Instruction: Generate impression based on medical findings.

Input: Female, 73 years old, with multiple myeloma and new onset back pain. Cervical:A grade 1 retrolisthesis of C5 relative to C6 is seen. Alignment is otherwise unremarkable. Vertebral body heights are preserved. No pathologic marrow signal change or enhancement is detected. The visualized spinal cord demonstrates normal signal intensity and morphology throughout. No pathologic cord or leptomeningeal enhancement is seen.C2-3: Facet hypertrophy. Mild posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild right foraminal narrowing. C3-4: Left sided facet hypertrophy. Posterior disc-osteophyte complex formation eccentric to the left foraminal region. No significant spinal canal stenosis. Moderate to severe left and mild right foraminal narrowing. C4-5: Left greater than right facet hypertrophy. Left ligamentum flavum thickening. Minimal posterior disc-osteophyte complex formation. Mild narrowing of the left aspect of the spinal canal. Moderate to severe bilateral foraminal narrowing.C5-6: Left facet hypertrophy. Posterior disc-osteophyte complex formation and disc uncovering. Mild generalized spinal canal narrowing. Severe bilateral foraminal narrowing. C6-7: Left greater than right facet hypertrophy. Mild posterior disc-osteophyte complex formation asymmetric to the right foraminal zone. No significant spinal canal stenosis. Moderate to severe right foraminal narrowing. C7-T1: Right greater than left facet hypertrophy and ligamentum flavum thickening. No significant spinal canal or foraminal stenosis. Thoracic:Marrow signal characteristics are diffusely heterogeneous but there are no edema-inducing lesions and no evidence of any pathologic marrow enhancement.The thoracic kyphosis is mildly exaggerated likely due to mild anterior wedging from T4 through T9. Overall, vertebral body heights are preserved.The visualized spinal cord illustrates normal signal intensity throughout. No pathologic cord or leptomeningeal enhancement is seen. No epidural abnormalities are detected.At T2-3, a central disc protrusion minimally impinges upon the spinal cord but causes no significant spinal canal or foraminal stenosis.At T7-8, a moderately sized right paracentral disc protrusion slightly flattens the ventral spinal cord but causes no significant generalized spinal canal or foraminal stenosis.Lumbar:Marrow signal characteristics are diffusely and mildly heterogeneous. In addition, within the anterior aspect of the L1 vertebral body, there is a 6 mm well-circumscribed focus of enhancing marrow replacement. Vertebral body height and morphology are preserved. Trace anterolisthesis of L3 relative to L4 and L4 relative to L5 is seen. Elsewhere alignment is anatomic.The distal spinal cord, conus and nerve roots of the cauda equina are unremarkable. No pathologic cord or leptomeningeal enhancement is suspected. No epidural abnormalities are seen.T12-L1: Minimal facet hypertrophy. Minimal bulging disc. No significant spinal canal or foraminal stenosis.L1-2: Mild facet hypertrophy. No significant spinal canal or neuroforaminal stenosis. L2-3: Mild facet hypertrophy. Mild laterally bulging disc. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. L3-4: Moderate facet hypertrophy. Mild disc bulging and disc uncovering. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. L4-5: Moderate facet hypertrophy. Mild disc bulging and disc uncovering. No significant spinal canal stenosis. No significant foraminal narrowing. L5-S1: Mild facet hypertrophy. No significant spinal canal or foraminal stenosis.

Output: 1.A single 6 cm focus of enhancing marrow replacement is seen within the L1 vertebral body which, although nonspecific, could represent an isolated site of myelomatous disease.2.Elsewhere no definite myelomatous lesions are seen.3.Relatively modest degenerative findings are seen. No areas of high-grade spinal canal stenosis are suspected. Significant neuroforaminal narrowing is, however, noted at multiple cervical levels.


Instruction: Generate impression based on medical findings.

Input: 68-year-old female presents with right wrist pain after a fall, evaluate for tear of the triangular fibrocartilage complex. Some sequences are limited by patient motion artifact.TRIANGULAR FIBROCARTILAGE COMPLEX: Gadolinium extends from the radiocarpal joint into the distal radioulnar joint through a large tear of the articular disc of the triangular fibrocartilage complex near its radial attachment. There is also undulation and increased signal intensity within the volar radioulnar ligament which is suspicious for a tear of this structure. LIGAMENTS: Contrast is also noted within the mid-carpal joint, perhaps from a tear of the membranous portion of the lunotriquetral ligament, however, the actual defect is not well defined. No definite tear of the scapholunate ligament is identified.TENDONS: There is a small amount of fluid along the extensor pollicis longus tendon as it courses over the second compartment tendons, of questionable significance. The remaining tendons appear intact. BONES: There is a fracture through the hook of the hamate best seen on image 10 of series 9 with edema in the adjacent medullary bone. Bone marrow signal intensity is otherwise normal.ADDITIONAL

Output: Tear of the triangular fibrocartilage complex and fracture of the hook of the hamate. These findings were relayed to the patient following the procedure. Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: 63-year-old man with history of prostate cancer. PELVIS:PROSTATE:Prostate Size: 47 x 37 mmPeripheral Zone: There is an 12 x 8 mm area of T2 hypointensity, diffusion restriction, and enhancement in the right paramedian prostatic base (series 1001, image 17). Additionally, there is a well encapsulated focus of benign prostatic hyperplasia in the mid peripheral zone of the base (series 1001, image 13).Central Gland: The central gland appears normal.Seminal Vesicles: Seminal vesicles appear normal.Extracapsular Extension: There is no evidence of extracapsular tumor extension.BLADDER: The bladder is normal.LYMPH NODES: There is no significant lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Focus of adenocarcinoma in the right prostatic base without evidence of extracapsular extension or nodal spread.


Instruction: Generate impression based on medical findings.

Input: Images are limited by patient motion. Since the prior outside exam, there has been interval progression of previously seen osseous neoplastic disease at the S1 level. There is now diffuse abnormal signal involving the S1 vertebral body, with more confluent involvement of the right aspect of the sacrum. There is a prominent ventral epidural soft tissue component of tumor with loss of the inferior dorsal cortex of the S1 vertebral body. The epidural tissue measures up to 10 mm in greatest thickness, with near complete effacement of ventral epidural fat and complete effacement of the tapering distal thecal sac at these levels. The abnormal soft tissue spans the L5-S1 to lower S2 levels. Tumor encroaches upon the inferior aspect of the right L5-S1 foramen and appears to efface the right S1-S2 and probable S2-S3 foramina.There is a new area of abnormal signal in the posterior inferior L4 vertebral body system with additional osseous neoplastic disease. More ill-defined lesions are again seen along the superior endplate of L4 anteriorly. Multiple areas of abnormal signal are seen in the L5 vertebral body which appear progressed, with a focal concavity of the superior endplate appears unchanged. A discrete osseous lesion is also present in the L1 vertebral body. There is also a discrete rounded lesion in the left sacrum at the S2-S3 level which appears grossly unchanged.The spine is in normal alignment. There is mild disc narrowing at L4-L5 with loss of normal T2 hyperintense signal. There is also disc narrowing and desiccation at L1-L2. The vertebral body and disk heights are otherwise well-maintained. The spinal cord is of normal caliber and grossly normal signal. The distal spinal cord and conus are within normal limits with the conus terminating at the L1 level. There is mild developmental narrowing of the mid to distal lumbar spinal canal due to shortened pedicles and prominence of ventral epidural fat.The bladder is severely distended. There is a prominent component of the mass which is presacral in location although incompletely evaluated.

Output: 1.Compared to outside exam, there has been interval new thickening progression of osseous neoplastic disease centered at the S1 level, with now a large soft tissue component of ventral epidural tumor which completely effaces the distal thecal sac at this level. This likely accounts for the patient's cauda equina syndrome. Dedicated MRI of the lumbar spine with and without contrast recommended for a full evaluation, when able to tolerate.2.Tumor extends into the right S1-S2 and likely S2-S3 foramina which are completely effaced but incompletely assessed.3.Additional progression of osseous neoplastic disease elsewhere in the lumbar spine. No evidence of other significant central spinal canal stenosis or cord compression, although there is a mildly developmentally slender distal spinal canal.4.Severely enlarged bladder.Dr. Veronesi discussed these findings over the telephone with Dr. Christina Kim on 3/24/2016 12:15 AM, when a preliminary read was requested.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate for tenosynovitis of L wrist History: L wrist swelling and pain along extensor tendons A marker was placed along the dorsal aspect of the wrist. Deep to the marker, we see fluid surrounding the extensor digitorum tendons of compartment 4, compatible with the suspected clinical history of tenosynovitis. There is also mild increased signal intensity within the tendons themselves suggesting tendinosis/inflammation. There are multiple slips of the extensor pollicis longus, a normal anatomic variant. The remaining extensor tendons appear intact. The flexor tendons appear intact. There is a tiny focus of increased signal intensity within the dorsal fibers of the scapholunate ligament which may represent a small perforation of questionable significance. The ligament otherwise appears intact given the limitations of a non arthrogram study. The lunotriquetral ligament is not optimally visualized but we see no findings to suggest disruption. The triangular fibrocartilage complex appears intact within the limitations of a non arthrogram study. There is a suture line along the volar skin surface the wrist with low signal intensity within the underlying subcutaneous fat compatible with scarring. There is discontinuity of the flexor retinaculum compatible with carpal tunnel release. There is a small 6 mm lobulated collection of fluid signal intensity within the soft tissues dorsal to the scaphoid near the attachment of the dorsal intercarpal ligament which likely represents a small ganglion. Mild osteoarthritis affects the basilar joint. There is a small focus of edema type signal abnormality in the distal diaphysis of the first metacarpal of uncertain significance.

