Instruction: Generate impression based on medical findings.

Input: Male, 78 years old, with brain lesion. fMRI examination for surgical planning. The hand sensory cortex is identified along the bilateral post-central gyri (see the yellow colored regions on key image 151 series 601). The corresponding motor cortex, although not explicitly visualized, can be extrapolated as directly across the central sulcus from the sensory cortex, which would place the hand motor area in very close proximity and possibly contiguous with the patient's right pre-central mass. (Please note that areas of yellow color mapping along the ventricles and brainstem are likely related to motion. Areas of violet color mapping reflect activation which correlates negatively with the task and which are irrelevant for the purposes of this study.)

Output: Very limited functional MRI due to patient sedation. Only passive sensorimotor manipulation could be performed, and only manipulation of the hands produced reliable functional activation. The hand sensory cortex maps as expected to the bilateral post-central gyri. The corresponding motor cortex can be extrapolated as being directly across the central sulcus from the sensory cortex.


Instruction: Generate impression based on medical findings.

Input: 11-year-old female with knee pain and swelling for weeks status post fall. MENISCI: Medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: Bone marrow signal is normal. Articular cartilage is intact.LIGAMENTS: Cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Normal examination.


Instruction: Generate impression based on medical findings.

Input: 77-year-old male with known prostate cancer and history of head and neck cancer presents with altered mental status and negative head CT. There is no evidence of intracranial hemorrhage, mass, or acute infarct. Periventricular white matter T2/FLAIR hyperintense foci are seen, likely representing mild small vessel ischemic disease. Nonspecific T2/FLAIR hyperintense lesion is also seen within the right cerebellum measuring up to 1.0 cm (image 11, series 401). There is no associated enhancement or diffusion restriction. 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, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.No evidence of acute infarct, intracranial mass or mass effect. No evidence of intracranial metastatic disease. 2.Mild chronic small vessel ischemic disease. Rounded T2/FLAIR hyperintense lesion in the right cerebellar hemisphere is nonspecific and may also represent sequela of prior ischemia or possibly treatment-related injury.


Instruction: Generate impression based on medical findings.

Input: 56 years, Male, Reason: evaluate posterior anal margin related to lesion, lipoma? Please do fistula protocol. Pt is kidney transplant patient. History: 1 cm painless mass posterior anal margin. PELVIS: MalePROSTATE, SEMINAL VESICLES:The seminal vesicles are dilated bilaterally, likely representing seminal vesicle cysts. There is a small amount of T1 shortening within the right cyst, likely representing hemorrhagic/pernicious contents.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES:A nonenhancing cystic lesion within the subcutaneous tissues immediately deep to the skin, posterior to the anal verge measures 2.2 x 1.0 cm (5/19). No fat is evident within the lesion. This lesion is unchanged from the recent CT of 1/23/2015 but was not present on the CT of 7/15/2011.OTHER: A right iliac fossa transplant is partially visualized.

Output: 1.Unilocular subcutaneous cyst posterior to the anal verge has nonspecific features. A developmental cyst, such as a tailgut cyst, or an epidermal inclusion cyst may be considered. An abscess is considered unlikely given lack of surrounding inflammatory changes. 2.Bilateral seminal vesical cysts.


Instruction: Generate impression based on medical findings.

Input: Male 63 years old Reason: hcc screening History: hep C cirrhosis ABDOMEN:LIVER, BILIARY TRACT: Nodular contour to the liver with prominence of the hepatic fissures consistent with cirrhotic morphology. Small pericholecystic fluid/wall thickening, may be secondary to chronic liver disease. No significant gallbladder distention. No intraluminal signal void seen to suggest underlying cholelithiasis. No suspicious liver parenchymal lesion. Patent hepatic vasculature.SPLEEN: Splenomegaly measuring 17.8 cm.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple T2 hyperintensities are suggestive of renal cysts. T2 hypointense lesion within the left kidney demonstrates intrinsic T1 hyperintensity signal and is suggestive of a hemorrhagic cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace abdominal ascites. Upper abdominal varices.

Output: 1. Cirrhotic liver morphology with stigmata of portal hypertension. No suspicious liver lesion.2. Small pericholecystic fluid/wall thickening, may be secondary to chronic liver disease. No significant gallbladder distention.


Instruction: Generate impression based on medical findings.

Input: 79 year old female with metastatic breast cancer to bone. CVA with left hemiparesis. Hydronephrosis in the past and a stage IV decubitus ulcer presenting with altered mental status. Nonenhanced head CT:Examination demonstrate no evidence of gross intracranial metastatic disease. To entirely exclude possibility of metastatic lesions enhanced MRI or CT exam is recommended. Finding highly suspected of advanced small vessel disease of indeterminate age are noted.There is no evidence of hemorrhage, edema, mass effect, midline shift or hydrocephalus.Multiple poorly defined lytic bony changes with no definitive evidence of breakthrough of cortex are suspected for metastatic lesions.

Output: 1.Limited value examination for metastatic disease due to lack of intravenous contrast. No gross evidence of metastases no disease to the brain. Small osseous lytic skull metastases.2.Small vessel disease of indeterminate age.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Rule out central canal stenosis or neural foraminal stenosis. Signs and symptoms: Hyperreflexia. Nonenhanced cervical spine MRI:Foramen magnum is unremarkable.C2-C3 demonstrate mild degenerative changes without spinal stenosis however mild right neural foraminal compromise is noted.C3-C4 demonstrate mild degenerative disease and bilateral uncovertebral hypertrophy which results in moderate right and mild left neural foraminal compromise without central spinal stenosis.C4-C5 demonstrate mild disc disease, mild loss of disc height and mild bilateral facet degenerative changes. Findings results in moderate right and moderate to severe left neural foraminal compromise without central spinal stenosis.C5-C6 demonstrate moderate disc disease and loss of disc height, mild bilateral facet and ligamentum flavum hypertrophy. There is also a broad-based disc-osteophyte complex present at this level (larger on the left) with resultant effacement of subarachnoid space, flattening and posterior displacement of the cord and moderate central spinal stenosis. There is also significant bilateral neural foraminal compromise. There is also mild hypertrophic changes of posterior longitudinal ligament at C5 and C6 levels contributing the spinal stenosis. There is mild reversal of cervical lordosis at this level. The signal intensity of the cord remains within normal.C6-C7 demonstrate moderate disc disease and loss of disc height and mild bilateral facet and ligamentum flavum hypertrophy. There is a shallow broad-based disc-osteophyte complex present at this level extending from midline to the left with resultant effacement of ventral subarachnoid space on the left, subtle flattening deformity of the cord and moderate central spinal stenosis. Significant bilateral (L>R) neural foraminal compromise is also detected.C7-T1 demonstrate mild degenerative changes without central spinal stenosis. There is however moderate to severe left and patent right neural foramen detected.The upper most visualized thoracic spine demonstrate no evidence of spinal stenosis or appreciable neural foraminal compromise.Nonenhanced lumbar MRI:There is normal anatomical alignment and unremarkable signal intensity of the vertebral column.Examination at T11-T12 through L2-L3 demonstrate mild degenerative changes without spinal stenosis or foraminal stenosis. L3-L4 demonstrate mild disc disease and loss of disc height, moderate bilateral facets hypertrophy and mild facet effusion. Mild ligamentum flavum hypertrophy is also noted. Although there is mass effect on the thecal sac by hypertrophic changes no convincing spinal or neural foraminal compromise or stenosis is present.L4-L5 demonstrate mild disc disease and moderate bilateral facet and ligamentum flavum hypertrophic changes. Mild right and patent left neural foraminal compromise and no central spinal stenosis.L5-S1 demonstrate mild disc disease and loss of disc height, mild bilateral ligamentum and advanced bilateral facet hypertrophic changes and including mild bilateral (R>L) facet effusion. No spinal stenosis, however significant (R>L) neural foraminal compromise is detected.

Output: 1.Degenerative changes at C5-C6 and C6-C7 levels with resultant moderate central spinal stenosis (worse at C5-C6) and bilateral neural foraminal compromise and mild reversal of cervical lordosis as detailed. Mild degenerative changes at other levels however without central spinal stenosis. Additional multilevel neural foraminal compromise as detailed per level.2.MRI of lumbar spine demonstrate mild degenerative disc disease and more severely degenerative and hypertrophic changes of facets and ligamentum flavum as detailed per level above. Findings are more noticeable in the lower lumbar spine in particular at L5-S1 level which results in significant bilateral neural foraminal compromise. There is however no central spinal stenosis at any level. Additional levels of neural foraminal compromise as detailed per level above. There is progression of degenerative changes since prior lumbar MRI exams from 2004.


Instruction: Generate impression based on medical findings.

Input: Male 55 years old Reason: Metastases and primary cancer/ staging History: Rectal Polyp Overall image quality: GoodPELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted. BLADDER: No significant abnormality noted. LYMPH NODES: Lymph nodes in the perirectal space, within the mesorectal fascia: Present. Reference measurement of 0.7 x 0.5 cm (series 7 image 13).Lymph nodes outside the mesorectal fascia: None.BOWEL, MESENTERY: Rectal Tumor:Size: 2.6 x 3.6 x 4.4 cm (image 28/series 5) (series 7 image 27)Tumor appearance on T2-weighted images: Hyperintense to muscle.Tumor location: (For lower rectal tumors):Distance of the lower edge of the tumor to the anal verge (lower edge of the anal canal): 4.5 cmDistance of the lower edge of the tumor to the pelvic floor (relationship of the tumor to the anal sphincter complex): Extends into the external sphincter complexCircumference of the rectum involved: 360Relationship and proximity of the tumor to adjacent structures (prostate, seminal vesicles): No prostate invasion.MRI T-stage: T3a - Tumor invades < 0.5 cm into perirectal fat or extramuralTumor Distance to Mesorectal Fascia: < 0.5 cm (image 22/series 7).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Circumferential mass arising from the distal rectum with small adjacent perirectal lymph nodes as detailed above.


