Instruction: Generate impression based on medical findings.

Input: Clinical question: Rule out vessels and hemorrhage. Signs and symptoms: As above. Nonenhanced brain MRI:The examination demonstrates a previously known large new right thalamic acute hematoma measuring at 27 x 35mm in transaxial dimension. There is surrounding vasogenic edema and resultant mass effect on the third ventricle however without evidence of midline shift. There is dissection of hemorrhage into the ventricular system as was noted on prior study and without significant change. There is mild dilatation of the supratentorial ventricular system (right greater than left without significant change since prior study. A left frontal approach ventricular catheter with the tip in the body of right lateral ventricle similar to prior exam is again noted.Additionally examination demonstrate multiple small foci of flair hyperintensity in bilateral subcortical and periventricular white matter as well as right basal ganglia consistent with chronic small vessel ischemic strokes.Small foci of hemorrhagic encephalomalacia in the left anterior frontal and a smaller in the right anterior frontal lobes as noted on prior exam.Nonenhanced brain MRA:Examination demonstrate no evidence of vascularity within the right thalamic hemorrhage or in the surrounding brain parenchyma to suggest a vascular malformation.Bilateral internal carotid arteries remain widely patent across the skull base and in their supraclinoid segments.Bilateral anterior and middle cerebral arteries are patent. There is a tiny vascular outpouching along the superior aspect of the right M1 segment of middle cerebral artery is present and is suggestive of a tiny infundibulum. Less likely possibility of a small aneurysm cannot be entirely excluded however. Distal branches of bilateral anterior and middle cerebral arteries are unremarkable. There is no detectable abdomen AP at the level anterior communicating artery. Bilateral two arteries, bilateral pica branches, basilar artery and all of its branches are visualized and unremarkable.

Output: 1.Nonenhanced brain MRI demonstrate no evidence of any acute or new finding since prior exam. Acute hematoma in the right thalamus, surrounding vasogenic edema, dissection of hemorrhage into the ventricular system remain all very similar to prior study. Shunted lateral ventricles demonstrate no change in size or position of the left ventricular catheter. Chronic small vessel ischemic strokes and bilateral anterior frontal (left greater than right) encephalomalacia as was noted on prior studies.2.Nonenhanced brain MRA demonstrate no detectable increased vascularity within the right thalamic hemorrhage or its surrounding parenchymal. All major intracranial arteries and their distal branches remain patent. Tiny focus of vascular outpouching along the superior aspect of right MCA is believed to represent an infundibulum. Less likely possibility of a tiny aneurysm cannot be entirely excluded. Unremarkable nonenhanced MRI otherwise.


Instruction: Generate impression based on medical findings.

Input: History of cervical cancer presenting for planning prior to radiation treatment. PELVIS:UTERUS, ADNEXA: The fiducial marker extends through the lower uterine segment into the peritoneum. There is a poorly enhancing tumor along the right aspect of the cervix measuring approximately 1.1 x 1.1 cm (series 1103, image 289), decreased from the prior study where the tumor measured 2.3 x 1.1 cm.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.The fiducial marker extends through the lower uterine segment into the peritoneum.2.Interval decrease in cervical lesion size as described.


Instruction: Generate impression based on medical findings.

Input: 53 years Female (DOB: 5/22/1962)Reason: cord lesions vs compression History: prior R Optic neuritis / now R side weaknessPROVIDER NAME: THOMAS J KELLY THOMAS J KELLY MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There are several periventricular white matter lesions present some which are perpendicularly oriented to the lateral ventricles. Some extend to the corpus callosum. These are not associated with any contrast enhancement.There is a vague signal hypointensity present in the central portion of the lower brainstem on susceptibility weighted imaging on postcontrast imaging demonstrates linear enhancement suggesting this represents a vascular structure. It is associated with some T2 signal hyperintensity. It's possible this represents capillary telangiectasiaNo 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 some minor mucosal thickening in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:There is T2 signal hyperintensity within the cervical spinal cord extending from the C2-3 disc space level to the C4 vertebral body level measuring 5 x 26 mm in sagittal dimensions. It predominantly involves the right hemicord posteriorly. It appears to be associated with some vague enhancement that should be noted that the post contrast imaging is degraded by patient motion. There is a lesion nearly contiguous with the above described lesion present within the cervical spinal cord at the C2 vertebral body level which is also suspected to be associated with contrast enhancement.The cervical vertebral bodies are appropriate in overall alignment and height. There is multilevel disc desiccation present. There are foci of T1 signal hyperintensity within the C2, C3 and C5 vertebral bodies as well as the T2 and T3 vertebral bodies which most likely represent vertebral body hemangiomas.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 mild disc bulge present at this level.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a mild disc bulge present at this level.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a small left lateral recess disc protrusion at this level associated with some uncovertebral osteophytes and mild encroachment of the nerve roots at the left lateral recess.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.

Output: 1.There are upper cervical spinal cord lesions present associated with some suspected enhancement following contrast administration which would be suggestive of a subacute or acute demyelinating plaques. Some the post contrast imaging of the cervical spine is degraded by patient motion which may confound interpretation of contrast enhancement.2.There are are several periventricular white matter lesions present some which are perpendicularly oriented to the lateral ventricles and extending to the corpus callosum. There are number is somewhat limited. Demyelination is certainly a consideration here3.Findings raise the question of capillary telangiectasia versus a venous anomaly within the lower brainstem.4.There are some mild degenerative changes present in the cervical spine without significant compromise to spinal canal or exiting nerve roots. This is worse at C5-6 where there is some mild encroachment of left-sided exiting nerve roots.


Instruction: Generate impression based on medical findings.

Input: 2 year-old female with history of sickle cell disease and status post Moya Moya surgery. Evaluate for hematoma and CVA. Examination demonstrates an area of hypoattenuation in the right superior frontal gyrus, which corresponds to that on MRI 1/21/2010 and is compatible with a subacute stroke. There is no appreciable change in CT attenuation of areas of the acute infarcts involving bilateral centrum semiovale and right posterior parietal lobe previously seen on MRI. New since prior exam is a focus of hyperattenuation along the left postcentral gyrus, compatible with cortical hemorrhage. New since prior exam are postsurgical changes status post bilateral temporal craniotomies. There are small amount of blood products in the left temporal extraaxial space under the cranial flap. There is bilateral temporal scalp soft tissue swelling. There are small amount of pneumocephalus in the bifrontal regions and in the interhemispheric fissure and small emphysema in the left frontal subgaleal region. There are 2 Burr holes in the bifrontal bones. The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, or midline shift. The osseous structures are unremarkable except for postsurgical changes. The mastoid air cells are clear. There is opacification of the ethmoid air cells.

Output: 1. New focus of cortical hemorrhage at the left postcentral gyrus. 2. Interval postsurgical changes status post bilateral temporal craniotomies as described above. 3. Right superior frontal subacute stroke.


Instruction: Generate impression based on medical findings.

Input: Reason: Evaluate hepatobiliary and pancreatic abnormalities seen on CT scan. Known ascending carcinoma of the colon. History: As above ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter T2 hyperintense lesions in the hepatic dome and left hepatic lobe without enhancement likely represent cysts. No suspicious hepatic lesions. No extrahepatic biliary ductal dilatation. Minimal intrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Cystic lesion in the pancreatic tail measures 2.2 x 1.4 cm (601/33) and appears to communicate with the main pancreatic duct, which is not dilated. No enhancement is evident.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral simple appearing renal cysts measuring up to 5.7 cm in the left lower pole.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Extensive colon diverticulosis without evidence of diverticulitis. Apparent soft tissue signal in the cecum/ascending colon on axial T2-weighted images with possible corresponding restricted diffusion, image 48 series 706. However please note that this study is not protocoled for adequate evaluation of bowel.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Small subcentimeter T2 hyperintensities within the liver likely represent cysts. No suspicious hepatic lesion evident.2.Cystic lesion in the pancreatic tail likely represents a side branch IPMN.3.Reported ascending colon adenocarcinoma not seen with certainty (please note that this study is not protocoled for adequate evaluation of bowel). 2.5 cm area of apparent restricted diffusion along dependent aspect of proximal ascending colon/cecum, no definite corresponding postcontrast enhancement seen on subtraction imaging sequences. Correlation with patient's colonoscopy recommended.


Instruction: Generate impression based on medical findings.

