Instruction: Generate impression based on medical findings.

Input: Osteomyelitis First ray: Normal marrow signal. A small lobulated tarsometatarsal joint focus of low T1/high STIR signal is identified at the and MTP joint which may reflect a small amount of joint fluid or cystic structure however this is incompletely characterized on this exam..Second ray: Normal marrow signal.Third ray: Normal marrow signal.Fourth ray: Normal marrow signal.Fifth ray: There has been amputation of the fifth ray to the level of the mid metatarsal diaphysis. Although there is soft tissue ulceration to the level of the surgical margins, the margins margins appear sharp and there is no definite evidence of residual osteomyelitis given the absence of discrete low T1 signal intensity. Increased STIR signal is noted within the remaining metaphysis which may be reactive in nature given the recent surgery. There is ill-defined heterogeneous signal intensity within the surgical bed containing areas of increased T1 signal. This may in part represent a postsurgical hematoma but absent intravenous contrast, it cannot be further characterized.There is mild diffuse subcutaneous edema particularly within the plantar soft tissues. Within the limits of this exam, there is no discrete fluid collection.

Output: Surgical changes of fifth ray amputation to the level of the mid metatarsal diaphysis. There is no definite evidence of residual osteomyelitis but close follow-up is recommended.


Instruction: Generate impression based on medical findings.

Input: Right ataxia. There are T2 hyperintense lesions within the left midbrain, pons, bilateral basal ganglia, as well as the bilateral cerebral hemisphere white matter, predominantly in a periventricular distribution. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. There are secretions in the right sphenoid sinus. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: 1. Bilateral basal ganglia and thalamic and right pons chronic lacunar infarcts and a background of chronic cerebral white matter small vessel ischemic disease, but no evidence of acute infarction.2. Findings suggestive of acute right sphenoid sinusitis.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old. SLE, dermatomyositis, reactive arthritis. Now with R ankle ulcer with cellulitis. There is ulceration of the skin and subcutaneous fat lateral to the distal fibula with inflammation of the adjacent soft tissues. However, we see no well-defined or rim-enhancing fluid collection to indicate an abscess. The inflammation extends to the peroneal musculature, but the peroneal muscles and tendons appear intact, as do the remaining tendons. We see no marrow signal abnormality to indicate osteomyelitis. Additional edema and mild diffuse enhancement is noted within the medial subcutaneous fat of the ankle as well as along the dorsum of the ankle. A small amount of fluid is noted in the tibiotalar, talonavicular, and subtalar joints, not necessarily of any clinical significance. The visualized ligaments are within normal limits. There is a small amount of fluid at the knot of Henry, also of doubtful clinical significance.

Output: Soft tissue ulceration and inflammation without osteomyelitis.


Instruction: Generate impression based on medical findings.

Input: Reason: questioning status of Prostate cancer History: Prostate Cancer, no pathology reports or PSA is available at the time of this study. PELVIS:PROSTATE:Prostate Size: 5.0 x 3.5 x 3.9 cm.Peripheral Zone: There is focus of low T2 (series 401 image 84) and ADC (series 508 image 404) signal at mid base of right peripheral zone. While this is immediately adjacent to central zone, this region is asymmetric, and is intermediate suspicion for malignancy.Central Gland: Large nodule in the transition zone of the prostate gland measuring 2.2 x 2.3 cm that is hypoattenuating on ADC (series 508 image 324) and T2 (series 401 image 70) sequences with early enhancement. There is mild displacement of the intraprostatic urethra towards the right from this lesion. However, the margins of this lesion is well-defined and may represent stromal hyperplastic nodule.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.2.3 cm early enhancing nodule in the left transition zone as above. This may represent stromal hypoplastic nodule given well-defined margins but remain PI-RADS 2.2.Tiny focus in the right peripheral zone, correlation with PSA or biopsy result is recommended. This lesion is intermediate for malignancy, PI-RADS 3. Consider targeted biopsy or follow-up MRI to ensure stability. PI-RADS™ v2 Assessment Categories:PIRADS 1 – Very low (clinically significant cancer is highly unlikely to be present) PIRADS 2 – Low (clinically significant cancer is unlikely to be present)PIRADS 3 – Intermediate (the presence of clinically significant cancer is equivocal)PIRADS 4 – High (clinically significant cancer is likely to be present) PIRADS 5 – Very high (clinically significant cancer is highly likely to be present)https://www.acr.org/~/media/ACR/Documents/PDF/QualitySafety/Resources/PIRADS/PIRADS%20V2.pdf


Instruction: Generate impression based on medical findings.

Input: 28-year-old female with a history of ACL reconstruction. Evaluate lateral meniscus. Presents with right knee pain. MENISCI: There is increased signal abnormality within the posterior horn of the lateral meniscus which may represent prior tearing or postsurgical change from prior partial meniscectomy, appearing similar to the prior study. There are no fluid filled defects to confirm a retear. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is partial-thickness articular cartilage degeneration along the weightbearing surface of the lateral femoral condyle above the posterior horn of the meniscus. There is superficial fraying of the articular cartilage of the weightbearing surface of the medial femoral condyle. The patellofemoral articular cartilage appears intact. There are tricompartmental osteophytes.LIGAMENTS: Note is made of postsurgical changes of prior ACL graft reconstruction. The ACL graft appears intact. There is low signal intensity along the anterior aspect of the mid substance fibers of the ACL graft which may represent anterior arthrofibrosis versus synovitis. Lobulated fluid signal intensity along the posterior aspect of the proximal fibers of the graft which may represent mucoid degeneration versus ganglion formation. The PCL appears intact. The LCL and MCL appear intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Postoperative changes of ACL graft reconstruction. The ACL graft appears intact. Low signal intensity abnormality along the anterior aspect of the graft may represent anterior arthrofibrosis versus a synovitis. Lobulated fluid signal intensity along the posterior aspect of the graft may represent mucoid degeneration versus ganglion formation. 2. Mild osteoarthritic changes of the knee. 3. Nonspecific subcutaneous edema along the anterior aspect of the knee.


Instruction: Generate impression based on medical findings.

Input: Left sided stroke: Right hemiparesis. Brain MRI: There are areas of gyriform restricted diffusion and high T2 signal in the left parietal lobe adjacent to an underlying area of encephalomalacia, with associated cortical laminar necrosis and probable chronic microhemorrhages. There are also punctate foci of cortical and subcortical restricted diffusion and high T2 signal in the left frontal lobe. There is a background of mild scattered cerebral white matter T2 hyperintensity without restricted diffusion, which may represent chronic small vessel ischemic disease. There is no evidence of intracranial hemorrhage or mass. 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.Brain MRA: There is lack of flow-related enhancement of the imaged portions of the left internal carotid artery. There is reconstitution of flow in the left middle and anterior cerebral arteries at the circle of WIllis. The right vertebral artery appears to terminate as the PICA. There is a fetal right PCOM. The other cerebral arteries are unremarkable and there is no evidence of saccular aneurysms. Neck MRA: There is lack of enhancement through the left internal carotid artery. There is mild narrowing of the origin of the right internal carotid artery. The right vertebral artery is diminutive. The other portions of the major cervical arteries are intact.

Output: 1. Acute areas of infarction involving the left parietal and frontal lobes, mainly in a watershed distribution superimposed upon a chronic left parietal lobe infarct. 2. Significant steno-occlusive disease at the origin of the left internal carotid artery.


Instruction: Generate impression based on medical findings.

Input: Female 71 years old Reason: Right shoulder pathology, possible rotator cuff. ROTATOR CUFF: There is intermediate signal intensity within the supraspinatus tendon indicating moderate-severe tendinosis with extension to both articular surfaces suggesting surface fraying. While we see no discrete fluid-filled full-thickness rotator cuff tear, there is a linear focus of high signal intensity within the proximal supraspinatus tendon extending to the bursal surface best seen on the sagittal oblique sequence, compatible with a bursal surface tear. Furthermore, low signal intensity undersurface fibers of the tendon appear to end abruptly approximately 1.5 cm proximal to their expected site of attachment on the greater tuberosity, suggesting delamination and retraction. Small foci of fluid signal intensity within the distal supraspinatus tendon at its insertion represent small interstitial insertional tears with possible extension to the bursal surface on the anterior cuts. There is mild fatty atrophy of the supraspinatus muscle. There is tendinosis of the infraspinatus with mild interstitial tearing along the myotendinous junction but no full-thickness tear. Mild fatty atrophy of the infraspinatus muscle. The teres minor muscle and tendon are unremarkable. There is increased signal intensity within the superior fibers of the subscapularis tendon at its insertion compatible with partial thickness undersurface tear. The subscapularis muscle is unremarkable.SUPRASPINATUS OUTLET: Mild osteoarthritis of the acromioclavicular joint. Small amount of fluid within the subacromial/subdeltoid bursa containing intermediate signal intensity, presumably representing debris/synovitis.GLENOHUMERAL JOINT AND GLENOID LABRUM: Normal alignment of the glenohumeral joint. Given the limitations of this non-arthrographic study, the labrum appears normal for age.BICEPS TENDON: Thickening and increased signal intensity within the long head of biceps tendon at its transition from rotator interval to the intertubercular sulcus, indicating mild tendinosis. The tendon is also slightly perched upon the lesser tuberosity. ADDITIONAL

Output: 1. Rotator cuff tendinosis and partial thickness tears as described above most severely affecting the supraspinatus tendon.2. Osteoarthritis of the acromioclavicular joint.3. Mild tendinosis of the biceps tendon which appears slightly perched along the lesser tuberosity.4. Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Myelination is normal for age. Ventricular size is normal. No midline shift. No evidence of bleed, mass effect, or edema. There is no abnormal signal in the T2 and FLAIR images.There are no evidence of acute ischemic or hemorrhagic lesion on this scan.Flow voids of the cerebral and the visualized internal carotid arteries are within normal limits.