Instruction: Generate impression based on medical findings.

Input: There are numerous areas of cystic encephalomalacia, corresponding to areas of previously seen hemorrhagic insult on the previous perinatal MRI. The most conspicuous areas involve the right anterior frontal lobe as well as involving the right superior frontal gyrus near the vertex. Smaller areas of abnormality are seen along the occipital poles bilaterally. There is associated ex vacuo dilatation of the frontal horns. There is also focal ex vacuo dilatation of the lateral margin of the body the left ventricle areas of additional encephalomalacia in the region of the basal ganglia bilaterally. In additiona, the caudate nuclei are barely identifiable. Areas of T2 hyperintensity were seen to involve these deep gray nuclei previously. There is a relative severe paucity of white matter limiting assessment for normal myelination, although this appears delayed.The basal cisterns remain patent. There is no midline shift or mass effect. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is prominence of Waldeyer's ring structures as well as cervical and retropharyngeal lymph nodes, which are nonspecific but most likely reactive in a patient of this age. There is mild fluid signal within the mastoid air cells bilaterally.SPINE

Output: 1. Interval expected evolution of previously seen scattered areas of parenchymal hemorrhagic insult, with subsequent development of encephalomalacia. Also suggestion of previous insult to basal ganglia and bilateral caudate nuclei now with associated encephalomalacia.2. Overall paucity of white matter volume limiting evaluation for degree of myelination, although it appears to be delayed.3. Skin marker along its sacral dimple at most minimal linear low signal within the subcutaneous fat extending to the left aspect of the coccyx, without evidence of a clear sinus tract extending into the central spinal canal.4. No MR evidence of tethered cord. Abnormal focal somewhat linear T2 hyperintense signal along the midline dorsal aspect of the distal cord at the T12 level. Differential diagnosis includes a developmental conus cyst, a small area of focal myelomalacia, atypical cervical hydromyelia, with cystic neoplasm not entirely excluded, and follow-up postcontrast imaging is recommended. Ventricularis terminalis cyst is felt to be less likely given its eccentric location within the cord, and partial split notochord is felt to be unlikely given lack of any associated segmentation anomalies.5. Trace scattered prominence of the central spinal canal within the cord, likely within normal limits.


Instruction: Generate impression based on medical findings.

Input: The lumbar lordosis is preserved. The bone marrow signal intensity and morphology of the lumbar vertebral columns demonstrate scattered fat deposition in the vertebral bodies. There is no evidence of compression fracture. There is developmental narrowing of the lower lumbar spine from L1 to L5. The spinal cord below T11 demonstrate normal signal intensity and caliber. The conus medullaris is normal at the L1 level. Decreased T2 signal intensity is present throughout the lumbar intervertebral disks without disc height change. T12-L1: Shallow posterior central disk protrusion with no mass effect on the central canal. Bilateral neural foramen are patent. Unchanged from prior examination. L1 -- 2: There is a diffuse disc bulge with superimposed left paracentral focal protrusion which along with posterior facet and ligamentous hypertrophic degenerative changes causes moderate left lateral recess and neuroforaminal stenosis as well as mild central spinal stenosis, slightly worsened since prior examination. L2 -- 3: There is a diffuse disc bulge which along with posterior facet/ligamentous hypertrophic degenerative changes and epidural lipomatosis causes moderate to severe spinal stenosis and mild bilateral neural foraminal stenosis, worsened since prior examination. L3 -- 4: There is a diffuse disc bulge at this level which along with posterior facet/ligamentous hypertrophic degenerative changes cause moderate to severe spinal stenosis and mild bilateral neural foraminal narrowing. These findings are unchanged from prior examination. L4 -- 5: There is a diffuse asymmetric leftward disc bulge at this level which along with posterior facet/ligamentous hypertrophic degenerative changes which cause moderate spinal stenosis with moderate left and mild right neuroforaminal narrowing. These findings are similar to prior examination. L5 -- S1: There is a diffuse disc bulge at this level and posterior facet/ligamentous hypertrophic degenerative changes causing mild spinal stenosis and lateral recess stenosis with flattening of the bilateral S1 nerve sheath origins as well as mild bilateral neuroforaminal stenosis. The paraspinal soft tissue is unremarkable.

Output: 1.Degenerative disease of the lumbar spine as described above have progressed since 2010.2.Moderate to severe spinal stenosis is demonstrated at L2 -L4 levels predominantly on the basis of degenerative disease with superimposed developmental spinal canal narrowing.3.There is new flattening of bilateral S1 nerve sheaths.


Instruction: Generate impression based on medical findings.

Input: Focal seizures with secondary generalization, most likely temporal semiology. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma, including the hippocampi, appears unremarkable. There is no evidence of grey matter heterotopia. 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 are grossly unremarkable. There is a right auricular subcutaneous lipoma that measures up to 20 mm. There is fluid and mucosal thickening in the bilateral maxillary, right ethmoid, and right frontal sinuses.

Output: 1. No gross structural intracranial abnormality.2. FIndings suggestive of acute sinusitis.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Evaluate for bleed, mass effect. Signs and symptoms: Mental status changes Non-enhanced MRI of brain:No evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus. Cortical sulci, ventricular system and all CSF cisterns as well as gray -- white matter differentiation is unremarkable.Calvarium, mastoid air cells, middle ear cavities and limited view of paranasal sinuses are negative.

Output: Negative nonenhanced CT of brain and calvarium.


Instruction: Generate impression based on medical findings.

Input: Planning for stereotactic brain biopsy. Enhanced head CT:80 cc of Omnipaque 350 is administered for this study.Stealth enhanced head CT for stereotactic brain biopsy protocol is utilized.There is poor visualization of a previously known mass in the inferior fourth ventricle. Compared to priors stealth brain MRI protocol there is no definitive operation interval change. This tumor however it is very poorly defined on this exam and precise measurement is not possible.This is study is otherwise unremarkable.

Output: stealth enhanced head CT for surgical planning. Exam very poorly visualizes patient's known tumor in the inferior fourth ventricle.


Instruction: Generate impression based on medical findings.

Input: 69-year-old man with fall and head trauma. Questionable loss of consciousness. There is no evidence of intracranial hemorrhage or edema. Scattered areas of hypoattenuation are present in the subcortical, periventricular, and basal ganglia regions. These are consistent with age determined small vessel ischemic disease. No CT findings of acute stroke are present. Large vessel calcifications are noted in the carotid arteries.Fullness of the sella is noted. MRI is recommended to evaluate for the presence of a sellar mass.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base reveal no CT evidence of fracture. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. No CT evidence of intracranial hemorrhage or fracture.2. Sellar fullness is present. Recommend pituitary protocol MRI tube evaluate for presence of sella mass.3. Age-indeterminate small vessel ischemic disease.


Instruction: Generate impression based on medical findings.

Input: 74-year-old female with right ear pain, right neck pain, right shoulder pain, right suboccipital adenopathy, fever and chills. History of contrast allergy premedication (unreadable wording.) Enhanced CT of soft tissues of neck:Limited view of the intracranial content is essentially unremarkable for patient's stated age of 74.Images through the skull base, cavernous sinuses, paranasal sinuses and bilateral petrous bones are also normal.Very small soft tissue densities within the left external auditory canal is likely secondary to debris.The soft tissues of the suboccipital region demonstrate no evidence of lymphadenopathy as clinically indicated. No abnormality of occipital bone is detected either.Images through the neck demonstrate no evidence of a mass or pathologic adenopathy. The facia planes are well preserved. There is no evidence of any inflammatory changes of soft tissues of neck. There is no abnormal enhancement of soft tissues of neck. There is no evidence of any osseous or cartilaginous erosion. Limited images of mediastinum and upper lung fields are negative for masses or adenopathy.The aortic arch appears a slightly dilated and measures 43.5-mm in its widest visualized portion.Moderate degenerative disk disease at C5 -- C6 and C6 to C7 levels are noted. There is loss of disk height and subtle sclerotic changes of the adjacent endplates. There is a slight reversal of cervical lordosis which may be positional or secondary to degenerative spondylosis. There is partial visualization of the neural foramina in the cervical region. This demonstrate compromise the right neural foramina at C6 -- C7, C5 -- C6 bilaterally and C4 -- C5 on the right. Although this test is not appropriate for evaluation of central spinal stenosis there is no bony central canal stenosis. Considering a provided clinical date of an MRI of cervical spine might be helpful for further evaluation of patient's pain.

Output: 1.No evidence of mass or pathologic adenopathy in the neck.2.No evidence of any inflammatory/infectious process in the neck.3.No detectable suboccipital adenopathy as clinical data indicates.4.Well pneumatized paranasal sinuses, mastoid air cells and middle ear cavities.5.Degenerative disk disease throughout the cervical spine with multilevel neural foramina compromise as detailed above.6.Limited view of intracranial content is essentially unremarkable for patient's stated age.


Instruction: Generate impression based on medical findings.

