Instruction: Generate impression based on medical findings.

Input: Compared to MRI from 7/14/2015 interval decompression of previously seen massively dilated right lateral ventricle is seen. Diffuse thinning of the cortical mantle is again seen. There is development of a large extra-axial collection collection along the right cerebral convexity with mass effect on the right cerebral hemisphere and leftward midline shift which is improved since prior. There is also a small subdural collection along the left cerebral convexity which is new. Small amount of intraventricular blood products are noted layering within the occipital horns. There is also pneumocephalus consistent with recent surgical manipulation. No evidence of acute infarct.Postcontrast images demonstrate abnormal enhancement involving the occipital horns suspicious for ventriculitis. There is also enhancement involving the dura particularly along the left cerebral hemisphere which may be reactive to the adjacent subdural collection or sequela of prior ventricular drainage. No findings to suggest cerebritis or intraparenchymal abscess. Evidence of prior injury with cystic changes involving the left cerebellar hemisphere again noted. The brainstem as well as the cerebellar peduncles are also small.

Output: 1. Abnormal enhancement involving the ventricular walls along the occipital horns. Findings are suspicious for ventriculitis. No findings to suggest intraparenchymal abscess or cerebritis.2. Compared to MRI from 7/14/2015 interval decrease in caliber of the previously seen massively dilated right lateral ventricle and development of a large extra-axial collection along the right cerebral convexity with resulting mass effect on the adjacent parenchyma. Leftward midline shift is overall slightly improved in the interval. There is also a small left sided subdural collection which is new since prior.3. Pneumocephalus, thin left-sided subdural collection, and dural enhancement may all represent postprocedural change related to prior ventricular decompression.5. Severe thinning of the cortical mantle and extensive left cerebellar encephalomalacia again seen.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Reason: hx of prostate cancer, evaluate for disease History: see above. PELVIS:PROSTATE:Prostate Size: 2.7 x 4.8 x 2.7 cm.Peripheral Zone: In the posterior right base, there is a focal T2 hypointense region that demonstrates restricted diffusion and early enhancement, measuring approximately 9 x 8 mm (series 1301 image 17). Additional multiple smaller T2 hypointense foci within the right mid and base.Central Gland: No significant abnormality noted.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No lymphadenopathy.BONES, SOFT TISSUES: No osseous lesions.OTHER: No significant abnormality noted.

Output: Multifocal lesions in the right mid and base with dominant tumor in the right posterior base.


Instruction: Generate impression based on medical findings.

Input: Migraines for 9 months with a normal neurological exam. There are numerous nodules with grey matter signal characteristics along the bilateral lateral ventricular margins, right greater than left. THere is also prominence of the bilateral lateral ventricles, particularly the posterior portions, right more than left. There is prominence of the left parasagittal retrocerebellar cerebrospinal fluid spaces, associated with mild cerebellar asymmetry, in which the left cerebellar hemisphere is slightly smaller than the right. There is no evidence of intracranial hemorrhage or acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a right maxillary sinus retention cyst.

Output: Extensive bilateral lateral ventricular subependymal heterotopia with associated ventriculomegaly, right more than left, and mild cerebellar asymmetry.


Instruction: Generate impression based on medical findings.

Input: Visual field defect, unspecified [368.40], Reason for Study: ^Reason: Bitemporal hemianopia History: Bitemporal hemianopia Orbit MRIThe globes, optic nerves, extraocular muscles and retroglobal spaces are symmetric and normal. The lacrimal glands are normal. There is no evidence of signal abnormality, mass, or abnormal contrast enhancement. Optic chiasm appears to be normal.Brain MRI No evidence of acute ischemic or hemorrhagic lesion on the scan.Scattered high signal intensities on FLAIR imaging on periventricular white matter indicate nonspecific small vessel ischemic disease.There is a well-circumscribed about 7 mm sized pineal gland cyst without evidence of mass effect toward surrounding structures.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra- or extra-axial fluid collection, hemorrhage, restricted diffusion/acute ischemia or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. Mucosal thickening on bilateral maxillary sinuses, frontal sinus and ethmoid sinuses and there is small retention cyst on the right maxillary sinus.

Output: 1. Normal orbit MRI scan.2. No evidence of acute ischemic or hemorrhagic lesion on the scan. No abnormal enhancement.3. Minimal nonspecific small vessel ischemic disease.


Instruction: Generate impression based on medical findings.

Input: 54-year-old male with history of aortic valve replacement (bioprosthetic) for severe aortic regurgitation and a ventricular septal defect with chest pain, syncope, dizziness, diaphoresis. Minimal paravalvular leak on TEE. Referred for cardiac MRI to evaluate for questionable dehiscence. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 49%. The LVEDV is 173 ml (normal range 142+/-34), the LV end diastolic volume index is 103 ml/m2 (normal range: 74+/-15), the LVESV is 89 ml (normal range 47+/-19) and the LV end systolic volume index is 53 ml/m2 (normal range 25+/-9). The LV mass is 109 g (normal range 164+/-36) and the LV mass index is 65 g/m2 (normal range 85+/-15). There are no regional wall motion abnormalities present. There is small amount of late gadolinium enhancement in the basal anteroseptal wall possibly due to previous VSD repair.The native T1 myocardial relaxation time is 1110 ms in the ventricular septum and 1147 in the LV free wall.There is no LV thrombus. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 53%. The RVEDV is 133 ml (normal range 142+/-31), RV end diastolic volume index is 79 ml/m2 (normal range 82+/-16), the RVESV is 62 ml (normal range 54+/-17), and the RV end systolic volume index is 37 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is normal in size.Aortic ValveThe bioprosthetic aortic valve opens opens widely. There is no significant aortic regurgitation. No paravalvular leak is noted.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsScattered subcentimeter pulmonary nodules and mild mediastinal and hilar lymphadenopathy. Correlation with chest CT is suggested. 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: No convincing evidence of aortic perivalvular leak or aortic valvular dysfunction.1.The left ventricle is normal in size with mildly reduced systolic function. LVEF 49%. 2.Small amount of late gadolinium enhancement in the basal anteroseptal wall possibly due to previous VSD repair.3.The right ventricle is normal in size with normal systolic function. RVEF 53%.4.Normally functioning bioprosthetic aortic valve with no regurgitation and no paravalvular leak.5.Scattered subcentimeter pulmonary nodules and mild mediastinal and hilar lymphadenopathy. Correlation with chest CT is suggested. 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: Thyroid nodules RIGHT LOBE MEASUREMENTS: 7.2 x 2.4 x 2.1 cmLEFT LOBE MEASUREMENTS: 6.9 x 2.6 x 1.9 cmISTHMUS MEASUREMENTS: 7 mmRIGHT LOBE: Again noted heterogeneous echotexture without any focal lesions.LEFT LOBE: Heterogeneous echotexture without any focal lesions, unchanged.ISTHMUS: Previously described isthmic subcentimeter cystic lesions are unchanged.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-appearing lymph nodes are unchanged.OTHER: No significant abnormality noted.

Output: Diffuse enlarged thyroid with two subcentimeter cystic isthmic nodules without any significant change.


Instruction: Generate impression based on medical findings.

Input: 66 years Female (DOB:11/29/1949)Reason: please evaluate AVfistula for changes, prior to SRS History: Pulsatile tinnitus (has improved since last scan)PROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.There is a redemonstration of an asymmetrically prominent right hypoglossal artery branch of the ascending pharyngeal artery when compared to the left side. The hypoglossal branch appears to anastomose with the odontoid arch system.. Then goes on to anastomose with the C2 artery. The previously noted prominence of the inferior petrosal sinus is not present on the current exam.There is prominence of the clival branch of the right meningohypophyseal trunk of the right internal carotid artery.The anterior communicating artery is identified. An incompletely visualized vessel originating from the ACOMA is suspected to represent the median artery. The anterior communicating artery is large. This appearance has not changed since the prior exam dilated component of the anterior communicating artery The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.There is extracranial origin of the posterior inferior cerebellar artery bilaterally.

Output: 1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.A large right hypoglossal branch of the ascending pharyngeal artery is present. This is a nonspecific finding. There is no convincing evidence for arteriovenous fistula or vascular lesion. Other explanations may be collateralization or congenital cause or a vascular lesion below the field-of-view on this exam. The change since the prior exam could imply a decrease in flow from a prior lesion.


Instruction: Generate impression based on medical findings.

Input: History of BRCA2 mutation There is scattered fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.There are small foci of enhancement bilaterally, none of which are uniquely enhancing. There is an area of enhancement in the right lateral inferior breast, which is thought to be parenchymal. No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on medical findings.

