Instruction: Generate impression based on medical findings.

Input: Evaluate acute stroke and assess for early hemorrhagic conversion; right gaze deviation, left hemianopsia. Brain MRI:Motion artifacts degraded exam quality.There are multifocal restricted diffusion areas on the right frontal lobe, parietal lobe, temporal lobe and occipital lobe indicating acute ischemic infarction. There is no evidence of hemorrhagic transformation.Underlying brain show multiple scattered high signal intensities on periventricular white matter indicating non specific small vessel disease.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRA:3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate decreased in-flow signal intensity on the right MCA comparing to that of the left MCA indicating slow or decreased flow through the right MCA. Bilateral PCAs are fetal origin.Multiple tandem luminal narrowing (less than 50%) of vertebrobasilar system.Left MCA and bilateral ACAs appear to be normal.Neck MRA:3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate about 6mm segmental luminal stenosis of the right extracranial ICA just above the bifurcation, based on the MRA it appears to be about 90% stenosis. Right vertebral artery is dominant and the left vertebral artery is not clearly visualized with tortuosity indicating proximal left vertebral artery stenosis.The distal right vertebral artery appears to be irregular and there are multifocal luminal stenosis. Normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries.

Output: 1. Right MCA territorial (right PCA is fetal origin) acute ischemic infarction without evidence of hemorrhagic transformation.2. More than 90% luminal stenosis of the right ICA just above the bifurcation.3. Decreased in flow related enhancement on the right MCA than that of the left MCA indicating decreased or slower flow. 4. Atherosclerotic changes of the vertebrobasilar system indicating intracranial atherosclerosis.


Instruction: Generate impression based on medical findings.

Input: 52 years Male (DOB: 6/2/1963) PROVIDER/ATTENDING NAME: SERVICES ANCILLARY SERVICES ANCILLARY The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is T2 signal hyperintensity along the right hemicord at the C7-T1 level.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with ligamentum flavum hypertrophy. There are uncovertebral osteophytes present at this level bilaterally. There is associated effacement of spinal fluid ventral and posterior the spinal cord at this level. Overall there is moderate spinal stenosis at this level. There is associated mild encroachment of the exiting nerve roots bilaterally at this level. There are mild endplate reactive changes at this level.At C4-5 there is loss of disc space height, disc desiccation and diffuse disc bulge. There are small uncovertebral osteophytes present at this level bilaterally. There is associated effacement of spinal fluid ventral and posterior the spinal cord at this level. Overall there is mild to moderate spinal stenosis at this level. There is associated moderate encroachment of the exiting nerve roots bilaterally at this level . There are mild endplate reactive changes at this level.At C5-6 there is loss of disc space height, disc desiccation and diffuse disc bulge. There are uncovertebral osteophytes present at this level associated with disc material bilaterally. There is associated partial effacement of spinal fluid ventral and posterior the spinal cord at this level. Overall there is mild spinal stenosis at this level. There is associated moderate encroachment of the exiting nerve roots bilaterally at this level .At C6-7 there is loss of disc space height, disc desiccation and diffuse disc bulge. There are uncovertebral osteophytes present at this level associated with disc material bilaterally. There is associated partial effacement of spinal fluid ventral and posterior the spinal cord at this level. Overall there is mild spinal stenosis at this level. There is associated moderate encroachment of the exiting nerve roots bilaterally at this level .At C7-T1 there is loss of disc space height, disc desiccation and diffuse disc bulge. There are uncovertebral osteophytes present at this level associated with disc material bilaterally. There is associated partial effacement of spinal fluid ventral and posterior the spinal cord at this level. Overall there is mild spinal stenosis at this level. There is associated moderate encroachment of the exiting nerve roots on the right side more than the left at this level . There are endplate reactive changes at this level which are high signal on T2 and inversion recovery imaging.The vertebral artery flow voids appear to be intact.

Output: 1.There are multilevel degenerative changes present in the cervical spine with moderate spinal stenosis at C3-4 and milder degrees of spinal stenosis at the levels below that as detailed above. There is additional encroachment of exiting nerve roots bilaterally at C4-5, C5-6, C6-7 and C7-T1.2.There is spinal cord lesion present on the right hemicord at the C7-T1 level. This could represent myelomalacia. Demyelination may have a similar appearance


Instruction: Generate impression based on medical findings.

Input: 72 years Female (DOB:1/17/1944)Reason: SAH? Prior SAH/aneurysm, now vomiting/presyncope History: vomitingPROVIDER/ATTENDING NAME: NATHAN S TRUEGER NATHAN S TRUEGER MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images without associated DWI abnormalities.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 a minor mucous retention cyst in the right maxillary sinus. 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 redemonstration of recanalization at the aneurysm base apparently covered by coils (helmet effect) measuring 1.2 mm.There is asymmetry in the A1 segments right larger than left. The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The vertebral arteries are similar in size.

Output: 1.The examination is stable compared to the 6/2014 exam. There is redemonstration of early recanalization into the aneurysm coils at the base of the ACOMA aneurysm by approximately a millimeter.2.Redemonstration and no change of periventricular and subcortical white matter changes of a mild degree are nonspecific. They are most likely vascular related.


Instruction: Generate impression based on medical findings.

Input: 12-year-old male with suspected glomulovenous malformation of the right knee. MENISCI AND LIGAMENTS: The menisci are intact. The ACL, PCL, MCL, and lateral collateral complex are intact.BONE AND MARROW: No significant abnormality noted.SYNOVIUM: The synovium is normal in appearance.MUSCULATURE: Musculature is normal and does not appear to be involved by the venous malformation.ADDITIONAL

Output: Serpiginous enhancing vascular malformation along the lateral aspect of the knee is contained within the subcutaneous tissues and does not connect with the deep venous system.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Evaluate for meningioma. Signs and symptoms: Meningioma. Headache. Pre and post enhanced brain MRI:No acute intracranial process and negative diffusion weighted series.Examination redemonstrates a stable small meningioma in right anterior frontal along the inner table of the skull and measuring 8 x 9 mm in transaxial dimensions. This finding is not associated with any appreciable mass effect or edema of the adjacent parenchyma.The cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination is otherwise within normal and stable since prior exam. There is no detectable abnormal parenchymal or leptomeningeal enhancement other than above detailed meningioma. Calvarium and soft tissues of the scapula unremarkable.Images through the orbits including axial fat sat post enhanced series are negative.All paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal patterns.

Output: 1.No acute intracranial process.2.Stable small 8 x 9 mm right frontal convexity meningioma since prior exam.3.Unremarkable pre and post enhanced brain MRI otherwise.4.Normal pneumatization signal pattern of all paranasal sinuses and bilateral mastoid air cells and middle ear cavities.


Instruction: Generate impression based on medical findings.

Input: 58-year-old male with hemarthrosis. Evaluate for structural abnormality versus PVNS. MENISCI: The medial and lateral meniscus appear normal.ARTICULAR CARTILAGE AND BONE: There is generalized thinning of the articular cartilage along the medial femoral condyle. There are focal areas of intermediate signal intensity partial defects along the articular cartilage of the medial femoral condyle anteriorly with adjacent subchondral bone marrow edema. Similarly there are foci of intermediate signal intensity partial defects along the articular cartilage of the medial facet of the patella. There are focal areas of subchondral bone marrow edema within the medial and lateral facet of the patella.LIGAMENTS: The collateral and cruciate ligaments appear normal.EXTENSOR MECHANISM: The extensor mechanism appears normal.ADDITIONAL

Output: 1. Findings most compatible with pigmented villonodular synovitis.2. Articular cartilage degeneration and other findings as described above.


Instruction: Generate impression based on medical findings.

Input: 54-year-old female with seizure There is no evidence of intracranial hemorrhage, mass or edema. Bilateral periventricular white matter changes increased compared to prior exam. The ventricles and basal cisterns are normal in size and configuration. The calvaria skull base are normal. The visualized paranasal air cells are normally pneumatized.

Output: 1.No acute intracranial hemorrhage, mass or edema.2.Bilateral periventricular hypodensities consistent with small vessel disease of indeterminant age, although definite progression since prior exam.


Instruction: Generate impression based on medical findings.

Input: There is an unchanged homogeneously enhancing left vestibular schwannoma measuring up to 12 mm. There is no extension through the porus acusticus or into the labyrinthine structures. The right internal auditory canal is intact. There is an unchanged 10 mm diameter cystic pineal gland without nodular enhancement. There are bilateral lens implants. The imaging potions of the skull, including prominent right occipital arachnoid granulations, are unchanged.

Output: No significant interval change in left vestibular schwannoma.


Instruction: Generate impression based on medical findings.

