Instruction: Generate impression based on medical findings.

Input: Diagnosis: Multiple sclerosisClinical question: MS, f/u progressionSigns and Symptoms: paresthesiasComments: 3T DCAM, Dr Javed MS protocol version 1.1, No DTI | There are multiple periventricular and subcortical white matter lesions as well as some cortically based lesions present some which are perpendicularly oriented to the lateral ventricles. Compared to the prior exam no new lesions are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Redemonstration and no change of multiple periventricular subcortical and cortical based lesions which would support the patient's diagnosis of demyelinating disorder.


Instruction: Generate impression based on medical findings.

Input: Acute mental status changes. Nonverbal. Question bleed. There is no evidence of intracranial hemorrhage, mass or or midline shift. Extensive areas of subcortical and periventricular white matter hypodensity likely represent small vessel ischemic disease, age indeterminate by CT. If there is concern for an acute stroke, an MRI may be considered for further evaluation. A lacunar infarct is noted in the left basal ganglia. Prominence of the sulci and ventricles is consistent with corticomedullary volume loss.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Small vessel ischemic disease, age indeterminate. No evidence of acute infarction by CT. However, an MRI may be considered if there is concern for acute stroke.


Instruction: Generate impression based on medical findings.

Input: Reason: HEADACHES: SARCOID: TREATED HIV: NOW SERO NEGATIVE History: FRONTAL HEADACHES: NORMAL SINUS SCOPE AND NORMAL EYE EXAM: HAS CHEST SARCOID. There is a punctate focus of susceptibility artifact along the left parietal cortex appearing unchanged and compatible with a chronic microhemorrhage or prominent vessel. The brain parenchymal signal is otherwise unremarkable. There is no restricted diffusion to suggest acute ischemic infarction. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is minimal mucosal thickening within the ethmoid air cells. The orbits, skull, paranasal sinuses, and scalp soft tissues are otherwise grossly unremarkable.

Output: No acute abnormality or specific findings to account for the patient's headaches. Please note that this examination does not include intravenous contrast, limiting sensitivity for findings of neurosarcoidosis.


Instruction: Generate impression based on medical findings.

Input: Epilepsy; planning for laser fiber placement. There has been interval removal of several transoccipital and transtemporal depth electrodes positioned from the right temporal lobe region with patchy enhancement along portions of the surgical tracks. There is also interval laser ablation of the right medial temporal lobe. There is no evidence of any substantial intracranial hemorrhage. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. There are postoperative changes in the skull and scalp.

Output: Operative-guidance MRI shows expected interval laser ablation effects in the medial right temporal lobe region.


Instruction: Generate impression based on medical findings.

Input: Reason: Metastasis to Cerebellum History: Gait instability with known metastatic lung cancer Nonenhanced head CT:There is no detectable abnormality of the cerebellum or the vermis on this non-infused head CT. The fourth ventricle and the cerebellar volume is within normal limits. If concern for metastatic lesion persist recommend contrast MRI.Images through supratentorial space demonstrate no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.Calvarium is intact.

Output: Negative nonenhanced head CT.


Instruction: Generate impression based on medical findings.

Input: Spells concerning for demyelinating disease: tremors and jerking. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are non-enhancing punctate foci of high T2 signal in the subcortical white matter of the left anterior insula and the anterior left temporal stem. There is a small developmental venous anomaly in the region of the left supramarginal gyrus. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Non-enhancing punctate foci of high T2 signal in the subcortical white matter of the left anterior insula and temporal stem are nonspecific. 2. Small developmental venous anomaly in the region of the left supramarginal gyrus.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old, with psychomotor slowness and right-sided hyperreflexia. Scattered Brain:Relatively proportional prominence of the lateral and third ventricles and the cerebral sulci is seen likely reflecting underlying parenchymal volume loss. The temporal horns of the lateral ventricles are not dilated. The fourth ventricle is within normal limits.Minimal periventricular T2 hyperintensity is seen which can be a normal finding in this age group. No evidence of any focal parenchymal lesion, edema or mass effect is observed. No diffusion restriction is seen. No findings to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collection are detected.C-spine:Exaggeration of the cervical lordosis is seen. A trace anterolisthesis of C6 relative to C7 is noted. Sagittal alignment is otherwise unremarkable.Vertebral body height and morphology are within normal limits. No evidence of marrow replacement or marrow edema is seen.The visualized spinal cord shows normal signal intensity and morphology throughout. No epidural abnormalities are suspected.The left thyroid lobe is questionably somewhat nodular. The paraspinal soft tissues are otherwise unremarkable.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Left facet arthropathy. No significant spinal canal stenosis or neuroforaminal narrowing. C4-5: Facet arthropathy. Loss of disc height and minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Moderate left foraminal narrowing. C5-6: Left greater than right facet arthropathy. No significant spinal canal stenosis. Moderate left foraminal narrowing. C6-7: Facet arthropathy. Minimal posterior disc-osteophyte complex formation. No spinal canal stenosis. Moderate left foraminal narrowing C7-T1: No spinal canal stenosis or neuroforaminal narrowing.

Output: 1.Proportionate prominence of the supratentorial ventricles and cerebral sulci is demonstrated most likely representing generalized parenchymal atrophy. No focal or acute intracranial lesions are detected.2.Relatively mild degenerative findings are seen in the cervical spine. No areas of high-grade spinal canal stenosis or spinal cord impingement are seen. At most, moderate foraminal narrowing is evident at several levels on the left.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old, with history of T-cell lymphoma and spinal metastases, status post extensive thoracic and lumbar spinal surgery, with chronic right lower extremity weakness. Dependent on walker/wheelchair, but able to ambulate at baseline. Now with worsened right lower extremity weakness and inability to ambulate. Cervical:There may be a mild curvature of the cervical spine in the coronal plane, but this could be positional. Sagittal alignment is unremarkable.Vertebral body height and morphology are within normal limits. No pathologic marrow replacement, edema or enhancement is seen.The visualized spinal cord demonstrates normal signal intensity and morphology. No pathologic cord or leptomeningeal enhancement is observed.Minimal disc degeneration is seen without significant compromise of the spinal canal or neural foramina.Thoracic:Evidence of instrumented posterior fusion is again seen beginning at T4 and continuing down to T11. The T8 vertebral body shows complete loss of height with artifact related to a spacer device within the right aspect of the vertebral body. These findings are unchanged from prior.The T10 vertebral body remains partially compressed with heterogeneous marrow signal, similar to prior. The remaining vertebral bodies demonstrate relatively unremarkable or only mildly heterogeneous marrow signal characteristics. No pathologic enhancement is suspected.A mild focal kyphosis is evident at the T3-4 level. A focal kyphosis is also evident at the T8 level. Anterior subluxation of T7 relative to T9 is unchanged.The spinal canal remains mildly narrowed at the T8 level due to vertebral body subluxation and and the compression deformity, but there is evidence of posterior decompression and the overall appearance is unchanged. Artifact from orthopedic instrumentation prevents accurate assessment for subtle cord signal abnormality, but no significant interval changes are suspected.No significant disc bulging or disc herniation is seen. The spinal canal is otherwise patent. The T8-9 neural foramina are not well visualized but are presumably significantly narrowed.Opacification possibly representing atelectasis is seen in the lung bases.Lumbar:Based on vertebral body counting from above, and the location of the last set of ribs, there are four lumbar type vertebral bodies.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement, edema or enhancement is seen.The visualized distal spinal cord, conus and nerve roots of the cauda equina are unremarkable. No pathologic intraspinal enhancement is suspected.The intervertebral disc spaces are preserved with no significant disc bulge or disc herniation identified. Facet hypertrophy develops at lower lumbar levels. The spinal canal and neural foramina remain patent.

Output: 1.Demonstration of findings related to extensive posterior instrumented fusion in the thoracic spine with a complete compression of the T8 vertebral body. The spinal canal may be mildly narrowed at this level, but has been decompressed posteriorly and the appearance is unchanged.2.Mild compression of the T10 vertebral body along with heterogeneous marrow signal characteristics suggesting treated disease are unchanged. No new compression deformity or pathologic marrow process is suspected.3.Relatively unremarkable evaluations of the cervical and lumbar spine with no new or significant findings to account for the patient's worsening symptoms.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Left lumbar radicular pain for 6 months. Signs and symptoms: As above. Nonenhanced lumbar MRI:The signal intensity of the vertebral column is unremarkable.The anatomical alignment of vertebral column is preserved.Lower most visualized thoracic spine and cord is unremarkable.T12-L1, L1-L2, L2-L3 levels are unremarkable.L3-L4 demonstrate mild disease and mild bilateral facet and ligamentum flavum hypertrophy without neural foraminal compromise or convincing evidence of central spinal stenosis.L4-L5 demonstrate mild to moderate left and mild right facet and ligamentum flavum hypertrophy and mild facet disease. There is a shallow right lateral disc protrusion with slight extension into the right lateral recess (axial T2 series 5 image 18 and sagittal T2 and T2 STIR images 6 through 8). This finding results in mass effect on the right lateral recess and right L5 nerve root. No spinal stenosis or significant neural foraminal compromise. No spinal stenosis and mild left neural foraminal compromise.L5-S1 demonstrate mild to moderate disc disease and loss of disc height, mild to moderate bilateral facet hypertrophic changes and mild bilateral ligamentum flavum hypertrophy. There is a broad-based central disc protrusion at this level which is in contact and slightly displaces the left S1 nerve root in the left lateral recess. No spinal stenosis or neural foraminal compromise.Unremarkable perispinal soft tissues.

