Instruction: Generate impression based on medical findings.

Input: 17 year-old male with knee pain and instability, concern for PCL tear MENISCI: The menisci are intact bilaterally.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted. No articular cartilage defect, fracture, or bone contusion.LIGAMENTS: The anterior cruciate ligament appears intact. The posterior cruciate ligament is thickened with increased signal intensity, and increased angulation on proton density images indicating a PCL tear. Discernible fibers are identified along the course of the PCL ligament indicating this is a partial tear. The lateral collateral complex ligament appears intact. There is increased signal intensity within the medial collateral ligament indicating a strain.EXTENSOR MECHANISM: No significant abnormality noted. The extensor mechanism is intact.ADDITIONAL

Output: 1.Partial tear of the PCL.2.MCL sprain.


Instruction: Generate impression based on medical findings.

Input: Breast cancer and C3-C4 autofusion (Klippel-Feil?): right upper extremity pain and tingling sensation, with decreased strength throughout. There are multiple Multiple unchanged congenital anomalies of the cervical spine, including incomplete fusion of the posterior elements of C1, a C4 butterfly-type vertebra fused with the C3 vertebral body, and dysplasia of the C5 posterior elements. There is no significant spondylolisthesis. There is also multilevel degenerative spondylosis. At C2/3, ligamentum flavum thickening and facet arthropathy result in mild to moderate left foraminal narrowing with mild bilateral neural foraminal narrowing, but no significant spinal canal stenosis. At C3/4, there is mild to moderate narrowing of the bilateral neural foramina, but no significant spinal canal stenosis. At C4/5, there is bilateral mild to moderate foraminal narrowing. At C5/6, a disc-osteophyte complex results in severe narrowing of the right neural foramen and moderate narrowing of the left neural foramen, as well as mild right paracentral narrowing of the spinal canal. At C6/7, a disc-osteophyte complex, ligamentum flavum thickening, and facet arthropathy result in moderate narrowing of the spinal canal, as well as severe bilateral neural foraminal narrowing. Aside from degenerative signal alterations, the vertebral bone marrow signal appears unremarkable. The spinal cord appears unremarkable. There is no evidence of mass lesions in the cervical spine. The paraspinal soft tissues are unremarkable.

Output: 1. Multiple congenital segmentation anomalies in the cervical spine and degenerative spondylosis that is most pronounced at the C5/6 and C6/7 levels.2. No evidence of metastases in the cervical spine.


Instruction: Generate impression based on medical findings.

Input: 64-year-old man with chronic neck pain. The craniovertebral junction appears within normal limits. The cervical spine alignment is maintained and the cervical vertebral bodies and disc spaces are appropriate in height. Scattered intermediate signal within some of the intervertebral discs likely reflects degeneration. The bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:At C2-C3 there is minimal disc bulge without significant compromise to the spinal canal. There is left-sided facet arthropathy. There is mild left neural foraminal narrowing.At C3-C4 there is severe disc bulge with moderate narrowing of the central spinal canal, mild bilateral facet joint arthropathy, and mild to moderate narrowing of the bilateral neural foramina.At C4-C5 there is mild disc bulge with moderate narrowing of the central spinal canal. There is mild bilateral facet joint arthropathy and mild narrowing of the bilateral neural foramina.At C5-C6 there is mild disc bulge with mild narrowing of the central spinal canal. There is mild bilateral facet joint arthropathy and mild narrowing of the bilateral neural foramina.At C6-C7 there is mild disc bulge without significant narrowing of the central spinal canal. There is mild bilateral facet joint arthropathy and mild narrowing of the bilateral neural foramina.At C7-T1 there is no significant disc bulge. The central spinal canal is not narrowed. There is mild bilateral facet joint arthropathy and mild narrowing of the bilateral neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Multilevel degenerative changes affect the cervical spine, worst at the C3-C4 level.


Instruction: Generate impression based on medical findings.

Input: Reason: 59M with history of low volume Gl6 prostate cancer, starting active surveillance History: as above. Limited examination due to artifact from left hip arthroplasty device on the DWI/ADC.PELVIS:PROSTATE:Prostate Size: 4.8 x 6.1 x 6.1 cm.Peripheral Zone: In the right posterior mid gland, there is a 0.6 x 1.1 cm focus of T2 hypointense signal, restricted diffusion and early enhancement, suspicious for tumor (series 801 image 12, series 704 image 224).Central Gland: Heterogeneous.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Possible small tumor within the right posterior mid gland peripheral zone.


Instruction: Generate impression based on medical findings.

Input: 38 year old male with a history of bicuspid aortic valve, aortic pseudocoarctation and aneurysm with perforated ulcer, 24mm hemashield graft to aorta in October 2013 presenting for repeat evaluation. FIrst part of the study was done May 22, 2015 but had to be aborted because patient developed a severe headache and was unable to go back into the MRI machine. Contrast had not yet been given. Patient returned on May 29 to complete the study without incident. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 57%, the LV end diastolic volume index is 89 ml/m2 (normal range: 74+/-15), the LVEDV is 192 ml (normal range 142+/-34), the LV end systolic volume index is 38 ml/m2 (normal range 25+/-9), the LVESV is 82 ml (normal range 47+/-19), the LV mass index is 58 g/m2 (normal range 85+/-15), and the LV mass is 128 g (normal range 164+/-36). There are no regional wall motion abnormalities present. Left AtriumThe left atrium is normal in size.Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 91 ml/m2 (normal range 82+/-16), the RVEDV is 198 ml (normal range 142+/-31), the RV end systolic volume index is 45 ml/m2 (normal range 31+/-9), and the RVESV is 98 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. Aortic valve not well seen on cine imaging.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 regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. Hemashield graft noted in the descending thoracic aorta with surrounding post-operative changes. The aortic dimensions are as follows: (Previous dimensions in parentheses) Sinus of valsalva 33x32mm (31 x 31mm)Sinotubular junction 28x27mm (30 x 27mm)Ascending aorta 32x32mm (31 x 31mm)Proximal aortic arch 30x30mm (32 x 32mm)Distal aortic arch 27x23mm (25 x 24mm)The abdominal aorta is imaged to just below the right renal artery. There is no left renal artery noted The abdominal aorta is ectatic with 4 regions of dilation. Previous measurements are in parentheses. 1. 4cm distal to the inferior border of the aortic graft measuring 35 mm (35mm) in diameter2. 10cm distal to the inferior border of the aortic graft measuring 32 mm (33mm) in diameter 3. 11cm distal to the inferior border of the aortic graft measuring 34 mm (33mm) in diameter4. 13cm distal to the inferior border of the aortic graft measuring 33 mm (33mm) in diameterPulmonary 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 FindingsA midline sternotomy with post-surgical changes is 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. Normal LV size and systolic function (LVEF 57%) without evidence of underlying fibrosis, inflammation, or infiltration.2. Normal RV size and systolic function (RVEF 51%). 3. Aorta measurements are given above. 4. Graft noted in the descending thoracic aorta.5. Multiple ectatic areas noted in abdominal aorta. 6. No significant difference from previous study done 2014-02-04I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Reason: Rule out osteomyelitis History: pain swelling Right toe:There is a focus of gas density overlying the tuft of the distal phalanx on the AP and oblique views which we suspect reflects air trapped between the upper toenail bed but we cannot entirely exclude focal bone erosion. If there is strong clinical concern for osteomyelitis, MRI could be obtained. Mild osteoarthritis affects the first MTP joint. Arterial vascular calcifications are noted.Left toe:There is irregularity of the soft tissues dorsal to the distal phalanx but we see no frank osteolysis to confirm osteomyelitis. Mild osteoarthritis affects the first MTP joint. Arterial vascular calcifications are noted.

Output: 1. Focus of gas density overlying the tuft of the distal phalanx of the right great toe. While we suspect this represents air trapped between the toenail bed, we cannot entirely exclude focal bone erosion. If there is strong clinical concern for osteomyelitis, MRI could be obtained.2. Soft tissue irregularity of the soft tissues dorsal to the distal phalanx of the left great toe without specific radiographic evidence of osteomyelitis.


Instruction: Generate impression based on medical findings.

Input: There is normal anatomic alignment of the basion, C1 and C2/dens articulations on the neutral, flexion and extension views. There is trace anterolisthesis of C2 on C3 without evidence of dynamic instability. Postoperative findings related to Chiari decompression with suboccipital craniectomy and occiput-C2 posterior fusion are again seen. There is mild loss of T2 disk signal in the C2-3, C4-5 and C5-6 disks without significant herniation, spinal canal or neural foraminal narrowing.There is diminished CSF spaces at the foramina magnum ventrally related to mild retroversion of the dens. Dens abuts the medulla, unchanged from prior, without evidence of impingement on the medulla on the flexion or extension views. Dorsal CSF flow is not seen on the CSF flow sequence secondary to susceptibility artifact from the hardware. T2 sequences however do demonstrate good dorsal CSF space.

Output: 1.Stable postoperative findings of Chiari decompression and occiput to C2 fusion. No MR evidence of dynamic instability.2.No syrinx in the cervical cord.