Input: Reason: RCT? History: pain Slightly suboptimal evaluation secondary to metallic susceptibility artifact related to the patient's history of prior rotator cuff repair.ROTATOR CUFF: There is linear increased signal abnormality within the distal supraspinatus tendon approximately 1 cm proximal to its insertion on the greater tuberosity measuring approximately 7 mm in AP dimension. This likely represents a near full-thickness bursal surface tear which is partially filled with granulation tissue, although focal tendinosis is also a possibility. There is also increased signal abnormality within the anterior fibers of the infraspinatus indicating a partial-thickness tear involving less than 50% of the tendon width measuring approximately 6 to 8 mm in the AP dimension. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: There is a moderate amount of fluid within the subacromial subdeltoid bursa. There are foci of low signal intensity debris internally which may represent a bursitis. Moderate osteoarthritis affects the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. Moderate osteoarthritis affects the glenohumeral joint. There is heterogeneity and increased signal intensity within the superior and anterior glenoid labrum likely representing a combination of degeneration and degenerative tearing. There is a small glenohumeral joint effusion.BICEPS TENDON: Note is made of postsurgical changes of a prior biceps tenodesis. ADDITIONAL

Output: 1. Postsurgical changes of prior rotator cuff repair with findings likely representing a high grade near full-thickness tear of the supraspinatus although focal tendinosis is a consideration. 2. Rotator cuff tendinosis and partial thickness tearing of the infraspinatus as described above. Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: There is a small collection posterior to the right paramedian cerebellum/sinus confluence which is relatively mid intensity on T1, hyperintense on T2, without enhancement, demonstrating no significant mass effect or susceptibility abnormality. This correlates with the previously identified hypodense fluid collection on the prior CT. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for acute cerebral, brainstem or cerebellar infarction. Flow voids are present within the major vessels indicating patency. The mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: There is a small collection posterior to the right paramedian cerebellum/sinus confluence which is relatively mid intensity on T1, hyperintense on T2, without enhancement, demonstrating no significant mass effect or susceptibility abnormality. This is most suggestive of evolving subdural hemorrhage mixed with CSF.


Instruction: Generate impression based on medical findings.

Input: 62 year-old female status post mucinous cystadenoma resection which contained a focus of invasive adenocarcinoma. Evaluate for metastatic pancreatic cancer. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Subcentimeter hypodense lesion near the falciform ligament in the left lobe of the liver is nonspecific (image 20/112 on series number 4).SPLEEN: Status post splenectomyPANCREAS: Patient is status post distal pancreatectomy. Within the distal remaining pancreas there is a 3.1x 1.9 cm cystic collection which may be in continuity with the pancreatic duct, however this is unclear. There is no solid enhancing component to this collection. The pancreatic remnant is otherwise unremarkable.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: Small aortocaval and mesenteric lymph nodes are not pathologically enlarged by CT criteria.BOWEL, MESENTERY: A small left of midline hernia contains mesenteric fat.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: Left adnexal cyst measures 3.8 x 3.6 cm (image 82/112). This can be further evaluated with gynecologic ultrasound or MRI.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1. No definite evidence of metastatic disease. There is a fluid attenuation collection at the distal portion of the pancreatic remnant as described above.2. Left adnexal cyst which is incompletely evaluated on this examination and should be further evaluated with gynecologic ultrasound or MRI if this patient is post-menopausal.


Instruction: Generate impression based on medical findings.

Input: Assess for spinal stenosis. Pain and hyperreflexia. Nonenhanced lumbar MRI:T12 -- L1 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise. Large left-sided adrenal cyst is noted.L1 -- L2 demonstrate mild degenerative changes without central spinal stenosis or neural foraminal compromise.L2 -- L3 demonstrate mild degenerative changes without central spinal stenosis. Mild bilateral neural foraminal compromise is present.L3 -- L4 demonstrate mild disk disease and moderate (left greater than right) facet and ligamentum flavum hypertrophy. Findings results in moderate left and mild right neural foraminal compromise and no central spinal stenosis.L4 -- L5 demonstrate moderate disk disease, mild loss of disk height and extensive (left greater than right) facet and ligamentum flavum hypertrophic changes. There is resultant significant central spinal stenosis with significant bilateral (right greater than left) foraminal compromise.There is a small left-sided synovial cyst projecting laterally from the left facet complex immediately at the level of the left neural foramina which contribute to compromise of the left neural foramina. This finding is best appreciated on axial T2 series 1401 on image 15 and sagittal T2/T2 stir image 5.L5 -- S1 demonstrate mild chronic compression deformity of the superior endplate of L5 (new since prior exam), mild disk disease and moderate left and mild right facet and ligamentum flavum hypertrophy. No spinal stenosis however left neural foramina compromise of moderate degree is noted.Compared to prior exam there is interval progression of degenerative changes and including progression of central spinal stenosis at L4 -- L5 as detailed.

Output: 1.Examination of the L4 -- L5 demonstrate extensive degenerative changes mostly of the posterior elements with resultant significant central spinal stenosis and neural foraminal compromise as detailed. There is interval progression of disease since prior study.2.Degenerative changes at other levels however none with significant central spinal stenosis. Multilevel neural foraminal compromise as detailed per level.


Instruction: Generate impression based on medical findings.

Input: Chiari malformation, abnormal increased growth. Pituitary: There is a non-enhancing, intrinsically T1 hyperintense lesion located between the adenohypophysis and neurohypophysis that measures up to 9 mm. The infundibulum is intact. The optic apparatus and cavernous sinuses are intact. The imaged portions of the brain parenchyma are unremarkable.Complete Spine: The cerebellar tonsils are not low-lying. The spinal cord displays normal signal and morphology. 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 a right sacral perineural cyst that measures up to 17 mm. There is no significant spinal canal stenosis. There is The paravertebral soft tissues are unremarkable.

Output: 1. Findings compatible with a subcentimeter Rathke cleft cyst.2. No evidence of Chiari malformations of spinal cord lesions.


Instruction: Generate impression based on medical findings.

Input: 17 month old male with ventriculomegaly and porencephalic cyst experiencing continued increasing head circumference. Evaluate for aqueductal stenosis. Sagittal T1 and T2 images demonstrate narrowing of the mid point of the cerebral aqueduct due to dysmorphism of the adjacent quadrigeminal plate. Minimal biphasic CSF flow is identified at the level of the aqueduct and fourth ventricle, although normal biphasic flow is noted anteriorly and at the level of the cerebellar tonsils.Redemonstrated is a right transfrontal Rickham catheter that terminates in a large right frontal lobe porencephalic cyst. The porencephalic cyst, lateral ventricles, and third ventricle have continued to increased in size, although this seems commensurate with calvarial growth. There remain a few scattered foci of residual susceptibility effect within and along the margins of the ventricular system and perhaps within the right prepontine cistern, unchanged. Also redemonstrated is diffuse cerebral white matter volume loss. There is no evidence of acute intracranial hemorrhage or acute infarct. There is approximately 5 mm midline shift to the left. The major cerebral flow voids appear to be intact. The cranial vault appears macrocephalic. Mastoid air cells and middle ear cavities are clear.

Output: Sagittal T1 and T2 images demonstrate narrowing of the mid point of the cerebral aqueduct due to dysmorphism of the adjacent quadrigeminal plate. Minimal biphasic CSF flow is identified at the level of the aqueduct and fourth ventricle, although normal biphasic flow is noted anteriorly and at the level of the cerebellar tonsils.


Instruction: Generate impression based on medical findings.

Input: 19-year-old male with history of T cell lymphoma status post bone marrow transplant and right septic hip status post IR drainage. Now presents with knee pain. MENISCI AND LIGAMENTS: No significant abnormality noted.BONE AND MARROW: There are innumerable geographic lesions with serpentine boundaries that demonstrate hyperintense peripheral T2 signal and mild rim enhancement in the femur, tibia, and fibula of both knees. Findings are compatible with numerous bone infarcts. No bone marrow edema or enhancement in either knee to suggest infection.SYNOVIUM: No significant abnormality noted. No significant joint effusion in either knee.MUSCULATURE: No significant abnormality noted.ADDITIONAL

Output: Numerous bone infarcts in both knees as described above without joint effusions or specific evidence of osteomyelitis.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Stroke workup. HIV-positive patient. Signs and symptoms: Slowed speech, right arm weakness, gait instability. Pre- and post enhanced brain MRI:Diffusion weighted images demonstrate a tiny focus of subcortical restricted diffusion (6 mm) in the subcortical white matter of left postcentral gyrus and a larger focus (14.5 x 6.5 mm) in the left paramedian lower pons consistent with acute ischemic strokes without evidence of susceptibility signal changes.Additionally examination demonstrates fairly extensive confluent FLAIR and T2 hyperintensity involving the white matter of bilateral cerebral hemispheres. Lesser degree of similar signal changes are present in bilateral basal ganglia and left pons. Susceptibility signal changes demonstrate multiple tiny foci of microhemorrhages in bilateral subcortical periventricular white matter as well as bilateral basal ganglia and right thalamus. Constellation of above findings are suggestive of advanced chronic minimally hemorrhagic small vessel ischemic strokes. Considering patient's HIV positive status the above detailed findings also could at least partially be secondary to chronic changes of HIV infection. Mild prominence of cortical sulci and supratentorial ventricular system for patient's stated age is suggestive of underlying parenchymal volume loss. Examination also demonstrated evidence of bilateral ovarian degeneration.There is no detectable abnormal enhancement of brain parenchyma or the meninges.Unremarkable images through the orbits and including axial fat sat post enhanced series.Unremarkable calvarium and soft tissues of the scalp. There is evidence of extensive opacification of left maxillary sinus and well-pneumatized paranasal sinuses otherwise.Findings and concerns on this study were discussed by phone (45901) with the emergency room physician (Dr. Padera) at the time of review of the study.