Output: 1.Mild to moderate degenerative changes at L5-S1 and a central broad-based disc protrusion with subtle mass effect on the left lateral recess and left S1 nerve root.2.Shallow small right lateral disc protrusion at L4-L5 with resultant mass effect on the right lateral recess and right L5 nerve root.3.No central spinal stenosis or significant neural foraminal compromise at any level.


Instruction: Generate impression based on medical findings.

Input: Images are moderately limited by patient motion. Postoperative changes are again seen from previous Chiari decompression with tonsillopexy. The cervical syrinx has significantly improved, now essentially collapsed, measuring 7 x 2 mm in greatest axial dimensions at the lower C6 level. It previously measured up to 6 mm AP at the same level on prior available sagittal cervical spine images. The syrinx was most conspicuous spanning the C2 and C3 levels where it measured up to 7 mm AP, now essentially barely visualized. Discontinuous syrinx remains visualized down to the lower C7 level, similar in extent to previous exam. Additional upper thoracic component is not well assessed on the current images, but likely is grossly similar.The fourth ventricle previously measured 3.2 cm AP on 4/19/2016, now only 2.1 cm. There is also slight decreased size of the fourth ventricle compared to the more recent 4/26/2016 exam. There is interval resolution of dorsal bulging of the upper cervical cord at the level of the neo-foramen magnum, with now well visualized dorsal CSF space caudal to the remaining cerebellar tissue. Previous heterogeneous signal dorsally at the level of the neo-foramen magnum has resolved, likely postoperative. Upon CSF flow imaging, biphasic flow is identified through the third ventriculostomy site into the prepontine cistern, as well as in the cerebral aqueduct, fourth ventricle, and minimally dorsal to the cervicomedullary junction, although flow is slightly asynchronous. There has been improvement in flow along the dorsal aspect of the upper cervical cord.A curvilinear structure is seen along the superior margin of the right lateral ventricle which may represent granulation tissue or debris, as it is located just deep to an area of linear hyperintensity in the overlying brain parenchyma suggesting a possible surgical tract. The previous ventriculostomy catheter has been removed. Lateral and third ventricles are grossly stable in size.

Output: 1.Previous ventricular catheter has been removed. Evidence of third ventriculostomy with biphasic flow through the surgical defect. Lateral and third ventricles are grossly stable in size, with interval decreased dilatation of the fourth ventricle.2.Interval expected evolution of postoperative changes at the neo-foramen magnum improved visualization of dorsal CSF space at this level. Previously noted subtle bulging of the upper cervical cord has resolved. Overall, improved visualization of biphasic CSF flow at this level.3.Significant improvement in cervical syrinx, with grossly similar upper thoracic component suggest, incompletely assessed.


Instruction: Generate impression based on medical findings.

Input: 16-year-old male with wrist pain, ulnar sided. Evaluate TFCC. LIGAMENTS: We see no contrast extending from the radiocarpal joint into the midcarpal joint to indicate a tear of the scapholunate or lunotriquetral ligaments.TRIANGULAR FIBROCARTILAGE COMPLEX: Contrast extends from the radiocarpal joint through a small defect in the articular disc of the triangular fibrocartilage into the distal radioulnar joint. The defect is situated approximately 2 mm medial to the distal radius. The ulnar attachment of the triangular fibrocartilage appears intact as do the ulnolunate and ulnotriquetral ligaments.TENDONS: The flexor and extensor tendons appear intact. BONES: The bone marrow signal intensity is within normal limits.

Output: Tear of the articular disc of the triangular fibrocartilage just medial to its radial attachment.


Instruction: Generate impression based on medical findings.

Input: 73-year-old male patient with right knee pain. MENISCI: There is abnormal increased intrasubstance signal intensity in the posterior horn of the medial meniscus that is compatible with minimal intrasubstance degeneration without tearing.There is increased intrasubstance signal intensity in the body and posterior horn of the lateral meniscus with globular increased signal intensity in the posterior horn of the lateral meniscus at its root that extends to the tibial articular surface, compatible with a degenerative tear. Additionally, there is mucoid degeneration within the anterior horn attachment of the lateral meniscus with an adjacent small subchondral cyst in the tibial plateau that is likely degenerative in etiology.ARTICULAR CARTILAGE AND BONE: There is perhaps minimal subjective thinning of the articular cartilage, which is essentially within normal limits for age. We see no fluid-filled defects. Small osteophytes are noted. There is a small focus of abnormal signal intensity in the posterior aspect of the medial femoral condyle, which may represent a developmental defect, although the overlying articular cartilage appears intact.LIGAMENTS: The anterior cruciate ligament, posterior cruciate ligament, medial collateral ligament, lateral collateral ligament complex, and patellar retinacula are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Mild intrasubstance degeneration of the menisci with possible degenerative undersurface tearing of the root of the posterior horn of the lateral meniscus, the clinical significance of which is uncertain.2.Minimal osteoarthritis, which is commensurate for age, without fluid filled cartilage defect. 3.Other findings as above.


Instruction: Generate impression based on medical findings.

Input: Reason: R/O Worsening of DZ History: Known DJD of L spine, acute chronic back pain Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. No abnormal enhancing lesions are identified in the lumbar spine.At L5-S1 there is disk dessication and a broad based central disk extrusion which is associated with partial effacement of the fat at the lateral recesses - left more than right. Disk material extrudes behind the superior endplate of S1. There is mild encroachment of the nerve roots at the left lateral recess. Compared to the prior CT lumbar spine this has not changed significantly.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is minor disk bulge at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There are degenerative disk changes present at L5-S1 with broad-based disk protrusion resulting in mild encroachment of the nerve roots at the lateral recesses- left more than right. Compared to the prior CT lumbar spine this has not changed significantly.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old, with brain lesion, stereotactic examination requested for preoperative planning. An enhancing nodule with central necrosis or cystic material is redemonstrated within the right occipital lobe showing no significant interval change from the prior examination. As before, the lesion is suspected to be intra-axial but it does abut the dura. The lesion induces moderate local mass effect.No additional pathologic intracranial enhancement is suspected. Confluent extensive periventricular T2 hyperintensity is unchanged. An enhancing lesion within the right parieto-occipital calvarium is also unchanged.

Output: Presurgical planning examination redemonstrates an enhancing lesion within the right occipital lobe showing no significant interval change.


Instruction: Generate impression based on medical findings.

Input: Weakness, visual disturbances, evaluate for multiple sclerosis flare. Also history of pseudotumor. Again seen are multiple T2 hyperintense lesions in the supratentorial and infratentorial white matter consistent with known demyelinating disease. Compared to 3/31/2011, there is a new focus of flair hyperintensity involving the left posterior frontal periventricular white matter involving the left precentral gyrus, axial flair image 23/34. There is also a small T2/flair hyperintense focus lateral to the left frontal horn, axial T2 image 18 of 30, which is also new. There is a focus of T2/flair hyperintensity involving the subcortical right frontal white matter which is decreased in the interval. No abnormal enhancement. No restricted diffusion. No intracranial hemorrhage. No intracranial mass or mass-effect. There is global parenchymal volume loss which is advanced for age. Volume loss also is noted involving the corpus callosum. Multiple lesions with T1 hypointensity are also again seen.Dedicated orbital sequences were not obtained, however, no obvious abnormality is appreciated. Empty sella is again noted. There is mild mucosal thickening involving the paranasal sinuses. There is moderate opacification of the right mastoid air cells.

Output: 1. Chronic demyelinating disease involving the supratentorial and infratentorial white matter. There is evidence of progression with at least two new lesions in the left frontal white matter as detailed above compared to 3/31/2011. No abnormal enhancement to suggest active demyelination. 2. Partially empty sella which is a normal variant but can be seen with intracranial hypertension in the appropriate clinical setting.


