Instruction: Generate impression based on medical findings.

Input: 52-year-old female with anisocoria, poor balance and incontinence. Evaluate for brain metastases. Further history reveals metastatic renal cell cancer history status post SRS to the right cerebellum. Since previous exam there has been interval increase in size of the hemorrhagic right basal ganglia metastatic lesion which now measures 1.2 x 1.2 cm (series 1001, image 19), compared to 0.4 x 0.6 cm previously. There is now a small amount of mass effect on the adjacent brain parenchyma as well as some surrounding parenchymal edema. There is small amount of mass effect on the adjacent sulci than right lateral ventricle. There is perhaps a small amount of focal leftward midline shift of 2 mm. Just posterior and medial to the right basal ganglia lesion is a second 3 x 5 mm enhancing focus which was not present on the prior examination and is suspicious for a additional site of metastasis.Within the right lateral cerebellum there has been interval decrease in the size and enhancement pattern of the hemorrhagic metastatic lesion. There is now only residual susceptibility abnormality and no appreciable enhancement status post SRS.The ventricles and basal cisterns are normal in size and configuration. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.Interval increase in the hemorrhagic right basal ganglia metastatic lesion with mild surrounding edema and with some mild mass effect and sulcal effacement.2.Just medial and posterior to the right basal ganglia lesion is a small enhancing focus which is suspicious for a small new metastasis.3.Interval decrease in the size and enhancement of the right cerebellar metastatic lesion post-treatment, which now only demonstrates susceptibility abnormality.


Instruction: Generate impression based on medical findings.

Input: 57 year old with history of left lumpectomy for invasive ductal carcinoma 5/2013. Patient received radiation and chemotherapy. She has dense breasts. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. Left breast skin thickening is related to post radiation changes. 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: New onset of dizziness and postural vertigo, more on the left. Looking for vascular or structural pathology. MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are unremarkable. There is scattered paranasal sinus mucosal thickening and suggestion of fluid within the left maxillary sinus.MRA: There is no evidence of significant steno-occlusive lesions or saccular aneurysms, within the limits of MRA.

Output: 1. No evidence of acute infarct, intracranial hemorrhage, or mass.2. No evidence of significant steno-occlusive lesions.3. Possible acute sinusitis.


Instruction: Generate impression based on medical findings.

Input: 34 years, Male, Reason: s/p TBI in 2002. Now with behavior changes History: mood instability, anger out burst. Several sequences are motion degraded. There are multiple scattered foci of susceptibility related to hemosiderin in the brain at the gray-white junction as well as at the cortical surface consistent with traumatic brain injury. Chronic hemosiderin deposition is relatively more prominent along the surface of the left inferior frontal and left temporal lobes as well as the superior parietal lobules. There is extensive encephalomalacia involving the left anterior temporal lobe as well as the left temporal lobe laterally along the left middle and inferior temporal gyri. There is also encephalomalacia involving the left superior parietal lobule. There is also small area of gliosis evident involving the right superior parietal lobule also likely related to prior trauma. Linear T2 signal abnormality with surrounding gliosis involving the right superior frontal gyrus may be related to prior ventriculostomy or ICP monitoring device.There is no intracranial mass or mass effect. No acute infarct. No extra-axial collections. No midline shift or herniation. There are areas of ex vacuo dilatation of the lateral ventricles. There is also multifocal thinning of the corpus callosum which may be related to Wallerian degeneration and/or traumatic injury. No hydrocephalus. There is polypoid mucosal thickening involving the bilateral maxillary sinuses. Evidence of prior left frontotemporal craniotomy.

Output: Multifocal encephalomalacia and chronic hemorrhage consistent with chronic traumatic brain injury. Findings are relatively more prominent in the left temporal and left parietal lobes as described above.


Instruction: Generate impression based on medical findings.

Input: Female, 37 years old, history of GBM, presumably IDH wild type, MGMT unmethylated, prior to resection and TMT/RT; PD two cycles of IDO pathway immunotherapy, D56 on anti-angiogenic agent plus Avastin. Postop findings are again seen compatible with bilateral frontal craniotomy. A cystic space occupying the left frontal lobe has not significantly changed.A large area of signal abnormality and mass effect is again seen involving the entire right frontal lobe, corpus callosum, insula, basal ganglia, and thalamus. The core of the lesion demonstrates a scarlike area of intense enhancement with more feathery subtle enhancement elsewhere. The intensity of enhancement has decreased when compared to the prior examination. However, the overall size of the abnormal has progressed. In particular, tumor-like bulkiness expanding many of the frontal gyri has progressed in areas which previously appeared simply edematous.Mass effect is again seen in the right cerebral hemisphere including inferior displacement and partial effacement of the right lateral ventricle, and a midline shift to the left of at least 5 mm. The left lateral ventricle is not dilated.Progressive enhancement has also occurred within the left cerebellum. The prior single enhancing nodule has become larger, and there is now a new rim-enhancing nodule which projects into the fourth ventricle, and perhaps an additional new satellite nodule just lateral to the original lesion. The fourth ventricle is partially effaced and signal abnormality extends from these lesions into the midbrain.

Output: Findings are again seen concerning for progressive disease. Although the intensity of enhancement of the right frontal lobe lesion has diminished, the overall size of the abnormality, and in particular the tumor-like bulkiness of many of the frontal gyri, have progressed. Furthermore, new and larger enhancing nodules are also demonstrated adjacent to the fourth ventricle.


Instruction: Generate impression based on medical findings.

Input: 21 years Male (DOB:11/19/1994)Reason: Evaluate for etiology of L sided headaches, episode of L sided numbness and weakness History: L sided headaches after head trauma, episode of L sided numbness and weaknessPROVIDER/ATTENDING NAME: THOMAS J KELLY THOMAS J KELLY MRI of the brainNo diffusion weighted abnormalities are appreciated.The cerebellar tonsils extend 3-4mm below the level of the foramen magnum.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 demonstrate small mucous retention cysts in the right maxillary and ethmoid air cells and to a lesser degree left maxillary sinus The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. Asymmetric mucosal thickening in the right nasal cavity is not entirely attributable in part to nasal cycling. Findings suggest that polypoid mucosal thickening may be present.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact and very small. The vertebral arteries are similar in size.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. Fat sat axial and coronal imaging were performed following contrast. Presence of contrast confounds the evaluation for a subtle dissection on these sequences. The 2DTOF and 3DTOF sequences reveal no evidence for vertebral or carotid dissection.

Output: 1.There is no evidence for intracranial or extracranial cerebrovascular occlusive disease.2.No evidence for cerebral hemorrhage.3.The cerebellar tonsils are low lying and borderline for Chiari 1 malformation. There is no evidence for ventriculomegaly.4.Mucosal thickening in the right nasal cavity is non-specific. The possibility of a small polypoid lesion such as a nasal polyp or other polypoid lesion cannot be excluded. If clinically appropriate, direct visualization may be helpful. The pattern of adjacent right maxillary and ethmoid mucosal thickening suggests this may be obstructive.


Instruction: Generate impression based on medical findings.

Input: Female 47 years old Reason: ? Angiolipoma of right vulva History: Asymptomatic enlarging soft tissue mass PELVIS:UTERUS, ADNEXA: The uterus is retroverted. Small submucosal T2 hyperintensities are consistent with leiomyomas. The ovaries are unremarkable.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Disc desiccation and mild bulging at the L5-S1 level with a small annular fissure.OTHER: There is mild asymmetric thickening of the right perineal soft tissue which extends into the right vulva. This follows fat signal intensity on all sequences. There is no capsule and there are no nodular enhancing foci. The lesion measures approximately 5.2 x 5.2 cm (series 1203, image 98). Trace free fluid in the pelvis.

Output: 1.Findings consistent with an unencapsulated lipoma in the right perineum extending to the right vulva.


Instruction: Generate impression based on medical findings.

Input: 24-year-old female. Left knee pain and instability. Left patellar dislocation. MENISCI: Medial and lateral menisci are normal in signal intensity and morphology without evidence of a tear.ARTICULAR CARTILAGE AND BONE: Small bone contusion at the anterior aspect of the lateral femoral condyle. The remainder of the bone marrow signal intensity is within normal limits. No patellar contusion is evident. Tibiofemoral and patellofemoral compartment articular cartilage is intact.LIGAMENTS: ACL, PCL, MCL, and lateral collateral ligament complex are intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Small bone contusion in the lateral femoral condyle, which may be sequelae of prior patellar dislocation. 2. Femoral trochlear dysplasia.


Instruction: Generate impression based on medical findings.