Input: 16 year old girl with history of left knee osteochondral defect and intra-articular loose body, presenting with continued left knee pain. MENISCI: There is marked attenuation of the anterior horn and body of the lateral meniscus. As the previous study showed a discoid lateral meniscus, the meniscal attenuation seen on the current study likely in part reflects interval surgery. However, there is also obliquely oriented signal extending through the junction of the body and posterior horn, compatible with a tear, and we suspect that the attenuation of the remainder of the body of the lateral meniscus as well as the anterior horn also in part reflects chronic attritional tearing. Blunting of the free edge of the posterior horn of the lateral meniscus may also represent prior surgery. There is a cyst along the posterior horn of the medial meniscus that appears to arise from its peripheral fibers. Horizontally oriented linear signal within the posterior body of the medial meniscus extending to the femoral articular surface seen on a single MRI slice may represent a horizontal tear. ARTICULAR CARTILAGE AND BONE: Cortically-based intramedullary low signal intensity within the distal femoral metaphysis posteriorly likely represents a healed nonossifying fibroma. As seen on prior radiographs, there is an osteochondral defect of the weightbearing portion of the lateral femoral condyle with heterogeneity of the overlying cartilage. The osteochondral defect measures approximately 1.4cm in greatest dimension. There is an ovoid loose body situated anterior to the lateral meniscus, which measures just over 1cm in greatest dimension. The articular cartilage of the medial tibiofemoral compartment appears normal, as does that of the patellofemoral compartment. LIGAMENTS: Anterior and posterior cruciate ligaments are intact. Medial collateral ligament and lateral collateral ligament complex are intact. EXTENSOR MECHANISM: Quadriceps tendon and patellar tendon are intact.ADDITIONAL

Output: 1.Osteochondral defect of the lateral femoral condyle with intra-articular loose body.2.Lateral meniscal abnormalities described above likely representing a combination of tearing and prior surgery for discoid meniscus.3.Parameniscal cyst that appears to arise from the posterior horn of the medial meniscus, possibly associated with a horizontal tear.


Instruction: Generate impression based on medical findings.

Input: Male, 13 months old, with seizure-like movements. The brain parenchyma shows normal signal intensity and morphology. No edema or mass effect is detected. No restricted diffusion is seen. There is no evidence of any cortical dysplasia or migrational anomaly. A normal variant mega-cisterna magna is suspected.The pituitary gland is within normal limits for age. The brain stem and cerebellar vermis are unremarkable. The cerebellar hemispheres are normally formed and the cerebellar tonsils terminate above the level of the foramen magnum.The pattern of white matter myelination is appropriate for age. No evidence of intracranial hemorrhage or pathologic extra-axial fluid collection is seen. Ventricular size and morphology are within normal limits.

Output: Unremarkable examination with no specific findings to account for the patient's seizures.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Radiculopathy, lumbar regionClinical question: lumbar radiculopathySigns and Symptoms: radiculopathy Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is mild bilateral facet hypertrophy at this level. There is disc desiccation at this level. There is a diffuse disc bulge at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is some disc desiccation at this level. There is a moderate to marked degree of facet hypertrophy present which is worse on the left compared to the right side. Lung the inferior aspect of the left facet joint and superficial to it there is a synovial cyst present. There is mild effacement of fat surrounding the left-sided exiting nerve roots at this level. There is mild anterior subluxation of L4 and L5.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: There are degenerative changes present in the lower lumbar spine worse at L4-5 where there is marked facet hypertrophy and mild subluxation resulting in encroachment of the nerve roots within the left neural foramen.


Instruction: Generate impression based on medical findings.

Input: Secondary malignant neoplasm of brain [C79.31], Reason for Study: ^Reason: eval for tumor resection History: left weakness Post right fronto-parietal craniotomy status.Previously seen right parietal lobe intra-axial enhancing masses (one at the right inferior parietal lobule and another at the precuneus) are not demonstrated on this scan with minimal tumor bed enhancement indicating near complete or complete resection status. Susceptibility lesions on tumor bed indicate operation related blood products. Minimal enhancement on the tumor bed may indicate postoperative changes, but may need follow up scan.The degree of brain edema and midline shift toward left do not show any significant interval change since prior scan.There is no evidence of acute ischemic or hemorrhagic lesion except resection bed blood products on this scan.The ventricles, sulci and cisterns are unremarkable and unchanged since prior scan. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Near total or complete resection status of the right parietal metastatic lesions, postoperative no unusual finding.2. Subtle enhancement of tumor beds are likely represent postoperative changes but needs follow up scan.3. Unchanged the degree of brain edema and midline shift toward left side since prior scan.


Instruction: Generate impression based on medical findings.

Input: 52-year-old female. Subcutaneous nodule. Evaluate for soft tissue mass and extension of mass. The leg was imaged from the tibial articulation in the knee to the ankle joint. Three markers were placed around the patient's palpable abnormality in the posterior lateral mid leg. This corresponded to a T1 hypointense and STIR hyperintense subcutaneous nodule that measures 1.4 x 2.6 cm in maximal transaxial dimensions and 1.9 cm in the CC dimension (series 6, image 22; series 6, image 22). Its enhancement cannot be assessed on post-contrast sequences due to extensive artifact at the edge of the coil. A second subcutaneous nodule with similar signal intensity and that diffusely enhances is seen in the medial anterior upper leg. It has maximal transaxial dimensions of 1 x 2.2 cm and a CC dimension of 1.8 cm (series 13, image 32; series 15, image 12). Neither of these nodules extend to the underlying musculature. Diffuse mild atrophy of the musculature of the leg. Varicose veins are noted mostly in the medial aspect of the leg. Mild subcutaneous edema greatest in the anterior and lower lateral aspect of the leg. Bone marrow signal intensity is normal. Incompletely imaging of the knee shows a small joint effusion with synovial thickening and enhancement, suggestive of synovitis. A small Baker's cyst is noted.

Output: Two subcutaneous nodules in the leg with nonspecific signal characteristics; both benign and malignant etiologies are included in the differential.


Instruction: Generate impression based on medical findings.

Input: 53-year-old male patient status post patellar dislocation. Assess MPFL. MENISCI: The lateral and medial menisci are intact.ARTICULAR CARTILAGE AND BONE: There is full-thickness loss of the articular cartilage along the lateral facet of the patella. There is also increased signal intensity in the medial facet articular cartilage indicating degeneration. There is an approximately 1.5 cm focus of intermediate signal intensity within the medial aspect of the patellofemoral articulation which likely represents a displaced cartilage fragment. There is also a 1 cm crescentic osteochondral fragment centered about the anterior aspect of the medial femoral condyle. There is a full-thickness cartilaginous defect along the lateral femoral condyle just above the anterior horn of the lateral meniscus with mild edema-type signal in the underlying bone. Increased signal intensity within the articular cartilage of the weightbearing portion of the lateral tibial plateau likely reflects degeneration. The medial compartment articular cartilage is intact.LIGAMENTS: The cruciate ligaments, medial collateral ligament, and lateral collateral ligament complex are intact.The medial patellofemoral ligament is not well visualized, likely representing a tear, with fluid and edema along the medial retinacular structures of the knee.EXTENSOR MECHANISM: There is an incomplete tear of the quadriceps tendon at the insertion on the patella. This includes a full-thickness but minimally retracted tear of the vastus intermedius, a full-thickness but minimally retracted tear of the vastus medialis, and partial thickness longitudinal tearing of the rectus femoris. The fibers of the vastus lateralis tendon can be traced to the insertion on the patella, although the medial fibers may be partially torn. Small ossicles are seen within the distal quadriceps tendon.ADDITIONAL

Output: Findings compatible with lateral patellar dislocation as described above. The medial patellofemoral ligament is not well seen and likely torn. Furthermore, there is tearing of the distal quadriceps tendon as described above and cartilage defects with fragments in the joint.


Instruction: Generate impression based on medical findings.

