Instruction: Generate impression based on medical findings.

Input: Follow up of enhancing lesions in the brain. There is no significant interval change in the areas of subcortical white matter T2 hyperintensity with a component of enhancement and mild volume loss rather than mass-effect, within the anterior right temporal lobe, although this appears to be less extensive than in 2012. Likewise, a subcentimeter focus of high T2 signal and enhancement in the left frontal lobe white periventricular matter is unchanged since the last exam and slightly smaller than in 2012. There are also unchanged patchy areas of high T2 signal elsewhere in the cerebral white matter without associated enhancement. There are scattered areas of susceptibility effect in the supratentorial sulci, particularly the right frontal lobe. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are bilateral lens implants.

Output: 1. No significant interval change in the areas of subcortical white matter T2 hyperintensity with a component of enhancement, but no mass-effect, within the anterior right temporal lobe, although this appears to be less extensive than in 2012. Likewise, a subcentimeter focus of high T2 signal and enhancement in the left frontal lobe white periventricular matter is unchanged since the last exam and slightly smaller than in 2012. These lesions may represent the sequela of inflammatory process, including a paraneoplastic syndrome, or vasculitis process rather than neoplasm.2. Unchanged nonspecific patchy areas of high T2 signal elsewhere in the cerebral white matter without associated enhancement, which may represent chronic small vessel ischemic disease and/or additional areas of a prior inflammatory process. 3. Redemonstration of scattered areas of supratentorial superficial siderosis, which may be related to a previous vasculitis process. An angiographic exam may be useful for follow up.


Instruction: Generate impression based on medical findings.

Input: Migraine patient now with unrelenting headaches for 3 weeks, family history of intracranial aneurysms. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No suspicious intracranial mass or mass-effect. There is a sub-centimeter pineal cyst measuring 9 x 5 x 5 mm without significant mass-effect or suspicious enhancement. Brain parenchyma is otherwise unremarkable for age. The ventricles are within normal limits in size and configuration. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits. MRA HEAD: The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. No evidence of aneurysms or vascular malformations.

Output: 1. MRI of the brain is essentially unremarkable. There is a subcentimeter pineal cyst without mass effect and of doubtful clinical significance. No suspicious intracranial masses, mass effect, or abnormal enhancement is appreciated.2. No intracranial aneurysms.


Instruction: Generate impression based on medical findings.

Input: Episodic neck swelling. There is no evidence of measurable mass lesions or significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable. There is no evidence of soft tissue edema in the neck. The osseous structures are unremarkable. The imaged intracranial structures are unremarkable. The cervical flow voids appear to be grossly intact.

Output: 1. No evidence of mass lesions or edema in the neck.2. The cervical flow voids appear to be grossly intact, although the assessment is limited. Consider a Doppler ultrasound for further evaluation of the neck vessels if clinically warranted.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: 17 year-old female. Right shoulder pain x 2 years. Evaluate for labral tear versus PASTA tear. ROTATOR CUFF: The supraspinatus, infraspinatus, subscapularis, and teres minor muscles and tendons are intact.GLENOHUMERAL JOINT AND GLENOID LABRUM: No evidence of a glenoid labrum tear. Glenohumeral joint alignment is anatomic. BICEPS TENDON: Biceps tendon is intact and normally situated in the bicipital groove.ADDITIONAL

Output: Small cysts in the posterior humeral head consistent with posterior superior glenoid impingement (internal impingement). No associated rotator cuff or labral injury.


Instruction: Generate impression based on medical findings.

Input: Lung cancer. ALK+. Failed treatment with Crizotinib. Now starting new chemotherapy with baseline status to evaluate CNS status. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Few foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter which are nonspecific. Brain parenchyma is otherwise unremarkable for age.No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved. Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: No evidence of intracranial metastases.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: Female, 79 years old, status post lumbar spine surgery with lower back pain and left leg radiculopathy. Postoperative findings are seen compatible with posterior instrumented fusion from L4 to L5 and laminectomy from L3 to L5. The surgical instruments were better assessed on prior CT.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or edema is observed.The visualized distal spinal cord, conus and nerve roots of the cauda equina are within normal limits. No epidural abnormalities are suspected.L1-2: No significant spinal canal stenosis or neuroforaminal narrowing. L2-3: Facet hypertrophy and ligamentum flavum thickening. Loss of disc height with disc bulging. Prominence of the dorsal epidural fat. Mild to moderate spinal canal narrowing. Severe right foraminal narrowing with probable nerve root impingement. Moderate left foraminal narrowing. L3-4: Postoperative findings. Loss of disc height. No significant spinal canal stenosis. At most, mild left foraminal narrowing. L4-5: Postoperative findings. Loss of disc height and minimal disc bulging. No spinal canal stenosis. No significant foraminal narrowing. L5-S1: Advanced facet arthropathy, particularly on the left. Disc bulging. No significant spinal canal stenosis. Moderate to severe bilateral foraminal narrowing.

Output: 1.Postoperative findings compatible with posterior instrumented fusion from L4 to L5 and laminectomy from L3 to L5.2.At L2-3, there is severe right and moderate left foraminal narrowing with a mild to moderate generalized spinal canal stenosis.3.At L5-S1, there is advanced facet arthropathy, particularly on the left, with moderate to severe bilateral foraminal narrowing.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old, with neck pain. Alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or abnormal marrow enhancement is seen.The right IAC/CP angle schwannoma is partially visualized on sagittal images. The brainstem and visualized spinal cord are otherwise unremarkable. No focal signal abnormality or pathologic intradural enhancement is seen. No epidural abnormalities are suspected.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Mild right paracentral posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild right foraminal narrowing. C4-5: No spinal canal stenosis or neuroforaminal narrowing. C5-6: Posterior disc-osteophyte complex formation asymmetric to the left. Effacement of the ventral thecal sac and mild flattening of the ventral cord. The left neural foramen is moderately narrowed.C6-7: Minimal posterior disc-osteophyte complex formation. No significant spinal canal or foraminal stenosis. C7-T1: No spinal canal stenosis or neuroforaminal narrowing. Hyperintense signal is seen within the left T3 pedicle and transverse process. This is only visualized on sagittal cuts.

Output: 1.Disc osteophyte disease is seen at C5-6 resulting in slight flattening of the ventral cord and a significant stenosis of the left neural foramen at this level.2.The remaining cervical levels are free of significant degenerative disease, spinal canal or foraminal stenosis.3.Signal abnormality is incidentally noted within the left T3 pedicle and transverse process. This may represent an incidental hemangioma though correlation for tenderness in this location is suggested.


Instruction: Generate impression based on medical findings.

Input: 62 year old woman with history of left breast IDC, ER/PR positive, s/p mastectomy (2006) and reconstruction. There is scattered fibroglandular tissue in the right breast.Mild parenchymal enhancement is noted bilaterally.Post-operative findings of left mastectomy and reconstruction with an intact retropectoral silicone implant. An enhancing focus in the right breast at 3 o'clock position at posterior depth is stable from prior exams. No additional abnormal foci of enhancement are seen.No abnormal lymph nodes are identified in either axillary region.

Output: MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on medical findings.

Input: The cervical spine is in normal alignment, with straightening of the normal cervical lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. There is redemonstration of persistent patchy areas of abnormal T2/STIR hyperintensity throughout the cervical cord with associated volume most conspicuous spanning the C2 level and at C4-C5 and C6-C7.There are stable minimal disc bulges at C5-C6 and C6-C7 without stenosis.Partial visualization of left maxillary sinus mucosal retention cyst or polyp. Additional areas of patchy abnormal signal are seen in the upper thoracic cord, incompletely evaluated.LUMBAR SPINE

Output: 1.Redemonstration of scattered cord lesions with associated volume loss consistent with chronic demyelinating disease. No definite new cervical cord lesion.2.Interval significant regression of previously identified left paracentral/foraminal disc extrusion at L5-S1, with now only minimal shallow central disc protrusion remaining and no significant stenosis at any level.3.Stable appearance of right foraminal/far lateral prominence of the disc bulge at L4-L5 which abuts the exiting right L4 nerve root. Slight asymmetric enlargement suggested of the exiting nerve root which may indicate inflammatory change. Please correlate with patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: 46-year-old female with right first MTP pain and history of stepping on glass under fourth metatarsal head one month ago. Evaluate for foreign body and osteoarthritis. A marker was placed on the ball of the foot, plantar to the fourth MTP joint of the foot. Just beneath the skin surface adjacent to the marker, is a nonenhancing focus of intermediate signal intensity which is slightly hyperintense to skeletal muscle on T1-weighted images and also hyperintense to skeletal muscle on fat-saturated T2-weighted images, which measures approximately 7 mm in the longitudinal dimension and 7 x 3 mm and the transverse dimension. There is very mild, if any, enhancement of the adjacent soft tissues. The fourth metatarsal and phalanges of the fourth toe appear normal. There is a moderate hallux valgus deformity (metatarsal-phalangeal angle of approximately 30 degrees) with moderate osteoarthritis of the first MTP joint, as seen on recent radiographs. There is associated lateral subluxation of the sesamoid bones relative to their normal location beneath the first metatarsal head and moderate degenerative arthritic changes at the metatarsal-sesamoid articulations. There is low signal intensity within the subcutaneous fat along the medial aspect of the first metatarsal head with enhancement on postcontrast sequences that presumably representing scar tissue. There is a mild synovitis of the first MTP joint.

