Instruction: Generate impression based on medical findings.

Input: Clinical question to be answered: Rule out intracranial hemorrhage. Signs and symptoms: Altered mental status and headaches. Heavy large vessel intracranial vascular calcification of vertebral arteries and carotids are noted. Large area of vasogenic edema in the right temporal lobe with extension into right parietal is noted. There is associated mass effect and midline shift to approximately 7 mm. no evidence of hemorrhage is detected. Cortical sulci, ventricular system and all CSF cisterns remain within normal. Follow-up exam but a dedicated MRI examination is highly recommended. This finding is concerning for malignancy or possibly an infectious process.

Output: Significant right-sided vasogenic edema with associated mass effect as detailed. Follow-up exam with an MRI is recommended.


Instruction: Generate impression based on medical findings.

Input: Recurrent pain and swelling Exam is slightly limited by patient motion artifact.MENISCI: No meniscal tear identified.ARTICULAR CARTILAGE AND BONE: Generalized thinning of the posterior lateral femoral condyle cartilage. There is also generalized thinning of the patellar cartilage without focal defect.LIGAMENTS: Cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: Quadriceps and patellar tendons are intact.ADDITIONAL

Output: Generalized thinning of the posterior lateral femoral condyle cartilage and patellar cartilage without focal defect.


Instruction: Generate impression based on medical findings.

Input: Nasal mass, turbinate hypertrophy. There is a cystic lesion in the right nasolabial junction that measures 14 mm in diameter. There is narrowing of the inferior portion of the piriform sinus aperture. The nasal turbinates are intact. The paranasal sinuses and nasopharynx are unremarkable. There is a partially empty sella. The orbits are unremarkable.

Output: 1. Findings compatible with a right nasolabial cyst that measures 14 mm in diameter. 2. Nonspecific partially empty sella.


Instruction: Generate impression based on medical findings.

Input: Left upper extremity paresthesias, and prior neck injury. There is multilevel degenerative spondylosis. At C3-4, there is a posterior disc-osteophyte complex that abuts the spinal cord and there is moderate to severe bilateral neural foraminal narrowing. At C4-5, there is a posterior disc-osteophyte complex that also abuts the spinal cord and there is moderate left and mild right neural foraminal narrowing. At C5-6, there is a posterior disc-osteophyte complex that mildly narrows the spinal canal and there is at least moderate bilateral neural foraminal narrowing. At C5-6, there is a posterior disc-osteophyte complex that effaces the anterior thecal sac in the spinal canal and there is at least mild bilateral neural foraminal narrowing. There is no significant degenerative disease at C2-3 and C7-T1. There is lack of the usual cervical kyphosis, but no spondylolisthesis. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: Multilevel degenerative cervical spondylosis with variable degrees of spinal canal and neural foraminal narrowing.


Instruction: Generate impression based on medical findings.

Input: 25-year-old with history of Hodgkin's lymphoma, status post chest wall radiation. High-risk for breast cancer. There is scattered fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.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: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on medical findings.

Input: 85 year-old male with fall and loss of consciousness. CT of brain without infusion.Large vessel intracondylar vascular calcification is noted.No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Patchy areas of periventricular lucencies are concerning for small vessel disease considering patient's age. Small area of cortical encephalomalacia in the high convexity left parietal is believed to represent an old small cortical stroke. No evidence of post traumatic findings. Calvarium, paranasal sinuses and mastoid air cells are unremarkable.CT of the cervical spine.Extensive degenerative changes of the cervical spine with significant loss of intervertebral disk height at multiple levels are noted. The alignment of cervical spine remains within normal limits. The facets are aligned and demonstrate no subluxation. A linear defect bilaterally across the pedicles of C6 is noted. There is however no evidence of any malalignment of these pedicles. Considering the patient's history I cannot entirely rule out nondisplaced bilateral pedicular fracture.These findings are best appreciated on sagittal image 15 for the right pedicle of C6 and sagittal images 24 and 25 for the left. Both of these findings are also appreciated on axial images 41 and 42. Follow-up with a repeat thin cuts CT and or an MRI is recommended.Dr. Watts from the emergency service was notified of the findings at the time of interpretation.

Output: 1.Unremarkable CT of brain without infusion.2.Suspected bilateral C6 pedicular fracture as detailed.3.Extensive degenerative changes of cervical spine.4.No malalignment of the cervical spine.


Instruction: Generate impression based on medical findings.

Input: Metastatic breast cancer with abnormality sphenoid area: difficulty concentrating and tremors. There is an unchanged enhancing lesion centered in the sphenoid triangle with epidural extension into the left middle cranial fossa that measures up to 5 mm in thickness, with mild mass effect upon the anterior pole of the temporal lobe and associated mild vasogenic edema. There is no evidence of intracranial hemorrhage or acute infarct. There is minimal periventricular white matter T2 hyperintensity, which is nonspecific. There is mild diffuse cerebral volume loss. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is mild mucosal thickening in the maxillary sinuses. There is a partially-imaged cystic lesion in deep lobe of the parotid gland that projects into the right parapharyngeal space that measures at least 15 mm. There are also multiple persistent subcentimeter cystic foci in the superficial portions of the right parotid gland. There are small scalp lipomas in the occipital region.

Output: 1. Unchanged lesion centered in the left sphenoid triangle with epidural extension into the left middle cranial fossa and associated mild vasogenic edema in the anterior temporal lobe.2. No evidence of intraparenchymal mass lesions, acute intracranial hemorrhage, or cerebral infarction.3. Multiple cystic lesions in the right parotid gland, which may be sequela of an inflammatory or autoimmune process versus a neoplastic condition such as Warthin tumors. Follow up with dedicated parotid imaging may be useful if clinically warranted.


Instruction: Generate impression based on medical findings.

Input: 46-year-old woman called back for bilateral breast masses on screening mammogram. An ML view and two spot compression views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density(BiRads Density Category B), unchanged in pattern and distribution. There are partially circumscribed masses in the lateral right breast near 9:00 position, central right breast near the 12:00 position and lateral left breast near the 2-o'clock position which which all persist on additional views. An ultrasound will be performed for further evaluation. Additional upper inner left breast mass also again seen, previously noted to be stable. No suspicious microcalcifications or areas of architectural distortion in either breast. BILATERAL BREAST ULTRASOUND:On physical exam, there is no palpable or visible abnormality of either breast.Targeted grayscale and color Doppler ultrasound right breast was performed for the mammographic areas of concern. Corresponding to the well-circumscribed mass seen in the lateral right breast is a 9 mm cluster of cysts with punctate echogenic foci likely representing milk of calcium at the 9:00 position 5 cm from nipple. The largest cyst within this cluster measures approximately 5 x 3 mm. Corresponding to the well-circumscribed mass seen in the central right breast on mammogram is a cluster of complex cysts at the 12:00 position 2 cm from nipple, with the largest cyst within this cluster measuring 7 x 7 mm. No internal vascularity or nodularity is appreciated in either location.Targeted grayscale and color Doppler ultrasound of left breast was performed for the mammographic area of concern. Correlating to the left upper outer quadrant mass seen on mammogram is a 5 x 6 x 5 mm cyst at the 2:00 position 5 cm from nipple. No internal vascularity or nodularity. Note that these findings correlate well to an MRI that was recently submitted showing multiple bilateral cysts.

Output: Bilateral breast cysts. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram.


Instruction: Generate impression based on medical findings.

Input: Status post third V-C placement and Rickham reservoir. Rule out ICH. A right frontal ventricular shunt has its tip at the midline. Pneumocephalus and subcutaneous emphysema are likely postprocedural. There is no evidence of intracranial hemorrhage. The lateral and third ventricles are enlarged, and the frontal horns appear more rounded than on the prior MRI. After accounting for differences in technique, this is suggestive of slight interval increase in size of the lateral and third ventricles. The fourth ventricle is within normal limits.The visualized paranasal sinuses and mastoid air cells are within normal limits for the patient's age.

Output: Expected postoperative findings from recent shunt placement. No evidence of intracranial hemorrhage. Slight interval increase in size of lateral and third ventricles.


Instruction: Generate impression based on medical findings.

Input: Female 17 years old; Reason: Left lateral knee pain after traumatic injury (hit by bus while standing) History: Pain with ambulation MENISCI: No significant abnormality noted. No meniscal tear is seen.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted. No fracture is seen. LIGAMENTS: No significant abnormality noted. The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: No specific findings to account for the patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: Reason: concern for physical exam changes since last MRI. Disc herniation History: + straight leg and faber test in the setting of L back pain For the purposes of this exam, there are 5 nonrib-bearing lumbar-type vertebral bodies with the most inferior well-defined disc space labeled L5-S1 as before. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign with small T1 hyperintense lesion at the S1 level compatible with focal fat or hemangioma. The conus medullaris is normal in position.Mild degenerative changes are seen, as described below: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: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis.L5-S1: Bilateral L5 pars defects are again seen. There is disc desiccation as well as disc bulge with a more focal left-sided protrusion which slightly effaces the left lateral recess and mildly narrows the left-sided neural foramen similar to prior. There is an associated left-sided dorsal annular fissure which is more apparent than prior. No significant spinal canal stenosis or right neural foraminal stenosis. Bilateral facet effusions are again seen. Paraspinous soft tissues are within normal limits.