Input: A 49 year old male with personal history of viral pericarditis on 2010 with tamponade that required pericardiocentesis and drainage. Recently an echocardiography was performed due to dyspnea and showed a left ventricular ejection fraction of 31%. Referred to cardiac MRI for further evaluation Left VentricleThe left ventricle is normal size with mildly reduced systolic function. There is a significant diastolic bounce of the interventricular septum. The overall LV ejection fraction is 47%, the LV end diastolic volume index is 86 ml/m2 (normal range: 74+/-15), the LVEDV is 192 ml (normal range 142+/-34), the LV end systolic volume index is 46 ml/m2 (normal range 25+/-9), the LVESV is 102 ml (normal range 47+/-19), the LV mass index is 44 g/m2 (normal range 85+/-15), and the LV mass is 98 g (normal range 164+/-36). There is epicardial late gadolinium enhancement involving the basal inferolateral wall which suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pattern is not typical for prior myocardial infarction.Left AtriumThe left atrium is normal in size (87ml). Right VentricleThe right ventricle is normal size with normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 73 ml/m2 (normal range 82+/-16), the RVEDV is 163 ml (normal range 142+/-31), the RV end systolic volume index is 37 ml/m2 (normal range 31+/-9), and the RVESV is 82 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is mild thickening of the pericardium with evidence of pericardial late gadolinium enhancement but not increased T2-signal. Additionally there is significant respiratory variation in the position of the interventricular septum. These findings suggest the diagnosis of constrictive pericarditis in the fibrotic stage.Extracardiac FindingsThe esophagus is dilated with significant thickening of the esophageal wall. Mediastinal lymphadenopathy is noted. 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. Normal LV size with mildly reduced systolic function (LVEF 47%) with epicardial late gadolinium enhancement in the basal inferolateral wall, consistent with the patients history of known prior myocarditis.2. There is mild thickening of the pericardium with evidence of pericardial late gadolinium enhancement without increased T2-signal. Additionally there is a prominent diastolic bounce of the interventricular septum which is associated with significant respiratory variation in the septal position. These findings suggest the diagnosis of constrictive pericarditis in the fibrotic stage.3. Normal RV size and systolic function (RVEF 50%).4. The esophagus is dilated with significant thickening of the esophageal wall. Mediastinal lymphadenopathy is noted. 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: 54-year-old female with pain. Evaluate for rotator cuff tear. ROTATOR CUFF: The supraspinatus muscle and tendon appear intact. The infraspinatus muscle and tendon appear intact. The teres minor and subscapularis muscles and tendons appear intact. The rotator cuff is within normal limits for age.SUPRASPINATUS OUTLET: There is no significant fluid within the subacromial/subdeltoid bursa. The acromioclavicular joint is within normal limits.GLENOHUMERAL JOINT AND GLENOID LABRUM: Mild to moderate osteoarthritis affects the glenohumeral joint with cartilage degeneration and small osteophytes. The anterior superior labrum appears detached from the underlying glenoid and while this may represent a normal variant sublabral foramen, heterogeneous signal abnormality of the anterior labrum, more inferiorly, raises the possibility of a degenerative tear. There is no glenohumeral joint effusion. There are small subchondral cysts within the inferior glenoid.BICEPS TENDON: The tendon of the long head of the biceps appears intact. ADDITIONAL

Output: 1. Normal appearing rotator cuff.2. Glenohumeral joint osteoarthritis and probable degenerative tearing of the anterior labrum.


Instruction: Generate impression based on medical findings.

Input: Dysphagia, unspecified(787.20) [787.20], Reason for Study: ^Reason: subacute stroke History: drooling, dysphagia, decreased grip strength Motion artifacts degraded image quality.There is focal enhancing lesion (about 4mm) on the midline to slightly right side of the tectum on T1 Gad enhanced images (series 1201, image 16/32). The lesion shows low signal intensity on T1 non contrast images and slightly high signal intensity on T2 weighted images. On FLAIR images, the lesion area shows CSF signal intensity. There is no evidence of mass effects of this lesion toward adjacent anatomical structure. There is no evidence of susceptibility artifacts on this lesion.Therefore, this lesion could be a partial volume averaging artifacts with tectum area CSF, possibly small pineal cyst and adjacent internal cerebral vein. However, possibility of small tectal glioma or capillary telangiectasia cannot be completely excluded. Repeat MRI scan with thinner section of the lesion with and without contrast enhancement may be considered for further imaging evaluation. There is no evidence of acute ischemic or hemorrhagic lesion on the scan.There is focal encephalomalacia on the left posterior inferior temporal lobe without evidence of susceptibility artifacts indicating chronic ischemic infarction.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Focal enhancing lesions on the tectum as described above, possibilities include partial volume artifacts, tectal glioma, capillary telangiectasia. Repeat exam with thin section around the tectum may be considered for further imaging evaluation.3. Focal encephalomalacia on the left inferior posterior temporal lobe likely represent chronic ischemic infarction, as described above.


Instruction: Generate impression based on medical findings.

Input: Reason: grade II oligodendroglioma w/ 1p19q deletion. History: brain tumor. The patient is status-post right-sided craniotomy for right temporal lobe surgery. Anterior aspect of the right temporal lobe has been surgically removed. The appearance of a surgical cavity and the adjacent structures is stable when compared to prior exam. T2 and flair MRI signal hyperintensity surrounding these surgical site are stable and suspect the least in part be related to gliosis. No convincing evidence for cerebral blood volume or permeability elevation is appreciated surrounding the original tumor bed.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.A punctate focus of susceptibility is present in the left centrum semiovale. In isolation this is of uncertain clinical significance.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 eyeball lenses are thin.

Output: 1.Status post right temporal lobe surgery for oligodendroglioma. There is no convincing evidence for recurrence.2.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on medical findings.

Input: 44 year old with history of right breast DCIS status post lumpectomy and re-excisions with calcifications near the surgical site. Dense breasts. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate to marked parenchymal enhancement is noted bilaterally, somewhat of a limitation to the study. No abnormal enhancement is seen in either breast, including at the lumpectomy site. Post operative volume loss and low T2 signal scarring is noted at the site of right upper outer breast lumpectomy, though no nodular enhancement is seen at the site of scarring -- and in fact the degree of background enhancement is quite low near the area of scarring. No abnormal axillary lymph nodes are identified in either axillary region. Post surgical change noted in the right axilla.

Output: No MRI evidence for malignancy. No suspicious enhancement near the lumpectomy or elsewhere in either breast. The 6 month mammogram follow up should still be performed based on the appearance of the mammograms. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on medical findings.

Input: 55 year old female. Evaluate for bleeding/trauma. Prominent cerebral sulci and cerebellar folia consistent with volume loss, unchanged.There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Cerebral volume loss with no acute intracranial abnormality seen.


Instruction: Generate impression based on medical findings.

Input: Follow-up prolactinoma: headaches and irregular menses. The pituitary gland enhances slightly heterogeneously, but no discrete tumor is discernible. The pituitary gland is not enlarged and there is no mass effect upon the optic apparatus or cavernous sinuses. The posterior pituitary bright spots is not conspicuous, however. The infundibulum is intact and located in the midline. There are subcentimeter nasopharyngeal retention cysts. There are foci of T2 hyperintensity in the imaged portions of the cerebral white matter.

Output: 1. The pituitary gland enhances slightly heterogeneously and the posterior pituitary bright spot is not apparent, but no discrete tumor is discernible to suggest an adenoma, and no evidence of pituitary apoplexy.2. Nonspecific foci of T2 hyperintensity in the imaged portions of the cerebral white matter. Follow up via a dedicated brain MRI may be useful.


Instruction: Generate impression based on medical findings.

Input: There is transitional anatomy with either 11 thoracic and 5 lumbar vertebrae or 12 thoracic and 4 lumbar vertebrae. For the purposes of this exam, the last fully formed disc space will be termed L4-S1. There are postoperative findings related to suboccipital craniotomy for Chiari decompression. There is expected biphasic CSF flow anteriorly and posteriorly across the neo-foramen magnum. There is minimal retroflexion of the dens. The cerebellar tonsils lie at the level of C1. At the C1-C2 level, there is focal syringohydromyelia which measures 6 x 5 x 12 mm in the transverse by cc dimensions, previously 7 x 7 x 12 mm. There is an approximately 58 x 41 mm fluid collection within the left abdomen and pelvis, as well as smaller amount of fluid within the right abdomen that is likely related to the patient's lumboperitoneal shunt. The vertebral column alignment is unchanged, with straightening of the cervicothoracic alignment. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The conus terminates at T12-L1, using the chosen nomenclature for this exam.

Output: 1.Transitional vertebral anatomy, as detailed above. Close attention and correlation during any future spine surgery is recommended. 2.Postoperative findings related to Chiari decompression surgery with patent neo-foramen magnum. 3.A focal syringohydromyelia at the C1-C2 level has minimally decreased in size. 4.Persistent intraperitoneal fluid collections may represent a pseudocyst related to the lumboperitoneal shunt. An ultrasound of this region may be useful for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old, with weakness in the left arm and leg, worsening gait. Evidence for anterior instrumented fusion is seen from C4 through C6. Spinal alignment is anatomic. Vertebral body heights are preserved. No worrisome marrow replacement or pathologic marrow enhancement is seen.The visualized spinal cord demonstrates normal signal intensity throughout. No pathologic intramedullary or leptomeningeal enhancement is seen. No epidural abnormalities are suspected.C2-3: Unremarkable. C3-4: Mild posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. C4-5: Obliteration of the disc space. No significant spinal canal or foraminal stenosis. C5-6: Near obliteration of the disc space. No significant spinal canal or foraminal stenosis. C6-7: Ligamentum flavum thickening. Minimal posterior disc-osteophyte complex formation. Mild spinal canal stenosis. No significant foraminal narrowing. C7-T1: Unremarkable.

Output: 1.Evidence of anterior instrumented fusion from C4 through C6.2.Mild disc degeneration and ligamentum flavum thickening result in mild spinal canal stenosis at C6-7.3.Elsewhere, no high-grade spinal canal or foraminal narrowing is detected.


Instruction: Generate impression based on medical findings.