Output: No evidence of acute ischemic or hemorrhagic lesion on this scan.


Instruction: Generate impression based on medical findings.

Input: Right shoulder pain Evaluation of the shoulder is limited by metallic susceptibility artifact from orthopedic anchor from prior rotator cuff repair. Evaluation is also limited by patient motion artifact particularly on the sagittal sequences.ROTATOR CUFF: The rotator cuff insertion is obscured secondary to metallic susceptibility artifact. There is fluid signal intensity proximal to the cuff insertion and the distal supraspinatus tendon is ill-defined. These findings are concerning for a full-thickness tear of the supraspinatus near the insertion with retraction and possible scar replacement. Fluid signal intensity is also identified within the intrasubstance of the infraspinatus tendon which likely reflects extension of tearing. Increased signal intensity is also present within the insertional fibers of the subscapularis concerning for interstitial an insertional tearing. The visualized teres minor tendon appears intact. There is severe fatty atrophy of the supraspinatus and infraspinatus muscles. There is also fatty atrophy of the superior fibers of the subscapularis and along the myotendinous junction. The teres minor muscle is normal.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. There is a small amount of fluid within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The humeral head is slightly high riding in relation to the glenoid fossa. Moderate osteoarthritis affects the glenohumeral joint and there is degeneration and degenerative tearing of the anterior and superior labrum. There is a small amount of fluid within the glenohumeral joint.BICEPS TENDON: There is fluid signal intensity within the intrasubstance of the biceps tendon within the intertubercular groove. More proximally, the intra-articular portion of the biceps tendon is not well seen which may relate to tearing. ADDITIONAL

Output: 1. Chronic rotator cuff tears and muscle atrophy as detailed above.2. Osteoarthritis of the glenohumeral and acromioclavicular joints.3. Tearing of the intra-articular portion of the biceps tendon.


Instruction: Generate impression based on medical findings.

Input: Left knee pain following fall one year ago The examination is limited by patient motion artifact. Furthermore, due to the patient's body habitus, the high-resolution coil could not be used; an alternative coil was used which results in slightly suboptimal image quality. The sagittal PD sequence was not obtained secondary to extensive patient motion.MENISCI: Evaluation of the menisci is limited due to reasons provided above. Within the limits of the exam, there are no findings to suggest an unstable meniscal tear.ARTICULAR CARTILAGE AND BONE: Evaluation of the articular cartilage is limited due to the reasons provided above. Subjectively, there is mild diffuse thinning of the articular cartilage of the medial compartment although we see no fluid-filled articular cartilage defects. Mild subchondral degenerative marrow signal is also noted within the medial condyle anteriorly. There appears to also be slight lateral subluxation of the patella in relation to the femoral trochlea.LIGAMENTS: The mid to distal fibers of the anterior cruciate ligament are poorly defined, with intermediate signal intensity. Although this could reflect mucoid degeneration, it could also reflect sequela of an old tear which has undergone subsequent scarring. There are no bony contusions to suggest an acute ACL tear. There is also thickening and longitudinally-oriented increased signal within the PCL which we suspect reflects the sequela of prior injury. The lateral collateral ligament proper appears slightly thickened which may reflect prior sprain. The remaining collateral ligaments are intact.EXTENSOR MECHANISM: A small focus of increased signal is noted within the quadriceps tendon at its insertion on the patella, suggesting mild tendinosis. There is no fluid filled tear identified. The patellar tendon is intact. There is linear low signal intensity within the subcutaneous fat anterior to the patella which may reflect the sequela of chronic bursitis/scarring.ADDITIONAL

Output: 1. Abnormalities of the both the ACL and PCL thought to represent the sequela of old tears. We see no bone contusions to suggest acute ligamentous tears.2. Mild degeneration of the articular cartilage of the medial compartment.3. Small joint effusion and Baker's cyst.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old, with Chiari malformation and pseudotumor cerebri, VA and LP shunts, six month follow-up. Evidence of suboccipital craniectomy and resection of the posterior C1 arch is again seen for Chiari decompression. The shape and positioning of the cerebellar tonsils are unchanged from prior.Minimal nonspecific T2 hyperintensity along the body of the right lateral ventricle is unchanged. No other new or significant parenchymal lesions are seen. No mass effect or edema is detected. No abnormal collections are noted. The previously seen minimal cerebral convexity subdural effusions are not well visualized on today's examination. The ventricular system is stable and normal in size.

Output: 1.Demonstration of findings compatible with surgical Chiari decompression. The cerebellar tonsils are stable in shape and positioning.2.No new or acute intracranial abnormalities.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Intracranial hemorrhage, fracture. Signs and symptoms: Head trauma. Nonenhanced CT brain:Diffuse area of encephalomalacia in the left frontal, temporal, parietal lobes with ex vacuo dilatation of the left lateral ventricle is consistent with an old stroke. This examination is otherwise unremarkable and in particular no evidence of acute intracranial process is detected.There is a slight widening of calvarium on the left side believed to be secondary to underlying parenchymal volume loss. Area of sclerotic change of the squamosal portion of left temporal bone may also be result of intracranial process however possibility of fibrous dysplasia should be considered. Visualized paranasal sinuses and mastoid air cells are unremarkable. There is no definitive abnormality of soft tissues of the scalp.Nonenhanced CT of cervical spine:The alignment of cervical spine remains within normal limits.There is no definitive evidence of fracture or malalignment. Advanced degenerative disk disease with large anteriorly projecting osteophytes at C3 -- C4 through C6 -- C7 levels are present. At C5 -- C6 within the anteriorly projecting osteophytes and lucent line is identified. Remote possibility of fracture of this osteophyte cannot be ruled out. There is no detectable soft tissue abnormality associated with this finding. Correlated with physical exam and direct palpation and if clinical concern persists a follow-up with an MRI is recommended.

Output: 1.No evidence of acute intracranial or calvarial pathology.2.Large area of encephalomalacia in the left frontal, temporal and parietal lobes with resultant ex vacuo dilation of left lateral ventricle.3.Calvarial changes secondary to significant left hemispheric parenchymal volume loss is evident by thickening of calvarium on the left. Focal area of fibrous dysplasia of the squamosal portion of the left temporal bone.4.No definitive evidence of fracture of the cervical spine. Lucent line traversing the anterior osteophyte at C5 -- C6 likely not a fracture. Please correlate with history and if clinical concern persists follow-up with an MRI is recommended.


Instruction: Generate impression based on medical findings.

Input: 46-year-old male with history of testicular cancer. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Reason: new or active MS lesions? History: Worsened L-sided spasticity MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. These appear to be stable. There is subtle gyral signal hyperintensity in the left middle frontal gyrus present identified on FLAIR MRI image #27.There is redemonstration of foci of signal hyperintensity centered in the globus pallidi(5mm on the left and 3mm on the right) - image #15 of coronal T2, image #16 on axial T2 and image #17 on FLAIR with signal loss on T1 - image #17. There is no associated contrast enhancement. It is stable since 2011.No abnormal enhancing mass lesions are appreciated within the brain parenchyma. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.A cystic lesion in the high occipital scalp tissues at the junction with parietal scalp along the midline is likely a pilonidal cyst.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI orbits:The eyeballs are intact. No intraconal or extraconal space mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. There is no optic nerve enhancement appreciated. The suprasellar cistern is intact .Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. There is multilevel disk dessication present.There is abnormal signal and loss of volume along the left posterolateral aspect of the spinal cord from the T2-3 to the T3-4 disk space levels. There is no associated contrast enhancement in the cervical spinal cord.No abnormal enhancing lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a small centra disk protrusion at this level.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a disk bulge at this level with associated endplate osteophytes.At C5-6 there is loss of disk space height, disk dessication and a disk bulge at this level associated with posterior ligamentous hypertrophy, bilateral uncovertebral osteophytes and endplate osteophytes. There is effacement of spinal fluid ventral and posterior to the cord. There is encroachment of the exiting nerve roots at this level.At C6-7 there is no significant compromise to the spinal canal . There is a left lateral disk protrusion at this level encroaching on the left exiting nerve roots at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. The LVA is larger than the RVA.

