Instruction: Generate impression based on medical findings.

Input: Left arm and face weakness. Assess for stroke. There is restricted diffusion in the mesial dorsal pons where there is also increased T2 signal compatible with an acute to subacute infarct. Scattered foci of T2 hyperintensity in the periventricular and subcortical white matter compatible with chronic small vessel ischemic changes. This is associated with a small right thalamic and right corona radiata chronic lacunar infarcts. Note is made of a prominent perivascular space in the left insula. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration. The paranasal sinuses are clear. The visualized mastoid air cells are clear. The orbits are unremarkable. Note is made of a 13 mm ovoid lesion in the subcutaneous tissues overlying the left zygoma compatible with sebaceous cyst.MRA head:The intracranial carotid arteries demonstrate mild atherosclerotic irregularity. The PCOM arteries are diminutive bilaterally. The V4 segment of the right vertebral artery is completely occluded from the level of the arch of C1. No significant intracranial aneurysm. MRA neck:Conventional arch anatomy. The carotid arteries are widely patent with normal contour and caliber throughout. The left vertebral artery is moderately stenotic at its origin but returns to a normal caliber and contour for the remainder of its course. The right vertebral artery is markedly narrowed and irregular throughout with complete occlusion of its intracranial portion. This is compatible with a dissection of indeterminate age. There is a subcutaneous lipoma incidentally noted in the right posterior paraspinal soft tissues.

Output: 1. Acute to subacute infarct involving the mesial dorsal pons.2. The right vertebral artery is markedly narrowed and irregular throughout with complete occlusion of its intracranial portion. This is compatible with a dissection of indeterminate age.3. Moderate stenosis of the origin of the left vertebral artery which is otherwise normal in caliber and contour. Mild atherosclerotic irregularity of the intracranial internal carotid arteries.4. Chronic white matter small vessel ischemic changes as well as chronic lacunar infarcts in the right thalamus and right corona radiata.


Instruction: Generate impression based on medical findings.

Input: altered mental status, unspecified [R41.82] / Disorder of brain, unspecified [G93.9] / Vascular headache, not elsewhere classified [G44.1], Reason for Study: ^Reason: poorly differentiated urothelial bladder cancer presented with AMS , R/o leptomeningeal spread. This is a limited examination with post contrast examinations only were performed.There is about 3cm sized heterogeneously enhancing pre sacral mass lesion with central non enhancing portion which may represent metastatic lesion.There is no evidence of abnormal enhancement on spinal cord, thecal sac or vertebral bodies throughout. Lower lying spinal cord is again demonstrated associated with spina bifida of sacrum. There is normal cervical lordosis. The cranial-cervical junction is normal. There is normal thoracic kyphosis and lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The cord signal is normal. The conus medullaris terminates at the level of L5S1. There is evidence of tethered cord or spinal dysraphism. There is no evidence of abnormal enhancement, cord compression or mass.

Output: 1. About 3cm sized inhomogeneously enhancing right side pelvic mass likely represent metastatic lesion.2. Tethered cord with spina bifida of sacrum.3. No evidence of abnormal enhancement on spinal cord, thecal sac or vertebral body.


Instruction: Generate impression based on medical findings.

Input: Patient with recent whiplash injury and strain of neck, numbness radiating down the left arm. Rule out fracture. I see no fracture. There is mild degenerative disc disease at C4/5, C5/6, and C6/7, with small posterior vertebral body osteophytes at these levels. There is perhaps a minimal retrolisthesis of C5 relative to C6, but otherwise alignment is within normal limits. Evaluation the neural foramina is limited due to under-rotation of the patient, but I suspect that there is mild narrowing of the neural foramina of the lower cervical spine. This would better evaluated with MRI, if clinically warranted.

Output: Degenerative disc disease and other findings as described above. I see no fracture.


Instruction: Generate impression based on medical findings.

Input: Bilateral carotid stenosis and episodes of spacing out for 3-5 min. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a punctate focus of encephalomalacia in the left thalamus and a small area of encephalomalacia in the right parietal lobe. There is diffuse patchy cerebral and pontine white matter T2 hyperintensity. 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 bilateral cavernous internal carotid artery flow voids are diminished. There also appears to be focal stenosis of the left intracranial vertebral artery. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are bilateral lens implants.

Output: 1. Chronic infarcts in the right parietal lobe and left thalamus, as well as probable chronic small vessel ischemia, but no evidence of acute infarct. 2. Steno-occlusive disease involve ing the carotid arteries and a small left PICA aneurysm are better depicted on the recent CTA.


Instruction: Generate impression based on medical findings.

Input: Diplopia. MG versus TED No appreciable orbital proptosis by imaging or enlargement of the extraocular muscles to suggest thyroid associated ophthalmopathy. Bilateral orbits appear within normal limits without evidence of mass or abnormal enhancement. Bilateral globes are intact. No abnormal signal within the optic nerves. There is artifact related to dental hardware which particularly degrades the diffusion and susceptibility weighted sequences. Within this limitation, there is no evidence of acute ischemia or acute hemorrhage. No intracranial mass or mass effect. There are multiple scattered foci of T2/FLAIR hyperintensity in the bilateral periventricular and subcortical white matter, similar to prior study, and compatible with mild chronic small vessel ischemic changes. No hydrocephalus. No extra-axial collections. Major flow-voids are preserved. No abnormal parenchymal or meningeal enhancement.Partially imaged is a circumscribed, lobulated, enhancing mass involving the left medial aspect of the parotid gland measuring approximately 2.2 x 2.9 cm in the transverse and craniocaudal dimensions, previously approximately 1.3 x 2.1 cm, measured similarly on 9/11/2010.

Output: 1. Bilateral orbits appear within normal limits. No imaging findings to suggest thyroid associated orbitopathy. 2. Mild chronic small vessel ischemic changes are again seen. Brain parenchyma appears otherwise within normal limits.3. Partially imaged is a lobulated, enhancing mass involving the medial aspect of the left parotid gland measuring approximately 2.2 x 2.9 cm in the transverse and craniocaudal dimensions. Finding is suspicious for neoplasm. Consider dedicated neck imaging and ENT consultation.Dr. Ali discussed with Dr. Qayum at 1550 hrs on 3/24/2015.


Instruction: Generate impression based on medical findings.

Input: Ms. Hand is a 41-year-old female with a strong family history of breast cancer including maternal grandmother, paternal grandmother, mother, sister and maternal great aunt. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.There is revisualization of three circumscribed enhancing masses, consistent with multiple benign fibroadenomata of both breasts. The mass in the right breast 3:00 position now measures 1.1 x 0.7 x 1 cm, previously measured 1.2 x 0.7 x 0.9 cm. The mass in the right breast 12:00 position now measures 1.1 x 0.7 x 0.9 cm, previously measured 1.0 x 0.7 x 0.7 cm, and is also stable. The mass in the left breast 8:00 position now measures 1.4 x 1.1 x 1.2 cm, previously measured 1.5 x 1.0 x 0.9 cm, stable from prior exam. No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. Stable benign fibroadenomata of both breasts BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old, with sarcoid, outside PET/CT showing a lesion in the brain. No enhancing lesions are identified intracranially. However, fairly extensive patchy T2 hyperintensity is seen in the periventricular and subcortical white matter bilaterally. No evidence of edema or mass effect is observed. The ventricles are normal in size. The sulci are slightly prominent suggesting a degree of parenchymal volume loss.

Output: No specific focal lesions are identified on this examination. However, extensive patchy white matter T2 hyperintensity is demonstrated which could represent the sequelae of lupus, microvascular ischemia or demyelinating disease among other possibilities. Please note that the examination as ordered is a limited surgical planning study. If a complete evaluation is warranted, MRI brain with and without contrast can be ordered. In addition, if the outside PET/CT can be made available and uploaded to PACS, comparison would be helpful to the interpretation.


Instruction: Generate impression based on medical findings.

Input: MRI Brain:A moderately sized area of somewhat patchy restricted diffusion is seen within the right occipital lobe correlating with the CT abnormality. Minimal susceptibility effect is seen in this area which could indicate petechial blood product. No frank hematoma is seen. One or two small foci of restricted diffusion are also suspected within the left occipital lobe. Mild local edema seen, but there is no significant generalized mass effect effect, midline shift or herniation. Minimal periventricular T2 hyperintensity is seen. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA Brain: The intracranial left vertebral artery is small and poorly visualized whereas on the prior MRA it was well-demonstrated. A possible mild narrowing of the mid basilar artery is seen, but this is unchanged. A moderate focal stenosis of the left distal P2 PCA is unchanged. Otherwise, no obvious anterior or posterior circulation deficits are seen. Redemonstrated is a 3 x 4 mm right MCA bifurcation aneurysm without significant change from the previous exam. A 2 mm aneurysm arising from the left A2 segment of the ACA is unchanged as well. MRA Neck: Descending aortic dissection is partially visualized on this examination. There is common origin of the brachiocephalic and left common carotid arteries. The common carotid arteries and cervical internal carotid arteries are normal in course and caliber. Both vertebral artery origins are patent. There is a smaller left and dominant right vertebral artery. There is no evidence of stenosis or occlusion.

