Instruction: Generate impression based on medical findings.

Input: Clinical question: Reason for for ventricular obstruction and herniation, evaluate for CSF leak. Pre- and post enhanced brain MRI:Diffusion weighted images are negative.Images through the supratentorial space demonstrate paucity of cortical sulci, small size of supratentorial ventricular system however with maintained midline, crowding and effacement of the basal cistern as well as evidence of minimal transtentorial herniation of left temporal lobe (coronal T2 series 1/1/2001 image 20). There is no detectable signal abnormality of supratentorial brain parenchyma.Images through posterior fossa demonstrate interval resolution of extensive previously seen edema of the inferior cerebellar hemispheres since prior MRI exam from 7-2-15 and with evolution of bilateral small foci of encephalomalacia of the cerebellum (R>L). Similar to prior exam the 14th ventricle is a small however in midline. There is postoperative changes of Chiari decompression with prolapse of the cerebellum into the expanded space and near complete absence of subarachnoid space in the posterior fossa and at the level of the compression. This appearance is similar to prior exam.Post enhanced images demonstrate no abnormal enhancement of brain parenchyma or the leptomeninges. Mild dural enhancement at the surgical site is within expected postoperative finding. There is no evidence of CSF from the fundus exam as is questioned clinically.Pre- and post enhanced cervical spine MRI:Examination demonstrates post operative changes of Chiari decompression. There is inferior prolapse of the cerebellum inferiorly with resultant near complete effacement of CSF space at the level of Chiari decompression. Small foci of encephalomalacia (R>L) in inferior bilateral cerebellum at the site of previously noted acute strokes are identified. The signal intensity and caliber of cervical cord is within normal.Post contrast images demonstrate no detectable abnormal enhancement of the cord or the pia-meninges. The expected epidural enhancement of the cervical region appears more pronounced and could represent engorgement/increased pressure.There is no evidence of CSF leak on this study.Pre and post enhanced MRV:Examination demonstrates normal appearing are intracranial venous sinuses and without evidence of abnormality. There is also normal visualization of bilateral internal cerebral veins, vein of Galen and straight sinus. Inferior sagittal sinus is also identified and unremarkable. Bilateral cavernous sinuses and bilateral inferior petrosal veins are detected. There is increased size and enhancement of the visualized upper cervical epidural venous plexus which could represent increased pressure. There is no detectable abnormality of cerebral cortical venous structures

Output: 1.Nonenhanced brain MRI demonstrate no evidence of restricted diffusion. There is a significant paucity of cortical sulci, slitlike ventricular system, effacement of basal cisterns and minimal transtentorial herniation of the left cerebellum. Prolapse of cerebellum into the expanded subarachnoid space at the level of Chiari decompression with resultant complete effacement of the CSF space and with small size of fourth ventricle. Findings are believed to be secondary to decreased intracranial pressure. This appearance is not significantly different than prior head CT examination from 9-8-15. Interval evolution of regions of bilateral inferior cerebellar acute strokes to small foci of encephalomalacia as detailed. No detectable abnormal enhancement.2.Pre and post enhanced MRI of cervical spine demonstrate prolapse of the cerebellum into the subarachnoid space at the level of Chiari decompression and with resultant complete effacement of subarachnoid space. Normal signal intensity and caliber of the cord. No detectable abnormal enhancement. The epidural venous plexus is prominent.3.MRV of intracranial circulation demonstrates normal appearing all intracranial venous sinuses, deep venous structures and the cerebral cortical veins. There is robust visualization of prominent visualized upper cervical epidural venous plexus which conceivably could represent increased venous pressure.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old, with altered mental status. Innumerable scattered foci of restricted diffusion are seen involving the watershed regions of the cerebral hemispheres, the basal ganglia, left thalamus, and the posterior fossa. The most conspicuous areas of restricted diffusion are in the bilateral parietal and occipital lobes and the cerebellum. A relatively large area of mild restricted diffusion without correlating T2 signal abnormality is seen involving the right parietotemporal junction.Most of the above-mentioned areas are associated with non-masslike gyriform enhancement. The right parietal and bilateral occipital lesions show evidence of gyriform T1 hyperintensity suggesting laminar necrosis. No evidence of basal cistern or cranial nerve enhancement is seen.Apart from those lesions which are diffusion restricting, there are numerous additional areas of periventricular and subcortical T2 hyperintensity which do not diffusion restrict. No evidence of significant generalized mass effect is seen. No brain herniation is demonstrated. The ventricles and sulci are proportionately prominent compatible with volume loss. No abnormal fluid collections are detected.

Output: Innumerable areas of restricted diffusion are seen indicating cytotoxic edema or a mixture of cytotoxic and vasogenic edema both supratentorially and infratentorially. There is a marked predominance of lesions in the cerebral watershed zones, the parietal and occipital lobes, and in the cerebellum. One rather large and ill-defined area at the right parietotemporal junction demonstrates a curious pattern of mild restricted diffusion with no correlating T2 signal abnormality. Most of the lesions demonstrate non-masslike gyriform enhancement indicating blood brain barrier breakdown.The distribution of the lesions noted above, with a preference for the watershed zones and posterior circulation, is very suggestive of a PRES-like phenomenon. Lesions related to PRES do not typically diffusion restrict to this degree, but it has been reported in severe cases. The rather curious pattern of mild restricted diffusion without T2 signal abnormality at the right parietotemporal junction is also supportive of an atypical vascular process such as PRES.Other differential considerations, including embolic ischemic disease and metastatic/neoplastic disease, are considered much less likely based on the imaging characteristics.


Instruction: Generate impression based on medical findings.

Input: 49-year-old male with acute medial knee pain following twisting injury of the right knee. Evaluate for meniscal injury. MENISCI: The lateral meniscus appears intact. There is intermediate signal intensity within the posterior horn of the medial meniscus along its superior fibers, suggesting fraying/degenerative tearing. The peripheral margin of the posterior horn of the medial meniscus is also irregular suggestive of tearing in the vascular zone. The anterior horn of the medial meniscus appears intact. There is a small amount of signal intensity within the body of the medial meniscus indicating degeneration, but we see no discrete tear.ARTICULAR CARTILAGE AND BONE: There is edema within the medial aspect of the tibial plateau. Best seen on images 12, 13 and 14 of series 6, is a linear subchondral focus of low signal intensity within the medial aspect of the medial tibial plateau, suspicious for a small subchondral fracture. There is near full-thickness to full-thickness articular cartilage degeneration along the medial femoral condyle above the posterior horn of the medial meniscus extending posteriorly. There is also a focal full-thickness defect of the articular cartilage of the lateral femoral condyle above the posterior horn of the lateral meniscus. There is a small intra-articular osteophyte along the lateral femoral condyle more anteriorly above the anterior horn of the lateral meniscus. Moderate articular cartilage degeneration affects the patella as well as foci of near full-thickness to full-thickness articular cartilage degeneration affecting the femoral trochlea. There are small tricompartmental osteophytes. LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: There is an ossicle within the proximal patellar tendon which may reflect old trauma. The quadriceps and patellar tendons are otherwise unremarkable.ADDITIONAL

Output: 1. Edema within the medial tibial plateau may represent a contusion. There is a small linear subchondral focus within the medial tibial plateau which is suspicious for a small subchondral fracture.2. Tricompartmental osteophyte formation with articular cartilage degeneration/defects as described above.3. Fraying/degenerative tearing of the superior fibers of the posterior horn of the medial meniscus and possible tearing of the peripheral fibers of the vascular zone.4. Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Brain metastases for SRS. There are multiple supratentorial and infratentorial metastases, which appear to be similar in size as on the prior MRI. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Pre-treatment planning MRI demonstrated multiple supratentorial and infratentorial metastases.


Instruction: Generate impression based on medical findings.

Input: There are scattered foci of T2 hyperintensity within subcortical white matter, pons, as well as the cerebellum, without associated restricted diffusion or susceptibility abnormality. The cerebellar foci have an appearance more like tiny foci of encephalomalacia, although one contrast enhances on the current exam (although not on the recent enhanced CT scan). The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. Note is made of a partially empty sella. There is no evidence for intracranial hemorrhage. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear.

Output: There are scattered foci of T2 hyperintensity within subcortical white matter, pons, as well as the cerebellum, without associated restricted diffusion or susceptibility abnormality. The cerebellar foci have an appearance more like tiny foci of encephalomalacia, although one contrast enhances on the current exam (although not on the recent enhanced CT scan). This constellation of imaging features is most suggestive of small vessel ischemic disease, with the one cerebellar lesion demonstrating enhancement likely representing a tiny focus of subacute ischemia. Other complications of HIV such as PML, primary HIV encephalopathy, infection, or metastasis are felt to be unlikely.


Instruction: Generate impression based on medical findings.

Input: Other specified disorders of brain [G93.89], Reason for Study: ^Reason: preop planning for craniotomy for tumor... Pt will take premeds PT will bring MRI clearance for Bladder stim device and heart plug History: preop planning for tumor resection Multiple fiducial markers attached on the scalp for the preoperative localization.28 mm x 24.1 mm sized enhancing right cerebellar hemispheric intra-axial mass with surrounding edema is seen. There is no other abnormal enhancement. Considering the patient history of gastrointestinal tract cancer, this lesion is consistent with metastatic lesion.The ventricles, sulci and cisterns are 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: Enhancing right cerebellar hemispheric intra-axial mass with the surrounding edema, consistent with metastatic lesion.


