Instruction: Generate impression based on medical findings.

Input: Clinical question to be answered: Evaluate for epidural hematoma in an anticoagulated patient can't get an MRI. Signs and symptoms: Myelopathy. This examination was performed with contrast to evaluate for possible epidural process (abscess, hematoma). This examination is not the appropriate test and it may not visualize any of these abnormalities on this exam. This exam however was performed due to patient's inability to obtain an MRI. Advanced degenerative disk disease at C3 -- C4 and C4 and C5 levels are again identified. There is grade 1 retrolisthesis of C4 in respect to C5. There is reversal of cervical lordosis into kyphotic deformity centered at C3 -- C4 level.Axial and sagittal reformatted images demonstrate no definitive evidence of any abnormal enhancement within the epidural space in the cervical region from C2 through C7. Images below this level are even further obscured due to shoulder artifacts and nondiagnostic for any of the above clinical question concerns.Foramina magnum.Examination at this level is unremarkable.C2 -- C3. No central spinal stenosis or neural foramina compromise.C3 -- C4.Minimal compromise of bilateral neural foramina. Flattening and posterior displacement of the cord secondary to ventral hypertrophic changes. Borderline central spinal stenosis of 7.9-mm is suspected.C4 -- C5. Advanced degenerative disk disease and retrolisthesis. Central spinal stenosis of 6.6-mm is suspected. Compromise of bilateral neural foramina secondary to degenerative changes.C5 -- C6. Minimal degenerative changes. Suspected minimal left neural foramina compromise. No central spinal stenosis.C6 -- C7.No central spinal stenosis or neural foramina compromise.C7 -- T1.Examination at this level is unremarkable.100 cc of Omnipaque was utilized for the above study.

Output: 1.Extensive degenerative changes of cervical spine with multilevel neural foramina compromise and central spinal stenosis as detailed.2.Limited value examination for detection of epidural hematoma or abscess however no definitive finding to suggest either one of the above suspected clinical questions.A


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old, with NASH cirrhosis, complicated by hepatic encephalopathy on lactulose, still with mental slowing, particularly speech. Image quality is degraded on some sequences by motion artifact. Within this limitation, the following observations are made.Intrinsic T1 hyperintensity within the basal ganglia bilaterally, predominantly the globus pallidus, is unchanged from prior. There may in addition be scattered foci of intrinsic T1 hyperintensity within the white matter of the corona radiata and centrum semiovale which appears more prominent than on the prior examination.Patchy ill-defined T2 hyperintense lesions within the bilateral cerebral white matter are again seen. Accounting for imaging artifact and differences in technique, there does not appear to be any significant interval change.No evidence of significant parenchymal edema or mass effect is seen. No parenchymal restricted diffusion is detected. There is no evidence of acute intracranial hemorrhage or any abnormal extra-axial fluid collection. The ventricles are normal in size and morphology.The bone marrow of the calvarium demonstrates diffusely hyperintense signal on diffusion-weighted and FLAIR imaging, and diffuse enhancement on postcontrast sequences, findings which seem to have progressed slightly from the prior examination.

Output: 1.Intrinsic T1 hyperintensity within the basal ganglia, and also scattered through the cerebral white matter, is seen, likely related to chronic hepatic dysfunction. The signal abnormality has perhaps progressed within the cerebral white matter though technical differences could contribute to the apparent change.2.Scattered white matter T2 signal abnormalities are again seen without significant interval change. No evidence of parenchymal edema or mass effect is identified. No enhancing parenchymal or leptomeningeal abnormality is seen.3.The marrow of the calvarium demonstrates signal characteristics suggesting elevated cellularity or infiltration. The etiology of these findings is uncertain, though in the setting of anemia, marrow reconversion could produce these findings.


Instruction: Generate impression based on medical findings.

Input: History of liver transplant and previous stroke now presenting with headache. There is no evidence of acute ischemic or hemorrhagic lesions. There is a small area of high T2 signal in the left superior frontal gyrus subcortical white matter on as well as focal tissue loss on the right cerebellar hemisphere. There is trace nonspecific periventricular white matter T2 hyperintensity diffusely. The ventricles, sulci and cisterns are unchanged in size. There is no intracranial mass, mass effect, or midline shift. There is moderate mucosal thickening in the left maxillary sinus.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Chronic infarcts in the right cerebellar hemisphere and left superior frontal gyrus.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: 80-year-old male with pituitary adenoma. Assess for changes. Redemonstration of the lesion within the pituitary gland which is unchanged in size measuring 11 mm x 9 mm; the lesion is isointense on T1, mildly hyperintense on T2 and demonstrates minimal enhancement. The lesion abuts the left cavernous portion of the internal carotid artery by less than 180 degrees similar to prior study. The CSF space between the optic chiasm and the superior aspect of the pituitary gland is effaced on the left, also similar to prior study.Again seen are scattered periventricular and subcortical white matter T2 hyperintense foci which are partially imaged.

Output: Stable exam with unchanged pituitary microadenoma.


Instruction: Generate impression based on medical findings.

Input: Clinical question: 83-year-old male with multiple myeloma. Presents with low back pain. Rule out bony disease. Evaluate for degenerative disk disease. Signs and symptoms: Moderate to severe low back pain. Constipation. Nonenhanced CT of lumbar spine girl inaxial 3 -mm continuous CT images of the entire lumbosacral spine were obtained. Sagittal and coronal 2-D reformatted images were also obtained.Examination demonstrates severely osteopenic lumbosacral vertebral column. The alignment of the vertebral column is within normal limits. Partially visualized lower T10 vertebrae demonstrate extensive lytic changes which considering patient's history likely represents multiple myeloma. The alignment and morphology the vertebral column from T11 through L5 remains within normal. No evidence of a destructive bony lesion is identified.There is a large irregularly-shaped lytic lesion in the vertebral body of S1 on the left which is also suspected from a myoma. Very large similar lesions within bilateral iliac wings and the ala of the sacrum and is also present.There is no significant degenerative disk disease on this exam. There is mild to moderate degenerative changes of posterior elements of both facets and ligamentum flavum.There is no definitive bony central canal stenosis. There is highly suspected neural foramina compromise bilaterally at at L4 -- L5 level mild neural foramina compromise at L3 -- L4 is also suspected. No definitive neural foramina compromise at any other level.For more detailed evaluation of degenerative disk disease, central spinal stenosis or neural frontal compromise an MRI examination is recommended. MRI can also better visualized the extent of changes of multiple myeloma which due to very severe osteopenia may be difficult to assess on CT.

Output: 1.Severe osteopenia results in very poor visualization of bony structures of lumbosacral spine.2.There is a destructive lytic lesion in partially visualized vertebral body of T10.3.Large irregularly-shaped lytic lesion is noted involving the vertebral body of S1. Likely secondary to multiple myeloma.4.Extensive lytic changes of the iliac wings bilaterally (left greater than right cortical and central ala (left greater than right) consistent with patient's history of multiple myeloma.5.Mild degenerative disk disease and hypertrophic changes of posterior elements are noted. No evidence of any bony central canal stenosis. Mild compromise of bilateral neural foramina at L4 -- L5 and to a lesser degree at L3 -- L4 level is suspected.


Instruction: Generate impression based on medical findings.

Input: Reason: Right shoulder pain x 6months,no improvement with physical therapy, NSAIDS, evaluate for rotator cuff tear History: Right shoulder pain ROTATOR CUFF: Increased T2 signal within the anterior supraspinatus likely reflects tendinopathy. Subscapularis, infraspinatus and teres minor are intact.SUPRASPINATUS OUTLET: Mild edema and effusion at the acromioclavicular joints indicates mild osteoarthritis.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenoid labrum is grossly intact.BICEPS TENDON: Biceps tendon is intact ADDITIONAL

Output: 1.Supraspinatus tendinopathy.2.Mild acromioclavicular joint osteoarthritis.


Instruction: Generate impression based on medical findings.

Input: Gait abnormality The spinal cord has grossly normal signal characteristics and overall morphology. There is no compromise of the spinal cord. The vertebral bodies are appropriate in overall height. There is straightening with loss of normal thoracic kyphosis and lumbar lordosis. There are degenerative changes in the cervical spine from C3-C4 to C6-C7 with mild to moderate spinal canal stenosis related to small disc osteophyte complexes and ligamentum flavum thickening. There are also multilevel degenerative changes in the lumbar spine including disc extrusion at the L4-L5 level which appears to cause high-grade spinal canal stenosis and cauda equina nerve root compression.

Output: This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No cord compression is identified. There is however large disc extrusion at the L4-L5 level which appears to cause high-grade spinal canal stenosis and mass effect on the cauda equina nerve roots.Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine.


Instruction: Generate impression based on medical findings.