Output: 1.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They are stable. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific. 2.The globus pallidus lesions are present but stable since the prior exam. Because the globus pallidi are vulnerable to metabolic abnormalities and many systemic or generalized disease processes and underlying metabolic or toxic (carbon monoxide fore example) process may be considered. Please correlate with the patient's clinical history.3.There is a spinal cord lesion present extending from the C2-3 disk level to the C3-4 disk level. This is compatible with demyelination.4.There are degenerative changes present in the cervical spine with moderate spinal stenosis at C5-6 and encroachment of the exiting nerve roots bilaterally at C5-6 and on the left side at C6-7.5.There is no evidence for optic neuritis identified based on this exam and no evidence for active MS in the brain, optic nerves or cervical spinal cord based on the lack of contrast enhancement.


Instruction: Generate impression based on medical findings.

Input: HPV+ T3N2b left tonsillar SCC, on OPTIMA clinical trial induction then RT alone from 11/23/15-12/24/15. There are treatment effects in the left oropharyngeal region. However, there is no residual measurable tumor in the left tonsillar fossa. There is no residual significant cervical lymphadenopathy. The parotid, submandibular, sublingual, and thyroid glands are unremarkable. The cervical arterial flow voids are grossly intact. There is mild degenerative spondylosis of the cervical spine. There is scattered paranasal sinus mucosal thickening. There is a right subacromial bursa effusion. The orbits and imaged intracanal structures are unremarkable. Thre is mild mucosal thickening in the right maxillary sinus. There are nodular lesions in the imaged portions of the lungs.

Output: 1. Post-treatment findings without evidence of residual or recurrent tumor in the oropharynx and no significant residual cervical lymphadenopathy.2. Nodular lesions in the imaged portions of the lungs may be related to sarcoidosis. Please refer to the separate chest CT report for additional details.


Instruction: Generate impression based on medical findings.

Input: There is an approximately 74 CC x 50 AP x 70 ML mm encephalocele containing brain tissue covered in dura herniating through a large occipital calvarial defect. At least 50% or more brain tissue appears to have herniated through the calvarial defect. The head appears proportionally smaller than normal.The lateral ventricles are not normally formed, however there may be a rudimentary/dysmorphic lateral ventricles in the herniated portion of the brain. Dysmorphic cerebellar tissue is suspected on some images within the inferior portion of the encephalocele with a possible rudimentary fourth ventricle. The brainstem is not well depicted, and the origin of the cervical spinal cord is not clearly seen, though it may arise within the encephalocele. A normal interhemispheric falx and corpus callosum are not identified.There is apparent signal abnormality in the superficial soft tissues of the lower lumbar/sacral region posterior to the spine best seen on series 3 image 21 and series 8 image 22. Imaging quality is suboptimal at least partly due to technical constraints including fetal movement, among other factors. However, this abnormality may correlate with a suspected spine abnormality on prior fetal ultrasound. These findings may represent spinal dysraphism with possible meningocele/lipomeningocele or perhaps myelomeningocele.The remaining spinal canal appears grossly well-formed.

Output: 1. Large occipital encephalocele containing more than half of the brain tissue with dysmorphic appearance of the brain as described above.2. Finding suggesting lumbar/lumbosacral dysraphism, as questioned on the prior fetal ultrasound. Superimposed meningocele/myelomeningocele are not excluded.


Instruction: Generate impression based on medical findings.

Input: Female 18 years old Reason: Evaluate for abnormality in the location of mass/pain History: Persistent right subcostal pain and mass ABDOMEN:LIVER, BILIARY TRACT: The liver parenchyma demonstrates homogeneous signal intensity, and no focal mass lesions are identified. No intrahepatic or extrahepatic biliary ductal dilatation is present. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis or hydroureter is seen. The bilateral renal parenchyma shows normal signal intensity.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: A skin marker was placed in the area of palpable abnormality. The chest wall soft tissues are normal in appearance and no abnormal enhancement is evident. The bone marrow signal is normal.OTHER: No significant abnormality noted.

Output: Normal examination. Specifically, no mass evident in the area palpable abnormality.


Instruction: Generate impression based on medical findings.

Input: The last formed disk space is referred to as L5-S1, consistent with prior exam. There are immediate postoperative findings related to interval L1 -- L5 interbody fusion via lateral retroperitoneal approach with placement of disk spacer devices, paravertebral swelling and edema as well as edema in the disk spaces and the endplates of L4 vertebral body. There is edema in the interspinous spaces of L3-4 and L4-5. The osseous marrow signal is heterogeneous and benign. There is relative improvement in lumbar levoscoliosis which can be further assessed with standing radiographs. There is degeneration of essentially all lumbar disks with severe loss of disk height, with improvement status post interbody fusion. The conus terminates at L1-2.T12-L1: Disk bulge and mild right facet arthropathy which in combination with scoliosis results in moderate to severe right neural foraminal stenosis and mild effacement of the thecal sac on the right with no significant spinal canal or left neural foraminal stenosis.L1-2: Mild right facet arthropathy, posterior longitudinal ligament thickening with ligamentum flavum thickening causing moderate right neural foraminal stenosis and no significant spinal canal or left neural foraminal stenosis.L2-3: Severe right and moderate left facet arthropathy with ligamentum flavum thickening, and disk bulge causing mild spinal canal stenosis and mild right neural foraminal stenosis.L3-4: Severe bilateral facet arthropathy, ligamentum flavum thickening, and associated severe spinal canal stenosis and moderate bilateral neural foraminal stenosis.L4-5: Severe left facet arthropathy and associated ligamentum flavum thickening as well as disk bulge causing moderate spinal canal stenosis and moderate left neural foraminal stenosis. No significant right neural foraminal stenosis.L5-S1: Severe bilateral facet arthropathy causing mild right and modearate left neural foraminal stenosis and mild spinal canal stenosis.Overall, the degree of neural foraminal stenoses have perhaps mildly decreased from the prior myelogram of the postsurgical levels, although differences in imaging modalities limits more definitive evaluation.

Output: 1. Expected immediate postoperative findings related to L1-5 XLIF with interbody cages appearing well-positioned as seen on CT. No large paraspinous hematomas. 2. There is relative improvement in degenerative lumbar levoscoliosis. There is some improvement in neural foraminal stenoses, although differences in technique limit comparison with prior CT myelogram. Individual levels as above including severe L3-L4 and moderate L4-L5 spinal canal stenosis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Reason: eval hemangioma and other liver lesions ? hemangiomas History: known hemangioma and liver masses, prior renal cell carcinoma, elevated ALT ABDOMEN:LIVER, BILIARY TRACT: There is patchy loss of signal on out of phase images suggesting steatosis.A large segment 8 lesion measures 8.1 x 7.0 cm (10/237) with T2 hyperintensity and peripheral nodular enhancement which fills in, likely representing a hemangioma. There are a few surrounding simple cysts. There are 6 additional lesions with peripheral nodular enhancement which fill in, likely representing hemangiomas. A lesion in segment 2 measures 2.3 x 1.5 cm (10/239). Additional hemangiomas are seen within segments 8 (10/252), segment 7 (10/254), segment 3 (10/258), segment IVb (10/257) and segment 5 (10/264).SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Susceptibility artifact in the inferior pole the left kidney is likely related to postsurgical changes.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.Dominant lesion in the right hepatic lobe has imaging features consistent with a hemangioma.2.Six additional lesions in liver also likely represent hemangiomas.


Instruction: Generate impression based on medical findings.

Input: Newly diagnosed MGUS vs myeloma; please evaluate for myeloma lesions. There is mild diffuse intermediate signal intensity in the lower lumbar spine, bones of the pelvis, and proximal femora, suggestive of residual red marrow. We see no convincing focal lesion to confirm myeloma. Low signal intensity focus adjacent to the lateral aspect of the right greater trochanter is noted, likely representing calcium hydroxyapatite deposition with adjacent soft tissue inflammation. There is also mild peritrochanteric inflammation on the left. These findings are of questionable current clinical significance.Mild osteoarthritis affects both hips.

Output: Residual red marrow without focal lesion to confirm myeloma. Other findings as above.


Instruction: Generate impression based on medical findings.

Input: Thoracolumbar scoliosis. There is severe scoliosis at the thoracolumbar spine, with a left convexity, apex at thoracolumbar junction. There is left lateral subluxation of L2 over L3. Degenerative changes are seen in the lumbar spine, with facet arthropathic changes, osteophytes, ligamentum flavum hypertrophy and disk bulging / herniation at multiple levels. There is spinal canal and neuroforaminal narrowing at multiple levels, as a result of the scoliosis and degenerative spine disease. There is resultant nerve impingement, which is better visualized on the MRI of same date.No evidence of segmentation anomalies, fracture, or par-interarticularis defect is seen.There is a large calcified lesion posterior to the left aspect of the uterus and may represent a fibroid. A large right renal cyst is noted.

Output: 1. Severe thoracolumbar scoliosis and degenerative disease of the lumbar spine resulting in spinal canal and neuroforaminal narrowing. Nerve impingement is present at multiple levels and is better defined on the MRI of same date. Please refer to MRI report for details.2. Right renal cyst.3. Uterine fibroid.


Instruction: Generate impression based on medical findings.

Input: Atypical parkinsonism: dysfluency, tremors. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There may be a punctate left hippocampal fissure remnant cyst. There is minimal nonspecific cerebral white matter T2 hyperintensity. There is a right parietal lobe developmental venous anomaly. The substantia nigra and the rest of the brainstem appears 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.