Instruction: Generate impression based on medical findings.

Input: Mental status changes, homicidal thoughts. Off Zoloft. Patchy areas of subcortical and periventricular white matter hypodensity likely represent small vessel ischemic disease, age indeterminate by CT. There is no evidence of intracranial hemorrhage, mass, midline shift or extra axial fluid collection. The ventricles and basal cisterns appear symmetric.A fixation plate in the left periorbital region is noted which would not preclude the patient from getting an MRI. An old buckle fracture of the right zygomatic arch is again noted. There is partial opacification of the left maxillary sinus. The remaining visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Stable examination without acute intracranial abnormality. Small vessel ischemic disease, age indeterminate.


Instruction: Generate impression based on medical findings.

Input: Cervical spine:There is slight reversal normal upper cervical curvature. There are no fractures or subluxations. The marrow signal is benign. The cervical cord is normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. Redemonstrated is opacification of the rightSinus with mucosal thickening in the remaining visualized. As the sinuses. Otherwise the visualized paraspinal contents are unremarkable.C2/3: UnremarkableC3/4: There is a small midline disc protrusion which indents the anterior midline cord, without intrinsic cord signal abnormality. There is also bilateral uncinate hypertrophy resulting in mild bilateral neural foraminal stenosis.C4/5: There is a left paracentral disc extrusion extending above and below the disc level causing anterior left hemicord flattening, without intrinsic cord signal abnormality. There is also left uncinate hypertrophy. There is focal leftward moderate central stenosis and mild left neural foraminal stenosis.C5/6: There is a tiny central disc protrusion without significant associated mass effect and no resulting stenosis.C6/7: UnremarkableC7/T1: UnremarkableThoracic spine:Sequences acquired towards the end of the thoracic exam are significantly motion degraded. Given this caveat:There is a smooth, physiologic thoracic kyphotic curve. The vertebral body heights and disc spaces are maintained. Marrow signal intensity is benign throughout. The thoracic spinal cord is grossly unremarkable.T1/2 demonstrates no significant disc bulge or cord encroachment.T2/3 demonstrates no significant disc bulge or cord encroachment. T3/4 demonstrates no significant disc bulge or cord encroachment. T4/5 demonstrates no significant disc bulge or cord encroachment. T5/6 demonstrates no significant disc bulge or cord encroachment.T6/7 demonstrates no significant disc bulge or cord encroachment. T7/8 demonstrates no significant disc bulge or cord encroachment. T8/9 demonstrates no significant disc bulge or cord encroachment. T9/10 demonstrates no significant disc bulge or cord encroachment.T10/11 demonstrates no significant disc bulge or cord encroachment. T11/12 demonstrates no significant disc bulge or cord encroachment. T12/L1 demonstrates no significant disc bulge or cord encroachment.

Output: 1.Originally a complete MRI of the spine with and without contrast was ordered. Unfortunately, due to the patient's back pain, she was unable to tolerate the exam. Multiple sequences were repeated due to motion. Per nursing, no meds were available and the service was paged. The patient requested to complete the rest of exam as an outpatient. Sequences acquired towards the end of the thoracic exam are significantly motion degraded.2.No MRI evidence of cervical cord myelopathy. The thoracic cord is grossly unremarkable.3.C3/4: There is a small midline disc protrusion which indents the anterior midline cord, without intrinsic cord signal abnormality. There is also bilateral uncinate hypertrophy resulting in mild bilateral neural foraminal stenosis.4.C4/5: There is a left paracentral disc extrusion extending above and below the disc level causing anterior left hemicord flattening, without intrinsic cord signal abnormality. There is focal leftward moderate central stenosis and mild left neural foraminal stenosis.


Instruction: Generate impression based on medical findings.

Input: Left shoulder pain. Assess for re-tear of rotator cuff. Evaluation of the humeral head and adjacent soft tissues is slightly limited by metallic susceptibility artifact related to recent surgery.ROTATOR CUFF: Since the prior study, the patient has undergone rotator cuff repair. There are multiple suture anchors in humeral head that extend to the surface of the greater tuberosity. One of the more posterior suture anchors appears to extend approximately 5 mm beyond the surface of the greater tuberosity, but the clinical significance of this is uncertain. Portions of the supraspinatus and infraspinatus tendons are visualized extending to these anchors. There is thickening and increased signal intensity of the posterior fibers of the supraspinatus tendon and anterior fibers of the infraspinatus tendon suggesting moderate to severe tendinosis. Small high signal intensity clefts vertically traversing the posterior fibers of the supraspinatus tendon and the anterior fibers of the infraspinatus tendon best seen on image 8 of series 1001 may represent very thin full-thickness defects, but I see no large fluid-filled gap or retraction of this portion of the cuff. More anteriorly, the insertional fibers of the supraspinatus tendon are indistinct on the coronal oblique fat suppressed T2 weighted sequence and I cannot determine if this represent additional tendinosis or perhaps insertional tearing filled with blood or granulation tissue. Nevertheless, I see no discrete fluid-filled gap. The supraspinatus and infraspinatus muscles appear normal. The teres minor tendon and muscle are intact. The subscapularis tendon and muscle appear normal.SUPRASPINATUS OUTLET: There is deformity of the distal clavicle and acromion process that presumably reflects interval surgery. I otherwise see no abnormalities of the acromioclavicular joint. There is a small amount of fluid in the subacromial/subdeltoid bursa that could represent a mild bursitis.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. There is a small amount of fluid within the joint but no frank effusion. There is mild blunting of the superior labrum that is new and may be due to interval surgery. The inferior labrum appears normal given the limitations of a non-arthrogram study.BICEPS TENDON: The tendon of the long head of the biceps is visualized within the bicipital groove. It is not well visualized within the rotator interval; this may either reflect prior surgery or interval tearing.

Output: Postoperative changes as described above including rotator cuff repair and possible bicipital tenotomy. The rotator cuff can be traced to its suture anchors within the humeral head. Heterogeneity of the cuff is most compatible with moderate to severe tendinosis, with smaller high signal intensity clefts within the cuff that may represent thin full-thickness defects, as well as poor definition of the most anterior fibers of the supraspinatus tendon that may reflect insertional tearing that could be pre-existing; however, I see no large fluid-filled gap or definable retraction of the tendon.


Instruction: Generate impression based on medical findings.

Input: BRAIN: There is no acute infarct, mass effect, or cerebral edema. There are scattered periventricular and subcortical white matter T2 signal abnormalities which are nonspecific, but likely vascular related. There is mild to moderate diffuse lateral and third ventricular prominence with a relatively normal sized fourth ventricle which is likely secondary to greater degree of central parenchymal volume loss, with possible superimposed normal pressure hydrocephalus. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. LUMBAR: The last well formed disk space is referred to as L5-S1. There is normal alignment of the lumbar spine. There is no osseous marrow signal abnormality. The conus terminates at L2 which is within normal limits.T12-L1: No disk herniation or spinal stenosis.L1-2: No disk herniation or spinal stenosis. L2-3: No disk herniation or spinal stenosis.L3-4: Minimal disk bulge, bilateral facet arthropathy and ligamenta flava thickening causing mild bilateral neural foraminal stenosis. No spinal canal stenosis.L4-5: Mild disk bulge, ligamenta flava thickening and facet arthropathy causing mild to moderate bilateral neural foraminal stenosis. No spinal canal stenosis.L5-S1: Mild diffuse disk bulge, facet arthropathy and ligamenta flava thickening causing moderate to severe bilateral neural foraminal stenosis. No spinal canal stenosis.

Output: 1.No acute infarct.2.Mild to moderate nonspecific white matter T2 signal abnormalities likely vascular related.3.Mild to moderate cerebral central parenchymal volume loss with possible superimposed normal pressure hydrocephalus.4.Multilevel lumbar spondylosis with bilateral neural foraminal stenosis at L3-4 through L5-S1, worst at L5-S1. No spinal canal stenosis. Please see details above.


Instruction: Generate impression based on medical findings.

Input: Numbness, pain, burning, fasciculations in the lower extremities. Evaluate for infiltrating pachymeningitis. Five lumbar type vertebral bodies are presumed to be present. Again seen is levoscoliosis of the lumbar spine with apex at the L2-L3 level. Vertebral body heights are within normal limits. Bone marrow signal is benign with T1 hyperintense focus at the T11 vertebral body compatible with focal fat or hemangioma. The conus medullaris is normal in position.Minimal degenerative changes are seen, as described below:L1-L2: Minimal disc bulge. No spinal canal or neural foraminal stenosis.L2-L3: There is a disc bulge without significant spinal canal or neural foraminal stenosis. Facet arthropathy on the right.L3-L4: Minimal disc bulge. No spinal canal or neural foraminal stenosis.L4-L5: Minimal disc bulge. No spinal canal or neural foraminal stenosis. Mild facet arthropathy and ligamentum flavum thickening.L5-S1: Minimal disc bulge eccentric to the left with mild left neural foraminal stenosis. No spinal canal or right neural foraminal stenosis. There is facet arthropathy particularly on the left and ligamentum flavum thickening.Cauda equina nerve roots in the upper lumbar spine are rightward deviated due to the levoscoliosis. No abnormal enhancement is seen involving the cauda equina nerve roots or the epidural space. Paraspinous soft tissues are within normal limits.