Input: New nocturnal headaches. Nonenhanced head CT:There is no evidence of intracranial hemorrhage, edema, mass effect or midline shift or hydrocephalus.There is also noted definitive evidence of small vessel ischemic disease as was noted on prior MRI exam.There is prominence of cortical sulci and supratentorial ventricular system similar to prior study. This may be begin or more range for patient's stated age of 89.Calvarium is intact. Visualized mastoid air cells and middle ear cavities are unremarkable. Limited view of the orbits demonstrate evidence of prior bilateral cataract surgery.

Output: 1.No evidence of acute intracranial process.2.Stable exam since prior MRI study from 8 -- 20 -- 10.3.Normal pneumatization of paranasal sinuses and mastoid air cells.


Instruction: Generate impression based on medical findings.

Input: 72-year-old female with HCV cirrhosis status post TACE/RFA of HCC. Evaluate for recurrence ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic hepatic morphology. Posttreatment changes from segment 5 TACE/RFA without residual arterial nodular enhancement or washout. Again noted is rim enhancement ablation cavity consistent with hyperemia.Unchanged segment 6 hepatic cyst.SPLEEN: No significant abnormality noted.PANCREAS: Unchanged T2 hyperintense lesion within the uncinate process of the pancreas, likely a side branch IPMN and measures 9 x 8 mm. No evidence of pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mildly prominent retroperitoneal lymph nodes are again noted, stable.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Post procedure changes of ablation of segment 5 HCC without measurable arterial enhancement or washout to suggest recurrent or residual tumor.2.Cirrhotic liver morphology.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old, with right-sided facial droop and left body weakness. Evaluate for stroke. Restricted diffusion is seen beginning in the right subinsular region and continuing through the corona radiata to reach the right lateral ventricular margin. There is no evidence of significant associated edema or mass effect. No acute intracranial hemorrhage is detected. Mild hemosiderin staining is seen along the right caudate nucleus secondary to chronic ischemia. Moderately extensive patchy periventricular and brainstem T2 hyperintensity is seen compatible with chronic small vessel ischemic disease. Also noted is evidence of a chronic right basal ganglia lacunar infarct. Apart from mild ex vacuo dilatation of the right frontal horn, the ventricular system is within normal limits.

Output: 1.Acute ischemia involving the right corona radiata. No significant associated edema, mass effect or acute hemorrhage is observed.2.Moderately extensive sequelae of chronic microvascular ischemic disease and chronic right basal ganglia lacunar infarction are seen.


Instruction: Generate impression based on medical findings.

Input: Nausea and jaundice. Evaluate for CBD obstruction. History of bowel perforation end-stage renal disease and sepsis. ABDOMEN:LIVER, BILIARY TRACT: Markedly decreased liver parenchymal T2-weighted signal intensity and loss of signal on in phase imaging compatible with iron deposition. The liver measures 21 cm in length.No focal lesion.Contracted gallbladder containing intermediate attenuation sludge. No intra or extrahepatic biliary ductal dilatation. No filling defect to suggest choledocholithiasis.SPLEEN: The spleen measures 11 cm in length without a focal lesion. It is low on T2 weighted signal intensity compatible with iron deposition.PANCREAS: The pancreas is mildly atrophic. The main pancreatic duct is minimally prominent without a discrete lesion.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: End-stage kidneys without hydronephrosis or suspicious lesion.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Percutaneous gastrostomy tube retention balloon within the distal gastric body. Partially imaged left lower quadrant end ileostomy.BONES, SOFT TISSUES: Loculated right-sided pleural effusion with adjacent consolidation/atelectasis. Small left pleural effusion and basilar atelectasis.Scoliosis.Osseous stigmata suggestive of renal osteodystrophy.Partially imaged anterior pelvic wound.OTHER: No significant abnormality noted.

Output: 1.Sludge within a contracted gallbladder. No choledocholithiasis or biliary ductal dilatation.2.End-stage kidneys. Findings of hemosiderosis.3.Moderate size loculated appearing right-sided pleural effusion with adjacent consolidation/atelectasis.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Please perform Dr.Javed's MS protocol. Signs and symptoms: Multiple sclerosis with acute lumbar radiculopathy, evaluate for myelitis or disc etiology. Pre and postcontrast enhanced lumbar MRI:There is normal anatomical alignment of vertebral column. There is however mild straightening of lumbar lordosis without significant change since prior exam.There is normal signal intensity over lowermost visualized thoracic cord and the cauda equina without abnormal enhancement.T11-T12 is unremarkable.T12-L1 is unremarkable.L1-L2 is unremarkable.L2-L3 demonstrate minimal disc desiccation and mild hypertrophy of ligamentum flavum without spinal stenosis or neural foraminal compromise.L3-L4 demonstrate a broad based shallow left lateral and far lateral disc protrusion at this level without significant change since prior exam from 2010. There is no spinal stenosis or neural foraminal compromise at this level. L4-L5 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.L5-S1 is unremarkable.Postenhanced images demonstrate no abnormal enhancement of the vertebral column, the discs or the epidural spaces.

Output: 1.Normal signal intensity and caliber of the lower most visualized thoracic cord, conus and cauda equina without abnormal enhancement.2.Mild degenerative changes of lumbar spine without spinal stenosis or neural foraminal compromise at any level. Findings remain similar to prior exam. There is a shallow broad-based disc protrusion laterally and far laterally at L3-L4 without significant change since prior exam. Please see above comments.


Instruction: Generate impression based on medical findings.

Input: SMA presenting with concern for new seizures: new onset "drop attacks". There is no evidence of intracranial hemorrhage, mass, or infarct. The brain, brainstem, and cerebellum appear 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, mastoid air cells, and scalp soft tissues are grossly unremarkable. There is a small right maxillary sinus retention cyst.

Output: No evidence of seizure foci.


Instruction: Generate impression based on medical findings.

Input: 18-year-old female status post rheumatoid cyst resection, annual evaluation Sequelae of frontal and left temporal craniotomy are again noted. A surgical cavity within the inferior left frontal lobe is stable in size and morphology. The degree and extent of T2 hyperintensity surrounding this cavity, likely representing gliosis, also remains stable. No suspicious enhancement is seen within or around the resection cavity.Elsewhere, no new areas of signal abnormality or pathologic enhancement are seen. No mass-effect or edema is detected. No abnormal fluid collections are seen. The ventricles are stable and normal in size.

Output: Stable postoperative findings with no evidence to suggest lesion recurrence.


Instruction: Generate impression based on medical findings.

Input: Evaluate for lesion in periaquaductal grey matter; cyclic vomiting. The cerebellar tonsils extend up to 5 mm inferior to the foramen magnum and display slightly pointed morphologies. The posterior fossa also appears to have a rather small capacity. There is no evidence of lesions in the periaqueductal region or elsewhere in the brainstem otherwise. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift. The major cerebral flow voids are intact. The orbits, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Findings suggestive of possible Chiari type 1 malformation.2. Left tympanomastoid fluid may represent otomastoiditis.


Instruction: Generate impression based on medical findings.

Input: History of left lumpectomy for DCIS in 2011. Patient received radiation and hormonal therapy. History of breast cancer in brother diagnosed at age 40. Scattered fibroglandular tissue is present bilaterally. Scarring from prior lumpectomy in the left upper inner quadrant is unchanged. Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: Stable post surgical changes of the left breast. No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on medical findings.

Input: MRA BRAIN: Again seen is a congenitally hypoplastic left vertebral artery with minimal contribution to the basilar artery. The left PICA artery is not visualized. Very small P-comm arteries are again noted bilaterally. There is a large right vertebral artery which is patent and likely the predominant source of contribution to the posterior circulation. The right PICA artery is visualized. The basilar artery appears within normal limits. Bilateral PCA arteries are patent. The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. No evidence of aneurysms or vascular malformations.MRA NECK: Again demonstrated is a severely hypoplastic left vertebral artery beginning at its origin and extending up along most of its length within the neck. Again seen is a large right vertebral artery which is likely the dominant contribution to the posterior circulation. The carotid arteries within the neck are within normal limits.

Output: 1.No evidence of aneurysm, significant steno-occlusive disease or dissection in the arteries of the brain or neck.2.Congenitally hypoplastic left vertebral artery and small bilateral PComm arteries unchanged from the recent head and neck CTA.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Evaluate for altered mental status in patient with metastatic lung adenocarcinoma. Signs and symptoms: 76-year-old male with newly diagnosed stage IV lung cancer. Enhanced head CT:60 cc of Omnipaque 350 is administered for this study.There is a focus of subtle increased density in the inferior aspect of the vermis measuring approximately 14 times 10-mm in size (axial image 7). There is no distinct mass effect or any detectable surrounding vasogenic edema. Possibility of artifact cannot be entirely ruled out considering patient's history. Recommend further follow-up with enhanced brain MRI. The fourth ventricle is normal in size. Images through the supratentorial space demonstrate no findings to suggest metastatic lesion. There are however subtle subcortical and periventricular low-attenuation of white matter in bilateral cerebral hemisphere concerning for moderate degree of small vessel ischemic stroke of indeterminate age. The cortical sulci, ventricular system and all CSF cisterns remain within normal.Limited images through the orbits are unremarkable.Calvarium is intact.

Output: 1.One subtle focus of increased density/enhancement in inferior aspect of vermis with no associated surrounding vasogenic edema or any detectable mass effect. To exclude possibility of metastatic lesion recommend follow-up with an MRI exam.2.Small vessel ischemic strokes of indeterminate age.3.Calvarium is intact.


Instruction: Generate impression based on medical findings.