Output: 1.There is a 6 mm left postcentral gyrus and a 14.5 x 6.5 mm eft paramedian pons restricted diffusion consistent with acute strokes.2.Extensive periventricular and subcortical as well as bilateral basal ganglia and pontine FLAIR hyperintensity with internal foci of hemorrhage suggestive of chronic minimally hemorrhagic small vessel ischemic strokes. Possibility of overlapping chronic changes of HIV infection cannot be entirely excluded.3.There is no detectable abnormal enhancement on post infused series.4.Prominence of cortical sulci and ventricular system for stated age consistent with underlying parenchymal volume loss.


Instruction: Generate impression based on medical findings.

Input: There is redemonstration of a marrow replacing lesion in the right posterior T6 vertebral body extending into the right pedicle, transverse process, and lamina. It appears lower in signal on T1 indicating progressive sclerosis. There is also involvement of the superior and inferior articulating processes as well the pars interarticularis. There is increased anterior extent of the posterior body component of the marrow signal abnormality as seen on 6/25-27, corresponding to an area of subtle ground glass opacity on CT. There is slightly greater conspicuity of confluent enhancement than on the prior exam on the fat saturated postcontrast images. There is no definite epidural extension. There is surrounding mild STIR hyperintensity.At the T7 level, there is additional abnormal marrow signal in the midline posterior elements and along the right lamina with minimal extension along the right posterior pedicle which demonstrates STIR hyperintensity and enhancement on the current exam. This is new since the previous MRI but is consistent with a hypermetabolic lesion on PET/CT.There remains ill-defined somewhat linear opacity in the right lower lobe near the T6 level, which appears slightly decreased in confluence since the previous MRI.The thoracic spine is in normal alignment, with a normal thoracic kyphosis. The vertebral body and disk heights are well-maintained. The spinal cord is of normal caliber and signal. There is no pathological enhancement.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine.Incidental note is again made of a heterogeneous oval left thyroid lobe lesion.

Output: 1. Slight progression of the anterior margin of the right T6 vertebral body metastatic lesion.2. Interval development since prior MRI of right T7 posterior element metastatic lesion corresponding to hypermetabolic lesion on PET scan.3. Redemonstration of linear opacity in the right lung which may represent an area of scarring.4. Grossly stable heterogeneous left thyroid lesion. Correlation with thyroid function tests is recommended and thyroid ultrasound may be obtained as clinically indicated.


Instruction: Generate impression based on medical findings.

Input: 50 years, Male, Reason: Hx of common bile duct dilation on MRCP, CBD stricture, chronic pancreatitis, jaundice, ascending cholangitis History: Jaundice. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: There is a focal T2 hyperintense lesion in the left hepatic lobe which is not seen on T1 precontrast or postcontrast sequences, possibly a cyst but findings nonspecific/of uncertain clinical significance. No suspicious hepatic lesion evident otherwise. Loss of signal on out of phase images suggest diffuse hepatic steatosis.Mild irregularity and narrowing of the proximal intrahepatic bile ducts. The common bile duct appears normal without dilatation or stenosis.SPLEEN: No significant abnormality noted.PANCREAS: Normal-appearing pancreatic duct. Previously seen pancreatic stent is not visualized, possibly removed. No evidence of pancreatic divisum. Normal parenchymal signal without focal lesion evident.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: 1.4-cm right renal hemorrhagic cyst. Simple 1.2-cm left renal 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: 1.Mild narrowing of the proximal intrahepatic bile ducts without dilatation. Common bile duct itself is normal without evidence of stricture.2.No evidence of cholangitis as clinically questioned.3.No findings of chronic pancreatitis.


Instruction: Generate impression based on medical findings.

Input: 49-year-old female with abnormal uterine bleeding. Evaluate for adenomyosis. PELVIS: Motion artifact limits evaluation.UTERUS, ADNEXA: The junctional zone is ill-defined and diffusely thickened measuring up to 13 mm. There are multiple subserosal T2 heterogeneous lesions with the largest measuring approximately 3.7 mm; these lesions demonstrate heterogeneous enhancement and most compatible with leiomyomata.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: Right iliac fossa kidney is noted.

Output: 1.Uterine leiomyomata.2.Within the limitations of motion artifact, findings suggestive of diffuse adenomyosis.


Instruction: Generate impression based on medical findings.

Input: left facial weakness, lower extremity weakness and sensory deficit. No evidence of acute ischemic or hemorrhagic lesion.Multifocal bihemispheric scattered high signal intensities on white matter on FLAIR images indicate non specific small vessel disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion.Minimal non specific small vessel ischemic disease.


Instruction: Generate impression based on medical findings.

Input: Brain MRI:The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. The paranasal sinuses and mastoid air cells are clear. Redemonstrated is a subcentimeter sebaceous cyst overlying the right frontal bone, as well as smaller similar appearing foci elsewhere in subcutaneous tissues.Brain MRA: There is antegrade flow within the distal bilateral vertebral arteries, within the basilar artery, distal bilateral internal carotid arteries and carotid siphons and bilateral anterior, middle and posterior cerebral arteries. No arterial stenoses, occlusions or aneurysms are identified. No arteriovenous malformations are identified and there is no evidence for cerebral vasculitis. Neck MRA:There is conventional takeoff of the great vessels from the aortic arch without evidence for stenosis of the origin of the great vessels or of the bilateral vertebral arteries. There are no stenoses of the bilateral common, internal or external carotid arteries or of the bilateral carotid bifurcations. There is no evidence for vasculitis, fibromuscular dysplasia or dissection of the carotid or vertebral arterial systems within the neck. There are no vascular masses identified.

Output: 1.Negative MRI of the brain.2.Negative MRA of the brain.3.Negative MRA of the neck.4.Specifically, there are no MRI/MRA findings to explain the patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: History of C5 fracture. Neck pain. There is reversal of cervical lordosis. Chronic wedging deformity of C5 and C6 vertebrae is present. There is extensive degenerative disease of the cervical spine. At C2 - C3 intervertebral level, there are facet arthropathic changes. At C3 - C4 intervertebral level, there are facet and uncovertebral joint arthropathic changes. There is disk protrusion causing spinal canal stenosis. At C4 - C5 intervertebral level, there is disc-osteophyte complex, causing spinal canal stenosis. There are degenerative changes of the uncovertebral joints and facet joints, causing bilateral neural frontal narrowing which is greater on the left. At the C5 - C6 intervertebral level, there is posterior disc-osteophyte complex, causing spinal canal stenosis. There is facet and uncovertebral joint degenerative disease, causing bilateral neuroforaminal narrowing, greater on the right. At the C6-C7 intervertebral level, there is posterior disc-osteophyte complex, causing spinal canal stenosis. There is facet and uncovertebral joint degenerative disease, causing bilateral neuroforaminal narrowing.The thyroid glands appear enlarged, with nodularity and calcifications.

Output: 1. Degenerative disease of the cervical spine as described above. Please also refer to MRI of the cervical spine findings for further correlation.2. Enlarged thyroid glands, with nodules and calcifications. This may represent goiter, but malignancy is difficult to be excluded. Please also correlate with thyroid imaging study and other clinical parameters.


Instruction: Generate impression based on medical findings.

Input: 38-year-old male with pain. Evaluate for TFCC tear. Evaluation of the triangular fibrocartilage complex is limited due to the lack of intra-articular contrast. A skin marker is placed along the ulnar aspect of the wrist adjacent to the distal ulna.LIGAMENTS: We see no findings to suggest a tear of the scapholunate or lunotriquetral ligaments.TRIANGULAR FIBROCARTILAGE COMPLEX: The articular disc of the triangular fibrocartilage appears thinned just medial to its attachment to the distal radius with intermediate signal intensity traversing the disc likely representing a near full-thickness to full-thickness perforation. There is also increased signal intensity within the ulnar fibers of the articular disc likely reflecting a combination of degeneration/degenerative tearing and adjacent synovitis.TENDONS: The extensor carpi ulnaris tendon appears slightly thickened as it courses along the ulnar styloid with increased signal intensity suggesting mild tendinosis. The remainder of the flexor and extensor tendons are within normal limits. BONES: There is a small cyst within the trapezoid which may not be of any clinical significance.ADDITIONAL

Output: 1. Findings suggestive of degeneration and tearing of the triangular fibrocartilage as described above.2. Mild tendinosis of the extensor carpi ulnaris tendon.


Instruction: Generate impression based on medical findings.