Input: The thoracic spine is in normal alignment, with a normal thoracic kyphosis. The vertebral body and disk heights are well-maintained. The thoracic vertebral bodies are mildly heterogeneous related to focal fat deposition. Multilevel degenerative changes are present. No worrisome focal marrow signal abnormality is appreciated. At upper T4 vertebral level, there is a 2 mm focus of T2 signal along the left paramedian ventral cord, nonspecific. The spinal cord is slightly ventrally displaced at T4 with slight cord flattening in the AP dimension. Otherwise, spinal cord is of normal caliber and signal. The paraspinal soft tissue structures are unremarkable.At C6-C7 and C7-T1: There is mild left foraminal disc protrusion with resultant mild left neural foraminal narrowing. No spinal canal stenosis.At T4-T5, there is left paracentral/foraminal disc extrusion which extends 2 mm cranially, indenting the ventral thecal sac, resulting in mild left neuroforaminal narrowing. There is no spinal canal stenosis.T10-11: There is a small left paracentral disc protrusion without significant neural foramina or spinal stenosis.Remaining thoracic intervertebral disc levels show no significant disk bulge, herniation, spinal canal or foraminal stenosis.MRI lumbar spine: Motion limited exam. The lumbar spine is in normal alignment, with a normal lumbar lordosis. The vertebral body heights are well-maintained. Mildly heterogeneous marrow signal related to focal fatty position. No worrisome focal marrow signal abnormality is appreciated. There is minimal loss of disc height at L5-S1 with disc desiccation. Remaining intervertebral disc heights are maintained. The distal spinal cord and conus are within normal limits with the conus terminating at the L1-L2 level. The paraspinal soft tissue structures are unremarkable.T11-T12: No significant disc disease or stenosis.T12-L1: No significant disc disease or stenosis.L1-L2: No significant disc disease or stenosis.L2-L3: Mild disc bulge which shallow left foraminal protrusion resulting in mild left neural foraminal narrowing. No spinal canal stenosis.L3-L4: Mild degenerative facet disease. No significant disc disease or stenosis.L4-L5: Mild degenerative facet disease. Minimal disc bulge and minimal bilateral neural foraminal narrowing.L5-S1: Facet arthropathy. Mild disc bulge with superimposed left foraminal disc protrusion with moderate to severe left neural foraminal narrowing, which may abut the exiting left L5 nerve root. Mild right neural foraminal narrowing. No spinal canal stenosis.There is linear area opacity in the right lung base may represent subsegmental atelectasis.

Output: 1. No evidence of spinal canal stenosis in the thoracic or lumbar spine.2. Mild degenerative spondylotic changes in the thoracic spine, mostly at T4-T5 resulting in mild left neural foraminal narrowing.3. Punctate focus of T2 signal abnormality in the left ventral cord at upper T4 vertebral level is nonspecific, but may represent mild myelomalacia. This likely relates to the incidental ventral displacement of the thoracic cord at T4 level with mild cord flattening and narrowing. Possibility of intradural extramedullary cystic focal lesion such as arachnoid cyst, versus ventral cord herniation is suspected. 5. Degenerative disc changes in the lumbar spine, worst at L5-S1, where there is disc bulge with superimposed left foraminal disc protrusion reflecting moderate left neural foraminal narrowing and possibly abutting the exiting left L5 nerve root. Correlate for left L5 radiculopathy.


Instruction: Generate impression based on medical findings.

Input: History of acute pancreatitis complicated by pseudocyst status post failed drainage at outside hospital. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size and signal intensity. Normal postcontrast enhancement. Note is made of a hepatic cyst in segment 8. No intra or extrahepatic ductal dilatation. Normally distended gallbladder.SPLEEN: The spleen is normal morphology size and enhancement.PANCREAS: The pancreatic neck body and tail is replaced by a large complex loculated collection which extends superolaterally along the left pararenal space along the greater curvature of the stomach measuring 13.8 x 5.6 cm. It extends inferiorly along the right inferior anterior pararenal space into the lower abdomen adjacent to the psoas muscle where it consists of a multiloculated cystic collection measuring 6.0 x 5.3 cm. The larger left superolateral collection is markedly heterogeneous, contains layering T1 weighted hyperintense material posteriorly compatible with proteinaceous and or hemorrhagic products and centrally is very low on both T1 and T2-weighted sequences suggestive of air. The collection demonstrates peripheral thick-walled enhancement.More than 50% of the pancreatic parenchyma is replaced by this collection. The residual pancreatic head has a normal caliber main pancreatic duct and demonstrates normal postcontrast enhancement.The splenic vein is occluded.The very proximal portal vein/SMV portal vein confluence is nearly completely occluded by mass effect (series 1201/184). No arterial pseudoaneurysm is identified.Nondiagnostic secretin images.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: See discussion above regarding peripancreatic fluid collection.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Very large collection replacing the majority of the pancreatic parenchyma and extending in the retroperitoneum as described above demonstrating peripheral thick-walled enhancement and internal heterogeneity compatible with walled off necrosis with possibility of superinfection given the intrinsic T1 and T2-weighted hypointense signal intensity suggestive of air (versus chronic blood products), may also be post treatment gas within the collection.Splenic vein thrombosis. Near complete occlusion of the portal vein/SMV confluence.


Instruction: Generate impression based on medical findings.

Input: 64 old female with witnessed partial seizure (new onset). Evaluate for bleed. Hypodense region in the left posterior parietal and left occipital lobes with no significant mass effect or volume loss concerning for a subacute infarct. MRI is recommended for further evaluation. Subcortical and periventricular white matter diffuse hypodensities consistent with small vessel ischemic disease of indeterminate age.There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1- Left posterior parietal and occipital lobes hyperdense the concerning for subacute infarct. MRI is recommended for further evaluation.2- Small vessel ischemic disease of indeterminate age.These findings were communicated to Dr. Christopher Chapman via phone at 10:50am.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Evaluate etiology of alteration of mental status. Signs and symptoms: Alteration of mental status. Nonenhanced brain MRI:No acute intracranial process and in particular no evidence of acute ischemic stroke.Ventricle and to a lesser degree subcortical patchy foci of flair/T2 hyperintensity on the in bilateral hemispheric white matter are nonspecific however considering the patient's stated age likely representing sequela of microvascular chronic ischemic changes of mild degree without hemorrhage.The cerebral cortex and cortical sulci are slightly prominent however without detectable signal abnormality.Bilateral basal ganglia, thalami, pons and cerebellum/vermis demonstrate normal morphology and signal intensity on all MRI sequences.Calvarium, orbits, paranasal sinuses and mastoid air cells demonstrate no abnormalities.

Output: 1.No acute intracranial process.2.Findings suggestive of mild chronic nonhemorrhagic small vessel ischemic strokes only in the subcortical and periventricular white matter.3.Unremarkable nonenhanced brain MRI otherwise.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Other specified disorders of muscleClinical question: rule out strokeSigns and Symptoms: R sided upper and lower extremity weakness The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There is no evidence for acute ischemic cerebral infarction. There is no evidence for acute intracranial hemorrhage mass or edema.


Instruction: Generate impression based on medical findings.

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

Output: No evidence of intracranial hemorrhage, mass, or acute infarct. Otherwise, please consider a dedicated angiography imaging study for further evaluation of vascular abnormalities.


Instruction: Generate impression based on medical findings.

Input: 21-year-old woman with history of Chiari malformation and reported history of syrinx, now with worsening symptoms and back pain. The thoracic spine is in normal alignment. The vertebral body and disk heights are well-maintained. There is a subcentimeter T1 and T2 hyperintense lesion consistent with hemangioma involving the T8 vertebral body. A subcentimeter T2 hyper and T1 hypointense lesion in the T10 vertebral body is nonspecific but may represent an atypical hemangioma. The spinal cord is of normal caliber and signal. There is no significant disc disease, spinal canal, or neural foraminal stenosis. The paraspinous soft tissues are within normal limits. Low-lying cerebellar tonsils are partially imaged on the sagittal counting sequence.LUMBAR SPINE

Output: 1.No evidence of syrinx in the thoracic cord. 2.Borderline low position of the conus medullaris at L2/L3 without fatty filum or other lesions to suggest cord tethering. Prone images may be considered if clinically warranted.3.Mild central disc protrusion at L5/S1. No significant spinal canal or neural foraminal stenosis at any level.


Instruction: Generate impression based on medical findings.

Input: History of Crohn's disease. Unknown phenotype, but a colonoscopy showed a normal colon and the terminal ileum was normal, nevertheless, a CT scan from an OSH showed inflammation in the small bowel. We need to assess his proximal ileum and jejunum. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Previously seen inflammatory wall thickening of the terminal ileum and right colon on OSH CT has resolved. No evidence of active or chronic inflammatory bowel disease. No fistulae, abscess, or sinus tracts are identified.Large amount of stool in the colon.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval resolution of the right colon and terminal ileum inflammatory wall thickening. Unremarkable appearance of the bowel with no evidence of inflammation. Large stool burden.


Instruction: Generate impression based on medical findings.

Input: Cognitive decline with prior strokes and Parkinson disease: please assess for burden of cerebrovascular disease. There are small areas of encephalomalacia in the bilateral deep grey matter structures and anterior right frontal lobe superimposed upon a background of diffuse bilateral cerebral hemisphere white matter T2 hyperintensity, primarily in a periventricular distribution. There is no evidence of intracranial hemorrhage or acute infarct. There is mild diffuse cerebral volume loss. There is an unchanged subcentimeter extra-axial lesion with susceptibility effect along the anterior right frontal convexity. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and mastoid air cells are grossly unremarkable. There is a subcentimeter nodule in the left occipital scalp, which may represent an inclusion cyst, but has gradually increased in size.