Input: Pain in the right elbow. LIGAMENTS: Evaluation of the intrinsic ligaments of the elbow is limited on this non arthrogram study. The ulnar collateral ligament, lateral ulnar collateral ligament and radial collateral ligaments appear grossly intact.TENDONS: There is thickening and intermediate signal intensity within the common extensor tendon indicating moderate tendinosis. There is linear fluid signal intensity within the common extensor tendon at the level of its insertion indicating interstitial tearing. The common flexor tendon appears intact. The biceps and brachialis tendons appear intact. The triceps tendon appears intact.ARTICULAR SURFACES AND BONE: No bone marrow signal abnormality is identified. SURROUNDING STRUCTURES: The imaged musculature of the right elbow appears intact.ADDITIONAL

Output: 1. Moderate tendinosis of the common extensor tendon with interstitial tearing as described above.2. Small amount of nonspecific subcutaneous edema along the posterior aspect of the olecranon which may reflect an early olecranon bursitis.


Instruction: Generate impression based on medical findings.

Input: Female, 21 years old, with brainstem lesion. Patchy but symmetric FLAIR hyperintensity is redemonstrated affecting the central pons in the vicinity of the transverse pontine fibers. Just posterior to this, there are thin linear foci of hyperintensity bilaterally which may correspond to the medial lemnisci. No significant interval change is seen when compared to recent prior examinations. On review of multiple prior examinations, abnormal signal in the pons is noted to have first become apparent on the 12/31/13 scan and has progressed over the intervening time. No other areas of focal signal abnormality are seen, and in particular, the other deep gray nuclei are unaffected.The region of abnormal signal in the pons was interrogated with single voxel spectroscopy (TE 35 ms). As a comparison, the nearest normal-appearing tissue was also interrogated more inferiorly in the pons. The lesional spectrum demonstrates reduction in the major metabolic peaks relative to normal appearing tissue. No evidence of lipid or lactate is seen. No atypical peaks are detected.

Output: Signal abnormality in the pons is redemonstrated showing no significant change from the recent prior examinations. This abnormality first became detectable in late 2013 and has progressed from that point.Spectroscopic assessment of the lesional tissue demonstrates a pattern consistent with chronic tissue injury. No lactate is seen to suggest active failure of aerobic metabolism. No lipid is detected to indicate ongoing membrane degradation. Although the differential remains broad for this abnormality, the pattern and morphology of the lesion are suggestive of prior osmotic demyelination. An inborn error of metabolism is not excluded, though patient age and imaging features make this less likely. Active inflammation and neoplasia are considered unlikely.


Instruction: Generate impression based on medical findings.

Input: 44-year-old woman with history of cervical cancer. PELVIS:UTERUS, CERVIX: There are bilateral clusters of small, T2 bright lesions in the cervix representing nabothian cysts (series 901, image 31). The cervix is otherwise T2 hypointense and normal in signal. No focus of abnormal signal is identified.The junctional zone of the uterus is at the upper limits of normal in size and there are small, T2 hyperintense areas within the myometrium.OVARIES: There are small ovarian cysts on the right and a 5.5 cm ovarian cyst on the left. Additionally there is a peripherally enhancing 2.0 cm cystic structure in the left ovary which likely represents an involuting corpus luteum.BLADDER: The bladder is unremarkable.LYMPH NODES: Subcentimeter lymph nodes are seen scattered in the pelvis bilaterally up to the level of the aortic bifurcation.BOWEL, MESENTERY: The rectosigmoid colon appears normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: A small amount of free pelvic fluid is likely physiologic.

Output: 1.No imaging evidence of cervical malignancy.2.Borderline findings of uterine adenomyomatosis.


Instruction: Generate impression based on medical findings.

Input: A patient submitted outside study for review. Submitted for review are:Ultrasound of the right breast dated 9/2/2016, ultrasound-guided core biopsy of the right breast dated 9/7/2016, performed at AMita health care institute. Bilateral breast MRI dated 9/19/2016 performed at Loyola hospital.For comparison,none are available. 1: Ultrasound of the right breast dated 9/2/2016:As per the report diagnostic mammogram was performed of both breast which are not submitted. Patient has history of a palpable mass in the right breast. Ultrasound demonstrates an irregular hypoechoic mass that measures 2.4 x 2.9 x 3.6 cm with apical blood flow corresponding to the palpable abnormality at 11:00 position 11 cm from the nipple. Located at 12:00 position 3 cm from the nipple is another suspicious hypoechoic mass with irregular margins, taller than wide that measures 1.7 x 1.5 x 1.3 cm with apical blood flow. This mass also demonstrates some anterior intraductal extension with hyperechoic areas possibly calcifications within it, labeled at right breast 12:00 2 cm from the nipple with apical blood flow.2. Ultrasound of the right breast dated 9/7/2016:Patient underwent ultrasound-guided core biopsy of the index mass, palpable in the right breast 11:00 position 11 cm from the nipple. 5 cores were obtained. Targeting appears adequate, clip coil was placed as per the imaging. Second site at 12:00 position 2 cm from the nipple was biopsied, 5 cores were obtained, ribbon clip was placed. Postprocedure mammogram was obtained as per the biopsy report however not submitted for review. Specimen radiograph was obtained from the cores of the biopsy sites (which site is not specified) and calcifications were noted at the biopsy site.Final pathology indicates DCIS grade 3 solid type at both sites.3: Bilateral breast MRI dated 9/19/2016:MRI images were uploaded on to Dyna CAD for postprocessing and were interpreted on Dyna CAD.Heterogenous dense breast parenchyma noted bilaterally. Moderate parenchymal enhancement noted bilaterally.Right breast 11:00 position palpable mass corresponds to biopsy-proven DCIS. A clip artifact is noted within the mass. The mass is irregular in shape with heterogenous enhancement and irregular margins, measuring 33 x 29 x 41 mm (AP X ML X CC). Second biopsy-proven area of DCIS is located anteriorly, approximately 19 mm anterior and medial to the previously described index mass. It presents as an irregular heterogeneously enhancing mass with a clip artifact within it that measures 22 x 24 x 31 mm (AP X ML X CC) located at 12:00 position anterior depth.Multiple additional masses are identified in the right breast that are located medial, posterior and anterior to the index mass. The posterior-most mass is located 2.5 cm posterior to the index cancer and approximately measures 9 x 8 x 13 mm (AP X ML X CC), located at 12:00 position posterior depth. There is non mass enhancement adjacent to the masses seen extending anterior to the anteriormost biopsy-proven area of DCIS reaching up to the nipple.Total extent approximately measures 11.6 x 7.2 x 8.4 cm (AP X ML X CC).No abnormality noted within the left breast. No suspicious bilateral axillary lymph nodes noted.

Output: 1. Multicentric right breast cancer, with maximum extent measuring up to 11.6 cm on MRI. 2 sites biopsied at outside hospital with results consistent with DCIS. The palpable mass in the right breast 11:00 position is highly worrisome for invasive cancer and multiple additional masses also appear very some for invasive cancer.2. No abnormality noted within the left breast or bilateral axillary lymph nodes.3. Diagnostic mammogram or postprocedure mammograms have not been submitted.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: 54 year old male patient with known pancreatic mass. Yearly surveillance exam, last on 8/2015. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic neck/body cystic lesion measures 1.8 x 1.2 cm (image 21, series 5), previously 1.2 x 0.9 cm. There is no suspicious mural nodularity or postcontrast enhancement. An adjacent punctate cystic focus is grossly stable in size. No new pancreatic lesion is identified. The main pancreatic duct is normal in size. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Stable enlarged mesenteric lymph nodes. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval enlargement of a probable pancreatic neck/body side-branch IPMN measuring up to 1.8 cm in size without suspicious features.


Instruction: Generate impression based on medical findings.

Input: Tremor, cold intolerance, sensory findings. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear 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 a right maxillary sinus retention cyst.

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


Instruction: Generate impression based on medical findings.

Input: Difficulty walking. Cerebral palsy, diplegic. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is diffuse paucity of periventricular white matter in the bilateral cerebral hemispheres, particularly posteriorly, with corresponding marked thinning of the posterior corpus callosum and prominence of the posterior lateral ventricles. In addition, there is associated generalized diminished white matter volume extending more peripherally into the posterior cerebral hemispheres, resulting in relatively prominent sulci. There is also diffuse T2 hyperintensity in the periventricular white matter bilaterally. The basal cisterns are normal in size and configuration. There is no midline shift or herniation. The posterior fossa contents are unremarkable. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening of the maxillary and ethmoid sinuses.

Output: Findings compatible with periventricular leukomalacia.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Clinical question: 70-year-old with ovarian carcinoma and history of hemorrhagic stroke. Altered mental status. Nonenhanced CT of brain:There is a large area of encephalomalacia in the right posterior temporal -- occipital region with ex vacuo dilatation of adjacent cortical sulci and ventricle. There was a large acute hemorrhagic stroke on this side on prior study.There is a subtle area of cortical and subcortical low attenuation in high convexity of the left posterior frontal and precentral stroke post which may represent a small cortical stroke of indeterminate age. This finding was not present on prior exam. Please correlate with history and follow up with an MRI is recommended. There is no evidence of hemorrhage. No midline shift is detected.

Output: 1.A very subtle small left precentral sulcus low-attenuation of cortex and subcortical white matter which is too small to determine the age however it is a new finding since prior examination. Correlate with history and follow-up with an MRI for acute ischemic stroke.2.Previously noted large area of hemorrhage in the right posterior temporal -- occipital junction has evolved into a large area of encephalomalacia and minimal demineralization. Unremarkable exam otherwise.