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old. Reason: Osteo of the 2nd toe History: toe infection and pain There is abnormal bone marrow signal diffusely involving the second proximal and middle phalanges. Signal is decreased on T1-weighted images and increased on T2-weighted images, with enhancement of the bone marrow. The second distal phalanx and metatarsal have normal bone marrow signal. There is additional signal abnormality in the surrounding soft tissues. These findings are compatible with osteomyelitis.There is also abnormal signal at the head of the first metatarsal, with decreased signal on T1-weighted images and increased signal on T2-weighted images, with enhancement of the bone marrow. There is additional signal abnormality in the surrounding soft tissues. The mid and proximal first metatarsal and of the first phalanges have normal bone marrow signal. These findings are compatible with additional focus of osteomyelitis.The remainder of the bones appear normal. The visualized tendons and ligaments appear intact.

Output: Findings compatible with osteomyelitis involving the second middle and proximal phalanges as well as the first metatarsal head.


Instruction: Generate impression based on medical findings.

Input: Male, 6 years old, with seizures. EEG showed frequent right-sided discharges. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen. In particular, the mesial temporal lobe structures are symmetric and free of pathologic signal abnormality.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. Signal intensity of the bone marrow is unremarkable. Diffuse paranasal sinus opacification is seen.

Output: No specific findings are seen to account for the patient's seizures.


Instruction: Generate impression based on medical findings.

Input: Left arm, leg, eye twitching in setting of fever. There is a right choroid fissure cystic lesion that measures up to 15 mm, with compression of the hippocampus and mild surrounding T2 hyperintensity. There are small patchy areas of T2 hyperintensity in the bilateral periventricular regions, particularly in the parietal lobes, which may represent terminal zones of myelination. The ventricles are not enlarged. There is no evidence of intracranial hemorrhage or acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Findings compatible with a right choroid fissure arachnoid cyst with compression of the hippocampus. Nevertheless, follow up via MRI with contrast may be useful for further characterization.


Instruction: Generate impression based on medical findings.

Input: Osteomyelitis First digit (thumb): There is no evidence of osteomyelitis. There are osteoarthritic changes of the MCP joint.Second digit (index): There is abnormal signal intensity and enhancement of the distal and middle phalanges of the index finger as well as destruction of the base of the distal phalanx and the majority of the middle phalanx. There is inflammation and edema of the surrounding soft tissues with an enhancing tract extending to the dorsal surface of the digit. There is no definite fluid collection to suggest abscess within the distal index finger. There is enhancement along the flexor tendon apparatus that extends proximally to the level of the mid metacarpal. The flexor digitorum superficialis splits at the level of the of the distal diaphysis of the second metacarpal with both halves extending deep to the profundus tendon; this may represent a normal Camper's chiasm accentuated by tenosynovitis although the presence of a longitudinal split tearing of the tendon cannot be excluded. Arthritic changes at the second MCP joint are likely degenerative in etiology. There is mild enhancement and edema of the base of the proximal phalanx of the index finger which is thought to be secondary to the arthritic changes or reactive to the flexor tenosynovitis as opposed to osteomyelitis. Edema extends from the index finger into the thenar eminence with additional mild soft tissue inflammation of the remaining hand.Third digit (middle): There is amputation of the ring finger through the base of the middle phalanx. There is no evidence of osteomyelitis.Fourth digit (ring): There is chronic erosive deformity of the PIP joint but no marrow signal abnormalities to indicate osteomyelitis.Fifth digit (pinky): There is no evidence of osteomyelitis.Wrist: Multiple low signal intensity foci are noted within the carpal bones which likely reflect degenerative cysts or chronic erosions. There is no evidence of osteomyelitis. There is perhaps a small chronic erosion of the radial styloid, but marrow signal intensity of the visualized portions of the distal radius and ulna is normal. There is mild synovitis of the distal radioulnar joint and perhaps mild tenosynovitis along the extensor tendons of the first dorsal compartment.

Output: Osteomyelitis of the distal and middle phalanges of the index finger with tenosynovitis of the flexor apparatus and other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Right shoulder instability The examination is slightly limited by motion artifact.ROTATOR CUFF: There is slight increased signal intensity within the distal fibers of the supraspinatus may reflect mild tendinosis or articular surface fraying but there is no evidence of a rotator cuff tear. There is increased signal intensity within the insertional fibers of the subscapularis which is likely iatrogenic in nature related to the intra-articular injection. The caliber and signal intensity of the rotator cuff musculature is normal.SUPRASPINATUS OUTLET: Moderate osteoarthritis affects the acromioclavicular joint. There is no fluid within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Mild osteoarthritis affects the glenohumeral joint but alignment is normal. Again seen is truncation and irregularity of the anterior and anterior superior labrum reflecting tearing. The posterior labrum is intact.BICEPS TENDON: Evaluation of the intra-articular portion of the biceps tendon reveals slightly increased signal intensity just prior to the insertion of the long head of the tendon onto the glenoid. This may reflect mild tendinosis or minimal extension of labral tearing into the biceps pulley but the extra-articular portion of the biceps is normal.ADDITIONAL

Output: .1. Tearing of the anterior and superior labrum with perhaps slight extension into the biceps pulley.2. Mild tendinosis of the supraspinatus tendon without evidence of a full-thickness rotator cuff tear. There is increased signal intensity within the insertional fibers of the subscapularis which is thought to be most likely iatrogenic in nature but correlation with physical exam findings is recommended to exclude a true subscapularis cuff tear.3. Moderate osteoarthritis of the acromioclavicular joint.


Instruction: Generate impression based on medical findings.

Input: 18-year-old male patient status post cavernous malformation resection. Patient refused contrast during examination. There are postsurgical changes from a right frontal craniotomy for resection of right frontal vascular lesion/cavernous malformation. There is a surgical tract extending through the frontal lobe to the right periventricular region areas of signal void and susceptibility artifact, compatible air and blood product, as seen on prior CT. There is restrict diffusion along the surgical tract compatible with cytotoxic edema. There is a small amount of residual pneumocephalus anterior to the right frontal lobe. Again seen more superiorly is a right frontal lobe developmental venous anomaly coursing cranially into a curvilinear vascular malformation within the right superior frontal gyrus measuring approximately 9 x 6 mm, which on prior demonstrates significant enhancement which would be unusual for a cavernoma. Blooming artifact is again noted on susceptibility. Remainder of the brain parenchyma appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The right maxillary sinus, anterior ethmoids and right frontal sinus remain opacified.

Output: 1.Expected postoperative findings related to resection of right frontal lobe vascular lesion/possible cavernous malformation.2.Stable vascular malformation in the right superior frontal gyrus with chronic hemosiderin deposition. Catheter angiogram can better assess for arteriovenous shunting.3.Persistent right paranasal sinus disease.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old, with pain and paresthesias. Neck pain radiating to the upper extremities, right more than left. Alignment is anatomic. Vertebral body height and morphology are within normal limits. No evidence of marrow edema or marrow replacement is seen.The visualized spinal cord demonstrates normal signal intensity and morphology. No epidural abnormalities are suspected.C2-3: No spinal canal stenosis or foraminal narrowing. C3-4: Left facet arthropathy. Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Moderate to severe left foraminal narrowing. C4-5: Mild facet arthropathy. No significant spinal canal or foraminal stenosis. C5-6: Left greater than right facet arthropathy. Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis or foraminal narrowing.C6-7: Left facet arthropathy. No significant spinal canal or foraminal stenosis. C7-T1: No spinal canal stenosis or neuroforaminal narrowing.

Output: Relatively mild degenerative findings are seen with no areas of high-grade spinal canal stenosis. Facet arthropathy and minimal disc osteophyte formation do, however, contribute to a moderate to severe narrowing of the left C3-4 neural foramen.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old, with altered mental status. Assess for new stroke. No restricted diffusion is seen. Minimal scattered small foci of periventricular T2 hyperintensity are seen. No evidence of parenchymal edema or mass effect is detected. No intracranial hemorrhage or abnormal extra axial fluid collections is evident. The ventricular system is normal in size and morphology. Marrow signal is unremarkable. Minimal ethmoid air cell mucosal thickening is seen.

Output: 1.No evidence of acute ischemia or any other acute intracranial abnormality.2.No findings are seen to account for the patient's altered mental status.


Instruction: Generate impression based on medical findings.

Input: NF1 and frequent headaches and plexiform of left eyelid and orbit. Orbit: There is an infiltrative and enhancing left preseptal and postseptal mass, which does not appear to have significantly changed. There is mild mass effect upon the other left intraorbital structures. The left optic nerve is intact. The right orbits is unremarkable.Brain: There are new T2 hyperintense lesions in the anterior and posterior portions the corpus callosum, eccentric to the left, as well as a new T2 hyperintense lesion in the right cerebellar hemisphere white matter. Otherwise, many of the supratentorial and infratentorial T2 hyperintense lesions are unchanged. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. New bright spots related to neurofibromatosis type 1 in the anterior and posterior portions the corpus callosum, eccentric to the left, as well as a new bright spot in the right cerebellar hemisphere white matter. Otherwise, many of the supratentorial and infratentorial T2 hyperintense lesions are unchanged. 2. The left preseptal and postseptal plexiform neurofibroma has not significantly changed.