Output: 1.Findings compatible with acute infarction involving the right greater than left posterior occipital regions.2.Moderate focal stenosis of the left P2 PCA, unchanged. Possible mild narrowing of the mid basilar artery, unchanged.3.Poor visualization of the intracranial left vertebral artery is new from the prior MRA and could represent a technical artifact or superimposed atherosclerotic disease.4.Aneurysms at the right MCA bifurcation and along the left A3 ACA are unchanged. No definite evidence of any new aneurysm is seen.5.A descending aortic dissection is partially visualized.


Instruction: Generate impression based on medical findings.

Input: Seizure, rule out structural cause. Examination is mildly motion degraded. No intracranial mass or mass-effect. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. The ventricles are within normal limits in size and configuration. The bilateral hippocampi are symmetric in size and signal characteristics.Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter as well as in the pons, which are nonspecific, but compatible with chronic small vessel ischemic changes. There is a focus of CSF intensity involving the left lateral thalamus with a rim of gliosis likely representing a lacunar infarct. There is global parenchymal volume loss, commensurate with age. Brain parenchyma is otherwise unremarkable for age.No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. There is a small mucous retention cyst in the left sphenoid sinus. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. No intracranial mass or abnormal parenchymal or meningeal enhancement. No findings to definitively suggest a seizure focus.2. Mild chronic small vessel ischemic disease. Chronic lacunar infarct in the left lateral thalamus.3. Global parenchymal volume loss.


Instruction: Generate impression based on medical findings.

Input: 27 years Female (DOB:8/7/1988)Reason: 3T scanner, qsm/permeabiltiy, CCM Protocol History: yearly surveillancePROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD There are multiple lesions which have a ring of low signal compatible with hemosiderin ring and smaller central area of T2 signal hyperintensity present which appear to be stable compared to the prior exam. The largest one appears to be in the left basal ganglia and internal capsule and measures 14 x 11 mm axial dimensions and is unchanged. Other smaller lesions evident on T2 imaging are located in the left hippocampus left fusiform gyrus right inferior temporal lobe gyrus, right anterior medial temporal lobe left isthmus of the cingulate gyrus left frontal lobe subcortical white matter, right frontal lobe subcortical white matter and a right paracentral lobule subcortical white matter and another one in the gray matter in that location and right superior frontal gyrus. Additional lesions are also identified on susceptibility weighted imaging which are not clearly identified on the T2 and FLAIR images..Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: The patient has multiple cerebral cavernous malformations scattered in both hemispheres which are stable compared to the prior exam.


Instruction: Generate impression based on medical findings.

Input: There are no structural or migrational abnormalities. There are no T2/FLAIR signal abnormalities. The hippocampi are symmetric and unremarkable. Ventricular size is normal. There is no midline shift. There is no restricted diffusion or abnormal susceptibility signal.

Output: Unremarkable MRI of the brain with no structural or migrational abnormalities.


Instruction: Generate impression based on medical findings.

Input: 60-year-old male with renal cell carcinoma, evaluate for metastases. There is a lesion in the right posterior temporal lobe with T2 intermediate signal, diffusion restriction and mild uniform enhancement with a slightly more prominent curvilinear peripheral enhancing component. This lesion measures 1.9 x 1.7 cm (13/133). This lesion contains a punctate focus of susceptibility, which could represent microhemorrhage, however no significant intrinsic T1 shortening or susceptibility is seen. A second lesion with intermediate T2 signal and diffusion restriction and mild uniform enhancement in the left posterior frontal lobe measures 2.0 x 2.3 cm (13/193). Again, no significant intrinsic T1 shortening or susceptibility is seen within this lesion to suggest hemorrhage. Anteriorly, this lesion demonstrates a region of more T2 hyperintense nonenhancing signal which could represent a small cystic component. There are a few punctate foci of increased T2 signal scattered throughout the cerebral white matter without enhancement or mass effect, including a focus in the anterior left frontal lobe, which are nonspecific.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.Enhancing lesions in the right posterior temporal and left posterior frontal lobes likely represent metastasis. No MRI findings of significant internal hemorrhage are seen. Hyperattenuation on prior CT likely reflected high cellularity.2.A few punctate foci of increased T2 signal are nonspecific but may be related to chronic small vessel ischemic disease.


Instruction: Generate impression based on medical findings.

Input: There are scattered foci of T2 hyperintensity within the white matter without associated restricted diffusion, mass effect, or susceptibility abnormality. There is diffuse volume loss without specific lobar predominant atrophy pattern. There are no findings of ventricular obstruction or hydrocephalus. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. Note is made of a partially empty sella. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain. Degenerative changes of the upper cervical spine demonstrates some degree of central spinal stenosis at the level of C3/4.

Output: 1.Mild chronic small vessel ischemic disease.2.Mild diffuse volume loss.


Instruction: Generate impression based on medical findings.

Input: 32-year-old male post resection of meningioma Post operative changes is post left temporal and frontal craniotomy again noted. Epidural fluid/air collection under the craniotomy flap as well as residual air in the subarachnoid space compatible with expected postoperative changes is stable in appearance. There is no evidence of intraparenchymal or extra-axial hemorrhage. Hypoattenuation in the anterior left temporal lobe adjacent to the surgical bed time, corresponding to area of restricted diffusion seen on prior MRI, is better defined on today's exam. Again noted minimal bulge of the left temporal lobe toward the basal cistern and left perimesencephalic cistern, stable.The appearance of ventricular system and the basal cisterns is unchanged compared to prior exam. There is no midline shift or hydrocephalus. Focus of high density above the left anterior clinoid corresponds to previously identified lytic or sclerotic left supraclinoid internal carotid artery, unchanged.Again noted cystic left cerebellar structure with CSF density, unchanged.The orbits are unremarkable. Left maxillary retention cysts are noted. Otherwise the visualized paranasal sinuses and mastoid air cells are well pneumatized.

Output: 1.Expected postoperative changes status post left frontal and temporal craniotomy as described above.2.Evolutionary change of left temporal lobe hypoattenuation corresponding to previously seen restricted diffusion compatible with infarct in left middle cerebral artery distribution.3.Unchanged posterior cranial fossa cyst.


Instruction: Generate impression based on medical findings.

Input: There is no evidence of intracranial hemorrhage or mass. There are punctate foci of restricted diffusion in the left superior frontal sulcus and precentral gyrus. There is otherwise a small area of encephalomalacia in the left precentral gyrus. Additional scattered punctate foci and confluent areas of T2 hyperintensity within the periventricular and subcortical white matter without associated restricted diffusion. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are bilateral maxillary osteointegrated dental implants and sinus lift surgery.

Output: 1. Punctate foci of restricted diffusion in the left superior frontal sulcus and precentral gyrus may reflect acute to early subacute ischemia superimposed upon an otherwise small chronic infarct involving the left precentral gyrus and a background of diffuse mild chronic small vessel ischemic disease.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: Female, 68 years old, with history of spinal stenosis and now worsening pain and one month of urinary incontinence. Concern for cord compression. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. The marrow signal characteristics are mildly heterogeneous with a well-circumscribed fatty signal lesion in the L4 vertebral body compatible with a hemangioma. This appearance has not changed from prior.The visualized spinal cord and conus are within normal limits. Details regarding the cauda equina are discussed by level below.Loss of disc T2 signal is evident from L3-4 through L5-S1. Additional level specific findings are as follows:L1-2: Facet hypertrophy and ligamentum flavum thickening. Moderately sized central disc extrusion extending slightly above and below the level of the adjacent endplates without significant interval change in size. This lesion effaces the ventral thecal sac causing a mild to moderate spinal canal stenosis and displacement of the adjacent cauda equina, again without significant interval change. No significant foraminal narrowing. L2-3: Mild facet hypertrophy and ligamentum flavum thickening. Mild bulging disc with a small superimposed right paramedian protrusion. Mild generalized spinal canal stenosis without cauda equina impingement. No significant foraminal narrowing. No significant interval changes. L3-4: Marked facet hypertrophy and ligamentum flavum thickening. Mild bulging disc with a small annular fissure centrally. Severe generalized spinal canal stenosis with crowding of the cauda equina, perhaps very slightly progressed from prior. Mild bilateral foraminal narrowing. No other significant interval changes.L4-5: Marked facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. Mild to moderate generalized spinal canal narrowing without significant change. Mild right and moderate left foraminal narrowing without significant interval change. L5-S1: Moderate facet hypertrophy and ligamentum flavum thickening. Left paracentral disc protrusion, slightly larger than prior. Mild effacement of the left ventral thecal sac, again slightly progressed. Moderate left and mild right foraminal narrowing, unchanged.

