Instruction: Generate impression based on medical findings.

Input: Patient used prophylactic antibiotics before and after the procedure as prescribed. The patient received antibiotic prophylaxis with oral Ciprofloxacin 500mg and Keflex 500 mg. The patient took 1 tablet of Ciprofloxacin 500mg the night before and morning of the procedure. The patient also took 2 tablets of Keflex 500 mg the morning of the procedure. After the procedures, the patient will take 2 tablets of Ciprofloxacin 500mg and 2 tablets of Keflex 500 mg.Following the discussion of the risks, benefits, and alternatives of the procedure, informed consent was obtained.  Dynatrim was used to localize the left mid gland peripheral zone of the prostate at the site of the T2 hypointense lesion. Using the Dynatrim guidance system an 18-gauge MR- compatible needle was inserted into the left side of the prostate. Upon confirmation of the tip of the needles close to the suspected lesion, MR guided biopsy using an 18 gauge biopsy needle was performed and 3 cores were obtained.Dynatrim was used to localize the left apex peripheral zone of the prostate at the site of the T2 hypointense lesion. Using the Dynatrim guidance system an 18-gauge MR- compatible needle was inserted into the left side of the prostate. Upon confirmation of the tip of the needles close to the suspected lesion, MR guided biopsy using an 18 gauge biopsy needle was performed and 3 cores were obtained.Dynatrim was used to localize the left apex transition zone of the prostate at the site of the T2 hypointense lesion. Using the Dynatrim guidance system an 18-gauge MR- compatible needle was inserted into the left side of the prostate. Upon confirmation of the tip of the needles close to the suspected lesion, MR guided biopsy using an 18 gauge biopsy needle was performed and 2 cores were obtained.The cores were hand delivered to the pathology lab.The patient tolerated the procedure well and was discharged without any immediate complications.ESTIMATED BLOOD LOSS: Less than 5 cc.

Output: Successful core-biopsies of the left mid gland peripheral zone, left apex peripheral zone and left apex transition zone prostate gland lesions.


Instruction: Generate impression based on medical findings.

Input: 77 years Male (DOB:5/1/1939)Reason: mass seen in pituitary, headache and dizziness History: headachePROVIDER/ATTENDING NAME: JAMES J WALTER MRI pituitary:The pituitary is enlarged measuring 20 x 18 mm sagittal dimensions and extends into the suprasellar cistern where it displaces the optic chiasm superiorly. The cavernous sinuses are intact bilaterally.MRI of the brainThere are multiple punctate foci of diffusion restriction present in the frontal lobes bilaterally as well as the occipital lobes, right thalamus, and cerebellar hemispheres.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate opacification of the left maxillary sinus associated with coastal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The left A1 segment is hypoplastic. The posterior communicating arteries are very small. The left vertebral artery is larger than the right vertebral artery.

Output: 1.Findings are available multiple diffusely distributed microinfarcts in both hemispheres and the posterior fossa. This consistent with an embolic shower2.There is a compatible with a pituitary macroadenoma which displaces the optic chiasm.3.No evidence for cerebrovascular occlusive disease.4.No evidence for intracranial aneurysm.5.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Status post SRS for AVM. Evaluate and compare with January 2015 study. Signs and symptoms: As above. Pre- and post enhanced brain MRI:No diffusion-weighted abnormalities.Examination redemonstrates an enhancing arteriovenous malformation in the left superior frontal gyrus measuring at 13.7 x 9.2 mm in transaxial dimensions compared to prior study measurements of 18 x 11 mm. There is a draining vein arising from the superior aspect of the AVM and extending posteriorly and superiorly without appreciable interval change in its size. Prominent left anterior-superior vertebral artery is again identified representing feeding pedicle. There is mild gliosis surrounding the VM without change since prior exam. Additionally there are scattered foci of FLAIR and T2 hyperintensity only in the subcortical and periventricular white matter of cerebral hemispheres and minimally in the left basal ganglia without significant change since prior exam and likely representing chronic microvascular ischemic process.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination otherwise.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells.Nonenhanced brain MRA:Routine nonenhanced brain MRA is performed which does not include the region of arteriovenous malformation. Patient was notified and will return for repeat exam without additional charge. Visualized images demonstrate patent unremarkable bilateral internal carotid arteries, bilateral anterior and middle cerebral arteries. This likely larger left anterior cerebral artery likely secondary to feeding patient's known arteriovenous malformation. Unremarkable bilateral vertebral arteries, PICA branches, basilar artery and its distal branches.

Output: 1.Pre- and post enhanced brain MRI demonstrate interval decreased size of an enhancing arteriovenous malformation in the left superior frontal gyrus measuring at 13.7 x 9.2 mm compared to prior study measurement of 18 x 11. No diffusion-weighted abnormalities and stable findings of mild chronic small vessel ischemic strokes.2.MRA of intracranial circulation was performed erroneously as a routine study which does not include the entire head. Patient will return for repeat exam without additional charge. Unremarkable MRA as detailed above.


Instruction: Generate impression based on medical findings.

Input: No significant interval change is seen. The trigone of the right lateral ventricle remains mildly expanded representing the site of a previously fenestrated intraventricular cyst. Minimal linear transparietal encephalomalacia is again seen representing the surgical tract. Foci of susceptibility involving the right lateral ventricle as well as the right medial temporal lobe also remain unchanged and compatible with chronic blood products and/or mineralization.The cerebral cortex, cortical sulci, ventricular system, and CSF spaces are otherwise unremarkable. No evidence of acute ischemia or hemorrhage. No extra-axial collections. Incidentally noted is a 6 x 5 mm pineal cyst and remains unchanged. Major flow-voids are patent.

Output: No evidence of reexpansion of the previously fenestrated right intraventricular cyst.


Instruction: Generate impression based on medical findings.

Input: Reason: pain History: pain. MENISCI: There is linear increased signal intensity within the posterior horn of the medial meniscus that extends to the tibial articular surface that likely represents a horizontal degenerative tear. Additional degeneration within the substance of the body of the medial meniscus. Anterior horn appears normal.The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: Moderate to severe thinning of the articular cartilage of the medial facet of the patella with foci of full thickness degeneration and underlying small subchondral cyst. Articular cartilage of the lateral facet appears relatively well preserved. Subjectively, the articular cartilage of the femoral trochlea appears thinned. There is also minimal subjective thinning of the articular cartilage of the tibiofemoral articulations, essentially within normal limits for age.LIGAMENTS: The anterior cruciate ligament and posterior cruciate ligament are intact. The medial collateral ligament is intact. The lateral collateral ligament complex is intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Degenerative horizontal undersurface tear of the posterior horn of the medial meniscus.2.Cartilage degeneration, most pronounced along the medial facet of the patella with relatively mild degeneration elsewhere.3.Baker's cyst.


Instruction: Generate impression based on medical findings.

Input: There is hemosiderin staining involving the choroid plexus of the lateral ventricles and the fourth ventricle, as well as within debris located in the dependent portions of the occipital horns bilaterally. Additionally, hemosiderin lines the occipital lobes bilaterally (left>right). There is evidence of colpocephaly with associated white matter loss, left greater than right. The corpus callosum is diffusely thinned. These findings are compatible with periventricular leukomalacia. There is slight dysmorphism of the quadrigeminal plate, and the CSF does not demonstrate flow on the sagittal CSF flow images at the level of the aqueduct, yet the aqueduct appears patent on the sagittal fiesta images.The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. No diffusion-weighted abnormalities to suggest acute ischemia are identified. There are no extraaxial fluid collections. Flow voids are present within the major vessels indicating patency. The mastoid air cells are clear.

Output: 1.Findings most compatible with colpocephaly and periventricular leukomalacia with evidence of prior ventricular hemorrhage. 2.There is slight dysmorphism of the quadrigeminal plate, and the CSF does not demonstrate flow on the sagittal CSF flow images at the level of the aqueduct, yet the aqueduct appears patent on the sagittal fiesta images.


Instruction: Generate impression based on medical findings.

Input: 36 year old with family history of breast cancer presents for screening MRI. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on medical findings.

Input: Female, 12 years old, with history of Chiari malformation, no surgery done, yearly follow-up examination. The cerebellar tonsils remain pointed and descend 10 to 11 mm below the level of the foramen magnum, similar to the prior exam. On cine flow imaging, biphasic CSF flow is seen along the ventral brainstem and spinal cord. Mild flow related signal is seen along the dorsal spinal cord at the level of the cerebellar tonsils. Again, findings are similar to prior.A small prominence of the CSF space posterior to the cerebellum is partially imaged on this examination appearing overall similar to the prior study. The visualized spinal cord demonstrates normal signal intensity and morphology throughout. No evidence of syrinx is seen.There is a mild reversal of the normal cervical lordosis. Alignment is otherwise unremarkable. Vertebral body heights are preserved and marrow signal characteristics are unremarkable. No evidence of spinal canal or foraminal narrowing is seen.

Output: 1.Findings compatible with Chiari malformation appearing similar to the prior examination.2.Partially visualized is a small prominence of the CSF space posterior to the cerebellum which may represent a small arachnoid cyst or focal prominence of the cistern.3.Appearance of the spinal cord remains within normal limits.


Instruction: Generate impression based on medical findings.