Input: History of chronic liver disease with hepatic dome lesion on CT. ABDOMEN:LIVER, BILIARY TRACT: The liver is slightly nodular in contour. It measures 17 cm in length. There are findings of portal hypertension including ascites, splenomegaly and perisplenic collateral vessels including splenorenal shunting.No suspicious arterial enhancing lesion, washout, restricted diffusion or T2 hyperintense liver lesion. The previously seen CT abnormalities are not well seen on this study and likely reflect transient hepatic attenuation differences related to perfusional anomalies.Distended gallbladder and gallstones.SPLEEN: Splenomegaly measuring 18.3 cm.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted. Gastroesophageal varices are noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small pleural effusions.

Output: 1.No suspicious liver lesion. The previously seen CT abnormalities likely reflect transient hepatic attenuation differences/perfusional anomalies.2.Findings of cirrhosis and portal hypertension including ascites, splenomegaly, perisplenic collaterals including splenorenal shunting.


Instruction: Generate impression based on medical findings.

Input: Ms. Luna-Yassin is a 38 year old female with multifocal left breast cancer with metastatic left axillary lymph node. She presents today for MRI evaluation while on neoadjuvant therapy to assess treatment response. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Left breast - In the left lower outer breast, the known index malignancy now measures approximately 1.6 x 1.0 x 1.0 cm (AP x ML x SI) previously measuring approximately 2.2 x 1.9 x 2.0 cm. The biopsy marker clip is present anteromedial to this mass. Extending anteromedially from the index malignancy are two additional enhancing foci, one of which has been biopsy-proven to be a satellite lesion. The total span of abnormal enhancement (index malignancy + enhancing satellite lesions) measures approximately 5.7 x 1.4 x 1.7 cm and 5.9 cm in the AP oblique dimension, previously measuring approximately 4.9 cm in the AP dimension. The two biopsy marker clips (one at the index malignancy and one at the satellite lesion) measures approximately 2.4 cm in the AP dimension. Right breast - There is a new rim-enhancing lesion identified in the right inferior breast measuring approximately 1.4 x 0.9 x 0.8 cm. This enhancing mass is associated with internal high T1 signal intensity, likely representing benign fat necrosis. Axillae - The known metastatic left axillary lymph node with associated biopsy marker clip now measures approximately 1.7 cm in maximal dimension, previously measuring 2.0 cm. There are no abnormal lymph nodes identified in the right axilla.

Output: (1) Overall interval decrease in size of known multifocal left breast malignancy. Residual abnormal enhancement (index malignancy + satellite lesions) continues to measure up to 5.9 cm in the AP dimension, greater than the distance between the two biopsy marker clips (one at the index malignancy and one at the satellite lesion) of approximately 2.4 cm. (2) Slight interval decrease in size of metastatic left axillary lymph node.(3) New rim-enhancing lesion in the right inferior breast, with imaging features suggestive of benign fat necrosis. Recommend correlation with an MR-directed ultrasound and/or mammogram. If no correlate is identified, then a short term 6 month MRI is recommended to confirm stability of this finding. BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required.


Instruction: Generate impression based on medical findings.

Input: Cervical spinal stenosis. C6 -- C7 stenosis. Left arm pain. CT of cervical spine without infusion:Sagittal reformatted images demonstrate moderate to advanced degenerative disk disease at C5 -- C6 and C6 -- C7 levels as well as hypertrophic and calcification of posterior longitudinal ligament and to a lesser degree degenerative changes of disks at the other levels.There is complete loss of cervical lordosis. There is straightening and minimal kyphotic deformity of the cervical spine centered at C4 -- C5 level. The bony density of the vertebral column is unremarkable with the exception of sclerotic changes related to disk disease.Foramen magnum.Examination at this level is unremarkable.C2 -- C3.Minimal degenerative disk disease is noted and otherwise unremarkable.C3 -- C4.Minimal degenerative disk disease and minimal hypertrophic changes of the articulating facets on the left. Hypertrophic changes at the level of the left uncovertebral is also present. Combination of a bald changes causes compromise of the left neuroforamina at this level.C4 -- C5.Calcification of posterior longitudinal ligament posterior to C4 is present. This causes indentation of thecal sac. There is mild hypertrophic changes of disks and posterior elements. Hypertrophic changes at the level of right uncovertebral causes compromise of right neural foramina. There is broad-based bulge of disk material which minimally flattens the ventral thecal sac. There is also suspected compromise of the left neural foramina secondary to degenerative changes.C5 -- C6.Heavy calcification of posterior longitudinal ligament which is in contact with the ventral aspect of the cord. Extensive hypertrophic changes of uncovertebral causes compromise of bilateral neural foramina. Bulge of disk material and ventral hypertrophic changes appear to do cause indentation of the ventral aspect of the cord and suspected central spinal stenosis.C6 -- C7.Advanced degenerative disk disease and extensive hypertrophic changes of uncovertebral bilaterally. Compromise of bilateral neural foramina. I suspect central spinal stenosis at this level however please reviewed dedicated report of MRI examination of cervical spine. C7 -- T1.Mild degenerative changes. No detectable central spinal stenosis or neural foramina compromise.limited view of upper thoracic spine to T4 level demonstrate normal degenerative changes and is otherwise unremarkable.

Output: Degenerative changes of disks, posterior elements, posterior longitudinal ligament as detailed above. Constellation of above findings results in multilevel neural frontal compromise and central spinal stenosis as detailed.


Instruction: Generate impression based on medical findings.

Input: Male, 94 years old, with gait impairment. Evaluate for spinal stenosis, metastatic disease. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. Marrow signal characteristics are somewhat heterogeneous but overall benign. Mild endplate edema is seen at the inferior L3 endplate with an associated Schmorl's node deformity. A small focus of STIR hyperintensity within the S2 vertebral body is nonspecific.The visualized distal spinal cord, conus and cauda equina are within normal limits. No epidural abnormalities are suspected.Note is made of severe hydronephrosis and hydroureter on the right. In addition, there are a number of enlarged retroperitoneal lymph nodes. A masslike lesion is partially visualized in the right pelvis.L1-2: Mild facet arthropathy and ligamentum flavum thickening. No significant spinal canal or foraminal stenosis. L2-3: Facet arthropathy and ligamentum flavum thickening. Mild disc bulging. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. L3-4: Moderate facet arthropathy and ligamentum flavum thickening. Moderate disc bulging. Mild spinal canal stenosis. Mild bilateral foraminal narrowing. L4-5: Moderate facet arthropathy and ligamentum flavum thickening. Mild bulging disc. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. L5-S1: Moderate facet arthropathy. No significant spinal canal or foraminal stenosis.

Output: 1.Relatively mild degenerative disease of the lumbar spine with no areas of high-grade spinal canal or foraminal stenosis.2.Severe hydronephrosis and hydroureter is evident on the right, in the context of retroperitoneal adenopathy and a probable right pelvic mass which is only partially visualized. Further evaluation with dedicated pelvic imaging is recommended. Findings were discussed with Dr. Campbell at 1:00 PM on 08/03/16.3.No definite osseous metastases are seen. A small focus of signal abnormality in the S2 vertebral body is nonspecific. If concern for osseous metastases persists, further evaluation with a nuclear medicine bone scan may provide additional information.


Instruction: Generate impression based on medical findings.

Input: Female 47 years old Reason: Eval for Ligament tear History: Medial elbow pain LIGAMENTS: Ligaments including the ulnar collateral and radial collateral ligaments are intact.TENDONS: The tendons, including those of the biceps, brachialis, and triceps, are normal without evidence of tearing or thickening.ARTICULAR SURFACES AND BONE: No significant abnormality noted. Bone marrow signal is normal.SURROUNDING STRUCTURES: No significant abnormality noted.ADDITIONAL

Output: Normal MRI of the elbow with intra-articular contrast.


Instruction: Generate impression based on medical findings.

Input: Reason: assess for lateral meniscus tear History: right knee pain. MENISCI: Complex multidirectional tearing of the body and anterior and posterior horns of the lateral meniscus, new compared to prior. There is near complete loss of the posterior horn in its expected location with ill defined signal anterior to the anterior horn likely representing flipped posterior horn.Complex multidirectional tearing of the posterior horn of the medial meniscus is slightly improved compared to prior.ARTICULAR CARTILAGE AND BONE: Previously seen cleft-like defect of the articular cartilage of the femoral trochlea centrally is not significantly changed. Increased signal intensity along the lateral patellar facet articular cartilage likely reflecting degeneration is also not significantly changed.Diffuse thinning of the articular cartilage of the medial tibiofemoral compartment with full-thickness defect of the femoral cartilage overlying the torn posterior horn of the medial meniscus with underlying femoral condyle edema, unchanged.Near full thickness defect of the articular cartilage overlying the lateral tibial plateau underlying the expected location of the posterior horn of the lateral meniscus. Tricompartmental osteophyte formation again noted.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.New complex multidirectional tearing of the body, anterior and posterior horns of the lateral meniscus, with the posterior horn flipped anterior to the anterior horn of the lateral meniscus.2.Previously seen multidirectional tearing of the posterior horn of the medial meniscus is stable to slightly improved compared to prior.3.Tricompartmental osteoarthritis.