Output: 1. Stable moderately sized disc extrusion at L1-2 resulting in a stable mild to moderate generalized spinal canal stenosis and displacement of the adjacent cauda equina.2. Possible slight interval progression of severe spinal canal stenosis at L3-4 which is due largely to posterior element hypertrophy.3. Mild interval increase in size of a left paracentral disc protrusion at L5-S1 causing slight progression of thecal sac effacement.4. Relatively mild degenerative findings at other levels are not significantly changed.


Instruction: Generate impression based on medical findings.

Input: 85-year-old female with HCV, cirrhosis, assess for HCC. ABDOMEN:LIVER, BILIARY TRACT: Liver contour: The liver contour is nodular. Cirrhotic liver morphology.Cholelithiasis again noted. No intrahepatic or extrahepatic biliary ductal dilatation. Portal vein: patent Hepatic veins: patentHepatic artery: patentLesions: Reference arterial enhancing lesion with no definite washout measures 0.9 x 1.0 cm or restricted diffusion, previously 0.8 x 1 cm lesion (image 68, series 100) in the hepatic dome adjacent to the middle hepatic vein.There is a second arterially enhancing lesion measuring 0.9 x 0.9 cm, appearing similar to the prior study (68; series 100), no definite washout or restricted diffusion.  SPLEEN: Mild splenomegaly and varices again noted. PANCREAS: Redemonstration of cystic lesions in the pancreatic body that likely represent sidebranch IPMNs (intraductal papillary mucinous neoplasms). The reference lesion in the body of the pancreas measures 0.9 x 0.8 cm, previously measuring 1.0 x 0.8 cm (19; series 9). The second reference lesion in the body of the pancreas measures 0.6 x 0.6 cm, previously 0.5 x 0.5 cm. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral cysts, unchanged. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Persistent subcentimeter arterially enhancing lesions in the dome of the liver without definite evidence of washout or restricted diffusion. Attention on follow-up examination recommended. Cirrhotic liver morphology.2.No significant interval change in the reference cystic lesions in the pancreatic body, which most likely represent sidebranch IPMNs.


Instruction: Generate impression based on medical findings.

Input: 21-year-old male with a history of Rosai Dorfman and status post chemotherapy. RIGHT LOBE MEASUREMENTS: 1.5 x 1.2 x 5.2 cmLEFT LOBE MEASUREMENTS: 1.6 x 1.3 x 4.3 cm.ISTHMUS MEASUREMENTS: 3.8 mmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant abnormality noted.ISTHMUS: Anterior, slightly hypoechoic round mass measuring 0.5 cm in diameter likely represents small thyroid nodule.PARATHYROID GLANDS: Not visualized.LYMPH NODES: Bilateral lymphadenopathy right greater than left. The largest measures 1.2 x 0.5 x 2.0 cm.OTHER: No significant abnormality noted.

Output: Bilateral lymphadenopathy right greater than left.


Instruction: Generate impression based on medical findings.

Input: Female 49 years old; Reason: Evaluate for ligament or meniscal abnormalities, any bony abnormalities History: one month of knee pain, large joint effusion MENISCI: There is focal blunting of the free edge of the posterior horn of the medial meniscus, indicating a partial thickness radial tear. Linear increased signal intensity in the peripheral fibers of the posterior horn of the medial meniscus extending to the femoral articular surface likely represent an interface with an intracapsular ligament rather than a true tear. There is mild blunting of the free edge of the body of the medial meniscus, likely reflecting chronic attritional tearing, as well as globular increased signal reflecting intrasubstance degeneration. The medial meniscus is mildly extruded medially. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is moderate degeneration of the articular cartilage of the medial compartment, particularly along the weight-bearing surface of the medial femoral condyle, with small foci of full-thickness cartilage degeneration. Tiny near-full-thickness to full-thickness defects are present in the articular cartilage of the medial tibial plateau. Underlying edema-type signal is present in the medial tibial plateau and medial femoral condyle. Partial-thickness cartilage degeneration is present along the medial facet of the patella. Near-full-thickness to full-thickness focal cartilage defects are noted along the medial facet of the femoral trochlea.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. Osteoarthritic changes of the knee, particularly at the medial tibiofemoral and patellofemoral compartments, with small foci of full-thickness cartilage degeneration.2. Partial-thickness radial tear of the posterior horn of the medial meniscus with medial extrusion of the body of the medial meniscus.3. Normal-appearing ligaments.4. Moderate to large joint effusion.


Instruction: Generate impression based on medical findings.

Input: Encounter for examination for normal comparison and control in clinical research program [Z00.6], Reason for Study: ^Reason: Metastatic breast cancer needs evaluation prior to starting trial. IRB 15-0500. History: Metastatic breast cancer needs evaluation No evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Normal brain MRI


Instruction: Generate impression based on medical findings.

Input: 72 years, Female, gait disorder. There are multiple patchy areas and scattered foci of T2/FLAIR hyperintensity involving the bilateral periventricular and subcortical white matter as well as the pons which are nonspecific but compatible with chronic small vessel ischemic disease. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size for age. No abnormal parenchymal or meningeal enhancement is appreciated on the axial post gadolinium sequence. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. There is minimal mucosal thickening involving the paranasal sinuses. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. Moderate chronic small vessel ischemic disease. No evidence of acute infarct, hemorrhage, intracranial mass effect, or hydrocephalus.2. No abnormal enhancement. Please note only single axial post gadolinium sequence was obtained. Per technologist note, patient had a contrast reaction and was transferred to the ER.


Instruction: Generate impression based on medical findings.

Input: 18 year old female with history of Ewing sarcoma now with metastases. Status post craniotomy for tumor resection. Patient has small postoperative subdural collection The patient is status post left frontal craniotomy appeared and there is an extra-axial hemorrhagic fluid collection of present underneath the craniotomy flap with a fluid fluid level associated some air bubbles. It is adjacent to the high convexities and measures approximately 9 mm in thickness . AP hypodense subdural component extends more posteriorly measuring approximately 5 mm in thickness and is also unchanged. There is mild midline shift the shift of the Falx cerebri up to approximately 6 mm to the right of the midlineA 0.7 cm hyperdense focus is present adjacent to the right chest appear frontal gyrus which has an extra-axial location. It was present on the MRI of 11/17/09.There is vasogenic edema present where the patient's known mass was paired this is edema pattern is stable since 11/19/09 MRI. There is some mass effect associated.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Status post left frontal craniotomy for tumor surgery with the some findings which can be accounted for on the basis of a immediate postoperative effects such as a lobe of intracranial air and subgaleal soft tissue swelling.2.There is a left-sided subdural hemorrhagic fluid collection present with some mild mass effect and midline shift. This has not changed since the prior exam.3.A 7mm extra-axial hyperdense focus is present adjacent to the right superior frontal gyrus. This could represent a small meningioma.


Instruction: Generate impression based on medical findings.

Input: Pain. Rule out patellar dislocation/chondromalacia, ACL injury, meniscal pathology. MENISCI: The menisci appear normal.ARTICULAR CARTILAGE: I see no focal articular cartilage defects.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: There is focal increased signal intensity within the lateral fibers of the proximal patellar tendon at its attachment to the patella, likely representing a combination of focal tendinosis and partial-thickness undersurface tearing. There is a small amount of edema within the underlying inferior pole of the patella. Distally, there is ossification within the patellar tendon just proximal to its insertion on the anterior tibial tubercle that may reflect prior injury/Osgood-Schlatter disease; however, I see no edema at this location currently. The quadriceps tendon appears normal. The tibial tubercle to trochlear groove distance and the Insall-Salvati ratio are within normal limits.ADDITIONAL

Output: Focal tendinosis and undersurface tearing of the proximal patellar tendon.


Instruction: Generate impression based on medical findings.

Input: 3-year-old male with seizure disorder and history of grade 4 IVH. Evaluate for acute changes Low attenuation of left cerebellar hemisphere consistent with encephalomalacia. Regions of encephalomalacia are also seen in the periventricular areas consistent with findings on prior MRIThere is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. No acute intracranial abnormality. 2. Left cerebellar and periventricular encephalomalacia as described in prior MRI.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old, with acute onset of truncal ataxia, right gaze weakness, hyperreflexia, high suspicion for Miller Fisher variant of GBS. Brain:A 3 mm focus of hyperintensity is seen within the subcortical white matter of the right precentral gyrus. No other areas of significant parenchymal signal abnormality are seen. No restricted diffusion is detected. There is no edema or mass effect. No pathologic parenchymal or extra-axial enhancement is seen. No findings to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid is detected. The ventricles are within normal limits.Cervical spine:Straightening of the cervical lordosis is likely positional. Sagittal alignment is unremarkable. Vertebral body morphology is unremarkable. No concerning marrow replacement or pathologic marrow enhancement is seen. A Schmorl's node deformity is seen at T3-4.The visualized spinal cord demonstrates normal signal intensity throughout. No pathologic intramedullary or leptomeningeal enhancement is seen. No epidural abnormalities are suspected.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Disc osteophyte formation with a central disc extrusion which contacts and minimally deforms the cord. No significant generalized canal stenosis seen. No significant foraminal narrowing is evident. C4-5: Posterior disc-osteophyte complex formation. Mild generalized spinal canal stenosis. Moderate left foraminal narrowing. C5-6: Posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Moderate left foraminal narrowing. C6-7: Posterior disc-osteophyte complex formation. No significant spinal canal or foraminal stenosis. C7-T1: No spinal canal stenosis or neuroforaminal narrowing.

