RVEF 52%).


Instruction: Generate impression based on medical findings.

Input: Reason: cervical radiculopathy History: neck pain radiating into posterior left shoulder The cervical vertebral bodies are appropriate in overall alignment and height. There is a small syrinx present within the spinal cord at the C6 vertebral body level.At C2-3 there is a large right paramedian disk extrusion which compresses the right half of the thecal sac and the right hemicord. Overall there is a moderate degree of spinal stenosis at this level.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a mild degenerative change is present at this levelAt C4-5 there is a diffuse disk bulge present associated with endplate and uncovertebral osteophytes and mild narrowing of the spinal canal and mild narrowing of the right neural foramen. Overall is a mild appearance the isthmus is normal.At C5-6 there is a left paramedian disk extrusion which compresses the left half of the thecal sac and left hemicord. There is associated endplate and uncovertebral osteophytes at this level. Overall there is a moderate degree of spinal stenosis at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is some disk desiccation at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Incidental note is made of partial empty sella.

Output: 1.There is a large disk extrusion at C2-3 which compresses the right hemicord and crates spinal stenosis.2.There is a large disk extrusion at C5-6 which compresses the left hemicord and creates spinal stenosis.3.There are degenerative changes present in the cervical spine associated with a encroachment of the right-sided exiting nerve roots at C4-5 and mild spinal stenosis at C4-5


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old, history of atypical meningioma and left leg dysfunction. Assess for etiology of leg dysfunction. Evidence of a right parietal craniotomy is seen. No definite residual or recurrent masslike lesion is seen subjacent to the craniotomy. Only mild nonspecific extra-axial thickening is noted.An extra-axial homogeneously enhancing mass is evident along the planum sphenoidale measuring 12 x 12 x 6 mm. This lesion induces minimal local mass effect but there is no evidence of significant parenchymal edema.No additional enhancing or masslike lesions are seen intracranially. In particular, the lower extremity motor areas of the precentral gyri are morphologically normal and free of any impinging or compressing lesions.Scattered small areas of T2 hyperintensity are seen within the cerebral white matter, somewhat more so on the right than on the left. No evidence of parenchymal edema or significant generalized mass effect is seen. No abnormal extra-axial fluid collections or acute intracranial hemorrhage is identified. A few scattered small foci of susceptibility are noted in the brain which likely reflect chronic microhemorrhage. The ventricular system is within normal limits for size and morphology.

Output: 1.Findings compatible with prior right parietal craniotomy. No evidence of any residual or recurrent masslike lesion is seen subjacent to the craniotomy. Only mild extra-axial thickening and enhancement is seen at this location which likely represents granulation or chronic dural thickening.2.A small presumed meningioma is evident along the planum sphenoidale causing no significant mass effect or parenchymal edema.3.No additional findings are seen to account for the patient's left leg dysfunction. In particular, the lower extremity motor areas are free of significant signal abnormality, and there are no adjacent compressing or impinging lesions.


Instruction: Generate impression based on medical findings.

Input: 10 year old female. Evaluate brain for abscess/ICP issues. Patient with fever and mental status changes. Increased seizure frequency. Microcephaly is noted. Extensive diffuse encephalomalacia appears similar to prior MRI. Parenchymal calcifications are noted. The ventricles are stably enlarged. There is no evidence of acute intracranial hemorrhage. There is no evidence of abscess formation given the limitations of noncontrasted CT.No acute abnormalities are noted in the calvaria and skull base. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Extensive encephalomalacia and enlarged ventricles that appears unchanged when compared to prior MRI.


Instruction: Generate impression based on medical findings.

Input: HIV, heroin abuse. Recently admitted with ataxia and neurocognitive changes. MRI showed cerebellar lesion and white matter lesions. Here again with the same presentation, repeat imaging for many acute changes. There are multiple scattered foci of predominantly subcortical white matter T2 hyperintensity without restricted diffusion, which have not significantly changed. There is also patchy T2 hyperintensity and swelling within the central pons and within the medial cerebellar hemisphere white matter, with increase in size of the left cerebellar lesion. The cerebellar tonsils remain mildly low-lying. There is a punctate focus of susceptibility effect in the periventricular white matter adjacent to the frontal horn of the left lateral ventricle. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift. The major cerebral flow voids are intact. The orbits are grossly unremarkable. The calvarial bone marrow is diffusely heterogeneous. The adenoids are prominent and contain punctate retention cysts. There are bilateral partially imaged parotid nodules.

Output: 1. Multiple supratentorial and infratentorial white matter lesions that likely represent the effects of opiate intoxication have not significantly changed except for a left cerebellar lesion, which has enlarged, but no evidence of acute intracranial hemorrhage or acute infarct.2. An unchanged punctate focus of susceptibility effect in the periventricular white matter adjacent to the frontal horn of the left lateral ventricle is nonspecific. 3. Nonspecific prominence of the adenoids may be related to HIV, for example.4. The appearance of the calvarial bone marrow may also be attributable to HIV. 5. Bilateral partially imaged parotid nodules may represent lymphoepithelial lesions. Dedicated imaging of the neck and parotid gland may provide further insights, nevertheless.


Instruction: Generate impression based on medical findings.

Input: 42-year-old female with history of right upper quadrant abdominal pain. Exam somewhat limited without intravenous contrast.ABDOMEN:LIVER, BILIARY TRACT: Scattered, probably benign cysts. No intrahepatic biliary ductal dilatation. The common bile duct measures up to 6 mm.SPLEEN: No significant abnormality noted.PANCREAS: Normal appearing pancreatic duct. Normal pancreatic parenchyma. No evidence of divisum or annular pancreas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No findings to account for the patient's right upper quadrant pain.


