Instruction: Generate impression based on medical findings.

Input: Female, 76 years old, with low back pain. Trace retrolisthesis of L1 relative to L2 is seen. Spinal alignment is otherwise unremarkable. Vertebral body heights are preserved. Scattered mild endplate degenerative signal abnormality is seen. No concerning marrow replacement or marrow edema is detected.The visualized distal spinal cord, conus and nerve roots of the cauda equina are unremarkable. No epidural abnormality is suspected.T12-L1: Mild bulging disc. No significant spinal canal or foraminal stenosis.L1-2: Facet arthropathy and ligamentum flavum thickening. Bulging disc. Mild generalized spinal canal stenosis. Mild bilateral foraminal narrowing. L2-3: Facet arthropathy and ligamentum flavum thickening. Bulging disc with a superimposed left foraminal protrusion. Mild generalized spinal canal stenosis. Moderate left and mild right foraminal narrowing. L3-4: Facet arthropathy and ligamentum flavum thickening. Bulging disc. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. L4-5: Facet arthropathy and ligamentum flavum thickening. Bulging disc asymmetric to the right. No significant spinal canal stenosis. No significant foraminal narrowing. L5-S1: Facet arthropathy and ligamentum flavum thickening. Prominence of the dorsal and ventral epidural fat. Bulging disc. Mild spinal canal narrowing. Moderate left and mild right foraminal narrowing.

Output: Multilevel disc degeneration is seen causing mild spinal canal stenosis at L1-2 and L2-3. Moderate foraminal narrowing is seen on the left at L2-3 and on the left at L5-S1.


Instruction: Generate impression based on medical findings.

Input: Urinary retention. There is loss of cervical lordosis, but no spondylolisthesis and the rest of the spinal column alignment is normal. There is disc-osteophyte complex at C5-6 level without significant spinal canal narrowing. The vertebral body heights are maintained. The spinal cord signal is normal. The vertebral bone marrow signal is unremarkable. The paravertebral soft tissues are unremarkable.

Output: No evidence of spinal cord compression. 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: 10 year old female. Evaluate brain for abscess/ICP issues. Patient with fever and mental status changes. Increased seizure frequency. Microcephaly is noted. Extensive diffuse encephalomalacia appears similar to prior MRI. Parenchymal calcifications are noted. The ventricles are stably enlarged. There is no evidence of acute intracranial hemorrhage. There is no evidence of abscess formation given the limitations of noncontrasted CT.No acute abnormalities are noted in the calvaria and skull base. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Extensive encephalomalacia and enlarged ventricles that appears unchanged when compared to prior MRI.


Instruction: Generate impression based on medical findings.

Input: Meningioma follow up. There is no significant interval change in the extra-axial enhancing mass along the planum sphenoidale and olfactory groove that measures 25 AP x 26 RL x 19 SI mm. There is unchanged mild confluent T2 hyperintensity along the adjacent inferior right frontal lobe, which likely represents edema. There is mild pneumosinus dilatans and hyperostosis. There are a few scattered foci of cerebral white matter T2 hyperintensity, which have progressed. There is no evidence of intracranial hemorrhage or acute infarct. There is an unchanged defect in the left cerebellar hemisphere and a new punctate defect in the right cerebellar hemisphere. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is a 5 mm wide right frontal bone outer table osteoma.

Output: 1. No significant change in the meningiomas along the planum sphenoidale and olfactory groove.2. Mild chronic small vessel ischemic changes with chronic cerebellar infarcts that have progressed, but no acute infarct.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate for osteomyelitis, hx osteo s/p amputation left 4th and 5th toes History: dorsal foot wound The fourth and fifth toes have been amputated. There is a band of intermediate signal intensity which extends from the dorsolateral margin of the forefoot to the osteotomy margins of the fourth and fifth metatarsals, presumably representing scar tissue, which shows some enhancement following gadolinium administration. The osteotomy margins, however, appear sharp and we see no findings to suggest osteomyelitis. There is ulceration of the plantar soft tissues beneath the third metatarsal head. There is replacement of the underlying subcutaneous fat with intermediate signal intensity which likely represents a combination of edema and scarring that extends to the plantar aspect of the head of the third metatarsal. There is minimal edema within the head of the third metatarsal as well as minimal enhancement, but we suspect this represents reactive osteitis rather than osteomyelitis as the signal intensity remains relatively preserved on T1-weighted images. There is signal abnormality within the base of the second metatarsal that was present on the prior study and we suspect represents an old fracture. There is a hallux valgus deformity and mild osteoarthritis of the first MTP joint, but we see no specific findings of osteomyelitis of the bones of the first ray. There is a small amount of fluid between the second and third metatarsals which may represent a mild bursitis of questionable significance. There is increased signal intensity within the musculature of the foot on T2-weighted images with enhancement following gadolinium likely representing a combination of atrophy and inflammation, but we see no rim-enhancing fluid collection to suggest abscess formation. Mild osteoarthritis affects the midfoot.

Output: Surgical changes of fourth and fifth toe amputation with soft tissue ulceration and scarring as described above. There is mild signal abnormality and enhancement of the head of the third metatarsal which is favored to represent reactive osteitis rather than osteomyelitis. These findings were relayed to Dr. Payne by phone at 12:35 PM on 1/11/2016.


Instruction: Generate impression based on medical findings.

Input: Female, 87 years old, with fluent aphasia. Evaluate for stroke. Patchy restricted diffusion is seen within the left temporal lobe. A punctate focus of restricted diffusion is also seen in the right centrum semiovale.Patchy periventricular white matter and basal ganglia T2 hyperintensity is seen bilaterally. No evidence of significant generalized mass effect is observed.No acute intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. The ventricles are slightly prominent which most likely represents parenchymal volume loss.

Output: 1.Patchy acute ischemia is seen within the left temporal lobe with a single punctate focus in the right centrum semiovale.2.Sequelae of fairly extensive chronic microvascular and lacunar ischemic disease is seen as well.3.No evidence of generalized mass effect is seen. No acute intracranial hemorrhage is detected.


Instruction: Generate impression based on medical findings.

Input: Reason: Evaluate right medial elbow for medial epicondylitis: tendinopathy vs. tear History: Medial right elbow pain x 2 years, s/p injections LIGAMENTS: There is increased signal intensity in the proximal fibers of the anterior bundle of the ulnar collateral ligament, which may represent mild degeneration, mild sprain, or perhaps small interstitial tear, but we see no full-thickness tear. Lateral collateral ligament is intact.TENDONS: Increased signal intensity within and around the common flexor tendon, indicating moderate tendinosis and perhaps interstitial tearing, but we see no full-thickness tendon tear. Common extender tendon is intact. Biceps, brachialis, and triceps tendons are intact.ARTICULAR SURFACES AND BONE: There appears to be cartilage loss along the radial head, but the remainder of the joint appears normal and bone marrow signal is normal.SURROUNDING STRUCTURES: There is mildly increased signal of the ulnar nerve as it passes posterior to the medial epicondyle, which may reflect mild neuritis but is of questionable clinical significance.

Output: Increased signal intensity within and surrounding the common flexor tendon representing moderate tendinosis and perhaps interstitial tearing, but we see no full-thickness tear.


Instruction: Generate impression based on medical findings.

Input: Male, 83 years old, with back pain radiating down the legs. A dextroscoliosis of the lumbar spine is seen with right lateral subluxation of L3 relative to L4. Sagittal alignment is grossly within normal limits. Chronic left lateral wedging of the L1 to L3 vertebrae, and right lateral wedging of L4, is seen related to scoliosis. Otherwise, vertebral body heights are preserved. No evidence of significant marrow edema is seen.The visualized distal spinal cord and conus are within normal limits. Within the right posterolateral spinal canal at the L5-S1 level, there is a collection which measures 20 x 7 mm in the axial plane and 25 mm in the sagittal plane. The collection is T1 and T2 bright with a hypointense circumferential rim and a hypointense internal septation. This collection narrows the thecal sac and displaces the adjacent nerve roots, though the sac was capacious to begin with and there is no significant crowding or impingement of the nerve roots.L1-2: Facet arthropathy and ligamentum flavum thickening have minimally progressed. Progressive loss of disc height but disc bulging is relatively unchanged. Mild generalized spinal canal narrowing, particularly affecting the left lateral recess. Moderate left foraminal narrowing, progressed. L2-3: Facet arthropathy and ligamentum flavum thickening have minimally progressed. Progressive loss of disc height but disc bulging is unchanged. No significant spinal canal stenosis. Moderate bilateral foraminal narrowing, progressed. L3-4: Facet arthropathy and ligamentum flavum thickening have minimally progressed. Loss of disc height and disc bulging are unchanged. Mild spinal canal narrowing without change. Moderate to severe left foraminal narrowing without change. L4-5: Facet arthropathy and ligamentum flavum thickening without change. Loss of disc height and disc bulging, asymmetric to the right foraminal zone, unchanged. Mild to moderate narrowing of the spinal canal, particularly the right lateral recess, without change. Severe right foraminal narrowing without change. L5-S1: Facet arthropathy and ligamentum flavum thickening, progressed. A dorsally projecting synovial cyst is seen on the right. Disc bulging with progression in the right foraminal zone. Mild spinal canal narrowing due to the right posterolateral collection as above. Severe right foraminal narrowing with likely nerve root impingement, progressed.