Output: 1.No specific lesions are seen in the brain or cervical spine to correlate with the suspected Miller Fisher syndrome.2.Disc degeneration is seen in the cervical spine, most notably affecting the C3-4 level where there is a disc extrusion which mildly impinges on the cord.


Instruction: Generate impression based on medical findings.

Input: Low back pain and radiation of pain down the right lower extremity. There is disc dessication with loss of height and slight disc bulging at L5-S1, as well as ligamentum flavum thickening and facet hypertrophy with trace joint effusions, which result in mild bilateral neural foraminal narrowing. There is also facet and ligamentum flavum hypertrophy at L4-5, with mild bilateral neural foraminal narrowing, but no significant spinal canal stenosis. Otherwise, there is no significant degenerative disease at T12 through L4. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: Degenerative spondylosis in the lower lumbar spine with mild neural foraminal narrowing bilaterally at L4-5 and L5-S1.


Instruction: Generate impression based on medical findings.

Input: Female, 17 years old, localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset, not intractable, without status epilepticus. Previous imaging and EEGs at Lurie Children's Hospital. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. No gray matter heterotopia or cortical dysplasia is evident. There are three or four very small nonspecific foci of T2/FLAIR hyperintensity in the subcortical white of the left cerebral hemisphere. Brain parenchymal signal is otherwise unremarkable. The mesial temporal lobe structures are symmetric and free of signal abnormality.Major flow-voids are preserved on T2 sequences. Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: No MRI findings to account for the patient's seizures. There are a few scattered foci of increased T2/FLAIR signal in the subcortical white matter of the left cerebral hemisphere, which are nonspecific. Correlation with prior outside imaging may be beneficial.


Instruction: Generate impression based on medical findings.

Input: Male, 39 years old. Knee instability MENISCI: There is complex tearing of the posterior horn of the medial meniscus associated with an intrameniscal cyst. When compared to the previous study, the intrameniscal cyst appears much more conspicuous. The anterior horn of the medial meniscus and the lateral meniscus are intact.ARTICULAR CARTILAGE AND BONE: A broad-based exostosis extending posteriorly from the proximal tibia is again noted, with normal bone marrow signal characteristics. The previously described small cartilage cap is not included in the field-of-view of this study. Remaining bony and articular cartilage is within normal limits, without bone marrow signal abnormality or focal cartilage defect.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1.Complex tear of the posterior horn of the medial meniscus with an associated intrameniscal cyst.2.Benign-appearing exostosis extending from the posterior tibia is not significantly changed.


Instruction: Generate impression based on medical findings.

Input: 99-year-old female with headache. There is no evidence of intracranial hemorrhage, mass or edema. Mild, diffuse hypodensities in the periventricular and subcortical white matter distribution consistent with mild small vessel disease, age indeterminate. If there is clinical concern for acute ischemia, MRI may be considered.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: Normal brain CT.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Stiff leg. Signs and symptoms: Lower extremity stiffness. Nonenhanced cervical MRI:Foramen magnum is unremarkable.C2-- C3 demonstrate mild degenerative changes and unremarkable otherwise.C3 -- C4 demonstrate mild degenerative changes and unremarkable otherwise.C4 -- C5 demonstrate mild degenerative changes with result in mild to moderate right neural foraminal compromise and unremarkable otherwise.C5 -- C6 demonstrate moderate degenerative disk and mild facet/ligamentum flavum hypertrophy without significant change since prior exam. There is no central spinal stenosis however moderate bilateral neural foraminal (right greater than left) compromise is present. No change since prior exam.C6 -- C7 demonstrate slight interval decreased size of a left lateral disk protrusion since prior exam. There is no central spinal stenosis. Mild left neural foraminal compromise is again noted without change.C7 -- T1 demonstrate asymmetric right-sided hypertrophic changes with resultant mild to moderate right neuroforaminal compromise.There is normal signal intensity and caliber all cervical and uppermost visualized thoracic cord similar to prior exam.

Output: 1.Stable mild to moderate degenerative changes of cervical spine.2.No evidence of central spinal stenosis at any level.3.Interval decreased size of a left lateral disk protrusion at C6 -- C7 since prior exam.4.Multiple levels of mild to moderate neural foraminal compromise without significant change since prior exam as detailed per level above.


Instruction: Generate impression based on medical findings.

Input: 76-year-old male with bleeding, left hepatic mass status post embolization, assess for rebleed. ABDOMEN:LIVER, BILIARY TRACT: The reference heterogeneous exophytic left hepatic mass measures 3.5 x 3 .3 cm, previously 3.3 x 2.3 cm. There is no washout on postcontrast sequences. There is progressive heterogeneous nodular enhancement on delayed sequences, which measures approximately 2.5 x 1.6 cm (29; series 15). No additional enhancing lesions are noted. There is a small adjacent simple cyst, which appears similar to the prior study. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No significant interval change in size of the reference exophytic left hepatic mass, which is incompletely characterized given the history of embolization, but may represent a hemangioma. Further evaluation with percutaneous biopsy could be considered for further characterization.


Instruction: Generate impression based on medical findings.

Input: Ms. Fellner is a 55 year old female with a strong family history of breast cancer and BRCA2 positive. Family history of breast cancer in her sister at age 35 and in her paternal aunt at age 45. There is heterogeneous amount of fibroglandular tissue in both breasts. 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: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old, with remote history of squamous cell carcinoma of the supraglottic larynx, and more recent history of lung adenocarcinoma, with focus of abnormal uptake seen within L5 on prior PET scanning. Assess for metastatic disease. On a background of heterogeneous marrow, there are numerous focal areas of pathologic marrow replacement within the osseous structures of the lumbar spine. A lesion is indeed seen within the right aspect of the L5 vertebral body correlating to an area of abnormal PET hypermetabolism. However, multiple additional foci are seen in nearly every other vertebral body as well. No evidence of extraosseous or epidural disease extension is seen.Spinal alignment is anatomic. Vertebral body heights are preserved. There is a transitional morphology of the L5 vertebral body. The visualized distal spinal cord, conus and nerve roots of the cauda equina demonstrate normal signal characteristics. No epidural abnormalities are suspected.L1-2: Unremarkable. L2-3: Unremarkable. L3-4: Mild loss of disc height and mild disc bulging. Mild to moderate generalized spinal canal narrowing. Mild bilateral foraminal narrowing. L4-5: Mild facet hypertrophy and ligamentum flavum thickening. Mild bulging disc with a small superimposed central protrusion. Moderate generalized spinal canal stenosis. Mild right foraminal narrowing. L5-S1: Moderate left and mild right facet hypertrophy. Very small central annular disc fissure. No significant spinal canal stenosis. No foraminal narrowing.

Output: 1.Numerous foci of pathologic marrow replacement are seen within nearly every vertebral body level of the visualized lumbar spine. Given the history, these are highly suspicious for metastatic deposits. No evidence of any significant extraosseous or epidural disease extension is seen.2.Multilevel degenerative findings are noted as above. Specifically, there is a mild to moderate spinal canal stenosis at L3-4, and a moderate spinal canal stenosis at L4-5.


Instruction: Generate impression based on medical findings.

Input: Low back and leg pain. History of lumbar fusion greater than 2 years ago. Assess for stenosis and and degeneration above fusion. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is maintained. Postoperative changes of L4-L5 fusion again seen with interbody graft, pedicle screws, and paraspinous rods better assessed on same-day CT. Bone marrow signal is benign with with mild nonspecific heterogeneity. The conus medullaris is normal in position.There are multilevel degenerative changes with a left paracentral disc protrusion at the L3-L4 level, which is new since prior MRI from 3/20/2012. L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: There is disc desiccation and height loss with a left-sided disc protrusion which is new since prior. There is also ligamentum flavum thickening and facet arthropathy. There is effacement of the left lateral recess as well as mild to moderate central canal stenosis. There is minimal narrowing of the neural foramen on the left. No right neural foraminal stenosis.L4-L5: Postoperative changes of fusion as above. There is mild right-sided neural foraminal narrowing related to endplate osteophyte. There is no spinal canal or left neural foraminal narrowing.L5-S1: Disc desiccation with mild disc height loss and small central disc protrusion with calcification. Disc contacts the S1 nerve root without clear impingement. No significant central canal stenosis. No significant neural foraminal stenosis. Paraspinous soft tissues are within normal limits.