Instruction: Generate impression based on medical findings.

Input: There is straightening of the normal cervical lordosis. The vertebral body heights are well-maintained. There is diffuse disc desiccation and degenerative bone marrow signal changes, but no evidence of tumor. At C3-4, a posterior disc osteophyte complex results in central spinal stenosis with compression of the spinal cord, which displays patchy high T2 signal, as well as at least moderate neural foraminal narrowing bilaterally. At C4-5 and C5-6 posterior disc osteophyte complexes result in moderate spinal canal stenosis and bilateral neural foraminal narrowing. There is no significant disc bulge, herniation, spinal canal or foraminal stenosis within the remainder of the cervical spine. The paravertebral soft tissues are unremarkable. THORACIC SPINE

Output: 1.Degenerative spondylosis in the cervical spine, in which a disc-osteophyte complex at C3-4 compresses the spinal cord, with associated edema or myelomalacia.2.Prominent ligamentum flavum thickening and possible calcification or ossification with associated moderate narrowing of the spinal canal at T10-11. 3.Degenerative spondylosis in the lumbar spine and congenital narrowing of the spinal canal result in compression of the spinal cord at L1-2 with associated edema or myelomalacia and indentation upon the cauda equina nerve roots at L2-3 and L3-4. In addition, the degenerative spondylosis is associated with moderate neural foraminal stenosis on the left at L3-4 and on the right at L4-5, as well as mild left neural foraminal narrowing at L4-5.4.Patchy enhancement surrounding the L4 through S1 spinous processes may be related to Baastrup disease.5.No gross evidence of lymphoma involving the spine.


Instruction: Generate impression based on medical findings.

Input: Altered mental status. Evaluate for a cerebral abscess. Status post evacuation 11/22/2016. Additional EMR indicates patient is undergoing a seizure workup. The exam is limited along the right convexity and adjacent scalp secondary to artifact from a ventriculoperitoneal shunt device. The right sided predominantly T1 hyperintense subdural collection is slightly smaller in size, measuring 16 mm in maximal thickness. The midline shift has improved from 5 mm down to 2 mm. Susceptibility and diffusion weighted images are limited in the presence of a right sided ventriculoperitoneal shunt device positioned under the scalp but there appear to be blood products within the collection. There is evidence of a right parietal burr hole and an intraparenchymal tract measuring up to 20 mm with T1 hyperintense fluid and restricted diffusion in the right parietal brain parenchyma, as well as mild surrounding enhancement. There is susceptibility abnormality in this region as well, indicating the presence blood products. There is extensive surrounding T2 hyperintensity. There is avid diffuse enhancement and thickening of the pachymeninges which also extends to the contralateral frontal region. There is a 2 mm thick subdural collection along the posterior left temporal lobe convexity. The right frontal approach ventriculostomy catheter is unchanged in position with the tip in the frontal horn of the right lateral ventricle. The right lateral ventricle has slightly less effacement compared to the prior exam. There is diffuse T2 hyperintensity in the right hippocampus. There is no evidence of territorial infarction. The major cerebral flow voids are intact. There is a left maxillary sinus mucous retention cyst.

Output: 1.Decrease in size of the subacute right cerebral convexity subdural fluid collection with improvement in the midline shift and slight improvement in the right lateral ventricular effacement. 2.Avid diffuse pachymeningeal enhancement in the right cerebral hemisphere with extension to the contralateral frontal region is nonspecific and be reactive or related to superimposed. 3.A surgical defect in the right parietal lobe with surrounding edema may represent a subacute hemorrhagic lesion perhaps with superimposed infection and associated cerebritis.4.A small left temporal convexity subdural collection may represent addition hemorrhage or perhaps an empyema.5.Edema in the right hippocampus is likely related to seizure activity.


Instruction: Generate impression based on medical findings.

Input: Reason: elevated LFT's with cholelithiasis ABDOMEN:LUNG BASES: Trace pleural effusions. LIVER, BILIARY TRACT:The liver demonstrates normal parenchymal signal intensity and enhancement. No suspicious hepatic lesions are identified. Area of decreased early enhancement along the interlobar fissure compatible with normal perfusional variation. Trace periportal edema. The hepatic vasculature appears patent. There is a trace amount of perihepatic ascites.Cholelithiasis including a large gallstone measuring up to 2.6 cm. There is mild gallbladder wall thickening as well as a small amount of pericholecystic fluid. There is mildly increased enhancement of the gallbladder mucosa. The intra and extrahepatic biliary ducts are not dilated. There is mild thickening and increased enhancement of the common bile duct. The common bile duct measures up to 6 mm. No choledocholithiasis is identified.SPLEEN: The spleen is mildly enlarged. PANCREAS: The pancreatic parenchyma demonstrates normal signal intensity and enhancement without suspicious focal lesions. The pancreatic duct is nondilated. There is no significant peripancreatic edema.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is trace edema within the subcutaneous soft tissues of the back.OTHER: No significant abnormality noted.

Output: Findings compatible with acute cholecystitis without evidence of associated choledocholithiasis. Mild mucosal thickening of the common bile duct may reflect cholangitis.


Instruction: Generate impression based on medical findings.

Input: Neoplasm of unspecified behavior of digestive system [D49.0] / Malignant neoplasm of unspecified kidney, except renal pelvis [C64.9], Reason for Study: ^Reason: 52 y/o with history of renal cell ca and IPMN s/p resection now with 6 months of low back pain For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is normal lumbar lordosis. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The conus medullaris terminates at the L1 level. There is no evidence of abnormal enhancement, cord compression or mass. Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: Mild disc desiccation. No neuroforaminal narrowing or spinal stenosis. L2-L3: Mild disc desiccation. No neuroforaminal narrowing or spinal stenosis. L3-L4: Mild disc desiccation. No neuroforaminal narrowing or spinal stenosis. L4-L5: There is minimal (grade 1) anterolisthesis of L4 on L5 with disc desiccation. No neuroforaminal narrowing or spinal stenosis. L5-S1: Mild disc desiccation. No neuroforaminal narrowing or spinal stenosis.

Output: 1. Grade 1 anterolisthesis of L4 on L5.2. Multilevel desiccation indicating degenerative changes.3. No evidence of metastatic lesion.


Instruction: Generate impression based on medical findings.

Input: 18 year-old male with sickle cell crisis and severe headache There is no evidence of intracranial hemorrhage, mass or edema. Crowding of the foramen magnum with the cerebellar tonsils extending inferiorly off the image corresponding to a Chiari 1 malformation as seen on the previous MRI.There is a subtle hypoattenuation in the region of the right external capsule, also seen on the previous MRI without surrounding gliosis or edema, and appears to represent prominent CSF space.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No acute intracranial abnormality. Chiari 1 malformation is again noted.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Headache Personal history of other diseases of the nervous system and sense organsClinical question: h/o clival chordoma s/p resection x 2, apparent recurrence on HCTSigns and Symptoms: h/o clival chordoma s/p resection x 2, apparent recurrence on HCT, c/o headache dizziness, slurred speech Since prior exam of 2004 the mass associated with the left half of the clivus extending into the left cerebellopontine angle cistern has enlarged. The mass extends down to the left cerebellar medullary angle cistern. The exophytic intracranial component now measures approximately 40 x 25 mm axial dimensions and 35 x 25 mm sagittal dimensions. The mass displaces the left cranial nerves VII and VIII as well as the left trigeminal nerve. It compresses the brainstem and displaces it and distorts it. It invaginates into the pons. The mass is heterogeneous in appearance on T1 and T2 imaging and known to contain calcifications. There are small cystic components associated with it.The component within the sphenoid bone is associated with expansion into the right middle cranial fossa which was also present on the prior exam and is also identified on CT. The internal carotid arteries are displaced laterally - especially the right internal carotid artery. The pituitary gland is displaced superiorly.There is metal artifact present adjacent to the left parietal bone. This distorts the imaging appearance of the left hemisphere. Ventriculostomy tube courses through the left frontal lobe into the left lateral ventricle with tip in the region of the foramen of Monro.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 right internal carotid arteries significantly displaced towards the right this includes the petrous portion of the right carotid canal in the cavernous portion of the right internal carotid artery. The basilar artery and posterior cerebral arteries as well as the superior cerebellar arteries drape around the posterior fossa tumor.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.Since the prior exam from 2004, the exophytic component of a clival mass has significantly increased in size and invaginates into the brainstem and displaces adjacent structures. This mass is known to represent a chordoma.2.The patient is status post ventriculostomy tube placement. The lateral ventricles are not dilated on the current exam


Instruction: Generate impression based on medical findings.