Output: Extensor digitorum tenosynovitis concentrated dorsal to the distal carpal row and other findings as described above.


Instruction: Generate impression based on medical findings.

Input: 40-year-old female patient with abdominal pain, bloating, and intermittent bleeding. Patient has family history of digestive disorders. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No local inflammation or stenotic disease. The stomach remained distended during the entire examination.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No local inflammatory changes or stenotic disease.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No evidence of inflammatory bowel disease or other acute intra-abdominal findings.2.The stomach remained distended during the entirety of the examination, which is nonspecific, and may represent gastroparesis in the appropriate clinical setting.


Instruction: Generate impression based on medical findings.

Input: 71-year-old male with recurrent prostate cancer after radical prostatectomy. Evaluate for pelvic recurrence.PSA of 0.13 ng/mL per EPIC on 3/22/2016 PELVIS:PROSTATE:Prostate Size: Status post prostatectomy.Seminal Vesicles: Status post prostatectomy.Extracapsular Extension: Status post prostatectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Foci of susceptibility in the left inguinal region, likely from prior herniorrhaphy.

Output: Status post radical prostatectomy without evidence of recurrent disease.


Instruction: Generate impression based on medical findings.

Input: History of sidebranch IPMN. Follow-up exam. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in signal and morphology. No focal mass lesion.No intrahepatic or extrahepatic biliary duct dilatation.SPLEEN: The spleen is normal in size.PANCREAS: There is redemonstration of a minimally complex cystic lesion within the pancreatic tail that connect to the main pancreatic duct via a small side branch compatible with a sidebranch IPMN. It measures 2.8 x 2.2 cm in maximum dimension (series 4 image 133), previously 2.5 x 2.2 cm. There are no solid, nodular, or enhancing components. The main pancreatic duct is nondilated.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral renal cysts, including a right upper lobe minimally complex cyst with thin septations, are not significant changed from prior. No hydronephrosis.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.Stable sidebranch IPMN.


Instruction: Generate impression based on medical findings.

Input: Male; 75 years old. Reason: obstruction? History: s/p RFA with increasing bili and LFTs ABDOMEN:LIVER, BILIARY TRACT: Interval posttreatment changes from thermal ablation of segment 8 HCC with new wedge-shaped area of non-enhancement spanning segments 8/5 and measuring up to 8.5 x 7.6 cm in greatest axial dimension (series 1101/3495). Increased T2 signal within this area, most likely due to post treatment edema. New mild perihepatic ascites. New mild intrahepatic biliary ductal dilation in the right and left hepatic lobes with poor visualization of the confluence of the right and left main hepatic ducts near Klatskin's point, which may be due to the posttreatment edema which extends to this location (series 301/22). Normal extrahepatic common duct is seen.Portal and hepatic veins are patent. Hepatic artery is patent.Cirrhotic liver morphology. No evidence of residual or recurrent segment 8 HCC. Previously described segment 2 and 3 arterially hyperenhancing lesions on prior CT are not appreciated on postcontrast sequences on the current MRI. No focal lesions which meet the criteria for HCC. Cholelithiasis.SPLEEN: Stable splenomegaly and perigastric varices.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: T2 hyperintense right adrenal lesion, stable in size and again likely the sequela prior of hemorrhage.KIDNEYS, URETERS: Small left inferior pole renal cyst.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. Posttreatment changes from recent thermal ablation of segment 8 HCC, as detailed above. No evidence of residual or recurrent disease.2. New intrahepatic biliary ductal dilation, which may be due to posttreatment change/edema extending to Klatskin's point. Continued follow up is suggested.


Instruction: Generate impression based on medical findings.

Input: Six rule female with history of intracranial METs, now with right-sided headache. There is no evidence of intracranial hemorrhage, mass or edema. Multiple areas of diffuse periventricular and subcortical white matter hypodensity consistent with small vessel ischemic disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered. Noncontrast evaluation is limited for evaluation of tumor.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 change.


Instruction: Generate impression based on medical findings.

Input: History of ulcerative colitis and primary sclerosing cholangitis with worsening right upper quadrant pain. Several sequences mildly limited by patient motion artifact.ABDOMEN:LIVER, BILIARY TRACT: There is mild segmental narrowing of the right and left hepatic ducts just proximal to the confluence of the common duct appearing similar to prior. Additional mild scattered intrahepatic biliary ductal irregularity/beading overall appear slightly less prominent. Mild scattered intrahepatic biliary ductal dilatation appears not significantly changed. There is again slight tortuosity of the distal common bile duct without high-grade stenosis/stricture. No abnormal biliary duct enhancement is identified. The gallbladder is contracted.There is a subcentimeter T2 hyperintense structure within segment 4B which demonstrates discontinuous peripheral nodular enhancement and is compatible with a benign hemangioma. No additional focal hepatic lesions are identified. The hepatic vasculature appears patent. SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic duct is nondilated.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple subcentimeter cysts, significantly changed.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: Findings consistent with early primary sclerosing cholangitis appearing similar to prior examinations.


Instruction: Generate impression based on medical findings.

Input: Please refer to the subsequent MRI report for further information.Exposure time: 58 seconds

Output: Successful fluoroscopic guided left wrist arthrogram for MRI.


Instruction: Generate impression based on medical findings.

Input: 82 years Female (DOB: 7/31/1933)Reason: bilateral arm pain History: bilateral arm painPROVIDER/ATTENDING NAME: BEN-ZION ROITBERG BEN-ZION ROITBERG The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is disc desiccation at this level.At C3-4 there is no significant compromise to the spinal canal. There are small uncovertebral osteophytes present associated loss of disc space height and disc desiccation. There is narrowing of the neural foramina bilaterally at this level. There is encroachment of the exiting nerve roots within the neural foramen at this level.At C4-5 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with endplate and uncovertebral osteophytes and effacement of spinal fluid ventral and posterior the spinal cord. There is some hypertrophy of the ligamentum flavum at this level. There is narrowing of the neural foramina bilaterally with encroachment of exiting nerve roots due to uncovertebral osteophytes and disc material. Overall there is a mild to moderate degree of spinal stenosis at this.At C5-6 there is loss of disc space height, disc desiccation and bilateral uncovertebral and endplate osteophytes associated with encroachment of the exiting nerve roots within the neural foramina bilaterally. There is some hypertrophy of the ligamentum flavum at this level. There is effacement of spinal fluid ventral and posterior the spinal cord and overall a mild to moderate degree of spinal stenosis at this level.At C6-7 there is no significant compromise to the spinal canal . There is loss of disc space height, disc desiccation and a diffuse disc bulge associated with endplate uncovertebral osteophytes at this level. There is encroachment of the exiting nerve roots within the neural foramina bilaterally at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge at this level as well as disc desiccation.The vertebral artery flow voids appear to be intact.Additional left parotid gland there is a cystic appearing lesion which is incompletely imaged on this exam.

Output: 1.There are multilevel degenerative changes present in the cervical spine with mild to moderate spinal stenosis at C4-5 and C5-6 and encroachment of exiting nerve roots in the neural foramina at C3-4, C4-5, C5-6 and C6-7.2.The inferior tip of the cystic appearing lesion is included in the left parotid space right behind the mandible which is not adequately assessed on this exam is uncertain what this represents. If clinically indicated additional imaging of the parotid gland may be of benefit.


Instruction: Generate impression based on medical findings.

Input: 71-year-old female with fatty infiltration of the pancreas, needs three-month follow-up. Enhancing lesion on prior CT, EUS negative ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions are evident. The common bile duct measures 1.0 cm, which may be normal for age status post cholecystectomy. Mild intrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant enhancement is seen within the neck of the gallbladder to correspond with lesion found on prior CT.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple nonenhancing bilateral renal cysts, some of which have intrinsic T1 signal, possibly hemorrhagic/mucinous. No hydronephrosis.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 abnormal pancreatic enhancement to to correspond to findings on prior CT.


Instruction: Generate impression based on medical findings.