Input: 59-year-old male patient with ill-defined pancreatic lesion found on CT and jaundice. ABDOMEN:LIVER, BILIARY TRACT: There is hepatomegaly. There is questionable mild nodular contour of the liver suggestive of cirrhosis. The gallbladder is hydropic of uncertain etiology. The distal common bile duct is not well seen; a focal stricture is not excluded. However, no definite lesion is identified.SPLEEN: No significant abnormality noted.PANCREAS: There is a focus of increased T2 signal and corresponding signal void on subtraction sequences within the body of the pancreas (image 26, series 10) which most likely represents a sidebranch IPMN; this lesion correlation to finding made on prior CT exam. An additional small cystic focus is suggested in the pancreatic head. There is no significant pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: There is mild gastrohepatic, periportal and peripancreatic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.At least two cystic foci within the pancreas with imaging characteristic most characteristic of sidebranch IPMNs (larger of these corresponds to hypodensity seen on prior CT). 2.Hydropic gallbladder of uncertain etiology and poorly visualized distal common bile duct without definite obstructing lesion; a distal CBD focal stricture is not excluded, although CBD is normal in size. 3.Questioned mild cirrhotic morphology of the liver. Mild gastrohepatic, periportal and peripancreatic lymphadenopathy may be reactive in etiology.


Instruction: Generate impression based on medical findings.

Input: 53 year old female with worsening creatinine. Evaluate for any parenchymal abnormalities, nephrolithiasis or hydronephrosis. ABDOMEN:LIVER, BILIARY TRACT: Gallstones without evidence of acute cholecystitis. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Note is made of multiple subcentimeter foci of fluid signal intensity, particularly involving the cortex, which are too small to characterize, but likely represent simple cysts. There is a focus of increased T1 signal abnormality in inferior pole of the right kidney, which likely represents a complex/hemorrhagic cyst. No focal mass lesions are identified. The right kidney measures 9.9 cm in length. The left kidney measures 9.3 cm in length.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. No focal mass lesion, renal calculus or hydronephrosis is identified within the confines of a noncontrast examination.2. Gallstones without evidence of acute cholecystitis.


Instruction: Generate impression based on medical findings.

Input: History of renal cancer status post nephrectomy. Presents for surveillance scan. ABDOMEN:LIVER, BILIARY TRACT: Scattered subcentimeter T2 hyperintense hepatic foci are unchanged and are likely cystsSPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post right nephrectomy without evidence of local recurrence. No regional lymphadenopathy.The left kidney is normal in appearance without a suspicious lesion or hydronephrosis.RETROPERITONEUM, LYMPH NODES: Stable small retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.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 evidence of local recurrence or metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Prostate cancer status post prostatectomy. PSA 0.2. PELVIS:PROSTATE:Prostate Size: Status post prostatectomy. There is an approximately 0.9 x 0.6 cm focus of asymmetric abnormal signal at the vesicourethral anastomosis which demonstrates diffusion restriction, suspicious for recurrent or residual tumor (series 701, image 73).Peripheral Zone: Status post prostatectomy.Central Gland: Status post prostatectomy.Seminal Vesicles: Surgically removed.BLADDER: No significant abnormality noted.LYMPH NODES: No lymphadenopathy by size criteria.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Subcentimeter focus of abnormal signal at the vesicourethral anastomosis suspicious for recurrent or residual tumor.


Instruction: Generate impression based on medical findings.

Input: Female 43 years old Reason: Please follow protocol IRB # 14-0288. Rectal cancer, please assess disease state post Chemo, RECIST compare to previous MRI. Overall image quality: GoodPELVIS:UTERUS, ADNEXA: The rectal mass continues to abut the posterior cervix (image 41/series 6), suspicious for invasion.BLADDER: No significant abnormality noted. LYMPH NODES: Lymph nodes in the perirectal space, within the mesorectal fascia: None.Lymph nodes outside the mesorectal fascia: None.BOWEL, MESENTERY: Rectal Tumor:Size: 1.4 x 2.0 x 7.1 cm (image 41/series 6) (image 24/series 10)Tumor appearance on T2-weighted images: Circumferential tumor with large soft tissue component along the left aspect of the rectum.Tumor location: Extending from the anal verge 7.1 cm proximally, involving the rectum to the distalmost sigmoid colon.(For lower rectal tumors):Distance of the lower edge of the tumor to the anal verge (lower edge of the anal canal): 2.0 cmDistance of the lower edge of the tumor to the pelvic floor (relationship of the tumor to the anal sphincter complex): Extends from the anal sphincter proximally.Circumference of the rectum involved: Complete circumferential distally but proximally occupies 180 degrees along the left aspect.Relationship and proximity of the tumor to adjacent structures (uterus, cervix, vagina): There is invasion of the adjacent mesorectal fat and fascia as well as invasion into the posterior wall of the upper vagina and cervix (image 41/series 6) (image 22/series 10).MRI T-stage: T4 - Tumor invades adjacent organs, as described aboveTumor Distance to Mesorectal Fascia: 0 cm (image 22/series 10).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of free fluid, likely physiologic and similar to prior.

Output: 1.Decreased size and extent of the circumferential rectal adenocarcinoma, with continued invasion of adjacent vagina and cervix.2.No lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: The cerebellar tonsils lie 8-9 mm below the level of the foramen magnum and demonstrate a pointed morphology, consistent with Chiari I malformation.Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cervical and visualized upper thoracic cord are normal in signal without evidence of syrinx. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: UnremarkableC3/4: Minimal posterior osteophyte disc complex without stenosisC4/5: UnremarkableC5/6: Mild posterior osteophyte disc complex and bilateral uncinate hypertrophy. There is mild right neural foraminal and moderate to severe left neural foraminal stenosis.C6/7: UnremarkableC7/T1: Unremarkable. Note is made of partial fusion of the vertebral bodies posteriorly.

Output: 1.The cerebellar tonsils lie 8-9 mm below the level of the foramen magnum and demonstrate a pointed morphology, consistent with Chiari I malformation.2.C5/6: Mild right neural foraminal and moderate to severe left neural foraminal stenosis.


Instruction: Generate impression based on medical findings.

Input: 59-year-old male with elevated PSA, prior negative biopsy. PELVIS:PROSTATE:Prostate Size: 5.1 x 5.7 x 4.5 cm.Peripheral Zone: Midline utricle cyst measuring 8 x 8 mm (series 901, image 17). Linear T2 hypointensity throughout the peripheral zone may reflect the background of chronic prostatitis. There is a 1.2 x 1.3 cm T2 hypointense focus in the right base peripheral zone (series 901 image 17) with corresponding restricted diffusion (series 608 image 284).Central Gland: Severe degree benign prostatic hypertrophy. Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Dominant lesion in the right peripheral zone base measuring 1.2 x 1.3 cm, best characterized as PI-RADS 4.


Instruction: Generate impression based on medical findings.

Input: History of recurrent pancreatitis and known pancreatic divisum. Please perform secretin stimulation test. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in signal and morphology. No focal hepatic lesion. The hepatic arteries, hepatic veins, and portal veins are widely patent. No biliary ductal dilatation. There is an accessory right hepatic duct. The common bile duct measures 6 mm in diameter.SPLEEN: No significant abnormality noted.PANCREAS: There are findings of pancreatic divisum. The main pancreatic duct is nondilated. The duct has a tortuous course once it enters the pancreatic head and is narrowed prior to entering the minor papilla. The ventral duct is also nondilated.Following the administration of secretin, there is no change in duct caliber or extracranial function of the pancreas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Kidneys are normal in signal and morphology. No hydronephrosis. There is a left inferior pole simple 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.Pancreatic divisum without associated dilatation of the pancreatic ducts. The main pancreatic duct however becomes markedly narrowed prior to entering the minor papilla.2.No change in duct caliber or exocrine function of the pancreas following secretin administration.


Instruction: Generate impression based on medical findings.

Input: Left neck tail of parotid lesion. There is a heterogenous, but rather well-defined mass in the tail of the right parotid gland that measures up to 33 mm. There is an additional nodule more superiorly within the left parotid gland that measures up to 15 mm. The right parotid gland and bilateral submandibular glands are unremarkable. The imaged portions of the upper aerodigestive tract are unremarkable. There is no evidence of significant upper cervical lymphadenopathy. The imaged portions of the orbits and intracranial structures are unremarkable. There is fluid within the bilateral mastoid air cells, right more than left.

Output: A mass in the tail of the right parotid gland that measures up to 33 mm and an additional nodule more superiorly within the left parotid gland that measures up to 15 mm are compatible with Warthin tumors.


Instruction: Generate impression based on medical findings.

Input: Female, 22 years old, with weakness and paresthesias. Cervical spine: There are no enhancing lesions identified in the cervical spinal cord. There is no abnormal epidural or intrathecal enhancement. The cervical spine alignment remains anatomic. There is preservation of vertebral body heights. There is no abnormal enhancement of the bone marrow. The intervertebral disc heights are maintained. There is no evidence of significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.Thoracic spine: There are no enhancing lesions identified in the thoracic spinal cord. There is no abnormal epidural or intrathecal enhancement. The cervical spine alignment remains anatomic. There is preservation of vertebral body heights. There is no abnormal enhancement of the bone marrow. The intervertebral disc heights are maintained. There is no evidence of significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.Lumbar spine: There is a transitional lumbosacral segment with apparent partial sacralization of the L5 vertebra. The lumbar spine alignment is anatomic. There is preservation of the vertebral body heights. There is no abnormal marrow signal. The intervertebral disc heights and signal are maintained. There is normal morphology and signal of the distal spinal cord and conus medullaris. There is no abnormal intrathecal enhancement. There is no significant spinal canal or neural foraminal stenosis. The paravertebral soft tissues are unremarkable.