Input: Male 29 years old with generalized abdominal pain and bloating. ABDOMEN:LIVER, BILIARY TRACT: No focal liver lesion, biliary ductal dilation, or ascites.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 abnormal bowel wall enhancement or diffusion restriction. No evidence of stricture, fistula or abscess.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of acute or chronic bowel wall inflammation.


Instruction: Generate impression based on medical findings.

Input: New right L5 radiculopathy, assess S1 screw. Right lower extremity weakness and pain. Five lumbar type vertebral bodies are again presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position at the upper to mid L2 level. There is fibrofatty infiltration of the filum terminale, measuring less than 2 mm in thickness.Again seen are postoperative changes of L5-S1 interbody fusion via left transforaminal approach. Left L5-S1 facetectomy with foraminal decompression again seen. Hardware appears in grossly unchanged position and was better assessed on recent CT from 7/11/2016. No foraminal or extraforaminal nerve root impingement is seen associated with the S1 screw as questioned. There is mild edema involving the L5-S1 disc space which may be on a postoperative basis. No surrounding inflammatory changes or fluid collections are seen to suggest infection.Individual levels as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: Disc desiccation with small central protrusion. No spinal canal or neural foraminal stenosis.L4-L5: Disc desiccation with small right central protrusion. No spinal canal or neural foraminal stenosis.L5-S1: Postoperative changes as described above. Spinal canal is decompressed. Left neural foramen is also surgically decompressed. There is enhancing scar tissue involving the left neural foramen without significant nerve root impingement within the limits of susceptibility artifact. There is mild to moderate right-sided neural foraminal stenosis with disc height loss and eccentric rightward disc bulge with calcification and endplate osteophyte, which are better seen on recent CT.

Output: 1. Postoperative changes of L5-S1 fusion again seen. Hardware was better assessed on recent CT, but there is no nerve root impingement associated with the S1 screw as questioned. There is mild to moderate degree of right-sided L5-S1 neural foraminal stenosis on a chronic degenerative basis related to partial calcified disc bulge and endplate osteophyte. Remainder of the neural foramina are patent.2. Fibrofatty infiltration of the filum terminale incidentally noted, with normal conus position.


Instruction: Generate impression based on medical findings.

Input: Low back painIMAGE ACQUISITIONS: Lumbar spine CT without contrast Lumbar spinal alignment is normal. Vertebral body heights are intact. Intravertebral disk spaces are normal.T12-L1: No neuroforamina or central canal stenosis.L1-2: No neuroforamina or central canal stenosis.L2-3: There neuroforamina worse central canal stenosis.L3-4: Diffuse disk bulge without central canal stenosis. No neuroforamina stenosis.L4-5: Diffuse disk bulge without central canal stenosis. Questionable right lateral disk protrusion. Neural foraminal narrowing bilaterally.L5-1: Diffuse disk bulge without central canal or neuroforamina stenosis.In the sacrum, there is a large low attenuation lesion with extension into the retroperitoneum. This is a biopsy-proven schwannoma. We would prefer MRI with contrast to further evaluate this lesion if clinically warranted.

Output: 1. Degenerative disease as described above2. Sacrum schwannoma


Instruction: Generate impression based on medical findings.

Input: 55-year-old female with headaches and nausea and loss of consciousness. Status post fall this a.m.. Neurologically intact. Multiple small subcortical and periventricular areas of low-attenuation are not a specific all were often these findings are secondary to small vessel disease or demyelinating disease. Considering patient's age findings are more likely to represent small vessel disease. Age of these show cannot be determined on CT.No evidence of hemorrhage, mass-effect, midline shift or hydrocephalus is detected. There is subtle prominence of the basilar tip which demonstrate punctate calcification this can be result of atherosclerotic disease and vascular tortuosity the remote possibility of an aneurysm cannot be entirely ruled out. Further evaluation with an MRI and MRA is recommended to exclude acute stroke and also evaluate for possibility of aneurysm of the basilar tip.The bony density of calvarium is unremarkable. Pneumatization of paranasal sinuses and mastoid air cells also unremarkable.

Output: 1.Nonspecific white matter patchy areas of low attenuation which are suspicious for small vessel disease of undetermined age.2.No evidence of an acute posttraumatic findings.3.Slight prominence of basilar tip as detailed.


Instruction: Generate impression based on medical findings.

Input: Rule out abscess or osteomyelitis of the right pubic bone. Study is severely limited by artifact from bilateral total hip prosthesis. There is generalized muscle atrophy in bilateral thighs. There is a 3 x 2 cm fluid collection, which may represent an abscess in the proximal medial aspect of the thigh. There is no definite signal changes within the adjacent pubic bone to indicate osteomyelitis. Adjacent edema and inflammatory changes are noted in the medial thigh. Superficial soft tissue defect is noted in the region, which may be related to prior radiation or surgery.Multiple defects are noted in the distal femur which are most likely postsurgical. There are bilateral knee effusions, right greater than the left. Small right Baker's cyst is noted. Scattered varicosities are noted within the thigh.

Output: 1.3 x 2 cm fluid collection which may represent an abscess in the medial proximal aspect of the thigh. There is adjacent soft tissue edema and inflammatory changes, but within the limitations of the study, there is no definite signal changes within the pubic bone to indicate osteomyelitis.2.Superficial soft tissue defect adjacent to the fluid collection in the medial thigh, which may represent sequela of prior radiation or surgery.3.Bilateral knee joint effusions.4.Generalized atrophy of bilateral thigh musculature.5.Defects in the right distal femur which are most likely postsurgical in etiology.


Instruction: Generate impression based on medical findings.

Input: Severe headaches with semiology consistent with migraine with aura and suspicion of autoimmune disease: bilateral nystagmus and peripheral neuropathy. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are several, at least 15, punctate foci of high T2 signal in the white matter of the bilateral frontal lobes, which may have progressed slightly since 2011. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is a subcentimeter left posterior nasopharyngeal retention cyst. There are partially imaged postoperative findings in the cervical spine.

Output: Punctate foci of T2 hyperintensity in the bilateral frontal lobe white matter are nonspecific, but may represent sequela of migraine, autoimmune, or chronic small vessel ischemic disease. Otherwise, no evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on medical findings.

Input: Low back pain. Five lumbar vertebrae are identified with a lumbosacral transitional morphology of L5. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. There is mild disc desiccation at L3-4. There is mild, diffusely decreased T1 signal within the bone marrow which remains hyperintense to skeletal muscle and which may be related to red marrow. Additional scattered foci of increased T1 and T2 signal within the vertebral bodies are compatible with benign hemangiomas and/or focal fat deposition. There is an area of cortical irregularity and/or defect involving the anterior inferior lateral aspect of the left T12 vertebral body with associated edema signal within the vertebral body. In addition, there is asymmetric enlargement and edema involving the left psoas muscle from T12 to approximately L4 without associated discrete collections.Mild facet arthropathy affects the lower lumbar spine. No significant disc pathology is noted within the lumbar spine. No significant central canal or foraminal stenosis. The visualized spinal cord, conus and nerve roots of the cauda equina are within normal limits.

Output: 1.Left anterolateral cortical irregularity and associated bone marrow edema involving the T12 vertebral body which is nonspecific but may reflect traumatic injury. There is associated edema involving the left psoas muscle. CT of the thoracolumbar lumbar spine is recommended for additional evaluation.2.Minimal degenerative changes of the lumbar spine without significant central canal or foraminal stenosis.


Instruction: Generate impression based on medical findings.

Input: 43 year-old right-handed male with recurrent GBM, WHO grade IV, IDH1 R132H mut, ATRX wt, s/p outside resection on 3/7/2016; compare to prior MRI on 4/28/16; currently s/p 2 cycles of IDO immunotherapy plus TMZ There are post-surgical findings of a right-sided craniotomy with removal of a right inferior parietal lobule and adjacent temporal lobe mass. The resection cavity is CSF signal intensity with surrounding siderosis appearing less prominent compared to prior exam. There is a small linear focus of enhancement along the superior aspect of the resection cavity, which may represent granulation tissue or a vessel. There are multiple scattered tiny enhancing nodules along the resection cavity appearing similar to prior exam. The previously described more heterogeneous prominence along the inferolateral aspect of the resection cavity appears decreased in thickness, with the hypo-enhancing central component no longer visualized.There are more conspicuous nodules now noted along the posterior aspect of the right thalamus extending laterally to the resection cavity, which do not demonstrate increased perfusion. However, on coronal images which are the best direct comparison, there is now a triangular-shaped area of enhancement along the lateral aspect of the unroofed portion of the right lateral ventricle, which demonstrates hyperperfusion and appears more confluent and conspicuous on this exam. This appears band-like on axial images, with increased extent of associated FLAIR hyperintensity. Additional areas of new linear enhancement along the right posterior body of the corpus callosum with extension along the right fornix as well as the left splenium/ependymal surface and right occipital horn lateral ependymal surface are also noted and demonstrate corresponding hyperperfusion and FLAIR hyperintensity. There is also ill-defined enhancement along the right splenium with mild hyperperfusion and FLAIR hyperintensity.There are bilateral extra-axial collections with the right collection appearing similar in size, measuring up to 9 mm. The left-sided collection appears nearly resolved with heterogeneous areas of increased susceptibility and diffusion restriction suggestive of residual blood products. Interval more focal blood products are also noted within the left paramedian anterior frontal and left posterior parietal subdural space measuring up to 6 mm in greatest thickness.There is redemonstration of an arachnoid cyst within the left middle cranial fossa measuring approximately 70 x 39 mm in AP and transverse dimensions (series 301, image 10). The cyst is still slightly T1 hyperintense with respect to CSF, but more homogeneously hyperintense on FLAIR. A definite fluid-blood level is no longer visualized. There is no associated diffusion restriction.There is no evidence of acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact.