Output: 1. No abnormal mass or enhancement to suggest pachymeningitis as questioned.2. Moderate levoscoliosis of the lumbar spine with apex at the L2-L3 level as seen previously.3. Mild degenerative changes with mild left L5-S1 neural foraminal narrowing. No significant spinal canal or foraminal stenosis in the remainder of the lumbar spine.


Instruction: Generate impression based on medical findings.

Input: 69 years Male (DOB:11/19/1946)Reason: encephalopathy History: encephalopatyPROVIDER/ATTENDING NAME: BRYAN A CAMPBELL SANDEEP S PULIMI MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are partially opacified. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. There is loss of signal present at the petrous segments of internal carotid arteries which is suspected to be artifactual. There are mild foci of narrowing without significant stenosis at the cavernous segments of the internal carotid arteries. There is loss of signal present at the proximal intracranial right vertebral artery just distal to the extracranial origin of the right posterior inferior cerebellar artery.There is mild narrowing of the left M1 segment with approximately 50% stenosis.At the proximal right M1 segment there is a 1.5 mm saccular extension protruding superiorly. No perforators are identified cessation this.The right A1 segment is hypoplastic.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are medium-sized. There is an infundibulum at the origin of the posterior communicating artery bilaterally.. The vertebral arteries are similar in size.

Output: 1.There is some intracranial cerebrovascular narrowings present without significant stenosis on the basis of WASID criteria. There is 50% narrowing at the left M1 segment.2.At the proximal right M1 segment there is a 1.5 mm saccular extension suspected to represent an aneurysm. It could also represent an infundibulum of the perforators not visualized on this exam. If clinically appropriate a CT angiogram may be helpful here.3.There is signal loss along the petrous segments of the internal carotid arteries as well as the right vertebral artery. As a result evaluation of these specific locations is suboptimal on this exam.4.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 5.There is no evidence for acute ischemic cerebral infarction on this exam.


Instruction: Generate impression based on medical findings.

Input: Female, 41 years old, with intractable epilepsy. Functional localization requested for presurgical evaluation. During the visual stimulation portion of the examination, the patient experienced one of her typical seizure episodes with involuntary movement of the right arm, disorientation and headache. The symptoms lasted less than 5 minutes, and after a short delay, the patient was fully recovered and able to proceed with the remainder of the exam. Sensorimotor cortical activation of the hand, foot and face maps as expected along the pre- and post-central gyri. Visual cortical activation maps as expected along the bilateral calcarine sulci.All tested language paradigms produce reliable language related cortical activation. Language is left dominant. Multiple foci of cortical activation are observed mapping to the left inferior frontal gyrus (primarily pars opercularis and pars triangularis) which likely reflect the putative Broca's area. Foci of activation in the left posterior temporal lobe are seen variable on all language paradigms, though the sentence completion paradigm produces the most robust activation. A focus of activation is seen along the left superior temporal sulcus which is typical of the putative Wernicke's area. However, foci are also seen more posteriorly in the superior temporal gyrus and the middle temporal gyrus, which could reflect additional sites of Wernicke's processing or sites of accessory language processing.

Output: 1.Technically successful fMRI for sensorimotor and language cortical mapping.2.Sensorimotor cortical activation maps as expected along the pre- and post-central gyri. Visual cortical activation maps as expected along the calcarine sulci.3.Language is left dominant. Cortical activation related to Broca's and Wernicke's areas maps to the customary locations as above.


Instruction: Generate impression based on medical findings.

Input: New onset tremor and bradykinesia: history of head injury. There is paucity of high SWI signal within bilateral substantia nigra nigrosome-1. There is mildly reduced T2 signal in the bilateral putamen and globi pallidi along with susceptibility effect, suggestive of mineral deposition. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma otherwise appears unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is retention cyst formation in the left maxillary sinus.

Output: Findings indicative of Parkinson disease. Otherwise, no evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on medical findings.

Input: 83 year old female with history of breast cancer, diabetes and heart failure admitted with acute decompensated heart failure. CMR ordered to evaluate for etiology of left ventricular dysfunction, including infiltrative processes. Left VentricleThe left ventricle is severely dilated with moderate-severely reduced systolic function. The overall LV ejection fraction is 30%, the LV end diastolic volume index is 124 ml/m2 (normal range: 65+/-11), the LVEDV is 220 ml (normal range 109+/-23), the LV end systolic volume index is 87 ml/m2 (normal range 18+/-5), the LVESV is 154 ml (normal range 31+/-10), the LV mass index is 82 g/m2 (normal range 67+/-11), and the LV mass is 146 g (normal range 114+/-24). The left ventricular systolic dysfunction is global. There is diffuse late gadolinium enhancement predominately in the bases in a pattern atypical for myocardial infarction to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The T1 times were elevated at 1250ms. There is no left ventricular thrombus. Left AtriumThe left atrium is moderately-severely dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 84 ml/m2 (normal range 69+/-14), the RVEDV is 150 ml (normal range 110+/-24), the RV end systolic volume index is 40 ml/m2 (normal range 22+/-8), and the RVESV is 71 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is at least trivial aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least mild mitral regurgitation. Mild thickening anterior leaflet.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 a small circumferential pericardial effusion.Extracardiac FindingsBilateral small, left greater than right, pleural effusions with subsegmental atelectasis left lower lobe and lingula. Fluid noted in superior esophagus suggestive of reflux. Nonspecific T2 high signal focus in mid thoracic vertebral body, incompletely characterized. With the history of breast cancer, comparison to outside imaging recommended. In absence of such comparison, consider further cross sectional imaging.Evidence of previous left rotator cuff repair and deformity of left humeral neck, better visualized on radiograph 12/24/15.

Output: 1. The left ventricle is severely dilated with moderate-severely reduced systolic function. The overall LV ejection fraction is 30%. The left ventricular systolic dysfunction is global. 2. There is diffuse late gadolinium enhancement predominately in the bases in a mid and epicardial distribution atypical for myocardial infarction. Additionally, there is increased T1 times, in combination, these findings are consistent with infiltrative disease, such as myocardial amyloidosis.3. The right ventricle is normal in size and function. 4. Nonspecific T2 high signal focus in mid thoracic vertebral body. With the history of breast cancer, consider further cross sectional imaging (such as with spin echo MRI of spine).


Instruction: Generate impression based on medical findings.

Input: AML. Evaluate for infection Ventilation images reveals normal bone marrow throughout the tibia and fibula. There is some mild stranding in the lateral subcutaneous fat. No evidence of an abscess in the soft tissues. No evidence of a uterine soft tissues.

Output: Mild stranding of the subcutaneous fat along the lateral aspect of the leg representing mild inflammation.


Instruction: Generate impression based on medical findings.

Input: 5 lumbar type vertebral bodies are identified. The lumbar lordosis is preserved. The vertebral body heights and intervertebral disc spaces are grossly preserved. The osseous marrow signal is within normal limits. Mild inferior endplate degenerative changes demonstrated involving the L4 vertebral body with Schmorl's node which is slightly larger and associated with increased edema compared to prior. The conus is normal in signal and morphology and terminates at the T12-L1 level. The cauda equina appear unremarkable. There is congenital narrowing of the spinal canal. There is diffuse desiccation of the intervertebral discs of the lumbar spine.Individual levels as below:L1-L2: No significant spinal canal or neuroforaminal stenosis.L2-L3: There is a mild diffuse disc bulge however without neuroforaminal or spinal stenosis.L3-L4: There is a mild diffuse disc bulge causing moderate right and mild to moderate left neuroforaminal narrowing and mild spinal canal stenosis which is predominantly on the basis of developmental spinal canal narrowing. The previously seen disc extrusion at this level is no longer seen. L4-L5: There is a mild diffuse disc bulge at this level causing moderate left and mild to moderate right neural foraminal narrowing and mild spinal canal stenosis. L5-S1: There is a mild diffuse disc bulge at this level and advanced facet arthropathy. There is partial effacement of the right lateral recess as well as mild to moderate right neural foraminal stenosis. No significant central canal stenosis.

Output: Developmental narrowing of the mid to lower lumbar spinal canal with superimposed degenerative changes as described above. There is mild spinal canal stenosis at the L3-L4 and L4-L5 levels. Additional details including neural foraminal narrowing as above.


Instruction: Generate impression based on medical findings.