Instruction: Generate impression based on medical findings.

Input: There are postoperative findings related to left frontal lobe surgery for resection of recurrent left frontal lobe mass. There has been interval expansion of heterogenously enhancing tumor posteriorly to the surgical cavity, with extension of tumor across the midline via the corpus callosum. The degree of surrounding T2 hyperintensity has slightly increased as well. There are nonspecific punctate foci of susceptibility effect in the right parietal region. The ventricles and the basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is no evidence of acute infarct.

Output: Interval progression of the left frontal lobe glioblastoma with extension across the midline via the corpus callosum.


Instruction: Generate impression based on medical findings.

Input: 31 years year-old Female with multiple sclerosis.INDICATIONS: Reason: MS; f/u progression History: weakness. There is redemonstration of numerous bilateral periventricular and subcortical T2 hyperintense and T1 hypointense white matter lesions. Disease is also redemonstrated within the corpus callosum and scattered within the brainstem and middle cerebellar peduncle. There is stable mild enlargement of ventricles and sulci, consistent with global volume loss much greater than expected for age, although stable.There is no midline shift or herniation. The major cerebral flow voids are intact.

Output: Stable appearance of previously demonstrated demyelinating plaques. There is moderate T1 and T2 burden of disease, including infratentorial lesions.Stable diffuse global volume loss.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old, history of brain metastases and CVA, esophageal cancer, on chemotherapy, status post whole brain radiation therapy, assess response. Redemonstrated is evidence of left frontal craniotomy. A resection cavity within the subjacent frontal lobe as well as surrounding T2 hyperintensity are not significant changed. Enhancement along the margins of the cavity has also not significantly changed.Also seen is evidence of a prior small left posterior parietal craniotomy. Small areas of T2 hyperintensity within the subjacent left temporal lobe are unchanged. No pathologic enhancement is seen within this resection bed.Four previously demonstrated enhancing lesions are again seen involving the right orbital gyrus, the right medial temporal lobe, and both cerebellar hemispheres. There has been no significant interval change in the size or morphology of these lesions, and no significant change in the degree of surrounding T2 hyperintensity. Several punctate foci of cortically-based enhancement are again seen involving the right middle frontal gyrus, right parietal lobe, and in the left occipital lobe (see key images). Most of these have not significantly changed from prior, and some lesions which were seen on the prior exam are no longer evident. They all correspond to areas of acute ischemia as demonstrated on the examination of 10/9/14.Sequelae of prior bilateral watershed and cortical ischemia are redemonstrated within the cerebral hemispheres and cerebellum. T1 hyperintensity along the superior frontal sulci may reflect cortical laminar necrosis. No evidence of new acute ischemia is seen.Scattered small foci of T2 hyperintensity within the periventricular white matter are demonstrated, not significantly changed and likely representative of chronic ischemic injury. A diffuse ill-defined periventricular hyperintensity, particularly along the occipital horns, has mildly progressed and may reflect the secondary effect of radiation.

Output: 1. Multiple intracranial enhancing lesions presumed to represent metastases have not significantly changed from the prior exam. No definite evidence of any new metastatic lesion is seen.2. Sites of prior surgery in the left frontal and left temporal lobes demonstrate a stable appearance with no evidence to suggest recurrent/progressive disease.3. Fluctuating punctate foci of cortically-based enhancement correspond to the sites of prior ischemic injury, likely representing evolution of ischemic injury, perhaps compounded by the effects of radiation. Continued attention to these lesions will be necessary on subsequent studies.


Instruction: Generate impression based on medical findings.

Input: 55 years Female (DOB: 2/9/1961)Reason: weakness, waxing and waning, History: MS with increased weaknessPROVIDER NAME: SANDEEP PULIMI CHRISTINE S JUN MRI brain:There is redemonstration of multiple periventricular and subcortical T2 and FLAIR hyperintense and T1 hypointense small lesions some of which are perpendicular to the lateral ventricles. There are additional lesions redemonstrated in the right thalamus and right posterior pons. These appear stable since 12/24/15. There is no associated contrast enhancement with these lesionsNormal 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.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. There is redemonstration of multiple T2 hyperintense lesions in he cervical spinal cord at the C2 level right posteromedian, the C4 level right posterolateral and C5-6 level posterior midline. No abnormal enhancing lesions are identified in the cervical spine. There is straightening of the normal cervical curvature.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 neural foramina. There is a broad based disk protrusion at this level partially effacing CSF ventral and posterior to the spinal cord. There is loss of disk space height and disk dessication. There is mild to moderate spinal stenosis at this level.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a disk bulge and disk dessication at this level.At C6-7 there is no significant compromise to the neural foramina. There is a disk bulge and disk dessication at this level associated with partial effacement of spinal fluid ventral and posterior to the spinal cord compatible with mild spinal stenosis.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. There is a T2 hyperintense lesion along the posterior aspect of the spinal cord at the C6-7 level associated with local atrophy. This can be identified in 2009. Smaller lesions are present in the right posterolateral cord at C1 and C3-C4. These seen on the 2009 exam. There is no compromise of thoracic spinal canal or exiting nerve roots. No abnormal enhancing lesions are identified in the thoracic spine.

Output: 1.Periventricular, subcortical right thalamic and right pontine lesions compatible with demyelination are stable since December.2.There are multiple spinal cord lesions compatible with demyelination. These are stable since last March3.There are degenerative changes in the cervical spine with mild to moderate spinal stenosis at C4-5. These are stable since last March4.There are several thoracic spinal cord lesions present compatible with demyelination. These are unchanged since 2009.


Instruction: Generate impression based on medical findings.

Input: There is multilevel degenerative spondylosis with a disc-osteophyte complex at C3-4 with mild right neural foraminal stenosis and mild spinal canal stenosis. In addition, there is a posterior disc-osteophyte complex with mild spinal canal narrowing and bilateral moderate neural foraminal stenosis. There is also a a disc-osteophyte complex at C6-7 with a superimposed right paracentral disc extrusion that encroaches into the right neural foramen and mild indents the spinal cord. However, there is no abnormal spinal cord signal. The vertebral body and disc heights are preserved. There is no pathological enhancement.

Output: 1. Mild degenerative cervical spondylosis with a disc-osteophyte complex at C3-4 that results in mild right neural foraminal stenosis and mild spinal canal stenosis, a posterior disc-osteophyte complex with mild spinal canal narrowing and bilateral moderate neural foraminal stenosis, and at C6-7 with a disc-osteophyte complex superimposed right paracentral disc extrusion that encroaches into the right neural foramen and mild indents the spinal cord. 2. No evidence of cervical spine 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: Thoracic spine:There is a smooth, physiologic thoracic kyphotic curve. The vertebral body heights and disc spaces are maintained. Marrow signal intensity is benign throughout. The spinal cord has a smooth contour and is without focal atrophy, edema, or myelomalacia. There are no masses.T1/2 demonstrates no significant disc bulge or cord encroachment.T2/3 demonstrates no significant disc bulge or cord encroachment. T3/4 demonstrates no significant disc bulge or cord encroachment. T4/5 demonstrates no significant disc bulge or cord encroachment. T5/6 demonstrates no significant disc bulge or cord encroachment.T6/7 demonstrates no significant disc bulge or cord encroachment. T7/8 demonstrates no significant disc bulge or cord encroachment. T8/9 demonstrates no significant disc bulge or cord encroachment. T9/10 demonstrates no significant disc bulge or cord encroachment.T10/11 demonstrates no significant disc bulge or cord encroachment. T11/12 demonstrates no significant disc bulge or cord encroachment. T12/L1 demonstrates no significant disc bulge or cord encroachment. Lumbar spine:Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. The visualized intra-abdominal and paraspinal contents are unremarkable.L1/2: UnremarkableL2/3: UnremarkableL3/4: UnremarkableL4/5: UnremarkableL5/S1:There is a small central disc protrusion confined anterior epidural fat without nerve root sheath or thecal sac abutment, and no resulting stenosis.

Output: 1.Negative noncontrast thoracic spine MRI.2.L5/S1:There is a small central disc protrusion confined anterior epidural fat without nerve root sheath or thecal sac abutment, and no resulting stenosis.


Instruction: Generate impression based on medical findings.

Input: 27 years Female (DOB:5/8/1989)Reason: prior lesion in right occipital lobes (restricted diffusion, high T2 signal, mild enhancement), evaluate for evolution History: headachePROVIDER/ATTENDING NAME: HELENE G. RUBEIZ SERVICES ANCILLARY There is a 19 x 37 mm axial dimension cystic lesion anterior to the left temporal lobe which is associated with some mild expansion of the adjacent bony structures. This most likely represents an arachnoid cyst. It follows spinal fluid on all pulse sequences.Previously noted punctate lesion in the right occipital lobe is no longer visualized.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is an arachnoid cyst present in the left middle cranial fossa. It is stable.2.Previously noted punctate lesion in the right occipital lobe most likely representing a microinfarct is no longer visualized.