Output: 1. Post-surgical findings of a right-sided craniotomy for prior resection of a right inferior parietotemporal lobe mass. There are multiple areas of stable scattered nodular enhancement along the margins of the resection cavity, with a few additional progressed or new nodular areas of enhancement extending from the margins some of which demonstrate hyperperfusion, including involvement of portions of the corpus callosum as well as scattered ependymal surfaces along the lateral ventricular margins. Findings are suspicious for tumor progression.2. Ill-defined nodular enhancement which appears progressed along the posterior aspect of the right thalamus, and does not demonstrate hyperperfusion.3. Previously described more heterogeneous prominence along the inferolateral aspect of the resection cavity appears decreased in prominence, likely evolved post-operative changes.4. Bilateral extra-axial collections appearing improved from prior exam. The right-sided collection is essentially stable, while the left-sided collection is nearly resolved except for a few areas of interval although non-acute more focal blood products, as detailed above.5. Interval expected evolution of blood products in left middle cranial fossa arachnoid cyst.


Instruction: Generate impression based on medical findings.

Input: 43-year-old male with right knee pain status post partial medial meniscectomy and patellar chondroplasty 5 years ago. Evaluate for medial meniscus tear versus chondromalacia. MENISCI: There is a defect in the undersurface fibers of the free edge of the posterior horn of the medial meniscus. There is branching intermediate signal intensity within the body of the medial meniscus which appears to extend to this defect as well as to both the tibial and femoral articular surfaces. Additional bandlike intermediate signal intensity within the posterior horn of the medial meniscus extends to this defect on multiple sequential images. This constellation of findings is more suggestive of a tear rather than postoperative changes. The anterior horn of the medial meniscus appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is thinning of the articular cartilage along the medial femoral condyle above the body of the medial meniscus. There is minimal edema type signal abnormality within the posterior aspect of the tibial plateau which is presumably degenerative in etiology. There is mild heterogeneity of the signal of the articular cartilage along the medial facet of the patella which may represent a combination of articular cartilage degeneration or postsurgical changes. There also appears to be a small fissure partially traversing the articular cartilage of the medial facet of the patella. We see no large fluid-filled defect. The trochlear cartilage appears intact.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Findings compatible with a medial meniscus tear and articular cartilage degeneration as described above.


Instruction: Generate impression based on medical findings.

Input: Right knee pain MENISCI: The lateral meniscus is intact and unremarkable. The medial meniscus however demonstrates irregularity and abnormal signal along the apical aspect with marked fraying and mild globular signal within the central body. No discernible discrete focal tear extends discretely into the body or either horn.ARTICULAR CARTILAGE AND BONE: Mild to moderate diffuse thinning of the cartilage more pronounced in the patellofemoral surface. This latter area demonstrates additional focal defects and no regular surface greater along the lateral facet. Minimal underlying early degenerative changes. Marrow signal otherwise unremarkable. Mild associated degenerative osseous changes.LIGAMENTS: No abnormality noted, ligaments are intact and well-visualized. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Medial meniscal fraying with associated mild degeneration of the medial meniscal body as described. Small to moderate effusion and associated mild scattered degenerative changes


Instruction: Generate impression based on medical findings.

Input: Reason: elevated PSA eval for prostate cancer History: see aboveBiopsy 2/10/2014: left apex Gleason 6 adenocarcinoma.Biopsy 10/28/2013: left mid Gleason 6 adenocarcinoma. Left apex is 6 adenocarcinoma PELVIS:PROSTATE:Prostate Size: 5.4 x 4.1 x 4.6 cm.Peripheral Zone: Diffuse low T2 signal throughout the peripheral zone may reflect chronic prostatitis and limits sensitivity of prostate MRI.There is a T2 hypointense lesion in the left apex measuring 1.2 x 0.9 cm with intermediate ADC signal and early enhancement, similar to the prior exam. No new lesions are evident.Central Gland: BPH nodules.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: Subcentimeter left external iliac nodes are stable.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Left apical lesion is stable and consistent with biopsy-proven adenocarcinoma. No new lesions are evident.


Instruction: Generate impression based on medical findings.

Input: right hip septic arthritis status post surgical drainage and IV antibiotics. There is a small amount of fluid signal intensity anterior to the right femoral head and deep to the the tensor fascia lata and iliopsoas muscles which demonstrates enhancement on postcontrast images which is compatible with postsurgical change. The right hip joint effusion seen on the previous study has resolved but there is persistent enhancement of the synovium which is not unexpected. There is high T2 and low T1 signal within the posterior acetabulum on the right which has not progressed in size since the previous exam, this area has abnormal enhancement on postcontrast images. Mild enhancement is also seen along the medial aspect of the right acetabulum and the lateral aspect of the obturator internus muscle although this has improved markedly compared to the prior exam.The remaining osseous structures are within normal limits for the patient's age.There is no pelvic free fluid. No evidence of bowel obstruction.

Output: 1.Resolution of the right hip effusion status post surgical drainage. There is persistent synovial enhancement which is not unexpected given the history of septic joint and surgical intervention.2.Osteomyelitis of the posterior right acetabulum appears similar to the previous exam, clinical correlation is needed as imaging finding may lag behind clinical response. 3.Edema and subperiosteal fluid medial to the acetabulum on the right have improved.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: Male 26 years old Reason: r/o torn meniscus History: swelling pain MENISCI: There is an obliquely orientated focus of increased signal intensity extending through the peripheral fibers of the posterior horn of the lateral meniscus to the femoral articular surface, indicating a tear that is continuous with the interface of the meniscus with the meniscofemoral ligament. Furthermore the popliteomeniscal fascicles appear distorted and torn. The body and anterior horn of the meniscus demonstrate normal signal intensity and morphology. The medial meniscus demonstrates normal signal intensity and morphology.ARTICULAR CARTILAGE AND BONE: There is edema within the posterior aspect of the lateral tibial plateau as well as the lateral femoral condyle above the anterior horn of the lateral meniscus. The articular cartilage is intact.LIGAMENTS: The anterior cruciate ligament is abnormally thickened and of increased signal intensity indicating at least a partial thickness tear. The slope of the distal fibers is maintained but the proximal fibers are distorted. The posterior cruciate ligament demonstrates normal signal intensity and morphology. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Findings consistent with at least a partial-thickness anterior cruciate ligament tear as well as a tear of the posterior horn of the lateral meniscus.


Instruction: Generate impression based on medical findings.

Input: 27-year-old female with pain ROTATOR CUFF: High T2 signal at the undersurface of the supraspinatus tendon approximately 1 cm from its insertion. Normal muscle bulk. No fatty infiltration.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: High T2 signal through the inferior aspect of the glenoid and labrum at the six o'clock position may represent a minimally displaced fracture. Intermediate signal at the inferior glenoid labrum compatible with granulation tissue possibly from prior surgery. Additional linear high T2 signal at the anterior inferior aspect of the glenoid labrum at approximately the 4 o'clock position. There is an additional associated nondisplaced fracture line.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1.Inferior labral tear tears with presumable chronic inferior glenoid fractures at the six o'clock and four o'clock positions as described above.2.Abnormal signal along the undersurface of the supraspinatus may represent partial undersurface tearing or tendinosis of the supraspinatus.


Instruction: Generate impression based on medical findings.

Input: Cervical spine: There is slight reversal of normal upper cervical lordosis without fracture. There is mild degenerative marrow signal heterogeneity without discrete suspicious osseous lesion. The cervical cord is normal in signal. There is mild degenerative cervical spondylosis with level specific findings as follows: C2-3: No significant central canal or neuroforaminal stenosis. C3-4: Mild posterior osteophyte disc complex without cord abutment or stenosis.C4-5: Posterior osteophyte disc complex causes anterior midline cord flattening without intrinsic cord signal abnormality. There are no significant stenoses. A focal disk protrusion seen on the prior study appears improved. C5-6: Posterior osteophyte disc complex and bilateral uncinate hypertrophy. There is moderate left neural foraminal and mild right neural foraminal stenosis.C6-7: Posterior osteophyte disc complex abuts the cord without deformation or stenosis. There is moderate left and mild right neural foraminal stenosis.C7/T1: Minimal midline posterior osteophyte disc complex without stenosis.Thoracic spine: There is a smooth, physiologic thoracic kyphotic curve. The vertebral body heights and disc spaces are maintained. Marrow signal intensity is benign throughout. The spinal cord has a smooth contour and is without focal atrophy, edema, or myelomalacia. There is no significant central canal or neuroforaminal stenosis. There is mild dependent pleural fluid versus thickening. Lumbar spine: Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. A simple renal cyst is present on the left, otherwise the visualized intra-abdominal and paraspinal contents are unremarkable.L1-2: No significant central canal or neuroforaminal stenosis. L2-3: No significant central canal or neuroforaminal stenosis. L3-4: Mild disc bulge and slight ligamentum flavum thickening without associated stenosis.L4-5: Disk bulge and slight ligamentum flavum thickening, and moderate bilateral facet hypertrophy containing bilateral facet effusions. There is mild bilateral lateral recess and mild bilateral neural foraminal stenosis.L5/S1: Mild disc bulge without stenosis.