Instruction: Generate impression based on medical findings.

Input: There are multiple foci of restricted diffusion throughout the right cerebral hemisphere predominantly in the deep white matter but also including the right basal ganglia as well as the right precentral gyrus. Foci of restricted diffusion along the corpus callosum are also noted. Mild diffusion restriction is also seen in the left posterior frontal and left parietal lobes. There has been evolution of the previously seen infarcts from MRI from 1/27/2016 involving the left frontal lobe.There is FLAIR hyperintensity associated with the above-mentioned infarcts. There are scattered foci of susceptibility effect compatible with chronic blood products which are similar to prior, particularly along the right lateral ventricle margin with additional areas including the left subinsular region, right lateral thalamus, and few foci involving the right pons and cerebellum. There is also a background of moderate degree of periventricular and subcortical FLAIR hyperintensity which is nonspecific but compatible with chronic small vessel ischemic disease. There is no intracranial mass or mass effect. No hydrocephalus. There is diffuse opacification involving the sphenoid sinus with frothy secretions and fluid levels as well as bilateral mastoid air cell opacification, which may be related to intubation. Mild paranasal sinus opacification elsewhere.MRA HEAD

Output: 1. Multiple acute infarcts in the bilateral, but predominantly right, cerebral hemispheres as described above. There has also been evolution of previously seen left posterior frontal infarct. Background of moderate chronic small vessel ischemic disease also noted.2. There is high-grade stenosis or near occlusion involving the right internal carotid artery, new since prior CT angiogram 1/26/2016. Extent of residual flow can be better assessed with CTA if clinically indicated. There is also significant attenuation/decreased flow involving the right middle cerebral artery and its branches compared to the left.3. Scattered foci of chronic hemorrhage appear similar to prior, relatively more prominent in the right periventricular white matter.


Instruction: Generate impression based on medical findings.

Input: 19-year-old male with newly diagnosed germinoma presenting with headaches, nausea, and vomiting. Evaluate for hydrocephalus. Postoperative changes status post right frontal craniotomy are again evident, with interval decrease in pneumocephalus and extra-axial fluid. No acute intracranial hemorrhage is evident. Again seen is diffuse decreased attenuation in the subcortical and periventricular white matter in the frontal lobes bilaterally which appear grossly unchanged. Hyperdense masses are again seen in the suprasellar and pineal regions, correlating with lesions seen on recent MRI. The suprasellar mass appears more prominent compared to the prior exam, which may be in part due to slice thickness and partial volume averaging. Hypodensity in the right periependymal region adjacent to the frontal horn of the right lateral ventricle is again seen, causing mass effect upon the ventricle at this level. The ventricles remain midline, with interval increase in volume of the lateral ventricles. The third and fourth ventricles demonstrate normal morphology and volume.Postoperative changes status post right frontal craniotomy, with the remaining calvaria stable in appearance. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Interval increased volume of the lateral ventricles.2. Increased prominence of suprasellar mass, which may in part be due to slice thickness and partial volume averaging. Stable appearance of pineal mass. 3. Postoperative changes status post right frontal craniotomy, with no acute intracranial hemorrhage.


Instruction: Generate impression based on medical findings.

Input: Female 77 years old Reason: Evaluate for discitis/osteomyelitis History: ?discitis of L4 on CTA Multiple endplate deformities with mild loss of height of L3, L4 and L5 vertebral bodies. Endplate deformity of L5 is stable dating back to 5/31/2014. L3 is stable dating back to 3/2/2016. L4 endplate deformity is new as of 4/11/2016 CTA abdomen pelvis. There is edema signal involving the inferior endplate of L4 with Schmorl's node. There is also an L3 Schmorl's node. Overall these findings are compatible with multiple Schmorl's nodes/mild compression fractures. Edema signal and L4 is compatible with recent injury. There is associated enhancement of the endplate of L4. No suspicious enhancement is seen. There is no evidence of discitis/ostial myelitis. Abdominal aortic aneurysm is incompletely imaged, please refer to 4/11/2016 CT angiography abdomen and pelvis.T12-L1: There is no significant compromise to spinal canal or neural foramina.L1-L2: There is no significant compromise to spinal canal or neural foramina. Small focal ectasia/perineural cyst involving the right L1 nerve root.L2-L3: Mild disc bulge. No neural foraminal or spinal canal stenosis.L3-L4: Mild disc bulge. Minimal neural foraminal narrowing. No spinal canal stenosis.L4-5: Moderate disc bulge. Moderate right and mild to moderate left neural foraminal narrowing. Mild central spinal stenosis. Partial effacement of the lateral recesses.L5-S1: There is no significant compromise to spinal canal or neural foramina.

Output: 1.Multiple endplate deformities of L3, L4 and L5 vertebral bodies consistent with mild compression fractures with Schmorl's nodes. L4 endplate deformity is recent given edema signal, as noted on CT.2.No evidence of discitis/osteomyelitis.3.Degenerative changes as described above worst at the L4-L5 level. Please see details above.


Instruction: Generate impression based on medical findings.