Output: A collection is evident within the right posterolateral spinal canal at the L5-S1 level. The collection may be either epidural or subdural in location. Internal signal characteristics suggest that the fluid is proteinaceous or hemorrhagic in nature. The collection does narrow the thecal sac and displace adjacent nerve roots. However, the sac was capacious at this level to begin with and the degree of overall narrowing is mild.Multilevel disc and posterior element degeneration is seen in the context of a scoliotic deformity. Progression of degenerative disease is seen at most levels. Of note, foraminal narrowing is moderate to severe on the left at L3-4, and severe on the right at L4-5 and L5-S1.


Instruction: Generate impression based on medical findings.

Input: History of bladder cancer status post radical cystectomy. Evaluate for metastatic disease. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, signal intensity and enhancement. No biliary ductal dilatation focal suspicious lesion or vascular abnormality.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post left nephrectomy. No evidence of tumor recurrence in the nephrectomy bed.Stable right renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: Status post cystoprostatectomy.BLADDER: Status post cystoprostatectomy.LYMPH NODES: Solidly enhancing left pelvic nodule measures 1.6 x 1.0 cm (series 18/29; series 14/30), compared to 0.9 x 0.5 cm previously.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: 6-mm low T1, high T2, enhancing focus in the right sacral ala is unchanged since prior. OTHER: No significant abnormality noted.

Output: 1.Slight interval increase in size of the solidly enhancing left pelvic lesion.2.No new sites of disease.


Instruction: Generate impression based on medical findings.

Input: Reason: Evaluate for ischemia, gait instability to L History: Gait instability to L, disorientation, suspected NPH The lateral ventricles and third ventricle and to lesser degree fourth ventricle are large. This was also the case in December. Biventricular diameter on the current exam is 55 mm and was the same in a comparable location on the prior exam. Third vebtricular diameter is currently 16 mm and previously was the same. Temporal horns remian enlarged.Although there is a punctate hyperintense lesion on the diffusion weighted images in the right centrum semiovale there is no associated diffusion restriction on ADC map. Rather there is T2 shine through.On susceptibility imaging there is a punctate focus of signal hypointensity identified in the left frontal lobe appeared in isolation is probably of little clinical significance. It is unchanged when compared to the previous examThere is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.The ventricles are large. This is nonspecific finding. One possibility is that this represents normal pressure hydrocephalus. Please correlate with patient's clinical symptoms.2.There are periventricular white matter lesions present many which are perpendicularly oriented to the lateral ventricle. These are nonspecific. Differential considerations include vascular related lesions as well as demyelination and vasculitis.3.There are periventricular white matter lesions present many which are perpendicularly oriented to the lateral ventricle. These are nonspecific. Differential considerations include vascular related lesions as well as demyelination and vasculitis.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old, with altered mental status status post OLT. No evidence of restricted diffusion, parenchymal edema or mass effect is seen. No pathologic parenchymal or extra-axial enhancement is detected.Mild symmetric T1 hyperintensity of the bilateral globus pallidus may reflect manganese deposition from chronic liver dysfunction. Minimal T2 hyperintense rimming of the lateral ventricles is a nonspecific finding and may be within normal limits.No evidence of significant intracranial hemorrhage is seen. A few scattered foci of susceptibility are seen in the cerebral hemispheres compatible with chronic micro-hemorrhage. No abnormal extra-axial fluid collections are detected. The ventricles are normal in size and morphology.The left maxillary sinus is small showing evidence of mucosal thickening or layering secretions.

Output: 1.No acute intracranial abnormality.2.T1 signal abnormality in the globus pallidus likely reflects the sequelae of chronic liver dysfunction.3.Findings suggestive of chronic left maxillary sinusitis.


Instruction: Generate impression based on medical findings.

Input: A patient submitted outside study for review. There is a biopsy proven malignancy in the left breast at the periareolar region. Submitted for review are breast MRI (8/10/16), ultrasound images of both breast (8/16/16) performed at outside institution. For comparison, digital mammographic images (7/25/2016), ultrasound images of left breast (7/25/2016), images from ultrasound guided biopsy of left breast and postprocedural left mammographic images (7/26/2016) are available. BREAST MRI (8/10/16):Breast MRI was performed with a protocol outlined in the outside radiology report.MR images could not be processed on the DynaCAD workstation; therefore, an interpretation was made with axial images on PACS. No reformatted sagittal or coronal images were available.There is scattered fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.There is an enhancing mass at superior aspect of the left retroareolar region, measuring 9 x 8 mm (AP x LR) on axial view, which corresponds to the proven carcinoma. The mass attaches to the skin and is located superior to the nipple. A marker clip is present within the mass.Although there are multiple enhancing foci in both breasts, they are background parenchymal enhancement. None of them are suspicious enough to require MR directed ultrasound or MR guided biopsy.No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in either axillary region.ULTRASOUND IMAGES OF BOTH BREAST (8/16/16):Although a hypoechoic structure is captured in each breast, the outside radiology report stated that these findings were non-specific, such as a fat lobule or normal background in real time study.

Output: 1. Unifocal carcinoma at superior aspect in the left retroareolar region.2. No abnormal enhancement in right breast. 3. No abnormal lymph nodes are identified in either axillary region.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on medical findings.

Input: 58 year old with veno thromboembolic disease, HTN and aortic dilation (on CT) presenting for cardiac and aortic assessment. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 60%, the LV end diastolic volume index is 80 ml/m2 (normal range: 74+/-15), the LVEDV is 182 ml (normal range 142+/-34), the LV end systolic volume index is 32 ml/m2 (normal range 25+/-9), the LVESV is 72 ml (normal range 47+/-19), the LV mass index is 46 g/m2 (normal range 85+/-15), and the LV mass is 104 g (normal range 164+/-36). There is subendocardial late gadolinium enhancement in the base-mid inferolateral wall suggesting the presence of an underlying fibrosing, infiltrative, or inflammatory process. This pattern is consistent with myocardial infarction. There is tardo-kinesis in this area, otherwise no regional wall motion abnormalities were seen. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 91 ml/m2 (normal range 82+/-16), the RVEDV is 205 ml (normal range 142+/-31), the RV end systolic volume index is 44 ml/m2 (normal range 31+/-9), and the RVESV is 100 ml (normal range 54+/-17).Right AtriumThe right atrium is not well seen.Aortic ValveThe aortic valve opens widely and there is least mild 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 common right innominate and left common carotid ("pseudo bovine arch", a normal variant) and normal left subclavian. The aortic root is dilated. The portion of the arch just beyond the the take-off of the branch vessels is tortuous and appears narrowed. The descending thoracic aorta is also severely tortuous. Measurements as below: Sinus of Valsalva: 42 mm x 41 mm x 41 mmSinotubular junction: 40 mm x 40 mmMaximally dilated portion of the ascending aorta: 49x50 mmMid-arch 48 x 50 mmPost-branch narrowing 29 x 24 mmDescending aorta 31 x 31 mm Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac 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 and systolic function. The overall LV ejection fraction is 60%. There is subendocardial late gadolinium enhancement in the base-mid inferolateral wall which could be consistent with previous MI. 2. The right ventricle is normal in size and systolic function (RVEF 51%)3. Dilated Thoracic Aorta, measurements as above. 4. Aortic valve not well-seen on this study. Suggest transthoracic echocardiography to assess for bicuspid aortic valve and evaluate for aortic regurgitation.


Instruction: Generate impression based on medical findings.

Input: Please note that postcontrast images were not obtained as patient could not tolerate further sequences due to pain. MRI thoracic spine and pelvis were not performedThe vertebral column alignment is within normal limits. There is a normal relationship of the dens with the arch of C1. Normal marrow signal. Minimal disc bulges are seen from C2-3 to C5-6 without spinal canal or neuroforaminal stenosis at any level. Normal signal within the visualized cord. . An unfused posterior arch of C1 and partially fused spinous processes of T1 and T2 are again seen. Postsurgical changes of left thyroidectomy. Paraspinous soft tissues are otherwise unremarkable.