Output: Overall no significant change since MRI from 8/9/2014. Bilateral L5 pars defects again seen. There is a left-sided disc protrusion at the L5-S1 level which is associated with mild narrowing of the left lateral recess as well as mild left neural foraminal narrowing, similar to prior. Spinal canal is patent. L5-S1 facet joint effusions again seen. Dynamic radiographs may be considered to assess for instability at this level.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old, with a right leg pain, shooting down the leg, back pain, reported weakness, history of prostate cancer. Diffuse patchy marrow replacement is seen compatible with widespread osseous metastatic disease, progressed from the prior MRI. No compression deformity is noted. The most conspicuous tumor deposit involves L5 and the sacrum, which show near complete marrow space involvement. At L4-5, spondylolisthesis, bulging disc and facet hypertrophy contribute to produce a moderate to severe spinal canal stenosis and bilateral foraminal narrowing. There was stenosis at this level on the prior examination, but it has progressed in the interval. Given the extensive tumor involvement of the sacrum, the possibility of foraminal encroachment and nerve root impingement by tumor is raised. Elsewhere, no significant spinal canal or foraminal stenosis is seen.

Output: 1.No evidence of acute cord compression is seen.2.Widespread osseous metastatic disease is seen.3.A large tumor deposit involving L5 sacrum seen which may contribute to L5-S1 and sacral foraminal encroachment and possible nerve root impingement. If clinically warranted, these findings can be better assessed with nonemergent dedicated lumbosacral imaging.4.Degenerative disease at L4-5 results in a moderate to severe spinal canal stenosis and foraminal narrowing, progressed from the prior examination.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o meniscal or ligamentous injury History: pain Due to to the patient's body habitus, a high-resolution coil could not be used. An alternative coil was used instead resulting in suboptimal image quality.MENISCI: There is enlargement of the body of the lateral meniscus with intrasubstance increased signal intensity indicating mucoid degeneration. This mucoid material extends through the peripheral fibers of the meniscus into the adjacent soft tissues resulting in a parameniscal cyst that extends along the periphery of the body and posterior horn of the lateral meniscus. Relatively mild intrasubstance degeneration is noted within the posterior horn of the medial meniscus. Despite the degree of intrasubstance degeneration, we see no definite communication with the articular surface. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: We see no articular cartilage defects. There is slight lateral translation of the patella relative to the femoral trochlea. Bone marrow signal intensity is normal.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The quadriceps and patellar tendons appear intact. The tibial tuberosity trochlear groove distance measures 19 mm, which is borderline abnormal. The Insall-Salvati ratios is within normal limits.

Output: 1. Extensive mucoid degeneration of the body of the lateral meniscus with parameniscal cyst formation, although we see no definite extension to the articular surface.2. Borderline elevated tibial tuberosity trochlear groove distance with slight lateral translation of the patella.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Explanation for back pain. Signs and symptoms: L3, L4 radiculopathy. Nonenhanced lumbar MRI:There is normal anatomical alignment of vertebral column however with slight straightening of lordosis.T11-T12, T12-L1 and L1-L2 levels are unremarkable.L2-L3 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise. Minimal bilateral facet effusion is noted.L3-L4 demonstrate moderate disc disease and loss of disc height, mild bilateral facet and ligamentum flavum hypertrophy without spinal stenosis or neural foraminal compromise.L4-L5 demonstrate moderate disease and loss of disc height, moderate bilateral ligamentum flavum and mild bilateral facet hypertrophic changes. Mild right-sided facet effusion. There is a shallow broad-based left lateral and far lateral disc protrusion with resultant moderate left neural foraminal compromise (sagittal T1 and T2 images for through 8). No spinal stenosis and patent left neural foramina.L5-S1 demonstrate moderate disc disease and loss of disc height and mild bilateral facet and ligamentum flavum hypertrophy. No spinal stenosis and only mild right neural foraminal compromise.

Output: 1.Shallow broad-based left lateral and far lateral disc protrusion at L4/L5 with resultant moderate left neural foraminal compromise and without spinal stenosis.2.Degenerative changes at other levels without spinal stenosis at any level. Neural foraminal compromise as detailed per level above.


Instruction: Generate impression based on medical findings.

Input: Male, 15 days old, history of ECMO, assess for hypoxic ischemic injury. Brain parenchymal morphology is within normal limits. The degree of gyral development as well as the pattern of white matter myelination are appropriate for the stated age. No evidence of focal signal abnormality is seen including no evidence of restricted diffusion.The corpus callosum is fully formed and intact. The pituitary region is normal. The brainstem, cerebellar vermis and cerebellar hemispheres are normally formed and unremarkable.No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. The ventricles are normal in size and morphology.

Output: Unremarkable evaluation of the brain. Specifically, there is no evidence of hypoxic-ischemic injury or any other acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: 16-year-old male with ankle pain x 4 months. TENDONS: No significant abnormality noted.LIGAMENTS: No significant abnormality noted. There is no defect within the anterior talofibular ligament (ATFL) or fluid surrounding the ligament. ARTICULAR SURFACES AND BONE: High STIR signal within the talus indicates a small amount of bone marrow edema. The osseous structures are otherwise unremarkable. ADDITIONAL

Output: Mild bone marrow edema within the talus without evidence of ligamentous or tendinous injury.


Instruction: Generate impression based on medical findings.

Input: Left choroid fissure cyst: yearly follow up. There has been interval decrease in size of the left choroid fissure cyst that measures approximately 20 AP x 21 RL x 15 SI mm, previously 31 AP x 22 RL x 19 SI mm. Besides the mild regional mass effect, the brain parenchyma appears otherwise appears unremarkable, with a normal degree of myelination. There is no evidence of intracranial hemorrhage or acute infarct. There is no evidence of hydrocephalus. There is no midline shift or herniation. The major cerebral flow voids are grossly intact. The skull and extracranial soft tissues are unremarkable.

Output: Interval decrease in size of the left choroid fissure cyst.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for pseudomeningiocele. CINE flow studies History: s/p chiari decompression with low pressure headache There is no evidence for ventriculomegaly.CSF flow appears to be disrupted at the level of the foramen magnum. The CSF at the foramen magnum is partially obliterated.The patient is status post chiari decompression with suboccipital craniectomy and posterior arch of C1 removal. There are postoperative changes present with local soft tissue swelling and minor patchy signal changes in the cerebellar tonsils.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate minor opacities.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Chiari one malformation status post recent decompression. The CSF flow is diminished at the level of the foramen magnum.


Instruction: Generate impression based on medical findings.

Input: Right breast IDC; New lytic lesion in the T12 vertebral body seen on CT scan for which bone biopsy recommended Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the lytic T12 vertebral lesion. Post biopsy images demonstrate no complications.

Output: T12 vertebral bone biopsy under CT guidance. A total of two core samples were delivered to pathology for analysis. Touch preps were positive for neoplasm consistent with suspected breast cancer metastasis.


Instruction: Generate impression based on medical findings.

Input: 20-year-old male with pain and weakness. Evaluate for rotator cuff tear or biceps tendinitis. ROTATOR CUFF: The supraspinatus muscle and tendon appear intact. The infraspinatus muscle and tendon appear intact. The subscapularis muscle and tendon appear intact. There is mild to moderate fatty infiltration of the teres minor muscle. The teres minor tendon appears intact.SUPRASPINATUS OUTLET: There are small cysts within the distal end of clavicle with edema within the underlying bone marrow. There is mild edema within the soft tissue adjacent to the distal clavicle, but the acromioclavicular joint alignment is normal and the bone marrow signal intensity of the acromium is normal. There is trace fluid within the subdeltoid bursa which may not be of any clinical significance.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is normal. We see no effusion. Although we see no frank fluid within the superior labrum, there is branching intermediate signal intensity indicating a SLAP tear. This tear appears to extend into the superior aspect of the anterior labrum as well. There is also linear intermediate signal intensity partially traversing the posterior inferior labrum with what appears to be a tiny paralabral cyst.BICEPS TENDON: The tendon of the long head of the biceps appears normal.ADDITIONAL

Output: 1. Cyst formation within the distal clavicle with underlying edema could be degenerative in etiology or reflect a stress injury/chronic repetitive trauma (i.e., posttraumatic osteolysis of the distal clavicle).2. SLAP tear with findings suggestive of a nondisplaced posterior inferior labral tear as well.3. Small cysts in the posterior aspect of the humeral head are of questionable current clinical significance, but can be seen in patients with posterosuperior glenoid impingement.4. Mild to moderate fatty atrophy of the teres minor muscle without apparent etiology. The rotator cuff otherwise appears normal as does the biceps tendon.