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


Instruction: Generate impression based on medical findings.

Input: Clinical question: History of PXA status post ablation with residual cyst. Signs and symptoms: Preop planning for cyst fenestration. Pre-and post-enhanced fusion brain MRI:Examination he demonstrate a previously known partially cystic partially solid and enhancing mass in the posterior fossa consistent with xanthoastrocytoma.Compared to prior exam there is interval decreased size of the cystic component of the tumor on the left. There is also suggestion of a slight interval decrease solid component of the tumor on the left. This appearance however may be as a result of decreased left cystic component rather than a true interval decreased size. The large right sided cystic component of tumor however demonstrate no convincing evidence of interval change in its size however the enhancement of its rim is more conspicuous compared to prior study. This however may be technique related. The overall transaxial dimensions of tumor measures at 33.7 x 42.6-mm compared to prior study measurements of 35 x 22.8mm.The craniocephalad axis of tumor measures a maximum of 52-mm compared to prior study measurement of 49.Supratentorial ventriculomegaly demonstrate no appreciable change. The right frontal approach ventricular catheter with the tip in the body of right lateral ventricle similar to prior exam. Gliosis along the course of right ventricular catheter in the right frontal lobe is again noted.

Output: 1.Revisualization of a pleomorphic xanthoastrocytoma with slight interval decrease in cystic component on the left and otherwise without significant change. Please see above comments.2.Shunted enlarged supratentorial ventricular system and a right frontal approach ventricular catheter remains stable since prior exam.


Instruction: Generate impression based on medical findings.

Input: 66-year-old male patient with elevated prostate specific antigen. Evaluate for prostate cancer. PELVIS:PROSTATE:Prostate Size: 4.7 x 3.7 x 3.8 cm (transverse by AP by craniocaudal).Peripheral Zone: There is a region of signal abnormality within the left base of the peripheral zone demonstrating T2 and ADC hypointensity measuring approximately 1.0 x 0.4 cm (image 18, series 501). This is on a background of rather diffuse, linear T2 hypointensity within the left base and left mid gland of the peripheral zone which may reflect prostatitis or scarring.There is an additional focus of T2 hypointensity, ADC hypointensity, and early enhancement within the medial anterior right apex of the peripheral zone measuring 0.5 x 0.4 cm (image 13, series 501), which is suspicious for tumor.Central Gland: The central gland is hyperplastic containing multiple BPH nodules.Seminal Vesicles: No definite involvement.Extracapsular Extension: No definite extraprostatic extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Two sites of signal abnormality within the right apex and left base suspicious for tumor. 2. No definite extraprostatic extension.


Instruction: Generate impression based on medical findings.

Input: Stroke: right upper extremity ataxia. There is restricted diffusion and high T2 signal involving the left parietal and occipital lobes over an area of up to 5 cm with a small amount of petechial hemorrhages, but no large hemorrhagic transformation or midline shift. There also appear to be additional punctate foci of restricted diffusion and in the left subinsular region and inferior left frontal gyrus. The cerebellum is unremarkable. The ventricles and basal cisterns are normal in size and configuration. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a small left maxillary sinus retention cyst. There is a small amount of fluid within the right mastoid air cells.

Output: Recent infarction involving the left parietal and occipital lobes over an area of up to 5 cm with a small amount of petechial hemorrhage, but no large hemorrhagic transformation or midline shift. There also appear to be punctate recent infarcts in the left subinsular region and inferior left frontal gyrus.


Instruction: Generate impression based on medical findings.

Input: Acinic cell parotid cancer now with headache and nausea, evaluate for progression of skull base metastases. There are postsurgical findings related to prior right lateral temporal bone resection and parotidectomy. There is marrow replacement with corresponding patchy heterogeneous enhancement involving the right basiocciput, petrous ridge, condylar and squamous portions of the occipital bone, and the right lateral mass of C1, with a small soft tissue component in the upper carotid space, all appearing similar to prior examinations. There are no new skull base osseous lesions identified. Intracranially, no new or suspicious lesions are seen. There are a few unchanged punctate foci of enhancement within the right lateral cerebellum, immediately adjacent to the abnormal skull base, with surrounding T2 hyperintensity. Supratentorially, there are several scattered foci of nonspecific T2 hyperintensity, which appear unchanged. There are no new enhancing intracranial lesions. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles remain normal in size and morphology.

Output: Findings related to right lateral temporal bone resection and parotidectomy without significant change in the treated right skull base and right craniocervical junction tumor, as well as the abnormality in the right cerebellar hemisphere.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: 50-year-old female with history of jejunal diverticulitis, assess resolution ABDOMEN:LIVER, BILIARY TRACT: Hepatomegaly measuring 22.5 cm in craniocaudal dimension. Punctate right hepatic hypodensity is too small to characterize but likely represents a cyst. Loss of signal on out of phase images suggests steatosis.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.PELVIS:UTERUS, ADNEXA: 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: 1.Resolution of diverticulitis without evidence of a small bowel lesion.2.Hepatomegaly and hepatic steatosis.


Instruction: Generate impression based on medical findings.

Input: Recurrent T2N2B squamous cell carcinoma of the base of the tongue, previously treated with concurrent cisplatin/RT and now receiving chemotherapy. There are post-treatment findings in the neck, including partial left glossectomy and pharyngectomy with flap reconstruction via mandibulotomy. There are persistent patchy areas of edema and enhancement in the remaining portions of the oral tongue and surrounding soft tissues, which may be related to treatment effects or denervation, but no evidence of measurable tumor in the oral cavity. There is no evidence of significant cervical lymphadenopathy based on size criteria. The remaining salivary glands appear to be unchanged. There are multilevel posterior cervical disc-osteophyte complexes that narrow the spinal canal. The imaged intracranial structures and orbits are unremarkable.

Output: 1. Extensive treatment effects in the upper aerodigestive tract region without evidence of gross tumor recurrence in the oral cavity region.2. No significant lymphadenopathy in the neck.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p rotator cuff repair, biceps tenodesis eval for re-rupture following fall History: s/p rotator cuff repair, biceps tenodesis eval for re-rupture following fall. Slightly limited examination due to motion artifact and metallic artifact on multiple sequences. ROTATOR CUFF: Metallic artifact within the humeral head and proximal humerus compatible with history of rotator cuff repair and biceps tenodesis.Full thickness tear of the supraspinatus tendon with retraction. The infraspinatus, subscapularis, and teres minor are grossly intact. Diffuse fatty atrophy of the rotator cuff muscles. SUPRASPINATUS OUTLET: Moderate AC joint osteoarthritis. Small amount of fluid within the subacromial/subdeltoid bursa. Small joint effusion. GLENOHUMERAL JOINT AND GLENOID LABRUM: Moderate osteoarthritis of the glenohumeral joint. Diffuse thinning of the glenohumeral joint articular cartilage. Irregularity of the anterior and posterior labrum compatible with degeneration. BICEPS TENDON: Postsurgical changes of a biceps tenodesis. The common biceps tendon is visualized at its insertion on to the radial tuberosity although cannot be followed in its entirely to the site of tenodesis. ADDITIONAL

Output: 1.Postsurgical changes of rotator cuff repair with full thickness tear of the supraspinatus with retraction. Diffuse rotator cuff muscle atrophy.2.Postsurgical changes of a biceps tenodesis. The common biceps tendon is visualized at its radial tuberosity insertion although cannot be followed in its entirely to the site of tenodesis.3.Findings compatible with adhesive capsulitis.4.Degenerative arthritic changes as described above.


Instruction: Generate impression based on medical findings.

Input: Male 74 years old with history of adenoid cystic carcinoma of palate and CRT Enhancing perineural lesion along the maxillary nerve within the right pterygopalatine fossa and foramen rotundum with extension into the cavernous sinus is redemonstrated. The lesion measures approximately 6 mm (1601/38), and is not significantly changed from prior exam. Areas of increased T2/FLAIR signal most prominent in the subcortical areas suggestive of white matter ischemic degenerative changes. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. Right maxillary sinus mucosal thickening and diffusion restriction appears similar to prior exam. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: 1. Perineural tumor involving the maxillary nerve within the foramen rotundum and pterygopalatine fossa, appearing similar to prior exam. 2. Stable right maxillary sinus mucosal thickening.


Instruction: Generate impression based on medical findings.