Output: 1. Small cutaneous/subcutaneus focus of intermediate signal intensity within the soft tissues along the plantar aspect of the base of the proximal phalanx. The etiology and significance of this finding is uncertain, but the signal characteristics are atypical for a foreign body. This could represent a focus prior soft tissue injury. If there is strong clinical concern for a foreign body, targeted ultrasound examination is recommended.2. Osteoarthritis and hallux valgus deformity of the first MTP joint.


Instruction: Generate impression based on medical findings.

Input: Episodes of falls, intermittent confusion, decreased proprioception, positive Romberg. OSH CT with "old tiny lacunar infarcts in bilateral basal ganglia" images not available. Evaluate for stroke or other pathology. There is no evidence of intracranial hemorrhage. There is periventricular and white matter T2/FLAIR hyperintensity which is nonspecific but likely related to small vessel ischemic changes. However, a confluent region of FLAIR/T2 signal abnormality noted along the anterior aspect of the body of the right lateral ventricle within the corona radiata. There is no conspicuous ex vacuo dilatation of the adjacent ventricle, although there is overall smaller size of the right lateral ventricles compared to the left, a normal variant. Additional focal T2/FLAIR hyperintensity in the basal ganglia bilaterally are likely from prior lacunar strokes. There is no abnormal intracranial enhancement. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.No evidence of intracranial hemorrhage or acute infarct. 2.Mild-moderate chronic small vessel ischemic changes, with greater confluence along right corona radiata3.Additional chronic lacunar infarcts along the basal ganglia.


Instruction: Generate impression based on medical findings.

Input: Altered mental status, unspecified [R41.82], Reason for Study: ^Reason: stroke, seizures History: 82Yrs female with h/o above p/w possible first time sz? There is no evidence of acute ischemic or hemorrhagic lesion.Tissue loss with corresponding ventricular enlargement on the right hemisphere involving right basal ganglia, right thalamus, right frontal, temporal and somewhat parietal lobe with evidence of susceptibility lesions indicating hemosiderin deposition. Patchy FLAIR high signal intensity on bilateral periventricular white matter indicating nonspecific small vessel ischemic lesion.There is no mass, mass effect, edema, midline shift, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Right hemispheric extensive encephalomalacia with ex vacuo changes of the right lateral ventricle as described above with hemosiderin deposition indicating prior hemorrhagic infarction.2. No evidence of acute ischemic or hemorrhagic lesion. 3. Minimal non specific small vessel ischemic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 21 years old, with history of benign brain tumor, hearing malformation, spina bifida, and tethered cord. Follow-up for worsening symptoms. Brain:The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen. Parenchymal enhancement is within normal limits.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage The ventricular system is normal in caliber and morphology. Findings related to Chiari decompression are seen including suboccipital craniectomy and resection of the posterior arch of C1. The CSF space remains well expanded at this level and the cerebellar tonsils are neither crowded nor peglike. CSF flow is seen through both the anterior and posterior aspects of the foramen magnum, similar to prior. There is minimal deformation of the dorsal surface of the medulla which may reflect prior tumor at this location. There has been no significant interval change.C-spine:Straightening of the cervical lordosis may be positional. No significant malalignment is seen. Vertebral body height and morphology are within normal limits. No marrow replacement or marrow edema is seen.The spinal cord demonstrates normal signal intensity and morphology throughout. No spinal canal stenosis or neuroforaminal narrowing is detected.L-spine:Surgical findings are redemonstrated including multilevel laminectomy beginning at L2 and extending down into the sacral region. The thecal sac is expanded from L3 down, similar to the prior exam. There remains a small amount of fatty material along the posterior aspect of the thecal sac at the S1 level which is stable.The distal spinal cord remains very closely apposed to the posterior aspect of the thecal sac from the L2 level down. At lower levels the cord spreads and adheres along the posterior thecal sac and becomes inseparable from numerous septations and presumed areas of scar tissue. The overall appearance of these findings has not significantly changed.Spinal alignment is anatomic. Vertebral body morphology is within normal limits. No marrow replacement or marrow edema is suspected.No new intraspinal lesions are seen. The spinal canal and the neural foramina remain widely patent.The appearance of a skin dimple within the left aspect of the posterior soft tissues at approximately L4-5, along with an associated somewhat curvilinear tract which extends more deeply to the paraspinal tissues, is unchanged.

Output: 1. Redemonstration of findings related to Chiari decompression. The appearance of the tissues at the foramen magnum is stable. CSF flow is present along both the ventral and dorsal aspects of the foramen magnum.2. Minimal residual deformation of the dorsal medulla, at the site of prior tumor, is unchanged. No evidence of new tumor growth is seen.3. Evaluation of the cervical spine is otherwise unremarkable.4. Redemonstration of findings related to tethered cord and surgical correction in the lumbar spine. There has been no significant interval change in the appearance of these findings.


Instruction: Generate impression based on medical findings.

Input: Rule out a volar plate or collateral ligament injury to the right SF PIP joint. Evaluation of the fifth finger on several sequences is limited by excessive noise.The PIP joint is held in slight flexion. There is edema likely representing bone contusion from prior injury in the head of the proximal phalanx and the base of the middle phalanx. There is also a small amount of fluid in the PIP joint. The collateral ligaments of the PIP joint appear intact. The volar plate appears intact. The flexor tendon apparatus appears normal. The extensor tendon is difficult to see dorsal to the middle phalanx but its attachment to the middle and distal phalanges appear intact. Although the A2 pulley is difficult to visualize, we suspect that it is intact.

Output: Bony contusions in the head of the proximal phalanx and the base of the middle phalanx of the right fifth digit. We see no findings to indicate collateral ligament injury or volar plate injury.


Instruction: Generate impression based on medical findings.

Input: Hemangioma of intracranial structures [D18.02], Reason for Study: ^Reason: PRE-OP, craniotomy for cavernous malformation resection, CCD, please place neurosurgery resident to place fiducials History: Pre-op, cavernous malformation Multiple fiducial markers were seen for the preparation of stereotactic surgery.Redemonstration of left cerebellar hemispheric cavernous malformation with associated developmental venous anomaly. No change since prior scan.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.

Output: Redemonstration of left cerebellar cavernous malformation with associated developmental venous anomaly as described above. No change since prior scan.


Instruction: Generate impression based on medical findings.

Input: Reason: characterize liver lesions History: hx liver lesions ABDOMEN:LIVER, BILIARY TRACT: There is redemonstration of a T2 hyperintense structure within hepatic segment 5 which measures 1.2 x 1.4 cm, not significantly changed in size. This structure demonstrates peripheral nodule enhancement and centripetal fill-in and meets imaging criteria for a benign hemangioma. No additional hepatic lesions are identified. The hepatic vasculature appears patent.Cholelithiasis without evidence of cholecystitis. No biliary ductal dilatation.SPLEEN: Probable splenule, unchanged.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mild prominence of the retroperitoneal lymph nodes, not significantly changed.BOWEL, MESENTERY: Diverticulosis without specific evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Chronic elevation of the left hemidiaphragm.

Output: Hepatic segment 5 lesion compatible with a benign hemangioma, not significantly changed in size. No suspicious hepatic lesions are identified.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for osteo of R cranial bone History: R parietal bone defect The patient is status post right-sided craniotomy. There is a redemonstration of some adjacent dural thickening which was also previously present adjacent to the right temporal lobe. This dural thickening appears to have to be stable compared to the previous exams. It currently measures 30 x 6 mm in axial dimensions.There is a redemonstration of encephalomalacia along the right parietal lobe in the right temporal lobe and right posterior frontal lobeThere is an extra-axial mass adjacent to the medial aspect of the right precentral gyrus which measures 11 x 16 mm coronal dimensions and previously measured 13 x 9 mm coronal dimensions.There is redemonstration of a left-sided extracranial mass currently measuring 15 x 18 mm and previously measuring 17 x 13 mm located adjacent to the the left subcentral lobule.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The right eyeball lens is thin.

Output: 1.The patient is status post right-sided craniotomy. The appearance of the craniotomy defect in the adjacent soft tissues is stable. There is no convincing evidence for osteomyelitis at this time.2.There is redemonstration of a two slowly growing extra-axial mass lesions suspected to represent meningiomas. One is located adjacent to the left subcentral lobule and the other one is located adjacent to the right paracentral lobule and precentral gyrus.3.There is encephalomalacia involving right posterior frontal, parietal and posterior superior temporal lobes.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate for RTC tear, OA History: pain, decrease ROM. ROTATOR CUFF: Moderate supraspinatus, infraspinatus, and infraspinatus tendinopathy without discrete full-thickness tears. Mild diffuse fatty atrophy of the musculature.SUPRASPINATUS OUTLET: Mild to moderate osteoarthritis of the AC joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is normal. Mild osteoarthritis of the glenohumeral joint. Within the limitations of a nonarthrographic study, the glenoid labrum is intact.BICEPS TENDON: The biceps tendon is intact.ADDITIONAL

Output: Moderate rotator cuff tendinopathy without discrete full-thickness tear.