Instruction: Generate impression based on medical findings.

Input: 16-year-old female with a history of lymphoma and C. Diff presenting with facial swelling, CNVII deficit, and toe walking on exam. Evaluate meninges and white matter to rule out possible structural etiology, special attention to CN VII. MRI Brain:There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no evidence of abnormal enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRI IACs:The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable.

Output: No evidence of acute intracranial hemorrhage, mass, or acute infarct. No abnormality of the IACs is appreciated.


Instruction: Generate impression based on medical findings.

Input: Patient AMS and unable to provide history. Possible internal hardware on CXRReason: Stroke? Subacute changes seen on CTA. History: AMS, not triggering vent effectively, unwitnessed fall3/29/195263 yearsFemale MRI of the brainNo diffusion weighted abnormalities are appreciated. The exam is somewhat compromised due to patient motion which may obscure more subtle abnormalities.A small focus of encephalomalacia is present along the lateral posterior aspect of the right orbital gyrus, the right insular cortex and right frontal lobe and a small region measuring approximately 2 cm in size.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses demonstrate air-fluid levels in the maxillary sinuses, sphenoid sinuses and ethmoid air cells and mucosal thickening in the frontal sinuses. The visualized portions of the mastoid air cells are partially opacified. The patient status post intubation. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is a 6 mm x 4 mm aneurysm present at the right M1 segment which has a small neck. A branch of the superior division of the right middle cerebral artery originates from the base of this aneurysm. This particular branch also supplies the small focus of encephalomalacia.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The vertebral arteries are similar in size. There is fenestration of the anterior communicating artery.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. The vertebral arteries are not well imaged proximally in part related patient motion. It is suspected that there is occlusion of the right vertebral artery at its origin. The right vertebral artery appears to be reconstituted distally most likely from collaterals

Output: 1.There is a 6 mm x 4 mm aneurysm present at the right M1 segment which has a small neck. A branch of the superior division of the right middle cerebral artery originates from the base of this aneurysm. This particular branch also supplies the small focus of encephalomalacia. CT angiography be helpful in further assessing this.2.Findings suggest occlusion of the right vertebral artery at its origin with distal reconstitution via collaterals. Please note that the vertebral arteries are not adequately imaged proximally due to patient motion. CT angiography be helpful in further assessing this.3.There is no evidence for acute ischemic cerebral infarction. 4.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 5.A small focus of encephalomalacia is centered in the right frontal lobe which involves small portions of the right orbital gyrus, insular cortex and inferior frontal gyrus.6.The exam is somewhat compromised due to patient motion which may obscure more subtle abnormalities.


Instruction: Generate impression based on medical findings.

Input: History of Crohn's ileocolitis with side to side ileocolonic anastomosis. Evaluate for active Crohn's disease. ABDOMEN:LIVER, BILIARY TRACT: The liver dome is not included on several of the image sequences. Cholelithiasis with a partially contracted gallbladder. No suspicious liver lesion. No biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal cyst. Otherwise, unremarkable. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes from an ileocecectomy. Side to side ileocolonic anastomosis is well visualized.The small bowel is adequately distended with oral contrast.The small bowel fold pattern is maintained.There is a mild postcontrast short segment enhancement of the neoterminal ileum (series 17/6) with mild restricted diffusion.Otherwise there is no abnormal small bowel wall thickening, restricted diffusion or postcontrast enhancement. No perienteric inflammatory changes such as fibrofatty proliferation.No fixed luminal narrowing or associated prestenotic/upstream dilatation to suggest a flow-limiting stricture.No sinus tract or fistula formation.No free fluid or loculated fluid collection.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: See discussion above.BONES, SOFT TISSUES: No evidence of peri-anal disease on the limited sequences obtained.OTHER: No significant abnormality noted.

Output: Mild postcontrast enhancement and restricted diffusion of the neoterminal ileum involving approximately 4 cm. No evidence of fibrostenotic or fistulous disease.


Instruction: Generate impression based on medical findings.

Input: Other encephalitis and encephalomyelitis [G04.81], Reason for Study: ^Reason: evaluate for worsening vs improvement of autoimmune encephalitis; patient is on a tapering dose of steroids History: Headaches Redemonstration of right hippocampal head and amygdala volume loss, unchanged since prior scan.There is no evidence of abnormal enhancement on the scan.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: Unchanged right hippocampal head atrophy since prior scan. Otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Pain and swelling. Cyst on dorsum of wrist with lunate cyst. A combination of fluid and intermediate signal intensity surrounds the tendons of the fourth extensor compartment as they course dorsal to the distal radius, indicating tenosynovitis. Multiple separate tendon slips are noted, which may either reflect anatomic variation or chronic longitudinal tearing. At the level of the radiocarpal joint, the fluid surrounding the tendons disappears, but there is thickening of the supratendinous extensor retinaculum. Distal to the retinaculum, fluid is noted within the fourth extensor compartment extending to the level of the metatarsal bases, indicating additional tenosynovitis. One of the slips of the extensor indicis tendon is markedly enlarged with foci of high signal intensity that likely reflects a combination of severe tendinosis and partial-thickness tearing. A relatively small amount of fluid is noted adjacent to the tendons of the first, second, and third extensor compartments, perhaps representing relatively mild tenosynovitis, but not necessarily of any current clinical significance. There is enlargement of the extensor carpi ulnaris tendon as it courses along the ulnar styloid with linear intrasubstance signal that extends to the surface of the tendon suggesting a partial thickness tear; there is only trace fluid within the extensor carpi ulnaris tendon sheath, however. The flexor tendons are unremarkable.There is a lobulated and branching mass of fluid signal intensity along the volar lip of the distal radius measuring just over 1 cm in mediolateral dimension, approximately 1 cm in craniocaudal dimension, and approximately 6 mm in AP dimension, likely representing a ganglion, perhaps arising from the attachment of the long radiolunate ligament. There is also a small lobulated collection of near-fluid signal intensity along the ulnar neurovascular bundle at the level of the proximal diaphysis of the fourth metatarsal which may represent a small ganglion or varix.There is a slight negative ulnar variance. There is mild increased signal intensity within the medial fibers of the articular disc of the triangular fibrocartilage complex suggestive of degenerative tearing at its ulnar styloid attachment. There is heterogeneous abnormal signal intensity within the lunate bone concentrated along its periphery, particularly medially, which is of low signal intensity on T1-weighted images and high signal intensity on T2-weighted images. This may represent a cluster of degenerative cysts or intraosseous ganglia, although the possibility of an unusual pattern of osteonecrosis is also considered. Centrally, the marrow signal of the lunate is relatively preserved. A couple of small foci of signal abnormality within the scaphoid and capitate are of doubtful clinical significance. Moderate osteoarthritis affects the basilar joint, with thickening of its capsular ligaments.Evaluation of the intrinsic ligaments of the wrist is limited due to lack of intra-articular contrast, but I see no specific findings of disruption.

Output: Fourth extensor compartment tenosynovitis and other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old, with pain and pop at L2-3 after lifting heavy object. Pain radiates to upper buttocks. Symptoms of two weeks' duration. The last vertebral body bearing fully formed ribs will be designated T12. This numbering scheme gives five fully lumbar type vertebral bodies and a transitional S1 vertebral body.Spinal alignment is anatomic. Vertebral body heights are preserved. Patchy areas of fatty marrow signal are seen. No worrisome marrow replacement or evidence of marrow edema is detected.The visualized spinal cord, conus and cauda equina are within normal limits.Disc T2 signal diminishes slightly at lower lumbar levels but overall disc height is preserved throughout.L1-2: Unremarkable. L2-3: Unremarkable. L3-4: There may be a very small subchondral cyst along the left superior L4 endplate. Otherwise unremarkable. L4-5: Possible very small left foraminal disc protrusion. Slight effacement of the left lateral recess. No significant generalized spinal canal stenosis. No significant foraminal narrowing on either side. L5-S1: Moderate facet hypertrophy and ligamentum flavum thickening. Mildly bulging disc. Effacement of the right lateral thecal sac. Mild generalized spinal canal stenosis. No significant foraminal narrowing on either side. S1-S2: Facet hypertrophy greater on the right. No significant spinal canal or foraminal stenosis.

Output: No large disc herniation, significant spinal canal or neuroforaminal stenosis is detected on this examination. At most, there may be a very small left foraminal disc protrusion at L4-5. Fairly substantial facet hypertrophy is also evident at L5-S1 and S1-2.


Instruction: Generate impression based on medical findings.