Output: 1. No suspicious lesions in the cervical, thoracic, or lumbar spine, and no significant interval change since the prior study from 8/11/12. 2. Mild cervical and lumbar degenerative disease as detailed above is not significantly changed. 3. Please see separately dictated MRI pelvis report for description of findings in the pelvis.


Instruction: Generate impression based on medical findings.

Input: Assess for encephalitis: intermittent seizure-like activity, catatonia, and delusions. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. Scattered areas of sulcal T2-FLAIR hyperintensity are likely attributable to supplemental oxygen. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No imaging manifestations of encephalitis or other potential sources of seizures.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Patient with right vertebral dissection. Signs and symptoms: Diplopia and vomiting. Nonenhanced brain MRI:Examination demonstrates diffuse scattered foci of restricted diffusion in the right cerebellum both inferiorly and superiorly as well as a punctate focus within the right cerebellar tonsil consistent with acute ischemic strokes. Findings are also well visualized on Flair and T2-weighted images. There is no evidence of hemorrhage or mass effect. Fourth ventricle remains within normal size and midline and CSF spaces/cisterns in the posterior fossa remain patent.There is no detectable acute ischemic stroke in the supratentorial brain parenchyma.FLAIR and T2-weighted images demonstrate above detailed acute nonhemorrhagic strokes. Additionally there is a single tiny focus of FLAIR hyperintensity in the subcortical white matter of right parietal lobe which is believed to represent an artifactual finding. The signal void of the right vertebral artery is identified intracranially.Unremarkable cerebral cortex, cortical sulci, ventricular system and CSF spaces.Unremarkable calvarium and soft tissues of the scalp.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.Findings and concerns on this exam were discussed by phone with referring services Fadi Mikhail #6229 at the time of review of the study.

Output: 1.Diffuse patchy foci of acute nonhemorrhagic ischemic stroke in the right cerebellum and right cerebellar tonsil without significant mass effect.2.Unremarkable nonenhanced brain MRI otherwise.


Instruction: Generate impression based on medical findings.

Input: Possible Chiari malformation, headaches, and back pain. The cerebellar tonsils are minimally low-lying, extending up to 3 mm inferior to the foramen of magnum. The cerebellar tonsils display a normal morphology and there is intact CSF flow across the foramen magnum. The spinal cord displays normal signal and morphology, without evidence of syrinx. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: Minimally low-lying cerebellar tonsils with intact CSF flow across the foramen magnum and no evidence of cervical spinal cord syrinx.


Instruction: Generate impression based on medical findings.

Input: Knee pain following injury MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There is a nondisplaced fracture of the lateral tibial plateau with minimal depression of the articular surface. There is some irregularity of the articular cartilage overlying the fracture site of the tibial plateau. The articular cartilage of the remaining lateral compartment appears thin but is otherwise intact. There are no full-thickness defects of the articular cartilage of the medial or patellofemoral compartments.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Nondisplaced fracture of the lateral tibial plateau with minimal depression. There is a large associated lipohemarthrosis. These findings were discussed with the ordering physician Dr. S. Naaman at the time of interpretation.


Instruction: Generate impression based on medical findings.

Input: 72 year old man with history of ischemic cardiomyopathy and previous PCI, with worsening exertional fatigue, referred for cardiac MRI with vasodilator stress testing.MEDICATIONS: aspirin, atorvastatin, carvedilol, clopidogrel, digoxin, furosemide, hydralazine, spironolactone, valsartan First Pass PerfusionDuring hyperemia, there is no residual ischemia out of regions with myocardial scar.Viability/ Myocardial ScarThere is transmural late gadolinium enhancement involving the mid-apical inferolateral wall and apical inferior wall. This pattern is consistent with transmural myocardial infarction and these segments are not viable. There is also non-transmural infarction involving the mid anterolateral wall. This segment has an intermediate probability of viability. There is another region epicardial late gadolinium enhancement involving the basal inferoseptum, inferior, and inferolateral walls that spares the endocardium and is atypical for myocardial infarction. This suggests the presence of underlying myocardial fibrosis, inflammation, or infiltration. Viability within these segments can not be determined as the scar is not "ischemic" in nature. The remainder of the myocardium is viable.Left VentricleThe left ventricle is normal in size with moderately reduced systolic function. The overall LV ejection fraction is 40%, the LV end diastolic volume index is 93 ml/m2 (normal range: 74+/-15), the LVEDV is 199 ml (normal range 142+/-34), the LV end systolic volume index is 56 ml/m2 (normal range 25+/-9), the LVESV is 119 ml (normal range 47+/-19), the LV mass index is 49 g/m2, and the LV mass is 106 g. There is akinesis of the apical inferior, mid-apical inferolateral walls. There is hypokinesis of the mid anterolateral wall. Left AtriumThe left atrium is mild-moderately dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 79 ml/m2 (normal range 82+/-16), the RVEDV is 169 ml (normal range 142+/-31), the RV end systolic volume index is 40 ml/m2 (normal range 31+/-9), and the RVESV is 85 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThere is thickening of the anterior mitral leaflet tip. The mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace 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 grossly normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. There is no residual "ischemia" noted. 2. The LV is normal in size with moderately reduced systolic function (EF 40%). 3. There is akinesis of the apical inferior and mid-apical inferolateral wall with reduced wall thickness and transmural late gadolinium enhancement. Taken together these findings suggest previous myocardial infarction, with no evidence of viability in these segments. 4. Additionally, there is a non-transmural myocardial infarction involving the mid anterolateral wall. This segment has an intermediate probability of viability. 5. There is a non-myocardial infarction pattern of late gadolinium enhancement involving the base of the left ventricle suggesting that the patient's LV dysfunction is due to both ischemic and non-ischemic etiologies.6. Normal size RV with normal systolic function (EF 50%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Patient with metastatic lung cancer with prior brain metastases status post radiation. Signs and symptoms: As above. Pre and post enhanced brain MRI:No evidence of restricted diffusion.Examination redemonstrate a small enhancing metastatic focus in the left anterior temporal lobe measuring approximately 4.5 mm compared to prior study measurement of 6 mm. There is no convincing evidence of any additional enhancing metastases lesions in the left anterior temporal lobe as was reported on prior study.There are no additional foci of parenchymal or leptomeningeal enhancement to suggest additional metastatic lesions. There are however multiple small foci of susceptibility signal changes without enhancement in bilateral cerebral and bilateral cerebellum without change since prior exam which could represent regions of chronic hemorrhage, abnormal, treated metastatic lesions or post treatment related findings.Ventricular system, CSF spaces and cortical sulci remain within normal and without change since prior exam.Calvarium is again demonstrate multiple foci of signal changes and enhancement without convincing evidence of interval change. The enhancement of the left frontal calvarial metastatic lesion is less conspicuous on current study which may be as a result of interval treatment. There is no detectable epidural spread of tumor from calvarial metastatic lesions.Approximately 5 mm left retro-orbital enhancing presumably metastatic lesion demonstrates no significant change.

Output: 1.No acute intracranial process.2.4.5 mm left anterior temporal metastatic lesion compared to prior study measurement of 6 mm. No convincing evidence of additional parenchymal or leptomeningeal enhancing metastatic lesions.3.Stable approximately 5 mm left retro-orbital enhancing metastatic focus.4.Multiple calvarial metastatic lesions without change in the size however the left frontal calvarial metastases demonstrate less conspicuous pattern of enhancement.


Instruction: Generate impression based on medical findings.

Input: Limited examination done for preoperative planning. Motion degraded postcontrast images.There is an enhancing mass in the right posterior frontal lobe measuring 2.0 x 2.2 cm (series 301, image 148). There is minimal localized mass effect. An additional smaller enhancing lesion in the left precentral gyrus measures 0.6 x 0.6 cm (series 301, image 132). There is surrounding high T2 signal compatible with vasogenic edema in the right frontoparietal lobes and left frontal lobe.The ventricles and sulci are mildly prominent compatible with age-related volume loss, aside from the areas of sulcal effacement in the areas of the masses. The cisterns remain patent. There is no midline shift or mass effect. 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. A left maxillary retention cyst is noted, previously noted to be T1 hyperintense on outside imaging.

Output: Enhancing lesions in the bilateral posterior frontal lobes with surrounding vasogenic edema are most consistent with metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Foot pain There is abnormal marrow edema of the first metatarsal extending from the proximal diaphysis into the head. A discrete fracture line is not visualized although there is a small full-thickness articular cartilage defect of the head of the metatarsal best appreciated on series 901 image 11/48.The marrow signal of the visualized tarsals, metatarsals and phalanges is normal.There is soft tissue edema surrounding the head of the first metatarsal with a trace amount of fluid in the first metatarsophalangeal joint felt to be reactive in nature. The remaining soft tissues and muscles are normal. The visualized extensor and flexor tendons are also normal.

Output: Small full-thickness cartilage defect of the head of the first metatarsal with associated marrow edema throughout the diaphysis. No discrete fracture line is identified.