Input: 43 year-old status post left lumpectomy in July 2015 and re-excision in September 2015 for DCIS. No current breast complaints. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There is less parenchymal enhancement in both breasts, compared to the prior study. An enhancing focus is no longer seen in the left breast at upper outer quadrant. Post-surgical scar is present at 12:00 position in the left breast.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on medical findings.

Input: 56 years, Male, right temporal lobe epilepsy. Surgical candidate. There is T2/FLAIR hyperintensity involving the bilateral hippocampi, right greater than left. Right hippocampal volume is grossly preserved with the left hippocampus slightly smaller than the right.Remainder of the brain parenchyma demonstrates scattered foci of T2/FLAIR hyperintensity in the bilateral periventricular and subcortical white matter which are nonspecific but compatible with mild chronic small vessel ischemic changes. There is mild supra and infratentorial parenchymal volume loss. No evidence of infarct or hemorrhage. No intracranial mass or mass effect. No hydrocephalus. No extra-axial collections. Calvarium and extracranial soft tissues are grossly unremarkable.

Output: The right hippocampus is slightly larger than the left and demonstrates asymmetric high T2/FLAIR hyperintensity compared to the left. These findings may be a postictal in etiology.


Instruction: Generate impression based on medical findings.

Input: Subdural hematomas. 73-year-old female Patient is status-post of left and right craniotomies.There is redemonstration of bilateral subdural hematomas which have decreased in density since previous exam.. These are unchanged in thickness since the prior exam measuring approximately 9 mm in the right and 13 mm on the left. There is an intracranial pressure monitor present.Along the left inferior frontal gyrus and anterior temporal lobe. There is hypodensity present. This was also present on the prior CT exam. It is suspicious for infarction.Some blood products are present in the occipital horn of the right lateral ventricle. The temporal horns the lateral ventricles are mildly dilated. The sulci are not effaced. In general, the lateral ventricles are larger on the current exam versus the prior CT exam. They are similar in size to the recent MRI exam of 12/30/09.There is opacification of the mastoid air cells and middle ears status-post intubation.There is mucosal thickening along the sphenoid sinus and ethmoid air cells.Opacification of a mastoid air cells is and partial opacification of paranasal sinuses is associated with intubation. Atherosclerotic calcifications of a moderate to marked degree are present in the distal internal carotid arteries.

Output: 1.The bilateral subdural hematomas have gradually decreased in size since exams dating back to 12/16/09.2.The lateral ventricles are mildly dilated, as described above.3.Findings are compatible with a foci of infarction in the left frontal lobe and temporal lobe.


Instruction: Generate impression based on medical findings.

Input: History of hepatocellular carcinoma status post repeat TACE/RFA. ABDOMEN:LIVER, BILIARY TRACT: The liver is cirrhotic in morphology. Patent hepatic vasculature.Anterior right hepatic lobe ablation cavity (see 9, image 38) measures 3.6 x 3.7 cm, previously 3.6 x 3.7 cm. The ablation cavity demonstrates intrinsic high T1 signal without enhancement, compatible with intracavitary blood products and/or proteinaceous material.At the location of the previously described 2 adjacent suspicious arterially enhancing lesions within segment 7/8, there is a new ablation cavity from intervening ablation (series 9, image 18) measuring 2.4 x 3.5 cm. Ablation cavity demonstrates intrinsic high T1 signal without internal enhancement, compatible with intracavitary blood products and/or proteinaceous material. The ablation cavity demonstrates equivocal thin rim enhancement (e.g., anteriorly on image 14 series 8/image 13 series 101) which may be treatment related, no corresponding washout seen on subsequent more delayed imaging.No new suspicious arterially enhancing lesions are identified.Status post cholecystectomy. No biliary ductal dilatation.SPLEEN: Mild splenomegaly with spleen measuring up to 14.7 cm in length. Large splenule.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Slight left adrenal nodularity is similar to prior.KIDNEYS, URETERS: Subcentimeter renal cysts not significantly changed.RETROPERITONEUM, LYMPH NODES: Stable mildly enlarged portacaval and gastrohepatic lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Focal fat-containing T2 hyperintense lesion in the left L2 vertebral body which has been previously biopsied and may represent a hemangioma, not significantly changed.OTHER: No significant abnormality noted.

Output: Interval ablation of 2 adjacent suspected HCC lesions in the right hepatic lobe without evidence of residual or recurrent hepatocellular carcinoma. The ablation cavity demonstrates equivocal thin rim enhancement which may be treatment related, no corresponding washout seen on subsequent more delayed imaging. Continued follow-up is recommended.


Instruction: Generate impression based on medical findings.

Input: Reason: Left side liver / L kidney lesion/ cystic on US. ABDOMEN:LIVER, BILIARY TRACT: The liver demonstrates normal signal intensity and enhancement without focal hepatic lesions. There is no intra or extrahepatic biliary ductal dilatation, common duct is upper normal, measuring 7 mm. The gallbladder is normal in appearance.SPLEEN: No significant abnormality noted.PANCREAS: No focal pancreatic mass is identified. The main pancreatic duct is not dilated.ADRENAL GLANDS: There is a lobulated, predominantly cystic mass extending from the lateral limb of the left adrenal gland, which demonstrates internal septations and peripheral T2 hypointensity, which is suggestive of calcification. Additionally, there is nodular peripheral enhancement of the lesion. The mass directly abuts the pancreas, but it is favored to be separate.The right adrenal gland is normal. 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: Predominantly cystic mass with enhancing rim and peripheral calcification favored to extend from the left adrenal gland. Differential consideration includes cystic pheochromocytoma and other cystic adrenal neoplasms.


Instruction: Generate impression based on medical findings.

Input: 5 year old male patient with developmental delay and focal epilepsy. Evaluate for structural abnormalities. There is abnormal T2/FLAIR signal involving the subcortical white matter of the left posterior frontal lobe, with blurring at the gray-white junction, and linear signal abnormality extending from the cortex to the lateral ventricle (transmantle sign). Portion of the signal abnormality appears to involve the lateral aspect of the left precentral gyrus.Remainder of the brain parenchyma including the hippocampi appear unremarkable. No intracranial mass or mass effect. No evidence of ischemia or hemorrhage. Ventricles are within normal limits. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Evidence of focal cortical dysplasia within the posterior left frontal lobe as described above.


Instruction: Generate impression based on medical findings.

Input: Female, 12 years old, with history of astrocytoma status post chemotherapy. Off therapy evaluation. Redemonstrated are findings secondary to suboccipital approach surgery. An exophytic lesion projecting from the left anterolateral aspect of the medulla is stable in size and morphology. Internal to this tissue, there is a region of intrinsic T1 hyperintensity with minimal if any superimposed true enhancement.No new intracranial lesions or pathologic intracranial enhancement is seen. A small linear focus of T2 hyperintensity adjacent to the right frontal horn is stable. Prominence of the cerebellar fissures is compatible with volume loss. No abnormal fluid collections are seen. The ventricles are stable and normal in size.

Output: Stable exophytic tissue projecting from the left anterolateral aspect of the medulla.


Instruction: Generate impression based on medical findings.

Input: 16 year old male with history of recent myocarditis and clinical VT, with recurrent arrhythmias now referred for repeat cardiac MR to evaluate scar burden and function. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 61%, the LV end diastolic volume index is 73 ml/m2 (normal range: 74+/-15), the LVEDV is 146 ml (normal range 142+/-34), the LV end systolic volume index is 29 ml/m2 (normal range 25+/-9), the LVESV is 57 ml (normal range 47+/-19), the LV mass index is 43 g/m2 (normal range 85+/-15), and the LV mass is 87 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is persistence of epicardial late gadolinium enhancement in the basal anterolateral and small segment of the mid inferolateral walls, but overall there is less myocardial involvement on this study. This pattern of late gadolinium enhancement is typical for prior myocarditis. The T2-STIR signal in the inferolateral and lateral walls seen on the previous study suggesting myocardial edema are no longer present; additionally the global relative enhancement ratio is normal.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 79 ml/m2 (normal range 82+/-16), the RVEDV is 158 ml (normal range 142+/-31), the RV end systolic volume index is 40 ml/m2 (normal range 31+/-9), and the RVESV is 80 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no significant pericardial disease noted.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal size left ventricle with normal systolic function (EF 61%), which is improved when compared to the prior study. LV diastolic volumes are similar to the previous study.2. There is persistence of epicardial late gadolinium enhancement in the basal anterolateral and small segment of the mid inferolateral walls, but overall there is less myocardial involvement on this study. 3. Normal size RV with normal systolic function (EF 50%).