Instruction: Generate impression based on medical findings.

Input: Brain metastasis treated with SRS: surveillance exam. There is a small area of unchanged high T2 signal in the left parietal lobe treatment bed. There is no evidence of associated enhancement or mass effect. There is no evidence of additional intracranial lesions. There is no evidence of acute intracranial hemorrhage acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are unchanged. There are scattered paranasal sinus retention cysts and mucosal thickening.

Output: Post-treatment findings in the left parietal lobe without evidence of measurable tumor.


Instruction: Generate impression based on medical findings.

Input: There are numerous foraminal and extraforaminal lumbar and sacral nerve root tumor that appear to not have significantly changed in size since 2014. Likewise, there are several tumors in the paraspinal soft tissues, which appear to be similar in size as before. There is degenerative spondylosis in the lower lumbar spine. In particular, a disc protrusion at L5-S1 has decreased in size considerably since 2014 and there is now minimal spinal canal narrowing as a result. However, there has been increased loss of disc space height at L5-S1 and increased degenerative bone marrow signal alterations at this level. There is no significant spinal canal stenosis at the other lumbar spine levels. There is no spondylolisthesis and the vertebral body heights are essentially preserved.

Output: 1. The numerous lumbosacral nerve root and paraspinal soft tissue neurofibromas do not appear to have changed significantly since 2014.2. Interval evolution of the degenerative disc disease, with involution of the disc protrusion at L5-S1, with minimal residual spinal canal narrowing, but increased loss of disc space height at L5-S1.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old, with history of grade 2 astrocytoma status post RT + TMZ several years ago. Evaluate for growth. Patchy, non-masslike T2/FLAIR hyperintensity is again seen within the pons and medulla showing no significant interval change in morphology or geographic extent. No associated enhancement is seen.A focus of susceptibility within the right posterior medulla, and a very small additional focus along the left posterior medulla, are unchanged, possibly representing foci of microhemorrhage or small cavernous malformations.Subcortical T2 hyperintensity within the right cuneus and in the right inferior frontal gyrus is unchanged. Likewise, scattered small foci of periventricular and subcortical white matter T2 hyperintensity are unchanged and nonspecific. No evidence of mass effect is seen. The ventricular system is stable in size and morphology. Prominence of the CSF space along the right cerebellar hemisphere is unchanged.

Output: Stable examination with no findings to suggest recurrent or progressive disease.


Instruction: Generate impression based on medical findings.

Input: Right hip pain, metastatic breast cancer Again seen is a lobulated subcentimeter focus of intermediate signal intensity on T1-weighted images which is hyperintense on T2-weighted images within the intertrochanteric region of the left femur. There is enhancement following gadolinium administration. This measures 6 mm in the transverse dimension and approximately 7 mm in the craniocaudal dimension and these dimensions are identical to those seen on the prior examination. The reference L5 vertebral body lesion also appears unchanged and there are no additional or new marrow abnormalities identified.The hip joints and sacroiliac joints appear normal with no abnormal enhancement to suggest synovitis. The imaged musculature and tendons of the pelvis are unremarkable.

Output: Signal abnormalities within the left proximal femur and L5 vertebral body are unchanged from the prior exam. There are no new marrow signal abnormalities or other specific findings to account for the patient's hip pain.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Chiari malformation 1 found on Brain MRI now checking spine to look for other anomaliesSigns and Symptoms: check for anomalies Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. The cerebellar tonsils extend approximately 8 mm below the level of the foramen magnum.No abnormal enhancing lesions are identified 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.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. No abnormal enhancing lesions are identified in the thoracic spine.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.No abnormal enhancing lesions are identified in the lumbar spine.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.No abnormal lesions are identified in the cervical spinal cord, the thoracic spinal cord or the lumbar spinal cord. There is no evidence for a syrinx.2.There is Chiari I malformation present.


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old. Reason: Thyromegaly History: Thyromegaly RIGHT LOBE MEASUREMENTS: 5.7 x 2.1 x 2.5 cmLEFT LOBE MEASUREMENTS: 5.8 x 2.0 x 2.3 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Mildly heterogeneous echotexture, without focal lesion.LEFT LOBE: Mildly heterogeneous echotexture, without focal lesion.ISTHMUS: Mildly heterogeneous echotexture, without focal lesion.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-appearing cervical lymph nodes are identified. A left cervical lymph node measures 1.3 x 0.4 x 0.8 cm, with a fatty hilum, favoring benignity.OTHER: No significant abnormality noted.

Output: Normal appearance of the thyroid, with benign appearing cervical lymph nodes.


Instruction: Generate impression based on medical findings.

Input: 79-year-old female with left-sided numbness and dysarthria. There is effacement of the gray-white matter differentiation involving the cortex of right insula and portion of the right temporal lobe which is highly concerning for an acute cortical stroke. Further follow-up with an MRI is highly recommended. Minimal small vessel disease is present. No evidence of hemorrhage, midline shift or mass effect is detected.

Output: 1.Highly suspected acute right MCA stroke. Further evaluation with an MRI.2.A small vessel disease of undetermined age.3.No evidence of hemorrhage.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old, with speech changes and and abnormality noted on prior imaging. Evaluate for changes in lesion status. An ill-defined region of T2 hyperintensity is redemonstrated involving the medial superior left temporal lobe, left periatrial white matter and left lateral thalamus. The extent of this abnormality is stable or at most very slightly increased when compared to prior examinations. However, there remains no evidence of significant mass effect. Ill-defined enhancement is again seen in this region, but the enhancement is stable to slightly reduced when compared to the prior study. Single voxel spectroscopy of this region shows markedly diminished NAA. The choline peak, however, has increased from that seen on the prior exam, and is now slightly higher than that observed in the contralateral normal hemisphere. A small doublet peak is evident at 1.15 ppm which may be artifactual, though propylene glycol, a common pharmaceutical and food additive, produces just such a peak in this location of the spectrum.A subcentimeter focus of enhancement and minimal diffusion restriction in the left centrum semiovale is unchanged. Likewise, a similarly sized T2 hyperintense non-enhancing lesion in the right parietal white matter is unchanged. Streaky perivenular enhancement in the right parietal lobe is still present though less distinct than on the prior exam.

Output: Overall, there has been little if any significant change in the appearance of scattered lesions as demonstrated on the conventional MRI sequences. MR spectroscopy of the dominant left temporal/periatrial lesion does, however, shows an interval increase in the choline peak, which is a marker for cell membrane turnover. Such a finding can be seen in gliosis or post-inflammatory repair, but also in neoplastic processes.As before, the differential diagnosis would include granulomatous disease, lupus, vasculitis, a post-inflammatory autoimmune phenomenon, and atypical demyelinating disease. Atypical neoplastic processes, such as intravascular (angiocentric) lymphoma, can also present with similar findings. While the overall stability of the lesion is somewhat reassuring, the MR spectroscopic evidence for increased membrane turnover warrants at least one additional follow up exam, perhaps at 6 months.


Instruction: Generate impression based on medical findings.

Input: Male, 29 years old, with history of epilepsy status post laser ablation. Surveillance imaging of the ablation focus. Sequelae of left occipital approach laser fiber placement are seen. Mild tissue distortion and signal abnormal are seen within the mesial left temporal lobe compatible with ablation. Two foci of enhancement at this site are present and appear smaller than the enhancing regions noted on the intraprocedural examination.The remainder of the brain is free of pathologic signal alteration or enhancement. No abnormal extra-axial fluid collections are detected. No significant edema or mass effect is seen. The ventricles are normal in size and morphology. Left frontal and left temporal burr hole defects are seen.

Output: Expected findings status post left mesial temporal ablation.


Instruction: Generate impression based on medical findings.

Input: 55 years, Male, status post meningioma resection. There are postsurgical changes of occipital craniotomy for resection of extra-axial tumor which was abutting the dorsal aspect of the cerebellum. There appears to be near total tumor resection. There is residual extra-axial enhancement abutting/invading the torcular herophili and medial aspect of the right transverse sinus which is suspected to represent minimal residual tumor. This area of enhancement measures approximately 10 x 6 mm. Dural venous sinuses remain otherwise patent. There is restricted diffusion involving the right posterior medial cerebellar hemisphere compatible with cytotoxic edema. Small scattered foci of air as well as small fluid collection with blood products at the resection site and beneath the craniotomy are noted. No large hemorrhage or significant mass effect is appreciated. No midline shift or herniation.Remainder of the brain again demonstrates minimal scattered foci of T2/FLAIR hyperintensity in the bilateral periventricular and subcortical white matter, which are nonspecific but compatible with mild chronic small vessel ischemic changes. More focal area of T2 hyperintensity involving the left inferior lateral aspect of the putamen is suspected to represent a chronic lacunar infarct and was seen previously. Ventricles are normal in size without evidence of hydrocephalus. Moderate degree of paranasal sinus opacification is again noted.