Output: 1. Small chronic infarcts in the bilateral deep grey matter structures and anterior right frontal lobe superimposed upon a background of chronic small vessel ischemic disease, but no evidence of acute acute infarct.2. An unchanged subcentimeter extra-axial lesion with susceptibility effect along the anterior right frontal convexity may represent a calcified meningioma.3. A subcentimeter nodule in the left occipital scalp, which may represent an inclusion cyst, but has gradually increased in size and is incompletely characterized.


Instruction: Generate impression based on medical findings.

Input: Brain tumor 3 yr follow up for change. There is no significant interval change in size of the enhancing sellar tumor, which measures up to 15 mm and abuts the left aspect of the optic apparatus. There is no evidence of intracranial hemorrhage or acute infarct. There are multiple nonspecific scattered foci of high T2 signal in the cerebral white matter. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There are postoperative findings in the right calvarium. The orbits, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No significant interval change in size of the sellar tumor.


Instruction: Generate impression based on medical findings.

Input: Female, 41 years old, with hyperprolactinemia. The pituitary gland is slightly small but still within acceptable limits for size. No definite focal lesions are seen. The pattern of enhancement is within normal limits. The pituitary stalk deviates towards the left but is otherwise unremarkable. No suprasellar lesions are seen.

Output: No definite focal pituitary lesions are identified.


Instruction: Generate impression based on medical findings.

Input: Reason: left MCA ischemic stroke NIHSS 19 History: NIHSS 19, right sided weakness, global aphasiaFLUOROSCOPY TIME: 115.9 minutesFrontal: 2784.03 mGyLateral: 1909.21 mGyOPERATORS: Greg Christoforidis Left common carotid artery: There is no evidence for carotid stenosis on the basis of NASCET criteria. There is a cobblestone appearance to the left ICA with broad pseudoaneurysms.Left internal carotid arteryThere is opacification of the left anterior cerebral arteries. There is occlusion of the left middle cerebral artery at the distal left mm1 segment with grade 4 leptomeningeal collaterals. The anterior temporal artery is proximal to the occlusion site.Intraprocedural arteriograms:Early on the microcatheter was noted to bulge into the left cavernous sinus, when the microcatheter was placed in the left M2 segment.There was a carotid cavernous fistula that developed during the procedure at the site of a 1 mm aneurysm.There is progressive recanalization of the left middle cerebral artery territory with TICI 2B reperfusion. Initially 70% of the territory reperfused, by the time the CCF was treated 95% of the territory had reperfused.There was progressive occlusion of the left sided direct cavernous carotid fistula.Left internal carotid artery following the procedure:There is recanalization of the left middle cerebral artery including superior and inferior divisions with some slow flow in a couple M5 branches.The cavernous carotid fistula was occluded at the end.Right common iliac artery: No contraindications to closure device.

Output: 1.Left middle cerebral artery distal m1 occlusion.2.Embolectomy with recanalization and reperfusion of the left middle cerebral artery using the Trevo embolectomy device.3.Direct carotid cavernous fistula development at site of a 1mm aneurysm at the ascending portion of the left cavernous internal carotid artery.4.Successful occlusion of left direct cavernous carotid fistula.5.Successful retrieval of prematurely detached embolic occlusion coil.6.Findings were discussed with Dr Cueva at the end of the procedure.


Instruction: Generate impression based on medical findings.

Input: Male 62 years old Reason: Left knee pain (superolateral) and instability for one month, no trauma. MENISCI: Medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: Marked thinning of the articular cartilage involving the lateral femoral condyle, but no focal cartilage defect. Mild irregularity of the medial facet of the patella.LIGAMENTS: Cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: No MRI findings to account for patient's symptoms. Extensive chondrocalcinosis involving the left knee on 8/27/2015 radiograph may account for patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: Brain MRIMultiple scattered T2/flair high signal intensity lesions on bilateral periventricular white matter and deep white matter including bilateral corpus callosum. There is no evidence of abnormal enhancement on the scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Cervical spine MRIThere is relatively well defined T2 high signal intensity lesion at the level of foramen magnum-C2 indicating possible demyelinating lesion.Diffuse bulging of discs with associated bilateral ligamentum flavum are seen at the level of C34, C45, C56 and C67 without evidence of spinal canal stenosis. No neuroforaminal stenosis is seen.There is normal cervical lordosis.The vertebral body height is preserved. Constellation of both brain and cervical spine MRI suggest demyelinating disease such as multiple sclerosis involvement of both brain and cervical spine.

Output: 1. White matter lesions and upper cervical spinal cord lesions indicate demyelinating disease such as multiple sclerosis involvement.2. No abnormal enhancement is seen.


Instruction: Generate impression based on medical findings.

Input: Progressive severe headache. BRAIN:The left cerebellar tonsil is elongated/peg-shaped and extends up to 2.8 cm below the level of the foramen magnum, to upper C3 level. It causes mild deformity of the caudal medulla and upper cervical spinal cord, which is more eccentric to the right within the spinal canal. There is faint T2STIR hyperintensity within the upper cervical cord at the C2-C3 level on sagittal and perhaps axial imaging which may reflect soft syrinx. The right cerebellar tonsil barely extends below the level of the foramen magnum. The fourth ventricle is normal size and there is no hydrocephalus. Overall volume of the posterior fossa is normal and the cerebellum is otherwise normal in morphology. Myelination is appropriate for age. There is no midline shift. A focal 10-mm CSF-intensity structure along the superior surface of the anterior edge of the tentorium cerebelli (vs adjacent to and extending through a small dural defect) which may represent a small arachnoid cyst. There is no abnormal intracranial contrast enhancement. Major intracranial vascular flow voids are preserved. There is minimal ethmoid mucosal thickening. A 4 mm fluid intensity within the pineal region is probably a small cyst, of doubtful significance. The adenoids, tonsils and retropharyngeal lymph nodes are prominent, which is a common incidental finding in this age group.The CSF study was performed at the mid sagittal plane. Dorsally, the flow signal is significantly attenuated with loss of synchronicity compared to the ventral flow. Ventrally, there is focal attenuation of the flow at the level of the most severe narrowing at C1 level but preserved biphasic flow cranial and caudal to this otherwise. WHOLE SPINE:There is a multiloculated lower cervical syrinx that is 3.0 cm craniocaudally extending from C4-C5 level to C7-T1 level which measures transaxially 7 mm x 6 mm. Two other smaller focal dilatations of the central canal are present at the upper and lower T4 levels. In addition, there is the faint T2-hyperintensity within the upper cervical cord at C2-C3 level described above, which may reflect pre/soft-syrinx.The spinal cord is otherwise unremarkable. The tip of the conus medullaris lies at L1-L2 level which is normal. The spinal canal is also preserved. The vertebral bodies are preserved in signal and morphology. The intervertebral discs are also unremarkable. Note, there are no post contrast images through the lower thoracic/lumbar spine. There is no abnormal contrast enhancement in the region of the syrinx.

Output: 1.Chiari 1 malformation, more pronounced on the left side. No hydrocephalus or other posterior fossa malformation. CSF flow study is remarkable for marked dorsal attenuation and loss of phasic synchronicity between the ventral and dorsal flow.2.Resultant lower cervical syrinx and smaller upper thoracic syrinxes are present as described above. Faint increased T2 signal in the upper cervical spinal cord at C2-C3 level may represent soft syrinx, but can be followed on the subsequent exams.3.Focal 10-mm CSF-intensity structure along the superior surface of the anterior edge of the tentorium cerebelli (vs adjacent to small dural defect) which may represent a small arachnoid cyst.


Instruction: Generate impression based on medical findings.

Input: Dementia, cerebral atrophy, evaluate for progressive dementia. Diffuse cerebral parenchymal volume loss is again seen which has minimally progressed since 12/17/2010. Prominent CSF space the level of the parieto-occipital sulcus and calcarine fissure are again noted. No disproportional volume loss involving the hippocampi is appreciated. There is prominence of the ventricular system which is minimally larger compared to 12/17/2010. Again seen are multiple foci of T2/FLAIR hyperintensity in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild-to-moderate chronic small vessel ischemic changes and minimally progressed since 12/17/2010. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. Major flow-voids are preserved.There is moderate mucosal thickening involving the bilateral maxillary sinuses and minimal thickening elsewhere. Bone marrow signal and extracranial soft tissues are within normal limits. Evidence of intraocular lens replacement bilaterally.

Output: 1. No intracranial mass or mass effect.2. Mild to moderate chronic small vessel ischemic changes have minimally progressed since 12/17/2010.3. Nonspecific pattern of diffuse cerebral parenchymal volume loss has minimally progressed since 12/17/2010, with relatively greater involvement of the bilateral frontal and parietal lobes and unchanged focal prominence of the CSF spaces at the parieto-occipital sulcus and calcarine fissure. Possible disproportional prominence of the ventricles for the degree of volume loss and aforementioned focal CSF spaces raises possibility of communicating hydrocephalus/NPH, in the appropriate clinical setting.


Instruction: Generate impression based on medical findings.