Input: 63 years Female (DOB:10/13/1952)Reason: right parietal stroke History: left face, arm weakness, left gaze/neglectPROVIDER/ATTENDING NAME: JAMES J WALTER RICHARD A KRAIG MRI of the brainThere is a focus of diffusion restriction present measuring approximately 34 x 18 mm axial dimensions which involves the precentral gyrus and some of the postcentral gyrus extending down to the level of the subcentral lobule in superiorly to the level of the hand motor area. It is of high signal on T2 and FLAIR MR imaging. It measures approximately 51 x 27 mm in coronal dimensions.There is a focus of encephalomalacia present along the left superior frontal gyrus posteriorly extending to the left middle frontal gyrus. Another focus of encephalomalacia is present in the left occipital lobe involving the left cuneus. Another focus of encephalomalacia is present along the right cerebellar hemisphere.There are punctate foci of signal loss on susceptibility imaging predominantly involving basal ganglia and midbrain .There is a moderate to marked degree of periventricular and subcortical confluent hyperintense white matter lesions present identified on the FLAIR and T2 images.The patchy foci of signal hyperintensity on T2 and FLAIR MRI in the brainstem.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.Exam is degraded by patient motion which may obscure more subtle abnormalities.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. There is 60% stenosis present along the ophthalmic segment of the left internal carotid artery measuring approximately 12 mm in length.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The right posterior communicating artery is larger than the left posterior communicating artery. The right posterior communicating artery is medium-sized whereas the left posterior communicating arteries there are small. Anterior communicating artery is small. The left vertebral artery is larger than the right vertebral artery.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis appreciated along the course of the vertebral arteries. However, the proximal vertebral arteries are not imaged adequately.There are nodular lesions present in the thyroid gland which are not adequately evaluated on this exam.

Output: 1.Findings are compatible with acute ischemic cerebral infarction involving right pre and postcentral gyri.2.There is a 60% stenosis present at the left internal carotid artery ophthalmic segment.3.There are multiple foci of encephalomalacia present which include left frontal lobe, left occipital lobe, and right cerebellar hemisphere. In general these are suspected to be of ischemic origin.4.There are microhemorrhages predominantly involving basal ganglia and upper midbrain. This pattern is suggestive of hypertension.5.Periventricular and subcortical white matter lesions of a moderate to marked degree are nonspecific. At this age they are most likely vascular related. 6.Patchy lesions in the brainstem are also likely vascular related.7.The proximal vertebral arteries are not imaged adequately. No obvious stenosis is appreciated in the proximal vertebral arteries.8.Exam is degraded by patient motion which may obscure more subtle abnormalities.9.There are nodular lesions present in the thyroid gland which are not adequately evaluated on this exam.


Instruction: Generate impression based on medical findings.

Input: Female 72 years old Reason: eval for possible right meniscus tear History: + McMurray with painful mechanical symptoms MENISCI: There is a complete degenerative tear of the lateral meniscus including the anterior horn, body and posterior horn. There is mild meniscal extrusion.The medial meniscus shows some intrasubstance degeneration in its posterior horn but no discrete tear is evident.ARTICULAR CARTILAGE AND BONE: Full-thickness cartilage loss involving the lateral compartment with subchondral marrow edema involving the lateral femoral condyle and lateral tibial plateau.In the medial compartment, there is diffuse chondral thinning and foci of full-thickness cartilage loss.Foci of cartilage loss involving the medial patellar facet.LIGAMENTS: The anterior and posterior cruciate ligaments are intact. The collateral ligaments and lateral collateral ligamentous complex are intact. EXTENSOR MECHANISM: There is mild prepatellar soft tissue swelling.ADDITIONAL

Output: 1.Degenerative tearing of the lateral meniscus with full-thickness cartilage loss in the lateral compartment.2.Joint effusion and synovitis.


Instruction: Generate impression based on medical findings.

Input: Nontraumatic intracerebral hemorrhage, intraventricular Abnormal electroencephalogram (EEG) The myelination pattern is appropriate for patient's age. The corpus callosum is thin. There is mild prominence of the extra-axial subarachnoid spaces. The gray-white matter differential aeration is preserved. The left lateral ventricle remains asymmetrically enlarged, similar to prior examination No areas of diffusion abnormality are identified. There is no evidence for acute intracranial hemorrhage. Susceptibility artifact from hemosiderin deposition is demonstrated within the lateral ventricles. There is no midline shift or mass effect.

Output: Stable asymmetric enlargement of the left lateral ventricle, prominence of the subarachnoid spaces, and thinning of the corpus callosum without evidence for acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 40 years old, with decreased movement of the left upper and lower extremity, history of TIA. Evaluate for past stroke. Please note that some sequences were omitted as the patient required to terminate the examination early due to chest pain.No restricted diffusion is seen. No areas of significant parenchymal signal abnormality, edema or mass effect are detected. No large acute intracranial hemorrhage is suspected. No abnormal extra-axial fluid collections are seen. The ventricles are normal in size and morphology. Patchy mucosal thickening and/or secretions are seen in the ethmoid air cells.

Output: 1.No evidence of acute or chronic ischemic injury is seen.2.No other specific findings are demonstrated which would account for the patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: 55-year-old male presented with mass in the right neck parapharyngeal. Please evaluate.Technique: Following the administration of 70 mL Omnipaque 3501.Contiguous axial images were obtained through the soft tissues of the neck. Sagittal and coronal reconstructions were performed.2.Contiguous axial images were obtained of the brain. There is a 3731 mm axial dimensions mass measuring 50 by a 34 mm and coronal dimensions which surrounds the styloid process on the right side. It is heterogeneous in appearance. It displaces the right submandibular gland inferiorly and a displaces the right tap mylohyoid muscle medially. It abuts the right mandible at the angle of the mandible and also is visually contiguous with the right carotid space and displaces the right carotid artery and right external carotid artery posterior lateral. The styloid process extends into this mass along its more superior aspect. This is centered in the right parapharyngeal space and visually contiguous with the right masticator space. Its density is a lower than that of muscle and higher than that of CSF. It appears to be well circumscribed and a is not associated with bony erosion. There is a vessel which appears to run through it and best seen on the recent MRI images along its inferior and posterior aspect which most likely represents the facial arteryAt the level of the right bone and just above now within the preepiglottic space and there is a 16 x 23 mm irregular shaped lesion which appears to be visually contiguous with the tongue base and contains a number of air bubbles at appearedWithin the right submandibular space anteriorly there is a 12-mm nodule present better seen on the recent MRI than on the CT scan which showed abuts and is visually contiguous with the mylohyoid muscle. Within the infrahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated.Within the visceral space the thyroid gland appears intact.The airway appears patent.The visualized intracranial structures which include the posterior fossa are intact. The visualized portions of the orbits and paranasal sinuses are intact. The paranasal sinuses and mastoid air cells are clear.The parotid and the submandibular glands appear intact with displacement of the right submandibular gland as indicated above.The visualized lung apices appear clear with some emphysematous changes.The carotid and vertebral vasculature visualized on this exam appears intact with displacement of the right carotid vessels as indicated above.The cervical vertebral bodies in general are intact with no evidence for canal stenosis. There are degenerative changes in the cervical spine with endplate and uncovertebral osteophytes and narrowing the neural foramina on the left side at C3-4 and bilaterally at C5-6. There is semi-disk disease also present in the cervical spine as well.CT head: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.No abnormal enhancing lesions are appreciated in 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.There is a new right to masticator space and parapharyngeal space mass as described above which appears well circumscribed. malignancy such as squamous cell carcinoma cannot be excluded. Schwanoma and nerve sheat tumors may have this appearance. Salivary gland neoplasm is also consideration. 2.There is a nodule present along the right submandibular space is indicated above better seen on the recent MRI exam . This is suspicious for lymphadenopathy3.there is an exophytic mass along the tongue base which projects into the preepiglottic space. The possibility this represents a neoplasm is raised. Please correlate with physical findings on clinical exam.4.Degenerative changes are present in the cervical spine as indicated above.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old, history of metastatic breast cancer to the brain, surveillance imaging. Again seen are findings related to tumor resection from the right paramedian parietal region. The resection cavity, and T2 hyperintensity surrounding cavity, have not significantly changed from the prior exam. Mild curvilinear enhancement within the resection cavity has decreased in conspicuity from the prior examination. No new areas of suspicious enhancement are seen within or around the treatment bed.Also redemonstrated is a treated left cerebellar lesion which continues to enhance similar to the prior examination. The lesion measures 15 x 10 mm and has not changed in size from the prior study. T2 hyperintensity surrounding this lesion is unchanged as well.No new or concerning areas of intracranial enhancement are identified. An incidental developmental venous anomaly is again seen adjacent to the left cerebellar lesion. A few scattered foci of nonspecific white matter T2 hyperintensity are unchanged. No evidence of significant parenchymal edema or mass effect is detected. The ventricular system is stable and normal in size.

Output: 1.Stable appearance of the right paramedian parietal resection bed with no evidence to suggest recurrent or progressive tumor.2.Stable appearance of the treated left cerebellar lesion. The lesion continues to enhance but is unchanged in size.


Instruction: Generate impression based on medical findings.