Output: Near total resection of previously seen posterior fossa extra-axial mass, presumably representing meningioma. Minimal residual tumor is suspected along the wall of the torcular herophili and medial aspect of the right transverse sinus. Venous sinuses remain patent.


Instruction: Generate impression based on medical findings.

Input: 60 year old male. Bilateral decubitus ulcers. Presenting with AMS. Evaluate for underlying osteomyelitis. Images are variably degraded by motion artifact, limiting evaluation.PELVIS: Mild edema in the subcutaneous fat and gluteus maximus of the right buttock (series 401, image 17). Marrow signal intensity of the pelvis is within normal limits. No evidence of osteomyelitis. Mild degenerative changes of the lumbar spine with multilevel disk bulges and posterior element hypertrophy. Mild osteoarthritis of the bilateral hips.Post-surgical changes in the sigmoid colon. Nonspecific mildly enlarged external iliac lymph node that is 1.3 x 1.4 cm (series 301, image 21). Prominent bilateral inguinal lymph nodes, likely reactive.

Output: 1. Mild edema in the soft tissues of the right buttock. No underlying osteomyelitis.2. Mildly enlarged right external iliac lymph node, nonspecific.


Instruction: Generate impression based on medical findings.

Input: History of left breast cancer status post lumpectomy. Currently treated for stage 3 ovarian cancer. BRCA1 carrier. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No suspicious enhancement is seen in either breast. In the right upper outer breast, there is a peripherally enhancing area with central fat density. Based on it's position, this correlates to the area of dystrophic calcifications/fat necrosis. The lumpectomy site in the left outer breast is well seen, but there is no suspicious nodular or mass like enhancement near this site. A normal blood vessel is seen adjacent to the posterior aspect of the lumpectomy bed. Elsewhere, a few bilateral scattered non-uniquely enhancing foci are present.No abnormal lymph nodes are identified in either axillary region. Post operative change is seen in the left axilla. Port-a-cath noted in the right upper medial chest wall.

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


Instruction: Generate impression based on medical findings.

Input: Clinical question: Thunderclap headache. Signs and symptoms: Transient loss of focus while driving and thunderclap headache. The CSF spaces are appropriate for the patient's stated age of 75 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.There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.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 scattered opacities in the ethmoid air cells and some mucosal thickening in the left sphenoid sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Incidental notes are made of partial empty sella and an 8mm Thornwaldt cyst. These are likely of little clinical significance.

Output: 1.No evidence for acute ischemic cerebral infarction.2.Periventricular and subcortical white matter lesions of a mild to moderate degree are nonspecific. They are associated with increasing age and most likely vascular related.


Instruction: Generate impression based on medical findings.

Input: 20-year-old female patient with endogenous insulin-mediated hypoglycemia. Evaluate for insulinoma. ABDOMEN:LIVER, BILIARY TRACT: No suspicious appearing hepatic lesion. No intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No pancreatic ductal dilatation. No lesion seen within the pancreatic parenchyma.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.No evidence of a pancreatic lesion, as clinically questioned.


Instruction: Generate impression based on medical findings.

Input: 68 year-old female with infiltrative lesion in the left temporal lobe undergoing preoperative surgical planning. Redemonstration of an infiltrative T2 hyperintense lesion in the left temporal lobe and extending into the left occipital lobe, parietal lobe, and splenium of the corpus callosum. There is local mass effect with sulcal effacement and effacement of the temporal horn of the left lateral ventricle.Stable additional areas of T2 hyperintensity in the periventricular white matter compatible with chronic small vessel ischemic changes.Postcontrast images demonstrate 2 small nodular foci of enhancement in the left temporal lobe measuring up to 3 mm. There is asymmetrically increased vascularity in the left temporal lobe with dilatation of the temporal branches of the left posterior cerebral artery.The expected intracranial vascular flow voids are present.The paranasal sinuses are clear. The visualized mastoid air cells are clear. The orbits are unremarkable.

Output: No significant interval change in large infiltrative masslike lesion centered in the left temporal lobe with extension of the occipital and parietal lobes.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Acute lymphoblastic leukemia not having achieved remission. Acute lymphoblastic leukemia not having achieved remissionClinical question: patient with lytic lesions in T spine seen on CT scan There are multiple foci of marrow replacement and contrast and enhancement scattered throughout the thoracic spine and in general throughout the visualized spine. There is partial compression of T11. Involving the left half of the T11 vertebra more than the right with approximately 30% loss of vertebral body height there is no evidence for retropulsion or compromise to spinal canal.Multiple marrow replacing lesions are also identified in the other visualized skeletal structures including the ribs and scapula.There is no compromise of thoracic spinal canal or exiting nerve roots.There is a large left-sided pleural effusion associated with airspace disease. There are multiple nodules present in the visualized portion of the right lung. There is a small right pleural effusion present.

Output: 1.Findings are compatible with diffuse skeletal metastases involving the visualized portions of the spine with mild compression fracture at T11 without significant compromise to the spinal canal at this time. Skeletal metastases are also suspected in the ribs and scapula.2.There are multiple nodules identified in the visualized portions of the right and left lung. Please refer to chest CT from 10/13/2015 for further comments.3.Bilateral pleural effusions-the left pleural effusion is larger and associated with airspace disease whereas the right pleural effusion is much smaller.


Instruction: Generate impression based on medical findings.

Input: Reason: Evaluate left knee for lateral meniscus tear (compare with 2007) History: lateral joint line pain MENISCI: There is increased signal abnormality and deformity of the posterior horn of the lateral meniscus which extends to the tibial articular surface indicating intrasubstance degeneration as well as a complex tear with a predominantly horizontal component. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is full-thickness articular cartilage degeneration along the weightbearing surface of the lateral femoral condyle above the posterior horn of the meniscus with areas devoid of articular cartilage. There is near full-thickness articular cartilage degeneration along the lateral aspect of the tibial plateau underlying the posterior horn of the lateral meniscus. There is partial-thickness articular cartilage degeneration along the weightbearing surface of the medial femoral condyle above the posterior horn and body of the meniscus. There is a near full-thickness to full-thickness articular cartilage defect along the lateral facet of the patella with associated delamination. There is full-thickness articular cartilage degeneration along the medial facet of the patella, centrally. There are tricompartmental osteophytes.LIGAMENTS: The cruciate and collateral ligaments appear intact. There are multiple foci of fluid signal intensity along the posterior aspect of the PCL which may reflect mucoid degeneration. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Degeneration and complex degenerative tearing of the posterior horn of the lateral meniscus which is progressed when compared to the prior examination. 2. Osteoarthritis of the knee including articular cartilage degeneration, full-thickness defects, and delamination, most pronounced along the lateral tibiofemoral and patellofemoral articulations. 3. Moderate size joint effusion.


Instruction: Generate impression based on medical findings.

Input: LV dysfunction Left VentricleThe left ventricle is mildly reduced. The overall LV ejection fraction is 48%, the LV end diastolic volume index is 86 ml/m2 (normal range: 65+/-11), the LVEDV is 142 ml (normal range 109+/-23), the LV end systolic volume index is 44 ml/m2 (normal range 18+/-5), the LVESV is 73 ml (normal range 31+/-10). 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.Left AtriumThe left atrium is normal. Right VentricleThe right ventricle is mildly reduced. The overall RV ejection fraction is 40%, the RV end diastolic volume index is 85 ml/m2 (normal range 69+/-14), the RVEDV is 141 ml (normal range 110+/-24), the RV end systolic volume index is 51 ml/m2 (normal range 22+/-8), and the RVESV is 84 ml (normal range 35+/-13). Right AtriumThe right atrium is normal. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation, but the severity of aortic regurgitation can be underestimated by the MRI pulse sequence used in this study.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation, but the severity of mitral regurgitation can be underestimated by the MRI pulse sequence used in this study.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation, but the severity of pulmonic regurgitation can be underestimated by the MRI pulse sequence used in this study.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation, but the severity of tricuspid regurgitation can be underestimated by the MRI pulse sequence used in this study.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac Findings . This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Mildly reduced LV EF at 48%2. Mildly reduced RV EF at 40%.


Instruction: Generate impression based on medical findings.

Input: 30-year-old female patient with medial joint line tenderness and mechanical symptoms. MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: There are no focal cartilage defects.LIGAMENTS: The anterior cruciate ligament, posterior cruciate alignment, medial collateral ligament, lateral collateral abdomen complex, and patellar retinacula are intact. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: No significant abnormalities or findings to account for patient's pain.


Instruction: Generate impression based on medical findings.