Output: Postoperative changes of L4-L5 fusion with hardware better seen on CT from same day. There is a left paracentral disc protrusion at the L3-L4 level, which is new since prior MRI from 3/20/2012, and results in effacement of the left lateral recess. There is also mild to moderate central canal stenosis at this level. No high-grade neural foraminal stenosis is evident at any level. Please see above for additional details.


Instruction: Generate impression based on medical findings.

Input: There is a new 13x12 mm mass-like focus of intense enhancement in the right lateral occipital lobe slightly inferior and lateral to the postoperative cavity with associated mild restricted diffusion and increased relative CBV. Surrounding hyperintensity couldThere is minimal enhancement along the resection cavity margin which is compatible with treatment change. There are postoperative findings related to right occipital mass resection with resolved pneumocephalus and decreased intrinsic T1 shortening along the surgical cavity and subjacent dural thickening with linear enhancement. There is persistent nonspecific and nonenhancing confluent T2 hyperintensity and mild mass effect in the right parietal and occipital lobes which is stable to slightly decreased.

Output: 1.New 12x13 mm solid enhancing nodule in the right lateral occipital lobe inferolateral to the resection cavity. There is mild restricted diffusion and some elevation in CBV. Although this patient has had recent radiation treatment, findings are suspicious for tumor progression. Suggest close follow-up.2.Evolution of right occipital resection cavity with mild enhancement in the resection bed which may represent treatment change.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Orbital cellulitis?. Signs and symptoms: Right eye pain with movement. Enhanced MRI of orbits:120 cc of Omnipaque 350 was administered.The retro-orbital fat is well preserved and with no evidence of stranding or abnormal enhancement. The extraocular musculature has normal morphology and size and no abnormal enhancement.The optic nerves are well visualized and with no abnormal enhancement.There is normal morphology and density of bilateral globes and with no abnormal enhancement.The adjacent paranasal sinuses demonstrate minimal sinus disease of the ethmoids and otherwise unremarkable.Cavernous sinuses and sella are normal and no abnormal enhancement. No evidence of preseptal soft tissue swelling or abnormal enhancement.

Output: Negative enhanced CT of orbits.


Instruction: Generate impression based on medical findings.

Input: Urothelial cancer with brain metastases. Status post resection and radiation. Evaluate extent of disease. Motion artifact limits the examination particularly the postcontrast images. Redemonstrated postoperative changes from a left frontal craniotomy and left frontal lobe tumor resection. Compared to the MRI from 10/6/2015, the resection cavity now has a more defined cystic appearance. Marked interval reduction in adjacent vasogenic edema is noted. There remains a thin enhancing rim which may represent granulation tissue. No suspicious masslike or nodular enhancement.The previously identified left temporal lobe metastasis has markedly reduced perilesional edema. No residual enhancing lesion is identified, however the postcontrast images are limited by motion artifact. Immediately medial to the resection cavity within the subcortical white matter is a 7 mm focus of increased T2 signal. This appears to have been present previously, but was largely obscured by the extensive vasogenic edema previously present in this region. No enhancement is noted on postcontrast images. This along with other scattered periventricular and subcortical white matter T2 bright foci likely represent small vessel ischemic changes.The ventricles and basal cisterns are normal in size and configuration. The expected intracranial vascular flow voids are present. The paranasal sinuses are clear. The visualized mastoid air cells are clear. The orbits are unremarkable.

Output: 1. Expected evolution of left frontal lobe resection cavity with marked interval reduction in perilesional vasogenic edema. No suspicious residual enhancement to suggest residual tumor.2. Interval reduction in perilesional edema adjacent to the left anterior temporal horn metastatic lesion. No residual enhancement is identified, however motion artifact mildly limits the exam in this region.Artifact from patient motion limits the examination, particularly on the postcontrast images. Performing future imaging with sedation may be useful for improving image quality.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Past pituitary adenoma. Evaluate for or regrowth of adenoma. Signs and symptoms: Worsening memory for a year. Pre-and post-enhanced pituitary MRI:Examination demonstrate stable post surgical changes of prior removal of pituitary adenoma. There is no convincing evidence of residual tumor which is a similar observation as prior study. There is revisualization of pituitary stalk with rightward course and termination to residual pituitary gland on the right similar to prior exam. Heart remarkable bilateral cavernous sinuses and similar to prior study. Unremarkable suprasellar visual complex.Pre-and post-enhanced brain MRI:Negative diffusion weighted images.T2 flair images demonstrate minimal punctate foci of hyperintensity in the periventricular white matter of cerebral hemispheres which are nonspecific however often represent microvascular ischemic changes. There are no prior dedicated brain MRI in particular of flair sequence which makes precise comparison difficult. However comparison with prior axial T2 weighted images demonstrate no convincing evidence of progression of findings.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and myelination are brain otherwise. Post-enhanced images fail to demonstrate any abnormal parenchymal, leptomeningeal, calvarial or orbital enhancement.The signal void of major intracranial arterial branches are identified. The signal intensity of the intracranial venous sinuses is within normal and with normal pattern of enhancement.

Output: 1.Stable post surgical changes of pituitary adenoma resection since prior exam and without evidence of residual tumor.2.Negative diffusion weighted images.3.Minute periventricular flair hyperintensity although nonspecific it could represent chronic microvascular ischemic changes of minimal degree.4.No detectable abnormal enhancement and unremarkable brain MRI otherwise.


Instruction: Generate impression based on medical findings.

Input: Biliary obstruction. Abdominal pain. History of ovarian/fallopian cancer. ABDOMEN:LIVER, BILIARY TRACT: Fatty liver. Numerous bilobar mildly and very hyperintense subcentimeter lesions in the liver. The number, distribution and enhancement characteristics suggest that this is primarily biliary hamartomas. No extra hepatic biliary ductal dilatation. There is moderate bilobar intrahepatic ductal dilatation with abrupt narrowing of the common hepatic duct (series 401/24) at the level of the patient's porta hepatis lymphadenopathy.Mild narrowing of the extrahepatic portal vein. Moderate to severe narrowing of the left portal vein.SPLEEN: The spleen measures 13.8 cm in craniocaudal length with a small non-specific hypoenhancing focus.PANCREAS: Pancreas divisum without pancreatic ductal dilatation or focal lesion.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Punctate bilateral T2-weighted hyperintensities, probable cysts.RETROPERITONEUM, LYMPH NODES: Extensive retroperitoneal lymphadenopathy. Porta hepatis lymphadenopathy. Extensive peripherally enhancing serosal implants along the falciform ligament, of the left lobe of the liver and posterior aspect of the antrum. Portocaval lymphadenopathy.BOWEL, MESENTERY: There is moderate volume of loculated ascites with thin septations suspicious for peritoneal carcinomatosis. Nodular implants along the greater curvature of the stomach, better evaluated on recent CT.BONES, SOFT TISSUES: Metastatic pulmonary nodules are partially imaged. Small right anterior abdominal hernia containing a short-segment or wall of small bowel, unchanged.OTHER: No significant abnormality noted.

Output: Intrahepatic biliary ductal dilatation to the level of the common hepatic duct where there is porta hepatis lymphadenopathy as well as tumoral implants. Numerous punctate liver lesions likely represent multiple biliary hamartomas. Mild narrowing of the extrahepatic portal vein. Moderate to severe narrowing of the left portal vein.Peritoneal carcinomatosis including moderate volume of loculated ascites and serosal implants along the stomach and liver.


Instruction: Generate impression based on medical findings.