Input: Male 19 years old Reason: Please evaluate for progression of PSC, cirrhosis, or dominant stricture History: 18 yo w ulerative colitis and IBD ABDOMEN:LIVER, BILIARY TRACT: The intrahepatic biliary ducts demonstrate an irregular appearance with areas of focal narrowing and dilatation. This is best appreciated on series 5, image one. The common hepatic, left main and right main ducts are irregular. The common bile duct is normal in caliber. A focal stricture in the common hepatic duct appears increased compared to prior study however the dilatation above this is not significantly changed.The liver is normal in morphology.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.Findings compatible with primary sclerosing cholangitis with intrahepatic ductal involvement. Increasing narrowing in the distal common hepatic ducts without significantly increased superior duct dilatation. Attention can be paid to this on additional surveillance imaging.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: 53-year-old female with history of knee pain after fall. MENISCI: There is linear signal abnormality within the posterior horn of the medial meniscus extending to the tibial articular surface compatible with a tear. The posterior root junction of medial meniscus is indistinct and possibly torn.Additionally, there is increased globular signal throughout the remaining posterior horn compatible with degeneration. There is degenerative globular signal abnormality and degenerative tearing of the lateral meniscus. There is also a femoral sided tear near the meniscal junction of the meniscofemoral ligament.ARTICULAR CARTILAGE AND BONE: There is a small cortical depression of approximately 2mm along the posterior aspect of the medial tibial plateau. There is thinning of the articular cartilage within the medial compartment as well as tricompartmental osteophytes. Increased signal abnormality within the posterior tibial plateau and lateral femoral condyle compatible with contusions. There is additional edema type signal within the anterior aspect of the medial tibial plateau possibly from direct injury.LIGAMENTS: There is complete disruption of the anterior cruciate ligament. There is increased signal abnormality within the PCL, but we see no discrete tear. The MCL and LCL are intact.EXTENSOR MECHANISM: The extensor mechanism is unremarkable.ADDITIONAL

Output: 1.Complete ACL disruption.2.Small 2mm depression fracture along the posterior aspect of the medial tibial plateau.3.Full thickness tear of the posterior horn of the medial meniscus in the background of degenerative signal abnormality. Additional tearing and degeneration is present within the lateral meniscus.4.Moderate joint effusion, degenerative changes and other findings as above.


Instruction: Generate impression based on medical findings.

Input: Left biceps, triceps, deltoid weakness. Evaluate for cervical stenosis. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is minimal retrolisthesis of C3 on C4, C4 on C5, and C5 on C6. Alignment is otherwise maintained. Bone marrow signal is benign.Degenerative changes are seen in the cervical spine as described below:C2-3: Small disc osteophyte complex eccentric to the right and ligamentum flavum thickening. There is no significant spinal canal stenosis. There is mild right neural foraminal narrowing. Left neural foramen is patent. C3-4: Disc osteophyte complex and ligamentum flavum thickening contribute to moderate spinal canal stenosis. There is mild deformity of the cord. There is questionable T2 hyperintensity just below the level of the stenosis at the C4 level on the left on the STIR sequence and sagittal oblique T2 sequence but no definite cord signal abnormality. There is also moderate left and mild to moderate right neural foraminal narrowing related to uncovertebral hypertrophy and facet arthropathy. C4-5: Disc osteophyte complex and ligamentum flavum thickening result in mild to moderate spinal canal stenosis. There is severe right and moderate left neural foraminal stenosis. C5-6: Disc osteophyte complex and ligamentum flavum thickening are associated with mild spinal canal stenosis. There is severe right and mild to moderate left neural foraminal stenosis.C6-7: No significant spinal canal stenosis. There is moderate to severe right and mild to moderate left neural foraminal stenosis related to uncovertebral hypertrophy and facet arthropathy.C7-T1: No significant compromise to the spinal canal or right neural foramen. Mild left neural foraminal stenosis related to facet arthropathy.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Multilevel degenerative changes in the cervical spine. There is moderate spinal canal stenosis at the C3-C4 level with mild cord deformity. There is questionable associated subtle T2 signal involving the left lateral aspect of the cord at the C4 level, but no definite cord signal abnormality. There is also mild to moderate C4-C5 and mild C5-C6 spinal canal stenosis.2. Multilevel neural foraminal narrowing including moderate left C3-C4, severe right C4-C5 and C5-C6, and moderate to severe right C6-C7 neural foraminal stenoses. Additional levels as above.


Instruction: Generate impression based on medical findings.

Input: A patient submitted outside study for review. Submitted for review are breast MRI (5/17/16) performed at Magnetic Resonance Imaging Center. For comparison, outside studies of digital mammographic images (4/21/16), ultrasound images of left breast (4/21/2016), a specimen radiograph and left digital mammographic images (5/5/2016) are available. BREAST MRI (5/17/16):Breast MRI was performed with a protocol outlined in the outside radiology report.There is extreme amount of fibroglandular tissue in both breasts.Marked parenchymal enhancement is noted bilaterally.There is a susceptibility artifact from a marker clip of recent DCIS biopsy at posterior far-lateral, superior aspect in the left breast. Because of strong parenchymal enhancement, no discrete enhancement around the marker clip is identified.No abnormal lymph nodes are identified in either axillary region.

Output: Non-diagnostic MRI due to marked parenchymal enhancement. If clinically indicated, repeat MRI at University of Chicago utilizing high temporal resolution technique can be performed.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on medical findings.

Input: Epilepsy. The hippocampi show normal, symmetric volume and signal characteristics. There is no evidence of grey matter heterotopia, intracranial hemorrhage, mass, or acute infarct. The degree of myelination is appropriate for age, otherwise. The ventricles and sulci are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is minimal mucosal thickening in the paranasal sinuses. Thre is also mild scattered T2 hyperintensity in the mastoid air cells, left more than right. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: No potential seizure foci are identified.


Instruction: Generate impression based on medical findings.

Input: Female, 23 years old, with di-di twin pregnancy, 32 week 6 day GA, midline brain cyst seen on twin A on ultrasound. Imaging was tailored for assessment of twin A which lies more caudally and more toward the maternal left. Brain parenchymal morphology and signal characteristics of twin A are within normal limits for gestational age. A normal cavum septum pellucidum is identified. More posteriorly, a slightly prominent cystic space is seen situated at midline, just below the splenium of the corpus callosum and above the internal cerebral veins. No other definite abnormal fluid collections are seen. Twin B is inadequately assessed due to excessive fetal motion, but the limited images obtained show no significant abormality. Maternal pelvicaliectasis is seen on the left, likely physiologic.

Output: A slightly prominent cystic space is seen in twin A situated between the splenium of the corpus callosum and the internal cerebral veins. This is a typical location for a cavum vellum interpositum, sometimes referred to as a cyst of the cavum vellum interpositum. The brain is otherwise within normal limits for gestational age. Please note that this exam was interpreted without the benefit of review of the prior US images. These will be obtained and reviewed, and if any change to the interpretation is warranted, an addendum to this report will be made.


Instruction: Generate impression based on medical findings.

Input: Back pain and numbness groin area, evaluation for disc herniation. For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing. The conus medullaris terminates at the L1-L2 level. The intervertebral discs demonstrate normal T2 intensity and height with no evidence of disc herniation. The paraspinal soft tissues are unremarkable.

Output: Normal lumbar spine MRI.


Instruction: Generate impression based on medical findings.

Input: 53 year old female patient with history of ALH in a biopsied fibroadenoma in the right breast 11 o'clock position. Benign fibrocystic change in 12 o'clock right breast. There is heterogeneous amount of fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally. Bilateral subglandular silicone breast implants noted.Clip artifacts are seen in the 12 o'clock and 11 o'clock positions. There is no abnormal enhancement at the 12 o'clock position. At the 11 o'clock position containing the clip there is an oval enhancing mass that measures 7 x 5 x 6 mm (AP x ML x CC). There is a benign morphology focus in the left breast 1 o'clock position with a possible fat containing correlate on T2 weighted sequence, most likely representing a benign intramammary lymph node. No abnormal lymph nodes are identified in either axillary region.

Output: Oval enhancing mass with clip in the 11 o'clock position consistent with biopsy proven fibroadenoma. No suspicious findings in the left breast.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on medical findings.

Input: Lateral hip pain The left ischiofemoral space is markedly narrowed (4 mm) with edema and tiny foci of fluid within the intervening soft tissues. These changes contact the anterior margin of the sciatic nerve and there is fatty atrophy of the quadratus femoris. Additionally, there is tendinosis and partial tearing of the hamstring tendons at their origin of the ischium which is of uncertain clinical significance. Mild edema is also noted lateral to the greater tuberosity which may reflect a component of mild inflammation but is commonly seen in asymptomatic patients. Evaluation of the acetabular labrum is limited given the lack of intra-articular contrast however there is a band of intermediate signal intensity traversing the anterior labrum, suspicious for tear. Minimal osteoarthritis of the left hip is noted.There are similar findings of ischiofemoral impingement on the right with similar degeneration and partial tearing of the hamstrings at the origin of the ischium. Similar increased signal is noted along the greater tuberosity which again could be of no clinical significance.Mild degenerative arthritis of the pubic symphysis is noted and there is severe degenerative disc disease of the lumbar spine.