Input: History of aneurysm, 6 mo follow-up. History of right MCA stroke and thrombectomy on Jun 8 2012 Brain MRI:No evidence of acute ischemia. Again seen is FLAIR hyperintensity and volume loss involving the right frontal, parietal, and temporal lobes as well as the posterior insula consistent with prior right MCA infarct. Small infarcts involving the right frontal corona radiata and anterior caudate also again seen. Mild FLAIR hyperintensity involving the bilateral periventricular white matter is compatible with chronic small vessel ischemic changes. Chronic right inferior cerebellar infarct is also again seen.Again seen are foci of susceptibility effect adjacent to the central sulcus in the region of the chronic infarct and unchanged indicative of chronic blood products. Additional scattered foci of chronic microhemorrhages in the right frontal lobe and in the right parietal periatrial white matter also unchanged. No intracranial mass or mass-effect. No extra-axial collections. No hydrocephalus. There is interval development of diffuse opacification of the left mastoid air cells. Mucosal thickening involving the right maxillary sinus is again seen.Brain MRAAgain seen is left PCOM artery aneurysm measuring 3.2 mm at the neck and 6 mm in length. No evidence of interval enlargement allowing for differences in technique with prior MRA and CTA. The left posterior communicating artery arises in its medial and inferior aspect. Aneurysm projects posteriorly and inferiorly.There is bulbous appearance at the right superior cerebellar artery origin which is unchanged. There are atherosclerotic changes involving the cavernous and supraclinoid internal carotid arteries with ectasia of the anterior genu of the left cavernous carotid artery. The anterior communicating and bilateral posterior communicating arteries are patent. No additional aneurysmal dilatations or flow-limiting stenoses are evident in the anterior-posterior circulation.

Output: 1. Encephalomalacia involving the right frontal, temporal, and parietal lobes consistent with chronic right MCA territory infarct. No new infarcts. 2. Multiple foci of chronic microhemorrhage including within the area of prior infarct are unchanged.3. Allowing for differences in technique with prior CTA and 1.5T MRA from 6/2014, no significant change in left posterior communicating artery aneurysm measuring up to 6 mm in length and 3 mm at the base. Left PCOM artery arises from the medial and inferior aspect of the aneurysm.4. Interval development of opacification of the left mastoid air cells.


Instruction: Generate impression based on medical findings.

Input: 17-year-old male with history of tibial OCD lesion. MENISCI: There is tearing and fraying through the free edge of the body of the lateral meniscus (image 24 series 6). The medial meniscus is small, however it is intact.ARTICULAR CARTILAGE AND BONE: Again seen is a heterogeneous lesion containing small cysts in the lateral tibial plateau extending to the articular surface with a maximal axial dimensions of 1.3 x 1.2 cm (image 23 of series 3). There is been mild subchondral collapse in the interim with a full-thickness osteochondral cleft measuring 4mm in depth(image 23 of series 6). There is mild adjacent edema signal abnormality. There is increased signal abnormality within the overlying cartilage of the lateral tibial plateau.LIGAMENTS: The ACL, PCL, MCL, and LCL complex are intact. EXTENSOR MECHANISM: There is a vertically oriented short segment partial-thickness tear through the distal patellar tendon with maximal mediolateral thickness of 3 mm. Patella alta again noted. Insall-Salvati ratio measures approximately 1.5. The tibial tubercle trochlear groove distance appears normal, however the femoral trochlea appears slightly shallow. Mild lateral subluxation of the patella in relation to the trochlear groove.ADDITIONAL

Output: 1. OCD lesion of the lateral tibial plateau with mild subchondral collapse which has progressed from prior. Increased signal within the articular cartilage likely indicates early degeneration.2. Free edge tear of the body of the lateral meniscus.3. Chronic partial thickness patellar tendon tear and patella alta.4. Mild lateral subluxation of the patella and shallow femoral trochlea.


Instruction: Generate impression based on medical findings.

Input: Syncope and collapse [780.2], Reason for Study: ^Reason: 31 yo lady with bradycardia and syncope, looking to evaluate for possible neuro cause, r/o Chiari malformation History: lightheadedness, syncope There is no evidence of acute ischemic or hemorrhagic lesion on the scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Specifically, there is no evidence of tonsillar herniation through the foramen magnum. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries. CSF flow study shows normal pulsatile craniofugal and cranio petal flow through the foramen magnum anterior to the brain stem as well as posterior to the brain stem.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion. No abnormal contrast enhancement.2. Normal brain MR angiogram and neck MR angiogram.3. Normal CSF flow study.


Instruction: Generate impression based on medical findings.

Input: There are post-treatment findings in the posterior fossa with cerebellar volume loss and distortion, confluent T2 hyperintensity in the cerebellar treatment zone and smaller areas of T2 hyperintensity in the brainstem that may include olivary degeneration, and persistent susceptibility effects and intrinsic T1 hyperintensity in the surgical cavity. However, there is an area of nodular enhancement that has developed in the left aspect of the cerebellar resection cavity, measuring up to 15 mm. There are unchanged punctate foci of susceptibility effect in the right basal ganglia and left precentral gyrus, which may represent chronic microhemorrhages or cavernous malformations. There is no evidence of acute cerebral infarct. There is a posterior left ventricular catheter that terminates in the right lateral ventricle with persistent confluent high T2 signal in the brain parenchyma along the catheter path. There is unchanged T2 hyperintensity along the previous right ventriculostomy tract in the right frontal lobe. The third and lateral ventricles remain collapsed.

Output: 1. Post-treatment findings in the posterior fossa with developing nodular enhancement, which may represent tumor progression.2. Unchanged appearance of the stunted ventricular system.


Instruction: Generate impression based on medical findings.

Input: Male 64 years old with cirrhosis. Assess liver lesions. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. No biliary ductal dilatation or ascites. Hepatic vasculature is patent. Splenorenal shunting is noted.Hepatic segment 5/8 exophytic lesion measures 4.1 x 3.1 cm, an exophytic segment 4 lesion measures 1.7 x 1.3 cm, a segment 7 lesion measures 1.6 x 1.5 cm and a segment 2/4A lesion measures 1.5 x 1.4 cm (series 9, images 109, 117, 118, and 126). All lesions are mildly T2 hyperintense with arterial enhancement and washout and are suspicious for hepatocellular carcinoma.SPLEEN: The spleen measures 12 cm in length.PANCREAS: The pancreas enhances homogeneously. There is no pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: A subcentimeter T1 hyperintense lesion in the midpole the left kidney does not enhance and is compatible with a proteinaceous/hemorrhagic cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Anterior abdominal wall ventral hernia contains only mesenteric fat, unchanged.

Output: 1.Multiple lesions suspicious for hepatocellular carcinoma. The largest is a 4.1 x 3.1 cm exophytic lesion segment 5/8.2.Evidence of portal hypertension with splenorenal shunting


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Altered mental status, unspecified. Multiple sclerosisClinical question: Evaluate for etiology of altered mental status, somnolenceSigns and Symptoms: worsening MS, altered mental status, somnolence The CSF spaces are appropriate for the patient's stated age with no midline shift. T2 and FLAIR hyperintense and T1 hypointense periventricular and subcortical white matter lesions of a moderate degree are present, some of which are perpendicularly oriented to the lateral ventricles. Similar lesions are also present in the brain stem and cerebellum. There are also T2/FLAIR signal hyperintense lesions present in the medial thalami, the right precuneus gray matter and the right superior frontal gyrus gray matter.Sagittal FLAIR imaging suggests a FLAIR hyperintense lesion in the cervical spinal cord at the C3-4 level without any evidence of enhancement on the postcontrast sagittal T1 images.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a small mucous retention cyst in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Multiple lesions scattered throughout the brain predominantly in the white matter as detailed above support the clinical history of demyelinating disorder. There are no enhancing lesions appreciated to suggest acute demyelinating plaque.2.Findings suggest possible demyelinating focus in the cervical spinal cord at C3-4


Instruction: Generate impression based on medical findings.

Input: Follow-up of thyroid nodules RIGHT LOBE MEASUREMENTS: 4.0 x 1.4 x 1.5 cmLEFT LOBE MEASUREMENTS: 3.9 x 1.1 x 0.9 cmISTHMUS MEASUREMENTS: 0.7 cmRIGHT LOBE: Markedly heterogeneity with no focal lesion.LEFT LOBE: Marked heterogeneity with single 7 mm hypoechoic nodule at the lower poleISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Possible enlarged parathyroid gland posterior to the right lobe measuring 2.0 x 0.5 x 1.1 cmLYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Heterogeneous thyroid with 7 mm nodule in the left lobe. Possible enlarged parathyroid gland posterior to the right lobe.


Instruction: Generate impression based on medical findings.

Input: Left upper temporal field cut. There is a somewhat infiltrative heterogeneously enhancing mass with areas of susceptibility effect centered in the right medial temporal lobe, with extension into the cerebral peduncle that measures at least up to 4 cm. There are several adjacent heterogeneously enhancing lesions in the right temporal, inferior parietal, and anterior occipital lobes. There is hazy confluent T2 hyperintensity surrounding all the lesions. There is effacement of portions of the right lateral ventricle, but dilatation of the right temporal horn. There is right uncal herniation and approximately 10 mm of midline shift to the left. There is no evidence of acute infarct. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: A mass centered in the right medial temporal lobe, with extension into the cerebral peduncle that measures at least up to 4 cm, with several satellite lesions likely represents a high-grade glial neoplasm. There is associated entrapment of the right temporal horn and 10 mm of midline shift to the left.


Instruction: Generate impression based on medical findings.