Input: Benign neoplasm of pituitary gland [D35.2], Reason for Study: ^Reason: op planning for pituitary tumor resection History: op planning for pituitary tumor resection Multiple fiducial markers attached on the scalp.Again T2 low and T1 low signal intensity pituitary mass was seen.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Pituitary gland mass (AP:13.5mm x RL:20.2mm x CC:6mm) was demonstrated.No change since prior scan.Otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: 34 years Female (DOB:10/26/1981)Reason: Choric LBP History: Choric LBP on opiatesPROVIDER/ATTENDING NAME: ELIZABETH L TUNG ELIZABETH L TUNG Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is mild facet hypertrophy at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is moderate facet hypertrophy at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: There are some mild degenerative changes present along the lower lumbar spine without significant compromise to spinal canal or exiting nerve roots.


Instruction: Generate impression based on medical findings.

Input: Neck and back pain, involved in MVA on 1/21/2016 Cervical: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is mild loss of cervical lordosis. Alignment is otherwise maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Minimal degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Minimal disc bulge. No significant compromise to the spinal canal. Minimal neural foraminal narrowing. C4-5: Minimal disc bulge. No significant compromise to the spinal canal or neural foramina.C5-6: Minimal disc bulge. No significant compromise to the spinal canal or neural foramina.C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.Thoracic: Thoracic sequences are slightly motion degraded. There is however no evidence of intraspinal hematoma or ligamentous injury. Thoracic vertebral body heights are maintained. Alignment is maintained. Minimal degenerative changes are seen including trace disc bulges in the lower thoracic spine. No significant spinal canal or neural foraminal stenosis is seen. Thoracic cord is normal in signal and contour. Bone marrow signal is benign. Paraspinous soft tissues are unremarkable.

Output: 1. No findings to suggest traumatic injury in the cervical or thoracic spine. Specifically, no cord signal abnormality, intraspinal hematoma, or evidence of ligamentous injury.2. Minimal degenerative changes as described above.


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old, pregnant at 30 weeks gestation with two-day history of blurred vision and headache. Exam is consistent with a partial right third nerve palsy. A mass is present in the right middle cranial fossa with a broad base of attachment along the greater sphenoid wing measuring 42 x 28 mm transaxial and 37 mm craniocaudal. There is a thin cleft of CSF signal separating this lesion from the adjacent temporal lobe indicating extra-axial origin. The lesion itself demonstrates T1 isointensity and mild T2 hyperintensity relative to white matter, with mild diffusion restriction. The adjacent greater sphenoid wing and anterior clinoid process seem to be mildly thickened.This lesion induces significant regional and generalized mass effect with compression of the adjacent temporal lobe, leftward uncal herniation, and compression and leftward deviation of the mid brain. Edema is present within the right temporal lobe tracking superiorly into the right parietal lobe and the basal ganglia. There is a moderate generalized midline shift of the anterior brain structures, while posteriorly, the falx seems pushed towards the right. This may reflect competing mass effect between the tumor on the right, and the entrapped enlarged left lateral ventricle. The right lateral ventricle is partly effaced. The fourth ventricle is normal.Dedicated MRA images demonstrate tumor related mass effect upon the right MCA system with vessels displaced superiorly and draping over the large tumor. Nevertheless, the MCA vessels demonstrate normal caliber with no evidence of significant stenosis or occlusion. Along the posterior margin of the tumor, there is a serpiginous prominent venous structure which may reflect venous engorgement due to mass effect or increased drainage from the adjacent lesion. Elsewhere, assessment of the intracanal vasculature is within normal limits. No definite evidence of any intracranial aneurysm is detected within the limitations of technique.

Output: A large extra-axial mass is present within the right middle cranial fossa with a broad base of attachment to the greater sphenoid wing. There are findings to suggest hyperostosis of the sphenoid and anterior clinoid process. Even without the benefit of IV contrast, the imaging findings are most suggestive of a large meningioma.This lesion induces significant regional and generalized mass effect with substantial edema tracking through the temporal lobe. There is right uncal herniation, a moderate midline shift to the left, effacement of the right lateral ventricle and entrapment/dilatation of the left lateral ventricle.MRA images demonstrate displacement of the right MCA vessels from their normal course but preservation of vessel patency. No evidence of significant vascular stenosis or occlusion is seen. No aneurysms are detected within the limitations of technique.


Instruction: Generate impression based on medical findings.

Input: New onset seizures. There is prominence of the extra-axial CSF spaces which is within normal limits for this age group. No restricted diffusion to suggest acute ischemia. There is tiny focus of T2 hypointensity with susceptibility layering within the left occipital horn. The ventricles are within normal limits in size. Brain parenchyma is otherwise unremarkable for age. No intracranial mass or mass-effect. Sulcation and myelination are within normal limits for age. Major flow-voids are preserved. Sella and orbits are grossly within normal limits. There is opacification of the bilateral middle ear cavities and mastoid air cells which may be related to intubation.

Output: 1. No intracranial mass or mass effect. No structural lesions to suggest seizure focus.2. Minimal intraventricular blood products noted dependently in the left occipital horn, which could be acute or chronic. 3. Prominence of the extra-axial CSF spaces which can be normal in this age group.


Instruction: Generate impression based on medical findings.

Input: Dizziness and ataxia There is no evidence of intracranial hemorrhage, mass or edema.There is a questionable area of hypodensity in the subcortical white matter of the left frontal lobe. A while this may be artifactual, MRI of the brain is recommended to evaluate for possible white matter abnormality. The ventricles and basal cisterns are normal in size and configuration.The calvarium and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Questionable area of hypodensity in the left corona radiata region of the left frontal lobe. While this may be artifactual, MRI is recommended to fully evaluate.


Instruction: Generate impression based on medical findings.

Input: C7 lesion seen on CT and history of hepatocellular carcinoma. There is diffuse low T1 and T2 signal in the C6 and C7 adjacent to the disc space, with associated mild patchy enhancement related to underlying degenerative spondylosis. In particular, at C6-7, there is a disc-osteophyte complex that results in moderate spinal canal stenosis and bilateral neural foraminal stenosis. In addition, at C7-T1, there is 5 mm of anterolisthesis and a disc-osteophyte complex, as well as ligamentum flavum thickening that results in severe spinal canal and bilateral neural foraminal stenosis. There is also rather significant bilateral neural foraminal stenosis and mild spinal canal narrowing at C3-4. The degenerative spondylosis at other levels is otherwise less pronounced. The vertebral body heights are preserved. The spinal cord displays normal signal characteristics. There is no evidence of mass lesions within the cervical spine. The paraspinal soft tissues and imaged intracranial contents are unremarkable. There appear to be small retention cysts in the bilateral maxillary sinuses.

Output: 1. Sclerotic degenerative endplate alterations at C6-7 a disc-osteophyte complex that results in moderate spinal canal stenosis and bilateral neural foraminal stenosis, but no findings specific for metastatic disease.2. At C7-T1, there is 5 mm of anterolisthesis and a disc-osteophyte complex, as well as ligamentum flavum thickening that results in severe spinal canal and bilateral neural foraminal stenosis.3. Rather significant bilateral neural foraminal stenosis and mild spinal canal narrowing at C3-4.


Instruction: Generate impression based on medical findings.

Input: History of tuberous sclerosis and seizures of increased frequency. There is a unchanged 7 mm avidly enhancing lesion at the grey-white matter junction along the anterior right superior frontal sulcus with associated surrounding T2 hyperintensity. There are postoperative findings in the right parietal lobe with unchanged associated scattered punctate foci of susceptibility effect and linear T2 signal abnormality surrounding the resection cavity, which likely represents gliosis and encephalomalacia. There is also unchanged linear T2 hyperintensity in the right forceps minor region. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged.

Output: 1. Unchanged enhancing lesion in the right superior frontal sulcus grey-white matter junction, which may represent a hamartoma or perhaps a neoplasm associated with underlying transmantle dysplasia.2. Unchanged postoperative findings in the right parietal lobe.3. Unchanged signal abnormality in the right right forceps minor region, which likely represents transmantle dysplasia with radial migration band.


Instruction: Generate impression based on medical findings.

Input: MRI: An area of T2 hyperintense, disorganized appearing tissue is redemonstrated within the cerebellar vermis measuring 22 x 25 mm. This lesion contains several foci of internal susceptibility corresponding to calcification on prior head CT, along with small foci of noncontiguous nodular enhancement. On some slices, there is the suggestion of a striated or "tigroid" appearance within the lesion best appreciated on thin slice T2 axial images. Mild bulging of the posterior wall of the fourth ventricle is seen without significant mass effect or hydrocephalus. The ventricles and sulci are unchanged.There are findings consistent with patient's known Chiari I malformation with inferior cerebellar tonsillar herniation and flattening. There is no acute infarct or midline shift. There are no separate areas of suspicious intracranial enhancement.MRS: Single voxel short and long TE spectroscopy of the cerebellar vermian lesion shows uniformly decreased myoinositol, choline, creatine and NAA peaks. Interrogation of normal-appearing cerebellar tissue demonstrates a normal spectroscopic pattern.