Instruction: Generate impression based on medical findings.

Input: 33 years, Female, multiple sclerosis. Numbness, weakness left leg. Follow-up for progression.. There are greater than 20 T2/FLAIR hyperintense lesions in the bilateral periventricular and subcortical white matter with morphology and distribution compatible with known demyelinating disease. There are slight difference in technique with the most recent study 12/17/2015 performed with thicker slices, while the study from 11/4/2014 is more comparable to the current study. Since 11/4/2014 there appear to be at least 2 new lesions involving the left posterior frontal white matter, series 501 images 47 and 51. The more inferior medial one was also present on most recent study 12/17/2015 while the more superior lateral one is not definitively present on 12/17/2015. No posterior fossa lesions are definitively appreciated.There is mild burden of T1 hypointense lesions. Brain parenchymal volume is preserved. No intracranial mass or mass effect. Ventricles and sulci are within normal limits. Calvarium and extracranial soft tissues are grossly unremarkable.

Output: Findings suggesting very mild gradual progression of demyelinating disease with two new left posterior frontal lobe lesions since 11/4/2014, and one new lesion since 12/17/2015.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Abdominal pain, other specified site. Backache, unspecifiedClinical question: evaluate for lumbar pathology for lower back pain and left sided abdominal painSigns and Symptoms: left sided pain and back pain Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There are perineural cysts present at the S2-S3 level within the sacral spinal canal eccentric towards the right side. There is some mild disc desiccation present.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is some loss of disc space height, disc desiccation and a diffuse disc bulge at this level associated with endplate reactive changes which are right on T2 and bright on T1. The endplate reactive changes are eccentric towards the right side.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is mild loss of disc space height at this level associated with a very minor disc bulge.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge present at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There are mild degenerative changes present in the lumbar spine without significant compromise to spinal canal or exiting nerve roots.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Evaluate CSF flow. Signs and symptoms: Left ear pain, status post foramen magnum to the atrial shunt. Nonenhanced brain MRI:Diffusion weighted images are severely compromised due to extensive metallic artifact. The images and the artifact demonstrate no abnormalities.Examination demonstrates extensive postoperative changes of Chiari decompression without appreciable change since prior study. There is prolapse of the cerebellum into the expanded thecal sac and neo foramen magnum similar to prior exam without visible CSF signal. A stent is noted extending from the fourth ventricle posteriorly and abutting the craniectomy site similar to prior exam.There is interval increased size of the fourth ventricle superiorly and extending into distal aqueduct with resultant elevation of the quadrigeminal plate posteriorly. It measures at approximately 11.5 x 14 mm in transaxial dimensions compared to prior study measurement of approximately 7 mm in transaxial. There is however no evidence of supratentorial ventriculomegaly. The normal size of supratentorial ventricles remain stable since prior study and with maintained midline. Cerebral cortex and cortical sulci and the supratentorial CSF spaces remain within normal and stable since prior exam. Signal void the major intracranial arterial branches are identified. The signal intensity of intracranial venous sinuses appear normal.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.CSF flow study:Demonstrate presence of biphasic flow anteriorly through the foramen magnum however significantly compromised at the level of the dens and with suggestion of interval worsening since prior. There is no detectable flow posteriorly through the foramen magnum.Previously noted flow through the fourth ventricle is significantly less conspicuous compared to prior exam.Nonenhanced cervical MRI:Stable postoperative changes of Chiari decompression as detailed in MRI of brain is again identified.A non-expansile syrinx involving the entire cervical cord demonstrate no interval change since prior exam. Straightening of cervical lordosis similar to prior study.Nonenhanced thoracic MRI:There is revisualization of a mildly expansile syrinx of the thoracic cord superiorly contiguous with syrinx of cervical cord and inferiorly terminating at T10 level similar to prior exam. The most expansile component of syrinx extends from approximately T2 inferiorly to T5 level and measuring maximum of 4.5-mm in transverse axis at T2 level similar to prior exam.There is normal signal intensity and anatomical alignment the vertebral column similar to prior study. No spinal stenosis or neural foraminal compromise is detected at any level.

Output: 1.Nonenhanced brain MRI demonstrate interval increased size of the superior aspect of the fourth ventricle and the distal aqueduct with resultant mass-effect and superior displacement of the quadrigeminal plate as detailed/measured. Stable exam otherwise and with revisualization of extensive Chiari decompression postoperative changes detailed above. CSF flow study demonstrate diminished flow through the foramen magnum anteriorly compared to prior exam and significantly less conspicuous flow through the fourth ventricle and the aqueduct since prior study.2.Nonenhanced MRI of the cervical spine demonstrate no evidence of an acute or new finding since prior study. Stable non-expansile syrinx involving the entire cervical cord since prior exam.3.Nonenhanced MRI of the thoracic spine demonstrate no evidence of an acute or new finding since prior study. Stable mildly expansile syrinx of thoracic cord extending from cervical spine inferiorly to T10 level similar to prior exam.


Instruction: Generate impression based on medical findings.

Input: Prostate tumor. Prior biopsy. Elevated PSA. PELVIS:PROSTATE:Prostate Size: 3.5 x 1.7 x 2.8 cmPeripheral Zone: 8 x 6 mm enhancing T2 hypointensity in the left mid gland with corresponding diffusion restriction is consistent with the patient's known prostate cancer, previously 9 x 6 mm. Central Gland: Heterogeneous without suspicious lesions.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted. Subcentimeter bilateral external iliac lymph nodes, unchanged.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Stable size and appearance of the patient's known prostate carcinoma.


Instruction: Generate impression based on medical findings.

Input: History of Crohn's disease at the TI. Evaluate extent of disease. 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: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Acute inflammation involving the terminal ileum and the surrounding proximal small bowel loops as well as suspected involvement of the adjacent sigmoid colon. These bowel loops are angulated and drawn in centrally towards the distal ileum with signal characteristics consistent with acute inflammation. A fistulous communication between the distal ileum and sigmoid colon is not visualized but cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: 66-year-old male with a right acetabular lesion and pain. Follow-up right acetabular lesion. BONE MARROW: Metallic susceptibility artifact from a right femoral intramedullary rod and screw device limits evaluation of the right hip. Note is made of foci of signal void along the superior and posterior aspect of the right hip which are presumably postsurgical in etiology.The reference ill-defined lesion along the superior aspect of the right acetabulum is not definitively visualized on today's examination and may represent postsurgical or posttraumatic bone marrow edema. There is a 17 x 16 x 15 mm (TR x AP x CC) focus of increased signal abnormality on fluid sensitive sequences within the right sacrum which enhances on postcontrast sequences (image 39; series 11), appearing similar to the prior study. There is an additional 8 mm focus of enhancing signal abnormality along the superomedial aspect of this sacral lesion (image 38; series 11).Note is made of heterogeneous bone marrow signal abnormality which is nonspecific but may reflect residual islands of red marrow.SOFT TISSUES: The imaged musculature of the pelvis is normal in appearance.JOINTS: There is a small amount of fluid within the femoroacetabular joints, bilaterally, which is not necessarily of any clinical significance.ADDITIONAL

Output: 1. Near complete interval resolution of the previously described lesion within the superior right acetabulum as described above.2. There is a 17 mm enhancing lesion within the right sacrum with an additional adjacent satellite lesion which is nonspecific, however, metastatic disease cannot be excluded, particularly in the setting of a known primary malignancy. Follow-up examination is recommended to evaluate for interval change and establish stability.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate for metastatic lesions History: pelvic lucencies on xray Note is made of innumerable foci of enhancement with associated decreased signal abnormality T1-weighted images and increased signal abnormality on fluid sensitive sequences affecting all of the bones of the pelvis, as well as multiple lesions within the proximal femora, bilaterally, and the imaged lower lumbar spine, consistent with metastatic disease. The largest lesion is situated within the right sacral wing. There is associated enhancing increased signal abnormality within the adductor musculature on the right likely representing soft tissue extension of disease. Note is made of a fat-containing right inguinal hernia. Mild osteoarthritis affects the hips. There is fatty infiltration of the musculature of the pelvis.

Output: Diffuse osseous metastatic disease involving the imaged bones of the pelvis and proximal appendicular skeleton.


Instruction: Generate impression based on medical findings.

Input: There is significant dilatation of the bilateral lateral ventricles due to a large intra- and suprasellar mass invading and obstructing the third ventricle. Periventricular T2 hyperintensity is compatible with transependymal flow. There is a large multicystic and solid mass arising from the sella with osseous remodeling of the sphenoid body. The entire left sphenoid sinus and the majority of the right sphenoid sinus are obliterated by the mass. The mass measures 4.9 x 6.3 x 4.2 cm and the solid portions avidly enhance. The superior portion of the mass is predominantly multicystic with fluid-fluid levels, which may represent blood, and scattered intrinsic T1 signal hyperintensity. There is encasement of the left internal carotid artery and lateral displacement of the right internal carotid artery. The right internal carotid artery is asymmetrically smaller compared to the left. The additional vessels within the circle of Willis are displaced peripherally by the mass. Presumably the optic chiasm and optic tracts are stretched, but are not clearly delineated on this examination.The cavernous sinus is likely filled with tumor. The right Meckel's cave is visualized and the left Meckel's cave is not visualized. There is mild bilateral convexity dural thickening and enhancement, likely secondary to recently shunt placement. Note that diffusion-weighted images are nondiagnostic anteriorly, as there is also dental hardware resulting in artifact.There are two frontal approach shunt catheters in place. The shunt catheter on the right extends to midline immediately superior to the suprasellar mass. The left catheter tip is in the body of the left lateral ventricle. A punctate focus of susceptibility effect is noted in the dependent portion of the left occipital horn, likely blood product secondary to shunt placement. Small amount of air in the nondependent portion of the right lateral ventricle. No extra-axial fluid collection is identified.