Input: 57-year-old male patient with history of multiple sclerosis presents with limb weakness. Evaluate for progression. BRAIN: Allowing for slight differences in technique including imaging plane and slice thickness, there is no definite change in numerous areas of increased T2/flair signal in the periventricular, cingulate-callosal junction, and to a lesser degree subcortical white matter. Stable lesions are seen in the cerebral peduncles, pons and left cerebellum. There is stable atrophy of the corpus callosum. These findings are compatible with the patient's history of multiple sclerosis and are not significantly changed compared to prior exam. There is no evidence of mass effect or midline shift.There is minimal mucosal thickening in the left maxillary and ethmoid sinuses, decreased compared to prior exam. CERVICAL SPINE:No new cord lesions. There is redemonstration of small foci of T2 hyperintensity in the cord at right C3-4 to C4-5 with atrophy. There is a small lesion at the C7 level on the right anteriorly, also similar to prior. There is near-anatomic alignment of the cervical spine. Bone marrow signal is benign. Level specific findings:C2-3: There is no significant spinal canal stenosis or neural foraminal narrowing at this level.C3-4: Left paracentral disc osteophyte complex and ligamentum flavum thickening causing mild spinal canal stenosis and mild to moderate bilateral neural foramina narrowing.C4-5: No significant neural foraminal narrowing or spinal canal stenosis. C5-6: No significant spinal canal stenosis or neural foramina narrowing. C6-7: Left uncovertebral hypertrophy with mild left neural foramina narrowing. No significant spinal canal or right neural foraminal narrowing. C7-T1: No significant spinal canal or neural foraminal narrowing.The right vertebral artery is small as before.

Output: 1.Numerous lesions in the supratentorial and to a lesser degree infratentorial white matter are compatible with the patient's history of known demyelinating disease and are not significantly changed allowing for differences in technique. No new lesions are seen.2.Small lesions in the cervical cord with associated atrophy are also not significantly changed. No new lesions in the cervical cord.3.Multilevel degenerative disk disease of the cervical spine as described above with mild spinal canal stenosis at C3-4 remains unchanged.


Instruction: Generate impression based on medical findings.

Input: Ms. Martin is a 40-year-old female with a family history of breast cancer in sister (diagnosed at the age of 33) and paternal grandmother. Known BRCA2 mutation. She is enrolled in a recent breast cancer screening study for high risk individuals. There is scattered fibroglandular tissue in both breasts. Minimal background parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on medical findings.

Input: Nausea, vomiting, and abdominal pain ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Ill-defined, hypodense lesion near the dome of the liver, measuring 11 x 9 mm. The etiology is unknown. This represents a focal lesion or focal fat. MRI of the liver may be helpful for further evaluation as clinically indicated.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Distal small bowel loops are slightly dilated, measuring up to 3 cm. Terminal ileum is decompressed. On image number 94, series number 3 there is a transition point between the mildly dilated small bowel loops in decompressed bowel loops. Mild fat stranding and small amount of free fluid is present in the pelvis. There are slightly enlarged lymph nodes in the right lower quadrant.Appendix is normal. No evidence of abscess or free air.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Nonspecific punctate sclerotic foci in the lumber vertebral bodies.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Mildly distended distal small bowel loops with transition point in the mid pelvis. These findings likely represent an early, mild, partial distal small bowel obstruction.


Instruction: Generate impression based on medical findings.

Input: 19-year-old male with Crohn's disease. Evaluate active disease involving the terminal ileum. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions. No intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No evidence of hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There has been significant interval improvement in the marked inflammatory changes including thickening and irregularity of the terminal ileum. There is residual thickening of the terminal ileum measuring approximately 1.5 cm with evidence of diffusion restriction and mild contrast enhancement at this location.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: There has been significant interval improvement in the marked inflammatory changes including thickening and irregularity of the terminal ileum. There is residual thickening of the terminal ileum measuring approximately 1.5 cm with evidence of diffusion restriction and mild contrast enhancement at this location.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Significant interval improvement in the marked inflammatory changes involving the terminal ileum with evidence of residual terminal ileum active inflammatory disease.


Instruction: Generate impression based on medical findings.

Input: Achilles pain TENDONS: There is perhaps minimal thickening and increased signal intensity of the Achilles which may reflect minimal tendinosis but this is equivocal. There is distention of the retrocalcaneal bursa with fluid indicating bursitis and there is associated reactive edema in the underlying calcaneus. The flexor, extensor, and peroneal tendons are intact.LIGAMENTS: The anterior talofibular ligament appears slightly thinned but is otherwise intact. The calcaneofibular, posterior talofibular, and ligaments of the distal tibiofibular syndesmotic complex as well as the visualized portion of the deltoid ligaments are intact. There is a tiny focus of fluid signal intensity adjacent to the posterior talofibular ligament which may reflect a small ganglion.ARTICULAR SURFACES AND BONE: Aside from the reactive edema within the posterior calcaneus, the remaining marrow signal of the ankle is normal. There is no osteochondral lesion.

Output: Retrocalcaneal bursitis with other findings described above.


Instruction: Generate impression based on medical findings.

Input: Lower extremity weakness. Evaluate for cord compression. There is developmental narrowing of the cervical spinal canal and superimposed mild degenerative changes including small disc osteophyte complexes at the C3-C4 to C6-C7 levels. There is mild or mild to moderate degree of spinal canal stenoses at these levels, relatively worse at the C3-C4 level. No higher grade spinal canal stenosis or evidence of acute cord compression. There are mild multilevel degenerative changes in the thoracic spine with disc height loss and disc bulges but without evidence of significant spinal canal stenosis.There is subcentimeter focus of T1 hypointensity and T2 hyperintensity involving the T5 vertebral body which is nonspecific.No obvious cord signal abnormality. Vertebral body heights and alignment are maintained. Please refer to separate report for findings in the lumbar spine.

Output: 1. This is a limited exam specific for the exclusion of cord compression only. No evidence of acute cord compression.2. Degenerative changes in the cervical spine as described above with mild or mild to moderate degree of spinal canal stenosis, relatively worse at the C3-C4 level. Dedicated cervical spine MRI can be considered for more detailed evaluation if clinically indicated.3. Dedicated lumbar spine study is reported separately.4. Subcentimeter lesion involving the T5 vertebral body, possibly an atypical hemangioma but nonspecific.


Instruction: Generate impression based on medical findings.

Input: 2-year-old male with history of neuroblastoma. Status-post two cycles of chemotherapy. Follow up exam. Views of the soft tissue neck show a large relatively homogeneous mass involving the left super mediastinum. This mass extends from the level of the thyroid gland and posterior to the carotid space down through the thoracic inlet. The inferior extent of this lesion is limited due to cut off however it extends beyond the thoracic inlet. This mass currently measures 44.3 x 29.9 mm in the transverse oblique and AP projections, and on the prior MRI exam it measured 38.1 x 23.7 mm on prior MRI exam in one accounting for differences in technique there is suggestion of mild interval increase in the size of this lesion.The remaining views and soft tissue neck show multiple lymph nodes involve the jugular chain and posterior triangle region with a prominent enhancing node involving the left jugular chain jugular digastric region approximating 14.4 mm. there is mild prominence of the tonsillar tissue within the oropharynx with no significant compromise of the pharyngeal/laryngeal airway. Normal enhancement is seen involving the carotid vasculature.

Output: 1. The large left-sided superior mediastinal mass with low cervical involvement air as described above. When accounting for differences in technique there is suggestion of mild interval increase in size from the previous MRI performed on 4/7/2010.2. Cervical lymphadenopathy most prominent in the left jugulodigastric region. See above discussion.


Instruction: Generate impression based on medical findings.

Input: Ms. Riddering is a 49-year-old woman with a strong family history of breast cancer presenting for screening MRI. There is heterogeneous amount of fibroglandular tissue in both breasts. Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. A few subcentimeter bilateral breast cysts are noted.No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on medical findings.

Input: Images are somewhat limited by patient motion.There is redemonstration of an enhancing mildly T2/FLAIR hyperintense and T1 isointense mass in the right posterior frontal lobe measuring 2.0 x 2.2 cm (series 301, image 148). There is minimal localized mass effect and a medial halo of mild diffusion restriction. An additional smaller enhancing lesion in the left precentral gyrus measures 0.7 x 0.7 cm (series 301, image 132). The extent of surrounding T2/FLAIR hyperintensity appears similar to prior exam. This mass also demonstrates diffusion hyperintensity without significant increased signal on ADC. Linear enhancement along the medial right thalamus appears vascular.There is an additional left cerebellar enhancing focus which is not well visualized on the previous exam secondary to patient motion artifact measuring 4 x 4 mm on 1501/56. There is a questioned punctate focus of diffusion restriction in the inferior left cerebellum ventrally, without signal abnormality or enhancement.The ventricles and sulci are mildly prominent compatible with age-related volume loss, aside from the areas of sulcal effacement in the areas of the masses. Nonspecific nonenhancing punctate foci of T2/FLAIR hyperintensity are again seen elsewhere within the white matter. The cisterns remain patent. There is no midline shift. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. A left maxillary retention cyst is noted.