Input: 59-year-old female status post cervical and thoracic decompression and fusion, tumor resection. Evaluate surgical site, tumor burden. Preoperative planning for treatment of a left frontal lesion. MRI Stealth Brain:Limited stealth sequences of the brain demonstrate a well delineated mass measuring 18 x 20 mm in the posterior aspect of the superior left frontal gyrus, which for the most part enhances centrally more than peripherally. There is surrounding vasogenic edema which causes mild localized mass effect, resulting in mild sulcal effacement. However, there is no midline shift or herniation. There is also no significant change in size or configuration of the mass and surrounding edema compared to the recent prior OSH Brain MRI from 10/24/2016. There are right cerebellar and right occipital lobe developmental venous anomalies. 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. There is mild left greater than right maxillary sinus mucosal thickening and right maxillary sinus mucus retention cyst. There is right greater than left mastoid air cell fluid. MRI C-Spine:There are postsurgical changes of a C7 corpectomy with vertical strut placement, which is fixed with an anterior plate and bilateral screws into the anterior inferior aspect of C6 and T1 vertebral bodies. There has also been partial resection of the posterior aspects of C6 and the whole of C7, with bilateral pedical screw placement at C5, T1 and T2, right pedicle screw placement at C6, and bilateral vertical rod placement extending from C5 through T2. Extensive motion degradation and artifact from hardware limits postcontrast evaluation for residual tumor. Although artifact limits full evaluation of the spinal canal, There appears to be no high grade spinal canal stenosis. The remainder of the vertebral body heights are maintained. There is interval disc height loss most prominently affecting the C5-6 and C7-T1 levels. The vertebral artery flow voids appear to be intact. The paraspinous soft tissue structures appear within normal limits.

Output: 1.Enhancing 18 x 20 mm mass in the left superior frontal gyrus with surrounding vasogenic edema which causes mild mass effect on the adjacent brain parenchyma but no midline shift or herniation. 2.Post-surgical changes of a C7 corpectomy with vertical strut placement, posterior spinal resection involving C6 and C7, and posterior spinal fusion elements extending from C5 through T2.3.Motion degradation and hardware susceptibility artifact limit full evaluation for residual tumor.4.Within the above limitations, there is no evident spinal canal stenosis or spinal cord compression.


Instruction: Generate impression based on medical findings.

Input: Clinical question: left-sided CVA. Signs and symptoms:left headaches, indeterminant right arm numbness. Nonenhanced head CT:Examination demonstrates extensive periventricular and subcortical low attenuation white matter. Findings are nonspecific however with no appreciable interval change since prior CT and MRI exams. There is no evidence of intracranial hemorrhage mass effect, midline shift or hydrocephalus.Calvarium is intact. Paranasal sinuses and mastoid air cells are unremarkable.

Output: 1.No evidence of an acute intracranial findings.2.Extensive periventricular and subcortical low-attenuation of white matter.


Instruction: Generate impression based on medical findings.

Input: 17 years Male (DOB:7/24/1998)Reason: evaluate for residual tumor History: s/p tumor and seizure focus resectionPROVIDER/ATTENDING NAME: PAULA L ZAKRZEWSKI JASON M KANE Since the prior exam patient is undergone right-sided craniotomy and right temporal lobectomy for a right temporal lobe mass. 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.There are blood products along the path of a previously placed in depth electrode as well as within the temporal lobe resection site. There are some superficial enhancement along the surface of the brain at the surgical site.A small extra-axial hemorrhagic collection is present adjacent to the depth electrode insertion site measuring about 7 mm in thickness and 38 mm in width. Another extra-axial collection of blood is present adjacent to the right frontal and parietal lobes at the surgical site measuring up to 5 mm in width.There is a scalp soft tissue swelling along the right parietal and frontal scalp as well as edema within the right temporalis muscle.The visualized portions of the paranasal sinuses demonstrate mild mucosal thickening. The visualized portions of the mastoid air cells are partially opacified. The visualized portions of the orbits are intact.

Output: Status post right temporal lobe surgery. There are blood products at the surgical site and along the extra-axial spaces adjacent to the craniotomy and burr hole sites. There is no convincing evidence for residual neoplasm. Please note however, that postoperative changes may mask a tiny nodule on MRI. The follow-up exam would be helpful in further evaluating for residual or recurrent tumor.


Instruction: Generate impression based on medical findings.

Input: For the purposes of numbering of the lumbar levels, a partially sacralized L5 vertebral body is identified and the last discernible disc space is labeled L5-S1 disc. Grade 1 L4-L5 anterolisthesis. The lumbar spine is otherwise in normal alignment, with a normal lumbar lordosis. The vertebral body and disk heights are maintained with mild disc desiccation throughout. No worrisome focal marrow signal abnormality is appreciated. The distal spinal cord and conus are within normal limits with the conus terminating at the L1 level. There is diffuse congenital narrowing of the lumbar spinal canal with superimposed prominence of the epidural fat and degenerative changes as described below:T12-L1: Minimal disc bulge and moderate bilateral facet degeneration, contributing to mild bilateral foraminal stenosis. No significant central spinal stenosis.L1-L2: Minimal disc bulge, thickening of the ligamentum flavum and moderate bilateral facet degeneration, contributing to mild bilateral foraminal stenosis. No significant central spinal stenosis.L2-L3: Mild disc bulge, thickening of the ligamentum flavum and moderate to severe bilateral facet degeneration, contributing to mild to moderate right and mild left foraminal stenosis. No significant central spinal stenosis.L3-L4: Disc bulge, thickening of the ligamentum flavum and moderate to severe bilateral facet degeneration, contributing to severe spinal canal stenosis and moderate bilateral foraminal stenosis. Findings are slightly progressed from prior study.L4-L5: Minimal anterolisthesis of L4 on L5. Disc bulge, thickening of the ligamentum flavum and moderate to severe bilateral facet degeneration, contributes to severe spinal canal stenosis and moderate bilateral foraminal stenosis. Findings are slightly progressed from prior study.L5-S1: No significant disc bulge, spinal canal or foraminal stenosis.There is partial ankylosis involving the sacroiliac joints right relatively greater than left. There are anterior bridging osteophytes.

Output: 1. There is congenital narrowing of the lumbar spinal canal with superimposed epidural lipomatosis and advanced degenerative changes. Degenerative changes are slightly progressed since 2005. There is severe L3-L4 and L4-L5 spinal canal stenosis and moderate bilateral neural foraminal stenosis, as detailed above.2. There is partial ankylosis involving the sacroiliac joints, right greater than left, which may be on a degenerative basis given associated anterior bridging osteophytes. Correlate however for any history of inflammatory spondyloarthropathy. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Other cervical disc displacement, unspecified cervical regionClinical question: herniated disk The cervical vertebral bodies are appropriate in overall alignment and height. Since the prior exam the patient is undergone anterior fusion at C4-5. A previously noted disc extrusion at C4-5 has been removed.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is a diffuse disc bulge associated with posterior ligamentum flavum hypertrophy as well as uncovertebral osteophytes. There is effacement of spinal fluid ventral and posterior the spinal cord at this level associated with mild flattening the spinal cord. Compared to the previous exam this has not progressed significantly. There is spinal stenosis of a moderate degree present at this level. There is mild encroachment of the exiting nerve roots within the neural foramina at this level.At C4-5 there is no significant compromise to the spinal canal. The patient is status post anterior fusion at this level and removal of disc protrusion. There is mild encroachment of the left-sided exiting nerve roots within the neural foramen at this level. There is subtle cord signal hyperintensity present this level which was also present on the preoperative exam.At C5-6 there is no significant compromise to the spinal canal. There is a mild disc bulge present at this level associated with some mild ligamentum flavum hypertrophy. There is mild encroachment of left-sided exiting nerve roots related to a small disc protrusion and some uncovertebral osteophytes.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a mild disc bulge present at this level associated with some mild ligamentum flavum hypertrophy.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There is moderate spinal stenosis and mild encroachment of exiting nerve roots present at C3-4 related to a degenerative changes which has not progressed since the prior exam.2.Status post anterior fusion at C4-5 with alleviation of spinal stenosis due to a large disc extrusion.3.There is encroachment of left-sided exiting nerve roots at C4-5 related to disc disease and uncovertebral osteophytes.4.There is mild encroachment of left-sided exiting nerve roots at C5-6 due to degenerative changes.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Headaches, history of GBM, post radiation. Signs and symptoms: As above Non-enhanced head CT:The examination demonstrates new area of low attenuation in the right basal ganglia measuring 13.9 x 14.5-mm on axial image 10. This finding could represent a lacunar infarct however possibility of tumor cannot be excluded. A smaller second similar lesion more posteriorly with extension into the thalamus is also present. Follow-up with an MRI is recommended. There is also a large area of CSF density well-demarcated collection measuring 33.5 x 33.6-mm in transaxial dimension and approximately 44 mm in cranial -- cephalad access. This is suspected for a cyst formation at the surgical site and or cystic tumor.The combination of above findings results in effacement of adjacent cortical sulci and subtle mass effect on the third ventricle and right lateral ventricle which appears a slightly smaller than before. There is also midline shift of approximately 4.6 mm to the left at the level of septum pellucidum.There is a small extra-axial collection likely subdural in the right frontal region anterior to the anterior edge of right frontal craniotomy flap which measures approximately 36 mm in length and 8.3 -mm in thickness which is measured on axial image 13.New since prior exam there is also a cortical based low attenuation of the left anterior frontal lobe that is suspected for a small cortical stroke. This finding is appreciated on axial images 13 to 15.A punctate size calcification at the anterior aspect of third ventricle is this could represent a small colloid cyst which was also noted before and report change.