Output: 1.Large intrasellar and suprasellar partially multicystic enhancing mass causing hydrocephalus from obstruction of the third ventricle most likely represents a craniopharyngioma, versus other etiologies such as an adenoma, or less likely a germ cell tumor or primary astrocytoma.2.Encasement of the left internal carotid artery by the mass and lateral displacement of the right internal carotid artery.


Instruction: Generate impression based on medical findings.

Input: There is now thick irregular enhancement in the site of the previous resection cavity and along the surgical tract in the left occipital lobe. No diffusion restriction in the area of the enhancement. There has been extensive interval increase in the associated T2/FLAIR hyperintensity surrounding the resection cavity, with predominantly white matter involvement although some cortex is also involved. There is associated mass effect, specifically on the left lateral ventricular atrium which is displaced anteriorly and partially effaced, as well as sulcal effacement. No midline shift. No additional enhancing lesions are noted.

Output: Interval significant increased irregular enhancement in the left occipital lobe resection cavity and surgical tract as above. Extensive associated T2/FLAIR hyperintensity with localized mass effect. Differential considerations include radiation necrosis, and perhaps slightly less likely tumor recurrence. Clinical correlation with history of radiation port/field is recommended. Additionally, supplemental MR perfusion imaging, with or without spectroscopy, is recommended for a more complete evaluation.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old, with urinary incontinence. Evaluate for cord compression. History of renal cell cancer with metastases. Alignment is anatomic. Vertebral body height and morphology are within normal limits. No areas of pathologic marrow replacement or edema are seen. No epidural lesions are suspected. There is no significant compromise of the spinal canal and there are no findings to suggest cord compression. Disc osteophyte disease is seen in the cervical spine.

Output: No evidence of cord compression.


Instruction: Generate impression based on medical findings.

Input: 16-year-old male with a history of a scaphoid fracture presents with persistent wrist pain. LIGAMENTS: No significant abnormality noted.TRIANGULAR FIBROCARTILAGE COMPLEX: No significant abnormality noted.TENDONS: No significant abnormality noted. BONES: Low T1, high T2 signal through the distal pole and waist of the left scaphoid. The remaining bones are normal in appearance.ADDITIONAL

Output: Abnormal signal through the distal pole and waist of the left scaphoid is suggestive of avascular necrosis.


Instruction: Generate impression based on medical findings.

Input: 47 years, Male, with multiple sclerosis. Paresthesias. Evaluate for progression. There are approximately 20 periventricular and subcortical supratentorial as well as infratentorial T2/FLAIR hyperintense lesions in the white matter with morphology and distribution consistent with known demyelinating disease. Multiple lesions are seen along the corpus callosum. Infratentorial lesions include the pons, right middle cerebellar peduncle, and right cerebellar hemisphere. Several apparent foci of hyperintensity in the cerebellum are most likely artifactual. Compared to 6/21/2013, no new lesion is definitively appreciated. Multiple lesions with T1 hypointensity are again seen. There is minimal global brain parenchymal volume loss including thinning of the corpus callosum. No intracranial mass or mass effect. No hydrocephalus. Bone marrow signal and extracranial soft tissues are unremarkable. Patchy opacification of the ethmoid sinuses again seen.

Output: No convincing evidence of progression of chronic demyelinating disease in the brain compared to 6/21/2013.


Instruction: Generate impression based on medical findings.

Input: History of diabetes, hypertension, blindness, presenting to the ED for evaluation of confusion/disorientation with slurred speech.. There is no evidence of intracranial hemorrhage, mass, or acute infarct. However, there is mild scattered cerebral white matter T2 hyperintensity without corresponding restricted diffusion. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are grossly unremarkable. There is mild scattered paranasal sinus mucosal thickening. There is bilateral intraocular silicone oil and a left superotemporal glaucoma drainage device.

Output: 1. Mild probable chronic small vessel white matter ischemic disease, but no evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Bilateral intraocular silicone oil.


Instruction: Generate impression based on medical findings.

Input: Reason: HCC screening History: Hepatitis C cirrhosis. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. Trace perihepatic ascites.There is redemonstration of a lesion within hepatic segment 7 which has not significantly change in size with reference measurements below. The lesion demonstrates increased T2 signal (more pronounced than prior), restricted diffusion, and arterial enhancement without definite washout.There is an additional arterially enhancing lesion more posteriorly within hepatic segment 7 with reference measurements below which demonstrates washout on more delayed images.The hepatic vasculature appears patent. Upper abdominal collateral vessels.Cholelithiasis. No significant biliary ductal dilatation.SPLEEN: The spleen is enlarged and measures up to 20 cm in the craniocaudal dimension. T2 hyperintense lesion within the anterior aspect of the spleen most consistent with hemangioma, not significantly changed.PANCREAS: No significant abnormality noted. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Susceptibility artifact related to IVC filter.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.INDEX LESION MEASUREMENTS (Current exam date/time: 9/16/2016 14:00:00)HEPATIC SEGMENT 7 ANTERIOR LESION: 1.3 x 1.0 cm (Image 154, Series 10); 1.3 x 1.0 cm on prior (7/28/2015) (Image 15, Series 10).HEPATIC SEGMENT 7 POSTERIOR LESION: 0.7 x 0.6 cm (Image 170, Series 10); 0.7 x 0.6 cm on prior (7/28/2015) (Image 27, Series 10).

Output: 1.Hepatic segment 7 arterially enhancing lesion which lacks washout but demonstrates newly increased T2 signal and restricted diffusion and is suspicious but not definitive for early HCC. 2.Additional hepatic segment 7 arterially enhancing 7 mm lesion which newly demonstrates washout and which is suspicious for HCC.3.Cirrhotic liver with sequelae of portal hypertension.


Instruction: Generate impression based on medical findings.

Input: 50 year-old female with pancreatic cancer on chemotherapy (gemcitabine). Additional history reveals patient is status post Whipple and radiation treatment. Please evaluate disease status. CHEST:LUNGS AND PLEURA: Bilateral pleural effusions with compressive atelectasis. Mild emphysema. No lung nodules identified.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Right-sided Port-A-Cath tip is in the SVC. No evidence of osseous metastatic disease. Bilateral thyroid nodules.ABDOMEN:LIVER, BILIARY TRACT: The liver is diffusely low-attenuation, due to fatty infiltration. In the posterior inferior right lobe of the liver the hypervascular lesion is grossly stable in size, measuring 2.4 x 1.9 cm (image 94/11 of series 4). This avid enhancement is unusual for a adenocarcinoma metastasis to the liver; however, enhancement on this study may appear exaggerated given the degree of fatty infiltration. The adjacent lesion in the lateral aspect of the liver is also grossly stable in size, currently measuring 1.1 x 0.8 cm (image 96/211 of series 4). This hypodense lesion in the left lobe liver near the falciform ligament is unchanged and had characteristics of a simple cyst on the patient's recent MRI. Attenuation differences within the liver elsewhere are likely due to transient differences due to phase of enhancement.There is a subcapsular fluid collection anterior to the right lobe of the liver. This measures 4.0 x 1.9 cm (image 68/211 series number 4).Extensive postsurgical changes are identified in the porta hepatis. There is fluid attenuation throughout the porta hepatis which may be postsurgical in etiology. Extrahepatic portal vein occlusion noted. Numerous varices are identified throughout the abdomen.SPLEEN: Stable mild splenomegaly. The splenic vein appears to drain inferiorly into the inferior mesenteric vein and there are splenic vein collaterals.PANCREAS: Patient status post Whipple with pancreatic head removal.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: The azygos and hemiazygos systems are dilated due to collateral blood flow.BOWEL, MESENTERY: Multiple collateral vessels are identified in the lack of flow through the portal vein. Diffuse ascites. There is diffuse infiltration of the mesentery as well as multiple soft tissue nodules which may be due to ascites. BONES, SOFT TISSUES: No significant abnormality noted. The osseous abnormalities identified on the patient's recent MRI are not seen on this exam.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The well-defined lesion identified medially to the right of the rectum measures 2.0 x 1.4 cm (image 29/211). This has peripheral calcification. Diffuse ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Gross stability of the two enhancing lesions in the right lobe of the liver. While the hypervascularity of these lesions is unusual for pancreatic adenocarcinoma, enhancement may be exaggerated given the degree of fatty infiltration throughout the remainder of the liver. Both should be followed to confirm stability.2. Multiple collateral vessels and ascites likely secondary to portal vein occlusion.


Instruction: Generate impression based on medical findings.