Output: Midline cerebellar vermian lesion with internal foci of calcification and scattered small foci of enhancement. There has been no significant interval change since prior imaging. Spectroscopic assessment of this lesion shows uniform reduction of all major detectable metabolites. This pattern is non specific but argues against an aggressive, highly proliferative process. The differential diagnosis would include non neoplastic or equivocally neoplastic processes such as dysplastic cerebellar gangliocytoma (Lhermitte-Duclos disease) or simply a developmental dysplasia of the cerebellum. Uniform reduction of MRS peaks has been reported in Lhermitte-Duclos. Low grade tumors such as ganglioglioma or pilocytic astrocytoma among others may also be considered, but the MRS features are not typical.


Instruction: Generate impression based on medical findings.

Input: 74 years Female (DOB:4/26/1941)Reason: metastatic lung cancer History: metastatic lung cancerPROVIDER/ATTENDING NAME: EVERETT E. VOKES EVERETT E. VOKES The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is no evidence for brain metastases. 2.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on medical findings.

Input: 30-year-old woman with right wrist pain. Evaluate right wrist ganglion cyst LIGAMENTS: No significant abnormality noted.TRIANGULAR FIBROCARTILAGE COMPLEX: The triangular fibrocartilage complex appears intact.TENDONS: No significant abnormality noted. BONES: There is a 2-3 mm round focus within the capitate which features highly T2 and low T1 signal, consistent with a small cyst or benign enchondroma. A punctate focus within the lunate has the same imaging characteristics. No fracture is evident.ADDITIONAL

Output: No evidence of a dorsal ganglion of the wrist.


Instruction: Generate impression based on medical findings.

Input: Male 35 years old Reason: staging evaluation for high rectal cancer. History: hematochezia Overall image quality: ExcellentPELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted. LYMPH NODES: Lymph nodes in the perirectal space, within the mesorectal fascia: Two prominent lymph nodes are seen within the mesorectal fascia superior to the mass. For future reference, a left perirectal lymph node measures 9 x 6 mm (series 601/41).Lymph nodes outside the mesorectal fascia: Multiple prominent to mildly enlarged bilateral high common iliac lymph nodes are seen. For future reference, a left common iliac lymph node measures 9 x 8 mm (series 601/44).BOWEL, MESENTERY: Rectal Tumor:Size: 3.5 x 4.5 x 5.9 cm (series 501/21 and series 601/34).Tumor appearance on T2-weighted images: Predominantly solid lesion with intermediate signal intensityTumor location: Upper-third(For lower rectal tumors):Distance of the lower edge of the tumor to the anal verge (lower edge of the anal canal): Not applicable.Distance of the lower edge of the tumor to the pelvic floor (relationship of the tumor to the anal sphincter complex): Not applicable.Circumference of the rectum involved: 100%.Relationship and proximity of the tumor to adjacent structures (prostate, seminal vesicles): Tumor abuts and exerts mass effect on the posterior dome of the bladder and the seminal vesicles without definite invasion.MRI T-stage: T3a - Tumor invades < 0.5cm into perirectal fat or extramuralTumor Distance to Mesorectal Fascia: 0 to 1 mm (series 601/34).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: High rectal tumor as detailed above with pelvic lymphadenopathy. Please note that the field of view does not include the aortic bifurcation.


Instruction: Generate impression based on medical findings.

Input: 54-year-old female with right hip pain and decreased range of motion. ACETABULAR LABRUM: There is heterogeneity and increased signal abnormality within the anterior acetabular labrum indicating degeneration/degenerative tearing within the limitations of a non arthrogram study. There is heterogeneity and increased signal abnormality within the posterior acetabular labrum indicating degeneration/tearing within the limitations of a non arthrogram study.ARTICULAR CARTILAGE AND BONE: There is no evidence of avascular necrosis as clinically questioned. There is a punctate focus of increased signal intensity within the right femoral head which likely represents subchondral cyst formation. Mild to moderate osteoarthritis affects the right hip.SOFT TISSUES: The imaged musculature of the right hip is normal in appearance. ADDITIONAL

Output: Osteoarthritis of the right hip and degeneration/tearing of the acetabular labrum. Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Male, 15 years old, with Chiari malformation. Evaluate for syrinx and for tethered cord. The cerebellar tonsils are pointed and descend 7 mm below the level of the foramen magnum. There is crowding at the level of the posterior foramen magnum. Robust biphasic CSF flow is seen along the anterior brainstem through the foramen magnum. Minimal CSF flow is seen posteriorly and along the cervical tonsils.There is a normal complement of vertebral bodies. No evidence of any segmentation anomaly is seen. Spinal alignment is anatomic. Vertebral body morphology and signal characteristics are within normal limits. The intervertebral discs are normal. No significant compromise of the spinal canal or neural foramina is noted.The visualized spinal cord demonstrates normal signal intensity and morphology throughout. No evidence of syrinx formation is seen. The conus tip terminates at the L1 level which is normal. The nerve roots of the cauda equina disperse evenly through the thecal sac. No intraspinal mass lesion or fibrofatty infiltration of the filum terminale is seen. No epidural abnormalities are suspected. On prone imaging, a mild anterior displacement of the conus and cauda equina nerve roots is demonstrated.

Output: 1.Findings compatible with Chiari I malformation.2.No evidence of syrinx formation or any findings to suggest tethered cord.


Instruction: Generate impression based on medical findings.

Input: Male 55 years old Reason: 55M with elevated and rising PSA and negative TRUS biopsy History: as above PELVIS:PROSTATE:Prostate Size: The prostate measures 6.2 x 4.5 x 6.0 cm.Peripheral Zone: Slightly heterogeneous. No focal suspicious lesion.Central Gland: Markedly enlarged and heterogeneous.Seminal Vesicles: No significant abnormality.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.The posterior gland is enlarged. There is no focal suspicious lesion.


Instruction: Generate impression based on medical findings.

Input: No findings to suggest acute cord compression. Post-operative changes of sub-occipital craniectomy for Chiari decompression. There is exaggerated kyphosis of the thoracic spine at T8 through 10 level as well as exaggerated lordosis of the lumbar spine. There are no acute fractures or subluxations. The marrow signal is benign. The spinal cord is normal in signal. The conus is normal in signal and morphology and terminates at an appropriate level. Multilevel disk height loss without significant central spinal canal stenosis or neural foraminal narrowing. The visualized paraspinal contents are unremarkable.

Output: No findings to suggest acute cord compression.


Instruction: Generate impression based on medical findings.

Input: Female 79 years old; Reason: evaluate for osteomyelitis History: R foot pain, persistent infection There is increased soft tissue edema throughout the ankle and dorsal aspect of the midfoot compared to prior, without marrow changes to indicate osteomyelitis. No loculated fluid collection to suggest abscess is seen. The lateral and medial collateral ligaments are intact. The Achilles tendon is intact. Scattered degenerative changes are similar to prior, most prominent at the carpometacarpal joints.

Output: Increased soft tissue edema, without evidence of abscess or osteomyelitis.


Instruction: Generate impression based on medical findings.

Input: 39-year-old woman with history of rectal carcinoid status post resection. ABDOMEN:LIVER, BILIARY TRACT: Segment 8 cyst (401/45) unchanged. Focus of mildly increased T2 signal in segment 6 (401/39) unchanged from the prior examination but too small to accurately characterize.Gallbladder is distended with sludge, otherwise normal. There is no intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Scarring in the lower right quadrant abdominal wall favored to be related to prior ostomy.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Simple right follicular adnexal cyst noted, additional small follicles also noted. Uterine fibroids and nabothian cysts noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The visualized rectum is underdistended (making evaluation suboptimal), however there is no proximal dilatation to suggest obstruction. The region of the low anterior resection and reanastomosis appears similar to priors.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of free pelvic fluid is noted, likely physiologic.

Output: Stable examination without evidence of recurrent or metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Male 52 years old Reason: Assess for labral tear, loose body History: Left shoulder instability ROTATOR CUFF: There is fluid signal along the undersurface of the supraspinatus tendon reflecting partial undersurface tearing. No full-thickness tear is identified. The remaining rotator cuff tendons are normal. There is no associated muscle atrophy.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a superior labral tear extending from the level of the biceps anchor the posterior superior labrum. The tear does not definitely extend into the biceps tendon.There is some degeneration of the anterior and posterior glenoid labrum.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1. Type II SLAP tear of the labrum. There is no extension into the biceps anchor.2. Partial undersurface tearing of the supraspinatus tendon.


Instruction: Generate impression based on medical findings.