Input: Chronic knee pain Due to the patient's body habitus, the high-definition knee MRI coil was not able to be used. An alternate coil was used, which limits image quality and evaluation.MENISCI: There is poorly-defined increased signal at the inner edge fibers of the body of the lateral meniscus, likely reflecting mild degenerative fraying. We see no findings to suggest an unstable tear. The medial meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is focal increased signal intensity within the articular cartilage of the medial patellar facet with slight prominence of the cartilage, reflecting partial-thickness focal degeneration (blistering). The medial and lateral tibiofemoral compartments appear normal.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Focal degeneration of the articular cartilage of the medial patellar facet.2. Mild degenerative fraying of the free edge of the body of the lateral meniscus. We see no findings to suggest an unstable tear.


Instruction: Generate impression based on medical findings.

Input: Altered mental status, evaluate. Exam is extremely limited due to patient's motion. Only limited postcontrast images were obtained given recent noncontrast MRI of the brain and cervical spine.Limited postcontrast MRI of the brain does not demonstrate any gross pathological enhancement intracranially. The postcontrast evaluation of the cervical spine is extremely limited but no large enhancing lesion is identified.

Output: Extremely limited exam due to patient motion with no large areas of pathological enhancement within the brain or cervical spine.


Instruction: Generate impression based on medical findings.

Input: A patient submitted outside study for review. Submitted for review are left digital mammographic images (3/9/15), ultrasound images of left breast (3/9/15), right digital mammographic images (3/11/15), ultrasound images of right breast (3/11/15), images from ultrasound-guided biopsy of left breast and postprocedural left digital mammographic images (3/11/15), breast MRI (3/20/15) performed at Advocate Lutheran General Hospital. For comparison, digital mammographic images (10/24/15, 11/5/14), ultrasound images of right breast (11/5/14) are available. LEFT DIGITAL MAMMOGRAPHIC IMAGES (3/9/15):The breast parenchyma is heterogeneously dense. A spiculated mass is present in the retroareolar region, measuring 2 cm. A nipple retraction is associated. No suspicious calcifications are seen in the left breast.ULTRASOUND IMAGES OF LEFT BREAST (3/9/15):An irregularly shaped hypoechoic mass is present at retroareolar region measuring 12 x 10 x 15 mm. The mass is attached to the nipple. A few normal appearing lymph nodes are seen in the left axilla.RIGHT DIGITAL MAMMOGRAPHIC IMAGES (3/11/15):The breast parenchyma is heterogeneously dense. Three circumscribed round masses are present at upper outer quadrant, likely cysts. They are confirmed benign cysts on the Utrasound study (3/11/15) and MRI (3/20/15). The asymmetry, measuring 2 cm, at posterior superior aspect on ML and MLO view. This lesion needs additional work-up.ULTRASOUND IMAGES OF RIGHT BREAST (3/11/15):Two simple cysts at 9:00 position-10:00 position are present in the right breast, corresponding to the mammographic findings.IMAGES FROM ULTRASOUND-GUIDED BIOPSY OF LEFT BREAST AND POSTPROCEDURAL LEFT DIGITAL MAMMOGRAPHIC IMAGES (3/11/15):Ultrasound guided needle biopsy was performed for the left retroareolar mass, with appropriate needle placement. Postprocedural left on graphic images show a marker clip within the left retroareolar mass.Per outside report, the result was malignant.BREAST MRI (3/20/15):Breast MRI was performed with a protocol outlined in the outside radiology report.Known carcinoma is visualized at left retroareolar region as a spiculated mass measuring 26 x 18 x 31 mm (AP x LR x CC). The mass abuts the nipple, which is enhancing with this mass, suspicious for invasion.A linear non-mass enhancement, measuring 21 x 6 x 11 mm, is seen in the right breast at far posterior upper outer quadrant. This enhancing lesion likely corresponds to the asymmetry on the mammogram.Three simple cysts are seen in the right breast.No abnormal axillary lymph nodes are identified in either axillary region.

Output: 1. Biopsy proven left breast malignancy, suspicious for invading to the nipple.2. Linear enhancing lesion in the right far posterior upper outer quadrant. This lesion could correspond to the asymmetry on mammogram. Additional work-up for the asymmetry at posterior upper outer quadrant in the work-up is recommended.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on medical findings.

Input: New lung cancer. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild scattered cerebral white matter T2 hyperintensity in the cerebral hemispheres and pons. There is no abnormal intracranial enhancement. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are grossly unremarkable. The bilateral maxillary sinuses are atelectatic with mild inferior bowing of the inferior orbital wall and contain mucosal thickening and secretions.

Output: 1. No evidence of intracranial metastases.2. Mild scattered cerebral white matter T2 hyperintensity in the cerebral hemispheres and pons is nonspecific, but likely represents chronic small vessel ischemic disease.3. Findings suggestive of bilateral silent sinus syndrome.


Instruction: Generate impression based on medical findings.

Input: 59-year-old male with previous stroke for evaluation of acute worsening left leg weakness. Multiple areas of ischemia of different ages are noted in the pons. A focus of diffusion restriction with increased T2/FLAIR signal is now noted in the right aspect of the pons, compatible with. There has been interval small chronic infarct in the ventral left aspect of the pons. There has been interval evolution of a now chronic focus infarct involving the mesial dorsal pons. Scattered foci of T2 hyperintensity in the periventricular and subcortical white matter compatible with chronic small vessel ischemic changes. There are also small chronic bilateral thalamic and basal ganglia lacunar infarcts. Note is made of a prominent perivascular space in the left insula. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration. The expected intracranial vascular flow voids are present. The paranasal sinuses are clear. The visualized mastoid air cells are clear. The orbits are unremarkable. Note is again made of a 13 mm sebaceous cyst overlying the left zygoma.MRA head:There is approximately 70% narrowing of the mid to distal M1 segment of the right middle cerebral artery proximal to its bifurcation. The anterior and middle cerebral arteries do not otherwise demonstrated areas of significant stenoses. The posterior communicating arteries are diminutive bilaterally. The V4 segment of the right vertebral artery is mildly narrowed with loss of flow related enhancement. The left vertebral artery is dominant. The basilar artery and posterior cerebral arteries are normal in caliber. No significant intracranial aneurysm. MRA neck:The left common carotid artery originates off of the innominate artery. The carotid arteries are widely patent with normal contour and caliber throughout. The left vertebral artery is normal caliber and contour for the remainder of its course. The origin of the right vertebral artery remains stenotic. Mild stenosis of the distal vertebral artery is again noted as it pierces the dura. This is compatible with a dissection of indeterminate age. There is a subcutaneous lipoma incidentally noted in the right posterior paraspinal soft tissues.

Output: 1. Acute to subacute lacunar infarct in the right aspect of the pons. Remote lacunar infarcts involving the mesial dorsal and ventral left aspects of the pons. 2. Unchanged stenoses of the right vertebral artery origin and distally as it enters the dura with associated findings suggesting slow flow.3. Right middle cerebral artery stenosis, as on the prior examination. No evidence of new flow-limiting stenosis, occlusion, or aneurysm in the major intracerebral arteries.4. Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 5. chronic lacunar infarcts in the bilateral basal ganglia and thalami.


Instruction: Generate impression based on medical findings.

Input: Reason: altered mental status to evaluate for stroke History: weakness, altered mental status MRI of the brainThere is a focus of diffusion restriction present along the left half of the splenium of the corpus callosum.There is a mild to moderate degree of periventricular and subcortical punctate and partly confluent 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 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. The left eye lens is thin.MRA brain:Exam is degraded by patient motion.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.The distal left PCA at the P3 segment appears slight more attenuated than the left.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The left A1 segment is small. The posterior communicating arteries are intact. The vertebral arteries are asymmetric in size - left larger than right.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. There is a moderate amount of patient motion present. Antegrade flow in the carotid and vertebral vasculature can be discerned, however, stenosis may be obscured by the motion artifact.

Output: 1.Exam is degraded by patient motion which may obscure subtle abnormalities.2.There is an acute/subacute infarction involving the left half of the splenium of the corpus callosum.3.The distal left PCA at the P3 segment appears slight more attenuated than the left. However, given the patient motion this may very well be artifactual.4.There is antegrade flow in the cervical vertebral and carotid arteries, however, stenosis may be obscured by the motion artifact.5.Periventricular and subcortical white matter changes of a mild to moderate degree are nonspecific. At this age they are most likely vascular related. 6.If additional information is needed, a CTA may be helpful given its shorter acquisition time relative to MRI/MRA


Instruction: Generate impression based on medical findings.