Input: Severe low back pain. The vertebral alignment is anatomic accounting for minimal straightening which may relate to position. The vertebral bodies are preserved in height. The vertebral bone marrow signal is unremarkable. There is mild degenerative lumbar spondylosis, including a left L2-L3 extraforaminal protrusion that seems to abut the exiting nerve roots. There is also a slight disc bulge at L5-S1, but no significant spinal canal or foraminal stenosis at any of the lumbar spine levels. There is partial loss of disc T2 signal at L2-L3, L5-S1 and to a lesser extent L3-L4. There is minimal disc height loss at L2-L3. The vertebral body heights are preserved. The tip of the conus medullaris is at the upper L2 level and appears to be unremarkable. There is a small amount of fat signal along the filum terminale at L4 and L5 levels. There are small T2 hypointense lesions within the uterus.

Output: 1. Mild degenerative lumbar spondylosis, including a left L2-L3 extraforaminal protrusion that seems to abut the exiting nerve roots, but no significant spinal canal or foraminal stenosis otherwise.2. Small filar fibrolipoma.3. Small probable uterine fibroids.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: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, pain and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The left elbow was localized fluoroscopically, and a spot radiograph was obtained. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using a 25-gauge needle.Under fluoroscopic guidance, a 22 gauge needle was advanced into the joint. Next, 7 mL Omnipaque 240 mixed with dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and the patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 1 minute 2 seconds

Output: Successful left elbow arthrogram.


Instruction: Generate impression based on medical findings.

Input: Neck pain with left upper extremity weakness Examination is limited to sequences per cord compression protocol. The vertebral bodies are appropriate in the overall alignment and height. The spinal cord has grossly normal signal characteristics and overall morphology. There is no compromise of the spinal cord. No evidence of intraspinal hematoma.

Output: Examination is obtained per limited MRI screening cord compression protocol. There is no evidence of cord compression. There is also no gross evidence of intraspinal hematoma, disc herniation, or ligamentous injury.


Instruction: Generate impression based on medical findings.

Input: Restaging olfactory neuroblastoma Face: Again seen are post-operative findings related to right medial maxillectomy and right anterior and posterior ethmoidectomy. There is no significant change in the enhancement within the right frontoethmoid treatment bed with small areas of low T2 signal. There is persistent mucosal thickening in the right maxillary sinus, slightly decreased in the interval. There is no new or enlarging mass. No new enhancement or mass involving the orbits. There is leftward nasal septal deviation. There is a subcentimeter Thornwaldt or nasopharyngeal retention cyst. There is a nonspecific 10 mm right level 2 lymph node which is not significantly changed since at least CT dated 10/30/2015 and favored to be reactive. Additional small scattered cervical lymph nodes are also nonspecific. No significant cervical lymphadenopathy by size criteria. Evidence of right thyroid lobectomy also noted.Brain: There is no evidence of intracranial extension of tumor. There is an unchanged prominent perivascular space in the right basal ganglia. The brain parenchyma otherwise appears unremarkable and there is no evidence of acute infection or 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.

Output: 1. No significant change in findings related to right sinonasal surgery with stable enhancement and focus of T2 hypointensity in the right superior anterior ethmoid surgical bed. These findings are nonspecific with possibility of posttreatment change versus stable small residual tumor. PET may be useful for further evaluation.2. No evidence of intracranial tumor.


Instruction: Generate impression based on medical findings.

Input: Dizziness for 9 years. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are scattered foci of high T2 signal in the cerebral white matter and patchy T2 hyperintensity in the pons. The cerebellum appears unremarkable. The inner ear structures and internal auditory canal appear grossly unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is extensive mucosal thickening in the right maxillary sinus, where there are also secretions. There is also diffuse mucosal thickening in the ethmoid and left maxillary sinuses.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. Scattered foci of high T2 signal in the cerebral white matter and patchy T2 hyperintensity in the pons are nonspecific, but may represent chronic small vessel ischemic disease. 3. The inner ear structures and internal auditory canal appear grossly unremarkable. 4. Findings suggestive of sinusitis.


Instruction: Generate impression based on medical findings.

Input: 61-year-old woman with history of alcoholic cirrhosis, please evaluate for underlying lesions and portal venous patency. ABDOMEN:LIVER, BILIARY TRACT: The liver is cirrhotic in morphology. No focal hepatic lesion identified.There is cholelithiasis. Mild gallbladder wall thickening is nonspecific in the setting of ascites. There is minimal intrahepatic biliary ductal dilatation.SPLEEN: There is mild splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Large volume of ascites in the abdomen. Small bilateral pleural effusions with adjacent atelectasis.

Output: 1.Limited examination without contrast enhancement and with significant dielectric artifact from large volume ascites. As per discussion with Kara Davey by phone at 16:30 on 10/14/2016, patient has had paracentesis and will return for pre and postcontrast imaging.2.Grossly no focal hepatic lesion seen.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old, with history of parotid cancer with lymph node metastases. Brain:Scattered foci of FLAIR hyperintensity are demonstrated in the cerebral white matter and pons, without significant interval change. No diffusion restricting lesions are seen. No edema or mass effect is detected. There is no pathologic parenchymal or left meningeal enhancement. No abnormal extra-axial fluid collections or evidence of intracranial hemorrhage is seen. Ventricular size and morphology remain within normal limits.Neck:Postoperative findings are redemonstrated compatible with right parotidectomy, right neck dissection and radiotherapy. No masslike lesion or pathologic enhancement is seen in the operative bed. Persistent enhancement of the geniculate, tympanic and mastoid portions of the right facial nerve are again seen similar to prior. The right submandibular gland remains smaller than the left. No pathologic adenopathy is detected in the visualized portion of the neck. T2 hyperintense material within the subcutaneous tissues of the face may reflect prior cosmetic instrumentation. The right mastoid air cells remain opacified similar to prior.

Output: 1.No evidence of intracranial metastases.2.Redemonstration of postoperative and posttreatment findings in the neck with no evidence of recurrent tumor or pathologic adenopathy.3.Persistent enhancement of the right facial nerve is redemonstrated without significant interval change.


Instruction: Generate impression based on medical findings.

Input: 65-year-old male with cerebellum dysfunction and recent fall There is a focus of hypodensity involving the right precentral gyrus white and gray matter corresponding to the area of restricted diffusion seen on prior MRI and likely represents an evolving subacute infarct. Subtle hyperdensity is seen along the precentral gyrus cortex which may represent laminar necrosis versus punctate petechial hemorrhage.A few hypoattenuating foci are seen in the periventricular region which is nonspecific but may represent small vessel ischemic disease of indeterminate age. There is no mass-effect, midline shift or edema. The ventricles and basal cisterns are normal in size and configuration.Minimal soft tissue swelling seen overlying the right parieto-occipital region without underlying fracture. The calvaria and skull base are radiographically normal. Partial opacification of the left maxillary sinus containing high density material which may represent inspissated mucus versus fungal sinusitis, grossly unchanged. The remaining visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Findings consistent with an evolving right precentral gyrus subacute infarct as seen on the prior MRI. CT is insensitive for the early diagnosis of acute nonhemorrhagic infarct. MRI brain can be considered if clinically indicated.2. Redemonstration of left maxillary sinus sinusitis containing high density material which may represent inspissated mucus versus fungal sinusitis.


Instruction: Generate impression based on medical findings.

Input: 35-year-old male with left knee pain. Evaluate patellar tendon instability. MENISCI: The medial and lateral menisci are morphologically normal.ARTICULAR CARTILAGE AND BONE: Note is made of a patella alta with an Insall-Savlati ratio of 1.9. The patellar tendon is intact and morphologically normal. The articular cartilage of the patella at the mid to inferior pole is markedly irregular with areas of full-thickness defects/intermediate signal intensity in the cartilage extending to the subchondral bone surface (for example series 601, image 13). There is hypoplasia of the trochlear groove which is abnormally flattened. Tibial tubercle to trochlear groove distance measures 9 mm, within normal limits.The articular cartilage of the femoral condyles and proximal tibia are morphologically normal. Bone marrow signal intensity is normal. There is no significant fluid within the knee joint.LIGAMENTS: The cruciate and collateral ligaments are morphologically normal.EXTENSOR MECHANISM: The extensor mechanism is intact and morphologically normal.ADDITIONAL

Output: 1. Patella alta as well as hypoplasia and abnormal flattening of the femoral trochlear groove.2. Patellar articular cartilage degeneration with areas of full-thickness defects extending to the subchondral bone surface.


Instruction: Generate impression based on medical findings.

Input: Right wrist pain. Evaluate for carpal ligament injury. There is widening of the scapholunate interval with contrast extension consistent with scapholunate ligament disruption. The triangular fibrocartilage complex is intact, without contrast extension into the distal radioulnar joint. No fracture or bone marrow edema is noted. A small subcentimeter cyst is noted in the triquetrum.

Output: Findings compatible with scapholunate disassociation and ligamentous tear.


Instruction: Generate impression based on medical findings.