Input: 73-year-old female. Evaluate for neoplasm and/or metastasis status post Whipple. ABDOMEN:LUNG BASES: No significant abnormality noted. Bilateral breast implants present.LIVER, BILIARY TRACT: There is a small amount of pneumobilia which is a normal finding status post Whipple. No focal hepatic lesions are identified. Patient status post cholecystectomy.SPLEEN: Multiple subcentimeter hypodense lesions within the spleen are nonspecific in appearance, but given the lack of lesions within the liver are more likely to represent benign lesions rather than metastatic disease. Calcified granuloma present in the spleen.PANCREAS: Patient is status post Whipple procedure. No mass is identified in the surgical bed. The remnant pancreatic duct is mildly dilated.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Hypodense lesion in both kidneys likely represent cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is some infiltration of mesenteric fat anterior to the surgical bed. This likely represents postsurgical changes but attention should be paid to this area on subsequent examinations.BONES, SOFT TISSUES: Postsurgical change are identified in the anterior abdominal wall.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: An exophytic mass arising from the uterus likely represents a fibroid uterus. However, this is nonspecific by CT and could be further evaluated with gynecologic ultrasound or MRI as clinically indicated.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Degenerative changes affect the lower lumbar spine. A sclerotic focus is in the right iliac wing may represent a large bone island but is nonspecific. A smaller sclerotic focus in the left iliac wing adjacent to the SI joint is also nonspecific.OTHER: No significant abnormality noted

Output: 1. No definite evidence of metastatic disease. 2. Postsurgical changes from the Whipple procedure including some infiltrative changes near the resection site. This should be followed on subsequent exams.3. Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Knee pain MENISCI: There is complex branching signal within the body of the medial meniscus reflecting complex tear. Similar findings are also noted within the body of the lateral meniscus compatible with a tear.ARTICULAR CARTILAGE AND BONE: There is severe articular cartilage loss of the medial compartment, particularly the anterior femoral condyle with full-thickness cartilage loss. There is underlying degenerative marrow signal of both the femoral and tibial components. Milder changes are noted within the lateral compartment. There is fissuring of the articular cartilage of the patellofemoral compartment with areas of full-thickness articular cartilage loss of the trochlea. LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Complex tearing of the medial and lateral menisci.2. Moderate to severe osteoarthritis with varying degrees of articular cartilage loss which is worst in the medial compartment.


Instruction: Generate impression based on medical findings.

Input: 50-year-old female with history of benign biopsy of the right breast and strong family history of breast cancer in her mother presents for MRI Surveillance. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Multiple cysts are present in both breasts.Focal non-mass enhancement is unchanged at middle 12 o'clock position in the left breast.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on medical findings.

Input: 64 years, Female, Reason: Patient with past stroke history and recent history of unexplained repeated falls History: Recent falls, loss of sensation in hands No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic changes. Slightly prominent perivascular spaces are incidentally noted along the superior frontal gyri. Brain parenchyma is otherwise unremarkable for age.No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal is within normal limits.

Output: 1. No intracranial mass or mass effect. No hydrocephalus. No evidence of acute infarct or hemorrhage.2. Mild chronic small vessel ischemic changes.


Instruction: Generate impression based on medical findings.

Input: 60 y/o female w/ IgG kappa multiple myeloma, left lower back pain, numbness/tenderness, left lower pelvic area pain Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is grade 1 anterolisthesis of L4 and L5. Alignment is otherwise maintained. Bone marrow signal is benign with no areas of edema or enhancement to suggest active myeloma lesions. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or right neural foraminal stenosis. Cystic enhancing lesion described below involves the inferior lateral aspect of the neural foramen on the left with minimal narrowingL2-L3: Disc bulge and facet arthropathy with suggestion of a small left foraminal disc protrusion. No significant spinal canal or right neural foraminal stenosis. Mild left neural foraminal narrowing. L3-L4: Disc bulge and bilateral facet arthropathy and prominence of the dorsal epidural fat. There is associated mild central spinal canal stenosis as well as mild bilateral neural foraminal stenosis.L4-L5: Disc bulge, moderate bilateral facet arthropathy, and ligamentum flavum thickening contribute to mild spinal canal stenosis. There is mild to moderate bilateral, left greater than right, neural foraminal stenosis.L5-S1: There is minimal disc bulge and mild to moderate bilateral facet arthropathy. There is no significant spinal canal or neural foraminal stenosis. Additional disc bulges are present in the partially imaged lower thoracic spine without high-grade spinal canal stenosis.There is a large cystic structure measuring greater than 7.5 cm in diameter inferior lateral to the right kidney without clear correlate on prior abdominal CT from 5/18/2012. There is a larger pelvic mass likely related to uterine fibroids which is partially imaged and demonstrates mass effect on the left psoas muscle.There is a peripherally enhancing tubular lesion along the posterior aspect of the left psoas muscle which measures approximately 7 x 10 mm in the axial plane and approximately 2.5 cm in the craniocaudal dimension. The lesion appears to course along the extraforaminal left L1 nerve root.There are 3 subcentimeter foci of enhancement involving the bilateral iliac bones and left sacrum.

Output: 1. No evidence of active multiple myeloma in the lumbar spine. There are 3 subcentimeter foci of osseous enhancement in the pelvis which are nonspecific but may be related to multiple myeloma.2. Peripherally enhancing fusiform cystic lesion involving the left psoas muscle at the L2 level (7x10 mm in axial plane) may represent an abscess. Neoplasm such as nerve sheath tumor with cystic degeneration (associated with the left extraforaminal L1 nerve root) and resolving hematoma are other considerations. Relative lack of inflammation involving the surrounding left psoas muscle or adjacent discitis-osteomyelitis argue against abscess. 3. Multilevel degenerative changes include grade 1 anterolisthesis at L4 and L5 and mild spinal canal stenosis at the L3-L4 and L4-L5 levels. There is also mild multilevel neural foraminal stenoses. No high-grade spinal canal or high-grade neural foraminal stenosis. Please see additional details above.4. Partially imaged large pelvic mass is compatible with uterine fibroids. There is also a cystic appearing mass inferior lateral to the right kidney without clear correlate on remote abdominal CT from 2012. Consider dedicated abdominal CT for better evaluation.


Instruction: Generate impression based on medical findings.

Input: Clinical question: History of lung cancer with metastases to brain. Evaluate for edema or new metastases. Signs and symptoms: Left hand locking up and left leg heaviness. Pre-and post enhanced brain MRI:Examination demonstrate multiple new small bilateral hemispheric and cerebellar metastatic lesions since prior exam. Radiologist supratentorially no metastatic lesion measures approximately at 6-mm in transaxial dimensions and located superficially in the left posterior temporal -- parietal junction. All additional new metastatic lesions are significantly smaller in size.There is evidence of interval decreased size of few previously known metastatic lesions since prior exam. A left posterior temporal metastatic lesion measures at 5.4-mm compared to prior study measurement of approximately 8.5 mm.There is no evidence of hemorrhage or any significant surrounding vasogenic edema or mass effect. The ventricular system remain within normal size and with maintained midline.Calvarium demonstrate no metastatic lesions.Images through the orbits and including axial fat sat post enhanced series are unremarkable.

Output: 1.Multiple new supratentorial and infratentorial small metastatic lesions since prior exam as detailed/measured above.2.Several decreased size of multiple previously known metastatic lesions as detailed.3.No significant peritumoral edema, mass effect or midline shift.


Instruction: Generate impression based on medical findings.

Input: A patient submitted outside study for review. Submitted for review are digital mammographic images (2/26/16, 7/19/16), ultrasound images of right breast (7/19/16), breast MRI (8/3/16), MRI guided biopsy of right breast and post-procedural mammogram (8/11/16) performed at outside institution. DIGITAL MAMMOGRAPHIC IMAGES (2/26/16, 7/19/16):The breast parenchyma is heterogeneously dense (BiRADS Density Category C). A marker clip from prior biopsy is present at posterior upper outer quadrant in the right breast.A focal asymmetry with possible architectural distortions is seen at upper outer quadrant in the right breast.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in left breast. ULTRASOUND IMAGES OF RIGHT BREAST (7/19/16):A few irregularly shaped hypoechoic lesions are detected within the upper outer quadrant in the right breast.BREAST MRI (8/3/16):The study was performed with a protocol outlined in the outside radiology report.There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There is an enhancing mass measuring 7 x 8 x 10 mm (AP x LR x CC) at 12:00 position in the right breast.Segmental non-mass enhancement, measuring 27 x 41 x 50 mm is present in the right upper outer quadrant, surrounding the mass.No abnormal enhancement is seen in left breast. No abnormal lymph nodes are identified in either axillary region.MRI GUIDED BIOPSY OF RIGHT BREAST AND POST-PROCEDURAL MAMMOGRAM (8/11/16):MRI guided biopsy was performed for 2 sites; the enhancing mass at 12:00 position (site #1), and non-mass enhancement at 10:00 position (site #2). A needle placement appears appropriate. A hematoma is present at 12:00 position after biopsy. Postprocedural mammogram demonstrates a coil clip at posterior 12:00 position, and a Hydromark clip at anterior 10:00 position.Per pathology report, the result of site #1 was malignant; invasive ductal carcinoma grade 1 with lobular features, ductal carcinoma in situ low-grade, and the result of site #2 was benign.

Output: 1. Biopsy proven carcinoma at posterior 12:00 position in the right breast.2. MR guided biopsy for non-mass enhancement in the right breast at upper outer quadrant was benign but discordant.If breast conservation surgery is planned, a needle localization for site #1 for lumpectomy, and site #2 for excisional biopsy is recommended.3. No mammographic or MR evidence of malignancy in the left breast.4. No abnormal lymph nodes in either axillary region.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on medical findings.