Output: No cord signal abnormality. No spinal 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: Left optic neuritis with scotoma. Orbits: The globes and optic nerves appears unremarkable. The ocular adnexa are intact. There is no evidence of mass lesions or abnormal intraorbital enhancement.Brain: There is a T2 hyperintense enhancing lesion in the right pituitary lobe that measures up to 6 mm. There is also a non-enhancing focus in the right lateral pituitary lobe that measures up to 4 mm. There is no mass effect upon the optic apparatus. There is no evidence of intracranial hemorrhage or acute infarct. There are a few punctate foci of T2 hyperintensity in the cerebral white matter, without associated enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: 1. An enhancing lesion in the right pituitary lobe that measures up to 6 mm may represent a microadenoma. A non-enhancing focus in the right lateral pituitary lobe that measures up to 4 mm may represent a cystic microadenoma.2. A few punctate foci of T2 hyperintensity in the cerebral white matter are nonspecific.3. The orbits are unremarkable.Discussed with Dr. Reder at 8:40 AM on 1/9/15.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: Parkinson's disease with tremor. Preoperative planning MRI. There is an anterior left frontal lobe developmental venous anomaly. There is a punctate focus of high signal on the post-contrast T1-weighted image with associated susceptibility effect in the inferior left pons. There is mild scattered cerebral white matter T2 hyperintensity. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. There is fluid within the right sphenoid sinus. The skull and scalp soft tissues are grossly unremarkable. There is a right lens implant. There is a large retrodental pannus with compression of the upper spinal cord. There is apparent fluid within the inferior left mastoid air cells.

Output: 1. Mild scattered cerebral white matter T2 hyperintensity is nonspecific, but may represent small vessel ischemia.2. A punctate focus of high signal on the post-contrast T1-weighted image in the inferior left pons may represent a telangiectasia, for example. 3. Anterior left frontal lobe developmental venous anomaly.4. Large retrodental pannus with compression of the upper spinal cord. 5. Fluid within the right sphenoid sinus may represent acute sinusitis.


Instruction: Generate impression based on medical findings.

Input: Fixed mass on the left temple. There is a well-defined heterogeneous predominantly high T2 and low T1 signal mass in the left temporal fossa that measures up to 25 mm. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a probable chronic lacunar infarct in the left basal ganglia and mild scattered foci of T2 hyperintensity in the cerebral white matter. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are unremarkable. There is a subcentimeter left maxillary retention cyst.

Output: A well-defined mass in the left temporal fossa that measures up to 25 mm may represent a lymphatic malformation or perhaps an inclusion cyst.


Instruction: Generate impression based on medical findings.

Input: Elevated PSA. No pathology report available. PELVIS:PROSTATE:Prostate Size: 4.8 x 6.7 x 6.1 cmPeripheral Zone: The peripheral zone is relatively thinned due to the patient's benign prostatic hyperplasia. There is a 6 mm focus of ADC abnormality (series 603/4 84) in the right medial mid-gland with subtle associated mild T2-weighted hypointensity.Central Gland: Changes of benign prostatic hyperplasia.Seminal Vesicles: No evidence of seminal vesicle invasionExtracapsular Extension: 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: 1.6 mm abnormal focus in the medial right mid gland peripheral zone may represent a site of prostatic adenocarcinoma.2.No extraprostatic extension of tumor.


Instruction: Generate impression based on medical findings.

Input: Female 21 years old Reason: Hx of pancreatic cyst, recent CT showing enlargement History: Pancreatic cyst ABDOMEN:LIVER, BILIARY TRACT: Diffuse hepatic steatosis.SPLEEN: No significant abnormality noted.PANCREAS: There is a 4.7 x 5.3 cm T2 hyperintense lesion centered on the distal pancreatic body/pancreatic tail which does not demonstrate definite communication with the pancreatic duct. There is a 1.1-cm nonenhancing nodular focus on the nondependent wall (series 7, image 23) that is isointense to the remainder of the lesion. This is nonspecific but may represent a mucin globule. There is a nonenhancing septation in the inferior aspect (series 4, image 16). There is no debris within the lesion. There is no pancreatic duct dilatation. Post administration of secretin the pancreatic duct demonstrates normal physiologic response. The pancreatic parenchyma upstream from the cystic lesion demonstrates loss of normal intrinsic T1 hyperintensity, mildly increased T2 signal and is relatively hyperenhancing and appears to retain contrast relative to the remainder of the pancreas. There are no surrounding peripancreatic inflammatory changes.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mildly prominent juxtaphrenic lymph node is nonspecific.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Cystic pancreatic lesion with nonenhancing internal nodule and septation. The appearance is worrisome for a mucinous cystic neoplasm. While pancreatic pseudocyst is a differential consideration, given the absence of a definite history of prior acute pancreatitis this is felt to be much less likely. 2.Abnormal signal in the upstream pancreas is likely due to a combination of edema and perfusional variation secondary to element and an element of obstruction from the above described cystic lesion. While very early acute pancreatitis could have a similar appearance this is felt much less likely given the absence of peri-pancreatic inflammatory changes.


Instruction: Generate impression based on medical findings.

Input: 85 year-old female with aphasia. Evaluate for CVA. Nonspecific, patchy areas of moderate hypoattenuation in periventricular and subcortical white matter. These changes were present on 2009 MRI.Intracranial vertebral artery calcifications.There is no evidence of intracranial hemorrhage, mass or edema. The gray-white matter differentiation is normal.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: 1.Patchy areas of white matter hypoattenuation most likely vascular related at this age. These changes were present on 4/29/2009 MRI. No evidence of acute ischemia, however CT is not sensitive in detecting early acute ischemia.2.No evidence for intracranial hemorrhage, edema, or mass.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old, with Parkinson's disease, pre-DBS evaluation. Scattered nonspecific white matter T2 hyperintense lesions are seen. No edema or mass effect is detected. Nonenhancing lesions are identified. There is no evidence to suggest intracranial hemorrhage or any abnormal extra-axial fluid collection. The ventricles are within normal limits.

Output: No edema, mass effect or pathologic enhancement is seen on this examination which was tailored for surgical navigation.


Instruction: Generate impression based on medical findings.

Input: 44-year-old female with persistent knee pain, evaluate for lateral collateral ligament tear MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: A small bone island is present within the tibia, otherwise no abnormal marrow signal. The articular cartilage is intact without full thickness defects.LIGAMENTS: The medial and lateral collateral ligament complexes are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Normal MRI knee without evidence of lateral collateral ligament tear.


Instruction: Generate impression based on medical findings.

Input: 23 years Female (DOB:12/12/1992)Reason: high opening pressure on LP, ID recommends MRI History: fever, meningitisPROVIDER/ATTENDING NAME: ELIZABETH A SONNTAG The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: MRI of the brain is within normal limits


Instruction: Generate impression based on medical findings.

Input: History of extraosseous Ewing's R, of the right hand. Surveillance, 24 months off therapy. A marker was placed along the dorsum of the hand overlying the space between the distal diaphyses of the second and third metacarpals. Small foci of signal abnormality deep and lateral to the marker likely represent postoperative changes. More diffuse increased signal intensity seen on the fat-saturated sequences in this vicinity likely simply represents artifact of incomplete fat saturation. I see no focal mass or abnormal enhancement to indicate tumor recurrence. The musculature of the hand appears normal. Bone marrow signal intensity is normal.

Output: No evidence of tumor recurrence.


Instruction: Generate impression based on medical findings.

Input: Seizure. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is minimal scattered nonspecific cerebral white matter T2 hyperintensity, which may represent chronic small vessel ischemic disease. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is deformity of the left inferior orbital wall, which may be due to a prior fracture. The skull, paranasal sinuses, and scalp soft tissues are otherwise grossly unremarkable.

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


Instruction: Generate impression based on medical findings.

Input: History of right renal mass, evaluate for interval change. ABDOMEN:LIVER, BILIARY TRACT: Punctate T2 hyperintensities within the liver too small to characterize but likely represent small cysts. Mild signal dropout on out of phase images suggestive of fatty infiltration.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is redemonstration of a partially exophytic lesion arising from the lower pole of the right kidney (series 18, image 17) which measures 1.1 x 1.1 cm, unchanged. The lesion is solid, isointense on T1, hypointense on T2, and demonstrates enhancement less than cortex. Left renal lower pole simple cysts are unchanged. No new suspicious renal lesions are identified.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: Right kidney 1.1 cm lesion compatible with renal cell carcinoma, unchanged. Given imaging characteristics, favor papillary subtype.


Instruction: Generate impression based on medical findings.

Input: History of right lumpectomy for IDC in 2002 followed by radiation therapy and chemotherapy. MRI guided biopsy of a central right breast enhancing lesion was performed in 2004 with pathology result of fibrotic breast parenchyma. Patient has had interval right breast reconstruction and left breast reduction July 2013. There is heterogeneous amount of fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.There are stable postsurgical changes in the lower inner quadrant of the right breast. There is a stable enhancing 10 x 5 x 8 mm lesion (AP x LR X CC) at 12 o'clock in the right breast, mid depth, with a biopsy clip artifact, corresponding to the previously biopsied benign lesion. No abnormal enhancement is seen in left breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on medical findings.

Input: Right knee pain, questioning iliotibial band syndrome or patellofemoral stress syndrome MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There is abnormal marrow edema within the patella with areas of near full-thickness to full-thickness articular cartilage loss particularly affecting the medial facet. The articular cartilage of the medial and tibial compartments is relatively preserved.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Articular cartilage loss affecting the undersurface of the patella with areas of near full-thickness to full-thickness loss affecting the medial patellar facet associated with likely reactive marrow edema within the patella. The remaining knee otherwise appears normal.