Input: MRI BRAIN: The exam is mildly motion degraded limiting evaluation. There is an acute infarct involving the right frontal and parietal operculum, right insular cortex with additional small focus of infarction in the inferior frontal lobe with mild regional sulcal effacement and mass effect. Tiny focus of diffusion hyperintensity involving the paramedian left parietal lobe medially may be related to procedure. Susceptibility sequence is motion degraded, however no obvious hemorrhage is appreciated. There is an old infarct in the left occipital lobe, left cerebellar hemisphere, left posterior limb of the internal capsule, and the left corona radiata with encephalomalacia. There are moderate periventricular and subcortical nonspecific T2 signal abnormalities which likely represent moderate chronic microvascular ischemic changes. There is no hydrocephalus. There is no midline shift or herniation. A nasogastric tube is partly imaged.MRA BRAIN: The anterior and posterior circulation is intact without flow limiting stenosis or intracranial aneurysm. Both vertebral arteries join to form the basilar artery. Tiny bilateral posterior communicating arteries are present. The anterior communicating artery is not definitely visualized.MRA NECK: The proximal right vertebral artery is not well seen which may be artifactual or related to mild non-flow limiting stenosis. right. There is separate origin of the brachiocephalic, left common carotid and left subclavian arteries. The right vertebral artery is nondominant. Bilateral common carotid and internal carotid arteries are patent. There is no flow-limiting stenosis in the bilateral carotid bifurcations (less than 50% by NASCET criteria bilaterally).

Output: 1.Acute right MCA territory infarcts involving the right frontoparietal operculum, insula, right frontal coronal radiata and a small focus in the inferior right frontal lobe. No significant mass effect. Susceptibility sensitive sequence is motion degraded however no obvious hemorrhage is appreciated. Tiny focus of restricted diffusion involving the paramedian left parietal lobe medially may be related to procedure or represent an additional tiny focus of infarct. 2.Chronic infarcts in the left occipital lobe and the left cerebellar hemisphere as detailed above. Moderate chronic small vessel ischemic disease.3.No significant steno-occlusive lesions in the intracranial or extracranial circulation in the neck.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: Other specified disorders of bladder [N32.89] / Unspecified urinary incontinence [R32], Reason for Study: ^Reason: Evaluate for tethered cord History: day time and night time enuresis For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The conus medullaris terminates at the L1 level. The filum terminale is normal in size and signal intensity. There is no evidence of tethered cord or spinal dysraphism. The paraspinal soft tissues are unremarkable.On prone scan, mobility of the filum and cauda equina are demonstrated.There are minimal diffuse bulging of intervertebral discs at the level of L45 without evidence of disc degeneration. Otherwise unremarkable.

Output: 1. No evidence of tethered cord.2. Minimal diffuse bulging of disc at the level of L45. Otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: 32-year-old male with renal cell carcinoma and lesion in the pancreatic neck, evaluate for abnormalities ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions. No biliary ductal dilation.SPLEEN: No significant abnormality noted.PANCREAS: 1 cm arterially enhancing mass in the proximal pancreatic body (series 14, image 38). No communication with the main pancreatic duct.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post partial left nephrectomy. Multiple bilateral renal cystic lesions without interval change, likely benign.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.No interval change in arterially enhancing pancreatic lesion, likely representing a neuroendocrine tumor.2.Status post partial left nephrectomy.


Instruction: Generate impression based on medical findings.

Input: 52-year-old woman with metastatic breast cancer. Restaging exam.. There is diffuse, heterogeneous, enhancing abnormal marrow signal within the calvarium with areas of expansion that correspond to the lytic lesions seen on recent CT. There are multifocal areas of dural enhancement adjacent to the calvarial lesions, however, there is no dural nodularity or mass effect on the underlying brain. There is also an enhancing lesion within the clivus. The visualized upper cervical spine vertebrae are unremarkable.There is no abnormal intraparenchymal mass, mass effect, or areas of abnormal parenchymal enhancement. There are a few small areas of abnormal T2/FLAIR signal in the subcortical white matter which are nonspecific and may be related to mild chronic small vessel changes. No evidence of acute infarct. The ventricles and basal cisterns are normal in configuration. There is no midline shift or herniation. There is no evidence of intracranial hemorrhage or abnormal extra-axial collection.The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses are grossly unremarkable.

Output: 1.Innumerable calvarial metastatic lesions.2.Multifocal nonspecific areas of dural enhancement adjacent to the calvarial lesions which are favored to be reactive in etiology; dural invasion is less likely but can not be entirely excluded. 3.No intraparenchymal metastatic lesions, edema or mass effect.


Instruction: Generate impression based on medical findings.

Input: Left knee pain and swelling MENISCI: There is blunting and truncation of the inner free edge of the medial meniscus with abnormal morphology of the posterior horn consistent with the radial tearing which involves the posterior horn and body. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is mild heterogeneity of the articular cartilage of the medial femoral condyle particularly anteriorly suggesting degeneration and possible partial thickness loss. There is no evidence of a full-thickness defect.The articular cartilage of the lateral compartment also appears thinned but otherwise intact.There is moderate to severe articular cartilage loss of the patellofemoral compartment with areas of near full-thickness to full-thickness loss particularly of the medial compartment.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Radial tearing of the medial meniscus involving the posterior horn and body.2. Moderate to severe articular cartilage loss of the patellofemoral compartment with mild degeneration of the medial and lateral compartments.


Instruction: Generate impression based on medical findings.

Input: Female, 17 years old, with Neurofibromatosis type I, with back pain and multiple intracranial findings of NF1. Brain and orbits:Mild patchy T2 hyperintensity is again seen in the bilateral thalami, as well as questionably in the pons and left basal ganglia, showing no significant interval change. T2 hyperintensity of the medial temporal lobes including the hippocampi is also unchanged. Gyriform cortical T2 hyperintensity within the paramedian posterior left frontal lobe is unchanged as well.No new areas of parenchymal signal abnormality are detected. No pathologic parenchymal or extra-axial enhancement is observed. There are no findings to suggest intracranial hemorrhage or any abnormal extra axial fluid collection. The ventricular system is normal in size and morphology.Redemonstrated is asymmetric thickening of the right optic chiasm and right prechiasmatic optic nerve. The intraorbital optic nerve does not appear to be involved. There is no associated pathologic enhancement. Findings are unchanged.Cervical and thoracic spine:Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or marrow edema is seen.Visualized spinal cord shows normal signal intensity and morphology throughout. No pathologic intraspinal enhancement is observed.Spinal soft tissues are unremarkable.The intervertebral discs are preserved. No significant bulge or herniation is seen. The spinal canal and neural foramina remain patent.