Instruction: Generate impression based on medical findings.

Input: 46 year old female patient with papillary carcinoma of the left breast s/p ultrasound core needle biopsy. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.There is a unifocal oval lesion with irregular margins and heterogenous enhancement in the 3 to 4 o'clock position in the left breast that measures 2.4 x 2.0 x 2.1 cm (AP X ML X CC) and contains biopsy clip artifact. No abnormal enhancement in the right breast.No abnormal lymph nodes are identified in either axillary region.

Output: Unifocal known cancer in the 3 to 4 o'clock position of the left breast without abnormal appearing axillary lymph nodes.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: Male, 14 years old, with neurofibromatosis type II, presenting with unsteadiness, right leg pain, and coordination problems. Brain and IACs:Solid enhancing tumors within both internal auditory canals are redemonstrated. Both lesions demonstrate a mild interval increase in size. For reference purposes, the lesion on the right measures approximately 10 x 6 mm, and previously measured approximately 6 x 4 mm.Thickening and abnormal enhancement of the cisternal segments of the bilateral fifth cranial nerves is also seen, right side more than left. These lesions have also become more conspicuous when compared to the prior examination. On the right this abnormal thickening and enhancement involves the cavernous sinuses as well.Patchy T2 hyperintensity and dysmorphism within the right lateral cerebral hemisphere is again seen without significant interval change. Smaller areas of signal abnormality are also unchanged within the left cerebellar in the superior. The cerebellar lesions are associated with foci of susceptibility which could reflect either mineralization, vascular structures or chronic hemosiderin deposition.A small focus of abnormal T2 hyperintensity and mild dysmorphism is seen within the left superior temporal gyrus. This region also shows minimal susceptibility effect and there is a small amount of ill-defined enhancement as well.No evidence of significant generalized mass effect is seen. No abnormal extra-axial fluid collections are detected. The ventricular system remains normal in size and morphology.A plaque-like enhancing lesion is evident along the left intraorbital optic nerve. This lesion was present on the prior examination and does not appear to have changed substantially.Spine:A large intradural extramedullary tumor is evident at the T4 level measuring up to 30 mm CC and 15 x 12 mm transaxial. The lesion enhances homogeneously and is relatively T2 hypointense. This lesion occupies nearly the entire spinal canal causing severe canal stenosis and severe cord compression. The cord is markedly flattened and displaced to the left anterior aspect of the spinal canal.At the C4 level, there is an enhancing intradural extramedullary tumor within the left lateral aspect of the spinal canal measuring up to 9 x 7 mm transaxial. This lesion exerts mild mass effect upon the spinal cord but without obvious cord edema.Numerous scattered small nodules ranging in size from punctate to 5 mm are seen along the conus and nerve roots of the cauda equina.Multiple foci of abnormal spinal cord signal, thickening and pathologic enhancement are seen including at the C2 and C3 levels and at the T2 and T3 levels.A few scattered areas of questionable foraminal and extraforaminal nerve root thickening are seen though none of these is large or discrete enough to allow for confident diagnosis of tumor.Allowing for a mild scoliotic curvature of the thoracic spine, alignment is anatomic. Vertebral body height and morphology are within normal limits. No concerning marrow signal abnormality is detected.

Output: 1.A large intradural extramedullary tumor is evident at the T4 level occupying nearly the entire spinal canal and causing a severe canal stenosis and severe cord compression. The signal characteristics of this lesion favor meningioma over nerve sheath tumor.2.A smaller intradural extra medullary tumor is evident within the left lateral aspect of the spinal canal at C4. This lesion causes only mild mass effect upon the spinal cord. The differential would include both nerve sheath tumor and meningioma.3.Numerous small enhancing nodules are seen along the conus and nerve roots of the cauda equina, likely representing small nerve sheath tumors.4.Multiple areas of abnormal cord thickening and enhancement are seen in the cervical and upper thoracic regions. These lesions are compatible with primary spinal cord neoplasms and statistically are most likely to represent ependymomas.5.Bilateral internal auditory canal nerve sheath tumors have mildly increased in size when compared to the prior examination.6.Nerve sheath tumors involving the bilateral fifth cranial nerves have also increased in size. Thickening and abnormal enhancement centered on the right cavernous sinus has also increased and may represent continuation of the nerve sheath tumor or meningioma.7.Scattered areas of parenchymal signal abnormality with mild dysmorphism of the overlying cortex and evidence of susceptibility are seen in both cerebellar hemispheres and in the left superior temporal gyrus. These lesions have not significantly changed from the prior examination and could represent areas of hamartomatous or dysplastic tissue. Low grade neoplasm is considered less likely.8.A small plaque-like enhancing lesion is evident along the intraorbital component of the left optic nerve. This lesion has not significantly changed and the differential would include meningioma versus nerve sheath tumor.


Instruction: Generate impression based on medical findings.

Input: Left finger numbness. Brain: There are several, at least 10, punctate cerebral white matter T2 hyperintense lesions. Some of these appear to be slightly larger than in 2010, although this may be attributable to differences in technique. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Cervical Spine: The spinal cord displays normal signal. There is lack of the usual cervical lordosis and a posterior disc-osteophyte complex at the C5-6 level that results in mild spinal canal stenosis. There are also smaller posterior disc-osteophytes at C4-5 and C6-7. There is a punctate perineural cyst in the left C5-6 neural foramen. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The paravertebral soft tissues are unremarkable. However, there is a left thyroid nodule that measures up to 15 mm, which is unchanged.

Output: 1. Some of the presumed intracranial demyelinating lesions appear to be slightly larger than in 2010, although this may be attributable to differences in technique. 2. No evidence of demyelinating lesions in the cervical spine.3. Lack of the usual cervical lordosis and a posterior disc-osteophyte complex at the C5-6 level that results in mild spinal canal stenosis. 4. Nonspecific left thyroid nodule, which is unchanged.


Instruction: Generate impression based on medical findings.

Input: ESRD status post renal transplant in 2005 who presents with PTLD in the CNS. There are postoperative findings related to left transfrontal biopsy. There is unchanged confluent T2 hyperintensity and susceptibility effect in the superior left frontal lobe without associated mass effect. There is also unchanged scattered cerebral white matter T2 hyperintensity, particularly in a periventricular distribution. 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 orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged, including a left occipital scalp lipoma.

Output: Unchanged areas of cerebral white matter signal abnormality that may represent treatment effects that are perhaps superimposed upon mild chronic small vessel ischemic disease, without evidence of recurrent PTLD, although the assessment is limited due to the lack of intravenous contrast.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Cerebral infarction due to unspecified occlusion or stenosis of left anterior cerebral arteryClinical question: please check vessel patencySigns and Symptoms: right sided weakness MRI of the brainA focus of diffusion restriction measuring approximately 7 mm in size is present along the posterior limb of the left internal capsule extending to involve the basal ganglia. This is associated with some T2 and FLAIR signal hyperintensity.There are subcentimeter foci of T2 and FLAIR signal hyperintensity present in the thalami, basal ganglia and cerebellar hemispheres bilaterally without associated diffusion restriction. There are patchy foci of T2 and FLAIR signal hyperintensity in the pons.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The right vertebral artery flow-void is absent, though the right vertebral artery is identified and is small.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. There is fetal origin of the posterior cerebral arteries bilaterally. The P1 segments are medium-sized. The right vertebral artery is not readily identified.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is mild narrowing at the proximal left vertebral artery. This is approximately 30% narrowing.The right vertebral artery is diminutive and stenotic proximally. It is not identified above the C1 level.

Output: 1.Subacute lacunar infarction involving the posterior limb of the left internal capsule.2.Multiple lesions in the basal ganglia, cerebellum and thalami which are compatible with prior lacunar infarcts3.Patchy lesions in the brainstem as well as periventricular and subcortical white matter lesions are present which are most likely vascular related.4.Findings suggest occlusion of the right vertebral artery distally.


Instruction: Generate impression based on medical findings.

Input: New diagnosis of adenocarcinoma of lung; staging MRI of brain. There are multiple, approximately 20, ring-enhancing supratentorial and infratentorial lesions. For example, the largest supratentorial lesion is located in the left occipital lobe and measures up to 18 mm and the largest infratentorial lesion is located in the right cerebellar hemisphere and measures up to 12 mm. There is no significant associated vasogenic edema and no evidence of acute intracranial hemorrhage. There is a background of mild scattered nonspecific foci of cerebral white matter T2 hyperintensive, but no evidence of acute infarct. The ventricles and sulci are mildly prominent diffusely due to cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and paranasal sinuses are grossly unremarkable. There is a left occipital scalp lipoma that measures 5 mm in thickness.