Instruction: Generate impression based on medical findings.

Input: Reason: labral tear/dislocation History: pain ROTATOR CUFF: The rotator cuff is intact.SUPRASPINATUS OUTLET: The supraspinatus outlet is within normal limits. GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint and glenoid labrum are intact. BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Normal-appearing shoulder without evidence of labral pathology.


Instruction: Generate impression based on medical findings.

Input: 31 years Female (DOB:6/23/1985)Reason: first seizure History: right tonic clonic movements, unrinary incontinencePROVIDER/ATTENDING NAME: DAVID G BEISER KOUROSH V REZANIA The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. These are unusual at this age. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific.


Instruction: Generate impression based on medical findings.

Input: 59-year-old male with aphasia and post transplant lymphoproliferative disorder, concern for CVA, mass or lymphoma. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are nonspecific foci of increased T2 signal in the subcortical white matter, cerebellum and brainstem, as well as confluent areas of increased T2 signal in the periventricular white matter. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is an approximately 21 x 28 x 53 mm mass just medial to the right carotid artery, which displaces the carotid artery laterally and was present on the prior CT neck examination, although it appears slightly increased in size. There is partially imaged upper cervical lymphadenopathy. Otherwise, the orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.Mass just medial to the right carotid artery, which appears increased in size from the prior CT examination, which may relate to the patient's post transplant lymphoproliferative disorder, although infection is a differential consideration.2.No evidence of acute intracranial hemorrhage, mass, or acute infarct.3.Nonspecific foci of increased T2 signal in the subcortical and white matter, as well as the cerebellum, and brainstem, suggestive of small vessel chronic ischemic disease.4.Partially imaged upper cervical lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: Reason: Assess extent of anterolateral thigh - looking for abscess, tracking areas of edema/possible pus History: Increasing WBC, pain anterolateral hip/thigh Please note that MRI pelvis was not performed due to inability of patient to tolerate exam. Service was paged at the time of the exam without response.There is a large collection of rim-enhancing fluid signal intensity within the subcutaneous fat along the lateral aspect of the right hip that appears to communicate with the skin surface. This collection penetrates the iliotibial band to enter the gluteus medius muscle as well as extending posteromedially between the greater trochanter and gluteus maximus muscle. Anteriorly, the collection extends deep to the tensor fascia lata. The cranial extent of this collection is beyond the field of view of this study. The caudal extent of the collection lies at the level of the subtrochanteric femur and overall the collection is at least 15 cm in craniocaudal dimension and approximately 11 cm in greatest transverse dimension. Foci of signal void within the collection likely represents air. Cutaneous skin staples are noted along the lateral aspect of the hip.Although the gluteus medius muscle is not included in its entirety, additional smaller rim-enhancing collections are noted within the muscle which may communicate with the larger subcutaneous collection. There is edema surrounding the collection with subcutaneous edema along the lateral aspect of the thigh down to just above the knee which appears to enhance, indicating cellulitis. There is also edema of the gluteus maximus muscle, tensor fascia lata, vastus lateralis, vastus intermedius, sartorius and tracking between the quadriceps musculature. Additional edema is present within the adductor muscles of the hip and thigh with relative sparing of the posterior musculature. Diffuse subcutaneous edema is also present. Bone marrow signal intensity is within normal normal limits. Slightly prominent right-sided inguinal lymph nodes are present. Osteoarthritis affects the knee with a small joint effusion.

Output: 1.Large rim-enhancing fluid collection with deep extension into the gluteal musculature and extension to the skin surface. We cannot exclude abscess on the basis of this study.2.Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Male, 14 years old. Abdominal pain and EGD significant for gastritis and duodenitis, concerning for potential Crohns diseaseEXAMINATION: MR enterography without and with IV contrast 07/14/2016, 1240 hrs. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions. 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: The kidneys enhance symmetrically, without focal lesion or hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No abnormal bowel wall thickening, abnormal enhancement, or dysmotility. No surrounding inflammatory changes about the bowel. The cecum is somewhat capacious and debris-filled.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: As aboveBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No evidence of bowel inflammation, abnormal motility, or other acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: eval lucency seen on plain film History: new left hip pain The proximal femoral lucency seen on recent radiographs likely corresponds to a focus of cortical thinning along the posterior aspect of the femur at and below the level of the lesser trochanter. This appears benign and we see no focal lesion within the medullary bone. There is patchy intermediate bone marrow signal intensity on T1-weighted images likely representing residual red marrow. Mild osteoarthritis affects the hip with cartilage degeneration. There is mild subchondral edema within the femoral head and acetabulum. Although this examination was not protocoled for detailed evaluation of the acetabular labrum, there is intermediate signal intensity within the superior labrum likely representing degeneration/degenerative tearing. There is a small lobulated collection of fluid signal intensity along the anterior superior aspect of the hip joint which may represent a paralabral cyst. Additional fluid signal intensity along the posterior aspect of the femoral neck may represent a small amount of fluid within the joint perhaps associated with a mild synovitis. On the large field-of-view images, mild osteoarthritis affects the right hip and degenerative disc disease affects the lower lumbar spine.

Output: 1. Osteoarthritis of the left hip and other findings as described above.2. The lucency within the proximal femur likely corresponds to an area of benign cortical thinning. We see no underlying medullary lesion.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old, with recent biopsy diagnosis of GBM in the left temporal lobe. Evaluate additional lesions in the right temporal lobe, right parietal lobe and left periventricular region for the possibility of nonenhancing tumor. Short TE single voxel spectroscopy was performed over T2 hyperintense lesions in the left periatrial region, the right parietal lobe, and the right mesial temporal lobe/hippocampus. The spectrum obtained from the left periatrial lesion demonstrates elevation of choline more than twofold relative to contralateral normal white matter, and significant reduction of NAA. The spectrum obtained from the right hippocampus also demonstrates elevation of choline and reduction of NAA. The spectrum obtained from a small right parietal lesion shows a nonspecific pattern of reduced NAA and normal to reduced choline.

Output: Lesions in the left periatrial region and the right mesial temporal lobe demonstrate MR spectra with features typical of tumor. A small lesion in the right parietal region shows a nonspecific spectral pattern is of uncertain significance.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Low back pain with left-sided radiation. Signs and symptoms: As above. Nonenhanced lumbar MRI:The alignment of vertebral column is anatomical.Lower most visualized thoracic spine and thoracic cord are unremarkable.T12 -- L1 is unremarkable.L1 -- L2 is unremarkable.L2 -- L3 demonstrate mild disk desiccation and mild hypertrophy of ligamentum flavum and minute fluid signal intensity in the right facet space. No spinal stenosis or neural foraminal compromise.L3 -- 4 demonstrate mild disk desiccation and loss of disk height, moderate right and mild to moderate left facet and ligamentum flavum hypertrophy. There is a central and slightly to the right broad-based disk protrusion resulting in subtle flattening and posterior displacement of the cord and mild central spinal stenosis. Mild bilateral neural foraminal compromise secondary to degenerative changes is also present.L5 -- S1 demonstrate moderate disk disease and loss of disk height , moderate left and mild right facet and ligamentum flavum hypertrophy is also noted. There is no central scar stenosis however moderate left and mild right neural foraminal compromise is detected. Bilateral SI joints and perispinal soft tissue/musculature remains unremarkable.

Output: 1.Degenerative changes at L4 -- L5 and a central disk protrusion results in mild central spinal stenosis. Bilateral neural foraminal compromise as detailed.2.Moderate disk disease and loss of disk height without central spinal stenosis however with bilateral neural foraminal compromise at L5 -- S1 is noted.3.Minimal degenerative changes at other levels however without spinal stenosis or neural foraminal compromise.


Instruction: Generate impression based on medical findings.

Input: Female 15 years old Reason: eval for tfcc tear; cyst History: wrist pain druj and swelling in area of tfcc. TRIANGULAR FIBROCARTILAGE COMPLEX: There is dorsal subluxation of the distal ulna relative to the sigmoid notch of the radius. There is positive ulnar variance. The volar and dorsal radioulnar ligaments are grossly intact at their radial attachments. The intervening articular disk of the triangular fibrocartilage complex has laminar increased signal intensity that we suspect reflects intrasubstance degeneration. We see no gadolinium entering the substance of the triangular fibrocartilage complex to indicate a tear. LIGAMENTS: Contrast is noted within the radiocarpal joint as expected. Although no contrast was seen in the midcarpal joint on conventional arthrogram, contrast is identified in the mid carpal joint on this study. We suspect that this reflects a small tear of the lunotriquetral ligament, perhaps most evident on image 8, series 601. The scapholunate ligament appears intact.TENDONS: The tendons and remaining soft tissue structures appear normal. BONES: There is mild edema type signal in the ulnar styloid which may relate to the aforementioned degeneration of the triangular fibrocartilage complex. There is also a small defect along the margin of the triquetrum with small cysts in the underlying marrow. The signal intensity of the bone marrow is otherwise within normal limits.