Input: Metastatic base of tongue cancer, with known epidural tumor at T1-T5, presenting with increasing back pain and new 4/5 weakness in right quadricep. No urinary symptoms, normal rectal tone. Had kyphoplasty at T3 on 12/2. Evaluate for cord compression. There is multifocal narrowing of the spinal canal, most pronounced at the level of C3-4, in addition to indentation of the cord at T3-4 without evidence of acute cord compression. There are numerous osseous metastases throughout the spine, similar in extent as on the prior exam. There has been interval kyphoplasty of the T3 pathologic compression fracture, with persistent approximately 50% loss of height and apparent retropulsion of cement inferiorly in the disc space, which mildly indents the spinal cord. No new pathologic fractures are identified. There are multiple epidural metastases, which do not appear significantly changed from the prior exam. Specifically, epidural tumor extends from T1 through T5 and is present at T10 and L2 with extension into the right neural foramina at these levels, as well as at S1 to S3. There is an intrathecal metastatic lesion at the level of L3-4 measuring up to approximately 30 mm, with compression of the cauda equina, which appears similar to the prior exam. There is multilevel degenerative spondylosis in the lower lumbar spine with associated minimal spinal canal and neural foraminal narrowing. There is edema within the upper thoracic and lower lumbar paraspinal muscles, perhaps related to denervation effects. There is partly imaged mediastinal and left axillary adenopathy.

Output: 1. Numerous metastases to the axial skeleton with epidural extension, particularly at in the upper thoracic region, with possible mild spinal cord compression and at T10 and L2 with associated neural foraminal narrowing, as well as at S1 to S3. However, the lack of contrast and axial images limit the assessment.2. Interval kyphoplasty of the T3 pathologic compression fracture with apparent retropulsion of cement and indentation of the spinal cord.3. Intrathecal metastatic lesion at the level of L3-4 measuring up to approximately 30 mm, with compression of the cauda equina.4. Partly imaged mediastinal and left axillary adenopathy related to metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Locoregional synovial sarcoma of spine (C2-T2) with cardiac extension; pulmonary relapse March 2016; surveillance imaging. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild scattered paranasal sinus mucosal thickening. There is also a mild effusion within the left mastoid air cells.Spine: There are postoperative findings related to C2-T2 laminoplasty and tumor debulking. There is interval decrease in size of the enhancing left paraspinal tumor with encasement of the left vertebral artery at these levels, with invasion of each neural foramen and minimal extension into the intraspinal epidural space, measuring up to 20 mm in thickness at the C3-4 level, previously 25 mm. There is persistent patchy heterogeneous marrow replacement throughout the cervical spine and upper thoracic spine, but the vertebral body heights are preserved. There is a kyphotic curvature at the cervico-thoracic junction, but no spondylolisthesis. The spinal canal is narrowed from C3-C7, which is in part attributable to kyphotic curvature, a tight laminoplasty and small posterior disc-osteophyte complexes. There is associated mild spinal cord flattening in this region, without spinal cord signal abnormality. The posterior paraspinal tissues are unchanged. There are nodules within the partially imaged right lung. There is a small right apical pneumothorax.

Output: 1. Slight interval decrease in size of the treated residual tumor.2. Persistent patchy heterogeneous marrow replacement throughout the cervical spine and upper thoracic spine, but the vertebral body heights are preserved. 3. The spinal canal is narrowed from C3-C7, which is in part attributable to kyphotic curvature, a tight laminoplasty and small posterior disc-osteophyte complexes. 4. No evidence of intracranial metastases.5. Pulmonary metastases and small right apical pneumothorax. Please refer to the separate chest CT report for additional details.


Instruction: Generate impression based on medical findings.

Input: History of mycosis fungoides with CNS involvement treated with 2 cycles of Cytarabine/Etoposide in need of reimaging. Brain: There is a right transfrontal Ommaya catheter that terminates in the right lateral ventricle. There is no evidence of acute infarct. There is persistent diffuse enhancement of the cisternal segments of the bilateral trigeminal nerves and oculomotor nerves, left more than right. There also appears mild diffuse enhancement involving the bilateral facial nerves. There are mild nonspecific patchy areas of high T2 signal in the cerebral white matter bilaterally. The rest of the brain parenchyma appears to be unremarkable. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Orbits: There is persistent, albeit slightly reduced, high T2 signal and mild hyperenhancement of the left inferior, medial, and superior oblique muscles. The high T2 signal in the right inferior recuts muscle is less conspicuous. The bilateral globes, lacrimal glands, and optic nerves are otherwise unremarkable.

Output: 1. Persistent enhancement of multiple cranial nerves related to lymphoma.2. Residual mild denervation edema in the extraocular muscles supplied by the left oculomotor nerve and to a lesser extent perhaps the right ocular motor nerve.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old, with right hard palate lesion. An enhancing mass is evident centered within the maxillary alveolus at the location of the right lateral incisor. This lesion measures 12 x 11 mm in the sagittal plane and 11 x 11 mm in the coronal plane. The lesion involves the alveolus and the underlying hard palate mucosa. There is a mild invasion into the overlying hard palate, but no invasion through the hard palate or involvement of the nasal cavity is seen.As noted on the prior CT, there is also evidence of erosion along the posterior right maxillary alveolus (see image 23 series 13). The erosive defect is filled with nonspecific soft tissue which demonstrates ill-defined enhancement and mildly hyperintense T2 signal.A cluster of small lymph nodes is evident just lateral to the submandibular glands bilaterally, but more so on the right. Although individually these lymph nodes do not meet imaging criteria for pathologic enlargement, they are somewhat concerning due to their increased number. Lymph nodes are also evident bilaterally at level 2, but again none of these meets imaging criteria for pathologic enlargement.The salivary glands and thyroid are unremarkable. No additional soft tissue neck lesions are seen. Bone marrow characteristics are unremarkable. Limited intracranial views demonstrate patchy asymmetric periventricular T2 hyperintensity which may reflect microvascular ischemic disease. The paranasal sinuses and nasal cavity are otherwise unremarkable allowing for a small mucous retention cyst in the right maxillary sinus.

Output: 1.An erosive lesion is evident along the right maxillary alveolus at the level of the lateral incisor. This lesion involves the alveolus and underlying mucosa with minimal encroachment upon the hard palate. No evidence of extension through the hard palate into nasal cavity is seen.2.A second area of bone erosion is seen more posteriorly along the right maxillary alveolar ridge. This region demonstrates mildly elevated T2 signal and mild ill-defined enhancement. Findings are nonspecific and may very well reflect a benign etiology, but direct inspection of this region is highly recommended.3.No definite pathologic adenopathy is detected in the neck by size criteria. Lymph node clustering along the submandibular glands, right side more than left, is somewhat concerning due to the unusual increased number of these nodes. Additional lymph nodes at level 2 bilaterally are nonspecific as they do not meet imaging criteria for pathologic enlargement.


Instruction: Generate impression based on medical findings.

Input: Susceptibility with corresponding areas of T2 hypointensity is again visualized in the basal cisterns symmetrically and along scattered bilateral supratentorial and infratentorial subarachnoid spaces, more prominent along the left greater than right occipital lobes, right temporal lobe, left parietal lobe, right greater than left sylvian fissure, and cerebellar sulci outlining the folia, especially along the superior vermis. There is also prominent susceptibility in the fourth ventricular outflow. Accounting for differences in technique between the T2* at 3T on this exam and GRE on the previous OSH exam, there is no significant change. Findings are more conspicuous on the current SWI images. There is no associated abnormality identified.The ventricles and sulci are normal in size. There are no masses, mass effect or midline shift. No diffusion-weighted abnormalities are identified. There is no abnormal enhancement within the brain.

Output: Superficial hemosiderosis of the basal cisterns and scattered supratentorial and infratentorial subarachnoid spaces appearing similar to the prior exam accounting for differences in technique, more apparent on SWI images. No causative abnormality identified.


Instruction: Generate impression based on medical findings.

Input: Left knee pain MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There is a 1.4 cm full-thickness articular cartilage defect of the lateral femoral trochlea anteriorly with additional areas of near full-thickness loss and associated underlying subchondral marrow edema. The articular cartilage of the patella demonstrates areas of heterogeneity but no full-thickness loss. The articular cartilage of the weightbearing portions of the lateral compartment appears spared as does the articular cartilage of the medial compartment. LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Full-thickness articular cartilage defect of the lateral femoral trochlea with additional areas of near full-thickness loss and associated marrow edema.2. Possible mild strain of the semimembranosus.3. Intact medial and lateral menisci.


Instruction: Generate impression based on medical findings.

Input: There is multifocal low T1 and T2 signal in the dorsal epidural space from the T4-T9 levels, which may represent ossification along the ligamentum flavum. There is associated severe spinal canal stenosis from the T4-T5 to T6-T7 levels with flattening of the cord and suggestion of high T2 signal within the spinal cord. There is no high-grade spinal canal stenosis in the cervical or lumbar spine.There is prominence of the lumbar dorsal and ventral epidural fat from the L3-S1 levels, along with narrowing of the distal spinal canal, which may be suggestive of epidural lipomatosis and possible developmental narrowing of the spinal canal. Additional note is made of prominent facet arthropathy, particularly at the L4-5 and L5-S1 levels.The vertebral bodies are appropriate in overall alignment and height.