Input: Clinical question: 14-year-old with history of glioblastoma multiforme status post 42 days of radiation and adjunctive chemotherapy. Signs and symptoms: Brain tumor. Pre-and post-enhanced brain MRI:Negative diffusion weighted series.Examination demonstrates significant interval decrease in edema since prior exam surrounding a left posterior temporal -- parietal surgical cavity. Small residual flair hyperintensity at the site surrounding the surgical cavity still persist. There is interval better visualization of adjacent cortical sulci and the left lateral ventricle secondary to decreased mass effect.There is also interval decreased size of the surgical cavity which demonstrate CSF signal intensity and measuring at 27 x 18-mm compared to prior study measurement of 34 x 28. The surgical cavity is well demarcated and demonstrate a very thin partial enhancement along its medial wall which appears to be contiguous with the trigone of left lateral ventricle. There is a small more nodular focus of enhancement at the site of attachment of surgical cavity with the trigone of left lateral ventricle as well as a second additional small focus of enhancement within the trigone. Findings could represent postoperative changes and a focus of enhancement in the trigone as well could represent a focus of choroid plexus. Further follow-up is holder is needed for better assessment. Enhancement along the inner wall of the surgical cavity has decreased since prior exam. There is also complete resolution of enhancement of the ependymal lining of the trigone and the occipital horn of left lateral ventricle since prior study. Ventricular system remain within normal size and without addition of midline.Postoperative changes of a left craniotomy and a small CSF signal intensity extra-axial collection demonstrates subtle interval decreased size.

Output: 1.Significant interval decreased peri-surgical vasogenic edema of the left posterior temporal, occipital and parietal lobe since prior exam.2.Interval decreased size of surgical cavity in left posterior temporal -- parietal with CSF signal intensity content.3.A thin band of enhancement along the medial wall of the surgical cavity extends from the trigone of left lateral ventricle to the inner table of skull and likely representing post surgical change. A tiny focus of enhancement within the left trigone is also noted. Enhancements at this sites are suggestive of post treatment /surgical change however further follow up is needed to entirely exclude possibility of residual tumor.4.Complete resolution of previously noted enhancement of the ependymal lining of the left trigone and occipital horn of lateral ventricle.


Instruction: Generate impression based on medical findings.

Input: Unspecified disturbances of skin sensation [R20.9], Reason for Study: ^Reason: evaluate for ischemia History: slurred speech, R sided weakness since 9pm 12/1 Brain MRI:No evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. 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.There is about 4.8 mm cerebellar tonsillar ectopia through the foramen magnum.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.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Mild cerebellar tonsilar ectopia.3. Normal brain MRA


Instruction: Generate impression based on medical findings.

Input: Benign intracranial hypertension [G93.2], Reason for Study: ^Reason: assess for subarachnoid hemorrhage, pituitary abnormality History: CT concerning for pituitary hemorrhage, headache and neck pain 26 years Female (DOB:6/20/1990)Reason: assess for subarachnoid hemorrhage, pituitary abnormality History: CT concerning for pituitary hemorrhage, headache and neck painPROVIDER/ATTENDING NAME: NAVNEET CHEEMA There is no evidence of acute ischemic or hemorrhagic lesion.Smooth linear enhancement of thickenings on post gadolinium enhancement without associated with small ventricle size or sagging of brainstem. These findings indicate either pachymeningeal irritation such as post lumbar puncture status, pachymeningitis or intracranial hypotension. Considering the patient recent history of a lumbar puncture with CSF drainage, this finding is not unexpected.The pituitary gland is measured about 11.1mm (right to left) x 10.3 mm (craniocaudal) with a homogeneous enhancement. There is no MRI evidence of pituitary gland hemorrhage. At this age female, these findings are within normal limits.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1. Diffuse pachymeningeal enhancement is seen most likely reflect recent lumbar puncture with CSF drainage.2. No evidence of acute ischemic or hemorrhagic lesion.3. No evidence of pituitary hemorrhage.


Instruction: Generate impression based on medical findings.

Input: 60 year-old male with worsening lower extremity numbness, date disturbance, multiple sclerosis Brain: Given differences in technique, there has been no significant change in the patients burden of T2 hyperintense lesions in the periventricular and subcortical white matter with morphology and distribution compatible with known demyelinating disease. A previously demonstrated prominent left frontal lobe lesion has decreased in size. There are also multiple infratentorial lesions in the brainstem and cerebellar hemispheres. Lesions are also noted in the dorsomedial midbrain and upper pons including the region of the medial longitudinal fasciculus, particularly on the left which may explain patient's internuclear ophthalmoplegia. Minimal enhancement is noted within a right periatrial/periventricular lesion (series 24, image 12). There is also mild parenchymal volume loss with mild thinning of the corpus callosum for age. There is no intracranial mass, mass effect, midline shift or herniation. No hydrocephalus.Cervical Spine: Redemonstrated are T2 hyperintense lesions within the cervical cord with morphology and distribution consistent with known demyelinating disease, stable in appearance. As before, the most prominent lesions are present at the C2 level involving the bilateral posterior aspects of the cord, right greater than left, as well as at the left ventrolateral C3-C4 level. None demonstrate contrast enhancement. Mild volume loss is redemonstrated involving the dorsal cervical cord associated with the C2 lesions.Vertebral body heights and alignment in the cervical spine are normal. Minimal degenerative changes include small disc osteophyte complex, eccentric to the right at the C4-C5 level. There is no significant spinal canal stenosis at any level. There is mild to moderate multilevel neural foraminal stenosis related to facet arthropathy and uncovertebral hypertrophy, relatively worse at the right C4-C5 level, unchanged.

Output: 1.Given differences in technique, there has been no significant change in the patients burden of T2 hyperintense lesions in both supratentorial and supratentorial brain. A previously demonstrated prominent left frontal lobe lesion has decreased in size. Minimal enhancement is noted within a right periatrial/periventricular lesion (series 24, image 12).2.Redemonstrated are T2 hyperintense lesions within the cervical cord, stable in appearance, without enhancement.3.Both brain and cervical cord findings are consistent with the provided history of multiple sclerosis.


Instruction: Generate impression based on medical findings.

Input: 38-year-old female with pain. Rule out ankle ligamentous injury. TENDONS: The flexor and extensor tendons appear intact. The peroneal tendons appear intact. The Achilles tendon is normal in appearance.LIGAMENTS: The lateral collateral ligament complex appears intact. The distal tibiofibular syndesmotic complex appears intact. The imaged components of the deltoid ligament appear intact.ARTICULAR SURFACES AND BONE: There is increased bone marrow signal abnormality within the distal fibula and talus which may reflect a combination of bone contusion and degenerative change. Again seen is a comminuted fracture of the calcaneus with intra-articular extension to involve the posterior and middle facet of the subtalar joint as well as extending anteriorly to involve the calcaneocuboid articulation. There is serpentine signal abnormality within the calcaneal fracture fragment about the posterior facet of the subtalar joint, consistent with avascular necrosis. There is linear decreased signal abnormality within the body of the talus along the anterior aspect of the posterior facet of the subtalar joint which may represent a nondisplaced subchondral fracture. There is narrowing of the anterior aspect of the tibiotalar joint with subjective thinning of the articular cartilage. The tibiotalar joint alignment is otherwise anatomic. Mild degenerative changes affect the talonavicular articulation.ADDITIONAL

Output: Comminuted fracture of the calcaneus with intra-articular extension as described above. There is avascular necrosis of the calcaneal fracture fragment about the posterior facet of the subtalar joint. Probable nondisplaced subchondral fracture of the talus as described above. No evidence of ligamentous injury, as clinically questioned.


Instruction: Generate impression based on medical findings.

Input: 10-month-old female status post tumor biopsy. Evaluate for hemorrhage. Status post right frontotemporal craniotomy with expected postoperative pneumocephalus and subcutaneous gas. Small amount of extra-axial fluid is seen in the operative field. No evidence of intra-or parenchymal or subarachnoid hemorrhage. The mixed cystic and solid attenuation suprasellar mass, which extends superiorly to the level of the foramen of Monro and posteriorly to the interpeduncular fossa, appears not significantly changed from recent MRI. There is mild compression of the anterior aspect of third ventricle, unchanged. The lateral and fourth ventricles appear unchanged from prior exam. No significant midline shift or evidence of herniation. The visualized paranasal sinuses and mastoid air cells are normal for age.

Output: 1.Expected postoperative pneumocephalus, subcutaneous gas, and small amount of extra-axial blood in surgical field. No evidence of intraparenchymal or subarachnoid hemorrhage.2.Known suprasellar mass appears not significantly changed.


Instruction: Generate impression based on medical findings.

Input: 75 year old woman with history of LV dysfunction who presents for stress cardiac MRI to evaluate for coronary disease as etiology of cardiomyopathyMEDICATIONS: hydralazine, isosorbide dinitrate, lisinopril, zocor First Pass PerfusionDuring hyperemia, there is a perfusion defect noted in the mid-inferior/inferolateral wallViability/ Myocardial ScarThere is late gadolinium enhancement transmural in thickness in the mid-inferolateral wall. This region is likely not viable. The remainder of the myocardium is viable. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 21%, the LV end diastolic volume index is 114 ml/m2 (normal range: 65+/-11), the LVEDV is 208 ml (normal range 109+/-23), the LV end systolic volume index is 89 ml/m2 (normal range 18+/-5), the LVESV is 164 ml (normal range 31+/-10), the LV mass index is 64 g/m2, and the LV mass is 117 g. There is diffuse hypokinesis. Mid-distal inferior and inferolateral akinesis. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 35%%, the RV end diastolic volume index is 80 ml/m2 (normal range 69+/-14), the RVEDV is 147 ml (normal range 110+/-24), the RV end systolic volume index is 52 ml/m2 (normal range 22+/-8), and the RVESV is 96 ml (normal range 35+/-13). Right AtriumThe right atrium is severely dilated. Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there at least mild mitral regurgitation difficult to quantify on this study.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilatated. Venous AnatomyThe IVC is dilated.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 severely dilated with severely reduced systolic function (LVEF 21%). Mid-distal inferior and inferolateral akinesis. 2. There is a perfusion defect noted in the mid-inferior/ inferolateral wall3. There is late gadolinium enhancement transmural in thickness in the mid-inferolateral wall. This region is likely not viable. The remainder of the myocardium is viable. 4. The right ventricle is normal in size with moderately reduced systolic function (RVEF 35%).