Output: 1.Suspect a small left frontal cortical stroke, local nor stroke of right basal ganglia as detailed above.2.Large cyst formation at the surgical site in the right temporal lobe measuring approximately 32.5 x 33 x 44-mm concerning for a cyst or a cystic tumor.3.Well-demarcated a small low-attenuation lesions in the right basal ganglia concerning for strokes and or tumor.4.A small CSF density subdural in the right frontal region measuring 36-mm in length and 8.3-mm in thickness.5.Combination of above findings results in further subtle increase in mass effect on the right lateral ventricle and midline shift of approximately 4.6 mm.6.Constellation of all these new findings require further evaluation with a dedicated MRI examination.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Lumbago with sciatica, right side Lumbago with sciatica, left sideClinical question: low back and leg painSigns and Symptoms: low back and leg pain Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is loss of disc space height and disc desiccation as well as a diffuse disc bulge. There are some endplate reactive changes at this level which are high signal on T1 and low signal on T2 STIR. The fat at the lateral recess bilaterally and the fat surrounding the exiting nerve roots within the neural foramina is not effaced at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge present at this level associated with loss of disc space height and disc desiccation. There is mild ligamentum flavum hypertrophy at this level. The fat at the lateral recess bilaterally and the fat surrounding the exiting nerve roots within the neural foramina is not effaced at this level.At L3-4 there is a large central disc extrusion present which compresses the thecal sac and effaces spinal fluid surrounding the nerve roots creating a moderate degree of spinal stenosis. The fat at the right lateral recesses partially effaced at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is disc desiccation present associated loss of disc space height at T12-L1 and T11-T12 associated with a minor disc bulge at T11-T12.

Output: There are multilevel degenerative changes present in the lumbar spine mainly in the form of disc disease. This is worse at L3-4 there is a moderate degree of spinal stenosis as a result of a central disc extrusion associated with encroachment of the right lateral recess more than the left lateral recess nerve roots.


Instruction: Generate impression based on medical findings.

Input: 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 or mass. The spinal cord displays normal signal and morphology. There is no abnormal enhancement. The paravertebral soft tissues are unremarkable.

Output: No significant spinal canal stenosis, spinal cord compression, or demyelinating lesions.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: 62-year-old male with a history of multiple myeloma with 3 weeks of cough, hemoptysis. Bronchoscopy showed adenocarcinoma of the lungs. Rule-out brain metastases. There are areas of white matter hypodensity in the right frontal lobe. Given the history of a neoplastic primary, metastatic involvement cannot be ruled out. An MRI with contrast is recommended for further evaluation. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. There is partial opacification of the dependent portions of the left maxillary sinus, improved compared to the prior examination. The remaining visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Patchy areas of hypodensity in the right frontal white matter. Given the history of neoplasm, an MRI is recommended for further evaluation to rule out metastatic foci as clinically indicated.


Instruction: Generate impression based on medical findings.

Input: Secondary malignant neoplasm of bone [C79.51], Reason for Study: ^Reason: with metastatic breast cancer and concerning cervical spine lesion, back pain; please evaluate for risk of cord compression/nerve compression History: with metastatic breast cancer Cervical spine MRIThere are interval development of soft tissue signal intensity at the level of C3 and C4 vertebral bodies, and left side lateral mass. On Gad enhancement scan, the enhancing portion of the soft tissue mass extend toward left side C23 and C34 neuroforamen as well as transverse foramen and encasing vertebral artery.Diffuse bulging of disc at the level of C45 and broad based disc protrusion central to right laterally at the level of C56 do not show any interval change since prior scan.At the level of C56 in conjunction with protruded disc with bilateral ligamentum flavum results mild to moderate spinal canal stenosis, grossly unchanged since prior scan.Spinal cord signal intensity is normal. There is normal cervical lordosis. The cranial-cervical junction is normal. Thoracic spine MRIThere are multilevel various sized soft tissue lesions on thoracic vertebral bodies including T3, T5, T8, T9, T10, T11, T12, L1 and L2. Left side T8, T9, T10, T11 and T12 ribs also show soft tissue lesion involvement. Especially at the level of T10, there is evidence of soft tissue extension from the left side rib toward pleura.The T10 vertebral body shows about 10% of compression fracture.There is normal thoracic kyphosis and the alignment is anatomic. The cord signal is normal. The conus medullaris terminates at the level of T12-L1.

Output: 1. Multilevel metastatic lesions involving both cervical and thoracic level as well as left lower ribs. In particular, at the level of C3 and C4, the lesion involves and encasing left side neural foramen and transverse foramen. There is also pleural extension of metastatic rib lesion at the level of T10.2. There is about 10% of compression fracture of T10 vertebral body. 3. Spinal cord signal intensity remains normal.


Instruction: Generate impression based on medical findings.

Input: 76-year-old male with history of kidney cancer ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter liver cyst in the hepatic dome, unchanged. No significant abnormality noted.SPLEEN: Subcentimeter T2 hyperintense focus in the spleen is unchanged, possibly a complicated cyst or lymphangioma. No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post right nephrectomy. No evidence of recurrent disease.Multiple T2 hyperintense simple appearing renal cysts in the left kidney, unchanged since prior exam.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No evidence of recurrent or metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Chest pain, unspecified [786.50] / Cervicalgia [723.1], Reason for Study: ^Reason: please r/o ischemia, vs mass, vs structural abnormality History: left sided weakness. Brain MRI:There is no evidence of acute ischemic or hemorrhagic lesion.There is a focal susceptibility artifact on the right temporal lobe on gradient echo images indicating small blood product. The possibility of cavernous malformation of this lesion cannot be completely excluded, however, the chance appear to be low considering the configuration of the lesion.Multifocal scattered high signal intensity lesions on bilateral deep white matter and periventricular white matter on FLAIR images indicate nonspecific small vessel disease.There is a large developmental venous malformation on the right cerebellar hemisphere.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 mastoid air cells are clear.Small retention cyst on the left side sphenoid sinus.Thornwaldt cyst was also seen.Brain MRA:3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.C-Spine:There is about 6mm sized T1 low and T2 high signal intensity well marginated lesion within the odontoid process of C2 indicating benign nature cystic lesion such as osteochondral cyst.There is evidence of atlanto-occipital assimilation, right greater than left.Severe neural foraminal stenosis on the right side of C23, C34, and mild neural foraminal stenosis on the C45 right side, C67 left side.There is no evidence of spinal canal stenosis.Spinal cord signal intensity appears to be normal.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. A small susceptibility artifact on the right temporal lobe anterior aspect, possible prior hemorrhagic focus or small cavernous malformation.3. Non specific white matter lesions on FLAIR and T2 weighted images.4. Developmental venous anomaly on the right cerebellar hemisphere 5. Normal MRA of brain.6. Degenerative disease of C-spine, multilevel various degree neural foraminal stenosis as described above.


Instruction: Generate impression based on medical findings.

Input: Metastatic lung cancer, brain mets, no therapy to brain lesions. EGFR/T790M+, on Tagrisso therapy. There is slight interval increase in size of several enhancing supratentorial lesions. For example, a right superior frontal sulcus lesion measures up to 8 mm, previously 6 mm. However, some lesions are unchanged or slightly smaller, such as a punctate lesion in the medial right occipital lobe. Furthermore, there is no evidence of residual cerebellar lesions. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Interval increase in size of several enhancing supratentorial lesions. Other lesions are not significantly changed or smaller.


Instruction: Generate impression based on medical findings.

Input: Clinical question: status post craniotomy. Signs and symptoms: Same Nonenhanced head CT:Extensive postoperative changes of a left frontal -- temporal craniotomy is again identified. There is no definite evidence of any interval change.Small area of low-attenuation along the anterior aspect of the left temporal lobe is better visualized than prior study. This finding may represent widened left sylvian fissure due to recent surgical intervention. Possibility of focal cortical edema cannot be entirely ruled out. Please correlate with exam and if there is clinical concern for ischemic change recommend an MRI study.There is no evidence of interval hemorrhage since prior study. No evidence of hydrocephalus. Minimal midline shift to the right of approximately 3 mm is again noted with no change. Expected postoperative changes of intracranial air and small epidural blood/fluid collection under the craniotomy flap is again noted.