Output: 1. This is a limited exam specific for the exclusion of cord compression only. There is multifocal decreased T1 and T2 signal in the dorsal epidural space from the T4-T9 levels, which may represent ossification along the ligamentum flavum. There is consequent severe spinal canal stenosis, flattening of the cord and suggestion of high signal within the spinal cord at these levels. Recommend dedicated MR of the thoracic spine; CT of the thoracic spine would also be useful.2. Findings suggestive of developmental narrowing of the lower lumbar spinal canal with epidural lipomatosis.


Instruction: Generate impression based on medical findings.

Input: 24-year-old female with right foot pain along the metatarsal heads Ankle: There is a lobulated T2 bright, T1 dark fluid collection measuring approximately 1.8 x 0.8 cm with small tail extending posterior from the tibiotalar joint, consistent with a ganglion cyst. No enhancement is visualized on postcontrast images. Minimal fluid is noted within the tibiotalar joint. The ATFL and PTFL as well as the deltoid ligament complex are intact. The bones appear normal. A soft tissue marker is noted along the posterior aspect of the ankle.Foot: A soft tissue marker is noted along the plantar aspect of the second and third metatarsals without underlying abnormality identified. The bones and soft tissues appear within normal limits.

Output: Ganglion cyst posterior to the tibiotalar joint as described above.


Instruction: Generate impression based on medical findings.

Input: Leg pain and numbness Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.Mild degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild facet arthropathy.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild facet arthropathy.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild facet arthropathy.L5-S1: There is disc desiccation with a disc bulge which is slightly eccentric to the right. There is also a small central disc protrusion. There is mild narrowing of the right neural foramen and minimal contact of the left S1 nerve root in the lateral recess. There is otherwise no significant spinal canal or neural foraminal stenosis. Paraspinous soft tissues are within normal limits.

Output: 1. Minimal degenerative changes in the lumbar spine without high-grade spinal canal or high-grade neural foraminal stenosis at any level. 2. At the L5-S1 level is a mild disc bulge with a small central protrusion which is associated with very mild contact of the right L5 nerve root in the right neural foramen as well as the left S1 nerve root in the left lateral recess, but without clear evidence of impingement.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Preoperative planning for tumor resection. Signs and symptoms: Headaches. Pre- and post enhanced Stealth brain MRI:Examination is performed utilizing Stealth protocol and is not a true diagnostic exam. There are also no prior exams for comparison.Examination demonstrates a partially solid partially cystic enhancing mass in the left inferior frontal lobe with fairly extensive surrounding vasogenic edema. Findings results in effacement of adjacent cortical sulci and deviation of midline to the right of approximately 5 mm at the level of septum pellucidum. The tumor measures at 33 x 32 x 30 in three dimensions. Posteriorly the M1 and A1 segment of the middle and anterior cerebral arteries are abutting the tumor however without evidence of encasement. There is no detectable additional foci of signal abnormality or abnormal parenchymal, leptomeningeal enhancement.Calvarium is unremarkable.Images through the orbits are unremarkable.All the paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal pattern.

Output: 1.Partially cystic and solid enhancing mass (33 x 32 x 30 mm) in the left paramedian inferior frontal with surrounding vasogenic edema and resultant 5 mm deviation of midline to the right.2.Unremarkable pre and post enhanced Stealth brain MRI exam otherwise.


Instruction: Generate impression based on medical findings.

Input: 34 year old man with cardiomyopathy referred to evaluate etiology. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 7%, the LV end diastolic volume index is 224 ml/m2 (normal range: 74+/-15), the LVEDV is 425 ml (normal range 142+/-34), the LV end systolic volume index is 208 ml/m2 (normal range 25+/-9), the LVESV is 395 ml (normal range 47+/-19), the LV mass index is 137 g/m2 (normal range 85+/-15), and the LV mass is 260 g (normal range 164+/-36). There is global hypokinesis. There is septal mid-wall late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. This pattern is consistent with the patient's history of old myocarditis but is also well described in "classical" dilated cardiomyopathy. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size with severely reduced systolic function. The overall RV ejection fraction is 24%, the RV end diastolic volume index is 106 ml/m2 (normal range 82+/-16), the RVEDV is 201 ml (normal range 142+/-31), the RV end systolic volume index is 80 ml/m2 (normal range 31+/-9), and the RVESV is 152 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is 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. Severe LV dilation with severely reduced systolic function (LVEF 7%). There is mid-wall late gadolinium enhancement of the interventricular septum. This finding most likely represents fibrosis related to either old myocarditis or "classical" dilated cardiomyopathy.2. Normal RV size with severely reduced systolic function (RVEF 24%). 3. Severe left atrial dilation.


Instruction: Generate impression based on medical findings.

Input: Clinical question to be answered coned rule out intracranial process. Signs and symptoms: Newborn with apnea. Poor quality exam secondary to extensive motion artifact. No definitive abnormalities detected. However poor quality of examination can obscure subtle findings. Repeat exam or an MRI is recommended. No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. No definitive calvarial abnormality.

Output: No gross abnormality in this limited examination of brain due to extensive motion.


Instruction: Generate impression based on medical findings.

Input: Clinical question: The spinal abscess. Signs and symptoms: Acute lower back pain; fever. Pre-and post-enhanced MRI:Examination demonstrates increased T2/T2 stir signal intensity of disk space at L5 -- S1 level which is more pronounced anteriorly. There is moderate degenerative disk disease at this level with loss of disk height and with mild grade 1 anterolisthesis. There is enhancement of the intravertebral disk at this level corresponding to T2 hyperintense signal abnormality. This enhancement minimally expands into the prevertebral soft tissues anterior to disk. There is very subtle associated T2/T2 stir hyperintense endplate signal change with this finding however with questionable evidence of enhancement. Constellation of above findings are highly suspected for diskitis however without an abscess formation. The enhancement does not reach the dorsal aspect of the disk and there is no detectable extension into the spinal canal/epidural space. There is no evidence of central spinal stenosis at this level however moderate bilateral neural foraminal compromise secondary to degenerative changes are identified.Post enhanced images also demonstrate expected subtle enhancement of the hypertrophied changes of the facets and the ligamentum flavum in the lower lumbar spine. This appearance is an expected finding and not secondary to infectious process.T12 -- L1, L1 -- L2 and L2 -- L3 levels demonstrate degenerative changes without spinal stenosis or neural foraminal compromise.L3 -- 4 demonstrate moderate disk disease and loss of disk height, mild bilateral facet and ligamentum flavum hypertrophy, no spinal stenosis or neural foraminal compromise.L4 -- 5 demonstrate moderate disk disease and loss of disk height, moderate to severe (right greater than left) facet hypertrophic changes and mild bilateral ligamentum flavum hypertrophy. Degenerative changes at this level results in mild grade 1 anterolisthesis however without central spinal stenosis. Mild to moderate right neural foraminal compromise secondary to asymmetric right-sided facet hypertrophic changes is noted.

Output: 1.Increased T2/T2 stir signal intensity in the L5 -- S1 disk space with enhancement is suggestive of diskitis. Very subtle similar central changes of the adjacent endplates with enhancement is also noted. There is no evidence of prespinal soft tissue abscess formation or any detectable abnormal signal or enhancement in the spinal canal/epidural space to suggest an abscess. No central spinal stenosis.2.There is expected subtle enhancement of hypertrophied bilateral facets and ligamentum flavum in the lower lumber spine.3.Normal signal intensity and caliber of the cord, conus and the cauda equina without abnormal enhancement4.No evidence of central spinal stenosis at any level.5.Neuroforaminal compromise as detailed per level.


Instruction: Generate impression based on medical findings.

Input: Female, 31 years old. Outside podiatry eval and x-ray with abnormality of mid-shaft area of 2nd metatarsal and separately a possible neuroma in the same foot. Right foot pain The imaged soft tissue structures of the foot are normal, without solid mass lesion, discrete fluid collection, or foci of abnormal enhancement. The imaged muscles and tendons are grossly normal. The underlying osseous structures are unremarkable, with normal cortical thickness and marrow signal. Specifically, there is no evidence of metatarsal stress injury.

Output: Normal examination, without evidence of mass lesion or stress injury.


Instruction: Generate impression based on medical findings.

Input: 58 year-old female with liver mass on CT examination. ABDOMEN:LIVER, BILIARY TRACT: Note is made of multiple subcentimeter fluid signal intensity foci in the liver, which are most consistent with simple cyst. The no enhancing mass lesions are identified. No suspicious enhancing mass lesions are identified. No evidence of intra or extrahepatic biliary ductal dilation. SPLEEN: Subcentimeter splenule. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multiple hepatic simple cysts, without evidence of a suspicious hepatic mass lesion, as clinically questioned. Of note, the comparison images from the outside institution CT did not show the entire liver.


Instruction: Generate impression based on medical findings.