Output: 1. Imaging features of bilateral ischiofemoral impingement.2. Although evaluation of the hip joint is limited by lack of intra-articular contrast, there is suspected tearing of the anterior labrum.3. Mild edema along the lateral aspect of the greater tuberosity bilaterally which is of uncertain clinical significance.4. Degeneration and partial tearing of the hamstrings tendons at their origins which again is of questionable clinical significance.5. Degenerative arthritis of the lower lumbar spine with additional findings described above.


Instruction: Generate impression based on medical findings.

Input: 30 year old male with a history of myocarditis with elevated troponin level. Referred for cardiovascular MRI to evaluate for possible occult ischemia, and myocarditis. MEDICATIONS: None First Pass PerfusionDuring hyperemia, no perfusion defects were present.Viability/ Myocardial ScarThere is no evidence of prior myocardial infarction. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 64%, the LV end diastolic volume index is 69 ml/m2 (normal range: 74+/-15), the LVEDV is 120 ml (normal range 142+/-34), the LV end systolic volume index is 25 ml/m2 (normal range 25+/-9), the LVESV is 44 ml (normal range 47+/-19), the LV mass index is 56 g/m2, and the LV mass is 97 g. There are no regional wall motion abnormalities present. There is an atypical pattern of late gadolinium enhancement which spares the endocardium and involves the basal septum and the basal anterolateral and inferolateral walls. Additionally these segments showed evidence of increased signal on T2-imaging and on T1-weighted early gadolinium enhancement images. Together these findings support the diagnosis of acute/ subacute active myocarditis.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 62%, the RV end diastolic volume index is 80 ml/m2 (normal range 82+/-16), the RVEDV is 138 ml (normal range 142+/-31), the RV end systolic volume index is 30 ml/m2 (normal range 31+/-9), and the RVESV is 52 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No evidence of prior myocardial infarction.3. Normal LV size and systolic function (LVEF 64%). There is evidence of acute/ subacute active myocarditis involving the basal septum and basal anterolateral and inferolateral walls.4. Normal RV size and systolic function (RVEF 62%).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: 43-year-old with known left breast cancer with additional MRI findings for which ultrasound is requested. Patient also complains of a newly appreciable palpable area of concern in the left upper outer breast that she feels she has stopped breast-feeding. A targeted bilateral ultrasound was performed.For the patient's area of concern in the left outer breast near 2:00, adjacent simple and complicated cysts are present. This correlates with cysts seen on the MRI.For the MRI detected mass in the left lower outer quadrant, a 1.4 x 1.4 cm hypoechoic oval mass with internal vascularity is present and correlates with the MRI. This should be biopsied under ultrasound guidance.In the left inner breast near 9:00, a 9 x 7 mm hypoechoic region with apical vascularity is seen. This is indeterminant in appearance and should also be biopsied under ultrasound guidance.In the right lower inner quadrant no suspicious cystic or solid mass was apparent. Likely the MRI finding at this site was focal nodular parenchymal enhancement.In the right axillary region several adjacent lymph nodes with thickened cortices are seen. Cortical thickness is up to 5 mm and nonhilar blood flow is noted.

Output: 1. Left lower outer quadrant 1.4 cm hypoechoic mass correlates with MRI can be biopsied under ultrasound guidance.2. Left inner breast 9 mm hypoechoic region with apical vascularity is indeterminant in appearance, could be a correlate for the MRI finding and should also be biopsied under ultrasound guidance.3. No suspicious finding in the right lower inner quadrant, a reasonable result given the the low suspicion for the right breast finding from MRI.4. Indeterminate right axillary lymph node, at least as suspicious in morphology as the known metastatic lymph node in the left axilla. Ultrasound-guided biopsy is recommended.Orders for this biopsy to be performed tomorrow have been placed by Donna Christian and the patient is scheduled for 9:00 AM.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: Right foot drop, lower extremity pain. Patient has MRI compatible spinal cord stimulator device. For the purposes of numbering, there are 7 cervical, 12 thoracic, and 4 lumbar type vertebral bodies, which is consistent with prior CT lumbar spine reports. The last rib-bearing vertebra is labeled T12.Partially imaged cervical spine demonstrates a disc herniation at the C3-C4 level on the sagittal images with mass effect on the ventral cervical cord which is not well evaluated. Small disc osteophyte complexes at the C4-C5 and C5-C6 levels are also present.Thoracic: There is a central disc protrusion at the T7-T8 level which effaces the ventral thecal sac and is associated with impression on the ventral aspect of the thoracic cord. There is overall mild to moderate degree of spinal canal stenosis at this level with some residual CSF space dorsally.Vertebral body heights and alignment of the thoracic spine are otherwise normal. Bone marrow signal is benign. No significant herniation, spinal canal stenosis, or neural foraminal stenosis is evident at the remainder of the thoracic spine levels. There is mild to moderate multilevel facet arthropathy in the lower thoracic spine.Lumbar: As mentioned above, there are 4 lumbar type vertebral bodies, which is consistent with prior CT lumbar spine reports. The last rib-bearing vertebra is labeled T12. Vertebral body heights are within normal limits. There is grossly unchanged appearance of the grade 1 anterolisthesis of L3 on L4 with evidence of interspinous fixation device at this level as seen on prior CT. Bone marrow signal is benign. Multilevel degenerative changes are seen, as described below:L1-L2: Minimal disc bulge, ligamentum flavum thickening, and facet arthropathy. No significant spinal canal or neural foraminal stenosis.L2-L3: Minimal disc bulge, ligamentum flavum thickening, and facet arthropathy. There is mild to moderate left neural foraminal stenosis. No significant spinal canal or right neural foraminal stenosis.L3-L4: Postoperative changes with interspinous fixation device better seen on prior CT. There is advanced facet arthropathy and bony proliferation along the ligament of flavum which contributes to mild to moderate spinal canal stenosis. There is disc uncovering and disc bulge which extends into the right neural foramen. There is associated moderate degree of right-sided neural foraminal stenosis. Left neural foramen is patent. L4-S1: Mild disc bulge and facet arthropathy. No spinal canal stenosis. Minimal narrowing of the neural foramina.

Output: 1. For the purposes of numbering, there are 7 cervical, 12 thoracic, and 4 lumbar type vertebral bodies, which is consistent with prior CT lumbar spine reports. The last rib-bearing vertebra is labeled T12.2. T7-T8 central disc extrusion with minimal craniocaudal extension. There is effacement of the ventral thecal sac and mild impression on the ventral thoracic cord. No cord signal abnormality. Otherwise no significant spinal canal or neural foraminal stenosis in the thoracic spine.3. Postoperative changes of interspinous fusion at L3-L4 with unchanged grade 1 anterolisthesis. There is mild to moderate degree of spinal canal stenosis at this level related to facet arthropathy and bony proliferation along the ligamentum flavum. There is also moderate right-sided neural foraminal stenosis where there may be impingement of the exiting right-sided nerve root.4. Mild to moderate left L2-L3 neural foraminal stenosis.5. C3-C4 disc herniation partially imaged on the sagittal localizer sequence with suggestion of mass effect on the ventral cord at this level.


Instruction: Generate impression based on medical findings.

Input: Prostate cancer, status post docetaxel. Right perianal/gluteal numbness. Obstructive uropathy. PELVIS:PROSTATE/SEMINAL VESICLES: Interval decrease in size of the prostate and reference measurement right pelvic soft tissue nodule. There is soft tissue enhancement of the prostate.BLADDER: No significant abnormality noted.LYMPH NODES: Reference measurement left external iliac lymph node and adjacent thickening of the right internal obturator muscle have decreased in the interval. The right internal obturator muscle measures 1.3 cm in thickness compared to 2.5 cm on the 2/2/2016 CT exam, and contrast enhancement is suggestive of metastatic disease.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Persistent cortical thickening and trabecular expansion of the right hemipelvis with scattered areas of T2 hyperintensity and contrast enhancement suggesting a mixed appearance of Paget's disease and metastatic lesions. Additional metastatic foci are suspected in the sacrum and left posterior ilium.OTHER: No significant abnormality noted.INDEX LESION MEASUREMENTS (Current exam date/time: 7/12/2016 11:30:00)LEFT PELVIC LYMPH NODE: 0.7 x 0.4 cm (Image 85, Series 9); 0.4 x 0.4 cm on prior (6/29/2016) (Image 131, Series 201).RIGHT PELVIC SOFT TISSUE MASS: 1.8 x 2.0 cm (Image 67, Series 9); 2.8 x 2.6 cm on prior (6/29/2016) (Image 139, Series 201).

Output: 1.Interval decrease in size of the prostate, right pelvic soft tissue nodule, and right internal obturator muscle thickness. Contrast enhancement of the right internal obturator muscle suggests metastatic disease.2.MRI features suggesting a mixed appearance of Paget's disease and metastatic lesions within the right hemipelvis. Additional foci of osseous metastasis are suspected in the sacrum and left posterior ilium.


Instruction: Generate impression based on medical findings.