Input: A 63 year old male with history of coronary artery disease: an angiography on 2007 showed proximal total occlusion of the left anterior descending artery and non significant obstructions in the proximal ramus and right coronary arteries. Recently the patient has been complaining about shortness of breath. Referred to stress cardiac MRI for further evaluation. MEDICATIONS: aspirin, clopidogrel, carvedilol, hydrochlorothiazide, olmesartan, simvastatin, venlafaxine First Pass PerfusionDuring hyperemia, no perfusion defects were present. A dark artifact was seen only in the region of the septum with stress and at rest.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 48 ml/m2 (normal range: 74+/-15), the LVEDV is 103 ml (normal range 142+/-34), the LV end systolic volume index is 21 ml/m2 (normal range 25+/-9), the LVESV is 46 ml (normal range 47+/-19), the LV mass index is 49 g/m2, and the LV mass is 106 g. There are no regional wall motion abnormalities present.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 50%, the RV end diastolic volume index is 75 ml/m2 (normal range 82+/-16), the RVEDV is 163 ml (normal range 142+/-31), the RV end systolic volume index is 38 ml/m2 (normal range 31+/-9), and the RVESV is 82 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 normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 56%).4. Normal RV size and systolic function (RVEF 50%).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: 82-year-old female with spinal stenosis. Presented with severe back pain and positive blood cultures. Please evaluate for epidural abscess. Please note that while there are no specific findings to suggest an epidural abscess, this exam cannot exclude an epidural abscess. Instead an MR is recommended for further evaluation. The exam is significantly limited by patient motion artifact and large body habitus. Within these limitations, the following observations are made. The bones are diffusely osteopenic. The alignment of the thoracic spine is anatomic. The vertebral body heights are grossly maintained. Multilevel degenerative disk disease is seen. Anterior and posterior osteophyte formation is seen at multiple levels, however there is no significant bony compromise of the central canal. The paraspinal soft tissues are grossly unremarkable. LUMBAR SPINE

Output: 1. Limited exam due to patient motion artifact and large body habitus.2. This exam cannot exclude an epidural abscess. An MR is recommended for further evaluation.3. Multilevel degenerative disk disease with central canal compromise at multiple levels.


Instruction: Generate impression based on medical findings.

Input: Clinical question: r/o TIA/CVASigns and Symptoms: transient disorientation on 7/28, < 20 min, no loss of strength, elevated LDL, family h/o CVA 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.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate minor opacities. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: MRI of the brain is within normal limits. There is no evidence for acute ischemic cerebral infarction.


Instruction: Generate impression based on medical findings.

Input: 21 years, Female, neurofibromatosis type I, cerebellar astrocytoma, hydrocephalus with VP shunt. Presenting with intermittent dull headaches. Susceptibility artifact related to right transparietal VP shunt catheter slightly limits evaluation. Ventricular system is well decompressed, similar to CT from 2/16/2012. Ventriculostomy catheter appears in unchanged position. There is no significant change in appearance of the masslike FLAIR hyperintensity corresponding to the known astrocytoma involving the left cerebellar hemisphere and extending into the vermis left greater than right. Unchanged mass effect including deformity of the fourth ventricle. Unchanged areas of susceptibility effect related to calcification and chronic blood products. Evidence of prior suboccipital craniectomy for partial tumor resection and volume loss primarily involving the right cerebral hemisphere similar to prior. No suspicious enhancement. Again seen is linear T2 hyperintensity involving the right frontal lobe related to prior right frontal ventriculostomy tract.No evidence of acute infarct, hemorrhage, new mass or new mass effect. Minimal mucosal thickening involving the paranasal sinuses. Mastoid air cells are clear. Diffuse fatty atrophy of the right muscles of mastication is again seen.

Output: No significant change in infiltrating cerebellar mass compared to 11/30/2011 consistent with known residual cerebellar astrocytoma. Unchanged associated mass effect and deformity of the fourth ventricle. Ventricular system remains decompressed.


Instruction: Generate impression based on medical findings.

Input: Ms. Warmack is a 61-year-old woman with hypertension, alcoholic cirrhosis, bipolar disorder, chronic mastoiditis, and history of presumed heart failure presenting for cardiac evaluation Left VentricleThe left ventricle is mildly to moderately dilated with severely reduced systolic function. The overall LV ejection fraction is 30%, the LV end diastolic volume index is 95 ml/m2 (normal range: 65+/-11), the LVEDV is 169 ml (normal range 109+/-23), the LV end systolic volume index is 67 ml/m2 (normal range 18+/-5), the LVESV is 119 ml (normal range 31+/-10), the LV mass index is 46 g/m2 (normal range 67+/-11), and the LV mass is 81 g (normal range 114+/-24). The systolic dysfunction is global. There is significant motion artifact throughout the study. However, no abnormal enhancement is present.No intracardiac thrombus. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with severely reduced systolic . The overall RV ejection fraction is 36%, the RV end diastolic volume index is 80 ml/m2 (normal range 69+/-14), the RVEDV is 142 ml (normal range 110+/-24), the RV end systolic volume index is 51 ml/m2 (normal range 22+/-8), and the RVESV is 91 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is visibly mild mitral regurgitation. Dedicated imaging was not performed.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 common origin of the right innominate and left common carotid artery. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no pericardial effusion.Extracardiac FindingsThere are multiple T2 hyperintense lesions in the liver, the largest is 4.0 x 5.5 cm. These are incompletely characterized and can be further evaluated with hepatic MRI. Considerations include cysts and hemangiomas.

Output: 1. LV ejection fraction is 30%. No abnormal enhancement.2. RV ejection fraction is 36%.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: NECK: There are extensive postoperative findings related to right orbital and sinonasal exenteration with myocutaneous flap reconstruction. There is no measurable tumor in the roof of the left posterior nasopharynx along the surgical margin. The previously demonstrated punctate right temporal scalp subcutaneous tissues nodule, the right temporal fossa enhancing lesion and right squamosal temporal bone calvarial lesion with extension into the overlying scalp are also no longer discernible. The right mandibular body lesion has not significantly changed in size, measuring up to 18 mm. There is unchanged asymmetric enhancement diffusely in the right foramen rotundum, without appreciable mass effect. There are persistent obstructed secretions in the frontal and sphenoid sinuses and mucosal thickening and fluid in the left maxillary sinus. There is nonspecific high T2 signal in the bilateral mastoid air cells. There is no evidence of significant lymphadenopathy in the upper neck. The salivary glands appear unchanged.BRAIN: There is a new lobulated peripherally enhancing lesion in the anterior right temporal lobe measuring up to 33 mm with extensive surrounding vasogenic edema and mild uncal medialization, partial effacement of the right lateral ventricle and midline shift to the left, measuring approximately 2 mm. There are otherwise unchanged scattered T2 hyperintensities in the subcortical and periventricular white matter, which are nonspecific. There are no other enhancing intracranial lesions.

Output: No measurable residual tumor in the left posterior nasopharynx along the surgical margin and in the right scalp and skull, but unchanged mandibular body metastasis.Persistent mild asymmetric enhancement in the right foramen rotundum may be post-treatment in nature.Interval development of what likely represent radiation necrosis in the anterior right temporal lobe, with extensive vasogenic edema. Otherwise, no evidence of brain metastases.4. Findings suggestive of acute left maxillary sinusitis with otherwise persistent obstructed secretions adjacent to the exenteration flap.


Instruction: Generate impression based on medical findings.

Input: Bilateral ACA and left MCA territorial ischemic infarctions. CTA evidence of left carotid bulb plaque irregularity. The 3D T1 weighted WATS sequence was applied.However, the images are blurred especially on posterior lateral aspect of the left carotid bulb prevents detailed analysis.Subtle linear low signal intensity (arrows on series 801, image 29/50) delineating carotid luminal high signal intensity might represent fibrous cap of carotid plaque and irregularity with interruption of the linear low signal intensity could represent ruptured portion of carotid plaque.However, there is no evidence of definitive evidence of fibrous cap interruption or intra-plaque hemorrhage (usually showing high signal intensity on T1 weighted image) on this scan.Black blood imaging attempt was not successful to show carotid bulb wall.Therefore, this MR exam is non-diagnostic.

Output: Non diagnostic MR imaging.


Instruction: Generate impression based on medical findings.

Input: The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The imaged spinal cord displays normal signal and morphology with the conus terminating at L2 . There is no evidence of filar thickening or fibrofatty infiltration and there is normal anterior translation of the conus upon prone positioning. The paravertebral soft tissues are unremarkable. There is a large amount stool in the colon.

Output: No evidence of tethered cord.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old, with stage IV melanoma and known brain metastases, reevaluate disease status. Numerous scattered lesions are demonstrated throughout the brain and cerebellum compatible with treated metastatic foci. All of these lesions induce strong susceptibility artifact, and a few show intrinsic T1 hyperintensity. None demonstrates any significant or convincing enhancement, and none is associated with significant parenchymal edema. No new lesions are suspected.Evidence of prior right parietal craniotomy is again seen with encephalomalacia in the underlying brain parenchyma, unchanged. Confluent periventricular white matter T2 hyperintensity is unchanged and may be related to prior therapy. No significant edema or mass effect is detected. No acute intracranial hemorrhage is seen. The ventricular system is stable and within normal limits for size.

Output: Numerous lesions are redemonstrated compatible with treated metastatic foci. On comparison with the prior examination, there has been no significant interval change. Specifically, no new or growing lesions are suspected.


Instruction: Generate impression based on medical findings.

Input: 80 years Female (DOB:9/14/1935)Reason: 1 year follow up History: left parietal massPROVIDER/ATTENDING NAME: PETER C. WARNKE PETER C. WARNKE The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a 6 x 9 mm coronal dimension sessile extra-axial lesion adjacent to the left calvarium and adjacent to the left parietal lobeThere is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There is effacement of spinal fluid posterior the spinal cord at the C1 level with partial effacement of spinal fluid ventral to the spinal cord at this level. There is mild anterior subluxation of C1 relative to C2.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.