Input: MRI: An area of T2 hyperintense, disorganized appearing tissue is redemonstrated within the cerebellar vermis measuring 22 x 25 mm. This lesion contains several foci of internal susceptibility corresponding to calcification on prior head CT, along with small foci of noncontiguous nodular enhancement. On some slices, there is the suggestion of a striated or "tigroid" appearance within the lesion best appreciated on thin slice T2 axial images. Mild bulging of the posterior wall of the fourth ventricle is seen without significant mass effect or hydrocephalus. The ventricles and sulci are unchanged.There are findings consistent with patient's known Chiari I malformation with inferior cerebellar tonsillar herniation and flattening. There is no acute infarct or midline shift. There are no separate areas of suspicious intracranial enhancement.MRS: Single voxel short and long TE spectroscopy of the cerebellar vermian lesion shows uniformly decreased myoinositol, choline, creatine and NAA peaks. Interrogation of normal-appearing cerebellar tissue demonstrates a normal spectroscopic pattern.

Output: Midline cerebellar vermian lesion with internal foci of calcification and scattered small foci of enhancement. There has been no significant interval change since prior imaging. Spectroscopic assessment of this lesion shows uniform reduction of all major detectable metabolites. This pattern is non specific but argues against an aggressive, highly proliferative process. The differential diagnosis would include non neoplastic or equivocally neoplastic processes such as dysplastic cerebellar gangliocytoma (Lhermitte-Duclos disease) or simply a developmental dysplasia of the cerebellum. Uniform reduction of MRS peaks has been reported in Lhermitte-Duclos. Low grade tumors such as ganglioglioma or pilocytic astrocytoma among others may also be considered, but the MRS features are not typical.


Instruction: Generate impression based on medical findings.

Input: Reason: ms progression History: pain, leg weakness MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of multiple periventricular white matter lesions which are bright on T2 and flair sequences as well as lesions extending to the corpus callosum at the callosocingulate junction. Punctate lesions are also present in the right thalamus and left thalamus. Comparing to the previous exam the number and distribution of these lesions has not changed. One in particular along the trigone of the left lateral ventricle is less conspicuous on the current exam when compared to the prior examNo 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 partial opacification of the left sphenoid sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits demonstrate prolapse of some of the left orbital fat into the maxillary sinus suggestive of a prior left orbital wall which has not changed since the prior exam.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. No abnormal enhancing lesions are identified in the cervical spine. There is redemonstration of a lesion which is hyperintense on T2-weighted imaging located along the right posterior and lateral aspect of the spinal cord at the C2-3 level which measures 10 mm superior inferior dimension. There is redemonstration of a lesion which is hyperintense on T2-weighted imaging located in the left hemicord posteriorly measuring 2 x 5 mm axial dimensions and 9 mm superior inferior length. This is also stable compared with prior exam.There is a 10-mm T1 hyperintense lesion within the T1 vertebral body most likely represent a vertebral body hemangioma.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.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a minor disk bulge present at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a minor disk bulge present at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There are multiple lesions scattered in the supratentorial brain which are relatively stable when compared to prior exam with the exception of a left periventricular white matter lesion adjacent to the trigone of the left lateral ventricle which has regressed since the prior exam. No new lesions are appreciated. This is compatible with patient's clinical history of demyelinating disorder2.There are couple lesions in the cervical spinal cord which are stable since the prior exam and compatible with patient's clinical history of demyelinating disorder.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old, with history of anaplastic astrocytoma, now off all therapy, compare to prior outside hospital MRIs. Evidence of a small craniotomy is again seen at the high left parietal vertex related to partial resection of a lesion within the left superior frontal gyrus. A bubbly cystic and hemosiderin stained cavity in the superior frontal gyrus is unchanged, and T2 hyperintensity in the surrounding parenchyma has decreased, particularly when compared to the examination of 1/16/2015. A short curvilinear area of mild diffusion restriction along the lateral margin of the cavity is new from prior. An irregular nodule of enhancement within the cystic cavity has not significantly changed from the immediate prior examination. However, this nodule, and previously demonstrated rim enhancement of the cystic tissue, have decreased when compared to older studies. No new enhancement is seen within or adjacent to the cavity, or elsewhere in the brain.Mild ex vacuo dilatation of the left lateral ventricle is unchanged. The remainder of the brain is unremarkable. Ill-defined T2 hyperintensity along the left lateral ventricle likely represents a treatment related effect. No suspicious lesions are seen in the right cerebrum.

Output: Findings are seen compatible with partial resection and subsequent treatment of a tumor within the left superior frontal gyrus. The size and morphology of a bubbly cystic cavity within the gyrus are not significantly changed. T2 hyperintensity surrounding the cavity has diminished when compared to prior examinations. A short curvilinear segment of restricted diffusion along the left lateral aspect of the lesion is new, but this is nonspecific and could reflect a treatment related effect. Attention on subsequent exams will be necessary. An enhancing nodule within the cavity is unchanged compared to the immediate prior study, possibly representing a combination of postoperative granulation and treated tumor. Enhancement in this region is in general reduced when compared to older exams.


Instruction: Generate impression based on medical findings.

Input: Syrinx, follow-up thoracic disk disease Again seen is a thoracic syrinx extending from the T3-T4 to the T7-T8 levels. Syrinx measures up to 5x5 mm in the axial plane at the T4-T5 level Atrophy of the mid thoracic cord is again noted with cystic myelomalacia at T7-8 involving nearly the full dimension of the thoracic cord . The spinal cord is anteriorly displaced which is at least in part related to exaggerated thoracic kyphosis. There is however focal kinking of the cord at the T6-T7 level where the thoracic cord abuts the ventral thecal sac. Degenerative changes are seen at multiple levels similar to prior with small disk bulges and a relatively more prominent disk protrusion at the left T6-T7 level which indents the left thoracic cord. Smaller disk bulges and small protrusions are seen at the T4-T5, T5-T6, T7-T8, and T8-T9 levels. levels. Posterior thecal sac is widely patent.Vertebral body heights are preserved. Small perineural cysts are again seen in the lower thoracic spine. There is loss of intravertebral disk space at the L1-L2 level with suggestion of ankylosis and mild retrolisthesis. Degenerative changes are also seen in the partially visualized cervical spine including mild anterolisthesis of C4 on C5.

Output: 1. Unchanged thoracic syrinx which extends from the T3-T4 to the T7-T8 levels. There is atrophy involving the mid thoracic cord. There is extensive bilateral cord signal abnormality at the T7-T8 level where there is suggestion of cystic myelomalacia. These findings may be related to remote ischemia, inflammation, or other injury.2. Unchanged kinking of the thoracic cord at the T6-T7 level where it abuts the anterior dural surface. Findings may be related to scar tissue however transdural cord herniation cannot be excluded. 3. Degenerative changes including left paracentral disk protrusion at the T6-T7 level which indents the thoracic cord again noted. Posterior thecal sac is widely patent. Exaggerated thoracic kyphosis again seen.


Instruction: Generate impression based on medical findings.

Input: Status post plexiform neurofibroma decompression: 3 month postoperative evaluation. There are postoperative findings related to thoracotomy with excision of the left chest wall plexiform neurofibroma and lower cervical spinal canal plexiform neurofibroma debulking and laminoplasty. There is new kyphotic deformity of the cervicothoracic junction with associated spinal canal narrowing and slight indentation upon the spinal cord, which otherwise appears to maintain normal signal characteristics. Otherwise, there is no significant interval change in size of the residual transpatial tumor in the left neck and upper chest, with extension of tumor in to the left neural foramina from C5 to T5, as well as extension into the left spinal canal at C7-T1, resulting in mild spinal canal stenosis. There is an unchanged lesion in the right T6-7 neural foramen without extension into the spinal canal. There are several lesions in the posterior intercostal spaces at multiple levels, which may represent additional nerve sheath tumors.

Output: 1. Postoperative findings related to thoracotomy with excision of the left chest wall plexiform neurofibroma and lower cervical spinal canal plexiform neurofibroma debulking and laminoplasty, with new kyphotic deformity of the cervicothoracic junction with associated spinal canal narrowing and slight indentation upon the spinal cord, which is suggestive of instability.2. No significant interval change in size of the residual transpatial tumor in the left neck and upper chest, with extension of tumor in to the left neural foramina from C5 to T5, as well as extension into the left spinal canal at C7-T1, resulting in mild spinal canal stenosis. There is an unchanged lesion in the right T6-7 neural foramen without extension into the spinal canal. Please refer to the separate chest MRI report for additional details.3. Several lesions in the posterior intercostal spaces at multiple levels, which may represent additional nerve sheath tumors.Discussed with Dr. Frim at 12:55 PM on 9/16/15.


Instruction: Generate impression based on medical findings.