Output: No evidence of enhancing spinal cord lesions, spinal cord compression, or spine tumors.


Instruction: Generate impression based on medical findings.

Input: Knee pain for two years with clicking MENISCI: No significant abnormality noted. The menisci are intact and normal in appearance.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted. No focal areas of chondromalacia. Normal bone marrow signal throughout.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

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


Instruction: Generate impression based on medical findings.

Input: 56 years Male (DOB:11/17/1959)Reason: Patient with recurrent left sided neck and upper chest pain. Rule out cervical radiculopathy. History: Left sided neck and upper chest pain.PROVIDER/ATTENDING NAME: ELBERT S. HUANG ELBERT S. HUANG 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. There is multilevel disc desiccation present.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is a mild disc bulge present at this level.At C3-4 there is a small central disc protrusion present at this level which impresses on the ventral aspect of thecal sac and effaces spinal fluid ventral and posterior the spinal cord. Mild degree of spinal stenosis.At C4-5 there is a left paramedian disc extrusion present with disc material extending behind the adjacent endplate. This disc extrusion effaces spinal fluid ventral to the left hemicord and mildly displaces and compresses the left hemicord. There is a high signal focus on T2-weighted imaging within this disc extrusion.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a small right paramedian disc protrusion present at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.There is opacification of left mastoid air cells.

Output: 1.There is a mild to moderate degree of spinal stenosis present at C3-4 related to a central disc protrusion.2.There are some encroachment of the left hemicord at the C4-5 level related to a small disc extrusion.3.There is opacification of the left mastoid air cells which are incompletely visualized on this exam.


Instruction: Generate impression based on medical findings.

Input: 24 year old female. Nausea/vomiting. Family history of IBD. SBFT suggested separation of ileal bowel loops and distal ileal narrowing consistent with possible Crohn's. Colonoscopy was normal. Evaluate for small bowel Crohn's disease. 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: Normal course and caliber of the small bowel. No evidence of active or chronic inflammatory bowel disease.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: Normal course and caliber of the small bowel. No evidence of active or chronic inflammatory bowel disease.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of inflammatory bowel disease or other significant abnormality.


Instruction: Generate impression based on medical findings.

Input: The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. However the post-PICA left V4 segment is diminutive. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.MRA NECK

Output: 1. No evidence for acute ischemia.2. Numerous foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter as well as pons are nonspecific however may be related to chronic microvascular ischemic disease.3. MRA of the head and neck are negative for evidence of steno-occlusive disease, with limited evaluation of right common carotid origin.4. Left sphenoid sinus disease.5. Heterogeneous thyroid gland. Further evaluation with thyroid ultrasound may be considered as clinically indicated.


Instruction: Generate impression based on medical findings.

Input: 54-year-old female with history of right breast IDC and low grade DCIS status post lumpectomy in 2004. Patient received radiation, chemotherapy and hormonal therapy. Personal history of sarcoma and melanoma. Li Fraumeni. No current complaints. There is scattered fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. Mild post-surgical distortion in the right breast. No abnormal lymph nodes are identified in either axillary region.Multiple high signal lesions on T2 W sequence within the liver most likely hemangiomas or cysts.

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


Instruction: Generate impression based on medical findings.

Input: Elevated prolactin (128.90). The pituitary gland is not enlarged and there is no evidence of sellar lesions, although artifact partially obscures this region. The infundibulum is midline. The posterior pituitary bright spot is intact. The optic apparatus and cavernous sinuses are unremarkable. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is scattered paranasal sinus mucosal thickening.

Output: No definite evidence of pituitary lesions, although artifact partially obscures this region.


Instruction: Generate impression based on medical findings.

Input: Reason: R knee medial femoral condyle OCD lesion History: R knee pain/swelling MENISCI: The medial and lateral menisci appear intact.ARTICULAR CARTILAGE AND BONE: Again seen are four tubular fixation devices within the medial femoral condyle extending to the articular surface. The most anterior device appears to penetrate the anteromedial cortex with its end lying just deep to the medial patellofemoral ligament, but this is unchanged from the prior study. Marrow edema along these fixation devices appears less prominent on the current study than on the prior study. There is minimal heterogeneity of the articular cartilage as well as slight thinning of the cartilage along the anteriormost fixation device, but we see no full thickness fluid-filled defect. The articular cartilage of the lateral and patellofemoral compartments appears normal. LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: Again seen is thickening of the proximal patellar tendon, although signal abnormality within this portion of the tendon has normalized. This may reflect healing tendinosis or postsurgical changes. The quadriceps tendon is normal in appearance. ADDITIONAL

Output: Surgical changes of osteochondral defect fixation as described above with improving bone and soft tissue edema. Although there is minimal heterogeneity and thinning of the articular cartilage of the medial femoral condyle, we see no fluid-filled cartilage defect or other complication. Other findings as above.


Instruction: Generate impression based on medical findings.

Input: Cavernous malformation status post recent resection. There are recent postoperative findings related to left temporal craniotomy and transtentorial presigmoid resection of a left pontine cavernous malformation. There is an expected amount of extra-axial fluid in the surgical bed and diffuse dural enhancement. There is circumferential susceptibility effect along the margins of the left pons resection cavity. There is decreased mass effect upon the fourth ventricle and cerebral aqueduct, with resultant decreased dilatation of third and lateral ventricles. There is vasogenic edema in the posterior pons and superior left cerebellar hemisphere, but no evidence of territorial infarct. There is fluid and mucosal thickening in the right sphenoid sinus.

Output: Recent postoperative findings related to left pontine cavernous malformation with interval resolution of the obstructive hydrocephalus.


Instruction: Generate impression based on medical findings.

Input: 43-year-old female status post left mastectomy for invasive lobular carcinoma in May 2011 with axillary node metastases, followed by chemotherapy and radiation therapy. Family history of breast cancer in her paternal grandmother and two paternal aunts. Mild parenchymal enhancement is noted bilaterally. The patient is status post left mastectomy.No abnormal enhancement is seen in either the right breast or left chest wall. Stable enhancing foci are again noted in the right breast. No abnormal axillary lymph nodes are identified in either axillary region. Post-surgical change is seen in the left axilla.

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


Instruction: Generate impression based on medical findings.

Input: 68-year-old female with sciatica. Acute left L5 -- S1 pain status post lifting. The density of vertebral column is within normal limits. There is grade 1 anterolisthesis of L5 in respect to S1. No evidence of pars defect is detected.T12 -- L1.Examined this level is unremarkable.L1 -- L2. Moderate degenerative degenerative disk disease with broad-based bulge of disk material is noted. No neuroforamina compromise or central spinal stenosis.L2 -- L3.Degenerative disk disease with very broad based bulge of disk material at this level is present this is more pronounced on the right side and I cannot entirely rule out possibility of a herniated disk. No should be made that CT is not sensitive for the definitive detection of herniated disk. An MRI is recommended. There is compromise of the right neuroforamina and to a lesser degree left neuroforamina. No central spinal stenosis.L3 -- L4.Mild degenerative disk disease and hypertrophy changes of posterior elements are present. No definitive central spinal stenosis or neural foramina compromise.L4 -- L5. Moderate to advanced degenerative disk disease is present. Diffuse bulge of disk material causes flattening and posteriorly displaces the thecal sac. No definitive evidence of neural foramina compromise is identified. There is however bulge of the hypertrophied ligamentum flavum into the neuroforamina posteriorly. There is also compromise of the lateral recesses of the canal at this level secondary to combination of hypertrophic changes of posterior elements and bulging disk. No definitive central spinal stenosis.L5 -- S1.Advanced degenerative disk disease with significant vacuum phenomenon is noted. There is grade 1 anterolisthesis at this level. There is compromise of bilateral neural foramina are in an. There is diffuse pseudo-bulge of disk material. On this examination I cannot entirely rule out possibility of a herniated disk.

Output: Extensive degenerative changes of disk and posterior elements as detailed above.


Instruction: Generate impression based on medical findings.

Input: There are multiple, approximately 10, nodular and peripherally-enhancing lesions at the grey-white matter interfaces. For example, the largest infratentorial lesion measures up to 7 mm in the left middle cerebellar peduncle and the largest supratentorial lesion measures up to 8 mm in the right inferior frontal gyrus. There is negligible edema associated with the lesions. There is no evidence of intracranial hemorrhage or acute infarct. There is a small developmental venous anomaly along the inferior and anterior aspect of the right thalamus. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits and scalp soft tissues are grossly unremarkable. There are small mucous retention cysts in the bilateral maxillary sinuses.