Output: 1.A calcified extra-axial lesion is present adjacent left parietal lobe which is stable. This could represent a burnt out meningioma.2.Findings are suspicious for mild spinal stenosis at the C1 vertebral level associated with mild subluxation at C1-C2. If clinically appropriate, additional imaging of this region may be helpful to further evaluate this.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old, with severe right thumb, hand and forearm pain in the C6-7 dermatome. Patient has known cervical radiculopathy there but last MRI was in 2012. Slight straightening of the cervical lordosis is seen. Spinal alignment is otherwise unremarkable. Vertebral body height and morphology are within normal limits. No evidence of marrow replacement or edema is seen. The visualized spinal cord is normal in signal intensity and morphology. No epidural abnormalities are suspected.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: No spinal canal stenosis or neuroforaminal narrowing. C4-5: Minimal posterior disc-osteophyte complex formation. No spinal canal stenosis or neuroforaminal narrowing. No interval changes.C5-6: Mild posterior disc-osteophyte complex formation and right uncovertebral hypertrophy. No significant spinal canal stenosis. Moderate right and mild left foraminal narrowing. No interval changes.C6-7: Mild posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. No interval changes.C7-T1: No spinal canal stenosis or neuroforaminal narrowing.

Output: Cervical spondylosis is redemonstrated at C5-6 and C6-7 without significant interval change. This causes moderate foraminal narrowing on the right at C5-6, but there is no significant spinal canal compromise. No new abnormalities are seen.


Instruction: Generate impression based on medical findings.

Input: 49-year-old male with a history of an extensive right knee injury presents with right knee pain. Surgical buttons are noted along the lateral femoral condyle and anterior margin of the tibial epiphysis. Additional surgical tunnels within the proximal tibial metadiaphysis and distal femoral diaphysis are noted. There is anterior soft tissue swelling with a thickened patellar tendon and a large suprapatellar effusion containing a focus of gas. Intra-articular calcification paralleling the articular surface of the distal femur is presumably posttraumatic in etiology.

Output: Surgical changes of a ligament and tendon reconstruction with a large joint effusion containing a small focus of gas density. Although this may reflect recent intervention, the possibility of infection cannot entirely be excluded.


Instruction: Generate impression based on medical findings.

Input: Hemangioma of intracranial structures [D18.02], Reason for Study: ^Reason: 3T scanner, CCM protocol, QSM, permeability History: Known CCM yearly surveillance About 12.5 mm (measured on the axial T2 weighted image the longest diameter) sized right postcentral gyrus cavernous malformation is seen with the surrounding hemosiderin deposition unchanged since prior scan. On post Gad enhanced image, especially posterior aspect of the lesion shows some enhancement which is unchanged since prior scan. Punctate susceptibility lesion on the right thalamus is also seen, unchanged since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no edema, midline shift, intra or extra-axial fluid collection, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Right postcentral gyrus cavernous malformation is again seen, unchanged in terms of maximum diameter, MR characteristics and findings since prior scan.2. Susceptibility lesion on the right thalamus is again see, unchanged since prior scan.3. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on medical findings.

Input: MRI Brain:Full evaluation is limited by extensive motion degradation. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild periventricular and subcortical white matter T2/FLAIR hyperintensity, which is nonspecific but likely related to chronic small vessel ischemic disease. There is moderate global volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact.Similar to the recent prior head CT, there is near complete opacification of the right maxillary sinus with opacities involving the right greater than left ethmoid air cells and small amount of fluid in the bilateral sphenoid sinuses. T2 hyperintensity and mild swelling seen in the subcutaneous fat of the right posterior neck, may represent dependent edema or related to recent trauma. A left parietal scalp fat intensity lesion likely represents a lipoma. An old burr hole is seen along the left parietal bone.MRA Brain: Full evaluation is limited by extensive motion degradation. The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The anterior communicating artery is not definitely visible. The majority of the basilar artery is not visualized extending cranially from the vertebrobasilar junction, measuring approximately 1 cm in length. The bilateral PCAs are visualized and supplied by posterior communicating arteries with small P1 segments bilaterally. The upper aspect of the short segment of visible basilar artery as well as the small bilateral SCAs likely have retrograde flow-related enhancement, from the anterior circulation. The AICAs are not definitely seen. The vertebral arteries are patent with no significant stenosis. The bilateral PICA arteries are visualized. No evidence of aneurysms.

Output: 1.Full evaluation is limited by extensive motion degradation. No evidence of acute infarct. 2.Mild chronic likely small vessel ischemic disease and moderate diffuse cerebral atrophy.3.The majority of the basilar artery is not visualized, with likely retrograde filling of the distal portion. This is favored to be chronically occluded, less likely developmental. The AICAs are not definitely visualized.4.Diffuse paranasal sinus findings. Please correlate clinically for possible acute sinusitis.


Instruction: Generate impression based on medical findings.

Input: Ms. Dooley submitted outside studies for review. Submitted for review are:-Bilateral breast MRI: 05/10/2016This examination was performed at Little Company of Mary Hospital. Multisequence MRI breast imaging with and without intravenous contrast was performed as per outside MRI breast protocol. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild background parenchymal enhancement is noted bilaterally.RIGHT BREAST:Spanning the entire right superior breast is a large area of clumped non-mass enhancement measuring approximately 4.5 x 2.9 x 2.7 cm (AP x ML x SI). Subtle susceptibility artifact from the two biopsy marker clips are noted in the superior and lateral aspects of this enhancement, compatible with biopsy proven DCIS. The anterior margin of this enhancement is approximately 1.4 cm from the right nipple base. Of note, there is a centrally dilated retroareolar duct seen with high T1 signal intensity internally, which courses through the area of non-mass enhancement. This duct is filled with either hematogenous or proteinaceous products. LEFT BREAST:There is no abnormal enhancement in the left breast.AXILLA:No abnormal axillary lymph nodes are identified in either axillary region.

Output: (1) 4.5 cm area of clumped non-mass enhancement spanning the entire right superior breast, with two biopsy marker clips at the superior and lateral margins, compatible with biopsy proven malignancy. (2) No MRI evidence for malignancy in the left breast. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: 65 years Female (DOB:12/5/1950)Reason: hx cervical fusion. eval for stenosis above/below or abnormality History: neck spasms, shooting neck pain to occiputPROVIDER/ATTENDING NAME: EDWIN RAMOS EDWIN RAMOS The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine. The patient status post anterior fusion from C4 through C7 using anterior plate and screws. This partially obscures visualization from C4 through C7 especially the neural foramina.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is a disc bulge present associated with some endplate and uncovertebral osteophytes and effacement of spinal fluid anterior and posterior the spinal cord. There is narrowing of the neural foramina bilaterally with encroachment of the exiting nerve roots bilaterally within the neural foramina at this level.At C4-5 there is no significant compromise to the spinal canal .At C5-6 there is no significant compromise to the spinal canal .At C6-7 there is no significant compromise to the spinal canal .At C7-T1 there is no significant compromise to the spinal canal or neural foramina.Some T2 signal hyperintensity is present within the brainstem on T2 imaging. The right vertebral artery flow voids very small and not readily perceptible distally. There is also on MRI internal auditory canals from 4/11/2016 which also demonstrates loss of the vertebral artery flow-void proximal to the right posterior inferior cerebellar artery origin.

Output: 1.Status post cervical spine anterior fusion from C4 through C7. There is a mild to moderate degree of spinal stenosis present at C3-4 associated with encroachment of the exiting nerve roots within the neural foramina bilaterally at this level.2.Findings are suspicious for occlusive disease involving the right vertebral artery. If clinically appropriate additional imaging of the right vertebral artery may be of benefit. Please note that there is a prior MRI of the internal auditory canals which also demonstrates right vertebral artery occlusive disease3.There are T2 signal changes within the brainstem which are suspected to be vascular related.


Instruction: Generate impression based on medical findings.

Input: Worsening low back and hip pain. Five lumbar type vertebral bodies are presumed to be present with the most inferior well-defined disc space labeled L5-S1. Vertebral body heights are within normal limits. There is grade 1 anterolisthesis of L3 on L4 which appears slightly worse than prior study from 6/6/2008. Alignment is otherwise maintained. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Disc desiccation and minimal bulge. There is also ligamentum flavum thickening and bilateral facet arthropathy. No significant spinal canal or neural foraminal stenosis.L3-L4: Grade 1 anterolisthesis with disc uncovering. There is also advanced bilateral facet arthropathy and ligamentum flavum thickening. These findings appear mildly progressed since prior study. There is moderate spinal canal stenosis which appears minimally worse since prior. There is also very mild bilateral neural foraminal narrowing.L4-L5: Mild disc bulge and advanced bilateral facet arthropathy. Minimal spinal canal narrowing. There is moderate left and minimal right neural foraminal stenosis. Left-sided neural foraminal stenosis appears slightly worse.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits. There is a focus of low T1 and low T2 signal involving the right aspect of the sacrum measuring approximately 11 mm in diameter, previously approximately 4 mm and 2008. Degenerative changes also noted at the sacroiliac joints.