Instruction: Generate impression based on medical findings.

Input: Right vestibular schwannoma treated to 12.5 Gy using SRS: dizziness. There is has been slight interval increase in size of the right vestibular schwannoma that is extends from fundus of the internal auditory canal to the cerebellopontine angle cistern, now measuring up to 21 AP x 24 RL x 18 SI mm, previously 20 AP x 21 RL x 16 SI. There is associated increased mass effect upon the right middle cerebellar peduncle and right cerebellar hemisphere, where there appears to be mild edema. There is persistent slightly diminished fluid signal within the right labyrinthine structures. There are unchanged mild scattered foci of cerebral white matter T2 hyperintensity, which likely represent microangiopathy.

Output: Slight interval increase in size of the right vestibular schwannoma.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Newly diagnosed lung cancer, evaluate for metastases. Signs and symptoms: Lung cancer. Pre-and post-enhanced brain MRI: No diffusion weighted abnormalities.Examination demonstrate multiple metastatic lesions in bilateral cerebral and cerebellar hemispheres. The lesions demonstrate enhancement and some with a venous of central necrosis. There is also surrounding beaking edema. The largest parenchymal metastatic lesion is seen the right thalamus and measuring approximately at 21 x 28-mm and with areas of central necrosis and extensive surrounding edema. This lesion causes but a subtle deviation of third ventricle to the. The largest metastatic lesion in the posterior fossa is in the right inferior cerebellar and measuring at 18 times 17-mm which also demonstrate rim enhancement and central necrosis with subtle surrounding vasogenic edema and regional mass-effect.  Additionally there is a large extra axial dural based enhancing tumor arising from the right greater wing of the sphenoid and extends along the dural into the right subfrontal region along the floor of the right anterior cranial fossa. It demonstrate isointense signal on flair and T2-weighted images and with diffuse enhancement. It applies mass effect and posterior displacement of right anterior temporal lobe and superior displacement of the right frontal lobe. It measures at least 25 x 36 in transaxial and 41-mm in cranial cephalad axis. This finding is not associated with any underlying destructive bony changes. The lesion is highly suggestive of a meningioma and less likely to represent a metastatic disease.No detectable abnormal calvarial signal abnormality or enhancement to suggest metastases.Unremarkable images through the orbits including axial fat sat post enhanced series.Extensive chronic right maxillary sinus disease and unremarkable other paranasal sinuses.

Output: 1.Pre-and post enhanced brain MRI demonstrate multiple bilateral cerebral and cerebellar metastatic lesions as detailed/measured above. There is trace deviation of third ventricle to the left.2.A large well-demarcated dural based isointense mass with uniform enhancement arising from the right greater wing of sphenoid and extending along the dura to the right subfrontal region without detectable destructive bony changes as detailed. Finding is highly suggestive of a meningioma and less likely representing a metastatic lesion.


Instruction: Generate impression based on medical findings.

Input: Female, 35 years old, with history of seizures and headache in the setting of eclampsia and PRES. The previously seen scattered areas of parenchymal signal abnormality in the bilateral frontal, parietal and occipital lobes have resolved. No residual edema or mass effect is seen. No restricted diffusion is demonstrated. Parenchymal volume is preserved with no areas of encephalomalacia.Susceptibility effect is redemonstrated within the right intraparietal sulcus, and in the right occipital lobe, similar to the prior examination. No acute intracranial hemorrhage or any abnormal extra axial fluid collection is seen. The ventricles are normal in size and morphology. Incidental note is made of a partially sella which has increased in prominence relative to the prior exam.

Output: 1.Resolution of prior findings compatible with PRES. No residual parenchymal signal abnormality is seen. No areas of parenchymal tissue loss are demonstrated.2.Susceptibility effect within the right intraparietal sulcus and in the right occipital lobe are redemonstrated similar to the prior examination. This could reflect chronic hemosiderin deposition related to the patient's prior episode of PRES.3.A partially empty sella is noted, more conspicuous than on the prior examination. This finding can reflect normal variation, though it is also seen in conditions of elevated intracranial pressure such as idiopathic intracranial hypertension.


Instruction: Generate impression based on medical findings.

Input: Female; 36 years old. Reason: 36 yo female with hx of breast cancer now with lesion in the left rectus abdominis suggestive of desmoid tumor please evaluate for changes and or abnormalities History: desmoid tumor ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable 2.5 x 1.4 cm enhancing lesion in the left rectus abdominis muscle (series 901/for 64), previously 2.5 x 1.4 cm.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Small amount of endometrial fluid is likely physiologic. Tampon device noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is a 2.5 x 1.4 cm enhancing lesion in the left rectus abdominis muscle (14/91).OTHER: Trace amount of free fluid in the pelvis is likely physiologic.

Output: Unchanged nonspecific enhancing lesion in the left rectus abdominis muscle, which again may be due to a desmoid and would be amenable to percutaneous biopsy.


Instruction: Generate impression based on medical findings.

Input: Right suboccipital mass with questionable change in size. There is a right suboccipital subcutaneous mass with fat signal characteristics that measures up to nearly 3 cm. There is no abnormal enhancing component. There is no significant cervical lymphadenopathy. The parotid submandibular glands appear unremarkable. There is mild mucosal thickening of the left ethmoid air cells and a small retention cyst in the atelectatic left maxilla sinus. The imaged portions of the brain and orbits are unremarkable. There is mild multilevel spondylosis of the cervical spine.

Output: A right suboccipital subcutaneous soft tissue lipoma measures up to 3 cm.


Instruction: Generate impression based on medical findings.

Input: ORBITS: The globes are symmetric and normal in appearance. There is bilateral proptosis, left greater than right, which is without significant interval change. There is prominent intraorbital fat bilaterally, similar to prior exam. The right optic nerve sheath is slightly more full compared to the left on the order of 1 mm or less, and without significant change. The optic nerves are not thickened and appear symmetric bilaterally with normal signal intensity. The extraocular muscles are within normal limits of size and appear symmetric bilaterally, and unchanged from prior exam. The lacrimal glands enhance symmetrically and are not enlarged. There is a partial empty sella with a thin and somewhat flattened pituitary gland which enhances homogeneously. There is a midline pituitary stalk. The cavernous sinuses enhance symmetrically and show no evidence of mass. The superior ophthalmic vein is not enlarged.BRAIN: There is no suspicious enhancement, acute infarct, mass, or cerebral edema. There are scattered periventricular and subcortical white matter T2 hyperintensities which are nonspecific. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: 1.Stable exam of the orbits with bilateral proptosis, left greater than right. No intraorbital mass, extraocular muscle thickening or suspicious enhancement.2.Scattered periventricular and subcortical white matter T2 hyperintensities are nonspecific. The differential diagnosis is wide and includes vascular related etiologies, demyelination, HIV-related etiologies among others.


Instruction: Generate impression based on medical findings.

Input: Male 55 years old with intractable epilepsy, cognitive slowing No evidence of diffusion restriction to suggest acute infarction. No evidence of intracranial hemorrhage or mass. Right frontal lobe encephalomalacia appears unchanged from prior exam. Patchy areas of subcortical and periventricular T2/FLAIR hyperintensity, appearing similar to prior exam and suggestive of chronic white matter small vessel ischemic disease. Stable thinning of the corpus callosum. The ventricles and basal cisterns are normal in size and configuration. No midline shift or herniation. The major cerebral flow voids are intact. The sinuses are almost completely opacified with progression noted in the sphenoid. The mastoid sinuses are relatively clear. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Right frontal lobe encephalomalacia likely secondary to chronic infarct, unchanged from prior exam. 3. Stable chronic white matter small vessel ischemic disease.4. The sinuses are almost completely opacified with progression noted in the sphenoid.


Instruction: Generate impression based on medical findings.

Input: Reason: Evaluate the Small Bowel History: H/o Crohn's Disease Evaluate the Small Bowel ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is a narrowed segment in the distal ileum on postcontrast exam in the region of prior inflammation, however this region appears normal on T2 weighted sequences. No evidence of active inflammation. No abscesses or fistulas.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of active disease.


Instruction: Generate impression based on medical findings.

Input: Abdominal pain in patient with history of liver transplant. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions are identified. The common hepatic duct appears dilated upstream to the anastomoses measuring up to 12 mm in diameter, not significantly changed. There is mild, diffuse intrahepatic biliary ductal dilatation which may have been seen on the prior study.The intrahepatic portal veins appear patent. There is once again significant narrowing of the portal vein at the confluence which remains patent (series 9, image 170) and appears similar to 2012 exam. The splenic vein and superior mesenteric vein appear patent. The hepatic veins appear patent. Evaluation of the hepatic arteries is somewhat limited by suboptimal arterial phase timing. The conduit connecting the hepatic arteries to the infrarenal aorta remains patent. The IVC is severely narrowed at the level of the hepatic anastomosis with dilation of the IVC just inferior to this level.SPLEEN: The spleen is mildly enlarged measuring up to 13.6 cm, previously 17.7 cm. An approximately 1 cm lesion within the superior aspect of the spleen which demonstrates peripheral, nodular enhancement is compatible with a hemangioma.PANCREAS: Pancreatic duct is nondilated.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Previously seen ascites has resolved.PELVIS:UTERUS, ADNEXA: Normal variant nabothian cysts are present in the cervix.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Previously seen ascites has resolved.