Output: Multiple subcentimeter supratentorial and infratentorial lesions are compatible with intracranial metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Walking trouble, right leg weakness per history. Signs and symptoms: Spastic in legs and significant sensation loss. Nonenhanced brain MRI:Negative diffusion weighted series.Examination demonstrates diffuse patchy foci of flair and T2 hyperintensity primarily in the periventricular and to a lesser degree subcortical as well as bilateral basal ganglia, left thalamus and pons without associated susceptibility signal changes. Considering patient's stated age of 76 findings are highly suggestive of chronic nonhemorrhagic small vessel ischemic strokes of mild degree.The slight prominence of ventricular system as well as the cortical sulci although may be at the upper limits of normal possibly show mild underlying parenchymal volume loss is suspected.The signal voids of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses are within normal.Unremarkable images through the orbits, paranasal sinuses, mastoid air cells as well as calvarium and soft tissues of the scalp.Nonenhanced cervical MRI:There is generalized smaller size of the spinal canal which is suspected to represent a congenital anatomical variation.There is mild to moderate degenerative changes of cervical spine however with normal alignment. Mild straightening of cervical lordosis is noted.Foramen Magnum demonstrate mild hypertrophy changes of posterior elements and ligamentous hypertrophy and including the posterior longitudinal ligament. Findings results in mild spinal stenosis at this level.C2 -- C3 demonstrate mild degenerative changes, mild central spinal stenosis and no neural foraminal compromise.C3 -- C4 demonstrate moderate loss of disk height, shallow centrally located osteophyte which results in slight flattening and deformity of the ventral aspect of the cord. There is mild central spinal stenosis and moderate right neural foraminal compromise.C4 -- C5 demonstrate mild disk disease with loss of disk height, broad-based central disk protrusion which in combination with moderate ligamentum flavum hypertrophy and congenitally small canal results in significant flattening deformity of the cord and central spinal stenosis. There is significant right and moderate left neural foraminal compromise at this level also. On sagittal T2 series there is suggestion of very subtle increased T2 signal intensity of the cord which could represent edema or myelomalacia.C5 -- C6 demonstrate minimal degenerative changes of the disk and facets as well as ligamentum flavum which in combination with congenitally narrow canal results in mild to moderate central spinal stenosis and moderate left and mild right neural foraminal compromise.C6 -- C7 demonstrate mild disk disease with loss of disk height shallow broad based bulge of disk and mild hypertrophic changes of posterior elements. There is resultant mild central spinal stenosis and mild bilateral neural foraminal compromise.C7 -- T1 is unremarkable.Uppermost visualized thoracic spine through T3 are unremarkable.

Output: 1.Nonenhanced head brain MRI demonstrates no acute intracranial process. Findings suggestive of mild chronic nonhemorrhagic small vessel ischemic strokes as detailed. Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells.2.Non-enhanced MRI of the cervical spine demonstrate generalized uniform smaller than expected caliber of the spinal canal suggestive of a congenital anatomical variation. Degenerative changes of cervical spine in combination with congenitally small canal results in multilevel central spinal stenosis and multilevel bilateral neural foraminal compromise (some significantly) as detailed per level. Spinal stenosis is most severe at C4 -- C5 and with resultant significant flattening deformity of the cord. There is suspected T2 hyperintensity of the cord at this level which could represent an cord edema on or myelomalacia. Please see detailed report above.


Instruction: Generate impression based on medical findings.

Input: Male 56 years old. Reason: s/p fall 3 wks ago with pelvic fx on MRI; assess for healing. History: improving pain A single AP view of the pelvis shows a nondisplaced fracture of the inferior ramus of the right pubic bone. The fracture line is indistinct which may represent some healing. Additional obturator ring fractures seen on prior MRI are not clearly visualized on the current study.There is disruption of the right first sacral arcuate line corresponding to the nondisplaced sacral ring fracture on MRI.Mild osteoarthritis affects both hips. There is degenerative disk disease of the lumbar spine.

Output: Pelvic fractures as described above, some of which are not well seen on this radiograph compared to the previous MRI.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Thoracic or lumbosacral neuritis or radiculitis, unspecifiedClinical question: lumbar radiculopathy, please compare to uploaded outside studySigns and Symptoms: lumbar radiculopathy bilaterally Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge present at this level which is unchanged since the previous exam. There is only partial effacement of the fat at the lateral recess bilaterally at this level. There is a right far lateral disc protrusion present at this level which was also present on the prior exam and is unchanged.At L4-5 there is loss of disc space height, disc desiccation and a diffuse disc bulge eccentric towards the left associated with mild ligamentum flavum hypertrophy. There is effacement of the fat surrounding the nerve roots at the left lateral recess and to a slightly lesser degree right lateral recess. These findings are stable compared to the prior exam.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is a moderate degree of facet hypertrophy present at this level associated with subtle 1 to 2 mm anterior subluxation of L3 and L4. These findings are stable compared to the prior exam.At L2-3 there is a moderate degree of facet hypertrophy present associated with subtle 1 to 2 mm anterior subluxation of L3 and L4. There is a diffuse disc bulge present at this level as well as ligamentum flavum hypertrophy. There is triangulation of the thecal sac. There is a 2 mm left-sided ligamentum flavum cyst present which is stable since the prior exam These findings are stable compared to the prior exam.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There are multilevel degenerative changes present in the lumbar spine worse at L4-5 where there is a mild degree of spinal stenosis. These findings are stable compared to the prior exam.2.There is very mild anterior subluxation of L3 on L4 and L4 on L5 present related to degenerative changes. These findings are stable compared to the prior exam.


Instruction: Generate impression based on medical findings.

Input: Low back pain Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits aside from minimal retrolisthesis of L3 on L4. Bone marrow signal is benign including fatty endplate marrow signal changes at the L5-S1 level which are on a degenerative basis. The conus medullaris is normal in position.Multilevel degenerative changes are seen including disc desiccation from L2-L3 to L5-S1 with mild to moderate disc height loss at the L5-S1 level.Additional levels as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Mild disc bulge eccentric to the right. Mild facet arthropathy. There is mild right neural foraminal stenosis. No spinal canal or left neural foraminal stenosis.L3-L4: Mild disc bulge slightly eccentric on the left. Mild facet arthropathy. There is mild left neural foraminal narrowing. No spinal canal or right neural foraminal stenosis.L4-L5: Disc bulge with small left foraminal protrusion. There is also moderate bilateral facet arthropathy. No significant spinal canal stenosis. There is mild to moderate left neural foraminal stenosis. Minimal right neural foraminal narrowing.L5-S1: Disc bulge and moderate facet arthropathy. No spinal canal stenosis. Mild bilateral neural foraminal stenosis. Paraspinous soft tissues are within normal limits.

Output: 1. Multilevel degenerative changes in the lumbar spine without significant spinal canal stenosis at any level. 2. Overall relatively mild neural foraminal stenosis at multiple levels as detailed above.3. Prominent facet arthropathy at the L4-5 and L5-S1 levels which may be contributing to patient's low back pain.


Instruction: Generate impression based on medical findings.

Input: 55-year-old female with low back pain and left hip pain The density and the alignment the vertebral column remains within normal limits. No significant degenerative disk disease is identified. There is however mild degree of degenerative disease at L5 -- S1 level. No evidence of spinal stenosis at any level.No evidence of central spinal stenosis or neural foramina compromise from T12 -- L1 through L3 -- L4 level.L4 -- L5.Minimal degenerative disk disease and hypertrophic changes of posterior elements are noted. Minimal bulge of disk material is present. Laterally within the neural foramina and far laterally there is broad-based bulge of disk material and a more focal area of disk protrusion. This is highly suspected of a large herniated disk. This finding is best appreciated on axial image 57 and 58. Lateral to the disk a prominent soft tissue density (axial image 55) is identified. This finding may represent inflamed and swollen nerve root or a migrated disk fragment laterally. I recommend further evaluation with an MRI examination or a post infusion study to exclude possibility of a mass. There is only minimal compromise of the left neuroforamina secondary to above findings. The right neuroforamina is patent and no central spinal stenosis is detected.L5 -- S1.Moderate degree of degenerative disk disease with a sclerotic changes of endplates are noted. No central spinal stenosis or neural foramina compromise. Mild bulge of disk material is also present.

Output: 1.Suspected large herniated disk at L4 -- L5 laterally and far laterally as detailed.2.Prominent soft tissue density adjacent to the disk at this same location may be represent a swollen nerve root or a mass. Further evaluation with a dedicated post infused MRI or a post infusion CT to exclude presence of the mass is recommended.3.No evidence of central spinal stenosis or neural foramina compromise at any other level.


Instruction: Generate impression based on medical findings.

Input: 27-year-old male with pain and effusion. Evaluate for soft tissue injury or meniscal injury. MENISCI: There is linear increased signal abnormality within the posterior horn of the medial meniscus which extends to the femoral articular surface consistent with a horizontal tear. There is blunting of the body of the meniscus suggesting extension of the aforementioned tear. The anterior horn appears intact. There is increased signal abnormality within the body of the lateral meniscus which is slightly blunted suggestive of fraying/tearing of the free edge of the body of the meniscus. The posterior and anterior horns appear intact.ARTICULAR CARTILAGE AND BONE: There is subchondral edema within the posterior aspect of the medial tibial plateau which may represent a contusion. There is also increased bone marrow signal abnormality within the lateral femoral condyle and posterior aspect of the lateral tibial plateau also consistent with contusions. There is a focal full-thickness articular cartilage defect along the weightbearing surface of the lateral femoral condyle, above the body of the meniscus, with underlying subchondral signal abnormality.LIGAMENTS: There is rupture of the proximal and mid substance fibers of the ACL. The PCL appears intact. The MCL and LCL appear intact.EXTENSOR MECHANISM: The Insall-Salvati ratio measures 1.3 suggesting patella alta. The tibial tubercle to trochlear groove distance is within normal limits. The extensor mechanism appears intact.ADDITIONAL

Output: 1. Tearing of the medial meniscus.2. Fraying/tearing of the free edge of the body of the lateral meniscus.3. Rupture of the ACL.4. Large joint effusion and focal articular cartilage defect along the lateral femoral condyle as well as other findings as described above.