Output: 1. Degenerative changes in the lumbar spine are minimally progressed since 6/6/2008. There is moderate spinal canal stenosis at L3-L4 related to degenerative spondylolisthesis which appears minimally worse. Flexion-extension radiographs may be helpful to assess for instability. There is also moderate left L4-L5 neural foraminal stenosis which appears slightly worse.2. Advanced facet arthropathy at L3-L4 and L4-L5 which may be contributing to patient's low back pain.3. Nonspecific focus of low T1 and low T2 signal involving the right sacrum which is larger since 2008. Finding is favored to represent an enlarging bone island but consider pelvic radiograph for confirmation.


Instruction: Generate impression based on medical findings.

Input: Pilocytic astrocytoma s/p XRT, craniotomy, and shunting. There are stable post-treatment findings in the left frontal lobe with unchanged confluent T2 hyperintensity surrounding the resection cavity. There is no abnormal intraparenchymal enhancement. Left transfrontal and right transoccipital ventricular shunt catheters are in unchanged positions. There is also a residual shunt catheter fragment in the third ventricle. There is T2 hyperintensity associated with the catheter tracks. There is no evidence of intracranial hemorrhage 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 grossly intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Stable post-treatment findings without evidence of tumor recurrence.


Instruction: Generate impression based on medical findings.

Input: 49 years Female (DOB:7/10/1966)Reason: assess for FLAIR changes compatible with SAH History: increasing RBCs on LPPROVIDER/ATTENDING NAME: JAMES A MASTRIANNI JAMES A MASTRIANNI MRI of the brainThere are several periventricular and and subcortical white matter signal hyperintensities identified on FLAIR MRI without diffusion restriction.The CSF spaces are appropriate for the patient's stated age with no midline shift. Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mild mucosal thickening in the right maxillary sinus.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Embolic occlusion coils are present at the patient's right anterior choroidal bilobed aneurysm (which is embedded into the medial aspect of the right temporal lobe) and the patient's mid-basilar aneurysm. The anterior choroidal artery remains patent. The appearance is stable since prior exams with a minimal remnant.There is redemonstration of a 2mm right ophthalmic artery aneurysm at the origin of the right ophthalmic artery. There is redemonstration of a left superior cerebellar origin 1 mm aneurysm. There is redemonstration of a 1 mm left PCOMA aneurysm.Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.The anterior communicating artery is identified. The posterior communicating arteries are small. The left vertebral artery is slightly smaller than the right vertebral artery.

Output: 1.No evidence for cerebrovascular occlusion.2.Status post embolic coil occlusion of a right anterior choroidal artery aneurysm with no evidence for recanalization at this time and no change since the prior MRA. This aneurysm is embedded in the right temporal lobe.3.Status post embolization of a basilar/left AICA origin aneurysm with minimal evidence for recurrence.4.There is redemonstration of a 2mm right ophthalmic artery aneurysm at the origin of the right ophthalmic artery. This indicates evolution of previously noted microinfarcts.5.There is redemonstration of a left superior cerebellar origin 1 mm aneurysm.6.There is redemonstration of a 1 mm left PCOMA aneurysm.7.Several periventricular and subcortical white matter lesions are present which are stable relative to the prior exam


Instruction: Generate impression based on medical findings.

Input: 63-year-old male with prostate cancer PELVIS:PROSTATE:Prostate Size: 4.4 x 5.3 x 5.7 cmPeripheral Zone: Subcentimeter nonspecific focus of T2 hypointensity in the right mid gland peripheral zone. The previously identified left mid gland lesion is not clearly seen on the current study.Central Gland: Marked degree of benign prostatic hypertrophy.Seminal Vesicles: Atrophy of the seminal vesicles.Extracapsular Extension: There is no evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative disease affects bilateral femoral heads. Patulous fat-containing right inguinal canal.OTHER: Previously seen filling defects in the left femoral vein and right common iliac vein are no longer present.

Output: 1.The previously identified left mid gland lesion is not clearly seen on the current study.2.Subcentimeter nonspecific focus of T2 hypointensity in the right mid gland peripheral zone.3.Marked degree of benign prostatic hypertrophy.


Instruction: Generate impression based on medical findings.

Input: MRI BRAIN:There is restricted diffusion involving the right basal ganglia extending from the right caudate body and extending inferiorly to the medial aspect of the putamen and including the posterior limb of the right internal capsule. There is corresponding T2/FLAIR hyperintensity. No associated susceptibility effect to suggest hemorrhage. No other focus of restricted diffusion. Remainder of the brain demonstrates several scattered foci of T2/FLAIR hyperintensity in the subcortical white matter which are nonspecific. No intracranial mass or mass effect. No hydrocephalus. No extra-axial collections. Paranasal sinuses and mastoid air cells are clear. Calvarium and extracranial soft tissues are unremarkable.MRA BRAIN:The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. No evidence of aneurysms or vascular malformations.MRA NECK:MRA of the neck without contrast is very technically limited but demonstrates no gross occlusion of the bilateral common carotid, internal carotid, or vertebral arteries.

Output: 1. Acute infarct involving the right basal ganglia including the right caudate body, medial putamen, and posterior limb of the internal capsule.2. Patent intracranial vasculature. 3. Very limited MRA neck without contrast demonstrates no obvious occlusion of the internal carotid, common carotid, or vertebral arteries in the neck. Dr. Syema Sheikh was notified on 10/2/2015 at 4:40 PM


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old, with radiating right lower extremity pain and numbness. Spinal alignment is anatomic. Vertebral body heights are preserved. Marrow signal characteristics are heterogeneous. Signal abnormality and enhancement are seen along the L4 superior endplate compatible with a Schmorl's node. Scattered additional nonenhancing Schmorl's nodes are also seen. Small enhancing foci along the superior L2 endplate are nonspecific but likely benign.The visualized distal spinal cord and conus are within normal limits. No epidural abnormalities are suspected. No pathologic intraspinal enhancement is seen.L1-2: Bulging disc. Mild generalized spinal canal narrowing. No significant foraminal narrowing. L2-3: Facet arthropathy and ligamentum flavum thickening. Bulging disc. Moderate generalized spinal canal narrowing with slight crowding of the cauda equina. Mild bilateral foraminal narrowing. L3-4: Facet arthropathy and ligamentum flavum thickening. Bulging disc. Moderate to severe spinal canal narrowing with crowding of the cauda equina. Mild bilateral foraminal narrowing. L4-5: Facet arthropathy and ligamentum flavum thickening. Bulging disc. Severe generalized spinal canal narrowing with crowding and likely impingement of the cauda equina. Moderate bilateral foraminal narrowing. L5-S1: Facet arthropathy left worse than right, and ligamentum flavum thickening. Bulging disc asymmetric to the left. Effacement of the left lateral recess and moderate generalized spinal canal narrowing. Moderate left and mild right foraminal narrowing.

Output: Multilevel disc and posterior element degeneration is seen. This results in a severe spinal canal stenosis at L4-5 and a moderate to severe stenosis at L3-4.


Instruction: Generate impression based on medical findings.

Input: 9-year-old male with bilateral knee pain on chronic steroids, concern for AVN MENISCI AND LIGAMENTS: The menisci are intact. The ACL, PCL, MCL, and lateral collateral complex are intact. The extensor mechanism is intact.BONE AND MARROW: The bones are diffusely demineralized consistent with an osteoporosis likely secondary to chronic steroids. In the proximal tibial diaphysis is a focal area of more severe osteoporosis. This focal area severe osteoporosis occupies nearly the entire volume of the proximal tibial diaphysis. No avascular necrosis or osteochondral defects are present. Focal area of low T1 signal along the medial aspect of the distal femoral metaphysis with corresponding high T2 signal likely represents a focal paraphyseal edema, which can be normal.SYNOVIUM: No significant joint effusion. The articular cartilage is intact.MUSCULATURE: Musculature appears moderately atrophic.ADDITIONAL

Output: Diffuse demineralization with a focal area of more severe osteoporosis in the proximal tibial diaphysis without evidence of avascular necrosis or osteochondral defect.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old, with meningioma, follow-up exam. A 10 x 8 mm enhancing extra-axial lesion is evident along the right lateral aspect of the spinal canal at the C1 level. This lesion effaces the CSF space, contacting and deforming the adjacent spinal cord. On comparison with the prior noncontrast C-spine MRI this lesion has probably not changed significantly in size.No other extra-axial or intra-axial lesions are appreciated. Brain parenchymal morphology is within normal limits. No evidence of concerning signal abnormally, edema or mass effect is detected. No abnormal extra-axial fluid or intracranial hemorrhage is observed. The ventricular system is normal in size and morphology.

Output: 1.A 10 x 8 mm extra-axial enhancing lesion is seen within the right lateral spinal canal at the C1 level compatible with the stated history of meningioma. This lesion impinges on the adjacent spinal cord. No significant interval change is suspected when compared to a prior examination from August 2015.2.The remainder of the examination is within normal limits. No additional intra-axial or extra-axial lesions are appreciated.