Output: 1.Postsurgical changes of liver transplant. Persistent narrowing at the portal vein confluence which remains patent. Evaluation of the hepatic arteries is suboptimal due to timing of arterial phase, but the hepatic artery conduit remains patent.2.Improving splenomegaly and resolution of ascites.


Instruction: Generate impression based on medical findings.

Input: 50-year-old female with glioblastoma on radiation therapy, evaluate for change in tumor size while on treatment area patient is experiencing headaches. There has been interval decrease in size of the patient's enhancing right posterior frontal lobe mass, measuring 34 mm transverse x 30 mm AP (previously 35 mm transverse x 38 mm AP. Additionally, there is significantly less vasogenic edema and its related mass effect, with right to left midline shift now measuring 4 mm (previously 7 mm). Beyond the vasogenic edema, there has been an increase in the degree of T2 abnormality involving the anteromedial frontal lobe, now crossing the splenium, and extending into the adjacent left frontal lobe. As before, there is persistent T2 abnormality with gyral thickening involving the anterior right temporal lobe and insula. There are small, patchy foci of new enhancement associated with both the T2 abnormality crossing the corpus callosum as well as within the right peri-insular frontal gyri. Perfusion analysis demonstrates elevated corrected rCBV within the enhancing rim of the primary lesion, especially along its undersurface. There is a suggestion of subtly increased rCBV involving the involved right hemispheric white matter (including the rightward corpus callosum) as compared to the contralateral side.There is no evidence of acute intracranial hemorrhage or acute infarct. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. Redemonstrated is a right maxillary sinus retention cyst. Remaining paranasal sinuses and mastoid air cells are clear. Expected vascular flow-voids are demonstrated.

Output: 1.Decreased size of a right posterior frontal lobe high-grade astrocytic neoplasm with concurrent decrease of associated vasogenic edema as well as mass effect.2.There has been an increase in the degree of T2 abnormality involving the anteromedial frontal lobe, now crossing the splenium, and extending into the adjacent left frontal lobe. 3.As before, there is persistent T2 abnormality with gyral thickening involving the anterior right temporal lobe and insula.4.There are small, patchy foci of new enhancement associated with both the T2 abnormality crossing the corpus callosum as well as within the right peri-insular frontal gyri. 5.Perfusion analysis demonstrates elevated corrected rCBV within the enhancing rim of the primary lesion, especially along its undersurface, evidence for viable tumor. There is also a suggestion of subtly increased rCBV involving the involved right hemispheric white matter (including the rightward corpus callosum) as compared to the contralateral side.


Instruction: Generate impression based on medical findings.

Input: History of rotator cuff tear now with shoulder pain, evaluate for recurrent tear. Foci of signal void within the soft tissues likely represent metallic susceptibility artifact from prior surgery. Similar foci within the humeral head presumably represent suture anchors.ROTATOR CUFF: There is a full-thickness tear of the supraspinatus tendon at the 12:00 position with delamination of fibers such that bursal surface fibers are retracted by approximately 1.5 cm and the articular surface fibers are retracted by approximately 2.5-3 cm. The tear measures just over 1 cm in the AP dimension. The retracted portions of the tendon appear thickened consistent with tendinosis. The more anterior fibers of the supraspinatus tendon appear to extend to the greater tuberosity. Mild fatty infiltration affects the myotendinous junction of the supraspinatus. The supraspinatus muscle otherwise appears normal. The aforementioned supraspinatus tear appears to extend posteriorly to involve the anterior fibers of the infraspinatus tendon. There also appears to be mild interstitial tearing of the infraspinatus tendon more proximally near the myotendinous junction. Mild fatty infiltration is present along the myotendinous junction of the infraspinatus. The infraspinatus muscle otherwise appears normal. The teres minor muscle and tendon are intact. The subscapularis muscle and tendon are intact.SUPRASPINATUS OUTLET: The acromioclavicular joint appears widened consistent with prior surgery. Bone marrow edema within the distal end of the clavicle is of uncertain etiology or significance, but we see no pronounced inflammatory changes to suggest infection. A small amount of fluid is present in the subacromial bursa which extends into but not beyond the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral alignment is within normal limits. A small amount of fluid is present within the glenohumeral joint without large effusion. Blunting of the superior labrum may be postoperative in etiology. The inferior labrum appears intact.BICEPS TENDON: The long head of the biceps tendon is not seen at the level of the rotator interval or within the proximal intertubercular groove. What we presume to be the biceps tendon is seen more distally, and these findings may reflect biceps tenotomy.ADDITIONAL

Output: Recurrent rotator cuff tear and postoperative changes as other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Left arm lymphedema and new left shoulder pain, known breast cancer There is severe osteoarthritis of the glenohumeral joint with diffuse cartilage loss and bone-on-bone apposition of the humeral head and glenoid. There is abnormal signal intensity within the glenoid which is favored to represent subchondral sclerosis and cyst formation rather than metastatic disease. There is flattening of the superomedial surface of the humeral head thought to reflect chronic remodeling with additional degenerative marrow edema and cystic changes in the underlying humeral head. There is a moderate-sized joint effusion with synovial enhancement indicating synovitis.There is intermediate signal intensity within the distal fibers of the supraspinatus suggesting tendinosis but we see no full-thickness fluid-filled tear. There is mild atrophy of the supraspinatus muscle. Mild insertional tendinosis also affects the infraspinatus tendon but again there is no evidence of a full-thickness tear. The teres minor and subscapularis tendons and muscles are normal.A trace amount of fluid is present within the subacromial-subdeltoid bursa. The acromioclavicular joint is normal. There is fluid within the biceps tendon sheath likely reflecting extension from the glenohumeral joint with mild associated tenosynovial enhancement. Evaluation of the intra-articular portion of the tendon of the long head of the biceps is limited given the internally rotated position of the patient but it otherwise appears grossly intact.

Output: Severe glenohumeral joint osteoarthritis with other findings described above.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old, with lumbar stenosis. All lumbar vertebral bodies demonstrate some degree of height loss. L1 is most severely affected with near complete loss of height centrally. L4 is the next most severely affected with approximately 70% loss of height. These findings are similar to prior.A kyphotic angulation of the spine is seen centered at L1. Stepwise mild retrolistheses of L2 on L3, L3 on L4, and L4 on L5 are seen, similar to prior.Marrow signal characteristics are heterogeneous and there is evidence of mild edema within the L1 vertebral body and along the endplates of L3-L5, likely degenerative in nature. Findings are unchanged. No worrisome marrow replacement is detected.The visualized spinal cord and conus are unremarkable. Details of the cauda equina are discussed below.With the exception of L1-2 and L5-S1, the intervertebral discs show severe loss of height. Additional level specific findings are as follows:T12-L1: Facet hypertrophy and ligamentum flavum thickening. Disc bulging, osteophytic spurring and mild vertebral body retropulsion. Mild generalized spinal canal stenosis. Mild foraminal narrowing. No significant interval changes.L1-2: Bulging disc asymmetric to the right. No significant spinal canal stenosis. Mild right foraminal narrowing. No interval changes. L2-3: Facet hypertrophy and ligamentum flavum thickening. Disc bulging and osteophytic spurring, asymmetric to the right. No significant generalized spinal canal stenosis. Moderate right and mild left foraminal narrowing. No significant interval changes.L3-4: Facet hypertrophy and ligamentum flavum thickening. Bulging disc and osteophytic spurring. Moderate to severe spinal canal narrowing with some crowding of the cauda equina. Moderate right and mild left foraminal narrowing. No significant interval changes.L4-5: Severe facet hypertrophy and ligamentum flavum thickening. Bulging disc and osteophytic spurring. Severe spinal canal stenosis with crowding and probable impingement of the cauda equina. Severe right and moderate left foraminal narrowing. No interval changes. L5-S1: Severe facet hypertrophy and ligamentum flavum thickening. Bulging disc. Moderate generalized spinal canal stenosis. No significant neuroforaminal narrowing. No significant interval changes.

Output: 1.No significant change in multilevel vertebral body compression deformities, most severely affecting L1 and L4.2.No significant change in severe disc degeneration with relatively severe spinal canal stenoses and right-sided foraminal narrowing at L3-4 and L4-5.


Instruction: Generate impression based on medical findings.