Instruction: Generate impression based on medical findings.

Input: New upper extremity numbness. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Spine: There are postoperative findings related to cord detethering and scoliosis surgery. The spinal cord is low lying, with the conus medullaris extending to the level of the inferior L3 vertebra. The previously demonstrated thin linear T1 hyperintensity along the filum terminale is not discernible due to the limited technique. There is no evidence of syringohydromyelia. There is mild thoracolumbar dextroscoliosis. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis.

Output: 1.No acute cerebral infarct or mass.2. Scoliosis and persistently low-lying conus medullaris, but no evidence of spinal cord compression or syringohydromyelia. 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: History of metastatic melanoma with brain metastasis treated with CTX: visual changes and headaches. There is a cystic tumor with a heterogeneously enhancing mural nodule in the left occipital lobe and surrounding vasogenic edema that measure up to 45 mm. There is a cystic tumor with a heterogeneously enhancing mural nodule and layering susceptibility effect from hemorrhage in the left cingulate gyrus and surrounding vasogenic edema that measures up to 17 mm. There is a heterogeneously enhancing tumor in the left postcentral gyrus with surrounding vasogenic edema that measures up to 10 mm with surrounding vasogenic edema. There is a cystic tumor with heterogeneous mural nodule with surrounding vasogenic edema that spans the right occipital and parietal lobes and measures up to 42 mm. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There is no evidence of acute infarction. There is a left maxillary retention cyst. There are post-operative findings related to left posterior parietal craniotomy. The orbits are grossly unremarkable.

Output: Multiple brain metastases, including a tumor in the left occipital lobe that measure up to 45 mm, a tumor with layering hemorrhage in the left cingulate gyrus that measures up to 17 mm, a tumor in the left postcentral gyrus that measures up to 10 mm, and a tumor that spans the right occipital and parietal lobes and measures up to 42 mm. While the lesions are associated with vasogenic edema, there is no midline shift.


Instruction: Generate impression based on medical findings.

Input: 37-year-old female with history of endoscopic repair of CSF leak an encephalocele repair. Rule out subdural hemorrhage. The area of low attenuation in the right frontal lobe is again seen. This could represent vasogenic edema, however, to exclude other etiologies, contrast enhanced CT or MRI should be performed. Previous area of high attenuation in the right frontal lobe is less conspicuous. There is no new additional evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. Post-surgical changes with sinus opacity of the sphenoid, right ethmoid, and maxillary sinuses. Right-sided frontal sinuses are also opacified. The mastoid air cells are normally pneumatized.

Output: Area of low attenuation in the right frontal lobe could represent vasogenic edema, though other etiologies should be excluded on MRI or contrast enhanced CT.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Klippel-Feil syndrome and neck pain with syrinx, evaluate for change. Signs and symptoms: Yearly evaluation. Nonenhanced cervical MRI:There is revisualization of a stable few is right arch of C1 bone and with intravenous increased bony volume/hypertrophy similar to prior exam. There is mild dorsiflexion of the dens with resultant effacement of ventral subarachnoid space and mild mass effect and posterior displacement of the cervical medullary junction of the cord without central spinal stenosis or interval change since prior exam.The alignment of vertebral column and 8 signal intensity remains within normal and stable since prior study.Impression there is a uniform thin linear increased T2 signal intensity traversing the entire cervical cord and into the upper visualized thoracic cord identical to prior exam. Findings could represent central canal or less a nonexpansile syrinx. The caliber of the cord remains within normal for age and without detectable signal abnormality otherwise.There is no evidence of spinal canal or neural foraminal compromise at any level.Unremarkable paraspinal soft tissues.Nonenhanced thoracic MRI:Examination demonstrates normal signal intensity and alignment of vertebral column without detectable congenital anatomical anomaly.There is no evidence of a spinal canal or neural foraminal compromise.There is a mildly expansile syrinx of thoracic cord identical to prior exam and extending from C5-C6 disc level inferiorly to mid T9 level without evidence of interval change in extent or size since prior study. The finding measures maximum of 2.5 mm in transverse axis. The nonexpansile and segmental syrinx extends superiorly to the cervical cord and inferiorly to approximately T12 similar to prior exam.No detectable paraspinal abnormalities and unremarkable signal intensity of the cord otherwise.

Output: 1.No evidence of an acute or new finding since prior study.2.Revisualization of fusion of the right arch of C1 with the occipital bone.3.Revisualization of syrinx of cervical and thoracic cord measuring maximum of 2.5 mm in short segmental expanded thoracic component of syrinx and approximately 1 mm in the nonexpansile component of syrinx similar to prior exam.


Instruction: Generate impression based on medical findings.

Input: Headache for 3 weeks. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is a right parietal lobe developmental venous anomaly. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and mastoid air cells are grossly unremarkable. There is a small left maxillary retention cyst. There is also a subcentimeter low signal nodule in the left occipital scalp, which may represent an epidermoid.

Output: Incidental right parietal lobe developmental venous anomaly, but no evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on medical findings.

Input: Patient with history of stenosis presenting with severe right-sided lumbar radiculopathy. The axial T1-weighted images are degraded by patient motion. There is multilevel degenerative spondylosis. At L1-L2, there is hypertrophy of ligamentum flavum and degenerative facet joint disease without significant spinal canal or neural foraminal stenosis. There is mild loss of intervertebral disc space at this level. At L2-L3, there is mild facet joint degenerative disease without significant spinal canal or neural foraminal stenosis. At L3-L4, there is thickening of the ligamentum flavum, facet joint hypertrophy, and epidural lipomatosis, resulting in severe spinal canal and mild right neural foraminal narrowing. At L4-L5, there is loss of disc height with mild disc bulging, ligamentum flavum thickening, facet joint hypertrophy, and epidural lipomatosis, resulting in moderate to severe central spinal canal stenosis and moderate bilateral neural foraminal narrowing. At L5-S1, there are mild disc herniations, prominent ligamentum flavum thickening, facet joint hypertrophy, and epidural lipomatosis, resulting in moderate right and severe left neural foraminal narrowing. There are endplate degenerative bone marrow signal alterations and scattered areas of fatty marrow at multiple levels of the lumbar spine. The imaged portions of the spinal cord are unremarkable. The lumbar spine alignment is anatomic and the vertebral body heights are preserved. The paraspinal soft tissues are unremarkable. There is nodularity of the left adrenal gland.

Output: 1. Multilevel degenerative spondylosis and epidural lipomatosis, with marked narrowing of the spinal canal at L3-4 through L5-S1 and variable degrees of neural foraminal narrowing.2. Nonspecific nodularity of the left adrenal gland, which can be further evaluated via dedicated imaging.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: Redemonstrated is a 13 x 15 x 11 cm enhancing mass arising from the left ICA with extension to the left CPA most compatible with a vestibular schwannoma. There is no significant mass effect on the adjacent brain stem. No evidence of a high riding jugular bulb or aberrant course of the ICA. Normal sigmoid sinus.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There is no midline shift or herniation. The pituitary gland is normal in size. There are no extraaxial fluid collections or subdural hematomas. The paranasal sinuses and mastoid air cells are clear.

Output: Left CPA mass, compatible with a vestibular schwannoma.


Instruction: Generate impression based on medical findings.

Input: Clinical question to be answered: Evaluate for etiology of new onset of severe headaches and epistaxis. Signs and symptoms: Complains a one week history of severe headaches No evidence of hemorrhage, edema, mass effect, midline shift or hydrocephalus. Cortical sulci, ventricular system and CSF cisterns remain within normal. There is apparent crowding of cerebellar tonsils at the level foramen magnum which may represent ectopia of the cerebellar tonsils. This finding can be further evaluated with an MRI exam. Calvarium is intact. Mastoid air cells and limited view of paranasal sinuses are unremarkable.