Output: 1.Stable appearing optic pathway glioma involving the right optic chiasm and right prechiasmatic optic nerve.2.Stable scattered foci of abnormal signal intensity in the brain which are nonspecific but likely related to NF1. No new intracranial lesions are seen.3.Unremarkable evaluation of the cervical and thoracic spine.


Instruction: Generate impression based on medical findings.

Input: Headache [R51], Reason for Study: ^Reason: assess for stroke, other pathology History: headache, increased BP 24 years Female (DOB:3/10/1992)Reason: assess for stroke, other pathology History: headache, increased BPPROVIDER/ATTENDING NAME: DAVID G. BEISER Brain MRINo evidence of acute ischemic or hemorrhagic lesion. A couple of high signal intensity on FLAIR/T2 images involving periventricular white matter at the left frontal lobe and right periventricular white matter are seen which are nonspecific.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRV3D MRV brain post-gadolinium with maximum intensity projections of the superficial/deep intracranial venous drainage demonstrate normal flow enhancement in the superior sagittal sinus, transverse sinuses, sigmoid sinuses, internal cerebral veins, vein of Galen and straight sinus.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. A couple of nonspecific FLAIR/T2 high signal intensity lesions on white matter of left frontal lobe and right periventricular white matter.3. Normal brain MRV.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Clinical question: Rule out right frontal lesion. Signs and symptoms: LLE numbness/weakness and anosmia. Pre and post enhanced brain MRI:Negative diffusion weighted series.Examination demonstrates diffuse scattered nonspecific foci of FLAIR and T2 hyperintensity along in the subcortical and periventricular white matter of bilateral cerebral hemispheres and minimally in the right basal ganglia. Findings are nonhemorrhagic and demonstrate no abnormal enhancement. Although nonspecific this appearance is often result of microvascular ischemic changes considering patient's stated age.The anatomical morphology and the signal intensity of brain is otherwise within normal on all MRI sequences for patient's stated age and without detectable abnormal enhancement.The signal void in major intracranial arterial branches are identified.Signal intensity of intracranial venous sinuses remain within normal and with normal pattern of enhancement.Calvarium and soft tissues of the scalp are unremarkable and without abnormal enhancement.Unremarkable images through the orbits including axial fat sat post enhanced series.Paranasal sinuses demonstrate acute on chronic right maxillary sinus disease and mild (L>R) chronic ethmoid sinus disease and unremarkable otherwise. Bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal patterns.

Output: 1.No acute intracranial process.2.Findings suggestive of mild to moderate chronic nonhemorrhagic small vessel ischemic strokes only in the subcortical and periventricular white matter of cerebral hemispheres.3.Unremarkable pre and post enhanced brain MRI otherwise.4.Acute on chronic sinusitis as detailed.


Instruction: Generate impression based on medical findings.

Input: Female 56 years old with acute lateral right knee pain and swelling. Evaluate right knee for recurrent lateral meniscus tear vs. DJD. MENISCI: There is degeneration and fragmentation of the posterior horn and body of the lateral meniscus indicating complex tearing. Tearing also extends into the anterior horn with intermediate signal intensity tissue adjacent to the root of the anterior horn that may represent a displaced meniscal fragment. Globular and linear intrasubstance degeneration of the medial meniscus appears similar to the prior exam and there is perhaps mild fraying of the posterior horn but we see no discrete tear.ARTICULAR CARTILAGE AND BONE: There has been marked progression of osteoarthritis in the lateral compartment with much of the weightbearing surface of the lateral femoral condyle and tibial plateau devoid of cartilage with adjacent degenerative subchondral signal abnormality. There has also been progression of osteoarthritis affecting the medial compartment with osteophytes and chondral loss along the medial femoral condyle. Cartilage loss of the patella has also progressed with full-thickness cartilage loss along the lateral patellar facet.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Progression of osteoarthritis particularly involving the lateral compartment with extensive tearing of the lateral meniscus and other findings as above.


Instruction: Generate impression based on medical findings.

Input: 42 years Male (DOB:1/30/1974)Reason: brain lesion History: brain tumor, haPROVIDER/ATTENDING NAME: RAYMOND ROOS RAYMOND ROOS There is redemonstration of a ring-enhancing mass centered along the left gyrus rectus associated with vasogenic pattern of edema in the left inferior frontal lobe white matter and to a lesser degree right inferior medial frontal lobe white matter.There are small foci of volume loss associated with T2 signal hyperintensity present in the left cerebellar hemisphere and left occipital lobe.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 demonstrate minor opacities. The visualized portions of the orbits are intact.

Output: 1.There is a left frontal lobe ring-enhancing mass present which is suspicious for a pyogenic abscess centered in the left gyrus rectus displacing the left medial frontal lobe across the midline.2.Foci of encephalomalacia are redemonstrated in the left cerebellar hemisphere and left occipital lobe.3.Examination was obtained for stereotactic surgical guidance


Instruction: Generate impression based on medical findings.

Input: 16-year-old male with history of knee pain, concern for fractureVIEWS: Right knee AP, lateral (two views) 3/13/15 Flabella is present. Apparent osseous defect in the superior medial aspect of the patella is a normal variant, seen on the prior MRI. Moderate knee joint effusion is present.

Output: Knee joint effusion without evidence of fracture.


Instruction: Generate impression based on medical findings.