Input: Reason: adnexal mass History: pelvic discomfort. History of breast cancer.Ultrasound report 4/29/2016: An ovary is seen midline and is normal in size and appearence. This is presumed to be the right ovary. A cyst with low level echoes, measuring 55 x 53 x 42 mm, is seen in the left adnexa. This may represent the left ovary. No free fluid visualized in pelvis. PELVIS:UTERUS, ADNEXA: Status post hysterectomy. 3 mm left Bartholin's gland cyst.The right ovary is normal-appearing containing small follicles measuring 4.6 x 3.4 cm. The left ovary measures 1.9 x 2.4 cm and contains small follicles.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: There is a small to moderate amount of free fluid in the pelvis, decreased since the prior CT.

Output: 1.Normal-appearing ovaries with small follicles.2.Small to moderate amount of fluid within the cul-de-sac is decreased from the prior exam likely represents loculated free fluid.


Instruction: Generate impression based on medical findings.

Input: 69-year-old male patient with history of elevated PSA. Evaluate for targetable lesions. PELVIS:PROSTATE:Prostate Size: 5.6 x 5.4 x 6.7 cm. Peripheral Zone: There is a 4 mm focus in the left base adjacent/contiguous to the transitional zone which demonstrates T2 hypointensity, ADC hypointensity, and early enhancement. Central Gland: The central gland is enlarged with BPH nodules. Seminal Vesicles: No significantly abnormality.Extracapsular Extension: Not applicable.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 4 mm lesion in the left base which likely represents an extension of BPH in the peripheral zone, however, a cancer cannot be excluded by MRI.


Instruction: Generate impression based on medical findings.

Input: Male 22 years old. Reason: r/o fx, surgical complication. History: right knee swelling, s/p patellar tendon repair. Four non-weightbearing views of the right knee demonstrate thickening of the patella tendon, particularly proximally, more so than seen on prior study. There are calcifications in the soft tissues along the inferior margin of the patella. We see no large joint effusion.

Output: Patellar tendon thickening and calcifications along the inferior margin of the patella as described above. These findings may reflect chronic tendinopathy and old post operative changes, however, we cannot exclude a superimposed "acute" partial thickness tear of the patellar tendon proximally. If further imaging is clinically warranted, MRI may be considered.


Instruction: Generate impression based on medical findings.

Input: Reason: fibroids, considering UFE History: heavy periods PELVIS:UTERUS, ADNEXA: The uterus measures 10.0 x 9.3 x 11.7 cm.There are innumerable intramural and subserosal fibroids within the uterus. No submucosal fibroids. Most of these lesions are only faintly enhancing. There is no avid enhancement within any particular lesion. For reference, a large subserosal fibroid at the fundus measures 3.3 x 4.2 cm (5/21). An intramural fibroid measures 2.5 x 2.9 cm (5/12).BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Innumerable subcentimeter foci in the subcutaneous tissues which are hypointense on T2 and isointense on T1 may be related to subcutaneous injections.OTHER: No significant abnormality noted.

Output: Innumerable subserosal and intramural fibroids within the uterus, measuring up to 4.2 cm, which demonstrate minimal enhancement. None of these lesions are avidly enhancing.


Instruction: Generate impression based on medical findings.

Input: 29-year-old with history of radical prostatectomy with persistently elevated PSA. Positive bladder neck surgical margin and positive lymph node. PELVIS:PROSTATE:Status post prostatectomy. There are small foci of susceptibility in the resection bed which is an expected postoperative finding. No definite residual enhancing soft tissue to indicate local recurrence.Seminal Vesicles: Surgically absent.BLADDER: Moderate bladder distention without bladder wall thickening or trabeculation.LYMPH NODES: There is a mildly prominent enhancing left common iliac lymph node which measures 7 x 10 mm, (series 1501 image 114). There are scattered normally sized inguinal and low pelvic lymph nodes.BONES, SOFT TISSUES: No focal suspicious lesion.OTHER: No significant abnormality noted.

Output: 1.Postoperative changes from radical prostatectomy without evidence of residual enhancing tumor to indicate local recurrence.2.Enhancing left common iliac lymph node as described above. This is nonspecific, but additional follow-up is warranted.


Instruction: Generate impression based on medical findings.

Input: Altered mental status MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is punctate SWI signal hypointensity along the right and left frontal subcortical white matter and medial left parietal subcortical white matter.There is patchy T2 and FLAIR signal hyperintensity along the pons and right thalamus.There are a couple right sided periventricular white matter lesions present which display T2 and FLAIR signal hyperintensity.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.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is a 2.5 mm left communicating segment ICA aneurysm directed inferiorly and posteriorly. The proximal portion of the left anterior choroidal artery courses adjacent and medial to this aneurysmThere is no evidence for intracranial cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The right PCOMA is large. The left PCOMA is small. The vertebral arteries are similar in size.There is fenestration of the left A1 segment.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.

Output: 1.No evidence for acute ischemic cerebral infarction.2.2.5mm left PCOMA aneurysm. Long term follow-up imaging is suggested.3.Several subcortical microhemorrhages are non-specific, however, it could represent early evidence for amyloid angiopathy.4.Lesions in the pons and right thalamus are suspected to be vascular related.5.No evidence for carotid or vertebral cervical cerebrovascular occlusive disease.6.Fast sequences were used due to patient instability. This may decrease sensitivity to smaller lesions.


Instruction: Generate impression based on medical findings.

Input: 61 years, Female, new onset headaches No intracranial mass or mass effect. No intracranial hemorrhage. There are multiple foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild to moderate chronic small vessel ischemic changes. No diffusion abnormality to suggest recent ischemia. There is global parenchymal volume loss which appears advanced for patient's age. No hydrocephalus. No extra-axial collections. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. There is minimal mucosal thickening involving the paranasal sinuses which are otherwise clear. There is moderate opacification of the right mastoid air cells. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. No evidence of intracranial mass or mass effect.2. Mild to moderate chronic small vessel ischemic disease.3. Global parenchymal volume loss which appears mildly prominent for age.


Instruction: Generate impression based on medical findings.

Input: Subarachnoid hemorrhage. Subarachnoid hemorrhageClinical question: R Pcomm aneurysm coilingSigns and Symptoms: R PComm aneurysmOPERATORS: Greg ChristoforidisFLUOROSCOPY TIME: 40.9 minutesFrontal: 1406.64 mGyLateral: 1785.82 mGyPROCEDURES: 1) cerebral angiogram 2) Intracranial cerebral aneurysm coil embolization with balloon assistance. 3) 3-D reconstructions of intracranial right internal carotid artery 4) Expert CT of the head without contrast. CT head: The ventriculostomy tip is located in the frontal horn of the right lateral ventricle. There is subarachnoid blood present and ventriculomegaly with intraventricular blood.Right common carotid artery: No stenosis at the carotid bifurcation on the basis of NASCET criteria. There is no evidence for carotid dissection. There is an atherosclerotic web at the right common carotid bifurcation.Right internal carotid artery: There is opacification of the right anterior, middle and posterior cerebral arteries. Venous and parenchymal phases were within normal limits. The right A1 segment is small and the right A2 segment only partially opacifies. There is a 5mmx8mmx6mm aneurysm present at the origin of the right PCOMA which incorporates the origin of the PCOMA at its base.The carotid siphon and cavernous carotid have an irregular wall with mild areas of narrowing.Left common carotid artery: No evidence for carotid stenosis on the basis of NASCET criteria. There is no evidence for carotid dissection. There is mild vessel irregularity at the left common carotid bifurcation.Left internal carotid artery: There is opacification of the left anterior, middle and posterior cerebral arteries and partial opacification of the right anterior cerebral artery. The ACOMA is medium sized. Venous and parenchymal phases were within normal limits. No evidence for aneurysm, AVM or AV fistula. There is an infundibulum at the origin of the left posterior communicating artery which is fairly large and partly opacifies the right PCA.The distal cavernous segment is irregular.Left subclavian artery: No evidence for arteriovenous fistula. No evidence for vertebral dissection.Left vertebral artery: No evidence for aneurysm AVM or arteriovenous fistula. There is opacification of the basilar artery and both posterior cerebral arteries. There is inflow of unopacified blood into the posterior cerebral arteries and into the basilar artery.Right subclavian artery: No evidence for arteriovenous fistula. No evidence for vertebral dissection.Right vertebral artery: No evidence for aneurysm AVM or arteriovenous fistula. There is opacification of the basilar artery and both posterior cerebral arteries.There is transient reverse filling of the left vertebral artery and the posterior communicating arteries.Intraprocedural angiograms:Serial arteriograms performed during aneurysm coiling demonstrate serial occlusion of the aneurysm using balloon remodeling. The balloon remained across the neck of the aneurysm throughout the procedure.Final RICA arteriogram :At the end of the procedure there is no opacification of the aneurysm with preservation of the PCOMA and anterior choroidal artery and no thromboembolic events.Right common iliac artery: No contraindications to closure device. There are atherosclerotic changes along the right common, external and internal iliac arteries.

Output: 1.8mm multilobulated right posterior communicating artery aneurysm.2.Subarachnoid hemorrhage. There is a small amount of intraventricular blood present.3.Ventriculomegaly with ventriculostomy in the frontal horn of the right lateral ventricle.4.Embolic coil occlusion of right PCOMA aneurysm using MRI (up to 3T) compatible coils.5.Findings were discussed with Dr Yamini.


Instruction: Generate impression based on medical findings.