Output: Negative CT of brain for any acute findings. Possible ectopic cerebellar tonsils as detailed.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o medial meniscus History: left knee pain MENISCI: There is mild increased signal within the posterior horn of the medial meniscus which suggests intrasubstance degeneration, but we see no medial meniscal tear. The lateral meniscus appears normal.ARTICULAR CARTILAGE AND BONE: Minimal signal heterogeneity of the patellofemoral articular cartilage suggests minimal degeneration but we see no fluid-filled defects. Bone marrow signal intensity is normal. LIGAMENTS: The cruciate and collateral ligaments appear normal. EXTENSOR MECHANISM: The quadriceps and patellar tendons appear normal. There is mild edema of the quadriceps fat pad, which is of questionable clinical significance.ADDITIONAL

Output: Minimal signal heterogeneity of the cartilage of the patellofemoral articulation. Mild edema of the quadriceps fat pad, which is of questionable clinical significance. We see no meniscal tear or other finding to account for the patient’s pain.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old. Knee injury. Suspected patellar dislocation. MENISCI: There is mild fraying of the menisci, medial greater than lateral, without discrete tear identified.ARTICULAR CARTILAGE AND BONE: There are high-grade focal cartilage defects of the lateral patellar facet and patellar apex on the background of severe generalized thinning, without significant underlying bone marrow signal abnormality. There is also mild to moderate diffuse thinning of the medial and lateral femoral condyles without focal cartilage defects. Bone marrow signal is normal.LIGAMENTS: Cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1.Severe cartilage thinning of the patella with full-thickness defects involving the apex and lateral patellar facet. Mild diffuse cartilage loss elsewhere in the knee.2.Mild meniscal fraying, without meniscal tear identified.3.Moderate joint effusion.


Instruction: Generate impression based on medical findings.

Input: T4aN2cMx cancer of the oral cavity. There is an infiltrative oral tongue mass that spans the midline and measures up to approximately 5 cm. The tumor extends along the anterior floor of mouth and gingiva, with invasion of the mandible. The tumor does not invade the masticator space, pterygoid plates, or skull base. There is no evidence of internal carotid artery encasement. There are multiple abnormal suprahyoid lymph nodes bilaterally. For example, a right level 1 lymph node measures 29 x 49 mm in axial cross-section and a left level1 lymph node measures 11 x 20 mm in axial cross-section. The right submandibular gland is compressed and perhaps even invaded by the adjacent lymphadenopathy. The other salivary glands are intact. The thyroid gland is unremarkable. There is multilevel degenerative cervical spondylosis. The imaged intracranial structures are unremarkable.

Output: 1. The oral cavity squamous cell carcinoma measures up to 5 cm and involves the oral tongue, the anterior floor of mouth, and gingiva, with invasion of the mandible. 2. Multiple bilateral suprahyoid lymph nodes are compatible with metastases.


Instruction: Generate impression based on medical findings.

Input: Pituitary lesion, 3month follow. Some of the images are degraded by patient motion. There is considerable interval decrease in size of the pituitary gland, which now measures up to 5 mm in craniocaudal dimension, without residual T1 hyperintensity. There is no mass effect on the cavernous sinuses or optic apparatus. There is encephalomalacia in the right occipital lobe and left basal ganglia with hemosiderin deposition. There is diffuse cerebral volume loss and scattered patchy cerebral white matter T2 hyperintensity. There are bilateral maxillary sinus retention cysts. There is a partially imaged T2 hyperintense nodule in the left parotid gland.

Output: 1. Interval resolution of prior pituitary apoplexy, without evidence of gross sellar tumor. Otherwise, assessment is limited by the lack of intravenous contrast and motion.2. Chronic infarcts in the right occipital lobe and left basal ganglia superimposed upon chronic small vessel ischemic disease.3. Partially imaged nonspecific nodule in the left parotid gland. Dedicated parotid imaging may be useful for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Cervical radicular pain after whiplash. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. No evidence of ligamentous injury. No hematomas involving the spinal canal. The cervical spinal cord has normal signal characteristics and overall morphology.Minimal degenerative changes are present in the cervical spine with mild multilevel disc desiccation as well as mild ligamentum flavum thickening at the C4-C5, C5-C6, and C6-C7 levels. There are minimal disc bulges at C3-C4, C4-C5, and C5-C6 levels. There is a small corticated ossification involving the posterior aspect of the right C5-C6 facet joint which may be related to remote trauma and present on recent CT cervical spine from 1/6/2016. No associated edema. Tiny perineural cysts incidentally noted at the left C3-C4 level.Individual levels as below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: 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.

Output: No evidence of ligamentous injury in the cervical spine. Minimal degenerative changes are seen without evidence of spinal canal or neural foraminal stenosis at any level in the cervical spine.


Instruction: Generate impression based on medical findings.

Input: 47-year-old BRCA mutation carrier presents for MRI screening study. History of bilateral breast cancer status post right lumpectomy in 2003 for invasive ductal carcinoma and left lumpectomy in May 2012 for invasive ductal carcinoma. Patient received radiation and chemotherapy. Family history of breast cancer in two sisters, maternal grandmother, maternal aunt and cousin. No current breast related complaints. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Stable post-surgical changes in both breasts, and stable fibroadenolipoma in the left breast.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on medical findings.

Input: 23 years, Female, Reason: h/o GVHD of the liver with persistent cholestasis. Evalaute liver and biliart tract History: same. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, 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 significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Normal MRCP


Instruction: Generate impression based on medical findings.

Input: 36 are old male with progressive left hip pain with history of car accident. There is linear increased signal abnormality traversing the anterior superior labrum at the 2 o'clock position indicating a tear. Additionally, there is heterogeneous signal abnormality traversing the posterosuperior labrum at the 10 o'clock position also suspicious for a tear. There is a small amount of fluid within the joint without evidence of a large effusion. The imaged musculature of the left hip is normal in appearance. There is peritrochanteric increased signal abnormality on fluid sensitive sequences with associated enhancement on postcontrast sequences with foci of low signal internally indicating a mild bursitis. The bone marrow signal abnormality is within normal limits.

Output: 1. Tearing of the acetabular labrum as described above.2. Findings consistent with a mild trochanteric bursitis.


Instruction: Generate impression based on medical findings.

Input: Cirrhosis and ascites. Evaluate for tumor versus bland portal vein thrombus. Outside hospital biopsy revealing hepatocellular carcinoma. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology with left and caudate lobe hypertrophy with a nodular contour.A discrete nodule adjacent to the IVC measures 3.4 x 3.1 cm and demonstrates faint arterial enhancement, washout and capsule formation compatible with hepatocellular carcinoma. Otherwise, the liver is diffusely heterogeneous. No additional discrete arterial enhancing lesion is seen on post contrast images however there are multiple discrete washing out lesions on portal venous and delayed phase imaging involving both the right and left hepatic lobe. Additional some of these lesions have faint T2 weighted hyperintensity, loss of signal on out-of-phase imaging and suggestion of capsule formation. There is a filling defect in the anterior division of the right portal vein. Although there is no vessel expansion or definite enhancement of the thrombus given the suspected extensive disease, tumor thrombus is nevertheless not entirely excluded.Trace perihepatic fluid.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: Lobular right cardiophrenic lymph node measuring 1.3 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cirrhosis with heterogeneous liver appearance. Suspected infiltrative HCC involving the right hepatic lobe and multiple satellite lesions in the left hepatic lobe given the degree of heterogeneity and several well-defined lesions seen on delayed phase imaging with associated faint T2-weighted hyperintensity, intracellular fat and suggestion of capsule formation - although not strictly meeting imaging criteria for HCC; multiple regenerative nodules is possible but less likely. There is a lesion adjacent to the IVC which meets imaging criteria for HCC. Correlate with site of and findings from patient's outside biopsy.2. Thrombus within the anterior division of the right portal vein. No vessel expansion or definite enhancement of the thrombus favors bland thrombus. In the setting of diffuse infiltrative HCC, tumor thrombus is not entirely excluded.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for rotator cuff tear and labral tear History: shoulder pain for a year or more with pain radiating to biceps ROTATOR CUFF: The supraspinatus, infraspinatus, teres minor, and subscapularis muscles and tendons are intact without evidence of tearing or tendinopathy. SUPRASPINATUS OUTLET: There is a tiny amount of fluid in the subacromial bursa. There is no specific evidence of rotator cuff impingement. GLENOHUMERAL JOINT AND GLENOID LABRUM: The anterior and posterior glenoid labrum appear intact without evidence of tearing. BICEPS TENDON: The long and short head of the biceps tendon are intact. ADDITIONAL

Output: Tiny amount of fluid in the subacromial bursa. Otherwise normal MR arthrogram of the shoulder.


Instruction: Generate impression based on medical findings.

Input: Reason: research History: new prostate cancer axial PELVIS:PROSTATE:Prostate Size: 4.6 x 2.3 x 3.3 cmPeripheral Zone: There is a lesion in the left apex measuring 11 x 8 mm which is dark on T2/ADC with early enhancement and washout, suspicious for prostatic adenocarcinoma. An additional lesion in the left paramedian mid gland measures 6 x 4 mm and is dark on T2/ADC. This lesion does not definitely exhibit early enhancement and washout and is considered indeterminate.Central Gland: No significant abnormalitySeminal Vesicles: No significant abnormalityExtracapsular Extension: NoneBLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Left apical lesion is suspicious for prostatic adenocarcinoma.2.Left paramedian mid gland lesion is considered indeterminate.3.No lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old, with metastatic lung cancer, surveillance imaging. At the site of the previous small enhancing lesion along the right superior frontal sulcus, only a focus of susceptibility is now evident. No residual enhancement is seen. A nonspecific enhancing focus within the left frontal bone is unchanged.No new pathologic intracranial enhancement is seen. No evidence of parenchymal edema, mass effect or diffusion restriction is detected. Scattered small foci of FLAIR hyperintensity within the cerebral hemispheres are nonspecific and unchanged. Ventricular size and morphology remain within normal limits.