Input: There is a subcentimeter T2 hyperintense enhancing focus within the dorsal columns of the cervical cord at the level of the C3 vertebral body, without appreciable expansion of the spinal cord. At C3-4, there is a posterior disc-osteophyte complex that slightly effaces the anterior thecal sac CSF. At C4-5, there is a disc-osteophyte complex with an eccentric left disc protrusion that indents the anterior aspect of the spinal cord. At C5-6, There is a central disc bulge, with a normal canal stenosis. There is no significant neural foraminal stenosis in the cervical spine. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The paravertebral soft tissues are unremarkable. The cerebellar tonsils extend up to 2 mm inferior to the foramen magnum.THORACIC SPINE

Output: 1. A subcentimeter enhancing lesion within the cervical spinal cord at the level of C3 may represent active demyelinating disease, an infectious myelitis, or autoimmune process, or vasculitis, for example. A brain MRI with contrast may be useful for further evaluation of disease extent if clinically warranted.2. Multilevel posterior disc-osteophyte complexes within the cervical spine, with impingement upon the spinal cord at C4-5. 3. The thoracic spine is unremarkable.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: 92-year-old male with diffuse lymphadenopathy, weight loss. Evaluate for mass. The lymph node biopsy with metastatic carcinoma likely renal in origin on pathology. Limited evaluation of the vasculature and solid parenchymal organs due to the lack of intravenous contrast.ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis. Bilateral simple renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Subcentimeter T2 hyperintense foci of the left iliac bone (series 3 image 19) are only seen in the coronal series.OTHER: Worsening right lower lobe consolidation and right pleural effusion since the 7/29/2016 PET/CT exam. Septations are noted within the right pleural effusion. Cardiomegaly. Sternotomy wires.

Output: 1.No suspicious renal lesion. Bilateral simple renal cysts.2.Right lower lobe consolidation and right pleural effusion increased in the interval. Dedicated CT chest is recommended for further evaluation.3.The small T2 hyperintense foci of the left iliac bone correspond to the known FDG-avid lesions identified on the 7/29/2016 PET/CT exam.


Instruction: Generate impression based on medical findings.

Input: 30 year old woman with cardiomyopathy referred to evaluated etiology. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 22%, the LV end diastolic volume index is 190 ml/m2 (normal range: 65+/-11), the LVEDV is 398 ml (normal range 109+/-23), the LV end systolic volume index is 148 ml/m2 (normal range 18+/-5), the LVESV is 310 ml (normal range 31+/-10), the LV mass index is 63 g/m2 (normal range 67+/-11), and the LV mass is 132 g (normal range 114+/-24). There is global hypokinesis. There is late gadolinium enhancement noted in the pattern of the septal mid-wall stripe. This pattern is associated with myocardial fibrosis and well described in dilated cardiomyopathy and old myocarditis. It does not consistent with old myocardial infarction. Based on T2-imaging there is no evidence of acute inflammation.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is mildly dilated with severely reduced systolic function. The overall RV ejection fraction is 17%, the RV end diastolic volume index is 104 ml/m2 (normal range 69+/-14), the RVEDV is 217 ml (normal range 110+/-24), the RV end systolic volume index is 86 ml/m2 (normal range 22+/-8), and the RVESV is 180 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 to severe mitral regurgitation with bileaflet tethering.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is a small pericardial effusion.Extracardiac FindingsThere is atelectasis or infiltrate in the right lower lung. Small lymph nodes noted in bilateral 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. Severe LV dilation with severely reduced systolic function (LVEF 22%). On late gadolinium enhancement images, a mid-wall septal stripe is noted. This pattern is not consistent with myocardial infarction and suggests the presence of underlying myocardial fibrosis. The pattern has been commonly described in dilated cardiomyopathy and also in old myocarditis. There is no evidence of active inflammation based on T2-imaging. No evidence of myocardial iron overload. 2. Normal RV size with severely reduced systolic function (RVEF 17%). 3. Severe left atrial dilation.4. Moderate to severe mitral regurgitation with bileaflet tethering. 5. Small pericardial effusion.6. See extra-cardiac findings.


Instruction: Generate impression based on medical findings.

Input: History of renal cell carcinoma status post bilateral nephrectomy. Please note that evaluation is limited by lack of IV contrast.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post bilateral nephrectomy. The previously seen bilateral heterogeneous retroperitoneal collections have nearly completely resolved, compatible with postsurgical hematomas. No definite soft tissue mass is identified.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Near-complete resolution of the bilateral retroperitoneal collections compatible with hematomas, without residual or recurrent soft tissue mass identified.


Instruction: Generate impression based on medical findings.

Input: 66 year old female with history of ovarian cancer and T4 vertebral lesion. Compare to previous studies for interval change. Multilevel degenerative changes present throughout the visualized thoracic spine, lower cervical and upper lumbar segments. The attenuation of the vertebral bodies is within normal limits with exception of T4 which redemonstrates a focal area of sclerosis correlating with the metastatic lesion seen on the previous MRI examination (3/22/2011). No evidence of fracture. No evidence of new lesions.Within the limits of CT scanning, the thecal sac and spinal cord are preserved with no significant spinal canal stenosis, with the exception of T11-T12 which demonstrates a small disk protrusion abutting the spinal cord. The neural foramen are patent. The paraspinal soft tissues are unremarkable.Incidental note is made of several surgical clips that are present within the left anterior pararenal space. A large liver lesion is incompletely imaged and appears grossly similar in size to the previous MR examination representing a hemangioma as previously noted on dedicated abdominal MR examination of 4/30/2010. Atherosclerotic calcifications the visualized thoracic and abdominal aorta. Several small lymph nodes are present within the superior mediastinum the largest of which measures 9 mm at the level of the AP window, (series 4, image 41), not pathologically enlarged by CT criteria.Visualized parts of the lungs are grossly clear bilaterally.

Output: 1. Stable T4 vertebral metastasis without evidence of change in size or vertebral body fracture. No additional metastatic lesions are identified.2. Stable appearance of previously noted liver hemangioma.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Baseline MRI prior to starting systemic chemotherapy treatment. Compared to study from 3 -- 5 -- 15. Signs and symptoms: Pre-and post-enhanced brain MRI:Examination demonstrate postoperative changes of a large right cerebellar resection. The CSF signal intensity surgical cavity without interval change in size is again noted. There is a very thin partial rim enhancement of the surgical cavity without convincing evidence of tumor residual or recurrence with interval improvement since prior study.Supratentorially examination demonstrate significant interval increase in parenchymal and leptomeningeal enhancement extending from left anterior temporal posteriorly at the site of previously resected tumor and highly concerning for recurrence. A very faint focus of enhancement at the site superficially in the left anterior temporal which measured 9 times 10-mm in size demonstrate significant interval increased size in an irregular fashion. There is also or increased ventricular thick rim enhancement of the left posterior temporal surgical cavity. In addition a new single parenchymal focus of enhancement in the periventricular white matter of left trigone of lateral ventricle (axial post enhanced series 1501 image 17) is concerning for new metastatic lesion. This finding measures approximately 5.9 x 6.5-mm and demonstrate restriction on diffusion weighted series.Expected postoperative changes of a large left frontal temporal craniotomy with mild epidural thickening under the craniotomy flap and with expected dural thickening and enhancement.

Output: 1.Significant interval increase enhancement of parenchyma and the leptomeninges in the left anterior and mid temporal lobe as well as surrounding the left temporal surgical cavity concerning for progression of disease. New small focus of enhancement in the periventricular white matter left trigone as mentioned above.2.Stable post operative changes right cerebellar without evidence of residual or recurrence.3.Stable dilated left lateral ventricle and mildly prominent right lateral ventricle with maintained midline.4.Expected postoperative changes of larger left frontal -- temporal craniotomy as detailed.


Instruction: Generate impression based on medical findings.

Input: 79-year-old female with hypertension now with progressive lower extremity weakness x 1 day. Generalized weakness x 2 weeks. No objective neuro findings on exam. Question acute ischemia. Question subdural hematoma. Patient has very poor gait. Patchy areas of deep subcortical and periventricular white matter hypodensity likely represent moderate small vessel ischemic disease, age indeterminate by CT. However, if there is concern for an acute stroke, an MRI is recommended for further evaluation. There is no evidence of intracranial hemorrhage, mass or midline shift. Prominence of the sulci and ventricles indicates mild to moderate corticomedullary volume loss.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Small vessel ischemic disease, age indeterminate. If there is concern for an acute stroke, an MRI is recommended for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Conus cyst, epilepsy For the purposes of numbering, there are 5 lumbar type vertebral bodies. Again seen is a mildly expansile T2 hyperintense focus involving the distal thoracic cord at the T12 level measuring approximately 4 x 3 x 10 mm in the AP, transverse, and craniocaudal dimensions. There is suggestion of communication with the central canal superiorly (better seen on prior study sag T2 image 6). No abnormal enhancement is appreciated on the postcontrast sequences.Vertebral body heights are normal. Alignment is normal. Bone marrow signal is normal. No significant spinal canal or neural foraminal stenosis is seen at any level. Conus is in normal position at the L1-L2 level. No evidence of filar lipoma or other lesions involving the cauda equina or filum terminale. No evidence of tethered cord.

Output: Unchanged appearance of the minimally expansile cystic focus/defect involving the dorsal cord in the midline at the T10 level. Finding is favored to represent a developmental malformation, possibly related to incomplete neural tube closure (although the osseous elements are intact) or ventricularis terminalis cyst, and less likely myelomalacia related to prior injury or nonenhancing cystic neoplasm.


Instruction: Generate impression based on medical findings.