Output: Positive ulnar variance and dorsal subluxation of the distal ulna with degeneration of the triangular fibrocartilage complex articular disk and probable tear of the lunotriquetral ligament. Signal intensity within the ulnar styloid and triquetrum may reflect ulnar abutment.


Instruction: Generate impression based on medical findings.

Input: A patient submitted outside study for review. Submitted for review are digital right mammographic images (7/31/15), ultrasound images of right breast (7/31/15) performed at Northshore University Healthsystem. breast MRI (7/15/15) are available for comparison. Following studies were performed to look for a MR detected enhancing lesion in the right breast.DIGITAL RIGHT MAMMOGRAPHIC IMAGES (7/31/15):The breast parenchyma is composed of scattered fibroglandular elements. No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in right breast. ULTRASOUND IMAGES OF RIGHT BREAST (7/31/15):Several sonographic images of right upper outer quadrant are submitted. There are no abnormal findings. No sonographic correlation is detected for the enhancing lesion seen on MRI.

Output: No mammographic or sonographic evidence for malignancy. No mammographic or sonographic correlation is detected. Follow-up MRI in 6 months is recommended.BIRADS: 1 - Negative.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on medical findings.

Input: 55-year-old man with history of back pain, compression fractures, and squamous cell carcinoma of the tongue. Thoracic Spine: There is diffusely increased T2 and decreased T1 signal in multiple cervical and thoracic vertebral bodies. In particular, the T3 vertebral body is collapsed with greater than 50% loss of height anteriorly, which is similar in appearance to 1/18/2016. Furthermore, at the T1 through T5 levels, there is apparent epidural tumor extending into the thecal sac, with compression of the spinal cord at the T4 level, and bilateral neural foramina, as well as extension of tumor into the paraspinous soft tissues. There is also abnormal bone marrow signal in the T10 vertebral with extension into the anterior epidural space and right neural foramen, but no spinal cord compression at this level. There are multiple bilateral perinephric tumors. In addition, there are enlarged cervical and upper mediastinal nodes. There appears to be debris in the trachea and pulmonary atelectasis. There is no spondylolisthesis.Lumbar Spine: Five lumbar type vertebral bodies are presumed to be present. There is high T2 and low T1 signal diffusely within in the L2 vertebral body, sacrum, and bilateral ilia. Furthermore, there appears to be epidural extension of tumor from the posterior L2 vertebral body into the right lateral recess and neural foramen, causing significant stenosis. Also, at the S1 level, there is partially imaged tumor in the central anterior epidural space, which is partially imaged, but pushes the thecal sac posteriorly. The vertebral body heights are preserved and the alignment is within normal limits. There is an intradural, extramedullary lesion in the thecal sac at the L3/L4 level measuring 27 x 18 x 16 mm with compression of the cauda equina nerve roots. There are multiple tumors within the right psoas muscle and bilateral retroperitoneal regions. There is mild degenerative spondylosis in the lower lumbar spine.

Output: 1.Multiple osseous metastases involving the axial skeleton, including a pathologic compression fracture of T3 and epidural tumor at T1 through T5 with compression of the spinal cord at the T4 level, and a metastasis in the thecal sac at the L3/L4 level with compression of the cauda equina nerve roots. However, assessment of metastatic disease is somewhat limited by the lack of intravenous contrast.2.Multiple abdominal and thoracic metastases. Please refer to the recent body CT for additional details.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: 59-year-old female with history of right breast cancer status post mastectomy and chemoradiation in 2000. Status post right mastectomy.There is heterogeneous amount of fibroglandular tissue in the left breast.Mild parenchymal enhancement is noted in the left breast.No abnormal enhancement is seen in left breast or right mastectomy bed. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on medical findings.

Input: 37-year-old female has peri-umbilical bulge. Rule out ventral hernia. History of uterine fibroids. ABDOMEN:LUNG BASES: Mild bibasilar dependent atelectatic changes. No acute infiltrates or effusions.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: There is a bowel-containing supraumbilical right sided paramedian ventral hernia with neck measuring approximately 3.9 cm diameter.PELVIS:UTERUS, ADNEXAE: Two masses within the uterus were found on the prior MRI exam, one consistent with fibroid, and one which represents either fibroid or focal adenomyoma. Scarring in the uterus and anterior abdominal wall with suggestion of adhesion. Nabothian cysts. Right lower quadrant cyst, likely paraovarian cyst or duplication cyst has a thickened wall and measures approximately 3 cm in diameter at axial image 104/148 of series 4.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Bowel-containing nonobstructing supraumbilical right sided ventral hernia. Left adnexal cyst.


Instruction: Generate impression based on medical findings.

Input: There is herniation of a portion of right medial orbitofrontal gyrus measuring up to 9 mm in width into the right ethmoid air cells through a defect in the right anterior cranial fossa measuring 7 mm. There is mild scattered paranasal sinus mucosal There are multiple prominent arachnoid granulation in the bilateral greater sphenoid wings. There is ptosis of the bilateral lacrimal glands.

Output: Subcentimeter right anterior cranial fossa encephalocele.


Instruction: Generate impression based on medical findings.

Input: 59-year-old man with history of HCC status post TACE/RFA in 2/2016. ABDOMEN:LIVER, BILIARY TRACT: Segment 6 ablation cavity (9/163) appear similar to the prior examination measuring 35 x 34 mm, previously 36 x 35 mm. There is no abnormal arterial enhancement noted in the zone of ablation. The liver is nodular in contour and cirrhotic in morphology. Additional arterially enhancing parenchymal nodules are noted without washout, likely regenerative.There is no intra or extrahepatic biliary ductal dilatation. Cholelithiasis noted without gallbladder wall thickening.SPLEEN: The spleen measures 15.5 cm but is otherwise normal in signal.PANCREAS: The pancreas appears normal.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Partially visualized small bowel and colon appear normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable appearance of the segment 6 of ablation cavity without evidence of recurrence or new disease.


Instruction: Generate impression based on medical findings.

Input: 74-year-old man with history of pancreatitis and small gallstones on CT. ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter hepatic cysts noted. No additional focal hepatic lesions identified.The gallbladder is distended with a small amount of pericholecystic fluid and wall edema (9/17). Additionally, there are small T1 hyperintense, T2 hyperintense stones within the gallbladder.At the level of the ampulla (12/89) there is a 6 mm filling defect with dilation of the upstream common bile duct measuring up to 9 mm.The splenic vein and portal vein appear patent.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas is edematous with diffusion restriction and increased T2 signal. Additionally, there is mild dilation of the main pancreatic duct.There is no evidence of pancreatic necrosis. The splenic artery appears patent without pseudoaneurysm. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral renal cysts are noted including a minimally complex, septated 25 mm cyst in the right superior pole (7/16). There is no enhancement or nodularity within this minimally complex cyst.No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: The small bowel and colon appear normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.6 mm obstructing stone in the common bile duct at the level of ampulla.2.Acute pancreatitis without evidence of complication.3.Mild acute cholecystitis.4.Findings text paged to Dr. Stier at 11:45 on 10/17/2016.


Instruction: Generate impression based on medical findings.

Input: Patient with an NF-1 and large (20-cm) mass along left flank above pelvis. Please define the margins of the plexiform neurofibroma on his left flank/back. Multiple markers placed along the left back/flank denote the patient's mass. Deep to the markers, there is a heterogeneous, poorly-marginated infiltrative mass within the subcutaneous fat which extends deeper to involve the left quadratus lumborum muscle. The subcutaneous portion of the mass is approximately 16 x 4 x 10 cm (transverse x AP x craniocaudal), it's inferior margin situated at approximately the level of the iliac crest, and it's medial margin just left of midline. The superior margin of the subcutaneous component lies at approximately level of L3, but the intramuscular component extends more superiorly to the level of L1, yielding an overall craniocaudal dimension of approximately 16cm. On T1-weighted images the mass has components isointense to both fat and muscle. The majority of the mass is hyperintense to muscle on fat-saturated T2-weighted images. Smaller, better defined nodular components are noted in the mass which have low T1-weighted and high T2-weighted signal. There is a tubular flow void within the mass, indicating a prominent vessel, that courses toward the lumbar vascular plexus. This mass may represent a plexiform/diffuse neurofibroma although could possibly represent a venous malformation.Multiple smaller masses with predominantly high signal intensity on T2-weighted images, some of which have a target appearance, are seen in the subcutaneous tissue and musculature compatible with nerve sheath tumors. Another approximately 1.5-2 cm lesion below the level of the iliac bifurcation with high T2 weighted signal also likely represents a nerve sheath tumor or perhaps a lymph node. Additional neurofibromas are seen arising from the sacral nerve roots. There is also a subcentimeter round focus of signal abnormality within the right ilium along the sacroiliac joint which is nonspecific but may simply represent a cartilaginous rest.