Output: Since the prior examination, enhancement related to the lesion along the right superior frontal sulcus has resolved. There is a small focus of susceptibility at this location. No new intracranial metastases are detected. An enhancing focus within the left frontal lobe is unchanged and nonspecific.


Instruction: Generate impression based on medical findings.

Input: Female, 3 years old, with infantile cerebral palsy. Evaluate for structural lesions. Former ex 23 week preemie. The corpus callosum is fully formed though it appears generally thinner than expected for age. The pattern of white matter myelination, on the other hand, does appear to be mature.The pituitary region is unremarkable. The brainstem, cerebellar vermis and cerebellar hemispheres are unremarkable. Prominence of the prepontine cistern is likely a congenital variant.No evidence of parenchymal edema or mass effect is seen. No restricted diffusion is detected. There is no evidence of any significant intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is within normal limits for size.

Output: 1.The corpus callosum is generally thinner than expected for age which may reflect either failure to properly developed or some degree of white matter loss.2.No other structural lesions or significant findings are seen to account for the patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: 74-year-old female with a L2 radiculopathy. Evaluate for stenosis. Better seen on the recent lumbar CT are postsurgical changes of a spinal fusion at the L4-5 levels with bilateral pedicle screw fixation and paraspinous rods.The vertebral body heights are maintained. There is grade 1 retrolisthesis of L2 on L3. There is multilevel disc desiccation and disc height loss with multilevel endplate degenerative changes and Schmorl's nodes. The distal spinal cord and conus demonstrate normal signal in morphology. The paravertebral soft tissues are unremarkable.Degenerative changes are visualized in the lower thoracic spine with Schmorl's nodes and mild endplate degenerative changes at the T11-12 level.Degenerative changes are seen in the cervical spine as described below:T12-L1: Tiny disc bulge without spinal canal or neuroforaminal stenosis.L1-L2: Small disc bulge and mild facet arthropathy without spinal canal or neuroforaminal stenosis. L2-L3: Grade 1 retrolisthesis of L2 on L3 and facet arthropathy. Moderate to severe bilateral neural foraminal stenosis and mild to moderate spinal canal stenosis. There is soft tissue material effacing the right L2-3 foramen and the right L2-3 lateral recess. This material is adjacent to both the disc and the facet/ligamentum flavum.L3-L4, L4-5: Posterior spinal fusion hardware artifact precludes evaluation at this level.L5-S1: Full evaluation is limited by presence of hardware artifact. There does not appear to be significant spinal canal stenosis.

Output: 1.Postsurgical changes of a posterior spinal fusion at the L4-5 level. Note that hardware artifact limits evaluation from L3 through L5.2.Grade 1 retrolisthesis of L2 on L3 contributes to moderate to severe bilateral neural foraminal stenosis and mild to moderate spinal canal stenosis.3.Soft tissue material effaces the right L2-3 foramen and the right L2-3 lateral recess. This material may originate from the disc or the adjacent facet/ligament complex. This could represent a disc extrusion or sequestered disc, epidural scarring or an atypical synovial cyst.


Instruction: Generate impression based on medical findings.

Input: Mother with history of brain aneurysm. Patient with history of headaches. MRI BRAIN: The cerebellar tonsils extend approximately 19 mm below the level of the foramen magnum. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. MRA HEAD: The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.

Output: 1. Cerebellar tonsils extend 19 mm below the level of the foramen magnum, consistent with Chiari 1 malformation. There is no evidence for ventriculomegaly on this exam.2. No evidence of intracranial hemorrhage, mass, or acute infarct.3. No evidence of intracranial stenosis or aneurysm.


Instruction: Generate impression based on medical findings.

Input: VT Left VentricleThe left ventricle is normal size. The overall LV ejection fraction is 54%, the LV end diastolic volume index is 72 ml/m2 (normal range: 65+/-11), the LVEDV is 125 ml (normal range 109+/-23), the LV end systolic volume index is 34 ml/m2 (normal range 18+/-5), the LVESV is 58 ml (normal range 31+/-10). There are no regional wall motion abnormalities present. . There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal. Right VentricleThe right ventricle is normal . The overall RV ejection fraction is 55%, the RV end diastolic volume index is 80 ml/m2 (normal range 69+/-14), the RVEDV is 138 ml (normal range 110+/-24), the RV end systolic volume index is 36 ml/m2 (normal range 22+/-8), and the RVESV is 62 ml (normal range 35+/-13). Right AtriumThe right atrium is normal. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation, but the severity of aortic regurgitation can be underestimated by the MRI pulse sequence used in this study.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation, but the severity of mitral regurgitation can be underestimated by the MRI pulse sequence used in this study.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation, but the severity of pulmonic regurgitation can be underestimated by the MRI pulse sequence used in this study.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation, but the severity of tricuspid regurgitation can be underestimated by the MRI pulse sequence used in this study.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 dilated. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac Findings . This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal LV size with lower normal LV systolic function.2. Normal RV systolic function, no evidence for ARVD.3. No evidence for delayed myocardial enhancement.


Instruction: Generate impression based on medical findings.

Input: Ms. Cooney is a 55 year old female with a personal history of basal cell carcinoma at age 40 years and a strong family history of breast and other cancers. Her mother had breast cancer at the age of 48 years. Her father had colon cancer at the age of 72 years, prostate cancer at 74 years and melanoma at 82 years. Her maternal aunt had breast cancer at 70 years. Her maternal grandmother had breast and ovarian cancer. Her maternal and paternal grandfathers had leukemia. The patient has a history of bilateral breast reduction in 2011. Mild parenchymal enhancement is noted bilaterally. Scattered fibroglandular tissue is present.RIGHT BREAST - Within the superolateral right breast, there is a tortuous ectatically dilated duct identified with increased T1 signal, consistent with proteinaceous fluid. At the terminal end of this duct, within the right nipple, is an irregular enhancing mass measuring 0.9 x 0.8 x 0.7 cm. These findings are highly suspicious for an intraductal mass with associated intraductal dilatation. LEFT BREAST - There is no abnormal enhancement identified within the left breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: (1) Suspected intraductal mass with associated dilatation in the right superior breast. An MR-directed US is recommended for further evaluation of these findings. If a suspicious sonographic correlate is identified, an US-guided biopsy may be recommended at that time.(2) No MR evidence of malignancy in the left breast.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required.


Instruction: Generate impression based on medical findings.

Input: Relapsed mul multiple myeloma, status post fall. Evaluate for fracture or mass. Five lumbar type vertebral bodies are present. Vertebral body heights are within normal limits. There is minimal L5-S1 retrolisthesis, alignment is otherwise maintained. Small osseous lesions are again seen such as at the dorsal L3 vertebral body compatible with known myeloma. L2 lesion with T1 hyperintensity most compatible with a benign hemangioma. No large lesions or compression fractures.There is extensive enhancing epidural tissue surrounding the lower thoracic cord extending superiorly outside the field-of-view and extending inferiorly to the upper L3 level. The more bulky component is at L1 and L2 levels. There is partial encasement of the lower thoracic cord, conus, as well as the cauda equina with mass-effect and leftward displacement. There is mild T2 hyperintensity within the visualized conus with swelling. There is soft tissue within the right T12-L1, L1-L2, and L2-L3 neural foramina. There is right paraspinous mass which is in contiguity with the epidural and right neural foramina tumor. The mass extends along the enlarged right psoas muscle inferiorly. There is T2 hyperintensity/edema involving the inferior aspect of the right psoas muscle which may be reactive.Degenerative changes are also seen in the lumbar spine with disk desiccation at L5-S1. There is moderate right and mild left L4-L5 neural foramina stenosis and mild to moderate right and mild left L5-S1 neural foramina stenosis related to disk bulge and facet arthropathy. No spinal canal stenosis is seen inferior to the mid L3 level.

Output: 1. Small osseous lesions in the spine and pelvis consistent with known multiple myeloma. No large lesions or compression fractures. Burden of osseous lesions can be correlated with prior PET studies. 2. Extensive epidural enhancing soft tissue with mass effect on the conus and upper cauda equina nerve roots extending inferiorly to the mid L3-level is most consistent with neoplasm. Please refer to separate thoracic spine MRI report for superior extent of tumor. Tumor extends to involve the right T12-L1, L1-L2, and L2-L3 neural foramina. There is also a right paraspinous mass which is in contiguity with the epidural and right neural foramina tumor. The mass extends along the enlarged right psoas muscle inferiorly with superimposed hemorrhagic psoas component not excluded.3. Edematous appearance of the conus with T2 hyperintensity. 4. Please refer to separate reports for findings in the pelvis as well as cervicothoracic spine. Findings of most likely epidural tumor at the thoracolumbar junction were discussed with Dr. Ramos (Neurosurgery) at 10 am on 1/22/2015.


Instruction: Generate impression based on medical findings.