Instruction: Generate impression based on medical findings.

Input: Clinical question: CCM? why the cyst and hemosiderin ring. Signs and symptoms: Hand 3 chest. Pre-and post-enhanced brain MRI:Negative diffusion weighted series.Examination demonstrates several punctate foci of flair hyperintensity only in the subcortical and periventricular white matter of cerebral hemispheres. Although the findings are nonspecific considering patient's stated age of 66 possibility of chronic microvascular ischemic changes should be considered. This finding is not associated with any hemorrhagic changes.There is a slight prominence of central cortical sulci for age. The signal intensity of brain parenchyma however remains reading normal otherwise on all MRI sequences.Post-enhanced images demonstrate normal abnormal enhancement the brain parenchyma, the meninges, calvarium or the orbits.The signal void of major intracranial arterial branches are identified.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells.Pre-and post-enhanced cervical MRI:Examination demonstrate a well demarcated T2/T2 stir hyperintensity intramedullary lesion measuring at 18 mm (cc) and 9 mm in (AP) centered at C6 level. The lesion results in expansion of the cord and significant effacement of subarachnoid space/spinal stenosis. There is subtle uniform enhancement of the lesion. There is extensive surrounding cord T2/T2 stir hypointensity consistent with hemosiderin deposition/staining. There is no evidence of T2 or flair hyperintensity surrounding the lesion to suggest cord edema or myomalacia. Constellation of findings are highly suggestive of a cavernoma.Examination in addition demonstrate extensive degenerative changes of cervical spine however maintained anatomical alignment.Foramen magnum is unremarkable.C2 -- C3 is unremarkable.C3 -- C4 demonstrate mild to moderate degenerative changes of the disk and the posterior elements. Additionally there is a prominent broad-based disk protrusion at this level. Constellation of findings of degenerative disease and larger disk protrusion results in mass effect, flattening and posterior displacement of the cord and moderate central spinal stenosis. There is inferior migration of disk fragment posterior to the body of C4 with associated mass effect and flattening deformity of the cord and central spinal stenosis as well. There is also moderate bilateral neural foraminal compromise. There is no convincing evidence of associated cord T2 hyperintensity at this level.C4 -- C5 mild disk disease and moderate bilateral facet hypertrophic changes and mild ligamentum flavum hypertrophy. There is a small broad-based disk protrusion also present at this level which results in flattening and posterior displacement of the cord and moderate central spinal stenosis. Moderate left and mild to moderate right neural foraminal compromise is present at this level.C5 -- C6 demonstrate degenerative changes with result in mild-to-moderate left and mild right neural foraminal compromise..C6 -- C7 demonstrate moderate bilateral ligamentum flavum hypertrophy and mild disk and facet disease. No spinal stenosis or neural foraminal compromise.C7 -- T1 is unremarkable with the exception of mild facet and ligamentum flavum hypertrophy.

Output: 1.Pre-and post-enhanced brain MRI demonstrates findings suggestive of mild chronic hemorrhagic small vessel ischemic strokes and unremarkable otherwise. Please see above comments.2.Pre-and post-enhanced MRI of the cervical spine demonstrate an intramedullary mass highly suggestive of a cavernoma measuring at 18 mm (cc) and 9 mm in AP with resultant expansion of the cord and central spinal stenosis as well as diffuse adjacent cord hemosiderin deposition/staining. Degenerative changes at C3 --C4 and a large disk protrusion at this level results in significant mass effect and flattening deformity of the cord and central spinal stenosis. There is inferior migration of disk fragment posterior to C4 level which also contributes to central spinal stenosis. Small central disk protrusion at C4 -- C5 results in moderate central spinal stenosis. Multilevel neural foraminal compromise of varying degrees (some significantly) as detailed per level.


Instruction: Generate impression based on medical findings.

Input: 76 year old female with a personal history of right lumpectomy and radiation therapy for invasive lobular carcinoma in 1999. Prior benign left breast biopsy in 1985, and surgical removal of scar tissue from the left breast in July 2010. No current breast complaints. Breast parenchyma is almost entirely fat in both breasts.Minimal parenchymal enhancement is noted bilaterally.Volume loss of the right breast with stable postoperative deformity and scarring is unchanged.A few small metallic artifacts are seen in the right breast and right axilla, from the surgical clips of the prior surgery.Stable duct ectasia is present in the left retroareolar area.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on medical findings.

Input: Enlarged orbital muscles: proptosis. Orbits: There is interval decreased enlargement of the extraocular muscles, with mild residual prominence of the right superior rectus muscle. There is mild protosis bilaterally, right more than left, which appears to be attributable to diffuse prominence of the orbital fat. Otherwise, the bilateral globes, lacrimal glands, and optic nerves bilaterally are intact. There is no evidence of orbital mass lesions.Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear 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 skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Interval decreased enlargement of the extraocular muscles, with mild residual prominence of the right superior rectus muscle. Mild protosis bilaterally, right more than left, appears to be attributable to diffuse prominence of the orbital fat.2. No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Preop study. Findings and symptoms: Preop imaging. Pre and post enhanced Stealth brain MRI:Examination is performed utilizing the stone protocol and is not a true diagnostic test.There are also no prior exams for comparison.Examination demonstrates a well-demarcated round extra-axial with T2 hypointense signal intensity and with diffuse enhancement in the left anterior and inferior frontal abutting the inner table of the skull as well as the falx. The mass measures maximum of 39 x 48 x 53 mm in size and consistent with a meningioma. There is surrounding vasogenic edema and constellation of findings results in significant mass effect on the left frontal horn of lateral ventricle and deviation of midline to the right of approximately 3 mm. This mass is inseparable from the very small caliber anterior aspect of superior sagittal sinus. Assessment for involvement of sinus cannot be made on this exam. Follow-up with dedicated imaging is recommended for further assessment if clinically desired.Ventricular system remains within normal size and the third ventricle is in midline. Cortical sulci and CSF spaces are unremarkable.

Output: Extra-axial dural based left anterior/inferior frontal mass highly suggestive of a meningioma and measuring at 39 x 48 x 53 mm size.


Instruction: Generate impression based on medical findings.

Input: Signs and symptoms: MVC. No neck pain. Clinical question: 71-year-old.? Fracture. Nonenhanced head CT:Findings of small vessel disease of indeterminate age is present and evident by few small patchy periventricular and subcortical white matter low attenuation.No evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.Calvarium is intact. Visualized paranasal sinuses and mastoid air cells are unremarkable. Limited view of the orbits are unremarkable.Nonenhanced CT of cervical spine:No evidence of fracture or subtle change is detected. The alignment of the vertebral column is unremarkable. Advanced degenerative disk disease at C6 -- C7 level and to a lesser degree at other levels are present. Sagittal reformatted images demonstrate significant bulge of disk material at C3 -- C4 which appears to be in contact with the ventral aspect of the cord. Possibility of a herniated disk cannot be ruled out. Please correlate with neurological exam and if needed follow-up with an MRI is recommended. Examination also demonstrated degenerative changes of posterior elements from C3 -- C4 inferiorly.Degenerative changes of cervical spine results in right neural foramina compromise at C5 -- C6 and left neural foramina at C6 to C7 level.

Output: 1.Nonenhanced head CT demonstrates minimal findings of small vessel disease of indeterminate age and otherwise unremarkable.2.CT of cervical spine demonstrates no evidence of fracture or malalignment. Extensive degenerative disk disease and hypertrophic changes of posterior elements are present. Significant bulge of disk material at C3 there C4 is best a patient on sagittal reformatted images and possibility of a herniated disk cannot be rule out.


Instruction: Generate impression based on medical findings.

Input: 53-year-old man with lower back pain and new left leg weakness. Evaluate for cord compression. The vertebral bodies are appropriate in the overall alignment and height. The spinal cord has normal signal characteristics and overall morphology. There is no compromise of the spinal cord. There is multilevel disc osteophyte complex formation with mild canal narrowing at C5-C6 and C6-C7. At L4-L5 there is disc herniation with mild narrowing of the canal. Also at the L4-L5 level the facets are noted to be edematous and degenerated.

Output: 1.This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No cord compression is identified.2.Degenerative changes as described above. If further imaging evaluation is clinically warranted, nonemergent MRI of the lumbar spine could be considered.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o infection, look for signs of increased icp History: fevers, confusion in liver transplant patient There is no evidence of intracranial hemorrhage, mass or edema. Patchy periventricular and subcortical white matter hypoattenuation is consistent with small vessel ischemic disease of indeterminate age.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Small vessel ischemic disease of indeterminant age. Otherwise, no acute intracranial abnormality.


Instruction: Generate impression based on medical findings.

Input: The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. The P1 segments are hypoplastic and the ACOM artery is not well seen and may be hypoplastic/aplastic which are developmental variants. Again seen is irregularity and moderate segmental narrowing of the left mid to distal P2 segment which is unchanged. The vertebral arteries, basilar artery, and right posterior cerebral artery are normal in course and caliber. There is no other evidence of flow-limiting stenosis or aneurysm.

Output: Irregularity and moderate multifocal narrowing of the left mid to distal P2 segment which is unchanged. No changes compared to the MRA from 5/4/2016.


Instruction: Generate impression based on medical findings.