Input: 59-year-old with history of right mastectomy for ILC in 2009 followed by radiation delayed reconstruction. Status post right mastectomy with reconstruction.There is scattered fibroglandular tissue in the left breast.Mild parenchymal enhancement is noted in the left breast.No abnormal enhancement is seen in left breast or in the right reconstructed breast. No abnormal lymph nodes are identified in either axillary region.T2 hyperintense lesions in the liver are unchanged.

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


Instruction: Generate impression based on medical findings.

Input: 70-year-old female with complaint of confusion, and aphasia. Patient on Coumadin. Rule out intracranial hemorrhage. There is no evidence of intracranial hemorrhage, mass or edema. Diffuse hypodensity and apparent low distribution consistent with small vessel ischemic disease, age indeterminate. If there is clinical concern for acute ischemia, MRI may be considered. Well-defined area of encephalomalacia involves the left occipitoparietal region consistent with previous ischemic event.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: No acute intracranial abnormalities. Diffuse hypodensity and apparent low distribution consistent with small vessel ischemic disease, age indeterminate. If there is clinical concern for acute ischemia, MRI may be considered.


Instruction: Generate impression based on medical findings.

Input: 67-year-old female presents with increased right hip pain. ACETABULAR LABRUM: The acetabular labrum is thickened with heterogeneous signal intensity compatible with a tear.ARTICULAR CARTILAGE AND BONE: Moderate bone marrow edema in the subcortical region of the femoral head and acetabulum. Moderate osteoarthritis affects the right hip.SOFT TISSUES: There is perhaps a mild strain of the right adductor muscles. ADDITIONAL

Output: 1. Moderate right hip osteoarthritis and marrow edema in the femoral head and acetabulum. Findings are favored to reflect osteoarthritis with reactive marrow changes, however, direct contusion injury may have a similar imaging appearance. Correlation with history of fall is recommended. No specific findings to suggest a stress fracture.2. Labral tear of the right hip.


Instruction: Generate impression based on medical findings.

Input: 76-year-old female with pancreatic cyst ABDOMEN:LIVER, BILIARY TRACT: Normal hepatic morphology without focal liver lesions. The gallbladder is within normal limits. The common bile duct measures up to 5 mm.SPLEEN: No significant abnormality noted.PANCREAS: Redemonstrated is a subcentimeter T2 hyperintense focus in the pancreatic body indicating that the main pancreatic duct, unchanged since the prior exam. Subcentimeter T2 hyperintense focus in the uncinate process measuring 4 mm is also unchanged. These are favored to be sidebranch IPMNs (intraductal papillary mucinous neoplasms). ADRENAL GLANDS: Left adrenal gland nodularity is unchanged.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Unchanged T2 hyperintense foci within the uncinate process and pancreatic body dating back to 6/4/2013, favored to be sidebranch IPMNs.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Rule out stenosis. Signs and symptoms: Neck pain. Nonenhanced cervical MRI:Foramen magnum is unremarkable.C2 -- C3 is unremarkable.C3 -- C4 demonstrate mild left uncovertebral hypertrophy with resultant mild left neural foraminal compromise.C4 -- C5 demonstrate moderate disk disease, loss of disk height and minimal hypertrophy changes of posterior elements. No spinal stenosis. Mild bilateral neural foraminal compromise however is present.C5 -- C6 demonstrate moderate disk disease and loss of disk height, mild bilateral ligamentum flavum hypertrophy and mild facet disease (right greater than left). No spinal stenosis however moderate right neural foraminal compromise is detected.C6 -- C7 demonstrate moderate disk disease and loss of disk height, mild to moderate bilateral ligamentum flavum hypertrophy and mild degenerative facet disease. There is a ventral hypertrophic spur with resultant partial effacement of ventral subarachnoid space which in combination with hypertrophic changes of ligamentum flavum results in mild central spinal stenosis. Moderate bilateral neural foraminal compromise is also detected. There is a well demarcated CSF signal intensity within the right neural foraminal laterally likely representing a prominent nerve sheet/Tarlov cyst.C7 -- T1 demonstrate minimal degenerative disk disease and mild bilateral ligamentum flavum and facet (left greater than right) hypertrophic changes. No spinal stenosis or convincing there is some neural foraminal compromise. A well-demarcated small focus of marrow signal change in the dorsal aspect of body of C7 is consistent with a skeletal capillary hemangioma.Degenerative changes all cervical spine at C4 -- C5 to C6 there C7 levels results in mild reversal of cervical lordosis.There is no convincing evidence of cord signal abnormality.Uppermost visualized thoracic spine demonstrate a small disk protrusion at T3 -- T4 level. The finding results in effacement of the ventral subarachnoid space and the status of subtle flattening deformity of the thoracic cord with ultrasound for spinal stenosis or cord signal abnormality.

Output: 1.Examination demonstrates moderate degenerative changes of cervical spine with resultant mild reversal of cervical lordosis at C4 -- C5 through C6 -- C7 levels.2.There is mild central spinal stenosis only at C6 -- C7.3.Multi-level neuroforaminal compromise of varying degrees as detailed per level above.4.Sagittal images demonstrate a central disk protrusion at T3 -- T4 level with subtle flattening deformity of the cord however without spinal stenosis or neural foraminal compromise.


Instruction: Generate impression based on medical findings.

Input: Female, 15 years old, with low back pain for months, worse with extension. Alignment is anatomic. Vertebral body height and morphology are within normal limits. No evidence of marrow replacement or marrow edema is seen. Within the limitations of MRI, no evidence of a pars defect is seen.The visualized distal spinal cord, conus and nerve roots of the cauda equina are within normal limits. No epidural abnormalities are detected.The intervertebral discs are preserved. No bulging or herniation is seen. No significant compromise of the spinal canal or neural foramina is detected. Mild facet hypertrophy is seen at L5-S1.