Input: MRI brain: There is no evidence of acute ischemia, edema or mass effect. There are no areas of abnormal signal. The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.There are mildly prominent bilateral cervical lymph nodes, nonspecific. There is mildly heterogeneous attenuation involving the bilateral parotid glands which can be seen in connective tissue disorders such as Sjogren's disease.MRI spine:There is extensive expansile T2 signal abnormality throughout the cervical spinal cord extending up to T2-T3 level. There are additional areas of hyperintense T2 signal abnormality involving T10 and T7-T8 vertebral levels, which are of indeterminate age but does not clearly appreciated on prior MRI dated 8/26/2015.The spine is in normal alignment. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The distal spinal cord and conus are within normal limits with the conus terminating at the lower L1 level.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the spine.There is diffuse hypointense signal involving the liver and spleen. Nonspecific mild diffuse low T1 marrow signal which can be seen in conditions such as anemia.

Output: 1. Interval development of extensive T2 signal abnormality throughout the cervical spinal cord, extending up to T2-T3 consistent with inflammatory myelitis related to NMO, for example. Additional small foci of T2 hyperintensity at the T7-T8 and T10 levels may also represent inflammatory/demyelinating plaques, possibly chronic but not seen on prior MRI from 8/26/2015. 2. Unremarkable MRI brain.3. Low T2 signal is noted in the partially imaged liver and spleen which can be seen with iron deposition and can be correlated with clinical findings.4. Mild heterogeneous signal involving the bilateral parotid glands which can be seen in connective tissue disorders such as Sjogren's.


Instruction: Generate impression based on medical findings.

Input: 46 years, Male, lung cancer. Please note comparison with outside MRI from 3/1/2016 is slightly limited due to limited sequences on prior study. Again seen are innumerable foci of intracranial metastatic disease with susceptibility indicating hemorrhage. There are at least 10 enhancing lesions which are evident involving the bilateral cerebral hemispheres as well as few punctate lesions involving the cerebellar hemispheres. Some of the hemorrhagic foci do not definitively demonstrate enhancement and may represent treated metastases.A relatively large right frontal lobe peripherally enhancing mass measures approximately 22 x 20 x 26 mm, previously measured approximately 21 x 15 x 22 mm. A right paramedian right parietal lesion measures 16 x 16 x 16 mm, previously 14 x 14 x 13 mm. A bilobed enhancing mass involving the left central sulcus measures approximately 18 x 13 mm in the craniocaudal and transverse dimensions in the coronal plane, previously 13 x 12 mm, measured similarly. There is decrease in central enhancement suggesting necrosis or treatment change. A punctate left lateral cerebellar enhancing lesion is not significantly changed. There is a punctate right cerebellar hemispheric lesion which was present on prior and not clearly enhancing on the current study. No new lesion is appreciated.Prior outside exam was obtained with limited sequences however there is increased FLAIR hyperintensity compatible with vasogenic edema associated with the relatively large right frontal, right parietal, and left central sulcus lesions. No evidence of midline shift or herniation. No hydrocephalus. No destructive calvarial lesions.There is a fluid collection in the left suboccipital scalp measuring approximately 11 x 10 mm, corresponding to a pin site of the prior stereotactic frame. There are surrounding inflammatory changes. There is central restricted diffusion which can be seen with pus.

Output: 1. Again seen is evidence of intracranial metastatic disease with multiple, predominantly supratentorial enhancing lesions. Compared to most recent MRI brain dated 3/1/2016 with limited sequences, there is mild enlargement of some of the lesions and, more significantly, increased surrounding vasogenic edema which may represent posttreatment change, although progression is not excluded. Suggest continued close follow-up. No new lesion is definitively appreciated. Please see details above.2. Susceptibility-weighted sequence demonstrates numerous foci of chronic hemorrhage, many of which correspond to the enhancing foci described above. The nonenhancing foci may represent treated metastases.3. 11 x 10 mm fluid collection with peripheral enhancement and surrounding edema in the left suboccipital scalp region, which appears to represent a pin site for prior stereotactic frame. Imaging features are highly suggestive of abscess, but suggest correlation with examination.


Instruction: Generate impression based on medical findings.

Input: Reason: Hx Multiple Myeloma; new onset back pain. Evaluate for myeloma lesions. History: Hx Multiple Myeloma; new onset back pain. Evaluate for myeloma lesions. Note is made of diffuse heterogeneous bone marrow signal abnormality within the imaged bones of the pelvis lower lumbar spine, and proximal femora. These findings likely represent residual islands of red marrow. No discrete myelomatous deposits are identified. The imaged musculature of the pelvis is unremarkable. Although this examination was not protocoled for detailed evaluation of the pelvic viscera, no acute abnormality is identified. There is a small amount of peritrochanteric inflammation, left greater than right which may be of no clinical significance. There is a 6 x 8 x 16 mm enhancing focus of increased signal abnormality and fluid sensitive sequences within the subcutaneous tissue abutting the lateral aspect of the right gluteal musculature. Tiny focus of enhancing signal abnormality in the right superior iliac bone adjacent to the sacroiliac joint may represent a site of prior bone marrow biopsy. There is a small amount of fluid within the hips bilaterally which is not necessarily of any clinical significance.

Output: 1. Diffuse heterogeneous bone marrow signal abnormality may represent islands of red marrow. No discrete myelomatous deposits are identified.2. Nonspecific 16 mm enhancing nodule within the subcutaneous tissue along the lateral aspect of the right gluteal musculature. A soft tissue myelomatous deposit is considered unlikely.


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old, with rheumatoid arthritis and headaches. Scattered small foci of T2 hyperintensity are again seen within the cerebral white matter, predominantly located in a subcortical distribution. The size and number of the lesions have not significantly changed. No restricted diffusion is seen. No edema or mass effect is detected. There are no findings to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collections. The ventricles are normal in size and morphology.

Output: Scattered small white matter lesions are unchanged in size and number. The differential remains broad and includes gliosis from prior infection, inflammation or trauma, demyelination, ischemia/vasculitis, as well as sequelae of migraine headache.


Instruction: Generate impression based on medical findings.

Input: 64-year-old male with a history of malignant pleural mesothelioma status post pleurectomy/decortication surgery LUNGS AND PLEURA: Note is made of multiple foci of restricted diffusion consistent with active disease. There is a focus of restricted diffusion corresponding to the pleural thickening along the left anterior upper lobe (series 608; image 432). There is associated enhancement on postcontrast sequences. Note is made of 2 additional foci of restricted diffusion corresponding to pleural thickening along the posterior aspect of the left lower lobe also consistent with active disease (image 96 and image 80 of series 608). There is associated enhancement on postcontrast sequences. Multiple additional foci of increased T2 signal abnormality and peripheral enhancement are identified along the paramediastinal pleura on the left corresponding to pleural thickening seen on prior CT examination, however, there is no restricted diffusion to suggest active disease. These findings likely represent postinflammatory change.Trace bilateral pleural effusions.MEDIASTINUM AND HILA: There is an additional focus of restricted diffusion corresponding to the left intercostal nodes seen adjacent to the body of the sternum on prior CT examination (image 304; series 608). There is associated pathologic enhancement on postcontrast sequences.CHEST WALL: Note is made of postsurgical changes consistent with the stated history of prior cytoreductive surgery. Right chest port tip terminates at the cavoatrial junction.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Small hiatal hernia.

Output: 1. Multiple foci of restricted diffusion with associated enhancement consistent with active disease/mesothelioma corresponding to pleural thickening along the anterior aspect of the left upper lobe and posterior aspect of the left lower lobe. There is also restricted diffusion corresponding to the previously described left intercostal nodes seen on prior CT examination suspicious for metastatic disease.2. Foci of abnormal enhancement and pleural thickening along the paramediastinal and posterior aspect of the left lower lobe do not demonstrate restricted diffusion and likely represent postinflammatory change rather than active disease.


Instruction: Generate impression based on medical findings.

Input: Clinical question : CVA. Signs and symptoms: Left-sided weakness Non-infused CT of brain:No definitive evidence of hemorrhage, edema, mass effect, midline shift or hydrocephalus. No detectable cortical stroke. There is subtle high density of right middle cerebral artery in the horizontal portion of sylvian fissure and considering patient provided clinical data possibility of thrombus within the right middle cerebral artery should be considered.Follow-up with a CTA and MRI examination of brain is recommended. Small area of low-attenuation in the region of the left external capsule may represent an old lacunar infarct. This examination is otherwise unremarkable. The above findings were relayed to the referring service via Stat Consult communication system.

Output: 1.Subtle high density of right middle cerebral artery in the right sylvian fissure as described above. Considering patient's provided clinical data this may represent clot within the right MCA main trunk.2.Small lacunar infarct of left basal ganglia.3.No evidence of acute cortical stroke or hemorrhage.


Instruction: Generate impression based on medical findings.