Input: 34-year-old male with history of excision/XRT for left wrist synovitis sarcoma. The field of view was increased to include the distal forearm. Again seen are foci of susceptibility artifact in the medial wrist related to previous resection. There is no discrete mass lesion present to suggest tumor recurrence. Again seen is edema and reticulation in the subcutaneous tissues along the ulnar aspect of the wrist/forearm, without significant interval change. There is persistent mild edema and enhancement within the pronator quadratus and extensor digitorum muscles, as seen previously, likely reflecting posttreatment change, most significant along the ulnar aspect of these muscle bellies. The extensor and flexor tendons are intact. There is unchanged fluid in the radiocarpal joints which may reflect mild synovitis.

Output: Posttreatment changes in the left wrist without evidence of disease recurrence.


Instruction: Generate impression based on medical findings.

Input: Left superificial parotidectomy for Warthin's tumor one year ago with increasing pain and left pharyngeal wall fullness. There has been interval left superficial parotidectomy. There appears to be scar tissue, but no evidence of tumor in the surgical bed. There is no significant cervical lymphadenopathy. The right parotid and bilateral submandibular glands are unremarkable. There is a punctate right thyroid cyst. There is mild prominence of the lingual tonsil, with a 3 mm diameter cystic lesion on the left side. The upper aerodigestive tract is otherwise unremarkable. The orbits and imaged intracranial structures are unremarkable. There is a punctate cystic lesion in the anterior wall of the left external auditory canal, which may represent an inclusion cyst. There is a small left maxillary sinus retention cyst. There is multilevel degenerative cervical spondylosis and findings related to laminoplasty.

Output: 1. Interval left superficial parotidectomy with what appears to be scar tissue, but no evidence of tumor in the surgical bed. 2. Mild prominence of the lingual tonsil, with a 3 mm diameter cystic lesion on the left side, which may represent a retention cyst.


Instruction: Generate impression based on medical findings.

Input: Male, 17 years old, with medically refractory epilepsy. Functional MRI requested for localization of language, motor and vision. Sensorimotor cortical activation of the hand, foot and face maps as expected along the pre- and post-central gyri. Of note, only left-sided foot sensorimotor activation is seen. Failure to visualize right-sided activity on the right may reflect variable patient effort or a technical artifact.Of the tested language paradigms, the most reliable language related cortical activation is seen with the word generation and sentence completion paradigms. Language is left dominant.Activation corresponding to the putative Broca's area is seen within the left inferior frontal gyrus (pars opercularis and pars triangularis). Activation corresponding to the putative Wernicke's area is represented by 2-3 foci within or along the posterior aspect of the left superior temporal sulcus.Passive visual cortical stimulation results in activation as expected along the bilateral calcarine sulci.

Output: Sensorimotor cortical activation of the hand, foot and face maps as expected along the pre- and post-central gyri.Language is left dominant. Broca's area activity is seen in its expected location of the left inferior frontal gyrus. Wernicke's area activation is seen in its expected location along the posterior aspect of the left superior temporal sulcus.Visual cortical stimulation generates cortical activation along the bilateral calcarine sulci.


Instruction: Generate impression based on medical findings.

Input: 53 years Female (DOB:9/5/1962)Reason: radiculopathy History: right hand weaknessPROVIDER/ATTENDING NAME: AASIM I PADELA JAMES R. BRORSON The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal. There is loss of disc space height and disc desiccation. There is a disc bulge at this level. There are endplate uncovertebral osteophytes present at this level associated with narrowing of the neural foramina bilaterally. There is encroachment of the exiting nerve roots on the right side and to a lesser degree the left side.At C6-7 there is no significant compromise to the spinal canal. There is loss of disc space height and disc desiccation. There is a disc bulge at this level. There are endplate uncovertebral osteophytes present at this level associated with narrowing of the neural foramina bilaterally with mild encroachment of exiting nerve roots.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: There are degenerative changes present in the cervical spine which are worse at C5 and C6. There are some encroachment of the exiting nerve roots on the right side at C5-6.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Disturbance of skin sensationClinical question: radiculopathy, numbness, right hip tightnessSigns and Symptoms: right sided lower extremity tightness, numbness diffusely Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is a 27 mm predominantly T1 hyperintense lesion with a spiculated appearance located within the left side of the L3 vertebral body which most likely represents a vertebral body hemangioma.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a minor disc bulge present at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.No significant compromise to lumbar spinal canal or neural foramina. There is a minor disc bulge present at L5-S1 without significant compromise to the adjacent nerve roots.2.There is a lesion within the L3 vertebral body which most likely represents a vertebral body hemangioma.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o fracture History: pain tenderness s/p trauma Rib series:A marker was placed along the lateral aspect of the left rib cage. There is a mildly displaced fracture through the anterior aspect of the left sixth rib.Left hip:There is patchy lucency and sclerosis in the femoral head indicating avascular necrosis. There is also narrowing of the hip joint indicating moderate to severe osteoarthritis. We see no acute fracture. If there is strong clinical concern for fracture, MRI may be considered.

Output: 1. Minimally displaced fracture of the anterior aspect of the left sixth rib.2. Avascular necrosis of the left femoral head with osteoarthritis of the left hip, but no acute fracture is evident. If further imaging is clinically warranted, MRI could be considered.These findings were relayed to Dr. Pursell by phone at 1:45 PM on 4/5/2016.


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old, with optic nerve pallor, right more than left. Assess for causes other than glaucoma. The optic nerves and the optic chiasm are small bilaterally. However, no evidence of pathologic signal abnormality or enhancement is seen along the course of the optic apparatus. The optic nerve sheaths are not dilated. The globes are round and symmetric. Lenses are normally positioned. The extraocular muscles demonstrate normal caliber and pattern of enhancement. The intraconal soft tissues are unremarkable. On limited visualization of the brain, prominence of the ventricles and sulci is seen compatible with underlying parenchymal volume loss. The septum pellucidum is present. There is likely a mild degree of periventricular T2 hyperintensity which is a nonspecific finding.

Output: The optic nerves and optic chiasm are of small caliber bilaterally with no other significant orbital abnormalities detected. The etiology for this finding is uncertain but it could reflect either atrophy or congenital hypoplasia.


Instruction: Generate impression based on medical findings.

Input: The clinical question to be answered: Mental status changes. Signs and symptoms: Unresponsive. No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Cortical sulci, ventricular system and all CSF cisterns remain within normal range for patient's stated age of 77. This examination demonstrates no interval change since prior study. Calvarium, paranasal sinuses and mastoid air cells are also unremarkable. Follow-up with an MRI examination is highly recommended considering patients provided clinical data.

Output: Stable CT examination.


Instruction: Generate impression based on medical findings.

Input: Choking, voice change, coughing spells, and right side facial numbness. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear 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 are grossly unremarkable. There is a small right maxillary sinus retention cyst. There is plagiocephaly.Internal Auditory Canals: The bilateral cranial trigeminal nerves are intact. The bilateral Meckel caves and cavernous sinuses are unremarkable. There is no evidence of mass lesions.

Output: No evidence of intracranial or skull base mass and no evidence of acute infarct.


Instruction: Generate impression based on medical findings.

Input: History of breast cancer: headaches x 1 month. Many of the sequences are degraded by patient motion. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is scattered cerebral white matter T2 hyperintensity, which is nonspecific. There is also a punctate focus of high T2 signal in the basal ganglia, which likely represents a chronic lacunar infarcts or prominent perivascular space. 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 mild scattered paranasal sinus mucosal thickening.

Output: No evidence of intracranial metastases.


Instruction: Generate impression based on medical findings.

Input: 4-year-old male with developmental delays, autism, exotropia. There is no restricted diffusion to suggest acute ischemia. No acute intracranial hemorrhage, mass effect or edema. Gray-white matter differentiation is well preserved.The CSF spaces are appropriate for patient's age. The imaged paranasal sinuses and mastoid air cells are clear. The orbits are unremarkable.

Output: MRI of the brain is within normal limits.


Instruction: Generate impression based on medical findings.

Input: History of chronic hepatitis C and cirrhosis. Presents for HCC screening. ABDOMEN:LIVER, BILIARY TRACT: Prominent hepatic fissures and diffuse reticular T2 hyperintensity compatible with chronic liver disease and fibrosis. Stable punctate cyst in segment VI.The reference segment 4 lesion measures 1.1 x 1.0 cm (series 11/26), compared to approximately 1.7 x 1.3 cm previously and demonstrates poor arterial phase enhancement but no washout.The reference segment 5 lesion is grossly unchanged measuring approximately 1.3 x 1.2 cm (series 11/35), compared to 1.5 x 1.4 cm previously, again with poor arterial enhancement but no washout.These lesions demonstrate no abnormal T2-weighted signal intensity or restricted diffusion.No new arterial enhancing lesion.Stigmata of portal hypertension including borderline splenomegaly and recanalization of the periumbilical vein and body wall collaterals.The portal vein is patent.Cholelithiasis in a hydropic gallbladder without specific evidence of acute inflammation. SPLEEN: Borderline splenomegaly measuring 15 cm in length. Stable nonspecific subcentimeter hypodense splenic lesion.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: Scattered degenerative endplate changes of the thoracic lumbar spine.OTHER: No significant abnormality noted.

Output: 1.Accounting for technical differences no significant change in the poorly enhancing hepatic lesions without washout. These do not meet imaging criteria for HCC.2.Cirrhotic liver morphology with fibrosis. No new liver lesion.3.Borderline splenomegaly and recanalized periumbilical vein. 4. Cholelithiasis in a hydropic gallbladder without specific evidence of acute inflammation.


Instruction: Generate impression based on medical findings.