Input: T4N2cM1 tonsil ca admitted for cycle 4/7-8 FHX elderly frail. There is a lingual cortex defect and diffuse enhancement in the right mandible, with ill-defined enhancement in the adjacent soft tissues measuring up to approximately 30 mm. There is diffuse thickening of the right trigeminal nerve from the inferior alveolar canal to the cavernous sinus and perhaps into the right foramen rotundum. There is also mildly prominent enhancement and thickening of the adjacent dura along the floor of the middle cranial fossa. There are denervation changes in the right tongue and right masticator muscles. There is no evidence of significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable. There is a lesion in the C7 vertebral body with endplate deformities. There is a punctate lesion in the superior portion of the C5 vertebra. There is multilevel degenerative cervical spondylosis with disc-osteophyte complexes at C3 through C7 that mildly indent the spinal cord. There is fluid within the bilateral mastoid air cells. There is mild mucosal thickening in the right maxillary sinus.

Output: 1. A lingual cortex defect and diffuse enhancement in the right mandible, with ill-defined enhancement in the soft tissues, measuring up to approximately 30 mm, which likely corresponds to the previously treated tumor, superimposed upon right tongue denervation changed. 2. Diffuse thickening of the right trigeminal nerve from the inferior alveolar canal to the cavernous sinus is compatible with perineural tumor spread, with denervation changes in the right masseter muscles.3. Treated metastatic lesion in the C7 vertebral body with endplate deformities. A punctate lesion in the superior portion of the C5 vertebra is nonspecific.4. No significant residual cervical lymphadenopathy based on size criteria. 5. Nonspecific fluid within the bilateral mastoid air cells.


Instruction: Generate impression based on medical findings.

Input: The cervical spine is in normal alignment, with a normal cervical lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber. There is redemonstration of a trace prominence of the central spinal canal from the C6-C7 level down to T1-2. There is no pathological enhancement.Previously seen mild spondylotic changes from C4-C5 through C6-C7 appear similar, except there is decreased conspicuity of the central annular fissure at C5-C6. There is up to moderate left foraminal narrowing at C5-C6, but unchanged.THORACIC SPINE

Output: 1.Interval postoperative changes relating to the bulking of exophytic intramedullary/intradural extramedullary predominant fat signal intensity mass centered at the T2 level, with residual fat components identified along the left lateral and dorsal midline cord, with slight interval increased visualization of surrounding CSF within the thecal sac.2.Interval significant increase somewhat nodular appearing enhancement within the cord adjacent to the areas of residual fat signal, likely relating to postoperative changes and granulation tissue formation. However, given the linear eccentric enhancement noted along the mass preoperatively, continued follow-up is recommended.3.Stable trace prominence of the central spinal canal within the cord just cranial to the level of the mass.


Instruction: Generate impression based on medical findings.

Input: 44 years Female (DOB:12/8/1971)Reason: Stroke w/u History: R thalamic hemorrhagePROVIDER/ATTENDING NAME: JAMES A MASTRIANNI JAMES A MASTRIANNI MRI of the brainThere is a right thalamic hematoma present measuring 15 x 20 mm in axial dimensions. There is a surrounding halo of edema present.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma. MR characteristics include bright on T1, dark on T2 and susceptibility effect.There are punctate foci of signal loss on susceptibility imaging present within the cerebellum, brainstem, right putamen and the left thalamus.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.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The left A1 segment is larger than the right A1 segment. The anterior communicating artery is not readily identified. The posterior communicating arteries are medium-sized. The vertebral arteries are similar in size.

Output: 1.There is a right thalamic hematoma present which is not appear to be significantly different in size when compared to the 6/11/2016 exam.2.There are multiple microhemorrhages present in the cerebellum, left thalamus and right putamen. This pattern is suggestive of hypertensive microhemorrhages. 3.No evidence for cerebrovascular occlusive disease.4.No evidence for intracranial aneurysm.


Instruction: Generate impression based on medical findings.

Input: 50-year-old female with right-sided neck pain that radiates to her arm and hand. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. Limited evaluation of the intracranial structures is unremarkable. Minimal right disc osteophyte complex at C4-C5 without thecal sac effacement, spinal canal or foraminal stenosis. Small right paramedian disc protrusion at C5-C6 with slight flattening of the thecal sac and ventral cord. The cervical spinal cord has normal signal characteristics and overall morphology.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: A right paramedian disc protrusion at C5-C6 causes effacement of the thecal sac and slight flattening of the ventral cord.


Instruction: Generate impression based on medical findings.

Input: To evaluate bullet in pelvis prior to MRI. Changes of degenerative disk disease and facet osteoarthritis affect the imaged lower lumbar spine. Mild osteoarthritis affects the left sacroiliac joint. The right sacroiliac joint demonstrates a normal appearance.There are no fractures identified.The hip joints demonstrate a normal radiographic appearance.A vascular graft is identified in the region of the right superficial femoral artery, the patency of which cannot be assessed on this noncontrast study.Atherosclerotic calcifications are noted in the aorta and iliac arteries.No organized fluid collections in the subcutaneous fat.In the left psoas muscle, at the level of the bladder, is an ovoid density, which measures 16 mm in craniocaudal dimensions and 7 mm in diameter. This is compatible with the stated history of bullet.

Output: 1. Bullet fragment within the left psoas muscle as above.2. Vascular graft as above, the patency of which cannot be assessed on this noncontrast study.3. Osteoarthritis and degenerative disk disease as above.


Instruction: Generate impression based on medical findings.

Input: History of renal cell carcinoma 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: Status post right nephrectomy. There is a stable small soft tissue nodule in the right nephrectomy bed (series 4, image 16) measuring up to 12 mm, unchanged from 5/5/2015 CT likely representing postoperative change. No suspicious left renal lesions. RETROPERITONEUM, LYMPH NODES: Reference aortocaval lymph node near the aortic bifurcation (series 8, image 35) measures approximately 4 x 6 mm previously 7 x 10 mm on 5/5/2015 CT. Previously described gastrohepatic lymph node is not well-visualized.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Fat-containing umbilical hernia.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy. No adnexal masses. Previously seen right adnexal lesion has resolved.BLADDER: No significant abnormality noted.LYMPH NODES: The previously described multiple cystic foci in the distribution of the obturator chains which are thought to represent lymph nodes have decreased in size from prior previously measuring up to 1.5 cm now measuring up to 0.7 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable soft tissue nodule in the right nephrectomy bed, likely postsurgical. Previously described abdominal and pelvic lymph nodes have decreased in size.


Instruction: Generate impression based on medical findings.

Input: A 50 year old male with known sarcoid in the lungs, COPD and paroxysmal atrial fibrillation. He is being considered as a candidate for lung transplant and thus referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 45%, the LV end diastolic volume index is 75 ml/m2 (normal range: 74+/-15), the LVEDV is 148 ml (normal range 142+/-34), the LV end systolic volume index is 42 ml/m2 (normal range 25+/-9), the LVESV is 82 ml (normal range 47+/-19), the LV mass index is 57 g/m2 (normal range 85+/-15), and the LV mass is 112 g (normal range 164+/-36). There is global hypokinesis with regional variation (the basal segments seem to be worse than the apical segments). There is no obvious late gadolinium enhancement noted to suggest an underlying fibrosing, infiltrative, or inflammatory process. However, the native myocardial T1 times is significantly increased (1,227ms), raising the possibility of diffuse interstitial fibrosis or inflammation. These findings are not diagnostic of cardiac sarcoid but might represent an early stage of involvement; cardiac PET may be helpful for further evaluation. No intracavitary thrombus was noted.No myocardial iron overload was noted.Left AtriumThe left atrium is normal in size (50ml). Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 42%, the RV end diastolic volume index is 82 ml/m2 (normal range 82+/-16), the RVEDV is 160 ml (normal range 142+/-31), the RV end systolic volume index is 48 ml/m2 (normal range 31+/-9), and the RVESV is 94 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 mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated (32mm).Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with mildly reduced systolic function, the LVEF is 45%. The base of the left ventricle seems to be functioning worse than the apex. 2. There is no obvious late gadolinium enhancement noted to suggest an underlying fibrosing, infiltrative, or inflammatory process. However, the native myocardial T1 times is significantly increased (1,227ms), raising the possibility of diffuse interstitial fibrosis or inflammation. These findings are not diagnostic of cardiac sarcoid but might represent an early stage of involvement; cardiac PET may be helpful for further evaluation. 3. The right ventricle is normal in size with mildly reduced systolic function, the RVEF is 42%. 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: 32 years, Male. Reason: stricture due to Crohn's disease that is active. Is there evidence of free air? History: right shoulder pain Small amount of pneumoperitoneum seen on lateral decubitus view, and in the subhepatic space on the supine view. Prominent, gaseous colon is noted in the right upper quadrant, relative paucity of gas in left-sided colon, finding suspicious for underlying colonic stricture particularly given patient's clinical history and prior MRI exam.

Output: Pneumoperitoneum, additional findings as above.Findings discussed with Dr. Rubin via phone at 1:50 PM on 7/14/2015.


Instruction: Generate impression based on medical findings.