Input: Clinical question: left-sided torticollis from the age of 9 months unknown cause, abnormal alignment of her head on her neck, 1mm cuts T1/T2/Flair per Dr Frim and Dr Katzman peds conferenceSigns and Symptoms: torticollis, abnormal alignment of her head on her neck, tenderness over the paraspinal muscles in the cervical region MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:There is anterior subluxation of C1 relative to C2 and some basilar invagination. C1 is partially incorporated into the skull base. The right lateral mass of C1 is incorporated into the skull base whereas the left half of C1 appears to be hypoplastic. C2 is rotated relative to C1. The distance between the odontoid and C1 is approximately 6 mm. The anterior arch of C1 appears to be bifid anteriorly. These findings also appear to been present on the 8/13/2015 exam.The right vertebral artery appears to narrow as it courses through these anomalies and appears to have an aberrant course.The cervical vertebral bodies are appropriate in overall height.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.

Output: 1.Findings suggest a congenital anomaly in the upper cervical spine with partial incorporation of C1 to the skull base and the malformation of C1. Additionally there is rotatory subluxation of C1 and C2 and basilar invagination. There is aberrant course of the right vertebral artery. The occipital condyles have also malformed and are asymmetric. If clinically appropriate a CT of the upper cervical spine and skull base would help further define these anomalies as well as the subluxation.


Instruction: Generate impression based on medical findings.

Input: 76 year old female admitted with possible CVA, DOE, elevated BNP with EF 18% on TTE of unclear etiology. Referred for cardiac MRI to rule out infiltrative disorders and RV thrombus. First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 18%. The systolic dysfunction is global. There are no regional wall motion abnormalities present. The LVEDV is 221 ml (normal range 109+/-23), LV end diastolic volume index is 132 ml/m2 (normal range: 65+/-11), LVESV is 181 ml (normal range 31+/-10), and LV end systolic volume index is 108 ml/m2 (normal range 18+/-5). The LV mass is 166 g (normal range 114+/-24) and the LV mass index is 99 g/m2 (normal range 67+/-11). There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Sigmoid septum is noted and is likely age related.The native T1 myocardial relaxation time is <1050 ms suggestive of absence of underlying diffuse fibrosis or infiltration.Left AtriumThe left atrium is severely dilated.Right VentricleThe right ventricle is severely dilated with severely reduced systolic function. The overall RV ejection fraction is 17%, the RVEDV is 228 ml (normal range 110+/-24), the RV end diastolic volume index is 166 ml/m2 (normal range 69+/-14), the RVESV is 232 ml (normal range 35+/-13), and the RV end systolic volume index is 128 ml/m2 (normal range 22+/-8). There is no right ventricle thrombus on contrast imaging.Right AtriumThe right atrium is severely dilated. 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 at least mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is a small pericardial effusion.Extracardiac FindingsSmall left pleural effusion. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during induced hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. The left ventricle is severely dilated with severely reduced systolic function. LVEF 18%. The systolic dysfunction is global. 4. The right ventricle is severely dilated with severely reduced systolic function. RVEF 17%.5. Severe biatrial dilation.6. Normal Native T1 myocardial relaxation time is <1050 ms suggestive of absence of underlying diffuse fibrosis or infiltration.7. No right ventricle thrombus on contrast imaging.


Instruction: Generate impression based on medical findings.

Input: 42 year old female with hypertension. Woke up this a.m. with togue and lip laceration and sore left shoulder. Concern for new onset of seizure Images at the level from a magnum demonstrate increased soft tissue density and is believed to represent Chiari malformation.This examination is otherwise unremarkable. No evidence of hydrocephalus, hemorrhage, midline sure or any edema is detected.Follow up exam and MRI is recommended.

Output: Chiari malformation and otherwise unremarkable CT of brain.


Instruction: Generate impression based on medical findings.

Input: 55 year old with FNA proven carcinoma at 2 sites in the right breast (3 and 9 o'clock position) presents for MRI evaluation. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.RIGHT BREAST:Following multiple suspicious lesions (all measurements: AP x LR x CC) are present;An irregularly shaped enhancing mass (21 x 19 x 14 mm) at anterior 3 o'clock positionAn irregularly shaped enhancing mass (19 x 16 x 16 mm) at posterior 9 o'clock positionA round enhancing mass (10 x 9 x 10 mm) with ill-defined margins at posterior 12 o'clock positionEnhancing subcentimeter masses at posterior 3 and 8 o'clock positionLEFT BREAST:No abnormal enhancement is seen in left breast. AXILLAE:No abnormal lymph nodes are identified in either axillary region.

Output: Multicentric cancer in the right breastBIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Headache. Family history of ischemic heart disease and other diseases of the circulatory systemClinical question: headache, family h/o cerebral aneurysm, please evaluate for aneurysmSigns and Symptoms: headache, family h/o cerebral aneurysm MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Incidental note is made of partial empty sella.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The right A1 segment is small. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.

Output: 1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 4.No evidence for intracranial mass lesion or acute ischemic cerebral infarction.


Instruction: Generate impression based on medical findings.

Input: Weakness [R53.1], Reason for Study: ^Reason: eval for pathology, h/o L4-5, L5-S1 laminectomy and fusion History: c/o LE weakness and urinary incontinence For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. Postoperative status, external fixation with the screws from L3 to L5.There is a grade 1 spondylolisthesis of L4 on L5 and mild retrolisthesis of L5 on S1 with disc degeneration of L4-5 and L5-S1, which appears to be stable.The vertebral body height is maintained. The signal of the visualized cord is normal. The conus medullaris terminates at the L1-2 level. Degenerative changes are specified by the intervertebral level as follows: L1-L2: Minimal disc bulging, no neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: Minimal disc bulging, no neuroforaminal narrowing or spinal stenosis. L4-L5: Pseudo-bulging of disc due to spondylolisthesis of L4 on L5, with minimal spinal canal narrowing. Disc dessication is seen. No evidence of neural foraminal narrowing.L5-S1: Diffuse bulging of disc, Disc dessication is seen. No neuroforaminal narrowing or spinal stenosis.

Output: 1. Postoperative status from L3 to L5 with the stable spondylolisthesis of L4 on L5 and minimal retrolisthesis of L5 on S1 since prior scan.2. Degenerative changes of intervertebral disc spaces are also stable since prior scan. 3. Visualized spinal cord signal intensity is normal.


Instruction: Generate impression based on medical findings.

Input: 9 years Female (DOB:11/22/2006)Reason: Please evaluate for brainstem malformation or aneurysm History: Episodic vertigoPROVIDER/ATTENDING NAME: MICHAEL H KOHRMAN CHARLES J MARCUCCILLI MRI of the brainNo diffusion weighted abnormalities are appreciated.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.The visualized portions of the paranasal sinuses demonstrate mild mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The nasopharyngeal and oropharyngeal tonsils are symmetric and large as can often be seen at this age. MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are medium-sized. The right vertebral artery slightly larger left vertebral artery. The right anterior inferior cerebellar artery and the left posterior inferior cerebellar artery are dominant.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.

Output: 1.There is no evidence for cerebral infarction or mass.2.No evidence for intracranial cerebrovascular occlusive disease.3.No evidence for extracranial cerebrovascular occlusive disease.4.Large tonsils in a child are best evaluated on a clinical basis.


Instruction: Generate impression based on medical findings.

Input: 17 year-old female, identify neurofibroma along back on right A skin marker was placed along the right lower back. A small 1.0 x 0.8 cm T2 bright ovoid mass is noted in the posterior right abdominal wall superficial to the right paraspinal muscles. Numerous additional T2 bright masses compatible with neurofibromas are noted within the abdomen, soft tissues and abdominal wall.

Output: Superficial neurofibroma posterior to the right paraspinal muscles at the site of concern as well as innumerable additional neurofibromas.


Instruction: Generate impression based on medical findings.