Output: Findings compatible with neurofibromatosis as described above. The heterogeneous, infiltrative left flank mass, as described above, may either represent a plexiform/diffuse neurofibroma or perhaps a venous malformation and extends anteriorly to involve the quadratus lumborum. Other findings as above.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Other intervertebral disc displacement, lumbar regionClinical question: new pain to left legSigns and Symptoms: new pain to left. Has history of right sided leg pain Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is bilateral facet hypertrophy of a moderate to marked degree associated with disc desiccation. There is associated encroachment of the nerve roots within the neural foramina bilaterally at this level and some partial effacement of the fat at the lateral recess on the left side. These findings are stable when compared to the previous exam.At L4-5 there is redemonstration of loss of disc space height, disc desiccation and diffuse disc bulge associated with endplate reactive changes. The endplate reactive changes are bright on T1. There is associated moderate bilateral facet and ligamentum flavum hypertrophy as well as effacement of spinal fluid surrounding the nerve roots within the thecal sac. Overall there is a moderate to marked degree of spinal stenosis present at this level. There is also effacement of the fat surrounding the exiting nerve roots on the right side at this level. When compared to the prior exam these findings are stable.At L3-4 there is diffuse disc bulge associated with a moderate degree of bilateral facet and ligamentum flavum hypertrophy. There is disc desiccation present. There are some mild endplate reactive changes present which are bright on T1 imaging. The fat at the lateral recesses is effaced bilaterally at this level and there is some crowding of the nerve roots within the thecal sac. Overall there is moderate spinal stenosis at this level. There is narrowing of the neural foramina bilaterally at this level. The exiting nerve roots within the neural foramina are surrounded by fat. Overall these findings have not changed compared to the prior examAt L2-3 there is disc desiccation and a right far lateral disc protrusion which extends into the right neural foramen and mildly displaces the right-sided exiting nerve root after it exits the neural foramen.At L1-2 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation present at this level.

Output: 1.There is redemonstration and no change of multilevel degenerative changes present in the lumbar spine with a moderate to severe degree of spinal stenosis at L4-5 and moderate spinal stenosis at L3-4 as well as some encroachment of the exiting nerve roots within the neural foramina on the left side at L5-S1 and the right-side at L4-5.2.There is a right far lateral disc protrusion at L2-3 which mildly displaces the right sided exiting nerve roots after the exit the neural foramen at this level. This is also stable compared to the prior exam


Instruction: Generate impression based on medical findings.

Input: Choroid plexus papilloma status post resection: surveillance. There are postoperative findings related to midline suboccipital craniotomy and resection of the posterior arch of C1. There is a persistent subcentimeter nodular focus of enhancement within the right cerebellomedullary angle. The lesion abuts the right vertebral artery. There is also subcentimeter patchy enhancement within the fourth ventricle. There is a right transparietal ventricular catheter which courses from the occipital horn of the lateral ventricle and terminates within the body of the lateral ventricle, indenting upon the cavum septum pellucidum. There is no significant change in size of the ventricular system. There is also interval resolution of bilateral subdural fluid collections and decreased diffuse smooth dural enhancement. There is no evidence of acute infarction. There is an unchanged mildly prominent and partially cystic pineal gland that measures up to 10 mm, which may be physiologic in nature. The major cerebral flows voids are grossly intact. There is fluid within the right mastoid air cells. The orbits are unremarkable.

Output: 1. Persistent subcentimeter foci of enhancement within the right cerebellomedullary angle and fourth ventricle, which may represent residual tumor and/or treatment effects. 2. Unchanged appearance of the shunted ventricular system, but resolution of the mild bilateral cerebral convexity subdural effusions.3. Fluid within the right mastoid air cells may represent mastoiditis.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Evaluate for progression of GBM in the left temporal lobe. Prior history of surgery and RT. Signs and symptoms: Left temporal lobe GBM. Pre and post-enhanced brain MRI:Examination demonstrates post operative changes of a left anterior temporal and frontal craniotomy for removal of temporal lobe tumor. Expected chronic postoperative changes of a partial resection of the anterior tip of the left temporal lobe demonstrate no significant change since prior exam. Mild residual gliosis immediately posterior to the lobectomy site is again identified and without convincing evidence of change since prior study. Stable mildly expanded left temporal horn of lateral ventricle.Similar to prior exam there is no detectable abnormal enhancement to suggest residual or recurrence of tumor.A few punctate foci of flair hyperintensity remains identical to prior study. There is also a more localized periventricular white matter flair hyperintensity in the left frontal lobe which is likely post treatment/radiation change which has also remained identical to prior exam.Unremarkable and stable pre-and post-enhanced brain MRI otherwise.

Output: 1.No evidence of acute or new finding since prior exam.2.Stable post surgical/therapy changes of the left anterior temporal lobe tumor without evidence of recurrence of disease.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for stress fx History: pain over 5th metatarsal and anterior ankle Marker is noted dorsal to the base of the fifth metatarsal. We see no signal abnormality of the fifth metatarsal or other bones to indicate stress fracture. Increased signal intensity in the distal third, fourth, and fifth metatarsals on fat-suppressed proton-density sequences is likely incomplete fat suppression.Small amount of fluid adjacent to the peroneus longus tendon as it enters and courses through the cuboid tunnel, perhaps representing mild tenosynovitis. Peroneus brevis tendon appears normal. Achilles tendon and posterior ankle tendons are unremarkable. Lateral collateral ligament complex is intact. Distal tibiofibular syndesmotic complex is intact. Visualized deltoid ligament is intact. The musculature of the foot appears normal. Plantar fascia and sinus tarsi are normal. We see no osteochondral defect.

Output: Small amount of fluid along the peroneus longus tendon as it courses through the cuboid tunnel, which may represent mild tenosynovitis. We see no stress fracture or other findings to account for patient's pain.


Instruction: Generate impression based on medical findings.

Input: 37-year-old male with new onset seizure. Evaluate for etiology of the seizure. There is scattered mild nonspecific periventricular and subcortical white matter T2/FLAIR signal abnormality. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears within normal limits. No findings to suggest seizure focus are appreciated. Specifically, there is no evidence of gray matter heterotopia or cortical dysplasia. The bilateral hippocampi are symmetric in size, signal characteristics, and with preserved internal architecture. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a left maxillary sinus mucous retention cyst and mild right maxillary sinus mucosal thickening.

Output: 1.No evidence of acute intracranial hemorrhage, mass or acute infarct.2.No findings to suggest seizure focus are appreciated.3.There is scattered mild periventricular and subcortical white matter T2/FLAIR signal abnormality which is nonspecific and may represent mild chronic small vessel ischemic disease (which would be slightly advanced for age), prior inflammation or less likely a demyelinating process.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old. Low back pain, falls There is severe degenerative disc disease at L3-4 and L5-S1. Vertebral body heights are preserved. There is mild straightening of the lumbar spine.

Output: Degenerative disc disease.


Instruction: Generate impression based on medical findings.

Input: 66 year old male with history of heart transplant in 9/2015 presenting for evaluation for function and evidence of rejection. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 50%, the LV end diastolic volume index is 99 ml/m2 (normal range: 74+/-15), the LVEDV is 198 ml (normal range 142+/-34), the LV end systolic volume index is 49 ml/m2 (normal range 25+/-9), the LVESV is 98 ml (normal range 47+/-19), the LV mass index is 45 g/m2 (normal range 85+/-15), and the LV mass is 89 g (normal range 164+/-36). There are no regional wall motion abnormalities. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. However, native myocardial T1 and myocardial ECV fraction are both elevated suggesting underlying inflammation, fibrosis, or infiltration.Left AtriumThe left atrium is consistent with transplant. Right VentricleThe right ventricle is normal in size with low normal systolic function. The overall RV ejection fraction is 49%, the RV end diastolic volume index is 92 ml/m2 (normal range 82+/-16), the RVEDV is 184 ml (normal range 142+/-31), the RV end systolic volume index is 47 ml/m2 (normal range 31+/-9), and the RVESV is 94 ml (normal range 54+/-17).Right AtriumThe right atrium is consistent with transplant.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 no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size. The anastomosis of transplant and native aorta is well seen without any significant stenosis. Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is a trivial pericardial effusion. Extracardiac FindingsSternal wires are present. Right renal cyst. Can not rule out left renal mass, correlation with other imaging 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.Post transplant protocol values: Global relative enhancement 1.4 (normal < 4)T2 STIR Edema ratio 1.99 (normal < 2)Native T1 time: 1183 ms (normal < 1050ms)Extracellular volume fraction 33% (normal 20-30%)

Output: 1. The left ventricle is normal in size and low normal systolic function. The overall LV ejection fraction is 50%. There are no regional wall motion abnormalities. There is no LGE and normal myocardial global relative enhancement and T2 ratio; however, native myocardial T1 and ECV fraction are both elevated suggesting underlying myocardial fibrosis, inflammation, or infiltration. 2. The right ventricle is normal in size with low normal systolic function. The overall RV ejection fraction is 49%.3. Mild mitral regurgitation.4. Extracardiac findings as above. Findings conveyed to referring team.