Output: Multiple supratentorial and infratentorial lesions are compatible with metastases, but no evidence of midline shift or acute intracranial hemorrhage.Discussed with Dr. Maitland at 11 AM on 5/13/15.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old, with low back pain in the setting of lung adenocarcinoma. Numerous patchy areas of T1 hypointense and STIR hyperintense marrow replacement are seen involving most of the visualized vertebral bodies with the possible exception of L1. The sacrum and iliac bones are also involved. Vertebral body heights are preserved. Within the limitations of a noncontrast examination, no evidence of significant epidural involvement is seen. Spinal alignment is anatomic.The distal spinal cord, conus and nerve roots of the cauda equina are unremarkable except as discussed below. No specific epidural abnormalities are identified.L1-2: Mild facet hypertrophy and ligamentum flavum thickening. Minimal disc bulging. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. L2-3: Facet hypertrophy and ligamentum flavum thickening. Disc bulging. Mild spinal canal stenosis. Mild bilateral foraminal narrowing. L3-4: Facet hypertrophy and ligamentum flavum thickening. Disc bulging with a superimposed central superiorly directed extrusion. Severe spinal canal narrowing with effacement of CSF and crowding of the cauda equina. Moderate left and mild right foraminal narrowing. L4-5: Facet hypertrophy and ligamentum flavum thickening. Mild disc bulging. No significant spinal canal stenosis. Moderate bilateral foraminal narrowing.L5-S1: Facet hypertrophy and ligamentum flavum thickening. Mild disc bulging. No spinal canal stenosis. Moderate to severe right and moderate left foraminal narrowing.

Output: Numerous areas of marrow replacement are seen involving the lumbar spine, sacrum and iliac bones which are highly suspicious for metastatic foci. No compression deformities are noted. Within the limitations of a noncontrast examination, no evidence of significant epidural disease involvement is seen.Multilevel degenerative findings are also demonstrated, most significantly affecting the L3-4 level where there is a severe generalized spinal canal stenosis. Scattered variable foraminal narrowing is also present, most significantly affecting the right L5-S1 foramen.


Instruction: Generate impression based on medical findings.

Input: History of right lumpectomy for breast cancer. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally. Postsurgical volume loss of the right breast is noted.No abnormal enhancement is seen in either breast. Postsurgical changes are again noted in the right outer breast, but no suspicious nodular enhancement is seen surrounding the surgical site. Normal intramammary lymph node again noted in the left outer breast posteriorly. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on medical findings.

Input: Evidence of migraines with "worst HA of life" and associated dizziness, nausea, and blurry vision yesterday. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.

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


Instruction: Generate impression based on medical findings.

Input: Meningioma, yearly follow up: evaluate for change in size. There is no significant interval change in the dural-based mass along the superior left frontoparietal convexity mass, which measures 19 AP x 23 RL x 18 SI mm, although assessment is somewhat limited by the lack of intravenous contrast. There is mild mass effect upon the underlying brain parenchyma, but no evidence of associated vasogenic edema. The mass appears to be separated from the superior sagittal sinus. There are unchanged nonspecific mild scattered punctate foci of T2 hyperintensity within the cerebral white matter, which likely represent small vessel ischemic disease. There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles are stable in size and configuration. There is no midline shift or herniation. The extracranial soft tissues are unremarkable, including a small right maxillary sinus retention cyst.

Output: No significant interval change in the left frontoparietal convexity mass, which likely represents a meningioma.


Instruction: Generate impression based on medical findings.

Input: Male; 68 years old. Reason: R/O HCC History: Hx TACE/RFA, HCV, cirrhosis LIVER, BILIARY TRACT: Nodular liver contour is compatible with cirrhosis.Wedge shaped defect in segment 2/3 is compatible with the patient's chemoembolization/ablation defect. There is a lesion within the ablation bed that demonstrates intrinsic high T1 signal and measures up to 1.1 x 1.0 cm, unchanged (series 901/241). Again, there is questionable arterial enhancement and washout (only on subtraction images), and as a result, the lesion remains indeterminate and continued imaging follow-up is recommended.An additional nodular lesion near the ablation zone in segment 4 also demonstrates high T1 signal and mild enhancement without definite washout. This lesion measures 1.1 x 1.0 cm, unchanged (series 903/248).Near the dome of the liver, there is a T1 hyperintense, T2 hypointense lesion that does not demonstrate enhancement and measures 1.1 x 0.9 cm, unchanged and again most compatible with a dysplastic nodule (series 901/356). An additional punctate T1 hyperintense lesion in the right hepatic lobe is too small to accurately characterize and may be an additional dysplastic nodule (series 901/111).No biliary ductal dilatation. Patent hepatic vasculature. SPLEEN: Mild splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No significant interval change in post therapy changes of the liver. Segment 2/3 ablation bed lesion is again indeterminate, but stable, and continued imaging follow-up is recommended. Close attention on follow-up for additional T1 hyperintense lesions described above is also recommended.


Instruction: Generate impression based on medical findings.

Input: Reason: hx of IPMN. Needs f/u MRCP. Last ercp 2013 History: Doing well other than recent diarrhea. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: The main pancreatic duct is nondilated. There are multiple cystic lesions within the pancreatic head, neck and body which communicates with the main pancreatic duct, likely representing side branch IPMNs. A lesion in the pancreatic head measures 5 mm (8/27) and is new from the prior exam. A lesion in the pancreatic body measures 5 mm (8/66) and is unchanged. Additional smaller lesions are present within the pancreatic body which are also unchanged. Anteroinferior cystic lesions without definite ductal communication are nonspecific (8/47). No abnormal enhancement.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small hiatal hernia.BONES, SOFT TISSUES: Focus along the crus of the right diaphragm with intrinsic T1 hyperintensity may represent an old focus of hemorrhage from prior surgery.OTHER: Cystic dilatation of multiple nerve roots in the spine.

Output: Multiple sidebranch IPMNs measuring up to 5 mm without suspicious features. A pancreatic head lesion is new from the prior exam. Pancreatic body lesions are not significantly changed.


Instruction: Generate impression based on medical findings.

Input: Left upper extremity radiculopathy Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is benign.The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: There is a disc osteophyte complex with uncovertebral hypertrophy resulting in moderate left-sided neural foraminal stenosis. No significant spinal canal or right neural foraminal narrowing.C3-4: Small disc osteophyte complex with uncovertebral hypertrophy results in no significant spinal canal stenosis. There is mild to moderate right and mild left neural foraminal stenosis.C4-5: Left paracentral disc osteophyte complex and uncovertebral hypertrophy, left greater than right. There is mild to moderate stenosis involving the left aspect of the spinal canal at this level including mild impression on the left ventral aspect of the cord. There is moderate to severe left and moderate right neural foraminal stenoses.C5-6: Disc osteophyte complex including bilateral uncovertebral hypertrophy. There is mild spinal canal stenosis, particularly on the left. There is severe left and moderate to severe right neural foraminal stenosis.C6-7: Disc osteophyte complex with uncovertebral hypertrophy. There is moderate to severe left and moderate right neural foraminal stenosis. No significant spinal canal stenosis.C7-T1: No significant compromise to the spinal canal. There is bilateral uncovertebral hypertrophy. There is mild bilateral neural foraminal narrowing.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Multilevel degenerative changes in the cervical spine. There is mild to moderate spinal canal stenosis involving the left aspect of the spinal canal at the C4-C5 level and to a lesser degree at the C5-C6 level. No cord signal abnormality.2. There is multilevel neural foraminal stenoses, relatively worse at the C4-C5, C5-C6, and C6-C7 levels. Please see details above.


Instruction: Generate impression based on medical findings.

Input: 54 year old presenting for evaluation of atypical chest pain MEDICATIONS: no cardiac medications First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. Left VentricleThe left ventricle is normal in size with systolic function. The overall LV ejection fraction is 63%, the LV end diastolic volume index is 71 ml/m2 (normal range: 65+/-11), the LVEDV is 140 ml (normal range 109+/-23), the LV end systolic volume index is 26 ml/m2 (normal range 18+/-5), the LVESV is 51 ml (normal range 31+/-10), the LV mass index is 27 g/m2, and the LV mass is 53 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 68%, the RV end diastolic volume index is 69 ml/m2 (normal range 69+/-14), the RVEDV is 136 ml (normal range 110+/-24), the RV end systolic volume index is 22 ml/m2 (normal range 22+/-8), and the RVESV is 43 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.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 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. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 63%).4. Normal RV size and systolic function (RVEF 68%).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: New onset headache with syncope and weakness. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

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


Instruction: Generate impression based on medical findings.

Input: Multiple sclerosis and lower extremity weakness. Brain: There are multiple supratentorial and infratentorial T2 hyperintense lesions. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.Spine: There are diffuse patchy T2 hyperintense lesions within the cervical spinal cord, which are not significantly changed. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There are prominent posterior disc-osteophyte complexes at T5-6, T6-7, and T9-10, which indent the spinal cord. The thoracic spinal cord signal otherwise appears unremarkable. The paravertebral soft tissues are unremarkable.