Input: 64 year-old male with prostate cancer. PELVIS:PROSTATE:Prostate Size: 4.9 x 3.0 x 4.0 cm (TR x AP x CC)Peripheral Zone: Note is made of multiple foci of decreased T2 signal abnormality in the right and left paramedian base of the peripheral zone of the prostate gland with associated restricted diffusion. While no postcontrast images are available for further evaluation, these findings are suspicious for prostate carcinoma. The largest focus measures 8 x 4 mm (17; series 801).Seminal Vesicles: There is no evidence of seminal vesicle involvement.Extracapsular Extension: No convincing evidence of extracapsular extension.BLADDER: Concentric bladder wall thickening is nonspecific, but suggestive of chronic outlet obstruction.LYMPH NODES: No evidence of lymphadenopathy.BONES, SOFT TISSUES: Focus of decreased T1 and T2 signal abnormality in the right superior pubic ramus likely represents a benign bone island. Nonspecific diffusely heterogenous bone marrow signal abnormality is incompletely characterized due to lack of contrast administration, but may represent islands of red marrow. OTHER: No significant abnormality noted.

Output: Multiple foci of signal abnormality in the base of the peripheral zone of the prostate gland. While no post contrast images were obtained, these findings are suspicious for prostate carcinoma.


Instruction: Generate impression based on medical findings.

Input: Drug resistant temporal lobe epilepsy treated with laser ablation of the left mesial temporal lobe 12/2015. There are expected findings related to left medial temporal lobe laser ablation. There is no gross evidence of other intracranial abnormalities. The ventricles are unchanged is size.

Output: Expected postoperative findings related to left medial temporal laser ablation.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Acute stroke? Signs and symptoms, acute ischemic stroke. Nonenhanced brain MRI:No acute intracranial process and negative diffusion weighted series.Examination demonstrates mild scattered foci of FLAIR and T2 hyperintensity without associated susceptibility signal changes highly suggestive of mild chronic nonhemorrhagic small vessel ischemic strokes. Findings are probably mainly in the subcortical and periventricular white matter and without detectable similar signal changes in the basal ganglia, thalami or pons. Unremarkable as cerebral cortex and cortical sulci as well as ventricular system and CSF spaces.Unremarkable orbits, paranasal sinuses, mastoid air cells and calvarium.Nonenhanced brain MRA:Bilateral internal carotid arteries are thickened and unremarkable through the skull base and in their supraclinoid segments.Bilateral anterior and middle cerebral arteries and their distal branches are unremarkable.Patent and unremarkable bilateral vertebral arteries, bilateral pedicle branches as well as basilar artery and distal branches.

Output: 1.No acute intracranial process.2.Mild chronic nonhemorrhagic small vessel ischemic strokes only in the subcortical and periventricular white matter.3.Unremarkable nonenhanced brain MRA.


Instruction: Generate impression based on medical findings.

Input: History of triple negative left breast cancer status post neoadjuvant chemotherapy, breast conservation surgery (October 2013) and adjuvant radiation therapy. History of 2 benign left breast percutaneous biopsies. Known BRCA 2 mutation carrier. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Two stable lobulated masses are present in the left breast, compatible with biopsy proven fibroadenomata. No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Secondary malignant neoplasm of brainClinical question: preop planning for crani for tumorSigns and Symptoms: preop planning There is a mass measuring 19 x 23 mm sagittal dimensions and 17 x 17 mm axial dimensions located along the right occipital pole. It is associated with a vasogenic pattern of edema.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 mucosal thickening in the in the right maxillary sinus into a lesser degree ethmoid air cells. There is some opacification of the left petrous apex. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: A mass in the right occipital lobe is suspicious for metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Systemic lupus erythematosus [710.0], Reason for Study: ^Reason: possible seizure History: as above No evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. 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.Mucous retention cyst on the right side of sphenoid sinus and mucosal thickening on the posterior ethmoid sinus.

Output: No evidence of acute ischemic or hemorrhagic lesion on the scan.No evidence of abnormal signal intensity on this MR scan.


Instruction: Generate impression based on medical findings.

Input: MRI Brain:The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. Moderate periventricular and subcortical T2/FLAIR hyperintense foci, nonspecific and probably reflecting chronic small vessel ischemic disease. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. Patchy right mastoid air cell opacification noted.MRA neck:Phase contrast technique is limited in evaluation of tortuous segments of the vasculature. There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. There is mild atherosclerosis of the carotid bifurcations, left greater than right. The carotid arteries are normal in course without evidence of significant steno-occlusive lesion. Both vertebral artery origins are patent. The vertebral arteries are co-dominant. There is no evidence of stenosis or occlusion.

Output: 1.Chronic small vessel ischemic disease. No evidence of acute ischemia.2.Within the limitations of a noncontrast MRA, there is no gross vascular compromise in the major neck arteries.


Instruction: Generate impression based on medical findings.

Input: Tongue squamous cell carcinoma with neck lymphadenopathy. There is an enhancing mass in the left oral tongue, which measures up to approximately 40 mm. The tumor extends into the left sublingual space, but does not appear to involve the root of the tongue or the mandible. There are multiple abnormal left level 1, 2, and 3 lymph nodes. In particular, there is a cystic or necrotic left level 2B lymph node with ill-defined margins that measures 30 x 35 mm in axial cross-section. The lymph node tumor appears to infiltrate into a small portion of the adjacent left parotid gland. A left level 1B lymph node also displays ill-defined margins and measures 12 x 16 mm in axial cross-section. The lymph node tumor appears to slight infiltrate into the adjacent left submandibular gland. The left lateral retropharyngeal lymph node is asymmetrically prominent and measures 5 x 7 mm in axial cross-section. There is a right level 2A lymph node with a rounded morphology, which measures 7 x 10 mm in axial cross-section, which is not enlarged by size criteria. The other right neck lymph nodes are unremarkable. There is a cystic right thyroid nodule that measures up to 9 mm. There are small maxillary sinus retention cysts. There are also secretions in the left sphenoid sinus. The orbits and imaged intracranial structures are unremarkable. There is a small posterior disc-osteophyte complex at C5-C6 that mildly indents the spinal cord.

Output: Left oral tongue mass compatible with squamous cell carcinoma with associated extensive left cervical lymphadenopathy, with signs of extracapsular extension.


Instruction: Generate impression based on medical findings.

Input: Ms. Segev is a 60-year-old female with personal history of right breast lumpectomy with re-excision in 2008 for ILC status post chemotherapy, radiation therapy and hormonal therapy. Personal history of benign left breast biopsies. Family history of breast cancer in sister, diagnosed at the age of 49. She has no current breast related complaints. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Postsurgical changes are reidentified in the right lower inner breast with complete resolution of seroma cavity, compatible with provided history of right breast lumpectomy.As on previous studies, there are several scattered foci of enhancement throughout the left breast, predominantly inferiorly, which appear stable compared to prior studies. In the medial left breast in the 9 o'clock position there is a stable lobulated enhancing mass which measures up to 1 cm in length.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on medical findings.

Input: Clinical question: Preop planning. Signs and symptoms: Preop planning. Nonenhanced head CT:Stealth nonenhanced head CT for surgical planning is performed. Halo is secured to patient's calvarium.Examination demonstrates a well demarcated cystic lesion in the right cerebellum measuring approximately 33.3 x 15-mm in size.There is no appreciable interval change since prior exam in the size or density of this is. The overall mass effect on the fourth ventricle with slight deviation across the midline to the left is also similar to prior study.Images through supratentorial space demonstrate small less ischemic disease of indeterminate age as was noted on prior MRI study.

Output: 1.Steath enhanced preoperative surgical planning CT the reidentifies a stable right cerebellar cyst.2.Small vessel ischemic disease of indeterminate age.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Low back pain. Sciatica, unspecified sideClinical question: low back and bilateral leg painSigns and Symptoms: low back and bilateral leg painClinical question: altered gait, suspect cervical stenosisSigns and Symptoms: altered gait neck pain Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. The patient is status post laminectomy and T2as well as T2 and T3 posterior fusion with pedicle screws. There is minor anterior subluxation of T2 on T3.Spinal stenosis at T2-3 has resolved since the prior exam.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is disk dessication present at this levelAt C4-5 there is no significant compromise to the spinal canal or neural foramina. There is disk dessication, loss of disk space height, diffuse disk bulge and posterior ligament hypertrophy. There are small end-plate and uncovertebral osteophytes present at this level. There are endplate osteophytes at this level.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is disk dessication, loss of disk space height, diffuse disk bulge and posterior ligament hypertrophy. There are small end-plate and uncovertebral osteophytes present at this level. There are endplate osteophytes at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is disk dessication, loss of disk space height and a minor disk bulge at this level. There are small uncovertebral osteophytes present at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Lumbar spine: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 disk space height, disk dessication, diffuse disk bulge and mild to moderate bilateral facet and ligamentum flavum hypertrophy. There is partial effacement of the fat surrounding the left exiting nerve roots at this level within the neural foramen. These findings are stable compared to the prior exam.At L4-5 there is marked loss of disk space height, disk dessication, diffuse disk bulge and moderate bilateral facet and ligamentum flavum hypertrophy. There is partial effacement of the fat at the lateral recess bilaterally at this level. The fat surrounding the exiting nerve roots within the neural foramen is not effaced. Overall there is moderate spinal stenosis at this level stable compared to the prior exam. These findings are stable compared to the prior exam. End plate reactive changes are present with milder T2 signal hyperintensity when compared to the prior exam.At L3-4 there is disk dessication, mild diffuse disk bulge and mild to moderate ligamentum flavum hypertrophy. There is partial effacement of the fat at the lateral recess bilaterally at this level. The fat surrounding the exiting nerve roots within the neural foramen is not effaced. These findings are stable compared to the prior exam.At L2-3 there is disk dessication, minor diffuse disk bulge and minor ligamentum flavum hypertrophy. There is partial effacement of the fat at the lateral recess bilaterally at this level. The fat surrounding the exiting nerve roots within the neural foramen is not effaced. These findings are stable compared to the prior exam.At L1-2 there is disk dessication and a minor diffuse disk bulge. There is redemonstration of a Schmorl's node at this level. There is partial effacement of the fat at the lateral recess bilaterally at this level. The fat surrounding the exiting nerve roots within the neural foramen is not effaced. These findings are stable compared to the prior exam.