Input: Reason: eval lumbar spine, known spondylosis History: back pain Using the last set of ribs as guidance, there are 4 lumbar type vertebral bodies with a sacralized L5. There is grade 1 retrolisthesis of L4 over L5. Loss of disc height is seen at the L4/5 level. Otherwise vertebral body heights and disc heights are maintained. There is degenerative endplate signal abnormalities at L4/5, otherwise bone marrow signal is unremarkable. Normal-appearing conus terminates at L1/2 level. Right renal cyst is noted. Otherwise visualized intra-abdominal and paraspinal structures appear unremarkable.T12/L1: No significant spinal canal stenosis or foraminal narrowing.L1/2: No significant spinal canal stenosis or foraminal narrowing.L2/3: Desiccated disc with mild lateral disc bulge. Mild facet arthropathy with ligamentum flavum thickening. No significant spinal canal stenosis. Mild bilateral foraminal narrowing.L3/4: Lateral disc bulge, facet arthropathy, and ligamentum flavum thickening resulting in mild spinal canal stenosis and mild bilateral foraminal narrowing.L4/5: Degenerative endplate changes of the bone marrow. Loss of disc height with desiccation of the disc. Uncovering of the disc posteriorly due to retrolisthesis with bulging disc symmetric to the right foraminal region. Moderate facet arthropathy with ligamentum flavum thickening. Mild to moderate spinal canal stenosis particularly affecting the lateral recesses. Severe right and moderate left foraminal narrowing.L5/S1: No significant spinal canal stenosis or foraminal narrowing.

Output: Grade 1 retrolisthesis of L4 over L5. Degenerative changes of the lumbar spine most severe at the L4-5 level.


Instruction: Generate impression based on medical findings.

Input: 47-year-old female with a history of uterine fibroids, status post bilateral uterine artery embolization. PELVIS:UTERUS, ADNEXA: The uterus measures 8.6 x 8.1 cm, previously 9.2 x 8.6 cm (series 8; image 27). Multiple uterine fibroids are again seen, which appear grossly decreased in size to the prior study. The largest reference subserosal fibroid located in the fundus measures 4.9 x 4.9 cm, previously 5.7 x 5.7 cm (series 12, image 6), there is interval decrease in enhancement when compared to the prior study. There is a necrotic intramural fibroid along the anterior wall of the body of the uterus, which measures 4.8 x 4.1 x 4.2 cm, previously 6.0 x 5.1 x 5.1 cm, without significant enhancement on postcontrast sequences.BLADDER: No significant abnormality noted.LYMPH NODES: No evidence of lymphadenopathy.BOWEL, MESENTERY: Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Focus of nodular enhancement in the anterior abdominal wall may represent granulation tissue from prior laparoscopic surgery, unchanged.

Output: Interval decrease in size and enhancement of multiple intramural, subserosal and pedunculated uterine fibroids, consistent with the stated history of uterine artery embolization; there is also interval decrease in overall size of the uterus.


Instruction: Generate impression based on medical findings.

Input: Back pain and continued fevers in the setting of antibiotics treatment for a pan-susceptible organism. General observations: The vertebral column alignment is within normal limits. The vertebral body heights are preserved. There is near complete loss of disc space and disc desiccation at L3-4 and L4-5. There is high T2 signal in the bone marrow along the endplates surrounding the L4-5 disc, which contains a small amount of fluid signal. There is milder high T2 signal in the bone marrow along the endplates at L3-4. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. Interspace observations:T12-L1: There is no significant compromise to spinal canal or neural foramina.L1-L2: There is no significant compromise to spinal canal or neural foramina.L2-L3: There is no significant compromise to spinal canal or neural foramina.L3-L4: There is a disc bulge that causes mild to moderate bilateral neural foraminal narrowing, but no significant narrowing of the spinal canal.L4-5: There is a disc bulge asymmetric to the right, ligamentum flavum thickening, and facet arthropathy causes effacement of the right lateral recess and moderate to severe central canal stenosis, as well as moderate left and severe right neural foraminal narrowing. L5-S1: There is a small eccentric right disc bulge with mild bilateral neural foramen narrowing, but no significant compromise to spinal canal.

Output: Lower lumbar spine degenerative spondylosis, particularly at L4-5, with moderate to severe spinal canal stenosis and severe right neural foraminal narrowing. Mild endplate edema and fluid in the disc space at L4-5 is also likely degenerative in nature, although superimposed discitis-osteomyelitis is a potential consideration. However, assessment is limited without intravenous contrast.


Instruction: Generate impression based on medical findings.

Input: Female, 30 years old, with migraines and seizure. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen. The medial temporal lobes structures are symmetric and free of signal abnormality.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology.

Output: Unremarkable evaluation with no specific findings to account for the patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: Metastatic melanoma with single brain lesion; please evaluate for radiosurgery planning. There is a presumably enhancing hemorrhagic lesion in the right medial occipital lobe lesion that measures up to 15 mm. 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, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Preoperative planning MRI shows a right medial occipital lobe lesion that measures up to 15 mm, which is compatible with a metastasis.


Instruction: Generate impression based on medical findings.

Input: For the purposes of reference, the last rib bearing vertebral body is at T12 and 5 lumbar vertebral bodies visualized. Images are slightly slightly limited by suboptimal signal to noise.The conus medullaris ends at the level of the mid L1. Distal cord is unremarkable.There is a stable mild-moderate chronic compression fracture of L4. There is a chronic compression fracture of T12 with moderate decrease in height of its right aspect and the mild decreased in height of its left aspect.There is stable mild retrolisthesis of L3 on L4.Mild increased STIR marrow signal is seen associated with T11, T12, L3, and L4 vertebral bodies, slightly more extensive at L3 and L4, but otherwise unchanged since the previous study.At T11-T12 there is high T2 signal within the disc space, most likely representing chronic fluid with no visualization of disc signal. There is bilateral moderate foraminal stenosis, with effacement of the foraminal fat perhaps due to chronic inflammatory changes.At T12-L1, there is no evidence of spinal stenosis or neural foraminal compromise.At L1-L2, there is no evidence of spinal stenosis. There is mild right facet hypertrophy with mild right neural foraminal stenosis.At L2-L3, there is broad-based mild to moderate disc bulge. There is moderate spinal stenosis and effacement of the anterior CSF space. There is mild bilateral facet hypertrophy with moderate to severe stenosis of the right neural foramen and mild to moderate narrowing of the left neural foramen.At L3-L4, there is mild disc bulge. The disc is mildly uncovered. There is a moderate spinal stenosis with partial effacement of the anterior CSF space. Facet hypertrophy is seen bilaterally, more on the left. Bilateral moderate to severe stenosis of the neural foramina is seen. The foraminal fat is not identified, most likely due to chronic infection. Increased T2 signal is seen in the disc space which is unchanged since the previous study. Encroachment of the lateral recesses is seen.At L4-L5, there is mild disc bulge with mild spinal stenosis. There is bilateral facet hypertrophy, left more than the right. There is severe neural foraminal narrowing on the left and moderate foraminal narrowing on the right.At L5-S1, mild facet hypertrophy is seen bilaterally.There is a slight asymmetric increase in T1/T2 signal in the right psoas and iliacus muscles which in part may be artifactual, although could also relate to asymmetric fatty replacement and/or sequelae of chronic infection.Subcentimeter cysts are noted in the kidneys bilaterally. Small bone island is seen in the left iliac wing with low T1 and T2 signal.

Output: 1. Redemonstration of now chronic discitis/osteomyelitis at L3-L4 and T11-T12, not significantly changed since the previous study. 2. Moderate central spinal stenosis persisting at L2-L3 and L3-L4, unchanged.3. Bilateral neural foraminal compromise in lumbar spine as described above, most severe at the level of L3-L4.


Instruction: Generate impression based on medical findings.

Input: 33 year old female with hidradenitis suppurativa, seronegative arthropathy, possible GERD and LVEF 49% on TTE. Referred for MRI to reassess LV function and evaluate for possible infiltrative diseases. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 54%. The LVEDV is 173 ml (normal range 109+/-23), LV end diastolic volume index is 76 ml/m2 (normal range: 65+/-11), LVESV is 80 ml (normal range 31+/-10), and LV end systolic volume index is 35 ml/m2 (normal range 18+/-5). The LV mass is 93 g (normal range 114+/-24) and the LV mass index is 41 g/m2 (normal range 67+/-11). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.The native T1 myocardial relaxation time is <1000 ms suggestive of the absence of underlying diffuse fibrosis or infiltration.There is no LV thrombus. Left AtriumThe left atrium is normal in size.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 58%, the RVEDV is 163 ml (normal range 110+/-24), the RV end diastolic volume index is 72 ml/m2 (normal range 69+/-14), the RVESV is 68 ml (normal range 35+/-13), and the RV end systolic volume index is 30 ml/m2 (normal range 22+/-8).Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsAsymmetric left axillary skin thickening and mildly enlarged lymph nodes compatible with patient's history of hydradenitis.Presence of multiple stones is noted in the gallbladder. 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.The left ventricle is normal in size with normal systolic function. LVEF 54%. Other quantitative values are noted above.2.The right ventricle is normal in size with normal systolic function. RVEF 58%.3.No findings to suggest prior ischemic damage or infiltrative process.4.Cholelithiasis. 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: 67 years Female (DOB:9/2/1948)Reason: new left sided hand weakness History: left handed weakness and tinglingPROVIDER/ATTENDING NAME: MICHAEL A WARD JAMES A MASTRIANNI 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. Additionally there are patchy T2 and FLAIR hyperintense lesions in the pons and the midbrain.There are punctate T2 and FLAIR hyperintense foci present in the left thalamus and left basal ganglia. These are not associated with diffusion restriction.The CSF spaces are appropriate for the patient's stated age with no midline shift. 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.On susceptibility imaging there are punctate foci of signal loss present in the left thalamus and left basal ganglia.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 appears be a focal stenosis at the proximal the right middle cerebral artery M1 segment on the noncontrast MRA of the brain, however, on the MRA of the neck which is with contrast this is not apparent. As a result this apparent right M1 narrowing probably represents artifact. Along the distal posterior cerebral artery vasculature there are apparent foci of narrowing and dilation. The basilar artery appears somewhat irregular but not stenotic. The carotid siphon is also irregular but not stenotic on both sides. There appears to be narrowing of the right internal carotid artery at the distal cavernous segment with approximately 40% stenosis.There is asymmetry in the size of the A1 segments of the left A1 segment being larger than the right A1 segment.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The vertebral arteries are similar in size. The left vertebral artery smaller than the right vertebral artery . MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. The left vertebral artery smaller than the right vertebral artery and the proximal left vertebral artery is stenotic.