Input: Knee injury, swelling. MENISCI: There is a complex tear with both vertical and horizontal components of the posterior horn and posterior aspect of the body of the medial meniscus. The lateral meniscus is intact. ARTICULAR CARTILAGE AND BONE: There is denuding of the articular cartilage of the lateral patellar facet with underlying subchondral edema which extends to the median eminence. There is significant thinning of the articular cartilage of the femoral trochlea with a region of full-thickness cartilage loss. There is complete loss of articular cartilage of the anterior and near-complete loss of the weight-bearing portion articular cartilage of the lateral femoral condyle up to above the posterior horn of the lateral meniscus. There is thinning of the posterior articular cartilage of the lateral femoral condyle. There is complete loss of the cartilage of the weight-bearing portion of the medial femoral condyle above the posterior horn with significant thinning of the remaining articular cartilage. Additionally there is complete loss of articular cartilage of the medial tibial plateau from the mid to posterior portions. Tricompartmental osteophytes are noted.There is increased T2 signal within the posterior medial tibial plateau with a linear component of low T1 and T2 signal which most likely represents a insufficiency fracture with surrounding edema. LIGAMENTS: The collateral and cruciate ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. Insufficiency fracture of the medial tibial plateau.2. Complex tear of the medial meniscus.2. Chondromalacia is described above.


Instruction: Generate impression based on medical findings.

Input: 37 year old woman with history of Lupus who presents with suspected cardiac shunt and is referred for further evaluation. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 61%, the LV end diastolic volume index is 65 ml/m2 (normal range: 65+/-11), the LVEDV is 105 ml (normal range 109+/-23), the LV end systolic volume index is 25 ml/m2 (normal range 18+/-5), the LVESV is 41 ml (normal range 31+/-10), the LV mass index is 53 g/m2 (normal range 67+/-11), and the LV mass is 86 g (normal range 114+/-24). There are no regional wall motion abnormalities present. . There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. No ventricular septal defect is present.Left AtriumThe left atrium is normal in size. The interatrial septum is somewhat aneurysmal. A small patent foramen ovale can not be excluded. No atrial septal defect is seen. The Qp/Qs was within normal range.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 78 ml/m2 (normal range 69+/-14), the RVEDV is 126 ml (normal range 110+/-24), the RV end systolic volume index is 39 ml/m2 (normal range 22+/-8), and the RVESV is 63 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function[LVEF 61%]2. The right ventricle is normal in size with normal systolic function [RVEF 50%]3. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.4. No evidence of a cardiac shunt.5. A small patent foramen ovale can not be excluded. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Male, 20 years old, history of Chiari malformation status post decompression surgery with chronic daily headaches. Brain:Evidence of Chiari decompressive surgery is again seen with expansion of the foramen magnum and a stable appearance of the cerebellar tonsils. The CSF space at the level of the foramen magnum is well expanded with the exception of slight narrowing ventrally due to a mild retroflexion of the dens, all stable findings. Adequate biphasic flow is seen both anteriorly and posteriorly through the foramen magnum.Brain parenchymal morphology is otherwise unremarkable. No evidence of restricted diffusion or other signal abnormality is seen. No intracranial hemorrhage or any abnormal extra axial fluid collection is detected. The ventricular system is patent and normal in size. No pathologic enhancement is seen.Spine:The spinal cord demonstrates normal signal intensity and morphology. No evidence of six formation is seen. The conus terminates normally at the L1 level. The nerve roots of the cauda equina dispersed evenly. No evidence of any intraspinal fatty lesion is seen. No evidence pathologic enhancement is seen.Spinal alignment is anatomic. Vertebral body morphology is normal. No worrisome marrow signal changes are seen. A nonspecific subcentimeter focus of T2 hyperintensity within the C5 vertebral body stable. No significant degenerative disc disease is seen. No spinal canal or neuroforaminal stenosis is detected.

Output: 1.Stable findings compatible with Chiari decompressive surgery. The CSF space at the foramen magnum remains well-expanded and adequate CSF flow is seen both dorsally and ventrally.2.Unremarkable evaluation of the spine. Particular, no evidence of any syrinx or other spinal cord abnormality is seen.


Instruction: Generate impression based on medical findings.

Input: 52 years Male (DOB:6/19/1964)Reason: r/o compression or stenosis History: neck and back pain, left sided weakness PROVIDER/ATTENDING NAME: JAMES R. BRORSON JAMES R. BRORSON Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.No abnormal enhancing lesions are appreciated in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a small central disc protrusion present at this level.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. There is a disc bulge at T8-9.No abnormal enhancing lesions are appreciated in the thoracic spine.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact.No abnormal enhancing lesions are appreciated in the lumbar spine.Is level.At L5-S1 there is marked bilateral facet hypertrophy present associated with mild anterior subluxation of L5 on S1. There is narrowing of the neural foramina bilaterally at this level associated with mild encroachment of exiting nerve roots. There is no significant compromise to the spinal canalAt L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There are some degenerative changes present in the lower lumbar spine at L5-S1 where there is some mild subluxation and facet hypertrophy associated with some mild encroachment of the exiting nerve roots2.There is some mild degenerative changes present in the cervical and thoracic spines without significant compromise to spinal canal or exiting nerve roots.


Instruction: Generate impression based on medical findings.

Input: Low back pain [M54.5], Reason for Study: ^Reason: lumbar pain concerning for spondylosis vs HNP History: lumbago For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is a focal endplate defects on the at the level of T12-L1 disc. Specifically, inferior endplate of T12 and superior endplate of L1 shows smooth margin defect with associated bone marrow edema. This finding suggests acute Schmorl's node. This can be symptomatic.Overall, T1 images of lumbar vertebrae, sacrum and bilateral iliac bones show relatively low signal intensity. However, since those signal intensities are brighter than those of intervertebral discs and adjacent muscle, these relatively lower T1 signal intensity can be seen as within normal range. There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing. The conus medullaris terminates at the T12-L1 level.The intervertebral discs demonstrate normal T2 intensity and height with no evidence of disc herniation. The paraspinal soft tissues are unremarkable.

Output: 1. Acute Schmorl's node, at the level of T12-L1 with surrounding edema.2. Otherwise no remarkable finding.


Instruction: Generate impression based on medical findings.

Input: Reason for Study: Low back pain [M54.5], Reason for Study: ^Reason: r/o spinal stenosis History: on going back pain. Chronic with flares. Abn x ray of L/S spine. Not much improvement with PT For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is grade 1 anterolisthesis of L5 on S1.There are diffuse bone marrow edema on both L5 and S1 vertebral bodies with high signal intensity of L5S1 disc. Considering the degree of anterolisthesis, the extent of bone marrow edema is a bit excessive. Therefore, the possibility of discitis may need to be excluded.There is normal lumbar lordosis. The vertebral body height is preserved. The signal of the visualized cord is normal. The conus medullaris terminates at the T12-L1 level. Degenerative changes are specified by the intervertebral level as follows: T12-L1: Disc desiccation. No neuroforaminal narrowing or spinal stenosis. L1-L2: Disc desiccation. No neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: Disc desiccation. No neuroforaminal narrowing or spinal stenosis. L4-L5: Disc desiccation. There is a focal central protrusion of disc which abuts thecal sac. No neuroforaminal narrowing or spinal stenosis. L5-S1: Grade 1 anterolisthesis of L5 5 on S1 with the subtle bulging of L5-S1 disc. High signal intensity of L5-S1 disc with associated post L5 and L1 vertebral bodies bone marrow edema are seen. The extent of bone marrow edema appears to be more excessive than usual acute disc degeneration related inflammatory change (Modic 1 change). Therefore, possibility of discitis may need to be excluded. Contrast enhanced MRI can be considered for further imaging evaluation. No neuroforaminal narrowing or spinal stenosis.

Output: 1. Bone marrow edema of both L5 and S1 vertebral bodies with focal high signal intensity of L5S1 disc, indicate diagnostic possibilities of discitis and excessive endplate degenerative changes (Modic 1 change). Gad enhanced MRI can be considered for further imaging evaluation.2. Grade 1 anterolisthesis of L5 on S1.3. Multilevel various degree degenerative changes of lumbar spine.


Instruction: Generate impression based on medical findings.

Input: Diarrhea. History of Crohn's disease. Evaluate for active bowel inflammation. History of ileocecectomy in 2013. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes from an ileocecectomy. Overall there is a paucity of distal small bowel loops related to prior ileal resection.The residual small bowel is well-distended with oral contrast. There are segments of the jejunum which appear poorly distended but are otherwise unremarkable, likely secondary to peristalsis. The neoterminal ileum is clearly identified. The bowel is normal in caliber and wall thickness. There is no abnormal postcontrast enhancement or restricted diffusion. No significant fibrofatty proliferation or mesenteric lymphadenopathy. No fixed luminal narrowing or prestenotic/upstream dilatation. No sinus tract or fistula formation. No significant free fluid or loculated fluid collection.The distal colon is collapsed. There is mild circumferential wall thickening of the distal colon with restricted diffusion and mild hyperenhancement compatible with a non-specific colitis. Large hiatal hernia. BONES, SOFT TISSUES: Small pleural effusions. Patchy marrow signal intensity is not significantly changed. OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: See discussion above.BONES, SOFT TISSUES: Patchy marrow signal intensity is not significantly changed.OTHER: No significant abnormality noted.

Output: 1.Paucity of small bowel related to previous resection without evidence of active small bowel inflammation or flow limiting stricture. 2.Nonspecific rectosigmoid wall thickening, enhancement and restricted diffusion compatible with a nonspecific colitis which may be infectious/inflammatory or less likely ischemic in etiology.


Instruction: Generate impression based on medical findings.