Input: Reason: rule out lumbar radiculopathy. hx of prostate cancer with radiation Rx History: L sciatica but sensory problems in both legs and pain in L paraspinal region Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is loss of lumbar lordosis as well as grade 1 anterolisthesis of L2 on L3 and mild retrolisthesis of L3 on L4. There is also grade 2 anterolisthesis of L5 on S1. The conus medullaris is normal in position. No suspicious lesions are seen in the spine to suggest metastatic disease. No abnormal enhancement in the epidural space or of the cauda equina nerve roots. Perineural cysts noted in the sacrum at the S2 level. There is T1 shortening involving the lower lumbar spine and sacral bone marrow consistent with history of prior radiation.There is osseous fusion involving the L4-L5 disc space. There is multilevel disc height loss, particularly the L3-L4 and L5-S1 levels and to a lesser degree L2-L3 level. There are degenerative endplate marrow signal changes as well as vacuum phenomena at these disc spaces. Small Schmorl's nodes are also evident.Multilevel degenerative changes are seen, as described below:T12-L1: Mild disc bulge, ligamentum flavum thickening, and bilateral facet arthropathy. There is no significant spinal canal stenosis. There is mild left neural foraminal stenosis.L1-L2: Mild disc bulge, ligamentum flavum thickening, and bilateral facet arthropathy. No significant spinal canal stenosis. No significant neural foraminal stenosis.L2-L3: Mild disc bulge, ligamentum flavum thickening, and moderate facet arthropathy. Grade 1 anterolisthesis as mentioned above. There is mild to moderate spinal canal stenosis. There is mild bilateral neural foraminal narrowing.L3-L4: Disc bulge, facet arthropathy, ligamentum flavum thickening result in effacement of the lateral recesses as well as mild central canal stenosis. There is mild to moderate right and mild left neural foraminal stenosis.L4-L5: Fusion across the disc space as mentioned above. There is effacement of the lateral recesses without significant central canal stenosis. There is mild right greater than left neural foraminal stenosis. L5-S1: Grade 2 anterolisthesis with advanced bilateral facet arthropathy. There is disc uncovering and mild bulge extending to the neural foramina. There is no significant central canal stenosis. There is effacement of the bilateral lateral recesses. There is moderate to severe right and severe left neural foraminal stenosis where there may be impingement of the exiting L5 nerve roots.Paraspinous soft tissues are within normal limits. Bilateral renal cysts are seen, including a relatively larger one on the right measuring approximately 5 cm in diameter.

Output: 1. Multilevel degenerative changes in the lumbar spine as detailed above. There is mild to moderate L2-L3 and mild L3-L4 central canal stenosis. There is also multilevel neural foraminal narrowing, which is severe at the L5-S1 level where there may be impingement of the L5 nerve roots, particularly on the left. There is also grade 2 anterolisthesis at this level. Additional levels as above.2. No findings to suggest metastatic disease in the lumbar spine.


Instruction: Generate impression based on medical findings.

Input: Metastatic breast cancer. At the left lamina and spinous process of C3, there is sclerotic lesion with mild expansion. Subtle changes of similar appearance are also seen at level of C2. The left C2 - C3 facet joint is indistinct. Given the history of breast cancer, metastatic disease needs to be considered, although the lack of significant progression based on comparison of prior MRI is less typical. Degenerative disease is again present, with disc-osteophyte complex at C5-C6 level, causing spinal canal stenosis. There is also neural foramina narrowing bilaterally secondary to degenerative disease of uncovertebral joints.

Output: 1. Sclerotic lesions at left lamina and spinous process of C2 and C3 vertebral levels, which can represent metastatic disease, although the reported stability between the two prior MRI studies is unusual.2. Degenerative disease of the cervical spine as described above. Please also correlate with MRI cervical spine.


Instruction: Generate impression based on medical findings.

Input: History of anal fistula with persistent fistulous drainage. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is a low T1 signal tract extending from the 12:00 position of the external sphincter and traveling through the subcutaneous fat of the left perineum corresponding to the patient's previously noted perianal fistula. There is a very trace residual T2 bright tract lumen, but no significant inflammation in the adjacent soft tissues. There is mild postcontrast enhancement of the tract compatible with granulation tissue. No associated abscess.Partially visualized colonic diverticulosis and a giant sigmoid diverticulum.OTHER: Trace bilateral hydroceles.

Output: 1.Healing. No fistula with granulation tissue and minimal fluid along the tract as described. There is no significant adjacent edema or associated abscess formation.


Instruction: Generate impression based on medical findings.

Input: History of Chiari decompression and for cervical syrinx. There are postoperative findings related to Chiari decompression. There is inferior extension of the cerebellar tonsils to the level of the dens with associated crowding of the neo-foramen magnum and diminished CSF flow anteriorly and posteriorly. The spinal cord displays normal signal and morphology, without evidence of syringohydromyelia. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis.

Output: 1. Postoperative findings related to Chiari decompression with inferior extension of the cerebellar tonsils to the level of the dens associated with crowding of the neo-foramen magnum and diminished CSF flow anteriorly and posteriorly. 2. No evidence of syringohydromyelia.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for signs of crystal arthropathy, ankle pain, difficulty ambulating History: as above TENDONS: There is lobulated fluid signal intensity within the tendon sheath of the flexor hallucis longus, and to a lesser degree, the flexor digitorum longus tendon sheath, just proximal to the level of the master knot of Henry indicating a tenosynovitis. The peroneal tendons appear intact. The Achilles tendon appears intact. The anterior tendons are unremarkable.LIGAMENTS: There is disruption of the anterior talofibular ligament. There is a tiny avulsion off the distal fibular tip at the insertion of the posterior talofibular ligament (image 6 series 5). The calcaneofibular ligament is also poorly visualized and may be disrupted. The imaged portion of the deltoid ligament is thickened with intermediate signal intensity suggesting prior injury or sprain. Portions of the ligament are poorly visualized suggesting partial disruption. There is also a tiny ossicle along the distal tip of the medial malleolus which may reflect prior trauma.ARTICULAR SURFACES AND BONE: There is bone marrow signal abnormality within the distal fibula which may represent a contusion in the correct clinical context. No discrete fracture line is identified. There is bone marrow signal abnormality within the posterior aspect of the tibial plafond which may be degenerative in etiology. No convincing erosions are evident.ADDITIONAL

Output: 1. Disruption of the ATFL as well as probable calcaneofibular ligament disruption. There is also a tiny avulsion fracture of the distal fibula at the insertion of the PTFL, which may be subacute or chronic in etiology. There is bone marrow signal abnormality within the distal fibula in the surrounding area, which is nonspecific, but may represent a bone contusion in the correct clinical context. 2. Findings indicating an intersection syndrome with tenosynovitis involving the flexor hallucis longus and flexor digitorum longus tendons as described above.3. Partial disruption of the imaged portions of the deltoid ligament with a tiny ossicle along the distal tip of the medial malleolus likely reflecting prior remote trauma.4. Osteoarthritis of the ankle and midfoot.


Instruction: Generate impression based on medical findings.

Input: 49 years Female (DOB:4/11/1967)Reason: r/o growth of adenoma History: h/o microadenoma of the pituitaryPROVIDER/ATTENDING NAME: RONALD N COHEN RONALD N COHEN MRI pituitary:The pituitary gland is appropriate in overall height and morphology. The infundibulum of the pituitary gland is midline. The cavernous sinuses are intact bilaterally.There is millimeter-sized cystic lesion in the middle of the pituitary adjacent infundibulum represent a small pituitary cyst.

Output: 1.Millimeter sized pituitary cystic lesion along the midline of the pituitary at the level of the infundibulum. This is stable.2.No convincing evidence for pituitary microadenoma. Asymmetry in the signal intensity in the pituitary gland can be accounted for on the basis of minimal asymmetric size right and left pituitary and some asymmetry in the adjacent bony structures. Please correlate with clinical evaluation.


Instruction: Generate impression based on medical findings.

Input: New onset seizures: starring spells. There is no evidence of intracranial hemorrhage, mass, heterotopia, or infarct. The brain parenchyma, including the hippocampi, appears unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a left maxillary sinus retention cyst.

Output: No gross evidence of potential seizure foci.


Instruction: Generate impression based on medical findings.

Input: 64-year-old female with complex cystic neoplasm seen on CT 12/2015. Evaluate renal lesion. 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: Right renal interpolar T2 hyperintense focus measuring 2.4 x 2.3 cm without evidence of enhancement; findings most consistent with a benign cyst. There is a focal area of renal cortex scarring adjacent to this cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Benign right renal interpolar cyst with focal area of adjacent renal cortical scarring.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Rule out intracranial bleed. Signs and symptoms: Stroke. CT of brain without infusion:Crowding of the cerebellar tonsils at the level from the magnum is again identified. Images through posterior fossa demonstrates minimal encephalomalacia along the medial aspect of right cerebellum. This area demonstrated acute stroke on prior MRI examination off January 29 of 2010. There is no evidence of any hemorrhage within the posterior fossa. Fourth ventricle remains normal and in midline. Images through the supratentorial space are essentially unremarkable and no evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus.Paranasal sinuses, mastoid air cells, middle ear cavities and calvarium are unremarkable.

Output: 1.Small area of low attenuation likely encephalomalacia or edema in the distribution of the right pica is consistent with patient's known prior right pica stroke.2.No evidence of any new area of stroke or hemorrhage is detected.