Output: Mild facet hypertrophy is seen at L5-S1. Otherwise, the examination is unremarkable with no additional findings to account for the patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: 7 years, Female, with right ear pain and bleeding. Evaluate for vascular malformation. There is enlargement and deformity of the right auricle which measures 4.5 x 1.5 x 5.9 cm and is diffusely contrast-enhancing; there are associated prominent flow voids suggestive of a vascular malformation (series 401, image 16) . The vasculature (ECA/retromandibular vein) within the right parotid gland is also more prominent when compared to the left parotid gland. Minimal prominent vascular enhancement is also seen involving the subcutaneous tissues overlying the right mastoid air cells. Remainder of the visualized scalp and deeper temporal bone structures appear within normal limits. There is mild hypoplasia involving the inferior cerebellar vermis can be normal variant. Limited evaluation of the visualized brain parenchyma appears otherwise unremarkable. Bone marrow signal is within normal limits.

Output: Enlargement of the right auricle with extensive enhancement and prominent flow-voids. Findings are suspicious for arteriovenous malformation. MRA covering the ear or conventional angiogram may be considered for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Migraine, unspecified, without mention of intractable migraine without mention of status migrainosusClinical question: Evaluate for cause of headaches The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is an isolated punctate subcortical white matter lesion on the medial aspect of the left temporal lobe. In isolation this is probably of little clinical significance and not unusual at this age.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.Findings suggest a disc protrusion at C4-5 with findings which are suspicious for spinal stenosis but cannot be confirmed on this exam.

Output: 1.MRI of the brain is within normal limits.2.Findings raise the question of disc extrusion in the cervical spine with possible spinal stenosis


Instruction: Generate impression based on medical findings.

Input: Cervical cancer with possible brain mets on CT head. There are two enhancing lesions within the inferior left cerebellar hemisphere that measure up to 8 mm and 4 mm each. There is mild surrounding vasogenic edema. There is no evidence of 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, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Subcentimeter lesions within the left cerebellar hemisphere likely represent metastases.


Instruction: Generate impression based on medical findings.

Input: 69-year-old female with known left IDC, receiving hormonal therapy. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.A known cancer is again seen at posterior 11:00 position in the left breast, measuring 25 x 22 x 30 mm (AP x ML x SI; previously 32 x 29 x 37 mm). Pectoral muscle tenting is again associated with this mass; however, there is no enhancement in the pectoralis muscle in this current study. No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in either axillary region.

Output: 1. Interval mild decrease in the size of the known cancer in the left breast, associated with pectoral muscle tenting.2. No MRI evidence of malignancy in the right breast.3. No abnormal lymph nodes in either axilla.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on medical findings.

Input: 67 year-old female with left arm tingling and numbness. There is no evidence of intracranial hemorrhage, mass or edema. Diffuse areas of hypodensity in the periventricular and subcortical white matter distribution consistent with small vessel disease, age indeterminate but grossly overall unchanged from the previous examination. Focal area of hypodensity adjacent to the right thalamus and basal ganglia unchanged from the previous study. No new cortical stroke is noted. If there is clinical concern for acute ischemia, an MRI may be considered.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized mastoid air cells are normally pneumatized. Limited view of the paranasal sinuses are unremarkable.

Output: Chronic ischemic focus unchanged. 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: Smoldering multiple myeloma. Assess for myelomatous involvement. THORACIC SPINE: There is multilevel degenerative cervical spondylosis that is better assessed on the recent cervical spine MRI, including minimal anterior subluxation of C7 relative to T1. Otherwise, the thoracic sagittal alignment is preserved. The vertebral body heights are preserved. Mild multilevel degenerative disc desiccation and height loss are most pronounced at T10-T11, where a small posterior central disc protrusion mildly narrows the spinal canal. There is also a small right foraminal disc protrusion along with right facet arthropathy resulting in mild T10 and T11 right neural foraminal stenosis. There is no other significant spinal canal stenosis. The vertebral bone marrow signal is unremarkable, accounting for mild degenerative signal anteriorly and T5-T6 and T10-T11. The spinal cord displays normal signal and morphology. There is no abnormal contrast enhancement. Apparent contrast enhancement in T7-T8 disc probably represents intrinsic T1 shortening rather than real enhancement. The esophagus is patulous. The paravertebral soft tissues are unremarkable.LUMBAR SPINE: There is a leftward convex curvature. Sagittal alignment is relatively preserved. The vertebral body heights are preserved. While the intrabody herniation in the inferior L1 has not changed, new intrabody herniations have developed at L2-L3 associated with mild subjacent contrast-enhancing marrow edema. This is associated with increased right-sided L2-L3 disc height loss and increased posterolateral, paracentral disc bulge resulting in left subarticular recess stenosis and moderate left neural foraminal stenosis while the mild right neural foraminal stenosis is unchanged. Otherwise, the vertebral bone marrow signal remain heterogeneous but without significant focal lesion. Focal contrast enhancement subjacent to the superior L3 endplate on the right correlates with small focal T2-hyperintensity, which is unchanged since the prior examination. The other levels show unchanged disc desiccation and height loss. The mild central and left paracentral canal stenosis at L3-L4 are unchanged, as well as the mild bilateral neural foraminal stenoses. Lower lumbar facet osteoarthritic changes along with small joint effusions are present. There is no significant spinal canal stenosis. The conus medullaris displays normal signal and morphology and its tip lies at lower L1 level. Heterogeneous pelvic marrow signal is not significantly changed from the prior MRI of May 17, 2016 and probably reflect posttreatment findings.