Instruction: Generate impression based on medical findings.

Input: 38-year-old male with malignant neoplasm of the testis and left RPLND ABDOMEN:LIVER, BILIARY TRACT: Normal liver morphology. Subcentimeter T2 hyperintense foci in the liver are not significantly changed and are likely benign. No suspicious liver lesions. The gallbladder is within normal limits. No intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Redemonstrated is a nonenhancing T2 hyperintense lesion on the left lateral margin of the aorta at the level of the bifurcation measuring 2.0 x 1.6 x 6.1 cm, stable to slightly smaller. Scattered subcentimeter mesenteric lymph nodes without pathologically lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Status post left orchiectomy and retroperitoneal lymph node dissection without evidence of metastatic disease to the abdomen or pelvis.2.T2 hyperintense lesion along the left lateral margin of the aorta at the level of the bifurcation is favored to represent a lymphocele or seroma.


Instruction: Generate impression based on medical findings.

Input: Transient right weakness, numbness, visual change, and headache. There is no evidence of masses in the spine. The vertebral column alignment is within normal limits, aside from mild straightening of the cervical spine. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal or neural foraminal stenosis. The spinal cord and cauda equina nerve roots are unremarkable. The paravertebral soft tissues are unremarkable. There is nonspecific prominence of the adenoids.

Output: No evidence of masses in the spine.


Instruction: Generate impression based on medical findings.

Input: 77 years Male (DOB:10/13/1939)Reason: evaluation of brain lesion History: Altered mental statusPROVIDER/ATTENDING NAME: SEJAL PATEL The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a hemorrhagic mass present in the right parietal lobe measuring 27 x 26 mm axial dimensions. There is associated vasogenic pattern of edema. There are some patchy enhancement associated with this.There is leptomeningeal enhancement present along the right hemisphere. On susceptibility imaging there are punctate foci of signal loss in the right frontal lobe subcortical white matter. There is some vasogenic edema present within the right frontal lobe.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is a hemorrhagic mass present in the right parietal lobe which is concerning for a neoplasm. This patient is reported to have a primary tumor in the esophagus. As a result it is suspicious for metastatic disease.2.There is leptomeningeal disease involving the right hemisphere. Differential considerations include leptomeningeal carcinomatosis and infection with meningitis. Please correlate with patient's clinical history.3.There are multiple microhemorrhages present in the right frontal lobe. These are nonspecific. In the current clinical context they could represent punctate foci of metastatic disease though they could also be a result of leptomeningeal carcinomatosis or meningitis.


Instruction: Generate impression based on medical findings.

Input: 67-year-old male with left renal mass ABDOMEN:LIVER, BILIARY TRACT: Scattered subcentimeter T2 hyperintense cysts are unchanged.SPLEEN: No significant abnormality noted.PANCREAS: Scattered punctate cystic foci in the body of the pancreas is unchanged and could represent a side branch type IPMN. The main pancreatic duct is normal in caliber.ADRENAL GLANDS: Small left myelolipoma. KIDNEYS, URETERS: Left superior pole renal cyst appears similar to the prior exam. No hydronephrosis or perinephric inflammation. Status post right nephrectomy. No evidence of local or regional recurrence.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.Status post right nephrectomy without evidence of recurrent disease.


Instruction: Generate impression based on medical findings.

Input: Reason: Rule out posterior circulation stroke. Evaluate centrum semiovale CT hyperintensity for hemorrhage or tumor. History: Sudden onset unsteadiness, vomiting, vertical nystagmus. There is no evidence of acute infarct. There is a lesion with substantial susceptibility effect and central T1 hyperintensity in the right posterior centrum semiovale that measures up to 10 mm. There is no surrounding edema or abnormal enhancement. There are a few scattered punctate foci of nonspecific cerebral white matter T2 hyperintensity. 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: A lesion in the right posterior centrum semiovale that measures up to 10 mm likely represents a cavernous malformation. No evidence of developmental venous anomaly, acute hemorrhage, or acute posterior circulation infarction.


Instruction: Generate impression based on medical findings.

Input: Pain in the right arm and shoulder. PT thinks it may be from c-spine. Brachial neuritis. The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There are small right sided uncovertebral osteophytes at this level with mild narrowing of the right neural foramen but with out nerve root compromise. At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There is no significant compromise to the cervical spinal canal or exiting nerve roots to explain the patient's radiculitis.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old, with history of lung cancer with rib and spine pain. Assess for the presence of a neoplastic process. Cervical:A trace degenerative retrolisthesis of C3 relative to C4 is demonstrated. Spinal alignment is otherwise unremarkable. No areas of worrisome marrow replacement or marrow edema are seen.No definite cord signal abnormality is seen. Questionable ill defined increased signal in the mid cervical cord, seen on the sagittal STIR and axial T2 sequences, but not the sagittal T2 sequence, may be artifactual and/or related to motion artifact.On post constrast images, no pathologic marrow space, epidural, or intradural enhancement is seen.C2-3: Right facet hypertrophy. No significant spinal canal or foraminal stenosis.C3-4: Facet hypertrophy. Disk osteophyte formation. Mild generalized spinal canal stenosis. Mild to moderate left foraminal stenosis.C4-5: Facet hypertrophy. Disk osteophyte formation. No significant spinal canal stenosis. Moderate left and mild right foraminal narrowing. C5-6: Left facet hypertrophy. Disk osteophyte formation with a focal component at the right subarticular/foraminal zone. No significant generalized parenchymal canal stenosis, but the right lateral thecal sac is effaced. Mild right foraminal narrowing. C6-7: Disk osteophyte formation, particularly along the left uncovertebral joint. No significant spinal canal stenosis. Mild left neuroforaminal narrowing.C7-T1: Facet hypertrophy. Otherwise, unremarkable.Thoracic:There is a slight curvature in the coronal plane, but alignment is otherwise unremarkable.A mild alteration of the marrow signal intensity in the upper and mid thoracic region may reflect radiation related change. Some of the upper thoracic vertebral bodies demonstrate a very subtle non uniform pattern of enhancement which is also favored to be treatment related. There is no definite evidence of any marrow space metastatic disease.The spinal cord demonstrates normal signal intensity and morphology. On postcontrast images, no concerning epidural or intradural enhancement is seen.Mild disk bulging is seen at T11-12 without significant spinal canal stenosis. A small left paracentral disk protrusion is present at T12-L1, again without significant stenosis.Elsewhere, the intervertebral disks are preserved with no compromise of the spinal canal or neural foramina.Partially visualized are numerous pulmonary nodules, some of which may be larger than on the prior exam. Volume loss and scarring is demonstrated in the right upper lung.Lumbar:The lumbar lordosis is straightened and there is a mild degenerative retrolisthesis of L5 relative to S1. A nonspecific, low signal, presumably sclerotic lesion is seen within the right iliac bone. No concerning marrow replacement or pathologic marrow enhancement is seen.The visualized spinal cord, conus and cauda equina are unremarkable. No pathologic epidural or intradural enhancement is seen.L1-2: Mild facet hypertrophy and ligamentum flavum thickening. Loss of disk height and bulging disk with a small left paracentral disk protrusion. No significant spinal canal stenosis. No significant foraminal narrowing. L2-3: Mild facet hypertrophy and ligamentum flavum thickening. No significant spinal canal or neuroforaminal stenosis. L3-4: Moderate facet hypertrophy and ligamentum flavum thickening. Mild laterally bulging disk. No significant spinal canal or neuroforaminal stenosis. L4-5: Mild facet hypertrophy and ligamentum flavum thickening. Mild bulging disk, particularly in the foraminal zones. Mild generalized spinal canal stenosis. Mild bilateral foraminal narrowing. L5-S1: Moderate facet hypertrophy. Loss of disk height with mild bulging and perhaps a very small central protrusion. No significant spinal canal stenosis. Mild bilateral foraminal narrowing.

Output: 1.No definite evidence of metastatic disease in the spine.2.Mildly altered signal intensity and pattern of enhancement within the mid to upper thoracic vertebral bodies is favored to represent a radiation related change.3.Questionable ill defined T2 signal abnormality is noted within the cervical spinal cord. This could be artifactual, as it is not confirmed on every sequence, and as there is some motion degradation on this exam. Follow-up imaging can be considered if clinical symptoms persist.4.Mild to moderate degenerative findings as discussed by level above.5.Numerous pulmonary nodules are partially visualized. Please consider dedicated chest imaging to assess for the possibility of interval growth.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for adductor tear History: hip pain for 2 years in groin ACETABULAR LABRUM: There is a small nondisplaced tear through the anterior superior labrum.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Small nondisplaced tear of the anterior superior acetabular labrum.


Instruction: Generate impression based on medical findings.