Instruction: Generate impression based on medical findings.

Input: Examination is motion degraded which limits assessment for subtle findings. Laminectomies are again seen from T6 to T9. Again seen is extensive long segment T2 signal abnormality involving the thoracic cord extending from approximately the T2 to the T12 levels not significantly changed in longitudinal extent since prior. Compared to examination from 2/18/2015, the expansile component of the signal abnormality appears to be improved. Many of the areas of T2 hyperintensity appear to be related to areas of cavitation with thinning of the cord parenchyma. Due to the motion degradation, the margins of the cord are difficult to define. There is evidence of adhesions in this thecal sac with areas of contour deformity of the cord and loculations of CSF. Shunt catheter is seen in the spinal canal at approximately the T9 level. There is a right pleural effusion which is again seen.T1 hyperintense lesions involving the T9 and T12 vertebral body are again seen. No suspicious osseous lesions. Vertebral body heights and alignment are grossly maintained. There is no significant spinal canal or neural foraminal stenosis at any level.

Output: Again seen is extensive T2 signal abnormality involving the thoracic cord from approximately the T2 to the T12 levels. Although the longitudinal extent of the signal abnormality is not significantly changed, the expansile nature appears less evident when compared to prior study from 2/18/2015. Most of the extensive T2 signal abnormality in the cord on the current study has the appearance of cavitation/cystic myelomalacia. There is also evidence of adhesions in the thecal sac/arachnoiditis as seen before. Findings are compatible with sequela of infection.


Instruction: Generate impression based on medical findings.

Input: Per EPIC, patient presented with a right neck lump in 2011 found to have squamous cell cancer of the right tonsil and underwent CRT in 2011. In 9/2013, he had a biopsy of the right pharynx which revealed SCCA, P16+. Underwent salvage right oropharyngectomy and right LN dissection in 2/2014. Completed reconstruction with supraclavicular flap. Pathology revealed a pT1N0 posterior oropharyngeal wall residual focus of p16+ SCC measuring 1.0 cm and extending within 4 mm of the deep margin. He developed a second local recurrence in 9/2014 at the right neck. He underwent a salvage surgery (12/10/14) with pathology revealing a 2.4 cm poorly differentiated non-keratinizing SCC of the right oral cavity. On 6/8/15, a mass is noted in the right nasopharynx (biopsy showed SCC). BRAIN: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is mild mucosal thickening of the right frontal sinus and moderate mucosal thickening of the right maxillary sinus. There is partial opacification of the anterior ethmoid air cells. There is partial opacification of the right mastoid air cells. NECK SOFT TISSUE: There is an ill-defined and infiltrative enhancing mass centered within the right lateral and posterior nasopharynx with effacement of the fossa of Rosenmuller, which extends anteriorly to the right pterygoid plates, laterally into the masticator space, posteriorly to the carotid space and superiorly to the skull base. The exact dimensions are difficult to delineate. The right mandibular condyle is inferiorly displaced relative to the left side, which may be degenerative versus tumor infiltration. The lesion surrounds the right V3 nerve but does not demonstrate definite intracranial perineural extension.Redemonstrated are postoperative findings related to resection of posterior right hemimandible as well as flap reconstruction of the right-sided pharyngeal soft tissues. There are postoperative findings related to right neck dissection. A screw plate extending from the mandibular symphysis along the right anterior mandibular body is better seen on prior CT. There is no evidence of significant cervical lymphadenopathy. The thyroid gland is unremarkable. The right internal jugular vein is not visualized. The airways are patent.

Output: 1. An ill-defined, infiltrative and heterogeneously enhancing lesion within the right nasopharynx extending anteriorly to the pterygoid plates, laterally into the masticator space, posteriorly to the carotid space and superiorly to the skull base with possible tumor infiltration at the right temporomandibular joint is consistent with known recurrent squamous cell carcinoma. No significant cervical lymphadenopathy.2. The lesion surrounds the extracranial right V3 nerve, but there is no definite evidence of intracranial extension.


Instruction: Generate impression based on medical findings.

Input: 77 yo male with metastatic prostate cancer, low back pain, right lower extremity pain and weakness For the purposes of numbering, there are 5 lumbar type vertebral bodies. Again seen are postsurgical changes of posterior instrumentation at the L4-L5 level with paraspinous rods and pedicle screws better assessed on recent CT. There is extensive marrow infiltrating tumor involving the L4 and L5 vertebrae. No recent MRI is available, however there is clear progression of tumor when compared to prior MRI dated 7/17/2012 with increased marrow infiltration involving the L4 and L5 vertebral bodies extending into the posterior elements and epidural space. There also multiple additional small enhancing lesions including the T10 vertebral body as well as the sacrum which are new since prior study from 2012.There is minimal loss of height involving the L4 and L5 vertebral bodies; vertebral body heights are otherwise grossly preserved. Alignment is within normal limits. There is moderate stenosis involving the spinal canal at the upper L4 level which becomes severe at the mid L5 level related to combination of epidural tumor tumor, posterior convexity of the L5 vertebral body and degenerative changes. Thecal sac becomes patent more inferiorly at the L5-S1 disc level. There is a prior laminectomy at the L4-L5 level; however the CSF spaces at this level remain effaced.There is moderate to severe stenosis involving the right L4-L5 neural foramen and moderate stenosis involving the right L5-S1 neural foramen. There is mild left L4-L5 and mild to moderate left L5-S1 neural foraminal narrowing. Expansile bone remodeling related to infiltrating tumor is better appreciated on recent CT. There is no significant spinal canal or neural foraminal stenosis at the L1-L2, L2-L3, and L3-L4 levels. Epidural enhancement dorsal to the L3 vertebral body is nonspecific and not definitively indicative of tumor. Small fluid collection in the posterior paraspinous soft tissues at the L5 level is noted but smaller than 2012.

Output: 1. No recent MRI is available for comparison however compared to 7/17/2012, there is evidence of progressive infiltration of the L4 and L5 vertebral bodies extending into the posterior elements as well as increased epidural tissue. There is moderate spinal canal stenosis at the upper L4 level. Spinal canal stenosis becomes worse more inferiorly and is severe at the mid L5 level. Thecal sac becomes patent again further inferiorly at the L5-S1 disc level.2. There is also worsening neural foraminal stenosis related to epidural tumor and expansile bony remodeling related to the infiltrating tumor, particularly on the right, where there may be impingement of the exiting right L4 and L5 nerve roots.3. Please see additional details above, including multiple new foci of osseous metastatic disease.


Instruction: Generate impression based on medical findings.

Input: There is approximately 22 x 22 mm transaxial dimension lesion at the left parieto-occipital junction, demonstrating a fluid-heme level. Contents anteriorly are T1 and T2 hyperintense, most consistent with extracellular methemoglobin. Posteriorly, contents are somewhat mixed between isointense and hyperintense on T1 and hyperintense on T2 suggesting a mixture of intracellular deoxyhemoglobin and intracellular met hemoglobin. Far posteriorly, there is a small area with susceptibility and enhancement which may suggest a small vascular nidus. There is mild regional mass effect upon sulci. There is no resulting midline shift.There are scattered foci of T2 hyperintensity in the white matter without restricted diffusion, mass effect, susceptibility abnormality, or enhancement representing mild chronic small vessel ischemic diseaseThe ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. The pituitary gland is normal in size. There is no acute cerebral, brainstem or cerebellar infarction. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Mucosal thickening is present within bilateral maxilla sinuses, and fluid is noted within a few dependent mastoid air cells.

Output: There is approximately 22 x 22 mm transaxial dimension hemorrhagic lesion at the left parieto-occipital junction. Far posteriorly, there is a small area with susceptibility and enhancement which may suggest a small vascular nidus. There is mild regional mass effect upon sulci. There is no resulting midline shift. Given patient age and history of urothelial cancer, this most likely represents a hemorrhagic metastasis, with other etiologies considered less likely.


Instruction: Generate impression based on medical findings.

Input: 28-year-old male patient with pain of left medial tibial distal diaphysis. Evaluate for stress fracture. Bone marrow signal is within normal limits. No specific evidence of a stress fracture.The soft tissues of the left lower extremity appear unremarkable.

Output: No specific evidence of a stress fracture or other acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Female 51 years old Reason: evaluate for History: hypoglycemia with hyperinsulinemia ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted. Normal intrinsic T1 hyperintensity throughout the pancreas. No pancreatic mass. No pancreatic duct dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes related to Roux-en-Y gastric bypass.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.No specific cause is identified for patient's hypoglycemia/hyperinsulinemia.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old. Fall, now with medial knee pain and instability MENISCI: The posterior horn of the medial meniscus shows intrasubstance intermediate signal compatible with degeneration, without discrete meniscal tear identified. The anterior horn of the medial meniscus is intact. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: Bone marrow signal intensity is normal. No focal articular cartilage defects are identified.LIGAMENTS: Cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Degeneration of the posterior horn of the medial meniscus without discrete meniscal tear identified.