Input: History of laryngeal cancer. Receiving chemotherapy. CT of the soft tissues of the neck:Images through the skull base and including cavernous sinuses remain within normal limits.Images through the larynx reidentifies post therapy changes and with no definitive evidence of residual tumor. It has not changed in appearance since 2/25/07. The thyroid cartilage shadow remains splayed. The glottis is not distorted. The epiglottis is not identified No evidence of pathologic adenopathy in the neck. There is a left jugular chain lymph node present at the level of the hyoid bone measuring about 8 mm short axis dimension which can be identified on previous exams dating back to 22507 when it measured 6 mm short axis dimension. Limited images through the apices of the lungs and mediastinum are negative for metastatic lesions. Large quantities of air within the esophagus may reflect reflux. This finding was noted on prior study and no change. There are atherosclerotic calcifications of the carotid bifurcations on the left side the there is concern for significant narrowing of the left internal carotid artery at its origin.There are degenerative changes present in the cervical spine with endplate and uncovertebral osteophytes at multiple levels and associated narrowing of the spinal canal and the neural foramina in the upper cervical spine there is some right-sided facet hypertrophy.The patient is status post median sternotomy.The esophagus appears to have diverticulum at the level of the thoracic inlet which is directed anteriorlyCT of brain with infusion.There is a focus of encephalomalacia in the left cerebellar hemisphere unchanged since prior exams which likely represents a prior infarct. Periventricular and subcortical white matter hypodensities are present which are nonspecific but likely vascular related at this age.. A hypodense focus is redemonstrated at the genu of the right internal capsule probably lacunar infarct. There is associated atrophy of the right caudate nucleus.Along the left parietal lobe adjacent to the left intraparietal sulcus there is a small focus of enhancement measuring approximately 6 mm in size. This was not present on prior exams and is suspicious for metastatic disease. If clinically appropriate an MRI of the brain may help confirm this and to help identify additional foci that may be present. It is best seen on image number 22 and 21 of the axial CTs of the head

Output: 1.Stable CT of soft tissues of the neck and with no evidence of tumor or pathologic adenopathy.2.Suspicion for left parietal lobe metastasis as described above. This is new since the prior exam. An MRI of the brain may help confirm this and identify any other lesions. referring clinician was paged.3.Findings raise the question of a left carotid stenosis please correlate with clinical evaluation and at any other evaluation of the carotids.4.Findings suggest an esophageal diverticulum unchanged since prior exams.5.Findings suggest old infarctions previously demonstrated as described above.


Instruction: Generate impression based on medical findings.

Input: Malignant neoplasm of esophagus, unspecified [C15.9], Reason for Study: ^Reason: esophageal CA with L1 soft tissue met and new LLE pain/weakness History: new LLE pain/weakness For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is an enhancing intramuscular lesion at the level of L1,32.9mm (CC) x 14.5mm (AP) x 22.2mm (RL) indicating metastatic lesion.There is about 17.8mm sized subcutaneous well circumscribed lesion without evidence of enhancement but with evidence of suppression on fat suppression scan. This is more likely represent fat containing benign lesion such as focal fat necrosis or inclusion cyst.There is no evidence of vertebral body metastasis.There are multifocal Schmorl's nodes at the level of L4 and L5 vertebral bodies with degenerative changes.The disc height of L45 is decreased indicating disc degeneration.The vertebral body height is preserved. The signal of the visualized cord is normal. The conus medullaris terminates at the T12-L1 level. Degenerative changes are specified by the intervertebral level as follows: T12-L1: Disc desiccation, no neuroforaminal narrowing or spinal stenosis. L1-L2: Disc desiccation, no neuroforaminal narrowing or spinal stenosis. L2-L3: Mild to moderate spinal canal stenosis due to disc bulging with bilateral ligamentum flavum thickening. No neuroforaminal narrowing or spinal stenosis. L3-L4: Disc desiccation with disc degeneration decreased disc height. No neuroforaminal narrowing or spinal stenosis. L4-L5: Disc desiccation, diffuse bulging of disc. No neuroforaminal narrowing or spinal stenosis. L5-S1: no neuroforaminal narrowing or spinal stenosis.

Output: 1. Left paraspinal muscle intramuscular metastatic lesion as described above.2. No evidence of vertebral body metastatic lesion.3. Multifocal disc degenerations especially at the level of L34 and L45 with the Schmorl's malformation as described above.4. Mild spinal canal stenosis at the level of L23.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Mass? Intracranial hemorrhage? Signs and symptoms: Central vertigo x 1 month history of metastatic melanoma to brain and with status post RT Non-enhanced head CT:A there is no evidence of intracranial hemorrhage, edema, mass-effect or midline shift or hydrocephalus.The cortical sulci, ventricular system, CSF cisterns are essentially minimal for patient's stated age of 74.Diffuse patchy areas of subcortical and periventricular low-attenuation are nonspecific however they are suspected for small vessel ischemic disease of indeterminate age. Similar findings were present on prior MRI examination from 12 -- 13 -- 2010.Calvarium is intact. Limited view of paranasal sinuses and mastoid air cells as well as middle ear cavities are unremarkable.Limited images through the orbit demonstrate ptosis bulbi of the right globe as was noted on multiple prior studies.

Output: 1.No evidence of any acute new findings in particular no evidence of hemorrhage or acute cortical stroke.2.Findings of small vessel ischemic disease of indeterminate age.3.Ptosis bulbi of right globe.4.Unremarkable calvarium, paranasal sinuses and mastoid air cells.


Instruction: Generate impression based on medical findings.

Input: History of horseshoe kidney and renal mass versus cyst in the lower pole of the right kidney. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size, signal intensity and enhancement without a focal suspicious lesion, biliary ductal dilatation or vascular abnormality. Minimally distended gallbladder.SPLEEN: The spleen is normal in size without a focal lesion.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Stable nonspecific mild left adrenal gland thickening.KIDNEYS, URETERS: Supernumerary kidneys which are fused at the midline.Stable size of the 2 right inferior pole cystic lesions, one of which contains a thin septation without abnormal enhancement. The more exophytic lesion demonstrates intrinsic T1 weighted hyperintensity without postcontrast enhancement compatible with a proteinaceous/hemorrhagic cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Supernumerary kidneys fused at the midline with right inferior minimally complex cysts.


Instruction: Generate impression based on medical findings.

Input: Redemonstrated is a left precentral gyrus intra-axial T2 hyperintense lesion which has slightly increased its transverse width now measuring 15 mm, previously 13 mm. Additionally, it now contains a new ring enhancing portion which measures 13 mm transverse by 7 mm AP by 13 mm craniocaudal dimensions.Cavum septum pellucidum is again noted incidentally. There is no diffusion abnormality to suggest the presence of acute ischemia. The ventricles and sulci are within normal limits. The basal cisterns remain patent. 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. The paranasal sinuses and mastoid air cells are clear.

Output: 1.Redemonstrated is a left precentral gyrus intra-axial T2 hyperintense lesion which has slightly increased its transverse width now measuring 15 mm, previously 13 mm. Additionally, it now contains a new ring enhancing portion which measures 13 mm transverse by 7 mm AP by 13 mm craniocaudal dimensions.2.Findings were discussed Dr. Kohrman on 4/29/2015 approximately 12:40 p.m.


Instruction: Generate impression based on medical findings.

Input: New-onset bilateral leg weakness of unknown etiology currently undergoing work-up with differential including GBS, transverse myelitis, spinal mass, hemiplegic migraine, or trauma. Brain: Many of the sequences are degraded by patient motion. 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 lateral ventricles are mildly asymmetric, which can represent a developmental variant. 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.Spine: Many of the sequences are degraded by patient motion. The mild prominence of the central canal throughout much of the thoracic spinal cord is incompletely characterized on this exam. The conus medullaris is located at approximately the L1 level. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. There is no abnormal enhancement or mass lesions within the spine. The paravertebral soft tissues are unremarkable.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or Chiari malformation.2. No evidence of mass lesions in the spine or transverse myelitis.3. The mild prominence of the central canal throughout much of the thoracic spinal cord is incompletely characterized on this exam. Please refer to the recent prior thoracic spine MRI for additional details.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Patient with known glioblastoma, on Avestin, now with speech difficulties, right-sided weakness. Rule out bleed. Signs and symptoms: Same Unenhanced head CT:Examination demonstrates no evidence of acute intracranial hemorrhage.Extensive low-attenuation of white matter of the left cerebral hemisphere and to a lesser degree of the right hemisphere is consistent with posttreatment changes as well as residual edema/encephalomalacia of patient's known tumor. There is no appreciable change when compared to prior MR. There is an irregularly shaped calcification of the proximal left frontal lobe at the site of previously noted susceptibility signals are prior MR. Dilated supratentorial ventricular system are essentially similar to prior study. There is no evidence of midline shift. Recommend further follow-up with an MRI exam.

Output: 1.No evidence of acute intracranial hemorrhage as clinically questioned.2.When compared with prior MRI constellation of intracranial findings of brain tumor, post therapy changes, ventriculomegaly remains essentially similar.3.Recommend follow-up with an MRI.


Instruction: Generate impression based on medical findings.

Input: 60-year-old male with known degenerative disc disease presents with arm and 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 multi-level degenerative disc disease with associated narrowing of the central spinal canal, most pronounced at C7-T1. However, there is no evidence of acute cord compression.

Output: 1. No acute cord compression. Please note that 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. 2. Multi-level degenerative disc disease, most severe at C7-T1.


Instruction: Generate impression based on medical findings.

Input: 52 year old female with left sided weakness. Evaluate for CVA. White matter changes present with area of low attenuation found in the right internal capsule and subinsular white matter. An additional area of white matter change is located periventricularly on the left. Age of the lesions is indeterminate. This may represent microangiopathic disease, however cannot rule out other white matter disease. Further evaluation with MRI is recommended.

Output: White matter changes in the right internal capsule, subinsular region, and the left periventricular region. Further evaluation with MRI is recommended.