Input: 57-year-old male with elevated PSA. PELVIS:PROSTATE:Prostate Size: 4.9 x 4.7 x 2.8 cm.Peripheral Zone: There is no intrinsic T1 hyperintensity within the peripheral zone. There is asymmetric T2 hyperintensity in the left apex/midgland peripheral zone (series 8, image 16). There is corresponding low signal on ADC. No early arterial enhancement.Central Gland: There is moderate degree benign prostatic hypertrophy.Seminal Vesicles: No significant abnormality noted. Extracapsular Extension: There is no evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Asymmetric T2 hyperintensity in the left apex/midgland peripheral zone may represent malignancy.


Instruction: Generate impression based on medical findings.

Input: 57-year-old male with chronic low back pain. There is minimal retrolisthesis of L2 on L3, otherwise alignment is within normal limits. Bone marrow signal is benign. There is patchy T1 and T2 hyperintensity such as within the left half of the L1 vertebral body, which may represent a vertebral body hemangioma. There is mild to moderate degenerative disc space narrowing most severely affecting L2-3 and L3-4. The distal spinal cord and nerve roots appear unremarkable. Additional level specific findings are as follows:T12-L1: Minimal degenerative disc disease without central canal or neural foraminal compromise.L1-L2: Mild degenerative disc disease without significant central canal or neural foraminal stenosis.L2-L3: Mild-moderate degenerative disc disease with minimal disc bulge. No significant central canal or neural foraminal stenosis.L3-L4: Mild degenerative disc disease without significant central canal or neural foraminal stenosisL4-L5: No significant degenerative disc disease or central canal stenosis. Mild left neural foraminal stenosis and facet degenerative changes.L5-S1: No significant degenerative disc disease, central canal, or neural foraminal stenosis mild facet degenerative changes.

Output: Mild to moderate multilevel lumbar degenerative disc disease. No significant central canal or neural foraminal stenosis at any level.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: 74-year-old male with bilateral quadriceps weakness. Evaluate for nerve impingement. Metallic susceptibility artifact limits evaluation of the right hip and surrounding musculature/soft tissues.Right hip:Metallic susceptibility artifact from a right total hip arthroplasty device limits evaluation. There is a large lobulated focus of fluid signal intensity along the right hip along the lateral margin of the rectus femoris musculature which is incompletely visualized due to metallic susceptibility artifact from the aforementioned right total hip arthroplasty device as well as incompletely characterized on this noncontrast examination, but measures at least 7.8 cm in the craniocaudal dimension and 4.9 cm in the transverse dimension. There is associated partial thickness tearing of the right rectus femoris muscle at the level of the myotendinous junction. The rectus femoris tendon attachment on the anterior inferior iliac spine appears intact. There is atrophy of the right psoas musculature. There is diffuse fatty atrophy of the musculature of the right hip most pronounced within the right gluteus minimus muscle and adductor musculature. Heterogeneous bone marrow may represent residual islands of red marrow.Left hip:There is fatty atrophy of the musculature of the left hip most pronounced within the gluteal musculature. There is nonspecific increased signal abnormality within the rectus femoris and vastus lateralis muscles. The remainder of the imaged musculature of the left hip is normal in appearance. Heterogeneous bone marrow may represent residual islands of red marrow. There is a 14 mm bladder diverticulum along the left posterosuperior bladder.

Output: 1. Postoperative changes of a right total hip arthroplasty with a lobulated fluid collection along the anterior and lateral aspect of the right rectus femoris muscle which is incompletely visualized/characterized due to extensive metallic susceptibility artifact. These findings appear most consistent with hematoma/seroma formation related to partial tearing of the right rectus femoris at the level of the myotendinous junction. Superimposed infection cannot be excluded by this examination.2. Fatty atrophy of the musculature of the hips bilaterally as described above.3. Nonspecific increased signal abnormality within the left rectus femoris and vastus lateralis muscle bellies can be seen in subacute denervation or myositis.


Instruction: Generate impression based on medical findings.

Input: Chiari decompression: headache and adrenal insufficiency. Brain: There are postoperative findings related to Chiari decompression, with an unchanged configuration of the cerebellum, which remains low-lying. There appears to be partly impeded flow of cerebrospinal fluid across the neo-foramen magnum, both anteriorly and posteriorly. There is increased patchy T2 hyperintensity in the pons. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There are small bilateral ethmoid sinus retention cysts.Pituitary: There is unchanged appearance of the pituitary gland, which measures up to 10 mm in height. The infundibulum is intact and there is no mass effect upon the optic apparatus or cavernous sinuses.Cervical Spine: The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology.

Output: 1. Postoperative findings related to Chiari decompression, with an unchanged configuration of the cerebellum and apparent partly impeded flow of cerebrospinal fluid across the neo-foramen magnum. 2. Increased nonspecific patchy T2 hyperintensity in the pons. 3. Unchanged appearance of the pituitary gland, which measures up to 10 mm in height. 4. No evidence of syringomyelia.


Instruction: Generate impression based on medical findings.

Input: Chiari malformation with cervical syrinx: new back/neck pain. There are postoperative findings related to Chiari decompression. The cerebellum is low-lying and appears adherent to the overlying dura posteriorly. There is increase in size of the cervical syrinx, with a cavity that measures up to 17 mm in width at the C2 and C3 levels. Inferior to the cavity, there is diffuse high T2 signal and swelling of the spinal cord from the C4 to C7 levels. The thoracic spinal cord is unremarkable. There is mild retroflexion of the dens. There is markedly impeded flow of cerebrospinal fluid across the neo-foramen magnum. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis.

Output: 1. Postoperative findings related to Chiari decompression. The cerebellum is low-lying and appears adherent to the overlying dura posteriorly, which may be due to adhesions. 2. Increase in size of the cervical syrinx since 2013, with a cavity that measures up to 17 mm in width at the C2 and C3 levels with what likely represents pre-syrinx from C4 to C7.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Assess for intracranial hemorrhage. Signs and symptoms: Altered mental status status post concussion two months ago with CLL and thrombocytopenia Nonenhanced CT of brain:There is no it is of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus. A very subtle area of low attenuation in the right basal ganglia at the level of genu of internal capsule may represent a lacunar infarct of indeterminate age. Please correlate with history and if needed follow-up with an MRI is recommended for detection of acute lacunar infarct.Cortical sulci, ventricular system and all CSF cisterns remain within normal for patient stated age of 77.There is also a small extra-axial collection of CSF density which measures approximately 36 mm in AP axis and 12-mm in thickness at the level of sylvian fissure on the left. This is associated with subtle bony remodeling of calvarium. This finding is believed to represent a small arachnoid cyst and is best appreciated on axial images 15 through 17.

Output: 1.Small low-attenuation in the genuine of right internal capsule may represent a small lacunar infarct of indeterminate age. Please correlate with history and follow-up with an MRI.2.Small extra-axial left temporal arachnoid cyst as detailed.3.Unremarkable CT examination of brain otherwise.


Instruction: Generate impression based on medical findings.

Input: 10-year-old male with history of knee pain from injury. MENISCI: No abnormal signal intensity within the meniscus, and no discrete tear..ARTICULAR CARTILAGE AND BONE: Small area of high T2/low T1 signal intensity within the medial femoral condyle, correlate with history and physical exam as this may represent a bone contusion. No fracture line is seen. The articular cartilage is intact.LIGAMENTS: The cruciate and collateral ligaments are intact. No significant abnormal signal intensity to suggest sprain/strain. EXTENSOR MECHANISM: The extensor mechanism is intact, without abnormal signal intensity.ADDITIONAL

Output: Findings suggestive of medial femoral condyle bone contusion, without fracture or meniscal abnormality.


Instruction: Generate impression based on medical findings.

Input: Nontraumatic subarachnoid hemorrhage, unspecified [I60.9], Reason for Study: ^Reason: evaluate structure, any infectious concerns? History: Infant with subarachnoid bleed. Brain MRIMultifocal symmetric bilateral posterior temporal, parietal and occipital lobe as well as splenium of bilateral corpus callosum restricted diffusion lesions without evidence of hemorrhagic conversion indicating acute ischemic infarction.There are, however, focal susceptibility artifacts on bilateral lateral ventricles occipital horns indicating intraventricular hemorrhages which is unchanged since prior head CT scan.The ventricles, sulci and cisterns are symmetric.There is no evidence of abnormal enhancement.The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.

Output: 1. Bilateral symmetric acute ischemic infarctions involving parietal, posterior temporal, and occipital lobes as well as splenium of bilateral corpus callosum indicating acute ischemic infarctions without evidence of hemorrhagic conversion.2. Intraventricular hemorrhage.3. Normal brain MRA


Instruction: Generate impression based on medical findings.