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Disturbance of skin sensationClinical question: please r/o stenosis or occlusive vessels and look for signs of strokeSigns and Symptoms: left facial weakness and slurred speech MRI of the brainScattered foci of diffusion restriction are present in the right post central gyrus and the right inferior parietal lobule. A couple punctate foci of diffusion restriction are present in the medial right parietal lobe and the centrum semiovale.A T2 and FLAIR signal hyperintense area is present in the right centrum semiovale associated with mild ex-vacuo effect on the adjacent lateral ventricle.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There is signal loss in the right hemispheric cortical venous vasculature presentThe CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.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.A small focus of encephalomalacia is present in the right cerebellar hemisphere.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal left vertebral artery, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is a high grade stenosis at the distal right ICA involving the ophthalmic segment and the communicating segment.There is occlusion of the right vertebral artery present. There is a stenosis at the intracranial left vertebral artery at the PICA origin.There is fetal origin of the left PCA with a small left p1 segment. The right PCOMA is small.The ACOMA is medium size. There is triplication of the ACA. The right A1 segment is very small.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The vertebral arteries are similar in size.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. The LVA has aortic arch origin. The RVA is very small and occluded distally.

Output: 1.High grade distal right ICA long segment stenosis with small right PCOMA and hypoplastic right A1 segment.2.Occlusion of the right vertebral artery with small left p1 segment and high grade stenosis at the intracranial LVA at the PICA origin.3.Acute foci of infarction in the right MCA territory.4.Chronic right sided watershed distribution infarctions and ischemic changes to the right MCA territory.5.Findings suggest hypoxia to the right MCA territory.6.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 7.Small right cerebellar chronic stage infarction.


Instruction: Generate impression based on medical findings.

Input: 35 y/o female with DLBCL admitted for chemotherapy now found to have a depressed EF on echocardiography where previously normal LVEF on cMR. Left VentricleThe left ventricle is mildly dilated (when indexed) and systolic function. The overall LV ejection fraction is 53%, the LV end diastolic volume index is 98 ml/m2 (normal range: 65+/-11), the LVEDV is 149 ml (normal range 109+/-23), the LV end systolic volume index is 47 ml/m2 (normal range 18+/-5), the LVESV is 71 ml (normal range 31+/-10), the LV mass index is 32 g/m2 (normal range 67+/-11), and the LV mass is 48 g (normal range 114+/-24). There are no regional wall motion abnormalities present. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 105 ml/m2 (normal range 69+/-14), the RVEDV is 159 ml (normal range 110+/-24), the RV end systolic volume index is 47 ml/m2 (normal range 22+/-8), and the RVESV is 72 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is trace mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace tricuspid regurgitation.AortaThere is a left sided aortic arch with a common right brachiocephalic and left common carotid trunk takeoff (normal variant). The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. There is artifact within the SVC, likely related to catheter. 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. Left ventricle is mildly dilated when indexed for body surface area with normal systolic function (LVEF 53%)2. Right ventricle is mildly dilated when indexed for body surface area with normal systolic function (RVEF 55%) Compared to CMR of 4/2/2015, the pericardial effusion is smaller and the LV and RV volume are slightly larger on current study. LVEF is also slightly lower.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: Follow up after laser ablation of the left hippocampal lesion. There is unchanged T2 hyperintensity, susceptibility effect and volume loss within the left hippocampus and parahippocampal gyrus, where laser ablation has been performed. The posterior hippocampus still demonstrates asymmetrically increased T2 signal. There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. Left frontal and parietal skull burr holes are again noted. The skull is otherwise unremarkable. The visualized portions of the paranasal sinuses and mastoid air cells are clear.There are unchanged numerous punctate foci of high T2 signal within the right parotid gland, which may again represent sequelae of an inflammatory process.

Output: Unchanged expected findings related to laser ablation in the left medial temporal lobe.


Instruction: Generate impression based on medical findings.

Input: 51-year-old with right breast high grade DCIS presents for wire localization There is a cluster of calcifications immediately anterior to the Hydromark clip placed at recent ultrasound-guided biopsy at anterior 12:00 position in the right breast. Architectural distortions are present posterior to the same marker clip. There is a rod shaped clip, which is from prior MRI guided biopsy revealing LCIS, located medial and posterior to the Hydromark clip. The plan was made to place one wire anterior to the clustered calcifications, second wire posterior to the architectural distortions, and third wire at the rod shaped clip.The procedure, risks including bleeding, mistargeting and infection, and benefits of needle-wire localization were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time out form was completed to confirm patient identity and site of procedure. The right breast was placed in an alphanumeric grid using superior to inferior approach. When the target was positioned in the aperture of the grid, the skin was cleansed with chlorhexidine. Local anesthesia was obtained using 2% Lidocaine. Using coordinates from the grid, a 5 cm x 1, and 9 cm x 2 Kopans needles were placed adjacent to the targets. On orthogonal mammography, adequate positioning of the needle was confirmed after adjusting depth so the needle tip was approximately 2cm deep to the center of the target. A spring wires were then deployed. Repeat two view orthogonal mammograms reveal the spring wires to be in adequate position. The mammogram was annotated and reviewed with Dr. Jaskowiak prior to the patient's procedure. Patient tolerated the procedure well and was sent to the holding area in stable condition. Dr. Abe performed the procedure.Orthogonal digital specimen radiographs revealed the calcifications and two clips and three spring wires to be within the specimen. Dr. Jaskowiak will shave posterior and inferior margins.

Output: Successful needle localization of the right breast malignancy.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on medical findings.

Input: There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There is unchanged extensive confluent T2 hyperintensity within the supratentorial white matter, as well as involving the basal ganglia, thalami, brainstem, and cerebellar white matter. There are multiple unchanged punctate foci of susceptibility effect in the supratentorial and infratentorial white matter. There is no definite abnormal intracranial enhancement. 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 skull and scalp soft tissues are unremarkable. There is fluid within left mastoid air cells and minimal paranasal sinus mucosal thickening.

Output: Unchanged treatment related effects including confluent T2 hyperintensity throughout the white matter and numerous punctate foci of susceptibility effect, which may represent treated metastases, microhemorrhages, and/or cavernous malformations. Assessment for metastatic disease is otherwise limited due to the lack of intravenous contrast.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Unspecified psychosis Malignant neoplasm of breast (female), unspecified siteClinical question: R/O brain metastasisSigns and Symptoms: confusion, h/o metastatic breast cancer There are multiple enhancing lesions scattered in both hemispheres of the brain as well as the left cerebellar hemisphere which are associated with vasogenic edema. The largest one is located in the left frontal lobe and measures 30 1I 28 mm axial dimensions and is centered in the left middle frontal gyrus. One in the right middle frontal gyrus measures 10 x 13 mm axial dimensions. One in the left cuneus measures 12 mm. One in the left inferior parietal lobule measures 12 mm smaller lesions are located in the left temporal lobe and left and right frontal lobes as well as the right occipital lobe. A couple lesions are present in the left cerebellar hemisphere the largest one measuring 10 mm diameter.There is associated mass effect and midline shift. The septum pellucidum is shifted approximately 6 mm to the right of midline. The uncus is deviated medially.A small lesion in the right side of the corpus callosum measuring 6 mm diameter is associated susceptibility effect.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Multiple lesions within the brain parenchyma are compatible with metastatic disease to the brain. One of the lesions in the corpus callosum is hemorrhagic. The largest one is located in the left frontal lobe and there is associated midline shift and subtle uncal deviation/herniation medially. There is a moderate amount of vasogenic edema associated with these lesions.


Instruction: Generate impression based on medical findings.