Input: 81 yo w known T8-9 vertebral lesion involving spinal canal s/p palliative XRT. Please eval for extent of disease for consideration of surgical debulking. Abdominal pain, back pain, mild lower extremity weakness. PET/CT 12/4/2015, CT chest 11/20/2015 There is an expansile enhancing mass involving the T8 vertebral body and posterior elements with diffuse low T1 signal and increased STIR signal. Mild endplate deformities of the T8 vertebral body are seen. There is mild right and moderate left compression deformity. The tumor extends into the epidural space diffusely, surrounding the spinal cord and causing severe spinal stenosis. There is no definite abnormal cord signal. The epidural component of the lesion extends from T7 to T9 levels. Additionally, there is involvement of the superior endplate of the T9 vertebral body with small area of enhancement. Tumor extension into the neural foramina results in severe bilateral foraminal stenosis at T8-T9, as well as severe left and moderate to severe right neuroforaminal stenosis at T7-T8. There is extension in the costovertebral junctions bilaterally at T8, with poor visualization of the left T8 proximal rib.The left anterior aspect of the T3 vertebral body demonstrates mild enhancement without additional corresponding signal abnormality.There is an approximately 5 cm right upper lobe mass, partially visualized.

Output: 1. There is an expansile T8 holovertebral metastatic lesion with diffuse epidural extension between the T7 and T9 levels, with severe central spinal canal stenosis. No definite abnormal cord signal at this time. Up to moderate associated compression deformity.2. Tumor extension into the neural foramina results in severe bilateral neuroforaminal stenosis at T8-T9, as well as severe left and moderate to severe right foraminal stenosis at T7-T8. 3. Likely additional metastatic involvement of the superior T9 endplate.4. The left anterior aspect of the T3 vertebral body demonstrates mild enhancement without additional corresponding signal abnormality. Continued close follow-up is recommended.5. Partially visualized right lung mass.


Instruction: Generate impression based on medical findings.

Input: 26-year-old male patient with alpha-1 antitrypsin deficiency. HCC screening. ABDOMEN:LIVER, BILIARY TRACT: The liver is nodular in contour with hypertrophy of the left hepatic lobe. No suspicious hepatic lesion is identified. There is no intra- or extrahepatic biliary ductal dilatation. SPLEEN: Splenomegaly measuring 20 cm in the craniocaudal dimension. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Cirrhotic morphology of the liver without suspicious hepatic lesion.


Instruction: Generate impression based on medical findings.

Input: Neoplasm of unspecified behavior of brain status post resection. There are postoperative findings related to left suboccipital craniotomy with a small amount of air and blood products within the surgical bed. There has been partial resection of a T2 hyperintense mass involving the left cerebellar hemisphere. The residual mass measures up to approximately 4 cm. There is persistent associated mass effect upon the adjacent brainstem with obliteration of the cerebellomedullary and cerebellopontine angle cisterns. In addition, the cerebral aqueduct is effaced and the fourth ventricle appears slitlike, while the lateral and third ventricles are dilatated and surrounded by periventricular T2 hyperintensity. While there is restricted diffusion within and surrounding the tumor, which may be due to ischemia, there is otherwise no evidence of acute territorial infarction. There are a few scattered nonspecific punctate foci of T2 hyperintensity within the cerebral white matter. There is mild mucosal thickening in the bilateral maxillary sinuses. The orbits are unremarkable.

Output: Postoperative findings related to recent left suboccipital craniotomy and partial resection of left cerebellar mass with persistent obstructive hydrocephalus.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: Recurrent bladder cancer and acute on chronic BLE and RUE weakness, new fecal incontinence. There is an enhancing lesion in the lesion in the T9 vertebral body without extravertebral extension. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. However, there are multiple T2 hyperintense nodules in the partially-imaged thyroid.

Output: 1. A lesion in the T9 vertebral body may represent a metastasis, but no evidence of spinal cord compression in the thoracic spine or pathological compression fracture. 2. Multiple nonspecific nodules in the partially-imaged thyroid. A thyroid ultrasound may be useful for further evaluation.


Instruction: Generate impression based on medical findings.

Input: 29-year-old male presents with acute left knee pain. MENISCI: Lobular intermediate signal with a more discrete linear component extending to the inferior articular surface in the posterior horn of the medial meniscus compatible with a tear. There is a small posterior parameniscal cyst. There is minimal extrusion of the menisci. No discrete tear involving the medial meniscus is identified.ARTICULAR CARTILAGE AND BONE: Bone marrow edema is noted in the lateral tibial plateau and lateral femoral condyle. There is some heterogeneity in the articular cartilage of the patellofemoral joint but no focal thickness tear is identified. There is however a focal cartilage defect with abnormal signal along the lateral aspect of the lateral condyle with underlying bone marrow edema.LIGAMENTS: Abnormal diffuse intermediate signal intensity throughout the anterior cruciate ligament with a full-thickness tear and proximal retraction of the ligament towards the origin. Abnormal appearance and signal of the MCL compatible with a severe sprain with suspicion for proximal tearing. High signal intensity through the lateral collateral ligament complex to a lesser degree is suggestive of a sprain.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Complete thickness tear of the ACL with associated tears of the lateral meniscus. Findings are also concerning for a high-grade MCL sprain with likely superimposed proximal tearing.


Instruction: Generate impression based on medical findings.

Input: History of prostate cancer diagnosed in 2009. PSA of 4.64. 2009 biopsy showed 3+3 disease involving 1 of 5 cores on the right, 5% of tissue. PELVIS:PROSTATE:Prostate Size: 5.4 x 2.2 x 4.5 cm.Peripheral Zone: The peripheral zone is relatively homogeneously T2 hyperintense. There are a couple punctate T2 hypointense foci with low ADC signal such as in the left medial mid gland measuring 2 to 3 mm (series 601/16 and series 704/264). This focus also has increased signal on high 1550 b value images (710:280)Central Gland: Mild changes of BPH.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No dominant lesion is evident. A few tiny foci in the left mid gland are nonspecific, but one of which is suspicious as above.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Reason: Is there a stress fracture of the cuboid or elsewhere History: lateral foot pain in a runner Bone marrow edema in the anterior talus adjacent to the sinus tarsi representing bone contusion. No distinct fracture line is identified.

Output: Bone contusion of the anterior talus. No definite stress fracture.


Instruction: Generate impression based on medical findings.

Input: Reason: on 3T Scanner, known paraclinoid ICA aneurysm History: Surveillance MRI of the brainThere is an 8 x 5 mm axial dimension left cerebellar lesion which is heterogeneous but mainly low signal on T2WI and mainly hypointense on T1WI, associated with susceptibility effect and an adjacent developmental venous anomaly. This appears to be stable since the prior exam.There is a punctate focus of susceptibility effect present at the right posterior temporal lobe it is best seen on the susceptibility images and not readily appreciated on the flair or T2 images. It is unchanged since prior exam.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No diffusion restriction is appreciated.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 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.MRA brain:There is a 3-mm aneurysm along the left internal carotid artery. It is a paraclinoid aneurysm. It is stable compared to the previous exam.Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. There is fetal origin of the right posterior cerebral artery with a hypoplastic right P1 segment. The left posterior communicating artery is small. The anterior communicating artery is small. The vertebral arteries are similar in size.

Output: 1.Findings are compatible with a small sporadic cavernous malformation in the left cerebellar hemisphere.2.A left paraclinoid aneurysm along the internal credit artery is stable3.A punctate microhemorrhage in the right temporal lobe and isolation is of unknown clinical significance. It is unchanged since prior exam.4.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 5.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on medical findings.

Input: Pelvic/hip pain with negative x-rays. Evaluate for abnormality to account for pain. Per conversation with ordering physician, though not included on the history request, concern for mass lesion status post lumbar MRI. Study was performed with contrast for this reason. The right hip joint is anatomically situated within the right acetabulum without evidence of femoral neck or pelvic fracture. Hip joint space is relative well-preserved and there are no large marginal osteophytes. Sacral arcuate lines are intact without CT evidence for insufficiency fracture. Degenerative spurring is noted at the pubic symphysis and there is vacuum gas and spurring at the SI joints indicating mild degenerative change.There is no mass lesion within the pelvis or hip girdles. There are no enlarged lymph nodes.The adductor, hamstring and gluteal musculature are within normal limits for CT technique.Non-specific stranding is noted in the posterior subcutaneous soft tissues on the most inferior CT cut on the left, perhaps denoting mild inflammation.Moderate to severe disk and endplate degenerative changes are noted at L4 L5 and L5-S1 with broad based disk bulges. No neuroforaminal compromise is appreciated on the sagittal images, but correlation with recent MRI of the lumbar spine is advised.

Output: 1.No evidence of mass lesion or other pathology to account for the patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: Epilepsy. The left hippocampal head appears to have slightly indistinct internal architecture and slight volume loss, with minimal signal abnormality. There is unchanged minimal asymmetry of the temporal horns of the lateral ventricles. There is also unchanged slight prominence of the bilateral lateral cerebellar hemisphere folia. Otherwise, there is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Suggestion of mild left medial temporal sclerosis, but no evidence of acute intracranial tumor.