Output: No definitive interval change since prior study. Please see above comments.


Instruction: Generate impression based on medical findings.

Input: Altered mental status, parietal subgaleal hematoma, pronator drift, anisocoria. Motion artifact degraded image quality.There is no evidence of acute ischemic or hemorrhagic lesion on the scan.Multifocal scattered patch high signal intensities on FLAIR imaging on bilateral periventricular white matter and deep white matter indicate nonspecific small vessel ischemic disease.Right parietal subgaleal hematoma still seen, comparing to the CT scan, no significant interval change since prior scan performed on June 17, 2015.There are about 3.7 mm thickness bilateral subdural fluid collections with evidence of linear susceptibility artifacts on gradient echo images indicate chronic subdural hemorrhage. There is no evidence of mass effect towards brain parenchyma and from these fluid collection.The ventricles, sulci and cisterns are symmetric and unremarkable. 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: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Non specific small vessel ischemic disease.3. Bihemispheric subdural fluid collections without mass effects toward brain parenchyma possibly represent chronic subdural hematoma.4. No change of right parietal subgaleal hematoma since prior CT scan.


Instruction: Generate impression based on medical findings.

Input: Images are degraded by motion artifact. FLAIR images are nondiagnostic.No diffusion-weighted abnormalities are identified. No evidence of acute hemorrhage. Stable appearance of the DBS leads extending from bilateral frontal burr holes, through the frontal lobes, with tips just caudal to the thalami bilaterally. Appropriateness of the lead placement should be determined by the referring physician. There is linear T2 hypointensity correlating with the known connectors, which appear to course close to the skin surface but are not optimally evaluated on MRI due to metal susceptibility artifact. No evidence of focal fluid collection. There is iron deposition of the bilateral globus pallidus compatible with history of Parkinson's disease. The ventricles and sulci are unchanged in size There are no masses, mass effect or midline shift. There are no extraaxial fluid collections. Flow voids are present within the major vessels indicating patency. Redemonstration of a well demarcated CSF signal intensity in the apex of the petrous apices with no change since multiple prior studies. The exact etiology of this finding is not clear however it may represent small meningoceles. Partially empty sella. Opacification of the left mastoid air cells. The orbits are unremarkable. No suspicious enhancement is identified.

Output: 1.DBS leads without significant change from prior CT. Appropriateness of the lead placement should be determined by the referring physician.2.Electrode connectors appear to course close to the skin surface along the right upper neck, but are not optimally evaluated with MRI due to metal susceptibility artifact. CT may be more helpful. No focal fluid collection.3.Interval opacification of the left mastoid air cells which is nonspecific. Please correlate clinically.


Instruction: Generate impression based on medical findings.

Input: Reason: R/O Tear History: Right knee pain MENISCI: There is a complex tear of the posterior horn of the medial meniscus with a radial component. There is associated medial extrusion of the body of the medial meniscus. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is full-thickness articular cartilage degeneration along the weightbearing portion of the medial femoral condyle and medial tibial plateau with underlying degenerative subchondral signal abnormality. There is relative sparing of the lateral tibiofemoral compartment articular cartilage. There is superficial fraying of the articular cartilage along the lateral facet of the patella. There is a linear focus of low signal abnormality within the femoral trochlea, centrally, consistent with an articular cartilage cleft. There are tricompartmental osteophytes.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Complex tear of the posterior horn of the medial meniscus with extrusion of the body of the medial meniscus.2. Moderate-sized joint effusion.3. Osteoarthritis of the right knee with articular cartilage degeneration/clefts as described above.


Instruction: Generate impression based on medical findings.

Input: A patient submitted outside study for review. Submitted for review are breast MRI (5/22/2016), images from MRI guided right breast biopsy with postprocedural right mammographic images (5/31/2016), images from mammographic guided wire localization for right breast (6/13/2016), digital mammographic images of right breast (6/30/2016) performed at outside institution. Patient has a proven right breast cancer at 6:00 position. BREAST MRI (5/22/2016):Breast MRI was performed with a protocol outlined in the outside radiology report. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There is an area of significant signal loss in the right breast at retroareolar region. A marker clip is visualized on T2-weighted images at inferior retroareolar region. There is a regional non-mass enhancement at right retroareolar region medial to the marker clip, measuring 18 x 31 x 15 mm (AP x LR x CC), likely a primary tumor with post biopsy changes. A benign appearing focal non-mass enhancement is seen in the right breast at upper outer quadrant, measuring 6 x 7 x 8 mm. No abnormal enhancement is seen in left breast. No abnormal lymph nodes are identified in either axillary region.IMAGES FROM MRI GUIDED RIGHT BREAST BIOPSY WITH POSTPROCEDURAL RIGHT MAMMOGRAPHIC IMAGES (5/31/2016):MRI guided biopsy was performed for the regional non-mass enhancement in the right retroareolar region and the focal non-mass enhancement at upper outer quadrant in the right breast. Postprocedural mammographic images show a marker clip at inferior retroareolar region, 2.4 cm inferior and posterior to the marker clip of the known cancer, and the other marker at posterior central breast. Per outside radiology report the results were benign.IMAGES FROM MAMMOGRAPHIC GUIDED WIRE LOCALIZATION FOR RIGHT BREAST (6/13/2016):Single wire localization was performed for the known cancer by lateral approach. Wire placement appears good.DIGITAL MAMMOGRAPHIC IMAGES OF RIGHT BREAST (6/30/2016):The study was performed after a lumpectomy for the right breast cancer. Postsurgical distortion with surgical clips are seen in the right breast. There are surgical clips within the right axilla from sentinel node biopsy. Mild skin thickening is seen. Interval removal of the marker clip within the tumor in the right retroareolar region. No suspicious mass, suspicious microcalcifications or suspicious areas of architectural distortion are noted in right breast.

Output: Status post benign MRI guided biopsy in the right breast and status post lumpectomy for right breast cancer.BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on medical findings.

Input: There is herniation of the anterior right medial orbitofrontal gyrus through a bony defect in the right fovea ethmoidalis, measuring up to approximately 15 mm. There is a small amount of cerebrospinal fluid along with the herniated brain. There is deformity of the right gyrus rectus. There is no midline shift. There is no evidence of acute infarction or intracranial abscess. There is an enlarged partially empty sella. There are postoperative findings related to functional endoscopic surgery, including bilateral uncinectomy and ethmoidectomy. There is diffuse mucosal thickening is present in the remaining ethmoid air cells, maxillary sinuses and frontal sinuses. There is also diffuse mild mucosal enlargement of the bilateral nasal turbinates. There is fluid in the nasal cavity and nasopharynx likely attributable to intubation. The orbits are unremarkable.

Output: 1. Findings compatible with a small ethmoidal meningoencephalocele.2. Postoperative findings related to endoscopic sinus surgery with diffuse paranasal sinus mucosal thickening and diffuse turbinate hypertrophy.3. Enlarged and partially empty sella, which may be associated with pseudotumor cerebri.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Reason: bilateral shoulder pain History: bilateral shoulder pain ROTATOR CUFF: There is mildly increased signal intensity within the supraspinatus tendon, which is consistent with tendinopathy. Additionally, there is a focal area of higher signal intensity partially traversing the articular side of the supraspinatus tendon near its insertion on the greater trochanter, which is consistent with a partial-thickness tear. The infraspinatus, teres minor and subscapularis muscles and tendons appear to be intact.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenoid labrum appears to be intact and the glenohumeral joint is within normal limits.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Tendinopathy and partial-thickness tear of the supraspinatus tendon.


Instruction: Generate impression based on medical findings.

Input: 29 year old woman with no prior medical history who presents with palpitations. Systolic function not well visualized by transthoracic echo and possible bicuspid valve seen. Cardiac MRI done to evaluate aortic valve, structure, and function Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 68%, the LV end diastolic volume index is 78 ml/m2 (normal range: 65+/-11), the LVEDV is 129 ml (normal range 109+/-23), the LV end systolic volume index is 25 ml/m2 (normal range 18+/-5), the LVESV is 42 ml (normal range 31+/-10), the LV mass index is 38 g/m2 (normal range 67+/-11), and the LV mass is 63 g (normal range 114+/-24). There are no regional wall motion abnormalities present. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 62%, the RV end diastolic volume index is 78 ml/m2 (normal range 69+/-14), the RVEDV is 129 ml (normal range 110+/-24), the RV end systolic volume index is 30 ml/m2 (normal range 22+/-8), and the RVESV is 49 ml (normal range 35+/-13). Normal RV wall motion.Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve appears tricuspid, opens widely and there is no significant aortic regurgitation. Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function (LVEF 68%)2. The right ventricle is normal in size with normal systolic function (RVEF 62%)3. Tricuspid aortic valveI 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, 52 years old, with a lesion in the right centrum semiovale. A round, T2 hyperintense nonenhancing lesion is redemonstrated within the right centrum semiovale measuring up to 15 mm in diameter. There has been no significant interval change in size or morphology of this lesion.No additional focal lesions are seen. No areas of edema or mass effect are detected. Diffusion-weighted images are within normal limits. No findings to suggest intracranial hemorrhage or any abnormal extra-axial fluid collections are observed. The ventricles are normal in size and morphology.