Output: 1. No significant interval change of the demyelinating lesions in the brain.2. No significant interval change of the demyelinating lesions in the spinal cord.3. Prominent posterior disc-osteophyte complexes at T5-6, T6-7, and T9-10, which indent the spinal cord.


Instruction: Generate impression based on medical findings.

Input: Male, 83 years old. Right shoulder pain. ROTATOR CUFF: The rotator cuff tendons are intact, without evidence of tear. There is no significant atrophy of the rotator cuff muscles. There are multiple subcortical cysts along the rotator cuff insertions on the humeral head, likely degenerative in etiology.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. There is trace fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There degenerative changes of the glenohumeral joint with subchondral cysts in the glenoid. Anterior and posterior horns of the labrum are irregular compatible with degeneration. There is a small amount of fluid within the joint.BICEPS TENDON: The tendon of the long head of the biceps is normal in course and morphology. ADDITIONAL

Output: 1.No evidence of rotator cuff tear.2.Osteoarthritis of the shoulder with associated labral degeneration as above.


Instruction: Generate impression based on medical findings.

Input: Question new onset seizure. LD, ADHD. There is a suprasellar solid/cystic mass extending into the third ventricle and left frontal horn. The mass contains punctate areas of calcification. The mass extends posteriorly causing effacement of the midbrain and the quadrigeminal cistern. There is bony remodeling of the sella. This mass most likely represents a craniopharyngioma, and an MRI is recommended for further evaluation. There is mild leftward midline shift. No evidence of intracranial hemorrhage.The lateral ventricles are mildly dilated.An air-fluid level is present in the left sphenoid sinus. The remaining visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Suprasellar solid/cystic mass as described above. This most likely represents a craniopharyngioma and an MRI is recommended for further evaluation.


Instruction: Generate impression based on medical findings.

Input: 14-year-old with history of Guillain Barre and left temporal lobe masslike lesion: 3 month follow-up exam. There is persistent diffuse T2 hyperintensity in the head and body of the left hippocampus associated with minimal swelling and poorly defined internal architecture. There is no associated restricted diffusion or contrast enhancement. There is no abnormal signal or enhancement elsewhere in the brain. There is no evidence of intracranial hemorrhage or acute infarction. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major intracranial vascular flow voids are intact. There is a small amount of residual mucosal thickening in the left sphenoid sinus. The orbits are unremarkable.

Output: 1. Persistent left hippocampus lesion. Differential considerations include a low grade neoplasm and a form of dysplasia, for example.2. Diminished findings related to sinusitis.


Instruction: Generate impression based on medical findings.

Input: Migraine, unspecified, intractable, without status migrainosus [G43.919] / Other abnormal findings on diagnostic imaging of central nervous system [R90.89], Reason for Study: ^Reason: please do dr javed MS protocol compare to prior History: severe headache. Redemonstration of multiple scattered FLAIR/T2 high signal intensity lesion on bilateral periventricular white matter including right corona radiata lesion (series 901, image 108) which shows punctate contrast enhancement, unchanged in terms of approximate number, extent and size since prior scan. Again these findings are non specific thus differential diagnosis include demyelination, inflammatory conditions, vasculitis and ischemic lesions.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: Multifocal scattered FLAIR/T2 high signal intensity lesions on bilateral periventricular white matter including a punctate enhancing lesion on the right side corona radiata, unchanged since prior scan.


Instruction: Generate impression based on medical findings.

Input: Multiple cystic lesions to thighs bilaterally and varicosities to lower legs. Left tibia/fibula: Bone marrow signal is within normal limits. There are numerous serpiginous vascular structures within the soft tissues communicating with veins compatible with varicose veins. No abnormal enhancing mass lesion is identified. The musculature appears normal.Right tibia/fibula: Bone marrow signal is within normal limits. There are numerous serpiginous vascular structures within the soft tissues communicating with veins compatible with varicose veins. No abnormal enhancing mass lesion is identified. The musculature appears normal.

Output: Bilateral varicose veins.


Instruction: Generate impression based on medical findings.

Input: Female 53 years old Reason: eval cord pathology including myelitis, demyelination, mass lesions, etc History: weakness, neurogenic bladder Postsurgical change lower lumbar spine with pedicle screws and lumbar fusion. The right S1 pedicle screw traverses close to the right S1 foramina. Postsurgical changes from bilateral total hip arthroplasties. There is mild red marrow recruitment involving the osseous structures of the pelvis. No suspicious sclerotic or lytic lesions. Imaged thecal sac within the pelvis is unremarkable.Mild age-related muscle atrophy. No pelvic lymphadenopathy.Urinary bladder is decompressed by Foley catheter.

Output: Etiology for the patient's urinary incontinence is not evident on the current exam of the pelvis.


Instruction: Generate impression based on medical findings.

Input: 68 year old male with pain. Evaluate for infection. TENDONS: There is circumferential fluid signal intensity about the flexor hallucis longus tendon suggesting tenosynovitis.ARTICULAR SURFACES AND BONE: Degenerative changes affect the third tarsalmetatarsal joint. No bone marrow signal abnormality is identified to suggest osteomyelitis.ADDITIONAL

Output: 1. Soft tissue edema about the mid and forefoot as described above. Superimposed infection cannot be excluded. There is no evidence to suggest osteomyelitis. 2. Subcentimeter focus of nonenhancing fluid signal abnormality within the interspace of the first and second metatarsals may represent a mild bursitis. Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Check for peroneal tendon and ATFL tear TENDONS: No significant abnormality noted. The tendons and peroneal tendons specifically are well visualized and uniform throughout.LIGAMENTS: No significant abnormality noted. Specifically the ATFL is observed and intact. In addition, the posterior talofibular ligament is also uniform and intact.ARTICULAR SURFACES AND BONE: No significant abnormality noted. ADDITIONAL

Output: Os trigonum with an associated adjacent ganglion cyst. Appearance can be associated with mild posterior ankle impingement.


Instruction: Generate impression based on medical findings.

Input: 64 year old male with extensive CAD (3v CABG 2015, VF arrest/STEMI with PCI to SVG-RCA 11/2015), HTN, hyperlipidemia presenting for evaluation of viability and ischemia prior to possible revascularization. MEDICATIONS: atorvastatin, aspirin, carvedilol, amiodarone, lisinopril, ticagrelolor First Pass PerfusionDuring hyperemia, perfusion defects were present in the mid inferolateral and basal infero-septal, inferior, inferolateral and lateral walls. Viability/ Myocardial ScarThere was late gadolinium enhancement noted in the apical-mid inferior wall (<50%), and mid to basal lateral and inferolateral walls (approximately 50%) subendocardial late gadolinium enhancement in a pattern typical for myocardial infarction; there is a focal area of delayed hyperenhancement within the mid inferolateral wall which is transmural, best seen on 3 chamber images. The areas with 50% wall thickness LGE are unlikely to be viable and the area of <50% is of intermediate likelihood of being viable. The remaining myocardium is likely to be viable. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 65%, the LV end diastolic volume index is 58 ml/m2 (normal range: 74+/-15), the LVEDV is 110 ml (normal range 142+/-34), the LV end systolic volume index is 20 ml/m2 (normal range 25+/-9), the LVESV is 38 ml (normal range 47+/-19), the LV mass index is 57 g/m2, and the LV mass is 109 g. There is hypokinesis present in the basal inferior and inferolateral walls. . Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 69%, the RV end diastolic volume index is 56 ml/m2 (normal range 82+/-16), the RVEDV is 106 ml (normal range 142+/-31), the RV end systolic volume index is 17 ml/m2 (normal range 31+/-9), and the RVESV is 32 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 no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.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 are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsNonacute right anterior rib fractures, likely from previous CPR. 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. Perfusion defects were present in the mid inferolateral and basal infero-septal, inferior, inferolateral and lateral walls.2. Late gadolinium enhancement noted in the apical-mid inferior wall (<50%), and mid to basal lateral and inferolateral walls (approximately 50%) subendocardial late gadolinium enhancement in a pattern typical for myocardial infarction; there is a focal area of delayed hyperenhancement within the mid inferolateral wall which is transmural, best seen on 3 chamber images. The areas with 50% wall thickness LGE are unlikely to be viable and the area of <50% is of intermediate likelihood of being viable. The remaining myocardium is likely to be viable. 3. Normal LV size and systolic function (LVEF 65%). There is hypokinesis present in the basal inferior and inferolateral walls. 4. Normal RV size and systolic function (RVEF 69%).


Instruction: Generate impression based on medical findings.