Output: 1.There is no evidence for acute ischemic cerebral infarction.2.Periventricular and subcortical white matter lesions of a mild degree as well as some patchy lesions in the pons and midbrain are nonspecific. At this age they are most likely vascular related. 3.Punctate lesions in the left thalamus and left basal ganglia may be related to prior lacunar infarcts.4.There is no intracranial cerebrovascular occlusion or stenosis appreciated. Some intracranial vasculature is irregular suggesting atherosclerosis.5.There is no evidence for extracranial cerebrovascular occlusion or stenosis.6.There are couple microhemorrhages present in the left thalamus and left basal ganglia. In isolation these are somewhat nonspecific. They could be hypertensive in nature given the locations.


Instruction: Generate impression based on medical findings.

Input: There is no suspicious intracranial enhancement, acute infarct, mass effect, or cerebral edema. There is moderate soft tissue crowding at the foramen magnum with slightly pointed cerebellar tonsillar morphology, without true peg-like appearance. There is a single small nonenhancing white matter T2 hyperintense signal abnormality in the right frontal white matter, nonspecific. There is punctate focus of susceptibility effect in the left basal ganglia, nonspecific probably representing calcification. There is mild to moderate volume loss.There is no hydrocephalus. There is no midline shift or herniation. There is a mucus retention cyst in the right maxillary sinus. There is a small nonenhancing rounded lesion in the scalp by the vertex of the skull which is nonspecific, and likely representing a small sebaceous cyst. The skull and extracranial soft tissues are otherwise unremarkable.

Output: 1.No intracranial mass, mass effect or suspicious enhancement.2.Moderate soft tissue crowding at the foramen magnum with slightly pointed cerebellar tonsillar morphology, but not fitting the strict criteria for Chiari I malformation. Clinical correlation is advised.


Instruction: Generate impression based on medical findings.

Input: Male 30 years old with left shoulder pain. Evaluate for labral tear. ROTATOR CUFF: The muscles and tendons of the rotator cuff are intact.SUPRASPINATUS OUTLET: There is edema within and along the capsule of the acromioclavicular joint and mild edema within the distal end of the clavicle. There is also slight irregularity of the distal clavicular margin. These findings may reflect a recent low-grade separation, stress reaction of the distal clavicle (posttraumatic osteolysis) or chronic osteoarthritic changes. Gadolinium deep to the anterior deltoid is likely iatrogenic. We see no additional fluid within the subdeltoid bursa to suggest rotator cuff tear.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is normal. There is abnormal signal intensity traversing the posterior labrum superiorly indicating a tear with small adjacent paralabral cysts. The tear extends anteriorly to involve the superior labrum and also extends inferiorly to at least the 6:00 position. There is also partial thickness tearing of the anterior inferior labrum which may represent further extension of the aforementioned tear.BICEPS TENDON: The tendon of the long head of the biceps is intact. The coracohumeral and superior glenohumeral ligaments are poorly defined on this study and we cannot exclude tearing of these structures.

Output: 1.Extensive tearing of the glenoid labrum as described above.2.Edema within and along the capsule of the acromioclavicular joint as well as within the distal clavicle may represent a recent low-grade separation, stress reaction of the distal clavicle (posttraumatic osteolysis) or chronic osteoarthritic changes.3.Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Male, 80 years old, with low back pain and spinal stenosis. Since the prior examination, posterior instrumented fusion has been performed with bilateral pedicle screws at L4 and L5. Laminectomy has also been performed at L4-5 with placement of an interbody fusion device. Enhancement within the posterior soft tissues of the operative bed is compatible with scarring.Spinal alignment is anatomic. Mild loss of height of the T12 vertebral body is unchanged. Likewise, moderate loss of height of the L1 vertebral body is unchanged. No significant marrow edema or pathologic marrow replacement or enhancement is seen.The distal spinal cord and conus are within normal limits. The nerve roots of the cauda equina are likewise unremarkable. No epidural abnormalities are seen.A right renal cyst is partially visualized.L1-2: Mild facet hypertrophy. Mild prominence of the dorsal epidural fat. No significant spinal canal stenosis or neuroforaminal narrowing. No interval changes. L2-3: Mild facet hypertrophy and ligamentum flavum thickening. Prominence of the dorsal epidural fat. No significant spinal canal or foraminal stenosis. No interval changes. L3-4: Postoperative changes. Facet hypertrophy and ligamentum flavum thickening. Prominence of the dorsal epidural fat. No significant spinal canal or foraminal stenosis. No other significant interval changes. L4-5: Postoperative changes. Hypertrophy of the residual facets. The previously seen right paracentral disc extrusion has decreased in size though some portion of it remains causing mild effacement of the right ventral thecal sac and slight displacement of the adjacent nerve roots. No significant generalized spinal canal stenosis. Moderate foraminal narrowing, unchanged on the right and slightly improved on the left. L5-S1: Facet hypertrophy and ligamentum flavum thickening. No significant spinal canal or foraminal stenosis.

Output: 1.Findings are seen compatible with posterior instrumented fusion from L4 to L5. The instruments are better assessed on CT.2.A right paracentral disc herniation at L4-5 has decreased in size when compared to the prior MRI. There remains a small component of this herniation which causes effacement of the right ventral thecal sac and may contact the adjacent nerve roots. Both neural foramina are moderately narrowed.3.Mild degenerative findings at other levels are not significantly changed. Chronic compression deformity of the T12 and L1 vertebral bodies are unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 37 years old, with left-sided numbness, burning lesion noted on outside MRI. An oval, T2 hyperintense and mildly diffusion restricting lesion is evident within the white matter adjacent to the posterior body and atrium of the right lateral ventricle. The lesion measures 29 x 23 mm on axial images and has not significantly changed in overall size. On postcontrast images, this lesion demonstrates incomplete ring enhancement with the open end of the ring oriented away from the ventricle. The pattern of enhancement is similar to that seen on the prior examination, though it is somewhat better defined on today's study.The lesion exerts only mild local mass effect. The right lateral ventricle is of smaller caliber than the left but this is felt to be due to anatomic variation rather than the lesion as this asymmetry involves the entire ventricle.Multiple additional small foci of T2 hyperintensity are seen elsewhere in the periventricular regions. These are most notable in the left periatrial white matter.No evidence of any intracranial hemorrhage or significant susceptibility artifact is seen. No abnormal extra-axial collections are detected. Parenchymal enhancement is otherwise unremarkable.Single and multi voxel spectroscopic assessment of the dominant right periventricular lesion shows mildly to moderately reduced NAA, and mildly elevated choline. Portions of the lesion show significant lipid resonances along with a smaller quantity of lactate. No unusual resonances are identified. Normal-appearing tissue immediately adjacent to the lesion shows normal spectra or only mild alterations of the expected metabolite patterns.On perfusion imaging, relative CBV is reduced over a majority of the dominant lesion with only small scattered areas of elevated relative CBV along the periphery of the lesion.

Output: A lesion is redemonstrated in the periventricular white matter along the right lateral ventricle which shows little significant interval change. Lesion location and morphology, and particularly the incomplete ring pattern of enhancement, along with the presence of additional smaller white matter lesions on the left, are most suggestive of a demyelinating process.The MR spectroscopic pattern of this lesion, while nonspecific, is compatible with a significant inflammatory process such as demyelination. The pattern is not supportive of a high-grade neoplastic process, and no specific features of either bacterial or fungal infection are seen. Perfusion imaging is reassuring for a benign process as a majority of the lesion demonstrates reduced rCBV. Alternate diagnostic considerations, including low-grade neoplasm or infection, are considered less likely at this time.


Instruction: Generate impression based on medical findings.

Input: Status post trauma, no neurologic activity. Normal gray-white matter differentiation. There are no changes to suggest diffuse axonal injury however MRI would be more sensitive in detecting changes of DAI. No coup or contra-coup lesion demonstrated.There is no evidence of acute intracranial hemorrhage, mass, midline shift or edema. No intra or extra-axial collection. There is a 5 mm thick left scalp hematoma overlying the left parietal-temporal region.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. No fracture or diastases demonstrated.Mucosal thickening is seen in maxillary antrum with a fluid level on the right and in the sphenoid sinuses. Nonspecific soft tissue opacification seen in the right ethmoid cells. The remainder of the visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: *Normal unenhanced brain CT.*No acute intracranial abnormality. However MRI would be more sensitive in detecting changes of DAI.