Input: The study is slightly degraded by motion.MRI BRAIN:There is no convincing restricted diffusion. There are scattered T2/FLAIR hyperintensities in the subcortical and periventricular white matter and in the centrum semiovale, most likely representing chronic ischemic vascular changes. A small chronic infarct is seen in the right cerebellum. There is volume loss with prominence of the ventricles and sulci. There is no midline shift. Basal cisterns are patent. There are tiny susceptibility foci dispersed throughout the white matter and a susceptibility focus in the right basal ganglia, representing old blood products from previous hemorrhage versus mineralization.MRA BRAIN:MRA image quality is significantly reduced by motion artifact. Within this limitation, the following observations are made.The internal carotid arteries are patent with atherosclerotic irregularities seen in the cavernous segments and the supraclinoid segments. The anterior cerebral arteries are patent with slight asymmetry of the A1 segments, right smaller than left. There may be mild narrowing of the right M1 middle cerebral arteries but this is equivocal. The right PCA is not visualized. The left PCA is patent.The right vertebral artery distal to the origin of the right PICA is not visualized. The visualized left vertebral artery and basilar artery are patent. The posterior communicating artery bilaterally are not visualized.

Output: 1. No evidence for acute intracranial hemorrhage, mass effect, or edema. There is no convincing evidence of acute ischemia.2. Chronic subcortical and periventricular white matter vascular ischemic changes with a small chronic infarct in the right cerebellum. 3. The right posterior cerebral artery is not visualized and may be occluded.4. The distal right vertebral artery, distal to the origin of the right PICA is also not visualized and may be occluded.


Instruction: Generate impression based on medical findings.

Input: Male, 16 years old. TS, annual followup. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions. No intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Punctate foci of T2 hyperintensity in the left renal cortex, compatible with angiomyolipomas, are unchanged from the prior study. An additional subcentimeter focus of low signal on both T1 and T2 sequences in the right renal cortex is also unchanged from multiple prior studies and may reflect a small focus of scarring. No new lesions are identified. No hydronephrosis.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: Unchanged punctate renal cortical angiomyolipomas.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Evaluate for growth of AA status post RT/TMZ+ TMZ. Now off all treatments. Signs and symptoms: Right frontal anaplastic astrocytoma. Pre- and post enhanced brain MRI:No diffusion-weighted abnormalities.Examination demonstrates a focus of FLAIR hyperintensity with underlying parenchymal volume loss and minimal chronic hemorrhage in the right frontal lobe and extending from cortex to the right lateral ventricle. Finding consistent with postsurgical and treatment changes of a anaplastic astrocytoma which remains nearly identical to prior exam.There is no detectable abnormal enhancement at the site which is also a similar observation as prior study.Unremarkable signal intensity of brain parenchyma otherwise on all MRI sequences and without detectable abnormal enhancement of brain parenchyma or the leptomeninges.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination otherwise.Unremarkable calvarium other than expected postoperative changes of right frontal craniotomy.Unremarkable images through the orbits including axial fat sat post enhanced series.All paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal pattern.

Output: 1.Stable post surgical/treatment changes of right frontal lobe astrocytoma.2.Unremarkable pre and post enhanced brain MRI otherwise and stable since prior study.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old, with new right leg numbness and weakness, and pancytopenia. Evaluate for nerve root compression, new or worsening vertebral compression fracture, hematoma or infection/abscess. Patient with history of myelofibrosis status post MUD stem cell transplant. Multiple heterogeneously T2 hyperintense cysts or lobules are seen involving the right sacral ala and right posterior iliac bone. These lesions were not evident on a hip MRI from 6/5/15, and no definite correlating lesions are seen on CT examinations from 8/26/14 or 2/12/2016. The lesions approach but do not appear to frankly encroach upon the sacral foramina.Vertebral body marrow signal is diffusely low on all sequences, findings compatible with myelofibrosis. A small area of fat signal intensity within the L3 vertebral body may represent a focus of presumed fatty marrow or a hemangioma.A compression deformity of the L2 vertebral body is seen with approximately 40% loss of vertebral body height. No marrow edema is detected suggesting that this is a chronic abnormality. The compression is new, however, when compared to a CT examination from 2014. There is mild posterior bowing of the compressed vertebral body, but this causes only mild narrowing of the spinal canal.No other compression deformities are seen. No areas of marrow edema are suspected. Apart from a mild kyphotic angulation centered at the compressed L2 body, spinal alignment is unremarkable.The visualized distal spinal cord, conus and nerve roots of the cauda equina are unremarkable. No epidural fluid collection or pathologic soft tissue process is seen. Prominent dorsal epidural fat is evident from L1 through L4.L1-2: No significant spinal canal or foraminal stenosis. Just below the disc level, posterior osseous bowing or retropulsion does cause mild effacement of the ventral thecal sac. L2-3: No significant spinal canal stenosis or neuroforaminal narrowing. L3-4: Mild facet arthropathy. No significant spinal canal or neuroforaminal stenosis. L4-5: Mild facet arthropathy. Mild disc bulging. No significant spinal canal stenosis. Minimal bilateral foraminal narrowing. L5-S1: Mild facet arthropathy. Mild disc bulging. No significant spinal canal stenosis. Mild left foraminal narrowing.

Output: 1.Multiple T2 hyperintense cysts or lobules are evident involving the right sacral ala and right iliac bone. No clear correlating lesions are seen on a recent CT examination from 2/12/2016, nor are any such lesions seen on older MRI examinations from 2015 and 2014. These lesions appear to be confined within the marrow space of the bone and do not significantly encroach upon the sacral nerve roots. One possible explanation is that these lesions represent intraosseous hemorrhage, possibly secondary to bone marrow biopsy or some other mild trauma. Follow-up CT of the pelvis can be considered to reevaluate for osseous integrity. In addition, the patient could return for postcontrast MRI imaging to assess for the possibility, albeit unlikely, of a neoplastic process.2.Bone marrow signal characteristics are diffusely abnormal compatible with patient's diagnosis of myelofibrosis. A moderate compression deformity of the L2 vertebral body is seen, though there is no marrow edema suggesting that it is chronic. No significant epidural pathology is suspected. No high-grade spinal canal or neuroforaminal stenosis is observed.


Instruction: Generate impression based on medical findings.

Input: 41-year-old female with knee pain. Assess for meniscal injury. MENISCI: There is linear signal abnormality within the posterior horn of the medial meniscus which extends to the tibial articular surface and body of the meniscus consistent with a horizontal cleavage tear. The anterior horn appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is mild chondromalacia affecting the articular cartilage along the lateral facet of the patella. No full-thickness or near full-thickness articular cartilage defects are identified.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Medial meniscus tear as described above.


Instruction: Generate impression based on medical findings.

Input: Male 73 years old Reason: rectal cancer staging History: As per chart, status post anterior resection for stage I rectosigmoid carcinoma in 2006, then with anastomotic recurrence and revision anterior resection and abdominoperineal resection in 2007. Overall image quality: FairPELVIS:PROSTATE/SEMINAL VESICLES: Numerous brachytherapy seeds are noted in the prostate.BLADDER: A pigtail catheter is noted extending from the right ureter, otherwise the bladder is unremarkable.LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: Patient is status post sigmoidectomy.There are multiple heterogeneous, peripherally enhancing lesions in the pelvis (series 7, image 21 and 26; series 12, images 148 and 157). The largest of these lesions lies between the right iliac vessels and right ureter, displaces the ureter medially, and measures 68 x 55 mm. There is internal septation with heterogeneous, dependent low T2 signal within this lesion. A second lesion sits immediately anterior to the sacrum, superior to the seminal vesicles, and measures 32 x 29 mm. This lesion also contains heterogeneous T2 hypointense signal. There is no masslike or nodular enhancement within these lesions. Additional, smaller lobulated areas of T2 hyperintensity (series 5, image 25) are also noted in the left hemipelvis along the pelvic wall.BONES, SOFT TISSUES: Small bilateral hydroceles.OTHER: No significant abnormality noted.

Output: Heterogeneous, peripherally enhancing complex cystic masses in the pelvis which are suspicious for disease recurrence, particularly of the mucinous subtype.


Instruction: Generate impression based on medical findings.

Input: Left knee instability MENISCI: There is maceration of the lateral meniscus with only a small remnant of the anterior horn remaining. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is severe full-thickness cartilage loss of the medial compartment of both the femoral condyle and tibial plateau. There is associated degenerative marrow edema in the underlying subchondral bone. There is moderate thinning of the articular cartilage of the medial compartment with areas of near full-thickness degeneration as well. There is heterogeneity and partial-thickness loss of the medial patellar facet and associated femoral trochlea. The articular cartilage of the lateral patellar facet is preserved.LIGAMENTS: The anterior cruciate ligament is absent. PCL is intact. The MCL is intact. The lateral collateral ligament complex is performed. EXTENSOR MECHANISM: There is increased signal and thickening of the distal portion of the patellar tendon with osteophyte formation of the anterior tibia. The quadriceps tendon is intact.ADDITIONAL

Output: 1. Ruptured ACL.2. Maceration of the lateral meniscus.3. Severe osteoarthritis of the lateral compartment with moderate changes noted in the medial and patellofemoral compartment.4. Rupture of the lateral collateral ligament complex.5. Large joint effusion and Baker's cyst containing small foci of low signal intensity which likely reflect a combination of synovitis and/or debris/loose bodies. 6. Thickening and increased signal of the distal portion of the patellar tendon which may reflect partial tearing or tendinosis.