Input: Left face and arm numbness. MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are multiple nonspecific foci of high T2 signal in the periventricular white matter. The brain parenchyma otherwise appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA: The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. There is a hypoplastic T1 segment of the right posterior cerebral artery with a relatively prominent right posterior communicating artery. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct. Nonspecific foci of T2 hyperintense signal in the supratentorial white matter may represent mild chronic small vessel ischemic disease.2. No evidence of flow-limiting stenosis, occlusion, or aneurysm in the major intracerebral arteries.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: PITUITARY: There is mild apparent hypoenhancement along the far left lateral aspect of the pituitary gland on series 1301 image 16, and not definitely present on the sagittal images. There is susceptibility artifact just inferior to this apparent abnormality likely due to sphenoid sinus are. Therefore, this apparent finding is felt to be artifactual.Contour and size of the pituitary gland are normal. There is no deviation of the pituitary stalk. The cavernous sinuses enhance symmetrically.BRAIN: There is no acute infarct, mass effect, or cerebral edema. There are a few punctate T2 signal abnormalities in the right matter adjacent of the left frontal horn (series 701 image 16), nonspecific, and of doubtful clinical significance. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There are mucus retention cysts in the bilateral maxillary sinusitis, in the right sphenoid sinus. The skull and extracranial soft tissues are unremarkable.

Output: No definite pituitary lesion. No significant abnormalities in the brain.


Instruction: Generate impression based on medical findings.

Input: Memory loss and pituitary adenoma. Brain: There is no evidence of intracranial hemorrhage or acute infarct. There are minimal scattered punctate foci of nonspecific T2 hyperintensity. The brain parenchyma otherwise appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is extensive bilateral maxillary and ethmoid sinusitis with sections.Pituitary: There is a T2 hyperintense lesion with delayed enhancement in the right anterior pituitary that measures up to 2 mm. The pituitary gland is otherwise not enlarged or atrophic. The pituitary stalk is intact. There is no mass effect upon the cavernous sinuses or optic apparatus.

Output: 1. A lesion in the right anterior pituitary that measures up to 2 mm may represent a microadenoma. 2. Minimal scattered punctate foci of nonspecific T2 hyperintensity. 3. Findings suggestive of acute sinuitis.


Instruction: Generate impression based on medical findings.

Input: 73-year-old male patient with inability to walk on left leg with worsening exam and in the ED. Question of an epidural bleed. Interval postsurgical changes of a right laminectomy/facetectomy of L3, and laminectomy of L4. There are 2.2 x 1.3 cm and 1.7 x 1.6 cm T2 hyperintense and T1 hypointense collections at these levels, respectively, within the surgical bed, which extend into the epidural space and partially efface the thecal sac. However, the extent of effacement is similar to overall slightly improved from the presurgical study. These collections are compatible with postoperative fluid. No epidural hematoma is identified.The lumbar spine is in normal alignment, with continued straightening of the normal lumbar lordosis. There is mild disc narrowing at L4-L5 with disc desiccation at this level as well as at L1-L2 to L3-L4. The vertebral body and disk heights are otherwise well-maintained. No worrisome focal marrow signal abnormality is appreciated. The distal spinal cord and conus are within normal limits with the conus terminating at the L1-L2 level. There is developmental narrowing of the lumbar spinal canal due to shortened pedicles predominantly although there also remains prominence of dorsal epidural fat along the upper lumbar spine. There is redundancy of the cauda equina nerve roots which are also thickened, due to the spinal stenosis detailed below. At T12-L1, there is no significant disc pathology or stenosis.At L1-L2, there is a trace disc bulge and minimal facet arthropathy and ligamentum flavum thickening. There is mild-moderate central spinal canal stenosis.At L2-L3, there is a stable trace disc bulge with slight left paracentral prominence. There is moderate bilateral facet arthropathy and ligamentum flavum thickening with overall mild to moderate central spinal canal stenosis.At L3-L4, there are post-surgical changes of a right laminectomy/facetectomy with fluid within the surgical bed as described above. There is trace disc bulge with left facet arthropathy. There is moderate-severe central spinal canal stenosis as well as narrowing of the lateral recesses. There is mild-moderate right foraminal narrowing and mild stenosis on the left.At L4-L5, there are post-surgical changes of a right laminectomy with fluid within the surgical bed as described above. There is a disc bulge with right-sided prominence. There is moderate-severe left facet arthropathy. There is severe central spinal canal stenosis as well as near complete effacement of the lateral recesses. There is mild to moderate left and moderate right foraminal narrowing.At L5-S1, there is no significant disk pathology or stenosis.

Output: 1. Post-surgical changes of right laminectomies/facetectomies of L3 and L4 with post-operative fluid in the surgical bed and similar to slightly improved central canal stenosis at the levels, although remaining high-grade. No evidence of an epidural hematoma.2. Developmentally narrow lumbar spinal canal with otherwise stable spondylotic changes at the other spinal levels.


Instruction: Generate impression based on medical findings.

Input: Please refer to the subsequent MRI report for further information.Exposure time: 3 minutes and 3 seconds.

Output: Successful arthrogram injection of the right wrist.


Instruction: Generate impression based on medical findings.

Input: Migraine without aura, not intractable, without status migrainosus [G43.009] / Headache [R51], Reason for Study: ^Reason: r/o structural lesion History: headache No evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Normal brain MRI


Instruction: Generate impression based on medical findings.

Input: 43-year-old male with left shoulder pain and weakness. Evaluate for rotator cuff tear. ROTATOR CUFF: There is thickening and increased signal abnormality within the supraspinatus tendon consistent with moderate tendinosis. No full-thickness or near full-thickness tear is evident. There is interstitial tearing of the infraspinatus tendon. The supraspinatus and infraspinatus muscles appear intact. The subscapularis and teres minor muscle and tendon appear intact.SUPRASPINATUS OUTLET: Note is made of an os acromiale.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a small glenohumeral joint effusion. Note is made of low signal abnormality within the fluid within the glenohumeral joint (image 12; series 4). There is fragmentation of the superior posterior glenoid labrum which is suspicious for degenerative labral tearing.BICEPS TENDON: There is a large amount of fluid within the tendon sheath of the long head of the biceps tendon. There is associated low signal intensity abnormality identified within the aforementioned fluid along the long head of the biceps tendon (image 10; series 4). ADDITIONAL

Output: 1. Findings suspicious for synovitis of the glenohumeral joint with associated tenosynovitis of the long head of the biceps tendon. 2. Interstitial tearing of the rotator cuff without evidence of near full-thickness or full-thickness rotator cuff tear.3. Os acromiale. 4. Fragmentation of the superior posterior glenoid labrum which is suspicious for degenerative labral tearing.


Instruction: Generate impression based on medical findings.

Input: 22-year-old male with worsening pain and drainage while on antibiotics. Assess status of osteomyelitis of the coccyx and adjacent fluid pocket. Again seen is ulceration of the soft tissues posterior to the coccyx. Inflammation extends from this ulceration into the subcutaneous fat along the gluteal crease which abuts the inferior margin of the bones of the coccyx. Although this inflammation appears similar to that seen on the prior study, the fluid pocket seen on the prior study has decreased in size. There is a small focus of gas within this collection. A discrete C1 segment, visible on the prior study, is not evident on the current examination, presumably related to interval destruction from osteomyelitis. Although there is mild residual edema within the C2 segment on the fluid sensitive sequences, the marrow appears largely fatty on T1-weighted images suggesting some interval healing. Enhancing inflamed tissue extends between the S5 and C2 segments. There is mild edema within the S5 segment on the fluid sensitive sequences but preservation of normal bone marrow signal on T1-weighted images, suggesting reactive osteitis rather than osteomyelitis.There is a small collection of rim-enhancing fluid adjacent to the inferior aspect of the ischial tuberosity that appears to communicate with the overlying skin surface via an enhancing sinus tract. This small amount of fluid appears to have decreased when compared to the prior study. There is no evidence of osteomyelitis of the ischium. A similar sinus tract is noted on the right that likely contacts the ischial cortex, but we see no associated fluid collection or evidence of osteomyelitis. We see no additional foci of osteomyelitis. There is loss of the soft tissue posterior to the right greater trochanter with mild enhancement along the trochanters bilaterally, suggesting inflammation, but we see no findings to suggest osteomyelitis. There is free fluid within the pelvis which is nonspecific.

Output: 1. Decubitus ulcer as described above with decrease in size of "fluid pockets" seen on the prior study.2. Sinus tract extending to both ischia without evidence of osteomyelitis.3. Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Seizures. There is no corresponding lesion is identified that corresponds to the abnormality suggested by the prior PET. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No corresponding lesion is identified that corresponds to the abnormality suggested by the prior PET, although this is a limited preoperative planning MRI.


Instruction: Generate impression based on medical findings.

Input: History of worsening migraines with aura and vision changes, evaluate for underlying abnormality. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

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


Instruction: Generate impression based on medical findings.