Input: A 70 year old female with history of coronary artery disease, s/p coronary artery bypass (2000), hypertension, hyperlipidemia, chronic obstructive pulmonary disease, pulmonary hypertension.MEDICATIONS: aspirin, benazepril, carvedilol, clonazepam First Pass PerfusionDuring hyperemia, there are two distinct perfusion defects. The first is large and severe, involving the basal and mid infero-septum, inferior and inferolateral walls. The second is also large but mild and involves the basal to mid anterior wall and the mid anteroseptal and anterolateral walls. The overall ischemia score is 12 out of a possible 32. 38% of the LV is ischemic. Viability/ Myocardial ScarThere is a non-transmural myocardial infarction involving the basal to mid inferolateral wall. These segments have an intermediate probability of viability. The remainder of the myocardium is free of myocardial infarction and likely to be viable. Left VentricleThe left ventricle is normal in size and systolic function. There is thinning and hypokinesis of the basal to mid inferior and inferolateral walls and the basal inferoseptum. The overall LV ejection fraction is 62%, the LV end diastolic volume index is 84 ml/m2 (normal range: 65+/-11), the LVEDV is 132 ml (normal range 109+/-23), the LV end systolic volume index is 32 ml/m2 (normal range 18+/-5), the LVESV is 51 ml (normal range 31+/-10), the LV mass index is 44 g/m2, and the LV mass is 69 g. Left AtriumThe left atrium is mildly dilated (121ml). Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 62%, the RV end diastolic volume index is 74 ml/m2 (normal range 69+/-14), the RVEDV is 117 ml (normal range 110+/-24), the RV end systolic volume index is 28 ml/m2 (normal range 22+/-8), and the RVESV is 44 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is severe mitral regurgitation with an eccentric jet. The posterior leaflet is tethered and the possibility of flail anterior leaflet can not be excluded.Pulmonic ValveThe pulmonic valve opens widely. There is mild 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 IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSternal wires were noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. There is extensive myocardial ischemia in a multivessel coronary distribution with evidence of a large amount of myocardial viability.2. There is a small non-transmural myocardial infarction in the basal to mid inferolateral wall.3. Normal LV size and systolic function (LVEF 62%) with thinning and hypokinesis as described above.4. Normal RV size and systolic function (RVEF 62%).5. There is severe mitral regurgitation with a tethered posterior leaflet. Additionally, the possibility of a flail anterior mitral leaflet can not be excluded. 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: Sciatica. The vertebral column alignment is within normal limits, aside from trace anterolisthesis of L4 on L5. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable, including mild scattered areas of focal fat or hemangiomas. There are trace disc bulges and mild facet hypertrophy in the lower lumbar spine, but no significant spinal canal or neural foraminal stenosis. The spinal cord displays normal signal and morphology. There is diffuse paravertebral muscle atrophy. There is edema in the posterior lower back subcutaneous tissues.

Output: Trace disc bulges and mild facet hypertrophy in the lower lumbar spine, but no significant spinal canal or neural foraminal stenosis. The spinal cord displays normal signal and morphology.


Instruction: Generate impression based on medical findings.

Input: 19 years, Male, daily headaches, history of cranial radiation.. Per chart, history of rhabdomyosarcoma of the left temporal bone with cholesteatoma. There is artifact related to dental hardware which slightly limits evaluation of the anterior frontal/craniofacial region. Brain parenchyma however appears unremarkable with no intracranial mass or abnormal parenchymal or meningeal enhancement. No evidence of ischemia, hemorrhage, or other parenchymal signal abnormality. Ventricles and sulci appear within normal limits. Major flow-voids are preserved.There is diffuse opacification of the left mastoid air cells with partial left middle ear and mastoid opacification evident on prior temporal bone CT from 1/27/2010. There is thinning of the left-sided tegmen mastoideum which is better assessed with CT. There is extensive opacification of the right anterior and posterior ethmoid air cells. There is moderate mucosal thickening involving the maxillary sinuses and to a lesser degree sphenoid sinuses, right worse than left. Sella and orbits are grossly within normal limits. Remainder of the bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. Brain parenchyma appears within normal limits. Specifically, no evidence of intracranial mass or abnormal enhancement.2. Moderate degree of opacification of the paranasal sinuses, right worse than left as described above, compatible with sinusitis.3. Diffuse opacification of the left mastoid air cells, which appears slightly increased since CT temporal bone dated 1/27/2010. Finding is nonspecific, and dedicated temporal bone imaging can be considered if clinically indicated.


Instruction: Generate impression based on medical findings.

Input: 51-year-old male with obstructive jaundice secondary to choledocholithiasis status post CBD stone removal. Hepatic duct stricture, elevated LFTs. ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter T2 hyperintense foci are too small to further characterize although reflect cysts cysts or hematomas. There is a contracted gallbladder containing stones. No intrahepatic or extrahepatic biliary ductal dilatation. No loculated fluid collection.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas enhances homogeneously. Remaining pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Prominent porta hepatis and para-aortic lymph nodes, likely reactive.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Nonspecific T2 hyperintense focus in the upper thoracic vertebra. T11 vertebral body lesion is favored to represent a hemangioma. T2 hyperintense lesion within the left iliac wing is nonspecific. Diffuse edema type signal within bilateral sacral alae.OTHER: No significant abnormality noted.

Output: 1.Contracted gallbladder with cholelithiasis. No intrahepatic or extrahepatic ductal dilation. No pericholecystic fluid. 2.Indeterminate osseous findings as detailed above. Consider dedicated imaging if clinically warranted.


Instruction: Generate impression based on medical findings.

Input: lower extremity weakness There is a minimal kyphotic angulation from C4 to C6 with disc disc desiccation indicating degenerative spondylosis.The cranial-cervical junction is normal. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The paraspinal soft tissues are unremarkable.There is no evidence of abnormal enhancement, cord compression or mass. Degenerative changes are specified by the intervertebral level as follows: C2-C3: no neuroforaminal narrowing or spinal stenosis. C3-C4: no neuroforaminal narrowing or spinal stenosis. C4-C5: there is minimal uncovertebral joint hypertrophy on the left, no neuroforaminal narrowing or spinal stenosis. C5-C6: diffuse bulging of disc with minimal uncovertebral joint hypertrophy on the right side inducing minimal spinal canal narrowing as well as minimal to mild right neuroforaminal narrowing. C6-C7: no neuroforaminal narrowing or spinal stenosis. C7-T1: no neuroforaminal narrowing or spinal stenosis.

Output: 1. Degenerative spondylosis of C spine with disc degenerations.2. Minimal to mild spinal canal stenosis at the level of C56, with minimal to mild neural foraminal stenosis on the right side of C56.3. Spinal cord signal intensity is normal and no abnormal enhancement.


Instruction: Generate impression based on medical findings.

Input: Chronic low back pain with standing Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is mild straightening of the lumbar spinal curvature as well as minimal retrolisthesis of L2 on L3. Bone marrow signal is benign with small foci of T1 hyperintensity compatible with small hemangiomas or foci of fat. The conus medullaris is normal in position. There are multilevel degenerative changes including disc desiccation as well as severe loss of disc height at the L2-L3 level. Disc heights at the remainder of the levels are grossly preserved. Additional details as below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Severe disc height loss which has progressed since prior MRI from 2/3/2005. There is also a disc bulge, bilateral facet arthropathy, and ligamentum flavum thickening contributing to mild spinal canal stenosis. There is mild to moderate right and mild left neural foraminal stenosis.L3-L4: Disc bulge, facet arthropathy, and ligamentum flavum thickening, contributing to mild to moderate spinal canal stenosis. There is also mild to moderate left and mild right neural foraminal stenosis.L4-L5: Mild disc bulge, facet arthropathy, and ligamentum flavum thickening. No significant spinal canal or neural foraminal stenosis.L5-S1: Minimal disc bulge. There is bilateral facet arthropathy. No significant spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: Multilevel degenerative changes in the lumbar spine, relatively worse at the L2-L3 and L3-L4 levels. There is mild L2-L3 and mild to moderate L3-L4 spinal canal stenosis. No higher grade spinal canal stenosis. There is also mild to moderate right L2-L3 and left L3-L4 neural foraminal stenoses. Additional details as above.


Instruction: Generate impression based on medical findings.

Input: History of Crohn's ileitis. Evaluate extent of disease. ABDOMEN:LIVER, BILIARY TRACT: Few punctate liver cysts. Liver is otherwise normal in morphology, size, and signal intensity. The patient is status post cholecystectomy. No biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The small bowel is relatively well distended with oral contrast. The terminal ileum is well seen. There is minimal enhancement and wall thickening of approximately 10 cm of the terminal ileum. Otherwise the ileum is normal within caliber, wall thickness and enhancement. No adjacent acute inflammatory changes. The remainder of the small bowel is normal in caliber, wall thickness and enhancement. Segments of the jejunum are suboptimally distended but otherwise unremarkable. The colon is also normal in appearance.No free or loculated fluid.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.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: Minimal enhancement and wall thickening of 10 cm of the terminal ileum suggestive of a mild active ileitis.


Instruction: Generate impression based on medical findings.