Input: 43-year-old male with knee pain, evaluate for medial meniscal tear. MENISCI: There is branching signal abnormality within the posterior horn of the medial meniscus indicating a complex tear, which consists of a longitudinal component extending to the tibial articular surface and perhaps the femoral articular surface along the inner half of the meniscus as well as a more vertical component extending to the tibial articular surface within the periphery. Increased signal intensity extends into the body of the medial meniscus which likely reflects intrasubstance degeneration. The anterior horn of the medial meniscus appears normal. There is prominence of the body of the lateral meniscus, suggesting a mild discoid morphology, which contains mildly increased signal intensity suggesting intrasubstance degeneration, but no discrete tear is evident.ARTICULAR CARTILAGE AND BONE: There is focal degeneration of the articular cartilage along the trochlea. The remainder of the articular cartilage is normal. No abnormal marrow signal within the bone.LIGAMENTS: The ACL and PCL are intact. The MCL and lateral collateral ligament complex is intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Complex tear of the posterior horn of the medial meniscus and other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Status post thoracolumbar fusion. Signs and symptoms: See above. Nonenhanced CT of thoracolumbar spine:Examination demonstrates severely compressed L1 vertebral body with significant posterior protrusion of fractured vertebrae into the spinal canal. There is evidence of interval laminectomy at L1 and L2 levels. There is also evidence of posterior fixating rods and fusion utilizing transpedicular screws bilaterally at T11, T12, L2 and L3 levels. In comparison with prior MRI examination there is slight interval improvement in the alignment of vertebral column and good minimal residual anterolisthesis of T12 in respect to L2. There is no evidence of fracture of any of the rods or transpedicular screws. The appropriateness of their positioning should be decided by the referring physician. Note is made of a surgical drain extending posterior to the spinal canal in the lower thoracic and upper lumbar region. Examination also demonstrate mild compression fracture of the superior endplate of L3.

Output: 1.Severely compressed fracture of L1 vertebrae with significant extension posteriorly into the spinal canal.2.Interval bilateral laminectomy at L1 and L2 levels. 3.Posterior fixating rods and multilevel transpedicular bilateral screw placement of T11, T12, L2 and L3 levels.4.Mild residual anterolistheses of T12 with interval improvement since prior MRI exam.


Instruction: Generate impression based on medical findings.

Input: 52 year-old male with a history of atrial fibrillation with three previous ablations and recent cardioversion with recurrence of atrial fibrillation. He is referred for cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 48%, the LV end diastolic volume index is 66 ml/m2 (normal range: 74+/-15), the LVEDV is 164 ml (normal range 142+/-34), the LV end systolic volume index is 36 ml/m2 (normal range 25+/-9), the LVESV is 86 ml (normal range 47+/-19), the LV mass index is 25 g/m2 (normal range 85+/-15), and the LV mass is 59 g (normal range 164+/-36). There is global hypokinesis. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is severely dilated (end-systolic volume 142 ml). Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 72 ml/m2 (normal range 82+/-16), the RVEDV is 174 ml (normal range 142+/-31), the RV end systolic volume index is 35 ml/m2 (normal range 31+/-9), and the RVESV is 84 ml (normal range 54+/-17).Right AtriumThe right atrium is severely dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium. The ostial measurements are as below. All of the pulmonary vein ostial had evidence of late gadolinium enhancement secondary to ablation; however, the left upper pulmonary vein appears to have the largest "ablation gaps."LUPV: 15x14mmLIPV: 14x9mmRUPV: 21x16mmRIPV: 17x13mmPulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with mildly reduced systolic function (LVEF 48%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.2. The right ventricle is normal in size and systolic function (RVEF 52%).3. The left and right atria are severely dilated. 4. The left inferior pulmonary vein diameter is somewhat small.5. The left upper pulmonary vein appears to have the largest "ablation gap."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: 60 year old with metastatic breast cancer. Now with new stroke seen on MRI. Signs and symptoms: new stroke stroke seen on brain MRI. CTA of intracranial circulation:65 cc of omni-350 is administered for this study.3-D reformatted images of this study were obtained utilizing a independent workstation. These images were utilized for interpretation on this exam. Additional 2-D reformatted images as well as MIP images were also utilized.CTA of intracranial circulation:Examination demonstrates patent and normal appearing bilateral internal carotid arteries across to skull base and in their supraclinoid portions. There are normal appearing patent bilateral posterior communicating arteries.Bilateral ophthalmic arteries are also visualized and unremarkable.Bilateral anterior and middle cerebral arteries with no evidence of pathology. Anterior communicating artery is unremarkable.There is a small left vertebral artery (hypoplastic nondominant). The left pica is visualized and unremarkable. The distal portion of left vertebral artery is extremely small and hypoplastic. This is a normal anatomical variation.The patent dominant right vertebral artery is also very small in size in a uniform fashion. The right pica is visualized and unremarkable. The basilar artery is small in it's caliber in a uniform fashion however remains patent throughout its course.The small size of the vertebral -- basilar system is believed to be secondary to prominent bilateral posterior communicating arteries.None infuse head CT:Examination again demonstrates a large area of vasogenic edema surrounding a mass in the right lateral aspect of the cerebellum measuring approximately 34 x 25-mm in size as was noted on prior MRI exam. There is significant mass effect on the fourth ventricle and anterior displacement and partial collapse of the fourth ventricle. This results in early onset of hydrocephalus of supratentorial ventricular system. Mass-effect in the posterior fossa and results in minimal effacement of the quadrigeminal plate cistern as well.Images through supratentorial space again demonstrate a focus of attenuation in the left periventricular white consistent with patient's known acute stroke described on prior MRI. There is no evidence of hemorrhagic transformation. There is no evidence of any new finding since prior exam.

Output: 1.CTA of intracranial circulation demonstrates no detectable abnormality of bilateral internal carotid arteries, middle and anterior cerebral arteries and their branches. There are prominent bilateral posterior communicating arteries. There is small caliber of bilateral vertebral arteries and basilar artery in a uniform fashion which is believed to be due presence of large bilateral posterior communicating arteries. There is however no evidence of any definitive vascular lumen compromise of the vertebral -- basilar system infectious carotid disease and or dissection.2.None infuse head CT demonstrates right cerebellar tumor with surrounding vasogenic edema and mass effect on the fourth ventricle. Resultant mild hydrocephalus and supratentorial ventricles. These findings remain stable since prior MRI exam. Stable left periventricular white matter stroke with no interval change.


Instruction: Generate impression based on medical findings.

Input: Urinary retention, paresthesias, and fatigue. The spinal cord displays normal signal. There is central posterior disc-osteophyte complex at C5-6, which abuts the spinal cord. There is focal thickening of the ligamentum flavum at multiple levels of the lower thoracic spine, which mildly narrow the spinal canal, but do not impinge upon the spinal cord. The vertebral column alignment is within normal limits. There is no evidence of enhancing mass lesions in the cervical or thoracic spine. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The paravertebral soft tissues are unremarkable. There is a nodule in the right thyroid lobe, which measures up to 18 mm. There is a retention cyst in the left maxillary sinus. The imaged intracranial structures are unremarkable.

Output: 1. No evidence of demyelinating lesions in the cervical and thoracic spinal cord.2. A central posterior disc-osteophyte complex at C5-6 abuts the spinal cord. 3. Focal thickening of the ligamentum flavum at multiple levels of the lower thoracic spine, which mildly narrow the spinal canal, but do not impinge upon the spinal cord. 4. Nonspecific nodule in the right thyroid lobe, which measures up to 18 mm. A thyroid ultrasound may be useful for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Reason: eval lunate History: potential Kienböck's? Eval cartilage n proximal capitate Multiple sequences are limited by patient motion artifact.LIGAMENTS: Although this examination is not protocoled for evaluation of the intrinsic ligaments of the wrist, there is heterogeneity and intermediate signal in intensity within the scapholunate and lunotriquetral ligaments which likely represent degeneration and perhaps degenerative tearing, however, no full-thickness tear is evident. TRIANGULAR FIBROCARTILAGE COMPLEX: There is a focal disruption of the volar aspect of the triangle fibrocartilage disc at the level of its insertion on the radius.TENDONS: The flexor and extensor tendons appear intact. There is a small amount of fluid within the tendon sheath of the extensor carpi radialis brevis and extensor carpi ulnaris which may reflect a very mild tenosynovitis. BONES: There is fragmentation of the lunate and decreased signal abnormality on T1 and T2-weighted images consistent with the patient's known history of avascular necrosis. There is increased bone marrow signal abnormality on fluid sensitive sequences within the scaphoid which may represent degenerative change. There is also increased bone marrow signal abnormality within the triquetrum with associated subchondral cyst formation likely degenerative in etiology. Note is made of increased bone marrow signal abnormality within the ulnar styloid which may be degenerative in etiology. There is a small amount of fluid within the distal radioulnar joint. There is a subchondral cyst within the capitate indicating degenerative changes. There is fraying of the articular cartilage about the lunocapitate articulation with partial thickness articular cartilage degeneration. There is subchondral cyst formation within the distal radius.ADDITIONAL

Output: 1. Fragmentation of the lunate and bone marrow signal abnormality consistent with the patient's history of avascular necrosis.2. Focal perforation of the triangular fibrocartilage at the level of its insertion on the radius. 3. Bone marrow signal abnormality within the scaphoid, lunate, triquetrum, ulnar styloid, distal radius, and capitate may be degenerative in etiology. There is partial-thickness articular cartilage degeneration affecting the lunocapitate articulation. Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: 19-year-old female with left knee pain Evaluation of the proximal tibia is limited by metallic susceptibility artifact resulting from an intramedullary rod.MENISCI: The menisci are intact.ARTICULAR CARTILAGE AND BONE: Mild increased signal intensity of the articular cartilage of the lateral facet of the patella inferiorly is suspected to be of no clinical significance although could conceivably represent mild intrasubstance degeneration. No fluid-filled cartilage defects. No bone marrow lesions.LIGAMENTS: The collateral and cruciate ligaments are intact.EXTENSOR MECHANISM: Diffuse thickening of the patellar tendon compatible with tendinosis with mild signal intensity within the proximal fibers at the patellar attachment. No fluid signal intensity to indicate a tear is seen. Quadriceps tendon appears intact.ADDITIONAL

Output: Postoperative changes and thickening of the patellar tendon compatible with tendinosis. Otherwise, no findings to account for the patient's knee pain.