Input: BRAIN: There is mild motion degradation of the study. There is no acute infarct, mass effect or midline shift. The cerebellar tonsils remain above the foramen magnum. The rostrum, genu, anterior and midbody of the corpus callosum have formed with hypoplasia of the posterior body and splenium of the corpus callosum. There is mildly colpocephalic appearance of somewhat parallel lateral ventricles. There is no hydrocephalus. There are no definite gray matter heterotopias. The hippocampi are symmetric in signal and volume. There is mild ethmoid and trace sphenoid sinus mucosal thickening. There are small bilateral maxillary sinus air-fluid levels.CERVICAL: There is straightening of the cervical spine with no marrow or cord signal abnormality. There is no suspicious enhancement in the cervical spine. There is no significant disk/endplate degenerative change, spinal canal or neural foraminal stenosis in the cervical spine. The paravertebral soft tissues are unremarkable.THORACIC: The thoracic spine alignment is normal. The bone marrow signal is within normal limits. There is no cord signal abnormality. There is no suspicious enhancement in the thoracic spine. There is mild diffuse epidural lipomatosis in the posterior epidural space essentially throughout the entire thoracic spine with slightly decreased CSF space around the upper and mid thoracic cord. There is no significant disk herniation, or neural foraminal stenosis. There may be trace bilateral pleural effusions.LUMBAR: The last well formed disk space is referred to as S1-2 with the S1 vertebral body lumbarized. There is spina bifida occulta with right-sided hemilamina defect of the L1 vertebral body. The conus terminates at L2, within normal limits and normal ventral motion on prone imaging. There is no meningocele, lipoma or evidence of tethered cord on the prone images. There is no significant spondylolisthesis. The vertebral body and disk heights are preserved. There is no suspicious enhancement within the lumbar spine.There is a nonenhancing 11-mm T2 hyperintense lesion likely consistent with a cyst. There are bilateral extrarenal pelves.

Output: 1.Mildly colpocephalic lateral ventricles with posterior corpus callosum hypoplasia. No definite anatomic abnormality to explain patient's seizure.2.Transitional vertebral anatomy with lumbarized S1, and the last well formed lumbar disk referred to as S1-2. If surgery is to be contemplated, correlation with imaging of the entire spine is recommended.3.No MR evidence of tethered cord.4.Spina bifida occulta at L1.5.Small bilateral maxillary sinus air-fluid levels may represent acute sinusitis in the proper clinical setting.6.Suspect trace bilateral pleural effusions.7.11-mm right renal cyst.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old, with seizures and altered mental status. No evidence of restricted diffusion, edema or mass effect is seen. No focal signal abnormality is observed. There are no structural lesions or parenchymal defects. Postcontrast images are within normal limits. No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. Ventricular size and morphology are within normal limits.

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


Instruction: Generate impression based on medical findings.

Input: Ms. Dieckow is a 57-year-old female with BRCA1 gene mutation and personal history of right breast lumpectomy in 2006 for IDC followed by radiation and chemotherapy. Family history of breast cancer in paternal aunt, paternal great aunt, and paternal great grandmother (diagnosed at the age of 50). There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Stable postsurgical changes are identified in the superior right breast, compatible with stated history of right breast lumpectomy. Multiple scattered foci of enhancement are seen throughout the left breast, appearing similar when compared to multiple prior examinations. No one focus appears more suspicious than the rest.There is no new abnormal enhancement seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: Stable postsurgical changes of the right breast. No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on medical findings.

Input: Pain in left hip [M25.552], Reason for Study: ^Reason: hx of hip injury now with radiculopathy History: hip pain , numbness in L foot and down buttock For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is a 19.3 mm (CC) x 8.2 mm (AP) x 10.9 mm (RL) sized disc extrusion at the level of L5-S1 and narrows left lateral recess compressing thecal sac and nerve roots. Extruded disc was extended superiorly.There are disc desiccation at the level of L4-5 and L5-S1.There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The conus medullaris terminates at the L1 level. Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: no neuroforaminal narrowing or spinal stenosis. L4-L5: Disc desiccation, no neuroforaminal narrowing or spinal stenosis. L5-S1: Disc extrusion superiorly and left lateral results left L5-S1 lateral recess narrowing with no cord compression.

Output: Disc extrusion with superior migration which results L5S1 left side lateral recess stenosis with nerve root compression.


Instruction: Generate impression based on medical findings.

Input: 69 year-old female with a history of breast cancer, poor visualized RV on TTE presents for further evaluation. Left VentricleThe left ventricle is normal in size and has normal systolic function. The overall LV ejection fraction is 69%, the LV end diastolic volume index is 83 ml/m2 (normal range: 65+/-11), the LVEDV is 144 ml (normal range 109+/-23), the LV end systolic volume index is 25 ml/m2 (normal range 18+/-5), the LVESV is 44 ml (normal range 31+/-10), the LV mass index is 39 g/m2 (normal range 67+/-11), and the LV mass is 67 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Native T1 pre-contrast time: 1037 msLeft AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is upper limits of normal in size and has normal systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 97 ml/m2 (normal range 69+/-14), the RVEDV is 169 ml (normal range 110+/-24), the RV end systolic volume index is 44 ml/m2 (normal range 22+/-8), and the RVESV is 77 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size (25.9 mm). Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is a round, circular hyperattenuated lesion noted in the liver. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size and has normal systolic function (LVEF 69%)2. The right ventricle is mildly dilated and has normal systolic function (RVEF 55%)3. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.4. There is a round, circular hyperattenuated lesion noted in the liver. If clinically indicated, a separate dedicated evaluation should be considered.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: Evaluate for growth of grade ll oligoastrocytoma on TMZ. Signs and symptoms: Grade ll oligoastrocytoma. Pre and post enhanced brain MRI:Examination redemonstrates extensive FLAIR and T2 hyperintensity in the left hemisphere most apparent in the left parietal region. Findings involves the cortex and extensively of the subcortical and periventricular white matter with resultant parenchymal volume loss and ex vacuo dilatation of the left lateral ventricle. Findings are consistent with previously surgical rise and treated left hemispheric tumor without significant change. There is no detectable abnormal enhancement of the brain parenchyma or the leptomeninges which is also a similar observation as prior study.Patchy and confluent right hemispheric white matter FLAIR hyperintensity similar to prior exam and representing post treatment changes and likely related to overlapping changes of chronic small vessel ischemic strokes. The midline is maintained and the CSF cisterns remain patent.Chronic expected postoperative changes of left parietal craniotomy similar to prior exam is again noted.

Output: Stable post surgical/treatment changes of left hemispheric oligoastrocytoma without evidence of new finding to suggest recurrence of disease.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o infection source or injury. History: 27yo female with new onset of right hip pain and weakness, now walking with a cane. No pmhx outside of working in a labor intensive job. She also has one bottle of positive blood culture. There is a right hip joint effusion with synovial enhancement. Edema type signal and enhancement is seen within the surrounding musculature including the abductors, quadriceps, iliopsoas and gluteal musculature. No discrete fluid collection is seen to suggest abscess formation. The underlying bone marrow signal is unremarkable.

Output: Right hip joint effusion with synovial enhancement and enhancement within the surrounding musculature is nonspecific and has a differential ranging from infection to connective tissue disease. Further evaluation with joint aspiration is recommended.


Instruction: Generate impression based on medical findings.

Input: 51 years Female (DOB:8/8/1965)Reason: lower back pain with LLE radiculopathy History: abovePROVIDER/ATTENDING NAME: MICHAEL J LEE MICHAEL J LEE Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is mild disc desiccation at L3-4, L4-5 and L5-S1.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: No compromise to lumbar spinal canal or neural foramina. There is only minor degenerative disc disease present.


Instruction: Generate impression based on medical findings.

Input: Redemonstration of mixed solid and cystic enhancing mass originating from the midbrain involving the tectum and projecting to the superior vermian cistern. Drainage catheter within the dominant tumoral cyst is unchanged in position. The enhancing portion of the mass similar to prior exam measuring 3.4 x 2.9 cm in axial dimension and 3.3 cm in craniocaudal dimension. The cystic component has increased in size.There is effacement of the quadrigeminal plate cistern and inferior displacement of the fourth ventricle, unchanged from prior. There is superior extension of the mass into the right thalamus. This is some susceptibility associated with the mass perhaps related to blood products.Right frontal approach ventriculostomy catheter with tip terminating in the anterior horn of the right lateral ventricle is unchanged. Ventricular system is mildly dilated but unchanged from prior examination. There is evidence of right frontal craniotomy with some susceptibility changes and a linear tract in the occipital lobe likely postprocedural. Normal flow-voids are demonstrated in the major intracranial vascular structures.

Output: 1. Stable size of the solid enhancing component of the mass with interval increase in size of the cystic component.2. Stable mildly dilated ventricular system with right frontal ventriculostomy catheter.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old, with history of glioblastoma multiforme, status post redo craniotomy for tumor resection. There are postsurgical changes of recent left-sided craniotomy for tumor re-resection in the left temporal lobe. Most of the nodular enhancement surrounding the resection cavity has been resected. Small nodular enhancement is noted along the anterior-inferior and medial aspect of the resection cavity. Focus of enhancement more superiorly involving the left periatrial white matter also remains unchanged.Expected postsurgical changes include pneumocephalus and small extra-axial collection beneath the craniotomy. No significant infarct, large hemorrhage, or new mass effect is appreciated. FLAIR hyperintensity surrounding the resection cavity as well as milder generalized FLAIR hyperintensity involving the bilateral centrum semiovale and corona radiata appears similar. There is mild diffuse sulcal effacement involving the left cerebral hemisphere. No midline shift or herniation. There is ex vacuo dilatation of the left lateral ventricle. No hydrocephalus. Right cerebellar hypoplasia is again noted.