Input: 31 year old woman with history of osteosarcoma, AML s/p chemotherapy with anthracycline based regimen, iron overload of the liver, diabetes who presents for vasodilator stress cardiac MRI to evaluate for complaints of chest pain and palpitations. MEDICATIONS: atorvastatin, metformin First Pass PerfusionDuring hyperemia, no perfusion defects were present.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 58%, the LV end diastolic volume index is 67 ml/m2 (normal range: 65+/-11), the LVEDV is 110 ml (normal range 109+/-23), the LV end systolic volume index is 28 ml/m2 (normal range 18+/-5), the LVESV is 46 ml (normal range 31+/-10), the LV mass index is 42 g/m2, and the LV mass is 69 g. There are no regional wall motion abnormalities present. Native T1 myocardial relaxation time is 976ms, which is normal. There is no evidence for myocardial iron overload.Left AtriumThe left atrium is upper normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 65%, the RV end diastolic volume index is 49 ml/m2 (normal range 69+/-14), the RVEDV is 81 ml (normal range 110+/-24), the RV end systolic volume index is 17 ml/m2 (normal range 22+/-8), and the RVESV is 28 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsLow signal intensity of the spleen consistent with the patient's clinical history of iron overload (T2-star ~8ms). No evidence of hepatic iron overload noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable. No evidence of myocardial iron overload.3. Normal LV size and systolic function (LVEF 58%).4. Normal RV size and systolic function (RVEF 65%).5. See extra-cardiac findings.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: Postoperative changes in the posterior fossa are partially imaged without evidence of a discrete mass in the field-of-view. There is kyphotic angulation of the cervical spine with apex at the C5 level, which may be in part positional. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There is no pathological enhancement.Minimal disc bulges are evident from the C3-C4 to the C7-T1 levels. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the cervical spine. THORACIC SPINE

Output: No evidence of metastatic disease in the spine.


Instruction: Generate impression based on medical findings.

Input: 40-year-old female with history of left rectus desmoid tumor status post resection. Evaluate for recurrence. 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: Unchanged small retroperitoneal lymph nodes.BOWEL, MESENTERY: Status post colectomy and take down.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Postoperative changes in the left hemi-abdominal wall. No suspicious masses or evidence of recurrence. PELVIS:UTERUS, ADNEXA: Leiomyomatous uterus. Partially septated uterus.There is a large cystic lesion in the left adnexa with enhancing internal septations measuring 7.1 x 5.8 cm (image 12 of series 15). This lesion has significantly increased in size compared to the prior CT.BLADDER: No significant abnormality noted.LYMPH NODES: Small pelvic nodes measuring up to 8mm.BOWEL, MESENTERY: Status post colectomy and take down.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Minimal ascites.

Output: 1.No evidence of desmoid recurrence in the anterior abdominal wall.2.Large left adnexal complex cystic lesion has significantly increased in size compared to the prior study and is suspicious. Followup with OB/GYN highly recommended.


Instruction: Generate impression based on medical findings.

Input: Male, 39 years old, with cervical radiculopathy, evaluate for stenosis. Alignment is anatomic. Vertebral body heights are preserved. No pathologic marrow replacement or significant marrow edema is detected.The visualized spinal cord demonstrates normal signal intensity throughout. No epidural abnormalities are suspected.C2-3: Mild facet arthropathy. Small central annular fissure. No significant spinal canal or foraminal stenosis. C3-4: Posterior disc-osteophyte complex formation, asymmetric to the right. Slight effacement of the right ventral thecal sac but no significant generalized spinal canal stenosis. Mild right foraminal narrowing. C4-5: Left facet arthropathy. No significant spinal canal stenosis. Mild left foraminal narrowing. C5-6: Facet arthropathy. Posterior disc-osteophyte complex formation asymmetric to the left. Effacement of the left ventral thecal sac and slight flattening of the left ventral cord. Mild right and moderate left foraminal narrowing.C6-7: Facet arthropathy. Broad posterior disc-osteophyte complex formation. Moderate generalized spinal canal stenosis with near complete effacement and slight flattening of the ventral cord. Severe bilateral foraminal narrowing. C7-T1: No significant spinal canal or foraminal stenosis.

Output: 1.Multilevel disc degeneration and posterior element hypertrophy.2.The spinal canal is most severely affected at the C6-7 level where a broad disc-osteophyte complex causes moderate generalized spinal canal stenosis.3.The neural foramina are severely narrowed bilaterally at C6-7, with moderate left foraminal narrowing at C5-6.


Instruction: Generate impression based on medical findings.

Input: Pineal cyst, follow-up in 6 months. Evaluate for changes and growth, headaches. Again seen is a pineal cyst measuring 21 mm in the AP dimension, 16 mm in the transverse dimension, and 12 mm in the craniocaudal dimension. There is no significant change since prior. No significant change in smooth enhancement involving the posterior wall measuring approximately 4 mm in thickness. Stable susceptibility effect and low T2 signal involving the inferior aspect of the pineal cyst which may be related to chronic products and/or mineralization. There remains mild mass effect on the tectum. The ventricles are within normal limits in size and configuration.Stable punctate foci of susceptibility associated with the ventricles bilaterally most likely represent chronic hemosiderin related to prior ventriculostomy/fenestration of the pineal lesion. No edema in the brain parenchyma. Unchanged linear area of gliosis in the right frontal lobe along prior catheter tract. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No other intracranial mass or mass-effect. Stable low-lying cerebellar tonsils which remain rounded and without significant crowding at the foramen magnum. There is patchy opacification of the ethmoid air cells and minimal mucosal thickening elsewhere in the paranasal sinuses.

Output: No significant change in pineal cyst compared to recent priors. Cyst is larger when compared to more remote prior study from 6/7/2012.


Instruction: Generate impression based on medical findings.

Input: Evaluate for renal mass invasion of liver. 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: Right renal superior pole mass measuring 6.1 x 5.2 x 8.9 cm (series 10/60), demonstrating relative hypoenhancement compared to the remaining renal parenchyma with central hypoenhancement suggestive of a central scar. There is no definite normal renal tissue encasing the superior aspect of the mass suggestive of perinephric fat involvement by the tumor. There is no definite evidence of invasion of the adjacent liver. The right adrenal gland is displaced anteromedially and not well visualized. Dorsomedially the tumor abuts the psoas fascia (series 10/65). No evidence of renal vein invasion. The mass distorts the superior collecting system without frank invasion. No locoregional lymphadenopathy or evidence of metastatic disease to the abdomen or pelvis.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: 6.1 cm right renal superior pole mass with suggestion of perinephric fat invasion and abutment of the psoas fascia without specific evidence of invasion into the adjacent liver as clinically questioned.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: Diagnosis: Malignant neoplasm of unspecified site of right female breast Malignant neoplasm of unspecified site of right female breastClinical question: history of breast cancer with new right arm pain and neuropathySigns and Symptoms: right arm pain and numbness and tingling 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.There is a T1 hyperintense focus present within the 12 vertebral body. A similar lesion is present at L1 but a bit smaller. It suppresses on the inversion recovery images. Most likely these represent vertebral body hemangiomasThere is a right paramedian disc extrusion present at C6-7 which is not entirely included on this exam. There is a partially visualized left-sided pleural effusion present.

Output: 1.There is no evidence for spinal metastases to the thoracic spine.2.Findings suggest a right C6-7 disc extrusion which is not entirely included on this exam and likely encroaches the right-sided exiting nerve roots at this level. Please refer to MRI of the cervical spine for further comments.3.There is a left-sided pleural effusion present which is not entirely imaged on this exam.


Instruction: Generate impression based on medical findings.

Input: 42-year-old female with SLE, antiphospholipid syndrome vs DIC, subdural lesion and dural sinus thrombosis on MRI, now with worsening neuro status after anticoagulation. Small right subdural collection is stable in size compared to prior MRI. Again, this could represent chronic subdural hemorrhage or infection. There is no evidence of new intracranial hemorrhage, mass or edema. Continued evolution of right occipital lobe infarct, currently measuring 2.5 x 2.1 cm (series 6, image 16/32). No additional foci of cortical low attenuation is identified.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. Partial opacification of the visualized sinuses are again noted. Nasopharyngeal soft tissue thickening is noted. These findings are likely accounted for on the basis of the patient's intubation status. The mastoid air cells are partially opacified.There is new left facial soft tissue thickening (series 6 image 10/32). Questionable right subretinal thickening (series 6 image 10/32).Microcalcifications within the parotid glands bilaterally associated with punctate hypodensities.