Instruction: Generate impression based on medical findings.

Input: 37 year old female with a personal history of left breast IDC and DCIS status post lumpectomy in 2007 followed by radiation, chemotherapy, and hormonal therapy. No current breast complaints. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.Expected volume loss and lower inner quadrant post surgical architectural distortion are present in the left breast. No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.A small area of enhancement on the skin of the right at 12 o'clock position is present. Clinical correlation is recommended.

Output: 1. No MRI evidence for malignancy in either breast. 2. A small area of enhancement on the skin of the right at 12 o'clock position. Clinical correlation is recommended. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on medical findings.

Input: There is transitional anatomy with lumbarization of S1. As numbered previously, the last fully formed disc is at S1-S2.There are stable postoperative findings in the lumbar region related to resection of a previous left paraspinal mass including resection of the left paraspinal musculature. There is persistent laxity of the left posterior abdominal wall with partial herniation of the left kidney. There is no mass-like enhancement within the surgical bed or within the spinal canal. The cauda equina remains along the right aspect of the spinal canal, likely secondary to the scoliosis, which includes convex leftward lumbar curvature and a rightward thoracic curvature, better assessed on standing radiographs. Again seen is hypertrophy of the left lumbar posterior elements which is likely compensatory. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. No abnormal signal in the spinal cord. Conus terminates normally. Again seen is multilevel left-sided lumbar neural foraminal stenosis related to the hypertrophy of the posterior elements.

Output: 1. Stable postoperative findings in the left lumbar region without evidence of tumor recurrence. Would suggest obtaining both axial and sagittal post contrast sequences with fat saturation in the lumbar spine on next follow-up study.2. Again seen is scoliosis which is better assessed on prior serial thoracolumbar standing radiographs. There is significant left-sided neural foraminal stenosis throughout the lumbar spine related to hypertrophy of the posterior elements.


Instruction: Generate impression based on medical findings.

Input: Left knee pain MENISCI: No significant abnormality noted. No discrete meniscal tear is seen. ARTICULAR CARTILAGE AND BONE: A small focus of signal abnormality in the posteromedial distal femoral metaphysis is probably of no clinical significance. No focal cartilage defects are seen.LIGAMENTS: No significant abnormality noted. The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

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


Instruction: Generate impression based on medical findings.

Input: 61 years, Male, episodic left-sided tonic spasms of the face, arm, and leg right frontal cortex lesion seen on outside MRI.. There is an approximately 20 x 15 x 20 mm enhancing mass with associated expansion of the cortex of the posterior aspect of the right superior frontal gyrus abutting the falx. Previously enhancing nodule in this region measured 9 x 6 x 6 mm. Restricted diffusion was noted previously corresponding to the area which is now enhancing, with current study demonstrating more peripheral restricted diffusion. There is suggestion of increased central necrosis. There is also increase in adjacent leptomeningeal enhancement along the right paracentral lobule. There is associated mild vasogenic edema which is not significantly changed. There is minimal susceptibility within this lesion may represent minimal blood products or mineralization. No other mass or abnormal parenchymal or meningeal enhancement is appreciated elsewhere in the brain. Prominent perivascular spaces are incidentally noted in the left subinsular region and left temporal stem. No hydrocephalus or extra-axial collections. No evidence of midline shift or herniation. Calvarium and extra cranial soft tissues are unremarkable.

Output: There is an enhancing mass involving the posterior aspect of the superior frontal gyrus which compared to 12/31/2015 demonstrates increased enhancement and central necrosis. There is also new adjacent leptomeningeal enhancement. Relatively mild surrounding edema is not significantly changed. Differentials include high-grade glioma, atypical infection, and less likely metastatic disease.


Instruction: Generate impression based on medical findings.

Input: The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The imaged spinal cord displays normal signal and morphology although there is unchanged mild dilatation of the central spinal canal measuring up to 1 mm. The conus terminates at L2. There is no evidence of filar thickening or fibrofatty infiltration and there is normal anterior translation of the conus upon prone positioning. The paravertebral soft tissues are unremarkable.

Output: 1.No evidence of tethered cord.2.Unchanged mild dilatation of the imaged central spinal canal.


Instruction: Generate impression based on medical findings.

Input: 55-year-old woman with a history of prior right hemiplegia episodes and endocarditis who presented with acute mental status change, slurred speech, and right-sided weakness. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage, intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. There has been interval resolution of many of the previously described supratentorial and cerebellar patchy T2/FLAIR hyperintense regions. There is residual nonspecific T2/FLAIR signal abnormality in the bilateral anterior frontal periventricular white matter, genu of the corpus callosum and the left parietal white matter, which may be related to prior ischemia. There is a small focus of chronic-appearing hemorrhage within the right superior temporal lobe, which was less appreciable on the prior examination likely due to differences in technique. No abnormal parenchymal or meningeal enhancement is evident. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are grossly clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. Interval resolution of most of the previously described patchy T2/FLAIR hyperintense regions, consistent with PRES. 2. Chronic appearing FLAIR hyperintensity in the left parietal white matter and bilateral anterior corpus callosum which may be related to prior ischemia or other injury.


Instruction: Generate impression based on medical findings.

Input: There are postoperative findings related to left L5-S1 hemilaminectomy and ligamentum flavectomy. There is vacuum disc phenomenon, loss of disc space height, endplate irregularity, and a mild eccentric left disc herniation with annular fissuring, which in conjunction with soft tissue that may represent scar formation, effaces the left lateral recess. Otherwise, there is minimal bilateral neural foraminal narrowing at this level. There is a mild central disc protrusion and bilateral facet and ligamentum flavum thickening at L4-5 without significant spinal canal or neural foraminal stenosis. There is no significant spinal canal or neural foraminal stenosis at T12 through L4. The vertebral body heights are preserved. There is no spondylolisthesis. The imaged portions of the spinal cord are unremarkable. There are findings related to right hip arthoplasty.

Output: Postoperative findings related to left L5-S1 hemilaminectomy and ligamentum flavectomy with degenerative spondylosis and what may represent scar tissue that efface the left lateral recess. Degenerative spondylosis is also present at L4-5 with minimal bilateral neural foraminal narrowing at this level. No significant spinal canal or neural foraminal stenosis at T12 through L4. 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: 36 week old infant with apnea; evaluate for bleed. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.Subtle areas of questionable low attenuation within the subcortical white matter and bilateral frontal lobes that could represent prior hypoxic injury; recommend follow up MRI if clinically indicated.

Output: Subtle areas of questionable low attenuation within the subcortical white matter in bilateral frontal lobes that could represent prior hypoxic injury; recommend follow up MRI if clinically indicated.


Instruction: Generate impression based on medical findings.

Input: MRI brain The ventricles and sulci are within normal limits. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with moderate chronic small vessel ischemic changes, unchanged from prior. There is stable chronic lacunar infarct in the left external capsule. The basal cisterns remain patent. There is no midline shift or mass effect. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is mild scattered opacification of the paranasal sinuses, minimally improved.MR thoracic spine: The thoracic spine is in normal alignment, with slightly exaggerated normal thoracic kyphosis. The vertebral heights are well-maintained. There is developmental ventral narrowing of the intervertebral disc between T4-T5 and fusion of the vertebrae posteriorly. There is mild disc desiccation and narrowing scattered along the mid to lower thoracic spine. There is mildly diffuse heterogeneous marrow signal which is nonspecific, with minimal endplate degenerative changes in the thoracic spine. There is a rounded T1 and T2 hypointense lesion in the T9 vertebral body, which likely represents an atypical hemangioma. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal.There is a subcentimeter perineural cyst at right T8 level. There is mild thickening of the ligamentum flavum and facet arthropathy at the T12-L1 level. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine.

Output: 1. No evidence of acute intracranial ischemia, edema or mass effect.2. Moderate chronic small vessel ischemic disease and chronic lacunar infarct in the left external capsule, unchanged.3. Mild degenerative changes in the thoracic spine, otherwise unremarkable MRI. There is developmental partial fusion of T4-T5.