Input: Right parietal ischemic stroke and a 60-year-old female. Images through posterior fossa demonstrates a focal area of low attenuation in the right aspect of pons with a small calcification. This is believed to represent an old lacunar infarct and dystrophic calcification. This finding was present on the prior exam and demonstrates no definitive interval change. To exclude other pathologies at this location an MRI exam is recommended.Images through the supratentorial brain parenchyma demonstrate no definitive evidence of stroke, hemorrhage, mass-effect or midline shift. A very subtle questionable lucency however overlapping the cortex of the operculum of the right parietal lobe is suspected on axial image 14 which was not present on the prior study. Further dilation with an MRI is recommended. This finding may represent a very small area of new cortical stroke.

Output: 1.Likely old lacunar infarct of the pons with calcification.2.Only suspect small lucency involving the cortex of the proximal right frontal lobe.3.Both these findings can be better evaluated with an MRI exam.


Instruction: Generate impression based on medical findings.

Input: 65 year old female with history of right knee pain. MENISCI: There is intrasubstance degeneration of the medial meniscus, but we see no discrete meniscal tear. There is poorly defined signal intensity particularly within the anterior horn of the lateral meniscus compatible with intrasubstance degeneration.ARTICULAR CARTILAGE AND BONE: There is severe osteoarthritis particularly at the patellofemoral articulation with near complete loss of all articular cartilage as well as subchondral cysts and bone marrow edema. There is relatively mild degenerative change affecting the tibiofemoral compartment. There are tricompartmental osteophytes. There are cyst-like lesions within the tibial plateau and posterior distal femur likely degenerative in etiology.The femoral trochlea is shallow and even convex superiorly which may reflect an underlying dysplasia. There is slight lateral translation of the patella.LIGAMENTS: There is increased signal intensity and thickening of the ACL compatible with mucoid degeneration. The PCL, MCL, and LCL are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Severe osteoarthritis predominantly affecting the patellofemoral joint with a loose body as well as degeneration of the menisci and ACL.


Instruction: Generate impression based on medical findings.

Input: 31-year-old female with right ankle anterolateral mass. Markers were placed over patient's palpable right ankle mass. Deep to these markers, there is a lobulated collection of fluid signal intensity arising from the sinus tarsus and extending into the soft tissues lateral to the talus between the anterior talofibular ligament and peroneus tertius. This collection measures up to 3 x 2 cm in greatest transverse dimension and up to 3 cm in greatest craniocaudal dimension. There is little if any enhancement of this collection on postcontrast images, and the findings are compatible with a ganglion.TENDONS: Tendons appear normal.LIGAMENTS: The visualized ligaments are intact, including the distal tibiofibular syndesmotic ligament and visualized components of the deltoid ligament.ARTICULAR SURFACES AND BONE: No significant abnormality noted. No osteochondral defects.ADDITIONAL

Output: Ganglion as described above.


Instruction: Generate impression based on medical findings.

Input: 57-year-old male with seizure-like activity. Evaluate for mass or stroke. There is no evidence of intracranial hemorrhage, mass, or acute infarct. No findings to suggest seizure focus are appreciated. The bilateral hippocampi are symmetric in size, signal characteristics, and with preserved internal architecture. There is scattered periventricular and subcortical white matter T2/FLAIR hyperintensity which is nonspecific. A focus of susceptibility abnormality in the medial left midbrain is seen only on susceptibility weighted images. A small T1 and T2 bright lesion is seen conforming to the undersurface of the right medial tentorium. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. Left greater than right maxillary sinus mucosal thickening is seen. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: 1.There is no evidence of a mass, infarct, hemorrhage or seizure focus.2.Scattered mild chronic likely small vessel ischemic disease.3.Focus of susceptibility abnormality in the medial left midbrain may represent a vascular lesion such as a developmental venous anomaly or focus of capillary telangiectasia for which a contrasted MRI exam may provide further information if clinically warranted.


Instruction: Generate impression based on medical findings.

Input: Spine pain. Evaluate for compression fracture. Patient on chronic high-dose steroids. Thoracic spine: The bones are diffusely demineralized, suggesting osteopenia or osteoporosis. Anterior wedging of multiple thoracic vertebral bodies and severe compression deformity of T9 appear grossly stable from prior CT. There is resultant marked kyphosis of the thoracic spine. No obvious acute fracture is present.Lumbar spine: The bones are diffusely demineralized, suggesting osteopenia or osteoporosis. Anterior osteophytes and mild multilevel degenerative disc disease are noted. Lucency of the left L4 pedicle is questioned, raising the possibility of age-indeterminate fracture, not present on prior MRI. The left L4 transverse process is also not well visualized. CT of the lumbar spine can be considered for further evaluation.Pelvis: The bones are diffusely demineralized, suggesting osteopenia or osteoporosis. Linear lucency and sclerosis of the right pubis/inferior pubic ramus may represent acute to subacute fracture. Mild degenerative changes affect the sacroiliac joints and left hip joint.

Output: 1.Multiple thoracic vertebral compression fractures, likely chronic. 2.Questionable age-indeterminate left L4 pedicular fracture; CT may be considered for further evaluation. 3.Right pubis/inferior pubic ramus fracture, likely acute to subacute.Findings were discussed via telephone with Dr. Curran at 1:33 PM on 8/13/2015.


Instruction: Generate impression based on medical findings.

Input: Male 27 years old Reason: TFCC tear History: wrist pain, instability. Numerous foci of signal void are noted in the soft tissues of the wrist particularly dorsally suggesting metallic susceptibility artifact related to prior surgery.TRIANGULAR FIBROCARTILAGE COMPLEX: We see no fluid signal intensity traversing the triangular fibrocartilage complex to indicate full thickness tear. There is thickening and increased signal intensity within both of the ulnar bands of the articular disk suggesting degeneration. There is also a small focus of abnormal signal intensity within the adjacent subchondral marrow of the distal ulna which is likely degenerative in etiology and overall the findings are similar to outside hospital MRI of 2013.LIGAMENTS: Evaluation of the intrinsic ligaments of the wrist is limited due to lack of intra-articular contrast. There is a small lobulated collection of near fluid signal intensity along the dorsal margin of the scapholunate ligament suggestive of a small ganglion but we otherwise see no specific findings to suggest tear of the scapholunate or lunotriquetral ligaments.TENDONS: The tendons appear normal. BONES: There is a focus of edema type signal within the ulnar and proximal aspect of the lunate bone volarly which is new compared to prior study. A small cystlike focus of abnormal signal is noted within the proximal triquetrum. These findings and nonspecific and we see no gross overlying cartilage defects. The remainder of the bone marrow signal is normal.

Output: 1. Findings suggestive of degeneration of the ulnar fibers of the articular disk of the triangular fibrocartilage complex but no discrete fluid filled tear.2. Small foci of bone marrow signal intensity as described above could reflect sequela of ulnar abutment but we see no discrete tear of the radial aspect of the triangular fibrocartilage complex nor do we see any articular cartilage defects.


Instruction: Generate impression based on medical findings.

Input: Restaging lung cancer There is no definite evidence of intracranial metastatic disease. There is a 5 mm focus of enhancement in the left superior parietal lobule seen only on the sagittal post gadolinium series 1101, image 10, and favored to represent artifact. Unchanged punctate foci of susceptibility, likely representing chronic blood products or mineralization, are noted in supra- and infratentorial locations at sites of prior metastases. There is no mass effect or midline shift. There is mild cerebral volume loss with extensive white matter T2 hyperintensity, which appears more confluent in the parietal lobes compatible with chronic small vessel ischemic changes and probable superimposed post treatment changes. There is no restricted diffusion, evidence for acute intracranial hemorrhage or extra-axial collection. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear.

Output: There is no definite evidence of intracranial metastatic disease. There is a 5 mm focus of enhancement in the left superior parietal lobule seen only on the sagittal post gadolinium sequence and is favored to represent artifact. Consider short-term follow-up for further evaluation as clinically indicated.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old, status post fall with abnormal finding on CT. Assess for infarct. No evidence of restricted diffusion is seen. No areas of significant parenchymal signal abnormality, edema or mass effect are detected. A few scattered foci of T2 hyperintensity within the cerebral white matter are nonspecific. There are no findings to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collections. The ventricles are normal in size and morphology. Marrow signal characteristics are unremarkable. A chronic deformity of the right lamina papyracea is demonstrated.

Output: 1.No evidence of any acute intracranial abnormality.2.In particular, there is no clear lesion to correlate with the finding on prior CT.


Instruction: Generate impression based on medical findings.

Input: 21-year-old female patient with history of PSC with evidence of mild progression on last MRCP dated 5/2015. ABDOMEN:LIVER, BILIARY TRACT: Irregularity of the intrahepatic and extrahepatic biliary ducts compatible with patient's history of PSC, stable. Intrahepatic and extra hepatic biliary ductal dilatation is similar compared to prior examination. The common bile duct measures up to 11 mm. No focal hepatic lesion or dominant biliary stricture.SPLEEN: No significant abnormality noted.PANCREAS: No pancreatic inflammation, pancreatic mass or pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Biliary ductal irregularity and dilatation appear similar compared to prior MRCP, compatible with history of PSC.2.No focal hepatic lesion.


Instruction: Generate impression based on medical findings.