Input: 72-year-old woman with remote history of breast cancer, now with increased tone in the upper extremities, pain, and decreasing ambulation. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. The cervical spinal cord has grossly normal signal characteristics and overall morphology. Poorly characterized degenerative changes are seen in the cervical spine. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1.Examination severely limited by patient motion despite attempts to repeat after sedation.2.No gross evidence of tumor or cord pathology.3.Multilevel degenerative disc disease, poorly characterized.


Instruction: Generate impression based on medical findings.

Input: H/o brain tumor. S/p biopsy. Examination demonstrates postsurgical change including a Burr hole in the right frontal bone. Again, a hypoattenuating mass is seen in the right frontal lobe with extension into the genu of corpus callosum and left anterior frontal lobe and mass effect on the right frontal horn. Please refer to the previous MRI for the measurements. No evidence of intracranial hemorrhage is identified. The ventricular size has been stable.

Output: Frontal tumor. Interval postsurgical change with no intracranial hemorrhage.


Instruction: Generate impression based on medical findings.

Input: Retroclival mass is better assessed on recent cervical spine MRI dated 3/25/2016. Images of the thoracic spine again demonstrate postoperative changes of laminectomy and posterior spinal fusion from T3 to T6. Susceptibility artifact limits evaluation of the surrounding structures. Compared to prior thoracic spine study dated 9/18/2015 there is slight increase in size of enhancing dural based mass with low T2 signal extending from T1 to the T4 levels. The increased thickening measures for example approximately 7 mm at the T2 level, previously 6 mm, and approximately 8-9 mm at the T3-4 level, previously 4 mm (measured in the sagittal plane). Craniocaudal extent is not significantly changed. There is slight increase in effacement of the dorsal thecal sac and anterior displacement of the cord. There is up to mild to moderate spinal canal stenosis at the T2 and T3-T4 levels. No evidence of frank cord compression or cord signal abnormality.There is trace grade 1 anterolisthesis of T2 on T3 which is unchanged. Exaggeration of the thoracic kyphosis is again seen. Mild multilevel degenerative changes are again seen including disc desiccation at multiple levels and small disc bulges involving the lower thoracic spine. There is no significant associated spinal canal or neural foraminal stenosis.

Output: Compared to prior thoracic spine MRI study dated 9/18/2015, there is slight increase in dorsal dural-based thickening involving the upper thoracic spine suspected to represent mild progression of known idiopathic pachymeningitis. There is associated increase in effacement of the dorsal thecal sac without evidence of high-grade spinal canal stenosis or cord signal abnormality.


Instruction: Generate impression based on medical findings.

Input: 38-year-old male with right upper weakness status post transoral resection of pituitary adenoma Restricted diffusion with matching ADC hypointensity, T1 hypointensity, and T2 hyperintensity is noted involving the leftward mid brain including the left cerebral peduncle. Changes from transsphenoidal surgery are again noted with residual pituitary mass containing central hemorrhagic products with upper bowing the optic apparatus, grossly unchanged from the recent postoperative pituitary MRI given the current brain acquisition technique. The ventricular system is unremarkable. There are no extra-axial fluid collections. Expected vascular flow voids are demonstrated.

Output: Acute to subacute ischemia involving the leftward mid-brain including the left cerebral peduncle. Results were discussed with the emergency room team caring for the patient on 8/5/2016 at 1:18 PM.


Instruction: Generate impression based on medical findings.

Input: 43-year-old male with history of renal cell carcinoma status post partial nephrectomy. ABDOMEN:LIVER, BILIARY TRACT: Hepatic steatosis. No focal liver lesions. No intrahepatic or extrahepatic biliary ductal dilatation. Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Interval decrease in size of a partially exophytic right interpolar kidney T2 hyperintense cyst. No hydronephrosis.Post changes of the partial left nephrectomy. Retroaortic left renal vein.RETROPERITONEUM, LYMPH NODES: Scattered right mesenteric lymphadenopathy is not significantly changed when compared to the prior exam.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Postsurgical appearance of a partial left nephrectomy without evidence of recurrent or metastatic disease.2.Hepatic steatosis.


Instruction: Generate impression based on medical findings.

Input: Unspecified fever [780.60] Motion artifact degraded image quality.In addition, FLAIR imaging was not completed specifically, the FLAIR imaging on the covered skull base to the level of midbrain. Therefore, if indicated, the study should be repeated without additional charge.On covered imaging, there is no evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Examination can be repeated without additional charge due to incomplete examination with the motion artifacts as described above.No evidence of acute ischemic or hemorrhagic lesion.No remarkable finding otherwise.


Instruction: Generate impression based on medical findings.

Input: 89 years Female (DOB:11/16/1926)Reason: eval for organic causes of seizure PROVIDER/ATTENDING NAME: TIEN S DONG EVAN H. LYON The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There are several punctate foci of susceptibility effect and subcortical white matter predominantly in the right hemisphere. Additional punctate foci of signal hypointensity on susceptibility imaging are identified in the cerebellum and left internal capsule.There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Some scattered punctate foci of signal hyperintensity are present in the brainstem.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 partial opacification of the right maxillary sinus with a small air-fluid level. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Periventricular and subcortical white matter lesions of a moderate degree and a few punctate lesions in the brainstem are nonspecific. At this age they are most likely vascular related. 2.No evidence for acute cerebral ischemic infarction.3.No abnormal enhancing mass lesion is appreciated within the brain parenchyma to explain patient's seizures.4.Multiple microhemorrhages in the right hemispheric subcortical white matter and cerebellum are nonspecific in distribution.5.Examination is somewhat compromised due to patient motion artifact which may obscure more subtle abnormalities6.Opacification of the right maxillary sinus with a small air-fluid level is present most likely is inflammatory in nature. The possibility of a superimposed acute sinusitis cannot be excluded. Another possibility is that this represents retained secretions. Please correlate with clinical symptoms.


Instruction: Generate impression based on medical findings.

Input: Morbid obesity. Preoperative evaluation for bariatric surgery. Exam limited by patient body habitus.RIGHT LOBE MEASUREMENTS: 4.7 x 1.9 x 1.9 cmLEFT LOBE MEASUREMENTS: 5.0 x 2.0 x 2.5 cmISTHMUS MEASUREMENTS: 0.8 cmRIGHT LOBE: Parenchyma is diffusely heterogeneous. No dominant nodules.LEFT LOBE: Parenchyma is diffusely heterogeneous. There is a isoechoic 1.5 x 1.5 x 1.3 cm nodule located at the lower pole.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Diffusely heterogeneous thyroid with solitary nodule in the left lower lobe.


Instruction: Generate impression based on medical findings.

Input: 18-year-old female with locked left knee. Several sequences are limited by patient motion artifact.MENISCI: We see no bucket handle tear. The anterior horn of the medial meniscus divides into two separate structures at its root, which could conceivably represent a chronic vertical tear, although we suspect this represents normal variant anatomy for this patient. ARTICULAR CARTILAGE AND BONE: We see no fluid-filled articular cartilage defects. There is moderate synovitis of the knee, particularly posteriorly with a joint effusion concentrated anteriorly in the knee. Multiple foci of rounded and bandlike low signal intensity in the suprapatellar pouch and also in the posterior knee may represent a combination of thickened synovial folds and debris, although we see no discrete articular cartilage defect. There is mild irregularity of the posterolateral surface of the lateral femoral condyle, which may represent early erosion. There also appear to be small erosions around the margin of the tibial plateau. There is mild marrow edema underlying these suspected erosions. LIGAMENTS: Cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: 1.Surgical changes of prior arthroscopy.2.Synovitis of the knee with what appear to be small erosions. This may represent an inflammatory arthritis or less likely synovial chondromatosis. Conventional radiographs are recommended for further evaluation.3.No bucket handle tear is evident. Other findings as above.


Instruction: Generate impression based on medical findings.

Input: Reason: left knee pain, evaluate for medial meniscus tear, chondral damage History: left knee pain MENISCI: There is mild intrasubstance degeneration of the posterior horn of the medial meniscus along with very mild surface irregularity along the undersurface fibers near the free edge likely representing fraying, but we see no fluid-filled or unstable-appearing tear. There is intrasubstance degeneration of the body of the meniscus as well. The anterior horn appears intact. There is minimal intrasubstance degeneration of the lateral meniscus which otherwise appears intact.ARTICULAR CARTILAGE AND BONE: There is near full-thickness to full-thickness degeneration of the articular cartilage of the patella along the median eminence and medial facet with underlying degenerative subchondral signal abnormality. There is also perhaps mild thinning of the articular cartilage of the lateral facet of the patella and femoral trochlea. There is focal full-thickness degeneration of the articular cartilage of the lateral tibial plateau, posteriorly, with degenerative signal abnormality in the underlying subchondral bone. The medial compartment articular cartilage appears relatively preserved.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Cartilage degeneration particularly affecting the undersurface of the patella. The medial compartment cartilage appears relatively spared.2. Mild intrasubstance degeneration of the menisci and possible fraying of the posterior horn of the medial meniscus, but no fluid-filled or unstable tear is evident.3. Mild edema within the lateral head of the gastrocnemius may represent a strain.