Instruction: Generate impression based on medical findings.

Input: Ms. Chen is a 57 year old female presenting for further evaluation of a suspected area of architectural distortion in the right central breast. There is scattered fibroglandular tissue in both breasts. Mild background parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. Specifically, there is no abnormal enhancement seen at the site of suspected mammographic abnormality in the right central breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. Patient may resume annual diagnostic mammography (with tomosynthesis), due next in May 2017.BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on medical findings.

Input: There are no fractures. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. Partially imaged is the patient's known large goiter with rightward deviation of the trachea (please see previous neck CT for complete characterization). The remaining visualized paraspinal contents are unremarkable.Disc desiccation with significant disc height loss is present throughout. Primarily Modic type I discogenic reactive endplate change is evident at C4/5.C1/2: Severe facet degeneration (right much greater than left) narrows bilateral neural foramina, moderate on the left and severe on the right.C2/3: Mild posterior osteophyte disc complex as well as mild right facet hypertrophy. There are no significant stenoses.C3/4: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, and mild bilateral facet hypertrophy. There is mild to moderate bilateral neural foraminal stenosis.C4/5: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, ligamentum flavum thickening, and mild bilateral facet hypertrophy. There is moderate central and severe bilateral neural foraminal stenosis.C5/6: There is partial vertebral body fusion as well as left facet fusion. Left uncinate hypertrophy and mild left facet hypertrophy cause mild left neural foraminal stenosis.C6/7: Posterior osteophyte disc complex, ligamentum flavum thickening, and left uncinate hypertrophy. There is mild central and mild left neural foraminal stenosis.C7/T1: Trace anterolisthesis C7 on T1, moderate left facet hypertrophy, and mild right facet hypertrophy. There is mild left neural foraminal stenosis.Facet disease at T1/2 and T2/3 encroach the neural foramina.

Output: 1.C1/2: Severe facet degeneration (right much greater than left) narrows bilateral neural foramina, moderate on the left and severe on the right.2.C3/4: Mild to moderate bilateral neural foraminal stenosis.3.C4/5: Moderate central and severe bilateral neural foraminal stenosis.4.C5/6: Mild left neural foraminal stenosis.5.C6/7: Mild central and mild left neural foraminal stenosis.6.C7/T1: Mild left neural foraminal stenosis.7.Facet disease at T1/2 and T2/3 encroach the neural foramina. If the patient has symptoms referable to the thoracic spine, a thoracic spine MRI could be acquired if deemed clinically beneficial.


Instruction: Generate impression based on medical findings.

Input: Please evaluate neck and ear pain. Enhanced CT of the soft tissues of the neck:60 cc of Omnipaque 350 was administered.Limited images of the intracranial demonstrate findings suggestive of small was ischemic disease.Images through the skull base, cavernous sinuses, bilateral Petrus bones and paranasal sinuses are unremarkable. Mastoid air cells and middle ear cavities are pneumatized and unremarkable.Images through the neck demonstrate no evidence of a mass or any pathologic adenopathy.Calcification and cystic changes of left lobe of thyroid there is suspected of goiter. Very limited view of the apices of the lungs are unremarkable.Examination demonstrates extensive degenerative disk disease of the cervical spine and hypertrophic changes of posterior elements. No evidence of lytic or sclerotic changes. There is no evidence of fracture or malalignment. There is however unusual presentation of posterior arch of C1 projecting anterior to the posterior elements of C2. This may be result of extensive degenerative changes at C1 -- C2 level. This can be started around or through the dedicated MRI of the cervical spine.

Output: 1.Negative enhanced CT of soft tissues of neck for tumor or pathologic adenopathy.2.Excessive degenerative changes of cervical spine and with unusual appearance of location of posterior arch of C1 anterior to the posterior elements of C2. There is no evidence of fracture or malalignment. If patient's neck pain persists recommend follow-up with dedicated MRI of cervical spine.


Instruction: Generate impression based on medical findings.

Input: Right upper extremity weakness and right lower extremity numbness for 1 day There are scattered restricted diffusion lesions on the left side precentral and postcentral gyri without evidence of hemorrhagic transformation. Previously seen left precentral gyrus restricted diffusion lesion is probably embedded in the present restricted diffusion lesions. Left paramedian pontine restricted diffusion lesion is not seen anymore.No change of extensive nonspecific small vessel ischemic disease.No change of multifocal susceptibility lesions on gradient echo images indicating multifocal small bowel hemorrhagic foci since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: New restricted diffusion lesion on the left pre and post central gyri without evidence of hemorrhagic transformation.No change of extensive nonspecific small vessel ischemic disease with the multifocal small hemorrhagic foci since prior scan is described above.


Instruction: Generate impression based on medical findings.

Input: Exam is limited by patient motion. There are areas of cortical diffusion restriction along the right superior temporal and right lateral frontal parietal region. Areas of sulcal susceptibility and FLAIR hyperintensity are also identified in these areas, consistent with the subarachnoid blood products seen on recent CT. Other scattered foci of susceptibility are similar to that of the prior exam, including within both thalami. There is a new left superior frontal gyrus oval area of susceptibility consistent with the previously seen small parenchymal hemorrhage, grossly unchanged. There is also slight increased conspicuity of very faint susceptibility in the left frontal deep white matter as compared to the prior MRI, corresponding to an area of subtle hyperdensity on CT. This may represent developing mineralization. There is a punctate focus of diffusion restriction in the right frontal deep white matter as seen on 501/215.Post-contrast images do demonstrate left carotid canal on the fat saturated postcontrast images which may relate to slow flow of contrast within the vessel.Compared to the recent CT, there are stable bilateral well hemispheric subdural effusions, slightly greater on the left side. On the left, the collection measures up to 11 mm in thickness, with long the right measures 8 mm. These are approaching CSF signal intensity on all sequences. There is no pathological enhancement. The ventricles and sulci are prominent, consistent with moderate age-related volume loss. The basal cisterns remain patent. There is no midline shift or significant mass effect. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with mild-moderate chronic small vessel ischemic changes including numerous scattered lacunar infarcts.The midline structures and craniocervical junction are within normal limits. MRA HEAD

Output: 1. Abnormal cortical diffusion restriction along the right superior temporal lobe and just cranially along the right lateral frontal parietal region, with associated areas of subarachnoid as well as parenchymal hemorrhage. Given background of numerous foci of susceptibility, this is felt to be most likely related to amyloid angiopathy, perhaps the rare inflammatory type, which can results in hemorrhagic infarcts.2. Redemonstration of left superior frontal gyrus parenchymal hemorrhage.3. Stable appearance of the thin left greater than right near CSF signal intensity subdural effusions, new since prior MRI.4. Complete occlusion or near occlusion of visualized portion of left internal carotid artery with likely minimal slow flow along the carotid canal on post contrast images, that is most likely chronic. CTA of the head and neck may be obtained for further evaluation.5. Mild stenosis and irregularity of the mid to distal basilar artery and the right P2 segment. Moderate focal narrowing at the left A1 segment origin. Decreased flow related enhancement in the left middle cerebral artery branches. Moderate irregular in narrowing of the cavernous right internal carotid artery.6. Unremarkable MRV head.


Instruction: Generate impression based on medical findings.

Input: Slurred speech and weakness, evaluate for stroke. The exam is partly motion degraded.MRI BRAIN: There are multiple small areas of diffusion restriction in the left occipital, frontal, parietal, and occipital lobes. There is a moderate amount of subcortical and periventricular white matter T2 hyperintensity. There are punctate foci of encephalomalacia within the bilateral basal ganglia, coronal radiata, and pons. There are also numerous scattered punctate foci of supratentorial and infratentorial susceptibility effect. There is no evidence of intracranial mass. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. There is a right sphenoid retention cyst. The orbits, skull, and scalp soft tissues are grossly unremarkable.MRA NECK: There common origin of innominate and left common carotid arteries. There is normal contrast opacification through the bilateral common carotid arteries, carotid bifurcations, and cervical internal/external carotids. The left vertebral artery is diminutive with multifocal areas of narrowing and loss of contrast opacification along V4. The right vertebral artery is dominant with focal high-grade stenosis at its origin. No evidence of aneurysm, dissection, or vascular malformation is apparent.

Output: 1. Multiple small areas of acute to early subacute infarcts involving the left occipital, frontal, parietal, and temporal lobes.2. The left vertebral artery is diminutive with multifocal areas of narrowing, as well as chronic occlusion along V4. The right vertebral artery is dominant with focal high-grade stenosis at its origin.3. No evidence of flow-limiting stenosis involving the carotid arteries.4. Scattered bilateral basal ganglia, corona radiata, and pons lacunar infarcts, as well as non-specific subcortical and periventricular T2 hyperintensity suggestive of chronic small vessel ischemic disease.5. Multiple supratentorial and infratentorial punctate foci of susceptibility effect may represent chronic microhemorrhages, perhaps related to hypertension or amyloid angiopathy, or septic emboli, for example.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.