Output: 1.Thoracic spine: No definite myelomatous involvement in the thoracic spine. Mild multilevel degenerative spondylosis but no significant spinal canal stenosis or cord compression. Apparent contrast enhancement in T7-T8 disc probably represents intrinsic T1 shortening rather than real enhancement. 2.Lumbar spine: No definite myelomatous involvement in the lumbar spine. Multilevel degenerative spondylosis is most pronounced at L2-L3, where increased posterolateral, paracentral disc bulge results in left subarticular recess stenosis and moderate left neural foraminal stenosis. There has not been significant change of the multilevel spondylosis otherwise. 3.Heterogeneous pelvic marrow signal is not significantly changed from the prior MRI of May 17, 2016 and may reflect treatment effects. Please refer to the recent pelvis MRI for additional details.4.The esophagus is patulous, which may be associated with gastroesophageal reflux.


Instruction: Generate impression based on medical findings.

Input: Lung cancer and head and neck cancer, for staging. There is no evidence of intracranial mass, edema, hemorrhage, or acute infarct. There is a mildly expanded and partially empty sella. There is inferior extension of cerebellar tonsils, up to 10 mm inferior to the foramen magnum. However, the tonsils maintain a normal rounded morphology. The ventricles are normal in size and configuration. The orbits and skull are grossly unremarkable.

Output: 1. No evidence of intracranial metastases.2. Partially empty sella and low-lying cerebellar tonsils, which can be manifestations of pseudotumor cerebri.3. Asymmetric enhancement in the right temporomandibular joint may represent synovitis or an anatomic variant.


Instruction: Generate impression based on medical findings.

Input: Ms. Heth is a 67 year old female with a personal history of left breast lumpectomy x2 in 2006 for DCIS/ADH treated with tamoxifen therapy and a right breast excisional biopsy in 2015 for periductal chronic inflammation. Family history of breast cancer in paternal aunt, diagnosed at the age of 50. She recently had biopsy of an enlarged left axillary lymph node, which was positive for breast primary. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.LEFT BREAST: Spanning the entire left central to inferior breast are numerous enhancing masses/nonmass enhancement measuring approximately 13.2 x 7.8 x 7.3 cm (AP x ML x SI). This enhancement extends up to within 1 cm of the left nipple base. The enhancement is greater than 2 cm from the pectoralis muscle border.RIGHT BREAST: There is no abnormal enhancement seen in the right breast.AXILLAE: In the left axillary region, there are 4 abnormal axillary lymph nodes identified, the largest of which measures approximately 2.0 cm and is biopsy-proven to be malignant. Hydromark clip is seen within this lymph node.No abnormal axillary lymph nodes are identified in the right axillary region.

Output: (1) Numerous enhancing masses/nonmass enhancement spanning the entire left central to inferior breast, measuring up to 13.2 cm, highly suspicious for malignancy. If tissue sampling of this abnormal area is warranted, an MR directed ultrasound with biopsy can be performed.(2) Biopsy-proven metastatic left axillary lymph node with appropriate clip placement.(3) No MRI evidence for malignancy in the right breast. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: Again seen is resection cavity in the right temporal lobe. Most of the surrounding FLAIR hyperintensity in the right temporal lobe is not significantly changed. There is however slight increase in FLAIR hyperintensity and more prominent increase in nodular enhancement which demonstrates restricted diffusion along the medial aspect of the resection cavity. This area of enhancement abuts the lateral ventricle. Perfusion images demonstrate no clear elevation in cerebral blood volumes in the regions with new enhancement.The ventricular system remains mildly enlarged but unchanged. Mild periventricular T2/FLAIR hyperintensity as well as additional scattered nonspecific foci of T2/FLAIR are not significantly changed. The right temporoparietal craniotomy flap with small underlying extra-axial fluid collection remains unchanged. No associated mass effect. No evidence of midline shift or herniation.

Output: Compared to the previous examination of 9/16/2015, there is increase in nodular enhancement along the medial aspect of the right temporal resection cavity, slight increase in associated FLAIR hyperintensity, and restricted diffusion. No clear elevated CBV in these regions is demonstrated although volume averaging and relatively small areas of new enhancement makes assessment on the perfusion sequence limited. As such, findings may be related to recent re-irradiation although early tumor progression is not excluded. Would suggest close follow-up evaluation.


Instruction: Generate impression based on medical findings.

Input: Evaluate for headaches. Rule out PRES syndrome: History of kidney transplant and chronic headaches. Recent worsening of headaches. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are mild scattered cerebral white matter T2 hyperintense foci. The ventricles and basal cisterns are normal in size and configuration. The cerebellar tonsils are minimally low-lying. There is no midline shift. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Mild scattered cerebral white matter T2 hyperintense foci are nonspecific, but not suggestive of posterior reversible encephalopathy syndrome.2. No evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on medical findings.

Input: Spina bifida with hydrocephalus, unspecified region [741.00], Reason for Study: ^Reason: eval for pathology s/p Chiari decompression History: LUE weakness and paresthesias Post suboccipital craniectomy status for the decompression of Chiari malformation. There is focal hemorrhage on the left posterior aspect of the lower medulla which extends to cervical medullary junction caudally and to the level of left inferior cerebellar peduncle cranial with surrounding edema.There is MR evidence of sub-occipital area dural irregularity and susceptibility artifacts indicating post surgical status.Multiple round susceptibility artifacts on anterior aspects of bilateral frontal lobes indicate postoperative pneumocephalus.There is no evidence of acute ischemic lesion on the scan.The ventricles, sulci and cisterns are symmetric and unremarkable. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Post decompressive suboccipital craniectomy status.2. Acute hemorrhage on the left posterior aspect of the lower medulla as described above with surrounding edema.3. No acute ischemic lesion.


Instruction: Generate impression based on medical findings.