Output: Expected postsurgical changes of redo left-sided craniotomy for tumor reresection. Small residual areas of nodular enhancement are seen along the medial and anterior inferior aspect of the left temporal resection cavity.


Instruction: Generate impression based on medical findings.

Input: Female, 16 years old. Ankle pain, injury TENDONS: No significant abnormality noted.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: Increased T2 signal in the talar neck and along the anterior aspect of the tibial metaphysis and diaphysis. No discrete associated T1 signal abnormality, suggesting that these findings are related to bone marrow edema without fracture.ADDITIONAL

Output: Bone marrow edema involving the talar neck and anterior distal tibia, compatible with bone contusion, without fracture identified.


Instruction: Generate impression based on medical findings.

Input: 69-year-old male with elevated PSA. Prostate biopsy on 7/31/2014 joint findings suggestive of neoplasm in left lateral apex PELVIS:PROSTATE:Prostate Size: 3.6 x 4.9 x 4.2 cmPeripheral Zone: There is a lesion in the mid peripheral zone measuring 5 x 3 mm, immediately left of midline, which is hypoattenuating T2/ADC and suspicious for prostatic adenocarcinoma.Central Gland: Multiple nodules within the central gland likely reflect benign prostatic hypertrophy.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: Enhancement and thickening within the right adductor rectus aponeurosisOTHER: No significant abnormality noted.

Output: 1.Mid peripheral zone lesion is suspicious for prosthetic adenocarcinoma. No extracapsular extension or lymphadenopathy identified.2.Enhancement and thickening of the right adductor rectus aponeurosis may be related to prior injury.3.Enlarged prostate with multiple central gland nodules likely related to benign prostatic hypertrophy.


Instruction: Generate impression based on medical findings.

Input: 48 year-old female with difficulty speaking and right-sided weakness; evaluate for ICH There is a focus of low attenuation in the left internal capsule/basal ganglia which may indicate early ischemia. Please obtain an MRI for further evaluation as this is a subtle finding. There is no evidence of acute intracranial hemorrhage, mass or edema.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Low-attenuation focus in the left internal capsule/basal ganglia which may indicate early ischemia. Recommend MRI for further evaluation. No evidence of acute intracranial hemorrhage.


Instruction: Generate impression based on medical findings.

Input: This exam is markedly degraded by motion artifact. There is no evidence of large mass or acute infarct. There are scattered patchy foci of non-specific T2 hyperintensity within the supratentorial white matter. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact.

Output: No evidence of acute infarct or large mass on this motion degraded non-contrast exam. Scattered foci of T2 hyperintensity within the supratentorial white matter are non-specific and may represent chronic small vessel ischemic disease. If there is concern for metastases, contrast enhanced, sedated, MRI is recommended.


Instruction: Generate impression based on medical findings.

Input: 46 year old female with left-sided headaches. No evidence of intracranial hemorrhage, mass effect, edema, or abnormal enhancement. Ventricles and basal cisterns are within normal limits.Paranasal sinuses, orbits, and osseous structures appear unremarkable.

Output: No abnormality to account for patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: Intractable epilepsy, convulsions. Many of the images are degraded by patient motion. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears grossly 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, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of potential seizure foci, within the limitations of patient motion artifact.


Instruction: Generate impression based on medical findings.

Input: Epilepsy. Hallucinations and altered mental status. History of left temporal lobe laser ablation for epilepsy. There are post treatment changes related to left hippocampal ablation with associated rim of restricted diffusion. There is also peripheral susceptibility and patchy intrinsic T1 hyperintensity along the ablation cavity, compatible with expected postoperative blood products. There is prominent associated T2/FLAIR hyperintensity. Evidence of trepanation within the left temporal and bilateral occipital bones is again noted, with conspicuous enhancement and T2/FLAIR hyperintensity along the peripheral bilateral occipital and left temporal sites of prior depth electrodes. Faint enhancement is seen along the electrode tracts.There is slight asymmetry of the lateral ventricles left greater than right side, unchanged. The basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact.

Output: Expected postoperative findings post left hippocampal ablation, with enhancement and FLAIR parenchymal changes surrounding the ablation site. Additional enhancement and T2/FLAIR hyperintensity along the bilateral occipital and left temporal depth electrode insertion sites.


Instruction: Generate impression based on medical findings.

Input: 58-year-old woman with left ankle pain. Evaluate for accessory peroneal tendinitis and avulsion. TENDONS: The tendons of the ankle are intact and appear within normal limits. No accessory peroneal tendon is identified, as clinically queried.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: The articular surfaces of the ankle appear within normal limits. Bone marrow signal intensity is within normal limits.ADDITIONAL

Output: Normal examination of the left ankle.


Instruction: Generate impression based on medical findings.

Input: 74 year-old female with recurrent laryngeal cancer. Status post laryngectomy. Rule out recurrence and lung metastases. CT of the soft tissues of the neck with infusion:Images through the skull base, cavernous sinuses, paranasal sinuses and petrous bones remain negative for malignancy. Small retention cyst within the left maxillary sinus is again identified with no interval change.Images through the neck demonstrate post therapy/surgical changes. No evidence of a mass or pathologic adenopathy is present. Tracheostomy is noted. Small foci of nonenhancing tissue within the right lobe of thyroid matter present assist and remains stable since prior exam. This lesion measures approximately 4 mm in transaxial dimension. No detectable left lobe of thyroid.Limited images of mediastinum are negative for adenopathy.Limited images of the apices of the lungs are negative for metastatic lesions minimal apical scarring is noted. Please review the dictated report of CT of chest.No evidence of osseous or cartilaginous erosion. Complete laryngectomy is noted.CT of brain with infusion:No evidence of metastatic lesion to the brain, leptomeninges or the calvarium is detected. Findings of possible minimal small vessel disease of indeterminate age is again identified.Significant increased vascularity at the level of the tentorium and across the left cerebellum is highly concerning for an arteriovenous malformation/dural AVF. This finding was present on multiple prior studies and without any significant interval change. Further evaluation with a CT A4 MRA -- MRI is recommended.60 cc of Omnipaque 350 was utilized for the above studies.

Output: 1.No evidence of recurrence of disease in neck.2.No evidence of metastatic disease to the brain, leptomeninges or the calvarium.3.Arteriovenous malformation or an AVF in the left cerebellum needs further follow-up with dedicated studies of MRI / MRA or CTA examination or conventional angiogram.


Instruction: Generate impression based on medical findings.

Input: Liver transplantation patient, altered mental status. No evidence of acute ischemic or hemorrhagic lesion.There is a focal high signal intensity on the left frontal lobe superior frontal gyrus subcortical white matter on FLAIR imaging which indicate age indeterminate ischemic lesion. Another focal tissue loss on the right cerebellar hemisphere is also seen which indicates chronic infarct.Bilateral basal ganglia signal intensities are normal.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion.Chronic infarct with tissue loss, left frontal lobe and right cerebellar hemisphere.


Instruction: Generate impression based on medical findings.

Input: Reason: Rule out pancreatitis History: elevated amylase lipase, continued abdominal pain/weight lossEXAMINATION: Pancreas MRI and MRCP without and with IV contrast 06/11/15 at 14:45 ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions. No intra- or extrahepatic biliary dilatation, the common bile duct measures approximately 4 mm in greatest diameter. No cholelithiasis or evidence of cholecystitis. Incidental note is made of a relatively low insertion of the cystic duct into the common hepatic duct.SPLEEN: A small splenule is noted at the splenic hilum, measuring approximately 2.5 cm in diameter.PANCREAS: No evidence of pancreatic/peripancreatic inflammation. No pancreatic ductal dilatation. No loculated fluid, abscess, or pseudocyst is identified.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: Normal examination. No evidence of pancreatitis.


Instruction: Generate impression based on medical findings.