Instruction: Generate impression based on medical findings.

Input: 51 years Female (DOB:5/6/1964)Reason: lumbar radiculopathy vs. MS History: R leg weaknessReferring Attending: RICHARD W KANG Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is a mild facet hypertrophy at this level.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.The uterus appears fairly large with multiple signal void type lesions.

Output: 1.No compromise to lumbar spinal canal or neural foramina.2.The uterus appears be fairly large with multiple signal void the lesions. One possibility is this represents fibroids. The uterus however is not included in its entirety on this exam and is not adequately evaluated. Please correlate with patient's clinical history and other studies.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old, with left chest pain and T11 radiculopathy, assess for compression fractures. Thoracic:Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. T1 and T2 hypointensity within the T11 vertebral body, contiguous with the inferior endplate, is seen suggestive of a Schmorl's node. No significant associated marrow edema is seen. A T1 hypointense, T2 isointense lesion is evident anteriorly within the T12 vertebral body, contiguous with the superior T12 endplate, with a mild rim of associated marrow edema. Neither vertebral body shows significant loss of height and no frank compression deformities are seen.The visualized spinal cord demonstrates normal signal intensity and morphology. No epidural abnormalities are suspected.A small left paracentral disc protrusion is seen at T7-8. A small right paracentral disc protrusion is seen at T8-9. The T10-11 and T11-12 discs show loss of T2 signal and mild loss of height. Facet hypertrophy develops at lower thoracic levels, particularly notable at T10-11 and T11-12. The left T11-12 neural foramen is mildly narrowed as a result. No other significant spinal canal or foraminal compromise is seen.Limited views of the cervical spine demonstrate multilevel disc osteophyte formation and perhaps some thickening of the posterior longitudinal ligament which results in spinal canal stenosis and possible cord impingement.Lumbar:Spinal alignment is anatomic. Vertebral body heights are preserved. No pathologic marrow replacement or marrow edema is seen.The visualized distal spinal cord, conus and cauda equina are within normal limits. No epidural abnormalities are suspected.Significant loss of disc height is seen at L5-S1 with endplate irregularity. Additional level specific degenerative findings are as follows:L1-2: No significant spinal canal stenosis or neuroforaminal narrowing. L2-3: No significant spinal canal stenosis or neuroforaminal narrowing. L3-4: Facet hypertrophy and ligamentum flavum thickening. No significant spinal canal or neuroforaminal stenosis. L4-5: Facet hypertrophy and ligamentum flavum thickening. Bulging disc with a small superimposed central protrusion. Mild generalized spinal canal narrowing with some effacement of the left lateral recess. Both neural foramina are significantly narrowed. L5-S1: Facet hypertrophy and ligamentum flavum thickening. Bulging disc with a superimposed left paracentral disc protrusion. This protrusion may impinge upon the descending left S1 nerve root. No significant generalized spinal canal stenosis is seen. However, both neural foramina are severely narrowed.

Output: 1.Marrow signal change is evident within T11 and T12, centered along the endplates, and favored to represent degenerative Schmorl's nodes. Although Schmorl's nodes are a frequent incidental finding, they can be symptomatic in the acute phase.2.No evidence of any frank compression deformity is seen in the thoracic or lumbar spine.3.At L4-5, disc degeneration and facet hypertrophy result in a mild spinal canal narrowing and significant compromise of the bilateral neural foramina grade4.L5-S1, disc degeneration with a left paracentral disc protrusion is seen with possible impingement of the left S1 nerve root. This, along with facet hypertrophy, contributes to severe bilateral foraminal narrowing.5.Multilevel degenerative findings are partially visualized in the cervical spine with areas of canal stenosis and possible cord impingement. This can be assessed with dedicated cervical spine imaging if clinically warranted.


Instruction: Generate impression based on medical findings.

Input: 42-year-old female with multiple sclerosis. Please evaluate for progression. Please do Dr javed MS protocol with DTI and compare to prior. Innumerable bilateral periventricular white matter lesions are redemonstrated, which are not significantly changed. No evidence of any new lesions is seen and no pathologic enhancement is detected on the present study.No mass effect is present. No abnormal extra-axial fluid collections are seen. Mild prominence of the ventricles and sulci is unchanged and compatible with volume loss.

Output: Innumerable white matter lesions are redemonstrated compatible with multiple sclerosis have not significantly changed.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Possible. Signs and symptoms: Fall Nonenhanced CT of brain:There is no evidence of acute post traumatic intracranial findings.Findings consistent with minimal small vessel disease of indeterminate age is noted.Cortical sulci, ventricular system and CSF cisterns remain within normal for patient of stated age of 87. Large vessel intracranial calcification of carotid and vertebral arteries are noted.Limited view of paranasal sinuses and mastoid air cells are unremarkable.Gadolinium demonstrate a large area of low attenuation within the marrow space in the right frontal lobe with suspected area also thinning of the inner cortex of right frontal bone. There is no associated epidural component with this finding. Findings could represent fibrous dysplasia however less likely possibility of a metastatic lesion cannot be entirely ruled out. There are no additional foci of abnormality of calvarium. This finding can be further evaluated either by a nuclear medicine study or a dedicated MRI of brain with enhancement.

Output: 1. No evidence of post traumatic findings of intracranial space or the calvarium.2.Findings consistent with minimal small vessel disease of indeterminate age.3.Large area of lytic change involving the right frontal bone which may represent fibrous dysplasia and less likely possibility of a metastatic lesion cannot be entirely ruled out. Follow up with neck medicine bone scan or an MRI of brain with enhancement is recommended.


Instruction: Generate impression based on medical findings.

Input: Male, 6 months old. Reason: Rickets, multiple fractures, sub dural , hydrocephalus, 2 month follow up MRI evaluate for changes History: 2 month follow up MRI evaluate for changes The previously seen numerous scattered foci of susceptibility are less conspicuous on this exam compared to the prior study dated 06/24/2015. Specifically, a focus in the left temporal lobe is decreased in size from prior, and additional foci in the left anterior frontal lobe, right anterior temporal lobe, bilateral occipital lobes, and along the left cerebellar vermis are no longer clearly seen. More tubular areas of susceptibility along the right parietal lobe are also significantly decreased in prominence from prior.The previously seen small bilateral frontal subdural hematomas are essentially resolved, with minimal residual prominence of the extra-axial spaces. There is no evidence of new intracranial hemorrhage and no new abnormal extra-axial fluid collection. The ventricles, cisterns, and sulci are normal in size and configuration. There is no midline shift or mass effect. There is no evidence of acute infarct. There is decreased opacification of the paranasal sinuses, bilateral mastoid air cells, and middle ears. The orbits are unremarkable.

Output: 1. The previously seen bilateral subdural hematomas are essentially resolved, with minimal residual prominence of the extra-axial spaces.2. Significant interval improvement in scattered areas of susceptibility without evidence of new intracranial hemorrhage.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Acute ischemic stroke. Signs and symptoms: Right leg weakness. Nonenhanced brain MRI:Examination demonstrates a 10 x 10 mm focus of restricted diffusion in the left cerebellum consistent with an acute nonhemorrhagic stroke. A tiny linear restricted diffusion is also noted in the right posterior cerebellum as well highly suggestive of a small acute stroke.Additionally there is a large left mid to posterior temporal and occipital as well as left pontine and multiple tiny right occipital foci of restricted diffusion as well consistent with acute ischemic stroke in the distribution of the left PCA.There is no evidence of hemorrhagic changes with the findings.Additionally examination demonstrated a large chronic left posterior frontal and parietal ischemic stroke without evidence of hemorrhagic changes. There is ex vacuo dilatation of left lateral ventricle secondary to chronic strokes and mild effacement of adjacent cortical sulci to the left temporal-occipital acute stroke.Examination also demonstrates moderate degree of chronic small vessel ischemic strokes.Prominence of cortical sulci and dilatation of supratentorial ventricular system consistent with underlying parenchymal volume loss.The signal voids of major intracranial arterial branches are identified.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.

Output: 1.Large acute nonhemorrhagic ischemic stroke in left temporal / occipital and left thalamus. Small foci of acute ischemic stroke in bilateral cerebellum (L>R) is also noted as detailed above.2.Chronic nonhemorrhagic small vessel ischemic strokes and a large chronic left MCA territory posterior frontal/parietal cortical stroke as mentioned.3.Prominence of cortical sulci and supratentorial ventricular system consistent with underlying parenchymal volume loss.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old, with general weakness, and known non-small cell lung cancer. Patchy periventricular T2 hyperintensity is again seen without significant change. Also unchanged is patchy T2 hyperintensity in the pons along with a slitlike central pontine defect.No definite evidence of any new intracranial lesion is seen. No parenchymal edema or mass effect is detected. No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is observed. The ventricular system is within normal limits for size.

Output: 1.Stable findings compatible with chronic microvascular and lacunar ischemic disease.2.No new or acute intracranial findings.3.No specific findings to account for the patient's symptoms.