Output: 1. Stable small right subdural collection. Please refer to MRI of the brain from 1-3-12 for further comments.2. Continued evolution of right occipital lobe infarct.3. Questionable right subretinal thickening that be due to partial retinal detachment or small subretinal hematoma. Recommend ophthalmoscopy for further assessment if clinically indicated.4. Parotid gland microcalcifications and hypodensities.Please correlate with clinical history for chronic inflammatory process involving the parotid glands bilaterally such as sialadenitis, Sjogren's syndrome, Sarcoid or other.5. New left facial soft tissue swelling. Correlate with clinical examination.6. Opacification of paranasal sinuses and nasopharynx is suspected to be at least in part related to intubation status.Findings discussed with Dr. Chwalisz at 10:30 AM 1/9/2012.


Instruction: Generate impression based on medical findings.

Input: Multiple sclerosis. There are multiple, greater than 10, T2 hyperintense white matter lesions, primarily in a periventricular distribution. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is scattered paranasal sinus mucosal thickening.

Output: No significant interval change in the intracranial demyelinating lesions, accounting for differences in technique.


Instruction: Generate impression based on medical findings.

Input: Right shoulder pain, bicipital tendinitis ROTATOR CUFF: There is moderate tendinosis of the supraspinatus tendon. There is a high-grade undersurface tear of the supraspinatus tendon measuring approximately 7-8 mm in diameter proximal to the tendon insertion. The tear appears to extend through the majority of the thickness of the tendon. There may be a focal perforation of the bursal surface fibers but this is equivocal and overall the bursal surface fibers appear intact. There is additional fraying of the articular surface fibers of the supraspinatus. Moderate tendinosis also affects the infraspinatus tendon with additional interstitial tearing extending along the myotendinous junction. There is increased signal intensity within the distal subscapularis tendon indicating moderate insertional tendinosis. The rotator cuff musculature is intact.SUPRASPINATUS OUTLET: Moderate osteoarthritis affects the acromioclavicular joint. There is a trace amount of fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Intermediate signal intensity replaces the superior labrum representing degeneration and degenerative tearing. The inferior labrum appears relatively intact. There is mild osteoarthritis of the glenohumeral joint and a small joint effusion with fluid concentrating in the subscapular recess.BICEPS TENDON: Evaluation of the long head of the biceps tendon is limited given the lack of intra-articular contrast and the internally rotated position of the patient. Within these limits, the tendon is not well seen within the rotator interval and portions of the biceps tendon are not seen within the bicipital groove suggesting rupture.

Output: 1. Rotator cuff tendinosis with high-grade partial-thickness tearing of the supraspinatus tendon; additional rotator cuff tearing as described above.2. Poor visualization of the long head of the biceps tendon suggesting complete tear.3. Osteoarthritis of the shoulder with other findings described above.


Instruction: Generate impression based on medical findings.

Input: Reason: Chiari malformation , has NOT had surgery. yearly follow up evaluate for changes History: yearly follow up , headaches. MRI brain:There is 1.1 cm descent of the right cerebellar consult and 0.5 cm descent of the left cerebellar tonsil which is similar to the prior exam. Effacement of the foramen magnum CSF space is similar to the prior exam. Biphasic CSF flow can be seen across the foramen magnum, similar to the prior exam.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. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. A small cyst in the pineal gland is unchanged.MRI cervical spine:Redemonstration of tonsillar descent consistent with a Chiari 1 malformation. Minimal prominence of the central canal at C5-C6 is unchanged, however no syrinx is seen in the cervical or upper thoracic cord. Straightening of cervical lordosis, otherwise alignment is anatomic. Normal marrow signal. No spinal or foraminal stenosis.

Output: 1.Chiari 1 malformation is stable without new intracranial abnormalities.2.Minimal central canal prominence at C5-C6 without evidence of syrinx.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old, history of esophageal cancer and brain metastases, status post drainage of cyst, status post radiosurgery. A left posterior parietal burr hole is redemonstrated. Subjacent to this, there remains an ill-defined heterogeneous lesion at the site of prior rim enhancement. Accurate sizing of this lesion is not possible given lack of IV contrast. However, the degree of surrounding parenchymal T2 hyperintensity has increased, now covering a wider geographic area involving the left parietal and occipital lobes, and with a greater degree of associated sulcal effacement.The known small right cerebellar lesion is vaguely identified as a region of ill-defined T2 hyperintensity. No other significant interval changes are detected. The ventricular size and morphology are approximately unchanged.

Output: 1.Limited precontrast examination of the brain. 2.Although accurate sizing of the dominant left parieto-occipital lesion is not possible, the degree of edema surrounding this lesion has increased. 3.A small lesion in the right cerebellum is vaguely discernible.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Headache(784.0)Subarachnoid hemorrhageClinical question: Please evaluate for lesions that may cause SAHSigns and Symptoms: headache, h/o SAH The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a linear increased T2 signal tract representing an old ventriculostomy tract located in the right frontal lobe.A previously noted punctate focus of diffusion restriction in the right parietal lobe white matter is reidentified and is associated with signal loss on SWI. The signal loss on SWI was not present on the prior exam. There are a couple other foci of punctate signal loss on SWI in the left temporal lobe and in the right occipital lobe adjacent to the right occipital horn.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There are several microhemorrhages identified within the brain parenchyma. These were not readily seen on the prior exam.2.There is no evidence for leptomeningeal disease.3.There is no MRI evidence for intracranial hypotension.4.There is no abnormal intracranial mass lesion identified.


Instruction: Generate impression based on medical findings.

Input: 59 years Female (DOB:10/9/1956)Reason: Pt with complaints of diplopia on extreme right gaze; transient events of dizziness History: see abovePROVIDER/ATTENDING NAME: TAO XIE TAO XIE 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. Punctate T2 and FLAIR hyperintense foci are present in the brainstem. These are stable and compared to the prior exam.A punctate T2 and FLAIR hyperintense lesion is present in the right cerebellar hemisphere measuring approximately 7 mm in diameter. This could represent an old lacunar infarct.No foci of diffusion restriction are present in the brain parenchyma.There are multiple punctate subcortical foci of susceptibility effect identified on susceptibility imaging. There is also a punctate focus of susceptibility present within the midbrain. Several foci of susceptibility effect are present in the cerebellar hemispheres.No abnormal enhancing mass lesions are appreciated within the brain parenchyma. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.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.There is a mottled appearance to the marrow of the visualized osseous structures.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 . There is asymmetry in the size of the cavernous sinuses with the right being slightly larger than the left especially along its posterior aspect. This is nonspecific and likely simply reflects anatomic variant.

Output: 1.There is no evidence for acute ischemic cerebral infarction.2.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 3.There is a mild degree of microhemorrhages distributed in predominantly subcortical white matter and also brainstem and cerebellum which do not have a specific pattern of distribution.4.Findings are compatible with old lacunar infarct in the right cerebellar hemisphere.5.There is no evidence for an orbital mass6.No intracranial lesion is identified which can explain the patient's diplopia on extreme right gaze. Perhaps it is below the threshold of detection on the current exam.


Instruction: Generate impression based on medical findings.

Input: History of hepatitis C and cirrhosis. Evaluate for HCC. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. No specific stigmata of portal hypertension. No intrahepatic or extrahepatic biliary ductal dilatation.The vessels are patent.Scattered punctate foci of arterial enhancement without washout with associated mild T2 hyperintensity measuring less than 5 mm are likely perfusional anomalies. No definite corresponding lesion to that seen on the ultrasound is identified.No suspicious lytic arterial enhancing lesion or washout on portal venous, equilibrium or delayed phase imaging. No discrete suspicious lesion on T2-weighted for diffusion-weighted imagingNormally distended gallbladder with small gallstones.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small left renal cysts.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: Cirrhotic liver morphology without a suspicious lesion or specific stigmata of portal hypertension. No definite corresponding lesion to that seen on ultrasound. Continued surveillance imaging is recommended.Cholelithiasis.


Instruction: Generate impression based on medical findings.

Input: Possible diabetes insipidus, profound hypoglycemia, and excessives urine output. Brain: There appears to be trace extra-axial hemorrhage along the right parieto-occipital convexities along the venous sinuses is likely artifactual. High FLAIR signal throughout the cerebral sulci are likely attributable to supplemental oxygen. Otherwise, there is no evidence of intracranial mass, or acute infarct. The brain parenchyma appears unremarkable. There is a normal degree of myelination. 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. High FLAIR signal throughout the cerebral sulci are likely attributable to supplemental oxygen. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Pituitary: The pituitary gland is normal in size and signal characteristics. The pituitary infundibulum is intact and situated in the midline. There is no ectopic posterior pituitary. The cavernous sinuses and optic apparatus are intact.