Output: 1. Delineation of an additional nodular enhancing focus in the lateral left cerebellum, also likely consistent with metastatic disease. This was not well visualized on prior exam secondary to patient motion.2. Otherwise, motion limited exam, with redemonstration of two lesions in the bilateral posterior frontal lobes with similar extent of surrounding vasogenic edema are most consistent with metastatic disease.3. Scattered nonenhancing nonspecific punctate foci of T2/FLAIR hyperintensity throughout the white matter, which could be compatible with chronic small vessel ischemic changes.4. A questioned focus of diffusion restriction in the ventral left inferior cerebellum not other signal abnormality, which could be artifactual or possibly represent a tiny developing metastasis versus lacunar infarct.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Status post tumor resection. Signs and symptoms: Status post craniotomy. Pre-and post-enhanced brain MRI:Examination demonstrates a large well-demarcated hemorrhagic mass and high convexity right posterior frontal lobe with large internal focus of enhancement. The combination of findings measures at 33 x 43 mm in transaxial dimensions. There is surrounding vasogenic edema and with resultant effacement of adjacent cortical sulci and trace deviation of midline to the left.Two tiny additional enhancing foci are metastatic lesion is also noted in the high convexity left posterior frontal and anterior parietal lobes with a larger lesion measuring only 4.5-mm in size. An additional small superficially located metastatic lesion approximately 4 mm is noted in the right posterior temporal -- occipital junction.Post-enhanced images also demonstrate a small developmental venous anomaly of the left frontal lobe.Calvarium demonstrate a tiny focus of enhancement in the left parietal (axial post enhanced series 1 to zero image 24 measuring approximately 4.5 mm. This finding demonstrate T2 hypointense signal pattern on axial T2 and T2 flair image 24 and could represent an additional metastatic lesion.Unremarkable images through the orbits. Mild extensive chronic sinusitis is noted. Its

Output: 1.Large hemorrhagic partially enhancing metastatic lesion in right posterior frontal measuring 43 x 33-mm in transaxial dimensions.2.Multiple additional subcentimeter metastatic lesions as detailed.3.4.5-mm focus of enhancement in the left parietal bone as detailed.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old, with history of stroke and dementia with worsening memory loss. Extensive confluent periventricular white matter T2 hyperintensity is redemonstrated appearing similar to the prior examination. Numerous additional scattered more discrete foci of parenchymal T2 hyperintensity are also redemonstrated including within the pons, unchanged. No restricted diffusion is seen.There is no evidence of parenchymal edema or mass effect. No acute intracranial hemorrhage or any abnormal extra-axial fluid collections are detected. Multiple scattered foci of susceptibility artifact are seen in the cerebral hemispheres, the thalami on the brainstem suggesting chronic microhemorrhage. No pathologic parenchymal or extra axial enhancement is observed. The cerebral sulci and the ventricles are mildly and proportionately prominent suggesting some degree of underlying parenchymal volume loss.

Output: 1.Findings are seen compatible with extensive chronic microvascular ischemic disease.2.Multiple scattered foci of microhemorrhage are also seen which may relate to small vessel ischemic disease though amyloid angiopathy can present similarly.3.A mild degree of generalized cerebral volume loss is demonstrated.4.No acute intracranial abnormalities.


Instruction: Generate impression based on medical findings.

Input: One month old male with large soft tissue mass on right head and history of sepsis. Examination of intracranial content demonstrates normal morphology and density of brain parenchyma. Cortical sulci, ventricular system and all CSF cisterns remain within normal limits. There is complete opacification of the left middle ear cavity and mastoid air cells. These findings represent otitis media. Right mastoid air cells and middle ear cavity cavity are well pneumatized and are unremarkable.Bony density of calvarium demonstrates some periosteal thickening in the right posterior parietal in region of large soft tissue abnormality of the scalp that was noted on clinical exam. No definitive evidence of abnormal enhancement is detected. No definitive evidence of any cavity formation is present. Although possibility of infection cannot be entirely ruled out possibility an old sub periosteal hemorrhage should also be considered. No definitive evidence of any edematous changes of the adjacent subcutaneous fat is detected. There is no evidence of any abnormality of the inner table of the skull or the marrow space. Further evaluation with an infused MRI is recommended.

Output: 1.Unremarkable CT examination of intracranial content.2.Left otitis media.3.Large low-density mass like lesion involving right posterior parietal scalp with irregularity of the outer cortex and periosteum of the parietal lobe as detailed above.4.Further evaluation with an infused MRI of brain is recommended.


Instruction: Generate impression based on medical findings.

Input: 43-year-old female with knee pain for months with sharp pain and catching and giving out with stairs, fast walking and twisting. History of prior lateral release and scope and history of arthritis. MENISCI: There is a complex tear of the posterior horn of the medial meniscus with both horizontal and vertical components. The anterior horn of the medial meniscus appears normal. The lateral meniscus appears normal.ARTICULAR CARTILAGE AND BONE: There is subchondral bone marrow edema within the medial femoral condyle and medial tibial plateau compatible. There is generalized thinning of the articular cartilage along the medial femoral condyle and medial tibial plateau with areas of full-thickness intermediate signal intensity defects extending to the subchondral bone with associated bone marrow edema. There is generalized thinning of the articular cartilage of the patella.LIGAMENTS: There is edema surrounding the medial collateral ligament compatible with sprain. The lateral collateral ligament appears normal. The anterior and posterior cruciate ligaments appear normal. EXTENSOR MECHANISM: The extensor mechanism appears normal.ADDITIONAL

Output: 1. Complex tear of the posterior horn of the medial meniscus with both vertical and horizontal components.2. Subchondral bone marrow edema within the medial femoral condyle and medial tibial plateau. There is a moderate joint effusion about the knee.3. Medial collateral ligament sprain.4. Articular cartilage thinning and degeneration as described above.


Instruction: Generate impression based on medical findings.

Input: Reported history of chronic pancreatitis. Assess for ductal abnormalities. The study was limited by lack of intravenous contrast. The patient's IV access failed and the patient refused to have a new IV placed. Motion artifact degrades image quality. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted. Fatty liver. SPLEEN: No significant abnormality noted.PANCREAS: The main pancreatic duct is normal in caliber. Limited unenhanced evaluation demonstrates no focal lesion. The pancreatic parenchyma demonstrates normal intrinsic T1 weighted signal intensity. 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: Motion limited nonenhanced examination shows no over signs of chronic pancreatitis. The main pancreatic duct is normal in caliber and the pancreatic parenchyma is unremarkable. Two punctate calcifications in the pancreatic head are noted on the comparison CT.Hepatic steatosis.


Instruction: Generate impression based on medical findings.

Input: The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

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


Instruction: Generate impression based on medical findings.

Input: Male 63 years old with elevated PSA and negative biopsies. Target potential lesions. PELVIS:PROSTATE:Prostate Size: 4.9 x 3.2 x 4.2 cmPeripheral Zone: There is a 6 x 4 mm lesion in the right mid gland (series 301, image 64) that is dark on T2 and ADC and demonstrates contrast enhancement suspicious for prostate adenocarcinoma. Additional areas in the right base and left mid gland are also suspicious for adenocarcinoma.Central Gland: Multiple BPH nodules.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: Small left pelvic lymph nodes are nonspecific (series 1401, images 87 and 92).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Note is made of a 8 x 5 mm utricle cyst.

Output: Multiple foci in the transitional zone are suspicious for prostate adenocarcinoma.


Instruction: Generate impression based on medical findings.

Input: 28 year old female status post shunt internalization The intracranial catheter courses through right frontal lobe, enters the left lateral ventricle with tip terminating near the left anterior limb of the internal capsule. This catheter course is unchanged when compared to prior examination.The CSF spaces are appropriate for the patient's stated age with no midline shift or evidence of hydrocephalus.Low density change in the pons, bilateral temporal lobes, and left cerebellar folia are noted, but much better demonstrated on previous MRI.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Unchanged position of right frontal approach ventriculostomy and unchanged ventricular sizes without evidence of hydrocephalus.


Instruction: Generate impression based on medical findings.

Input: Worsening chronic headache. 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 normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is minimal diffuse ethmoid sinus mucosal thickening.

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


Instruction: Generate impression based on medical findings.

Input: Male 34 years old; Reason: evaluate for sacroiliitis History: inflammatory back pain, uveitis, [+]HLA-B27 The sacroiliac joints appear normal, without enhancement or other findings suggestive of sacroiliitis. The visualized bone marrow is normal. Small amount of fluid is seen in the hip joints bilaterally, without definite evidence of synovitis. The soft tissues structures appear normal.

Output: No sacroiliitis or other findings to account for the patient's back pain.


Instruction: Generate impression based on medical findings.

Input: HeadNote that only post contrast sequences were obtained. This is in comparison to MRI brain without contrast study on 6/21/2015. The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. Cervical spine: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.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal 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.MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. Along the posterior aspect of the T7 vertebral body on the right there is a discrete lesion measuring 11 mm x 9 mm and demonstrates low signal intensity on T1 and heterogeneous signal intensity on STIR sequences with suggestion of mild enhancement (series 1201, image 9). Otherwise there are no additional abnormal enhancing lesions are identified in the thoracic spine.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.No abnormal enhancing lesions are identified in the lumbar spine.At L5-S1 there is disc dessication with a linear focus of increased signal on STIR/T2 sequences within the disk posterolaterally to the left which could represent a form of disk degeneration. There is mild disc bulge, minimal facet hypertrophy and ligamentum flavum hypertrophy with no significant compromise to the spinal canal or neural foramina.At L4-5 there is disc dessication with a linear focus of increased signal on STIR/T2 sequences within the disk posterolaterally to the right which could represent a form of disk degeneration. There is mild disc bulge, minimal facet hypertrophy and ligamentum flavum hypertrophy with no significant compromise to the spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is a right renal cyst.