Output: There has been no interval change in the size or morphology of a lesion previously identified in the right centrum semiovale. The differential remains broad and would include low-grade brain tumor, demyelination, and sequela of prior inflammation.


Instruction: Generate impression based on medical findings.

Input: Evaluate complex hepatic cyst for any changes ABDOMEN:LIVER, BILIARY TRACT: Left hepatic cystic mass measuring 8.1 x 6.5 x 7.3 cm in craniocaudal dimension, previously measured 8.1 x 6.2 x 6.7 cm. Thin nonenhancing septations seen within structure, similar to earlier study. Additional bilobar subcentimeter cystic foci without significant change.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Unchanged thin septation-containing left upper pole renal cyst. Additional nonenhancing renal lesions, likely simple and complex 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: Slight interval growth of left hepatic cystic lesion containing thin nonenhancing septations, appearance suggestive of mildly complex hepatic cyst or biliary cystadenoma. Additional hepatic and renal cystic foci unchanged.


Instruction: Generate impression based on medical findings.

Input: Left masseter lesion. There is a skin marker overlying the left cheek. There has been increase in size of an enhancing T2 hyperintense focus within the left masseter muscle that measures approximately up to 18 mm, previously 15 mm. The lesion now has a more bulky rather than sheet-like morphology. There is no significant cervical lymphadenopathy. The left parotid gland and other salivary glands are unremarkable. The Waldeyer ring structures are unremarkable. The thyroid gland is unremarkable. The osseous structures are unremarkable. There is a right maxillary sinus retention cyst. The imaged intracranial structures and orbits are unremarkable.

Output: Interval increase in size of a left masseter lesion, which may represent a vascular malformation or tumor versus a mesenchymal neoplasm, for example.


Instruction: Generate impression based on medical findings.

Input: Cervical cancer. RT planning. PELVIS:UTERUS, ADNEXA: Eccentric soft tissue wall thickening of the cervix anteriorly and on the right, measuring up to 15 mm (series 601, image 36) consistent with known cervical carcinoma, markedly decreased in size from prior. There is right parametrial invasion. Tumor bulges the endometrial cavity inwards on the right but with no discrete endometrial tumor (series 601, image 36).Extension of abnormal signal from the cervix into the anterior upper third of the vaginal cuff with mild wall thickening greater on the right, suspicious for local invasion (series 601, image 31). No bladder, ureteral, or rectal invasion.BLADDER: No significant abnormality noted.LYMPH NODES: Prominent pelvic lymph nodes at the left common iliac artery and at its bifurcation. For reference a left common iliac node is 13 x 9 mm (series 1104, image 755), similar to prior. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Significantly decreased size of cervical carcinoma with right parametrial invasion. Suspicious findings for direct location invasion into the upper third of the anterior vaginal cuff.2. Prominent pelvic lymph nodes suspicious for local metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Solitary cavernoma with growth between 2011 and 2014: Headaches. MRI: There is a cavernous malformation in the right cingulate gyrus that measures up to 7 mm, previously also 7 mm in 2014. There may be a small associated developmental venous anomaly. There is no surrounding edema or midline shift. There are no other intracranial mass lesions. There is no evidence of acute cerebral infarction. The ventricles are stable in size and configuration. There is a T2 hyperintense focus in the left frontal skull that measures up to 11 mm, which likely represents a hemangioma. MRA: There is no evidence of significant steno-occlusive lesions or aneurysms.

Output: A cavernous malformation in the right cingulate gyrus measures up to 7 mm, which is unchanged since 2014.


Instruction: Generate impression based on medical findings.

Input: A 25 year old female with history of non-ischemic cardiomyopathy (LVEF of 38%), hypertension, hyperlipidemia, obesity and insuline resistance. Referred to cardiac MRI for further evaluation Left VentricleThe left ventricle is mildly dilated with mild to moderately reduced systolic function. The left ventricle is hypertrabeculated and associated with myocardial thinning. The overall LV ejection fraction is 41%, the LV end diastolic volume index is 95 ml/m2 (normal range: 65+/-11), the LVEDV is 198 ml (normal range 109+/-23), the LV end systolic volume index is 56 ml/m2 (normal range 18+/-5), the LVESV is 117 ml (normal range 31+/-10), the LV mass index is 45 g/m2 (normal range 67+/-11), and the LV mass is 94 g (normal range 114+/-24). There is global hypokinesis with regional variation. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.No findings to support an active myocardial or pericardial inflammatory process.No myocardial iron overload was seen.No intracavitary thrombus was seen.Global Relative Enhancement1.7Normal <4T2 STIR Edema Ratio (ER)1.7Normal <2Left AtriumThe left atrium is normal in size. The LA volume is 65 ml.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 64 ml/m2 (normal range 69+/-14), the RVEDV is 133 ml (normal range 110+/-24), the RV end systolic volume index is 31 ml/m2 (normal range 22+/-8), and the RVESV is 65 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild to moderate tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsNon-significant lymph nodes are noted in the axilla. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is mildly dilated with mild to moderately reduced systolic function (LVEF 41%). The left ventricle is hypertrabeculated and associated with myocardial thinning. These findings suggest the diagnosis of left ventricular non-compaction. 2. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.3. The right ventricle is normal in size with normal systolic function, the RVEF is 52%. 4. There is moderate mitral regurgitation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Hemangioma of intracranial structuresClinical question: 3 T Scanner, QSM, permeability, CCM Protocol The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a 7 x 9 mm axial dimension lesion centered in the midbrain with heterogeneous signal centrally on T1 and T2 and a low signal ring. It has a popcorn-like appearance it previously measured similar dimensions in 2014 but was larger in 2004. There is no associated DVA appreciated.There is redemonstration of a well-circumscribed heterogeneous mass in the left half of the genu of the corpus callosum measuring 18 x 13 mm axial dimensions It is heterogeneous with predominantly high signal on T1 weighted imaging within its central portion. It has multiple septations and a low signal rim on all pulse sequences. There is extensive susceptibility effect associated with this. It protrudes into the frontal horn of the left lateral ventricle. It measured similar dimensions in 2014 but was larger in 2004. There is no associated DVA appreciated.There are multiple punctate lesions scattered in both hemispheres of the brain as well as in the brainstem which are low signal on susceptibility weighted imaging.There are multiple foci of marrow replacement and enhancement scattered throughout the calvarium. Since the previous exam in 2004 the appear to be more numerous, however, since the 2014 exams they are approximately the same.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is redemonstration of cerebral cavernous malformations in the genu of the corpus callosum and midbrain which are stable since 2014.2.Punctate lesions throughout the supratentorial brain and brainstem are nonspecific but could represent small cerebral cavernous malformations.3.Multiple small calvarial lesions are present. These are nonspecific though they could represent hemangiomas. They are more numerous since 2004 but approximately the same since 2014.


Instruction: Generate impression based on medical findings.

Input: 41-year-old female with history of metastatic renal cancer status post RFA in January. Follow-up new 5 mm nodule. ABDOMEN:LIVER, BILIARY TRACT: Previously noted segment 4a five mm arterially enhancing focus is no longer visualized. Postablation changes in the inferior right hepatic lobe without evidence of recurrent disease. Additional fat containing nonenhancing subcentimeter focus in segment 7 is noted. No arterially enhancing lesions are present.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Postoperative changes of left nephrectomy without evidence of recurrent disease.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Previously noted segment 4a arterial enhancing focus is no longer visualized. This may represent treatment effect. Correlate with clinical history.2.No evidence of recurrent tumor in the right inferior hepatic lobe ablation cavity. No suspicious arterially enhancing lesions.3.Postoperative changes of left nephrectomy without evidence of recurrent disease.


Instruction: Generate impression based on medical findings.

Input: Breast density study, exam for research purposes only. Research scanning of both breasts was performed with the research protocol. The images are stored for research analysis. Formal interpretation was not performed, existing data are not used for clinical purposes.

Output: This study was completed for research purposes only. Formal interpretation was not performed, existing data are not used for clinical purposes.


Instruction: Generate impression based on medical findings.