Input: There is straightening of the cervical spine. The osseous marrow signal is within normal limits. The vertebral body heights and are preserved. There is mild loss of normal T2 signal in all cervical disks. The cervical cord caliber and signal are within normal limits.C2-3: No disk/endplate degenerative change or spinal stenosis.C3-4: No disk/endplate degenerative change or spinal stenosis.C4-5: No disk/endplate degenerative change or spinal stenosis.C5-6: No disk/endplate degenerative change or spinal stenosis.C6-7: No disk/endplate degenerative change or spinal stenosis.C7-T1: No disk/endplate degenerative change or spinal stenosis.The imaged upper thoracic spine shows no disk herniation, or spinal stenosis. The flow-voids in the cervical spine are intact.

Output: No spinal stenosis or cord signal abnormality.


Instruction: Generate impression based on medical findings.

Input: 64 years Male (DOB:4/16/1952)Reason: patient with sharp pain in buttocks. Concern for neuropathic pain. Concerned for L3-L4-L5 disc disease History: patient with sharp pain in buttocks. Concern for neuropathic pain. Concerned for L3-L4-L5 disc diseasePROVIDER/ATTENDING NAME: JAMES J. CURRAN JAMES J. CURRAN 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. A T1 hyperintense lesion is present at T12 measuring approximately 15 mm in diameter most likely represents a vertebral body hemangioma.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a broad-based central disc protrusion at this level associated with some facet hypertrophy of a moderate degree.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is moderate bilateral facet hypertrophy present at this level. There is some loss of disc space height, disc desiccation and a disc bulge at this level. There is mild encroachment of the nerve roots of the right lateral recess at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is moderate facet hypertrophy at this level. There is a diffuse disc bulge present at this level associated with loss of disc space height and disc desiccation. There is some mild crowding of nerve roots within the thecal sac at this level. Overall there is a mild degree of spinal stenosis present at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina. There are some mild ligamentum flavum thickening at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: There are multilevel degenerative changes present in the lower lumbar spine with a mild degree of spinal stenosis at L3-4 and some mild encroachment of the right-sided nerve roots at the right lateral recess due to degenerative changes.


Instruction: Generate impression based on medical findings.

Input: Unspecified cerebral artery occlusion with cerebral infarction [434.91], Reason for Study: ^Reason: 72F with h/o CVA with altered mental status History: AMS Redemonstration of restricted diffusion on the left frontal lobe middle and inferior frontal gyri indicating subacute ischemic infarct. The degree of restricted diffusion has been reduced indicating normal evaluation process of acute ischemic infarct. No evidence of hemorrhage transformation.Redemonstration of multifocal chronic ischemic infarct with encephalomalacia involving right frontal lobe, right temporal occipital lobe, left occipital lobe left precuneus. Extensive nonspecific small vessel ischemic lesions, again do not show any significant interval 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: Evolving right frontal lobe middle and inferior frontal gyri subacute ischemic infarct without evidence of hemorrhagic transformation.No interval change of multifocal chronic ischemic infarct with encephalomalacia since prior scan.No change of extensive nonspecific small vessel ischemic disease.


Instruction: Generate impression based on medical findings.

Input: The left cerebellar tonsil extends 4 mm below the level of the foramen magnum, and the right 5 mm. Both maintain a normal rounded morphology.The ventricles and sulci are normal in size. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: 1.The left cerebellar tonsil extends 4 mm below the level of the foramen magnum, and the right 5 mm. Both maintain a normal rounded morphology. This constellation of findings is indeterminate, but the differential diagnosis is cerebellar ectopia versus Chiari malformation, with distinction requiring correlation with symptoms.2.Otherwise negative MRI of the brain including gadolinium enhancement.


Instruction: Generate impression based on medical findings.

Input: 11 year old female with dilated common bile duct on serial ultrasound, no elevation of LFTs ABDOMEN:LIVER, BILIARY TRACT: Normal hepatic morphology. There is mild fusiform dilatation of the mid common bile duct measuring up to 8 mm in diameter over a length of approximately 2 cm. No intrahepatic or ductal dilatation. The gallbladder appears moderately distended and otherwise otherwise normal.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Symmetric renal enhancement without 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: Mild fusiform dilatation of the mid common bile duct, which may represent a normal variant or type I choledochal cyst.


Instruction: Generate impression based on medical findings.

Input: Reason: 64 yo with biliary dilation noted on MRI History: abd pain ABDOMEN:LIVER, BILIARY TRACT: There is dilatation of the common bile duct to the level of the ampulla measuring up to 1 cm, similar to the prior exam. Soft tissue prominence at the ampulla is unchanged. Severe intrahepatic biliary ductal dilatation is unchanged. Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic duct is normal in caliber.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: T2 hyperintensities, likely cysts.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: Dilatation of the common bile duct to 1 cm and severe intrahepatic biliary ductal dilatation is stable. There is soft tissue prominence at the ampulla which is also unchanged.


Instruction: Generate impression based on medical findings.

Input: Altered mental status [780.97], Reason for Study: ^Reason: PT with recent bacteremia now altered mental status. Concern for CNS infection. History: PT with recent bacteremia now altered mental status. Concern for CNS infection. Motion artifacts degraded exam quality.There are restricted diffusion areas including on the left caudate nucleus head and bilateral internal capsule as well as right thalamus mesial aspect indicating acute ischemic infarct.There is no evidence of acute hemorrhagic lesion on the scan.Focal susceptibility artifacts on the left frontal lobe, no change since prior exam. Underlying brain shows minimal to mild diffuse brain atrophy which is age appropriate.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 are clear. There is opacification on the left mastoid air cell.

Output: Acute ischemic infarcts without hemorrhagic transformation on bilateral internal capsule, left caudate nucleus and right thalamus mesial aspect as described above.


Instruction: Generate impression based on medical findings.

Input: 46-year-old female with enlarged uterus, bulk symptoms. Evaluate for uterine fibroids, fertility preservation. Operative planning. PELVIS:UTERUS, ADNEXA: The uterus has a lobulated contour and is markedly enlarged measuring up to 19.4 cm in transverse, 11.6 cm in AP, and 23.7 cm in length. The enlarged uterus causes deviation of the urinary bladder and sigmoid colon anteriorly and to the right.Numerous T2 hypointense urine fibroids are noted, and the 2 largest uterine fibroids are listed for reference:The fibroid in the left lateral uterine fundus measures 8.4 cm in AP, 8.2 cm in transverse, and a 10.8 cm in craniocaudal diameter (axial series 5 image 17, coronal series 6 image 25). This fibroid is primarily subserosal in location, and internal degenerating components are noted on postcontrast sequences (series 11 image 259).The fibroid in the posterior lower uterine segment measures 8.1 cm in AP, 9 cm in transverse, and 8.2 cm in craniocaudal diameter (axial series 5 image 34, coronal series 6 image 24). This fibroid is favored to have submucosal and intramural components.The bilateral ovaries are difficult to reliably visualized.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Trace free fluid in the dependent pelvis is likely physiologic.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Markedly enlarged uterus containing multiple fibroids as described above.


Instruction: Generate impression based on medical findings.

Input: A surgical defect is noted involving the right parietal lobe, specifically containing an encephalomalacic cavity lined with hypointensity, most prevalent on susceptibility technique. A small developmental venous anomaly is immediately posterior. Expected overlying calvarial changes are evidence of the prior craniectomy.There are several other punctate lesions identified on susceptibility weighted imaging throughout the supratentorial and infratentorial brain, none of which demonstrate mass effect or perilesional edema.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There is no mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for acute intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: 1.A surgical defect is noted involving the right parietal lobe, specifically containing an encephalomalacic cavity lined with hypointensity, most prevalent on susceptibility technique, consistent with resection of a cerebral cavernous malformation. A small developmental venous anomaly is immediately posterior. 2.There are several other punctate lesions identified on susceptibility weighted imaging throughout the supratentorial and infratentorial brain, none of which demonstrate mass effect or perilesional edema, consistent with cerebral cavernous malformations.


Instruction: Generate impression based on medical findings.

Input: Syncope. The left parieto-occipital region intraparenchymal hematoma from January 2016 has resolved, leaving encephalomalacia and hemosiderin staining at the site, and there is no evidence of acute infarction or mass. There is diffuse patchy cerebral and pontine white matter T2 hyperintensity and a punctate focus of encephalomalacia in the right thalamus. There is a punctate focus of susceptibility effect in the left cerebellar hemisphere, which may represent a chronic lacunar infarct. There is a small developmental venous anomaly in the right cerebellar hemisphere. There is ex vacuo dilatation of the posterior left lateral ventricle superimposed upon mild diffuse cerebral volume loss. There is no midline shift or herniation. The orbits, skull, mastoid air cells, and scalp soft tissues are grossly unremarkable. There is a left maxillary sinus retention cyst.

Output: 1. Chronic right thalamus lacunar infarction and what likely represents chronic small vessel white matter ischemic disease, but no evidence of acute infarct. 2. The left parieto-occipital region intraparenchymal hematoma from January 2016 has resolved, leaving encephalomalacia and hemosiderin staining at the site.