Output: 1. Mildly enhancing discrete lesion within T7 vertebral body is nonspecific and follow-up with CT to further characterize the lesion would be useful. Alternatively, follow-up with MRI to ensure stability or resolution can be considered as well.2. No evidence of leptomeningeal disease as clinically questioned. 3. Mild degenerative changes affect the lumbosacral spine with no compromise of the spinal cord or neural foramina.


Instruction: Generate impression based on medical findings.

Input: 22-year-old female. Anterior hip pain. Evaluate for labral tear. ACETABULAR LABRUM: Gadolinium enters the anterior/superior labrum indicating a tear. The tear appears to extend from the 1 to 3 o'clock position and also appears to extend through the entire labrum on image 5, series 1301. The posterior labrum appears intact. ARTICULAR CARTILAGE AND BONE: Focal cartilage thinning along the superomedial aspect of the acetabulum is felt to represent normal variation rather than a true defect. We see no frank CAM or pincer deformity. Edema within the inferomedial aspect of the femoral neck suggestive of a stress reaction.SOFT TISSUES: Soft tissues about the right hip are unremarkable.ADDITIONAL

Output: 1. Labral tear, as described above.2. Mild edema along the inferomedial aspect of the right femoral neck suggestive of a stress reaction.


Instruction: Generate impression based on medical findings.

Input: Male 13 years old with Li Fraumeni syndrome presents for cancer screening. SOFT TISSUES OF THE NECK: No significant abnormality noted.CHEST:LUNGS AND PLEURA: No pulmonary nodule or pleural effusion.MEDIASTINUM AND HILA: The heart size is normal and there is no pericardial effusion. No mediastinal or hilar lymphadenopathy.CHEST WALL: No axillary or internal mammary lymphadenopathy. The bone marrow signal intensity is within normal limits for the patient's age.ABDOMEN:LIVER, BILIARY TRACT: No focal liver lesion, biliary ductal dilation, or ascites.SPLEEN: Normal in size and appearance.PANCREAS: No focal pancreatic lesion or pancreatic ductal dilatation.ADRENAL GLANDS: The adrenal glands are normal in size and signal characteristics.KIDNEYS, URETERS: No renal lesions or hydronephrosis.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No bowel obstruction.BONES, SOFT TISSUES: Bone marrow signal intensity is within normal limits for the patient's age.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Mildly distended and normal in appearance.LYMPH NODES: No pelvic or inguinal lymphadenopathy.BOWEL, MESENTERY: No bowel obstruction.BONES, SOFT TISSUES: Bone marrow signal intensity is within normal limits for the patient's age.OTHER: There is a small amount of pelvic free fluid.FEMURS: Well-defined, lobular medullary lesions in the distal right femoral diaphysis extending over a cranial-caudal distance of 10.6 cm are mildly hyperintense on T1 relative to skeletal muscle and homogeneously hyperintense on T2-weighted images. They are unchanged in size and appearance and consistent with nonossifying fibromas which were more clearly evaluated on the femur radiographs.

Output: Nonossifying fibromas in the right distal femur. No suspicious lesions.


Instruction: Generate impression based on medical findings.

Input: 46-year-old female with history of neoadjuvant chemotherapy, left lumpectomy and radiation therapy for IDC in 2015. Prior to these treatment, the patient received a left lumpectomy and complete left axillary lymph node dissection in 2014 at outside institution, but residual left breast cancer and metastatic left interpectoral and left internal mammary lymph nodes were confirmed after surgery. History of benign biopsy of right axillary lymph node. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There are post-surgical changes at the lower inner left breast.No abnormal enhancement is seen in left breast.No abnormal lymph nodes are identified in left axillary region or left retropectoral region.No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in right axillary region.There is a small metallic artifact from marker clip within one of the right axillary nodes.

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


Instruction: Generate impression based on medical findings.

Input: Ms. Deborah White is a 65 year old female with a personal history of left breast mastectomy in 12/2014 for IDC triple negative followed chemotherapy. She has a family history of breast cancer in her sister, paternal aunt, and paternal cousin. She has no current breast related complaints. MAMMOGRAM: Three standard views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density(BiRads Density Category B), unchanged in pattern and distribution. Stable benign calcifications are present in the superior right breast. An oval mass is noted in the lower inner right breast, which correlates with a nonenhancing mass on the prior MRI and is compatible with a benign etiology. There are no new masses, suspicious microcalcifications or areas of architectural distortion identified in the right breast.

Output: No mammographic evidence of malignancy in the right breast. As long as the patient's physical examination remains normal, right unilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.


Instruction: Generate impression based on medical findings.

Input: Neck pain. History of hereditary hemorrhagic telangiectasia. There is lack of the usual cervical lordosis. There is minimal disc-osteophyte formation at C4-5 and C5-6 with mild effacement of the anterior thecal sac cerebrospinal fluid and mild narrowing of the neural foramina at C4-5. There is also prominence of the facet joints at C7-T1 with narrowing of the bilateral neural foramina. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1. Minimal disc-osteophyte formation at C4-5 and C5-6 with mild effacement of the anterior thecal sac cerebrospinal fluid and mild narrowing of the neural foramina at C4-5. 2. Prominence of the facet joints at C7-T1 with narrowing of the bilateral neural foramina.


Instruction: Generate impression based on medical findings.

Input: 54 year old male with ischemic cardiomyopathy, previous percutaneous coronary intervention of left anterior descending artery and left circumflex referred for cardiac MRI prior to consideration of intervention of right coronary artery chronic total occlusion. Viability/ Myocardial ScarThere was subendocardial (< 50% thickness) late gadolinium enhancement noted of the mid to basal inferior / inferoseptum wall that likely represents prior myocardial infarction and is less likely suggestive of fibrosis, inflammation, or infiltration. The entire myocardium is viable by LGE criteria.Left VentricleThe left ventricle is normal in size and moderately reduced in systolic function . The overall LV ejection fraction is 33%, the LV end diastolic volume index is 99 ml/m2 (normal range: 74+/-15), the LVEDV is 217 ml (normal range 142+/-34), the LV end systolic volume index is 66 ml/m2 (normal range 25+/-9), the LVESV is 145 ml (normal range 47+/-19). There is mild hypokinesis of the mid to basal inferior, inferolateral, and inferoseptal walls and basal inferoseptal and inferior walls. At low dose dobutamine (20 mcg) there is augmented contractility of all segments suggesting viability. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and mildly reduced in systolic function. The overall RV ejection fraction is 42%, the RV end diastolic volume index is 63 ml/m2 (normal range 82+/-16), the RVEDV is 139 ml (normal range 142+/-31), the RV end systolic volume index is 37 ml/m2 (normal range 31+/-9), and the RVESV is 81 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is at least mild to moderate aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVCdrain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. There is mild hypokinesis of the mid to basal inferior, inferolateral, and inferoseptal walls and basal inferoseptal and inferior walls. 2. The left ventricle is normal in size and moderately reduced in systolic function (LVEF 33%). 3. The right ventricle is normal in size and mildly reduced in systolic function (RVEF 42%).4. All segments are viable by both LGE and low-dose dobutamine.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: Clinical question: Progressive glioblastoma, compared to last MRI. Signs and symptoms: Post 2 cycles of PD L1 therapy. Pre- and post enhanced brain MRI:Examination demonstrates postsurgical and therapy changes of right anterior temporal and inferior frontal lobes without significant change since prior exam. A well demarcated surgical cavity with hemosiderin laden surgical wall and adjacent right temporal lobe as well as extensive surrounding FLAIR hyperintensity remains nearly identical to prior study.There is resultant ex vacuo dilatation of right lateral ventricle with slight rightward deviation of midline also similar to prior exam.On post enhanced images there is a tiny linear focus of enhancement along the medial aspect of surgical cavity and abutting the right frontal horn of lateral ventricle. There is no convincing evidence of any appreciable interval change in the size or extent of this focus of enhancement. It measures approximately 10 x 6 mm in transaxial dimensions similar to prior exam. Additionally mild enhancement of the ependymal lining of the right frontal horn and a small focus of parenchymal enhancement in the corpus callosum is noted. These findings also appears to be fairly similar to prior exam and without convincing evidence of change. Finding is more suggestive of posttreatment change however less likely possibility of tumor cannot be entirely excluded.

Output: 1.Post operative/treatment changes of right anterior temporal and right inferior frontal tumor without evidence of change since prior exam.2.Persistent stable right frontal periventricular and corpus callosum enhancement in size, morphology and extent since prior study and more suggestive of posttreatment related finding however less likely possibility of residual tumor cannot be entirely excluded..