Input: 40 year-old female with HIV/AIDS and cervical cancer, status post radiotherapy. Presents with rectal bleeding. Evaluate for mass or inflammatory change. ABDOMEN:LUNG BASES: Small pleural-based nodules at the lung bases may be due to atelectasis or scar. No acute infiltrates or effusions.LIVER, BILIARY TRACT: Dilated gallbladder with cholelithiasis. Mild gallbladder wall thickening, possibly secondary to chronic cholecystitis. There is a benign hemangioma in the inferior right hepatic lobe, unchanged from the MRI examination.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: There is moderate left hydronephrosis and hydroureter with obstruction by infiltrative mass near the left ureterovesical junction, most likely a metastasis. The hydronephrosis is new since the MRI examination of 1/28/08.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diffuse colorectal wall thickening, probably due to post-radiotherapy change. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: The uterus demonstrates heterogeneous contrast enhancement with loss of the normal fascial planes between the uterus and bladder most likely due to direct tumor invasion. The interface between the rectum and uterus/cervix is indistinct, probably due to post radiotherapy change. New 1 cm right sided intrauterine mass near the fundus at axial image 94/144 of series 3. BLADDER: Diffuse bladder wall thickening. Left sided 4 cm diameter intraluminal mass is stable since 1/28/08. LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diffuse rectosigmoid wall thickening, probably due to post-radiotherapy change. BONES, SOFT TISSUES: Of sclerosis at the pubic symphysis is most likely due to radiation osteonecrosis.OTHER: No significant abnormality noted

Output: Post-radiotherapy changes to pubic symphysis and rectosigmoid. Cervical mass invades bladder. New left hydronephrosis and hydroureter due to bladder mass and infiltrative changes at the UVJ.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Stroke. Signs and symptoms: Right-sided weakness. Nonenhanced CT of brain:Subacute nonhemorrhagic right cerebellar and right medullary region in the distribution of right pica stroke is again identified. There is only subtle mass effect with effacement of sulci and no evidence of mass effect on the fourth ventricle.Well demarcated nonhemorrhagic lacunar infarct of right thalamus as was noted on prior MRI exam.Small vessel disease of indeterminate age is subcortical white matter of bilateral cerebral hemispheres (left greater than right). Overall this appearance also is similar to prior MRI examination. No evidence of hemorrhage.CTA of the cervical region:Right carotid, circumferential plaque at the origin of right internal carotid artery with no hemodynamically significant stenosis is noted. The right common carotid artery including its origin and the rest of the cervical portion of right internal carotid artery is unremarkable.Left carotid, circumferential complex plaque at the origin of left internal right artery with no minimal calcification is noted. This results in significant high-grade stenosis of left internal carotid artery at this site. The left common carotid artery and including its origin and the rest of the cervical portion of the left internal carotid artery is unremarkable and widely patent.Right vertebral artery is small in caliber and is believed to represent a non-dominant vertebral (and normal anatomical variation). There is no evidence of a stenotic lesion.Left vertebral artery, there is a non-calcific circumferential plaque at the origin of the dominant the left vertebral artery is noted. There appears to be more than 50% stenosis at this site. The rest of left vertebral artery is unremarkable.Limited view of lower tic origin the origin of major vessels are essentially unremarkable.CTA of intracranial circulation:Carotid system, patent bilateral supraclinoid internal carotid arteries. Minimal atherosclerotic irregularities noted.Middle cerebral arteries and their branches demonstrate mild atherosclerotic disease however but no evidence of any large vessel vascular occlusion or high-grade stenosis.Bilateral anterior cerebral arteries demonstrate multiple foci of high-grade stenosis and ectatic changes. Findings are secondary to atherosclerotic disease. Vertebral basilar system, diffuse atherosclerotic disease of the basilar artery with multi-level areas of mild vascular lumen compromise. Similar findings are noted in the intracranial component of dominant left vertebral artery in particular in its distal component.The right vertebral artery is the nondominant vessel. There is discontinuity of the distal component of the right vertebral artery. This represents occlusion of this vessel proximal to its junction with the basilar artery. The very distal portion of right vertebral artery is visualized and shows significant decrease in its caliber to its patent more proximal component.

Output: 1.Revisualization of multiple small vessel strokes, lacunar strokes and a right cerebellar -- medullary stroke in the distribution of right pica branch. No evidence of hemorrhagic transformation.2.Atherosclerotic plaque with minimal calcification however no hemodynamically significant stenosis at the origin of right internal carotid origin.3.Significant atherosclerotic disease of the left internal carotid artery origin with very high-grade stenoses.4.More than 50% stenosis at the origin of the dominant left vertebral artery and otherwise unremarkable vertebral arteries bilaterally in the neck.5.Atherosclerotic disease of supraclinoid internal carotid arteries, bilateral middle cerebral arteries with areas of mild to moderate vascular compromise. Atherosclerotic disease results in high-grade stenosis and ectatic changes of bilateral anterior cerebral arteries.6.Patent dominant left vertebral artery intracranially with minimal atherosclerotic disease.7.Patent basilar artery however but extensive atherosclerotic disease and mild vascular lumen compromise.8.Complete occlusion of the mid section of the intracranial component of the nondominant right vertebral artery. There is significant decrease in the caliber of visualized very distal right vertebral artery compared to patent a proximal component. If further evaluation is required for management a conventional angiogram would improve detection and the cause of occlusion and morphology of this vessel evaluation.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Cord compression? Enhancing lesion? Signs and symptoms: Bilateral lower extremity weakness. Enhanced cervical MRI:Examination demonstrates no detectable abnormal enhancement of the cord or the leptomeninges.There is enhancement along the adjacent endplates to C3-C4 disc space representing expected enhancement of degenerative changes.There is evidence of prior laminectomy at C4, C5 and C6 levels with resultant expansion of thecal sac and the expected minimal enhancement of postoperative changes posteriorly. There is revisualization of a focus of myelomalacia with decreased cord caliber similar to prior exam extending from C4 through C6.No evidence of a spinal canal compromise and no detectable abnormal enhancement of the cord or the meninges.Pre and post enhanced thoracic MRI:Examination demonstrates normal anatomical alignment of vertebral, without concerning detectable signal abnormality. No evidence of abnormal enhancement of the vertebral column is detected.Mild degenerative changes however without evidence of central spinal stenosis is detected.The signal intensity and caliber of the thoracic cord remains within normal limits and without detectable abnormal enhancement.Unremarkable perispinal soft tissues.

Output: 1.Post contrast cervical MRI exam demonstrate minimal expected enhancement of degenerative changes. Revisualization of myelomalacia and decreased cord caliber and without detectable cord or meningeal enhancement.2.Unremarkable pre and post enhanced MRI of thoracic spine.


Instruction: Generate impression based on medical findings.

Input: Arm weakness The examination is limited by motion artifact and pulsation from surrounding vessels.The musculature of the forearm is normal in caliber and signal without evidence of abnormal atrophy or edema. There is no evidence of a mass lesion or mass effect upon the forearm. The bone marrow signal of the radius and ulna are normal.

Output: Normal unenhanced MRI of the forearm.


Instruction: Generate impression based on medical findings.

Input: Alignment of the lumber spine is anatomic. The vertebral body heights are grossly preserved without evidence of fracture. There is infiltrative marrow abnormality involving all lumbar vertebral bodies and the visualized T11-12 vertebral bodies with slight increase in the right aspect of L1 and L2. At the level of L4, there is circumferential epidural enhancing soft tissue abnormality with mild to moderate central spinal stenosis, similar to the prior exam. Additionally, there is epidural tumor at the level of L3, eccentric to the left, which effaces the posterolateral aspect of the thecal sac and extends into the left lateral recess, unchanged. There is a large soft tissue mass with osseous destruction of the left iliac bone extending into the ipsilateral sacroiliac joint, unchanged.

Output: Widespread metastatic disease involving the vertebrae, epidural space, and left iliac bone; stable to minimally progressed since prior. Extent of epidural disease is not significantly changed in the interval with mild to moderate spinal canal stenosis at L3 and L4 again seen.


Instruction: Generate impression based on medical findings.

Input: 84 year old female with mental status changes status post fall. Rule out subdural hematoma. There is no evidence of intracranial hemorrhage, mass or edema. Low-attenuation in the periventricular white matter is consistent with small vessel ischemic disease of indeterminant age. The ventricles and basal cisterns are normal in size and configuration.In the brainstem, there is a tortuous basilar artery partially obscuring the brainstem. This finding is unchanged. If there is a clinical suspicion of stroke, MRI may be considered.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. No evidence of acute intracranial abnormality.2. Moderate small vessel ischemic disease of indeterminant age, unchanged.3. Unchanged tortuous basilar artery partially obscuring the brainstem. If there is a clinical suspicion of stroke, MRI may be considered.


Instruction: Generate impression based on medical findings.

Input: Benign neoplasm of cranial nerves [D33.3], Reason for Study: ^Reason: Brain tumor: Preop planning for resection History: headaches The scan was performed with multiple fiducial markers attached on the scalp.There is a large extra-axial mass on the left petrous apex with inhomogeneous enhancement.The mass is measured about 47.1mm(CC) x 35.7mm(RL) x 51.3mm(AP).The mass is centered at or around mesial skull base and eroding left petrous apex.The mass shows central non enhancing portion without evidence adjacent dural enhancement.The left cavernous sinus appears to be involved or completely pushed toward right side and the left cavernous sinus segment of the left ICA appears to be surrounded by the enhancing mass about 180-200 degree especially at the junction of petrous segment and posterior cavernous sinus segment.There is mass effects against brain stem, left cavernous sinus and left mesial temporal lobe.Differential diagnosis include left trigeminal nerve origin schwannoma or meningioma. There is no evidence of ventriculomegaly.The paranasal sinuses and mastoid air cells are clear.

Output: Left petrous apex extra axial mass with inhomogenous enhancement as described above.Differential diagnosis include Schwannoma and meningioma.