Input: Cervical spine:There is grade 1 anterolisthesis of C4 on C5 and reversal of cervical lordosis. Additionally, there is minimal retrolisthesis of C5 on C6 and minimal anterolisthesis of C7 on T1. Alignment is otherwise maintained. Vertebral body heights and intervertebral disc spaces are preserved. The cord signal is within normal limits. The marrow signal is normal. Prominent facet arthropathy is noted on the left extending from C3 level to T1 level, as well as the right C7-T1 level.C2-C3: No significant spinal canal or neural foraminal stenosis.C3-C4: There is no significant spinal canal stenosis. Moderate left-sided facet arthropathy results in moderate left neural foraminal stenosis. The right neural foramen is patent.C4-C5: There is predominantly left sided facet joint arthropathy and uncovertebral hypertrophy, resulting in mild to moderate left foraminal stenosis with patent right neural foramen. Small disc osteophyte complex results in mild central canal stenosis.C5-C6: Disc osteophyte complex results in moderate spinal canal stenosis. There is bilateral, right greater than left, neural foraminal narrowing.C6-C7: There is mild to moderate spinal canal stenosis and mild bilateral foraminal stenoses due to uncovertebral hypertrophy.C7-T1: Mild spinal canal stenosis is identified. There is mild to moderate right and mild left neural foraminal stenoses.Lumbar spine:For the purposes of numbering, there are 5 lumbar type vertebral bodies. There is loss of normal lumbar lordosis and mild dextroscoliosis of the lower lumbar spine. Vertebral body heights are preserved. There is severe loss of intervertebral disc space at the L3-L4 and to a lesser degree at L2-L3 and L4-L5 levels. Postsurgical changes of laminectomy are noted at the L3-L4 and L4-L5 levels. There are no fractures. The marrow signal is benign. The conus is normal in signal and morphology and terminates at L1-L2. No cord signal abnormalities identified. The visualized intra-abdominal and paraspinal contents are unremarkable.T12/L1: No significant spinal canal or neural foraminal stenosis.L1/2: There is bilateral facet joint arthropathy, with no significant spinal canal or neural foraminal stenoses.L2/3: Disc bulge eccentric to the left with bilateral facet joint arthropathy results in effacement of the left lateral recess, mild left neural foraminal narrowing, and mild central canal stenosis.L3/4: Small disc osteophyte complex and facet joint arthropathy results in effacement of the left lateral recess and mild to moderate left neural foraminal narrowing. There is minimal right neural foraminal narrowing. The spinal canal is surgically decompressed.L4/5: Spinal canal is surgically decompressed. Small disc bulge with endplate osteophyte results in partial effacement of the lateral recesses. There is severe right foraminal stenosis and moderate to severe left neural foraminal stenosis.L5/S1:Facet joint arthropathy results in moderate to severe right and mild-to-moderate left neural foraminal stenoses. No spinal canal stenosis identified.

Output: 1.Multilevel degenerative changes in the cervical spine, with up to moderate spinal canal stenosis at the C5-C6 level and multilevel neural foraminal stenoses as detailed above. No cord signal abnormality identified.2.Multilevel degenerative changes in the lumbar spine, minimally progressed as compared to prior study of 3/17/2012, with no significant spinal canal stenosis. Multilevel neural foraminal stenoses are identified in the lumbar spine, worse at L4-L5 and L5-S1 levels, as detailed above.


Instruction: Generate impression based on medical findings.

Input: Ms. Schnitz is a 48-year-old female with family history of breast cancer in a paternal aunt. Patient is a known BRCA mutation carrier. Personal history of benign MR-guided biopsy of right breast in 04/2014 for columnar cell change. Quality of this examination is slightly limited due to presence of motion artifact and aliasing.There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Focal susceptibility artifact from biopsy marker clip is reidentified in the right breast, at site of prior benign MR guided biopsy. There is no abnormal enhancement seen in either breast. No axillary or internal mammary lymphadenopathy.

Output: No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram.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: Right parapharyngeal mass, possibly right paraganglioma: evaluate extent of mass to vessels. MRI: There is a heterogeneous right parapharyngeal mass that measures up to approximately 25 mm. The mass appears to encase the right internal carotid artery, which is slightly narrowed. The mass also compresses the right internal jugular vein. The mass appears to be distinct from the deep lobe of the parotid gland. There are multiple enlarged right cervical lymph nodes, involving levels 2 through 5. For example, a right level 2B lymph node measures 17 x 24 mm. There is asymmetric enlargement of the right palatine tonsil with an apparent mass that measures up to approximately 10 mm in width. The nasopharynx, hypopharynx, and larynx appear to be intact. The thyroid and salivary glands appear unremarkable. There is multilevel degenerative spondylosis with mild spinal canal stenosis from C4 to C7. The orbits are unremarkable. There is mild bilateral maxillary sinus mucosal thickening. There is a cystic lesion in the left sella, which measures up to approximately 10 mm. MRA: Aside from mild narrowing of the right internal carotid artery due to encasement by tumor, the other major cervical arteries are patent.

Output: 1. A right parapharyngeal mass may represent an abnormal lymph node that encases the internal carotid artery, rather than a paraganglioma. Indeed, multiple right cervical lymph nodes are also pathologic.2. Asymmetric enlargement of the right palatine tonsil with what appears to be a mass may represent a squamous cell carcinoma, with metastatic disease to the right neck lymph nodes.3. A cystic lesion in the left sella measures up to approximately 10 mm. A dedicated pituitary exam may be useful for further evaluation.Discussed with Maureen Crowley at 4:35 PM on 10/22/15.


Instruction: Generate impression based on medical findings.

Input: History of right posterior thigh mass, evaluate for heterotopic bone. No fractures or osseous lesions are identified. No mineralization is present in the soft tissues, specifically at the site of the soft tissue mass seen on prior outside MRI. A small os acetabuli, a normal variant, is present.

Output: No calcifications at site of soft tissue mass seen on outside MRI.


Instruction: Generate impression based on medical findings.

Input: Sarcoid versus inflammatory muscle disease. Cervical:Examination is mildly motion degraded which limits evaluation for subtle cord signal abnormalities. No definite signal abnormality within the cervical cord is however appreciated. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is benign. Mild degenerative changes are seen throughout the cervical spine with small disc osteophyte complexes and mild bilateral facet arthropathy. Individual levels as below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: No significant compromise to the spinal canal or neural foramina.C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina. Small bilateral perineural cysts incidentally noted in the neural foramina.Paraspinous soft tissues are unremarkable.Lumbar:Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. T1 hyperintense lesion involving the L5 vertebral body is consistent with a hemangioma. The conus medullaris is normal in position. Perineural cyst at the right S2 level is incidentally noted.Individual levels as described below: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: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis.There is asymmetrically increased edema involving the paraspinous musculature on the left, best seen on the sagittal STIR sequence.

Output: 1. No evidence of cervical cord signal abnormality. There are mild degenerative changes throughout the cervical spine without significant spinal canal or neural foraminal stenosis at any level. 2. No spinal canal or neural foraminal stenosis in the lumbar spine.3. If there is high concern for leptomeningeal disease in the spine related to an inflammatory process, post gadolinium sequences may be considered. 4. There is edema involving the lumbar paraspinous musculature on the left.


Instruction: Generate impression based on medical findings.

Input: Yearly follow-up of swan-neck deformity, Ehler- Danlos syndrome Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate height. There is reversal of cervical lordosis centered at the C5-C6 level which straightens in the extension position. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Minimal degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Minimal disc bulge. No significant compromise to the spinal canal or neural foramina.C4-5: Minimal disc bulge and disc desiccation. No significant compromise to the spinal canal or neural foramina.C5-6: There is partial effacement of the ventral thecal sac related to the reversal of cervical lordosis and minimal bulge. Disc desiccation. No significant compromise to the spinal canal or neural foramina.C6-7: Minimal disc bulge and disc desiccation. No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. No significant spinal canal stenosis or neural foraminal stenosis at any level in the cervical spine. No cord signal abnormality.2. Kyphotic angulation at the C5-6 level, which straightens in the extension position, is unchanged.


Instruction: Generate impression based on medical findings.

Input: Claudication, question neurogenic. Rule out lumbar disc disease and spinal stenosis. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is straightening of the lumbar spinal curvature as seen before. Alignment is otherwise within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below, overall similar to prior MRI from 2/14/2012L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Minimal disc bulge. No spinal canal or neural foraminal stenosis.L3-L4: Mild disc bulge. No spinal canal or neural foraminal stenosis.L4-L5: Disc bulge with central annular fissure, mild bilateral facet arthropathy and ligamentum flavum thickening. There is no significant central spinal canal stenosis. Mild bilateral neural foraminal stenosis. L5-S1: Disc bulge and mild bilateral facet arthropathy. There is partial effacement of the right lateral recess. No significant central spinal canal stenosis. There is mild to moderate bilateral neural foraminal stenosis. Paraspinous soft tissues are within normal limits.

Output: Multilevel degenerative changes in the lumbar spine are not significantly changed since 2/14/2012. There is no significant central spinal canal stenosis at any level as questioned.