Output: 1. No convincing stigmata of hypoglycemic encephalopathy.2. Unremarkable pituitary gland.


Instruction: Generate impression based on medical findings.

Input: Microcephaly and lack of coordination. Additional history collected from electronic medical record: 4-year-old female born at 34 gestational weeks. Her foster mother brought her to pediatric neurology clinic with delayed speech, hypertonia-flexibility issues, developmental delays. Foster mom describes the patient as super forgetful. Had IEP which stated she functions at 30 months of age. It is believed that her birth mom was developmentally delayed and she did not receive any prenatal care. There is report of intrauterine growth retardation and question of intrauterine drug exposure. Her birth weight was 4 pounds 7 ounces. There is no developmental history of when Olivia walked or developed language. Foster mom states Olivia does have two siblings, one 8 year old and one 10 year old and they both also have some degree of microcephaly. There is a diffusely simplified gyral pattern of the cerebral hemispheres bilaterally and marked microcephaly. Otherwise, the degree of myelination is appropriate for age and the corpus callosum is fully formed. The cerebellar vermis may be mildly hypoplastic, but the cerebellar hemispheres and brainstem are intact. The pituitary gland is grossly unremarkable, with the posterior pituitary bright spot is demonstrated in normal location. There is no evidence of intracranial hemorrhage, mass, or infarction. The ventricles are not enlarged. There is no evidence of heterotopia or enlarged extra-axial cerebrospinal fluid spaces. There is no midline shift or mass effect. The cerebral flow voids appear to be intact. The orbits, paranasal sinuses, and mastoid air cells are grossly unremarkable.

Output: Microcephaly with simplified gyral pattern.


Instruction: Generate impression based on medical findings.

Input: Evaluate lumbar fluid collection. History of CSF leak following microdiscectomy in June 20, 2016. Prior surgical repair on 9/7/2016, lumbar drain placement, as well as epidural blood patch a 9/21/2016. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.There are postsurgical changes of discectomy at L5-S1 with a left-sided laminotomy at L5 and a fluid collection extending from the spinal canal, including the subdural and epidural spaces, and extending posteriorly into the left paraspinous and subcutaneous soft tissues. Compared to 9/1/2016, there has been decrease in size of the fluid collection. For example majority of the previously seen small subdural component has resolved although there remains small amount of subdural fluid at the right L4-L5 level. There is a subcutaneous fluid collection component which measures approximately 16 x 23 mm x 21 mm in the AP, transverse, and craniocaudal dimensions, previously 18 x 44 x 41 mm, findings compatible with decrease in size of pseudomeningocele. There is fluid/blood products predominantly along the right L4 to S1 dorsolateral epidural space related to recent blood patch with mild local mass effect on the thecal sac at the right L5 level. Lumbar drainage catheter is noted entering the spinal canal at the L3-L4 level and extending superiorly.Mild L4-L5 disc bulges again seen with dorsal annular fissure. There is otherwise no significant disc disease, spinal canal, or neural foraminal stenosis at any level.

Output: Compared to 9/1/2016, there is decrease in size of pseudomeningocele centered at the left L5-S1 level with residual fluid, changes related to discectomy, and expected changes related to recent epidural blood patch as detailed above.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old, with history of meningioma status post resection, three-month follow-up examination. Evidence of tumor resection from the left lateral ventricular atrium is again seen. Acute postoperative findings have resolved. There remains a thin surgical tract through the left parietal lobe and mild distortion and thickening along the atrial margins.No evidence of any residual or recurrent enhancing tumor is seen. No new intracranial lesions are identified. There is no evidence of significant parenchymal edema or mass effect. Scattered punctate foci of FLAIR hyperintensity within the cerebral hemispheres are nonspecific. Ex vacuo dilatation of the left ventricular atrium is seen. Otherwise, the ventricular system is within normal limits.

Output: Expected findings are demonstrated status post resection of a meningioma from the left lateral ventricular atrium. No evidence of residual or recurrent tumor is seen.


Instruction: Generate impression based on medical findings.

Input: Reason: pain History: lateral epicondylitis LIGAMENTS: Although this examination was not optimized for detailed evaluation of the intrinsic ligaments of the elbow, the ulnar collateral ligament appears intact. The radial collateral ligament appears intact. The lateral ulnar collateral ligament appears intact.TENDONS: There is thickening and intermediate signal abnormality within the common extensor tendon at the level of the lateral epicondyle indicating moderate tendinosis. There is also increased fluid signal intensity within the common extensor tendon at the level of its insertion on the lateral upper condyle indicating partial thickness tearing. Some of the fibers of the common extensor tendon can be traced to the level of its insertion. The flexor tendons appear intact. The biceps and brachialis muscles and tendons appear intact. The triceps tendon appears intact.ARTICULAR SURFACES AND BONE: There is bone marrow signal abnormality in the lateral epicondyle at the level of the insertion of the common extensor tendon which may reflect reactive osteitis or degenerative change. Otherwise no bone marrow signal abnormality is identified.SURROUNDING STRUCTURES: The ulnar nerve is normal in appearance.ADDITIONAL

Output: Tendinosis and partial-thickness tearing/strain of the common extensor tendon as described above. No full-thickness tear or retraction is identified.


Instruction: Generate impression based on medical findings.

Input: Evaluate for HCC recurrence status post RFA ABDOMEN:LUNG BASES: Left pleural effusion with compressive atelectasis.LIVER, BILIARY TRACT: Cirrhosis with recanalized umbilical vein. Large amount of ascites. Left hepatic lobe ablation zone measures 3.9 x 3.9 cm. No definite arterially enhancing lesion. The portal vein is patent.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.

Output: 1. Post ablation changes without definite arterially enhancing lesion.


Instruction: Generate impression based on medical findings.

Input: Dizziness and giddiness [780.4], Reason for Study: ^Reason: eval for post circulation stenosis, syndrome History: eval for post circulation stenosis, syndrome No evidence of acute ischemic or hemorrhagic lesion on this scan.Minimal to mild diffuse brain atrophy which is age appropriate with minimal patchy high signal intensities on periventricular white matter indicating nonspecific small vessel ischemic disease.The ventricular system appear to be slightly prominent but does not show any evidence of periventricular edema or evidence of occlusion of the CSF pathway. In particular, frontal and temporal horn prominency are proportional, no evidence of upward bowing of corpus callosum and approximate callosal angle appears to be normal.There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate tortuosity of the intracranial vessels, however, there is no evidence of intracranial arterial luminal stenosis or narrowing. There is no intracranial arterial aneurysm. The right PCA is fetal origin.3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate tortuous arterial system however, 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.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. No evidence of intracranial or extracranial arterial luminal stenosis or irregularity. No intracranial arterial aneurysm.3. Slightly prominent ventricular system without evidence of CSF flow stenosis or occlusion.


Instruction: Generate impression based on medical findings.

Input: Patient presents with left radial wrist swelling and nodule on thumb extensor tendon; evaluate for tenosynovitis or tendon rupture. LIGAMENTS: The scapholunate and lunotriquetral ligaments are intact.TRIANGULAR FIBROCARTILAGE COMPLEX: The triangular fibrocartilage complex is intact.TENDONS: There is mild interstitial tearing of the extensor pollicis brevis tendon along with signal changes surrounding the extensor pollicis brevis and abductor pollicis longus tendons, consistent with tenosynovitis. Mild subcutaneous edema is noted in the surrounding soft tissues. Flexor tendons are intact. BONES: There is no acute fracture.ADDITIONAL

Output: Mild interstitial tearing of the extensor pollicis brevis tendon along with mild tenosynovitis of the extensor pollicis brevis and abductor pollicis longus tendons.


Instruction: Generate impression based on medical findings.

Input: 73-year-old female with neck pain. Evaluate for osteoarthritis. 6 views of the cervical spine are provided. There is moderate degenerative disk disease throughout the cervical spine from C3-T1. There is mild multilevel facet degenerative disease. There is grade 1 anterolisthesis of C3 on C4. There is also multilevel mild-moderate neuroforaminal narrowing bilaterally.

Output: Degenerative arthritic changes as described above.


Instruction: Generate impression based on medical findings.