Output: 1.There are multilevel degenerative changes present in the lumbar spine worse at L4-5 where there is moderate spinal stenosis present stable since the prior exam. Associated end-plate reactive inflammatory changes have decreased since the prior exam.2.There are degenerative changes present in the cervical spine which are stable compared to the prior exam without significant compromise to the spinal canal or exiting nerve roots.3.Status post upper thoracic spine posterior fusion and laminectomy with resolution of prior spinal stenosis.


Instruction: Generate impression based on medical findings.

Input: pre eclampsia with severe headache No evidence of acute ischemic or hemorrhagic lesion.Diffuse pachymeningeal enhancement was demonstrated on post Gad enhancement images.Differential diagnosis include; post lumbar puncture status, pachymeningitis, pachymeningeal metastasis and intracranial hypotension.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Left maxillary sinus opacification with atrophic changes.

Output: 1. Diffuse pachymeningeal enhancement as described above; possible underlying diagnosis include post LP status, pahcymeningitis, granulomatous disease, carcinomatosis or intracranial hypotension.2. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on medical findings.

Input: Male, 37 years old, with back pain. Alignment is anatomic. Vertebral body heights are preserved. Mild degenerative endplate edema is seen at L4-5. Elsewhere, no significant marrow replacement or marrow edema is detected. The visualized distal spinal cord, conus and nerve roots of the cauda equina are within normal limits. No epidural abnormalities are suspected.L1-2: Unremarkable. L2-3: Unremarkable. L3-4: Mild facet arthropathy. Loss of disc T2 signal, mild disc bulging and a small central protrusion. No significant generalized spinal canal stenosis. Mild bilateral foraminal narrowing. L4-5: Mild facet arthropathy. Mild disc bulging with a small central disc protrusion. No significant generalized spinal canal stenosis. Mild bilateral foraminal narrowing. L5-S1: Moderate facet arthropathy. Mild disc bulging with a superimposed left foraminal protrusion. No significant generalized spinal canal stenosis. Mild left foraminal narrowing.

Output: Relatively mild disc degeneration is seen at L3-4, L4-5 and L5-S1 with disc bulging and small protrusions as discussed above. No areas of high-grade spinal canal stenosis are seen and only mild scattered foraminal narrowing is observed.


Instruction: Generate impression based on medical findings.

Input: 48-year-old female patient with right shoulder pain. Some sequences are limited by patient motion artifact.ROTATOR CUFF: There is diffuse thinning of the supraspinatus tendon likely representing a combination of chronic attritional tearing and prior surgery. However, the remaining tendon can be followed to its insertion on the greater tuberosity and we see no full-thickness tear. There does appear to be retraction of the undersurface fibers suggesting delamination that we suspect was present on the prior study. There is intermediate signal intensity of the tendon distally suggesting tendinosis. There is mild atrophy of the supraspinous muscle. There is intermediate signal intensity of the infraspinatus tendon likely reflecting tendinosis. Increased signal intensity along the undersurface fibers of the infraspinatus tendon seen on image 14, series 4 may represent undersurface fraying or tearing, but is not clearly visualized on the sagittal oblique view and may represent volume averaging with adjacent fluid in the joint. We see no full-thickness tear. There is mild atrophy of the infraspinatus muscle. The teres minor minor muscle and tendon is intact. There is perhaps mild tendinosis of the distal subscapularis tendon, but the muscle appears normal. Multiple suture anchor tracks are again noted in the humeral head. One within the posterior portion of the greater tuberosity is new from the prior study. One of the anchors seen in one of the larger tracks on the prior study is no longer evident.SUPRASPINATUS OUTLET: There is deformity of the distal clavicle and acromial process representing interval surgery. A small amount of fluid is noted in the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The superior labrum appears blunted which may reflect surgical debridement or tearing. There is deformity the posterior inferior labrum likely representing degenerative tearing, appearing similar to the prior study. Glenohumeral alignment is within normal limits. There is a small amount of fluid in the joint, but no large effusion.BICEPS TENDON: The patient has undergone a biceps tenodesis since the prior study. ADDITIONAL

Output: 1. Surgical changes of rotator cuff repair, acromioclavicular joint resection, and biceps tenodesis. 2. There is thinning of the supraspinatus tendon that we suspect represents a combination of chronic tearing and surgical changes, but we see no full-thickness tear.3. Additional rotator cuff tendinosis and other findings as described above.


Instruction: Generate impression based on medical findings.

Input: History of spinal stenosis in the cervical region. Per Epic note: several months of increasing right lower extremity pain and weakness especially while driving for long hours. There are postoperative findings related to anterior cervical discectomy and fusion from C6 to T1. At C5-6, there is a eccentric right disc-osteophyte complex that results in moderate-to-severe right neural foraminal stenosis, but no significant spinal canal stenosis. At C6-7, there is bilateral facet and uncovertebral joint hypertrophy with perhaps mild-to-moderate bilateral neural foraminal stenoses. At C7-T1, there is bilateral facet and uncovertebral joint hypertrophy with perhaps minimal bilateral neural foraminal stenoses. There is no significant spinal canal or neural foraminal stenosis at the other levels of the cervical spine. The cervical spinal cord displays normal signal characteristics and morphology. The cervical spinal column alignment is near-anatomic. The paravertebral soft tissues are unremarkable.

Output: 1. Postoperative findings related to anterior cervical discectomy and fusion from C6 to T1.2. At C5-6, there is a eccentric right disc-osteophyte complex that results in moderate-to-severe right neural foraminal stenosis, but no significant spinal canal stenosis. 3. At C6-7, there is bilateral facet and uncovertebral joint hypertrophy with perhaps mild-to-moderate bilateral neural foraminal stenoses. 4. At C7-T1, there is bilateral facet and uncovertebral joint hypertrophy with perhaps minimal bilateral neural foraminal stenoses. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Female; 71 years old. Reason: Evaluate for hamstring pathology. Patient has pain worst at the ischial origin, but pain and tenderness over the entire medial hamstrings to insertion. History: Evaluate for possible hamstring tear or avulsion. ACETABULAR LABRUM: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.SOFT TISSUES: No significant abnormality noted. Normal appearance of the conjoined and semimembranosus tendons bilaterally at their ischial insertions. No increased fluid signal to indicate acute inflammation or tear.ADDITIONAL

Output: Normal appearance of the hamstring tendons bilaterally. No specific findings to account for the patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: Progression of multiple sclerosis symptoms. There is a punctate focus of nonspecific T2 hyperintensity in the right frontal lobe centrum semiovale. There is a small left frontal lobe white matter developmental anomaly. Otherwise, there is no abnormal intracranial enhancement. There is no evidence of intracranial mass. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are grossly intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a small right maxillary sinus retention cyst. There is a subcentimeter left adenoidal probable retention cyst as well.

Output: Minimal nonspecific cerebral white matter T2 hyperintensity.


Instruction: Generate impression based on medical findings.

Input: 76-year-old male with history of C4-T1 cervical fusion presents with open wound and exposed spinous process of T1. Evaluate for osteomyelitis. There are postsurgical changes of posterior fusion from C4 to T2 and anterior cervical fusion from C5 to C7 with interbody bone grafts at C5-C6 and C6-7. A fragment of an old pedicle screw is again seen at the right T1 level as identified on the prior CT. There is evidence of wide laminectomies at the C2-3 to C6-7 levels. There is straightening of the cervical spine, which may be due to fusion.  Susceptibility artifact related to hardware limits evaluation. There is a soft tissue defect involving the posterior neck with exposure of the T1 spinous process and surrounding soft tissue edema and enhancement. Foci of susceptibility in the soft tissue adjacent to the T1 spinous process may represent foci of air related to wound dehiscence. There is no evidence of a drainable fluid collection. There is increased T2 and decreased T1 signal with enhancement of the spinous process of T1, which is suspicious for osteomyelitis (best seen on axial series 14, image 17). There is no evidence of discitis, abscess, or epidural collection. There is no evidence of central spinal canal stenosis or cord signal abnormality. There is mild left neuroforaminal stenosis at C3-4 and mild-to-moderate left neuroforaminal stenosis at C4-5.

Output: Bone marrow signal abnormality involving the T1 spinous process is suspicious for osteomyelitis. There are surrounding inflammatory changes in the adjacent soft tissues. There are suspected subcutaneous foci of air which may be related to the open wound. There is no appreciable drainable fluid collection in the paraspinous soft tissues, with susceptibility artifact from hardware slightly limiting evaluation. No findings to suggest discitis or epidural abscess.