Input: Firm nodule in the left medial eyelid. There is a T1 and T2 hyperintense cystic lesion in the subcutaneous tissues of the medial left upper eyelid, which measures 7 mm in diameter. The orbital contents are otherwise unremarkable bilaterally. The imaged intracranial structures and paranasal sinuses are unremarkable.

Output: A cystic lesion in the subcutaneous tissues of the medial left upper eyelid, which measures 7 mm in diameter, likely represents an inclusion cyst.


Instruction: Generate impression based on medical findings.

Input: Unspecified convulsions [R56.9], Reason for Study: ^Reason: possible epilepsy History: as above There are multifocal bihemispheric supra and infra tentorial asymmetric, mainly subcortical white matter and corpus callosum FLAIR high signal intensity lesions. Most of them are not enhancing on post Gad images but the right superior parietal lobule lesion. There is no evidence of surrounding edema.There is no evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.C Spine MRIThe cervical spine appears to be straightened.The cranial-cervical junction is normal. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The cord signal is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal stenosis, cord compression or myelopathy.

Output: 1. Multifocal mainly subcortical white matter FLAIR high signal intensity lesions as described above. Differential diagnosis include ADEM, other post viral infection encephalitis, or other demyelinating disease such as multiple sclerosis which is less likely.2. Normal cervical spine MRI


Instruction: Generate impression based on medical findings.

Input: Clinical question: Metastatic breast cancer. Signs and symptoms: Worsening pain. Nonenhanced Lumbar MRI:Examination demonstrates less than 50% compression fracture of the superior endplate of T12 with resultant mild kyphotic deformity. There is T2 STIR hyperintensity and T1 hypointensity of the T12 marrow space suggestive of edema. Finding is concerning for a metastatic lesion. The finding has remained stable since prior CT of abdomen from 4-13-15. There is mild ventral bulge of the superior aspect of T12 vertebra into the spinal canal resulting in subtle mass effect and posterior displacement of the cord however without spinal stenosis or neural foraminal compromise and no detectable signal abnormality of the cord.Large focus of marrow signal replacement within the vertebral body of L1, tiny focus in the body of L2, diffusely in of vertebral bodies of L3 and L4 as well as small focus in the inferior S2 vertebral body also suspected of osseous metastatic lesions. There is no detectable extraosseous spread of tumor and no evidence of spinal canal compromise or stenosis. No evidence of neural foraminal compromise at any level.Nonenhanced thoracic MRI:Examination demonstrates diffuse patchy foci of marrow signal replacement involving both the vertebral bodies, pedicles and the articulating facets at multiple levels and consistent with diffuse metastatic lesions. There is normal signal intensity and caliber of the thoracic cord.There is no convincing evidence of extraosseous spread of tumor into the spinal canal or perispinal soft tissues on this nonenhanced exam areaNo evidence of spinal stenosis or neural foraminal compromise at any level. Mild degenerative disease is however noted.

Output: 1.Nonenhanced MRI of lumbar spine demonstrate diffuse metastatic lesions of the lumbosacral spine as detailed. Stable less than 50% compression fracture of T12 with a slight kyphotic angulation compared to prior exams. No spinal stenosis or neural foraminal compromise at any level. Normal signal intensity and caliber of the lower most visualized thoracic cord, conus and cauda equina. No detectable extraosseous spread of tumor on this nonenhanced exam.2.Nonenhanced thoracic MRI demonstrate diffuse patchy foci of marrow signal changes consistent with metastatic disease however without fracture or malalignment and no detectable extraosseous spread of tumor. No spinal stenosis or neural foraminal compromise at any level. Normal signal intensity and caliber of thoracic cord.


Instruction: Generate impression based on medical findings.

Input: Female; 47 years old. Reason: History of UC and PSC History: Elevated ALP. ABDOMEN:LIVER, BILIARY TRACT: Questionable minimal irregularity of the intrahepatic biliary ducts and mild intrahepatic biliary ductal dilatation. There is a 6 mm stricture in the common hepatic duct which extends to Klatskin's point on series 4, image 65. Although no obvious associated enhancing masses are seen, these would be difficult to visualize given the location of this stricture. No suspicious hepatic lesions. Patent hepatic vasculature. SPLEEN: No significant abnormality noted.PANCREAS: No suspicious lesions or definite pancreatic ductal dilatation. Findings of pancreatitis seen on prior CT have resolved. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Questionable minimal irregularity and mild dilatation of the intrahepatic biliary ducts, which may correlate with the patient's recent diagnosis of primary sclerosing cholangitis (PSC). 2.Dominant 6 mm stricture in the common hepatic duct extending to Klatskin's point. Although no definite associated enhancing mass is seen, it should be noted that evaluation is limited given the stricture location and small size.


Instruction: Generate impression based on medical findings.

Input: 42-year-old woman with history of pain in the right deltoid muscle and a subcutaneous nodule noted on sonography. ROTATOR CUFF: There is a focal, full-thickness tear of the supraspinatus tendon (series 5, image 18) near its insertion without evidence of muscle atrophy or retraction. A small amount of subacromial/subdeltoid bursa fluid is noted. The infraspinatus, teres minor, and subscapularis are intact.SUPRASPINATUS OUTLET: No significant abnormality with a type II acromion.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is anatomic and no significant abnormality is noted. The labrum is grossly intact.BICEPS TENDON: The biceps tendon is situated within the bicipital groove without evidence of tear. ADDITIONAL

Output: 1.Nonspecific, ill-defined area of enhancement and T1/T2 signal abnormality within the subcutaneous soft tissues overlying the deltoid muscle. While this may represent an inflammatory process, neoplasm cannot be excluded, but there is no evidence of intramuscular involvement.2.Focal full-thickness tear of the supraspinatus tendon without retraction or muscle atrophy.


Instruction: Generate impression based on medical findings.

Input: 22-month-old male with history of Langerhans cell histiocytosis involving the left temporal bone and T7 vertebra: end of therapy evaluation. Brain: There has no discernible evidence of residual lesion in the left temporal bone region. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. The ventricles and basal cisterns are stable in size and configuration. There is no midline shift or herniation. The paranasal sinuses are unremarkable. Spine: There is compression deformity and mild focal kyphosis at T7, although the vertebral body height has increased, now measuring a minimum of 4 mm in thickness centrally, previously approximately 2 mm. Furthermore, there is no significant spinal canal stenosis and no associated enhancement or edema. The other thoracic vertebrae are intact. The spinal cord and cauda equina nerve root signal is within normal limits. The paraspinal soft tissues are unremarkable.

Output: 1. No discernible evidence of residual or recurrent Langerhans cell histocytosis in the left temporal bone region.2. Mild interval increase in height of the T7 vertebral body associated with the treated Langerhans cell histocytosis.


Instruction: Generate impression based on medical findings.

Input: 26-year-old woman with history of pelvic pain. PELVIS:UTERUS, ADNEXA: Fibroid uterus with largest measuring a subserosal fibroid measuring 14 x 11 mm located in the posterior body of the uterus (801/16). Endometrial stripe normal in size. Junctional zone within normal limits, no evidence of adenomyosis. Ovaries appear normal with small follicles.BLADDER: No significant abnormality noted.LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: Suboptimal evaluation on this nondedicated exam but located posterior to the rectum and in the presacral space is a rounded complex fluid and T1 hyperintense signal containing focus that measures 19 x 12 mm (image 206 series 1502). Appears to communicate with adjacent rectum via dominant fistulous tract located approximately 8 cm from the anal verge and measuring approximately 15 mm in length, image 16 series 1401 and image 15 series 801. These findings demonstrate associated restricted diffusion and, particularly with respect to the aforementioned rounded structure, delayed rim enhancement. Difficult to exclude postcontrast enhancement within this lesion due to inherent T1 hyperintense signal. More subtle appearing perianal fistulous linear tract arising from the 12 o'clock position on image 11 series 1401 nonspecific, may be artifactual. Visualized terminal ileum (imaged on coronal T2 imaging sequence) unremarkable.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Suboptimal assessment on this nondedicated exam but findings suspicious for perirectal abscess formation, please refer to discussion above. Also among differential considerations rarer entities such as tailgut cyst formation. Correlation with patient's clinical history/physical exam and laboratory values recommended.2.Visualized terminal ileum (only imaged on coronal T2 imaging sequence) unremarkable.3.Fibroid uterus as above.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Reason: Acute Right knee pain with effusion. Lateral joint line tenderness History: Acute Right knee pain with effusion. Lateral joint line tenderness MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage is intact. There is abnormal T2 signal in the lateral tibial plateau and lateral femoral condyle, consistent with bone marrow edema. There is a nondisplaced fracture through the lateral tibial plateau. There is a T2 hyperintense/T1 hypointense lesion in the posterior medial metaphysis of the distal femur extending to the growth plate which may represent a small nonossifying fibroma.LIGAMENTS: The ACL, PCL, MCL, and LCL are intact. EXTENSOR MECHANISM: The quadriceps and patellar tendons are intact.ADDITIONAL

Output: Nondisplaced lateral tibial plateau fracture.Findings communicated to Dr. Benjamin at 11:00 AM on 10/4/16.