Input: Right temporal lobe epilepsy: complex partial seizures. The brain parenchyma, including the hippocampi appears unremarkable. There is no evidence of intracranial hemorrhage, mass, or 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, and paranasal sinuses are grossly unremarkable. There is a small amount of fluid in the right mastoid air cells. There is a nonspecific low T1 and T2 signal subcentimeter apical scalp nodule.

Output: No evidence of gross seizure foci.


Instruction: Generate impression based on medical findings.

Input: 67-year-old female with worsening right-sided weakness and adenocarcinoma of the lung with brain metastases. MRI BRAIN:The wedge-shaped left parietal lobe MCA territory restricted diffusion has expanded since the prior exam, now extending into the left temporal lobe and to a smaller extent the left insula. No new separate areas of restricted diffusion are seen to indicate other areas of ischemia. Within the left parietal MCA territory, there is a pattern of intrinsic, gyriform T1 hyperintensity with minimal, if any, superimposed enhancement. This pattern likely represents laminar necrosis. There is some visualization of the previous gyriform pattern of susceptibility artifact on 11/4/2015, however imaging at 1.5 T likely results in decreased conspiuity of this finding when compared to prior. There has been interval increase in surrounding FLAIR abnormality, consistent with increasing edema. This results in effacement of the adjacent sulci and of the posterior horn of the left lateral ventricle. No midline shift and the basal cisterns appear intact. The enhancing, known metastases appear stable to slightly improved given changes in technique. There are no new foci of metastatic disease seen.Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic changes. There are no new areas of hemorrhage nor large extraaxial collections. Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.MRA NECK:Common origin of the brachiocephalic artery and the left carotid artery without evidence for stenosis of the great vessels. Small caliber of the right vertebral artery is likely secondary to atherosclerotic disease, though suboptimal image quality limits examination.There are no stenoses of the bilateral common, internal or external carotid arteries or of the bilateral carotid bifurcations. There is no evidence for vasculitis, fibromuscular dysplasia or dissection of the carotid or vertebral arterial systems within the neck. There are no vascular masses identified. MRA BRAIN:There is narrowing of a long segment of the inferior division of the left MCA that appears worsened allowing for differences in technique. In fact, the there is loss of flow signal completely at the distally aspect of this branch which is new from prior examination. Maderate narrowing in the left A2 ACA and in the left P3 PCA branches are unchanged.

Output: 1. Slowly progressive ischemic injury in the posterior left MCA territory is worsened and correlates with MRA findings of worsening inferior branch left MCA long segment stenosis and distal occlusion.2. The left vertebral artery is small in caliber. Otherwise, MRA of the neck is unremarkable.3. No new hemorrhage or metastatic disease is visualized. The previously seen metastatic disease is stable to improved from prior exam.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old, with history of metastatic lumbar spine tumor burden with radiculopathy. Thoracic:Numerous foci of T1/T2 hypointensity are seen throughout the thoracic spine. Many of these lesions are surrounded by a rim of STIR hyperintensity. Vertebral body heights are generally well preserved with only slight anterior wedging at some levels most notably T6. Comparison with prior CT examinations is limited, though the number and size of lesions has progressed over the prior two years.At no level does there appear to be gross epidural extension. The spinal canal is not significantly narrowed at any level. The left T2-3 neural foramen is mildly compromised due to some extraosseous tumor extension. Elsewhere, the foramina are patent. The spinal cord shows normal signal intensity and morphology throughout.Multiple hepatic masses are partially visualized.Lumbar:Numerous T1/T2 hypointense lesions are seen involving every vertebral level. As above, most lesions demonstrate rim STIR hyperintensity. Significant tumor extension into the ventral and left lateral epidural space is seen at L5 which causes spinal canal stenosis and crowding of the cauda equina nerve roots. Minimal ventral epidural tumor extension is seen at L4. As above, comparison with prior CT examinations demonstrates interval increase in lesion size and number over the prior two years. It does appear that epidural tumor at L5 has progressed when compared to examinations from earlier this year.The visualized distal spinal cord and conus are unremarkable.. The nerve roots of the cauda equina are within normal limits except as discussed above.A renal cystic lesion is seen on the left.From L1-2 through L3-4, the intervertebral discs are relatively well preserved with no significant spinal canal or foraminal compromise.At L4-5, facet arthropathy, disc bulging, and epidural tumor contribute to a significant spinal canal narrowing, particularly below the disc level. The neural foramina are mildly narrowed.At L5-S1, facet arthropathy and disc bulging contribute to mild spinal canal narrowing. The left neural foramen is significantly narrowed due to tumor involvement and degenerative change. The right neural foramen is moderately narrowed due to degenerative change.

Output: 1.Numerous sclerotic metastases are evident throughout the thoracic and lumbar spine. Lesions have increased in size and number when comparison is made to multiple prior CT examinations dating back to 2014.2.No significant epidural tumor is seen in the thoracic region. However, epidural tumor is present at the L5 level, progressed from earlier this year, which causes a significant narrowing of the spinal canal and crowding of the cauda equina. Minimal epidural extension is also seen at L4. These findings were discussed with Dr. Reed at 4:20 PM on 11/11/16.


Instruction: Generate impression based on medical findings.

Input: 4-year-old female patient with constipation and abdominal pain. Question of spina bifida. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is within normal limits. The conus medullaris is normal in position terminating at the level of L1-L2. There is expected dependent movement of the cord and cauda equina with prone positioning. No evidence of a posterior element spinal defect. There is no abnormal enhancement.The right kidney is not visualized. The bladder is distended. A small amount of free fluid is noted in the pelvis.

Output: 1. No specific evidence of spina bifida or tethered cord.2. Absent right kidney.