Input: Reason: Patient w/ LE wounds, elevated inflammatory markers-eval for osteo History: LE wounds Some sequences are limited by patient motion artifact. There is thickening and mild enhancement of the skin with edema of the underlying subcutaneous fat, compatible with cellulitis. There is mild atrophy of the musculature of the leg with patchy increased signal intensity within the musculature on T2-weighted images which may represent superimposed edema, but we see no enhancement of the muscle, nor do we see any fluid collection to indicate abscess formation. The bone marrow signal intensity is within normal limits without findings to suggest osteomyelitis. There is a small joint effusion of the knee as well as osteoarthritis of the knee.

Output: Cellulitis and other findings as described above without evidence of osteomyelitis.


Instruction: Generate impression based on medical findings.

Input: Evaluate for spinal stenosis. There is a normal lumbar lordosis. The lumbar spine alignment and the vertebral body height appear normal. T12/L1, L1/L2, L2/L3: unremarkable. L3/L4: mild disc bulge; no neuroforaminal compromise or spinal canal stenosis. L4/L5: disc bulge; bilateral facet joint and ligamentum flavum hypertrophy; bilateral facet joint space widening with fluid accumulation on the right and air accumulation on the left; bilateral neuroforaminal compromise; spinal canal stenosis (8 mm in AP). L5/S1: mild disc bulge; no neuroforaminal compromise or spinal canal stenosis. Incidental findings are atrophy of bilateral kidneys and heavy calcification in the abdominal aortic and iliac arteries.

Output: Degenerative disease of the lumbar spine, most pronounced at L4/L5, as detailed above.


Instruction: Generate impression based on medical findings.

Input: 75 years Female (DOB:3/27/1941)Reason: extensive stage small cell lung cancer History: extensive stage small cell lung cancerPROVIDER/ATTENDING NAME: JYOTI D PATEL JYOTI D PATEL The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

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


Instruction: Generate impression based on medical findings.

Input: Tongue cancer, chronic pain, pain and weakness in upper extremities Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is benign with diffuse T1 shortening which may related to prior radiation therapy.The cervical spinal cord has normal signal characteristics and overall morphology.Mild multilevel degenerative changes are present including mild generalized facet arthropathy. Individual levels as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: No significant compromise to the spinal canal or neural foramina.C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. No significant spinal canal or neural foraminal stenosis at any level.2. No cord signal abnormality.3. No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Stroke: Nystagmus, N/V, hypertension. There is a punctate focus of restricted diffusion in the right middle frontal gyrus subcortical white matter, without associated susceptibility effect. There is otherwise moderate scattered cerebral white matter T2 hyperintensity bilaterally. There is a prominent perivascular space in the left pons. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There is paucity of the right internal carotid artery flow void. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Punctate acute infarct in the right middle frontal gyrus subcortical white matter without evidence of hemorrhagic transformation. A background of moderate cerebral white matter signal abnormality likely represents chronic small vessel ischemic disease. Significant steno-occlusive disease involving the right internal carotid artery is better depicted on the recent CTA.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old, with numbness, Chiari seen on previous MRI. Brain:The right cerebellar tonsil is peglike in morphology and descends 7-8 mm below the level of foramen magnum. The left cerebellar tonsil maintains a more normally rounded configuration but still distends 5 to 6 mm below the level of the foramen magnum. However, the CSF space at the level of foramen magnum is not particularly crowded, and on CSF flow imaging, fairly robust biphasic flow is demonstrated both anteriorly and posteriorly.Elsewhere in the brain, a few scattered small foci of nonspecific FLAIR hyperintensity are seen within the cerebral parenchyma. No edema or mass effect is detected. No intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricles are normal in size and morphology. Bone marrow signal characteristics are within normal limits. A defect of the nasal septum is noted incidentally.Thoracic spine:As assessed on sagittal T2-weighted images, the spinal cord demonstrates normal signal intensity and morphology. No focal lesions are seen. No evidence of any syrinx is detected. Spinal alignment is anatomic. Vertebral body heights are preserved. Mild endplate degenerative changes are seen with small scattered disc protrusions. No high-grade spinal canal or foraminal stenosis is suspected.

Output: 1.Findings are seen compatible with Chiari I malformation. However, the CSF space at the foramen magnum is not particularly crowded, and CSF flow imaging shows robust biphasic flow both anteriorly and posteriorly.2.No additional significant intracranial findings are seen.3.On limited imaging of the thoracic spine, no additional spinal cord abnormalities are detected.


Instruction: Generate impression based on medical findings.

Input: Lung cancer, balance deficits, questionable neurologic deficit, evaluate for brain tumor No diffusion restriction is seen to suggest acute ischemia. No susceptibility weighted artifact is seen to suggest intracranial hemorrhage. Nonspecific T2/FLAIR hyperintense foci are seen throughout the periventricular and subcortical white matter. Given the patient's age, these are likely secondary to small vessel seen in disease. No mass lesion is seen within the brain. No abnormal areas of enhancement are seen. The CSF spaces are appropriate for the patient's stated age with no midline shift. Incidental note is made of a cavum septum pellucidum and cavum vergae, normal variants.Normal vascular flow voids are present in the major intracranial vasculature.The imaged portions of the paranasal sinuses are clear. Fluid is seen within the left mastoid air cells. The imaged portions of the orbits are intact.

Output: No evidence of intracranial metastases.


Instruction: Generate impression based on medical findings.

Input: Female, 11 months old, with macrocephaly. Assess for hydrocephalus or tumor. Parenchymal morphology and pattern of gyration are normal. The degree of white matter myelination is appropriate for the stated age. No areas of concerning signal abnormality are detected.The pituitary region is within normal limits. The corpus callosum is fully formed and normal. The brainstem, cerebellar vermis and cerebellar hemispheres are unremarkable.No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. No mass or mass-effect is seen. The pattern of intracranial enhancement is within normal limits. The ventricles are normal in size and morphology.

Output: Unremarkable evaluation of the brain.


Instruction: Generate impression based on medical findings.

Input: MRI BRAIN: No restricted diffusion to suggest acute ischemia in the brain. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Brain parenchyma is otherwise unremarkable for age. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved. Bone marrow signal and extracranial soft tissues are within normal limits. Partially empty sella, which may be a normal variant.MRI ORBITS: The right maxillary sinus is small which may related to hypoplasia or atelectasis from prior chronic sinus disease. There appears to be minimal mucosal thickening. There is no enophthalmos or significant downward displacement of right intraorbital contents. No abnormal mass or abnormal enhancement is seen in the orbits. The optic nerves are normal in size and signal intensity, and are symmetric bilaterally. No retrobulbar mass, chiasmatic mass, or parasellar abnormality is seen. Extraocular muscles are unremarkable.

Output: 1. Minimal chronic small vessel ischemic changes in the brain, which is otherwise unremarkable for age.2. No abnormal signal in the optic nerves or chiasm. 3. Small right maxillary sinus which may be related to atelectasis from prior chronic sinusitis versus hypoplasia. No additional imaging findings to suggest silent sinus syndrome. CT can better assess bony anatomy if clinically warranted.


Instruction: Generate impression based on medical findings.

Input: 34 years Female (DOB: 10/26/1981)Reason: Evidence of cervical radiculopathy History: Radicular pain down R arm after accidentPROVIDER/ATTENDING NAME: TODD STERN TODD STERN The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is no significant compromise to the spinal canal or neural foramina.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. There is a minor disk bulge at this level which appears chronic.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: There is no compromise to the cervical spinal canal or exiting nerve roots.


Instruction: Generate impression based on medical findings.

Input: Rectal cancer status post chemoradiation therapy. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: The reference lymph node at the level of the rectosigmoid junction on the left measures 2 mm in short axis (series 5/45), compared to 3 mm previously.BOWEL, MESENTERY: Diverticulosis. Small volume of fluid in the left pericolic gutter and adjacent to the bladder dome.Demonstrated again in the low/mid rectum is a region of very low T2-weighted signal intensity involving approximately 90 degrees of the left lateral rectal wall mucosa/submucosa compatible with post-treatment related fibrotic scarring. The region of signal abnormality measures approximately 1.5 x 8 mm (series 5/26) in cross-section, compared to 1.6 x 0.9 cm previously. No measurable discrete intermediate T2-weighted signal abnormality, focal postcontrast enhancement or restricted diffusion. No evidence of extramural extension.No enlarged mesorectal lymph nodes.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Mild interval decrease in size of posttreatment residual of the rectal mass with imaging characteristics suggestive of post radiation scar tissue without residual restricted diffusion or appreciable focal postcontrast enhancement.2.No enlarged pelvic lymphadenopathy, appearing similar to the prior. Small amount of free fluid in the pelvis.