Instruction: Generate impression based on medical findings.

Input: Female, 58 years old, with weakness and paresthesias. Evaluate for demyelinating disease. Brain:Numerous foci of white matter T2 hyperintensity are seen in the bilateral cerebral hemispheres ranging in size from punctate up to about 7 mm in diameter. A few of these lesions are periventricular in location but most are found in the more peripheral subcortical white matter. The morphology of these lesions is nonspecific. No discrete lesions are seen within the corpus callosum. With the exception of a punctate focus of signal abnormality in the pons, the posterior fossa structures are also spared.No evidence of restricted diffusion, parenchymal edema or mass effect is detected. No abnormal extra-axial fluid collections are seen. There is no evidence to suggest intracranial hemorrhage. The ventricles and sulci may be very slightly prominent for age but this is an equivocal finding.Bone marrow signal characteristics are unremarkable. Extensive paranasal sinus mucosal inflammatory disease is noted.Cervical spine:Evidence of instrumented anterior spinal fusion is seen at C5-6. Laminectomy has also been performed bilaterally from C3 through C7. These surgical findings are unchanged.Also unchanged is a band of T2 hyperintensity within the dorsal spinal cord at the C5-6 level which likely represents myelomalacia as the cord is thinned through this region. There may also be mild linear T2 hyperintensity tracking longitudinally within the cord at the C3 and C4 levels, also unchanged. No evidence of any new spinal cord lesion is seen.Reversal of the normal cervical lordosis is a stable finding. Degenerative endplate signal alteration is seen at C3 and C4, but no worrisome or destructive marrow lesions are suspected.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Posterior disc-osteophyte complex formation. Decompression of the spinal canal. No significant foraminal narrowing. C4-5: Posterior disc-osteophyte complex formation. Decompression of the spinal canal. Mild bilateral foraminal narrowing. C5-6: Disc space is not well visualized due to artifact from orthopedic instrumentation. Decompression of the spinal canal. No significant foraminal narrowing. C6-7: Decompression of the spinal canal. The neural foramen are not well visualized due to motion artifact. C7-T1: No spinal canal stenosis or neuroforaminal narrowing. Thoracic spine:Allowing for some image degradation by motion artifact, no spinal cord lesions are seen. The spinal cord demonstrates normal morphology throughout.A very slight scoliotic curvature of the thoracic spine is seen. Sagittal alignment is anatomic. Marrow signal characteristics are somewhat heterogeneous but without any aggressive or worrisome findings.Loss of disc height is seen from T3-4 through T9-10. Disc bulging is also evident at T6-7, T7-8 and T9-10 resulting in at most mild spinal canal narrowing. The T9-10 neural foramina are also likely narrowed to a mild degree. Elsewhere, no significant spinal canal or neuroforaminal stenosis is seen.

Output: 1.Numerous scattered T2 hyperintense lesions are seen within the cerebral white matter. A majority of these lesions are located peripherally in the subcortical white matter and the morphology of the lesions is nonspecific. Of note, the corpus callosum is completely spared. These imaging findings would not be typical for multiple sclerosis, though an atypical demyelinating process should still be considered. Other etiologies, including vasculitic, inflammatory and granulomatous processes, can also be considered.2.Evidence of extensive surgery is seen in the cervical spine including anterior fusion of C5-6 and bilateral laminectomy from C3 through C7. The spinal canal is widely decompressed through the operative region. A focus of encephalomalacia is seen within the spinal cord at the C5-6 level which is unchanged compared to the prior examination. The nature of this lesion is uncertain. Correlation with preoperative imaging would be helpful in this regard. There may be minimal T2 hyperintense signal within the cord above the C5 level, but this is also unchanged. No new cervical cord lesions are seen.3.No evidence of any focal spinal cord lesion is seen in the thoracic spine.4.Degenerative findings are evident in the cervical and thoracic spine with details as indicated above.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old, with grade 2 oligoastrocytoma, status post surgery and RT in 2009. The left paracentral lobule resection cavity is unchanged in size and morphology. Curvilinear vascular enhancement within the cavity is unchanged. No new or concerning enhancement is seen. The degree of surrounding T2 hyperintensity is also unchanged.No new intracranial lesions are seen. A right superior cerebellar developmental venous anomaly is redemonstrated. No edema or mass effect is detected. One or two scattered foci of nonspecific T2 hyperintensity are unchanged. Ventricular size and morphology are stable.

Output: Evidence of prior surgery and treatment is redemonstrated with no findings to suggest recurrent tumor.


Instruction: Generate impression based on medical findings.

Input: Left vestibular schwannoma: dizziness and tinnitus. There is an unchanged lesion that measures up to 5 mm in the fundus of the left internal auditory canal. The right cranial nerve 7 and 8 complexes are intact. The bilateral inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable.

Output: Unchanged lesion that measures up to 5 mm in the fundus of the left internal auditory canal, which likely represents a vestibular schwannoma.


Instruction: Generate impression based on medical findings.

Input: 45-year-old female with chronic right lower extremity wound with swelling TENDONS: No significant abnormality noted.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: Severe degenerative changes at the tibiotalar joint and subtalar joints. No abnormal bone marrow signal to suggest osteomyelitis. ADDITIONAL

Output: No specific evidence of osteomyelitis.


Instruction: Generate impression based on medical findings.

Input: 52 years, Female, Reason: h/o thryoid ca, liver mets, compare to previous, measurements pls, eval response to tx. History: none. ABDOMEN:LUNG BASES: Cardiomegaly.LIVER, BILIARY TRACT: Innumerable hepatic metastases are overall decreased in size from the prior exam. Reference T2 hyperintense lesion identified on prior exams is not identified on this exam, however there are significant remaining rim enhancing lesions throughout the right hepatic lobe likely representing tumor. For reference, a segment 7 conglomerate measures 7.0 x 5.6 cm (13/151), previously is 9.2 x 7.1 cm. A left hepatic cyst is stable.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mildly enlarged periportal node is unchanged measuring 1.9 x 1.5 cm (4/25).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Mild perihepatic ascites is increased.

Output: 1.Decreased hepatic metastases.2.Stable retroperitoneal lymphadenopathy.3.Increased perihepatic ascites.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old, with lung cancer. A new 5 mm enhancing nodule is evident within the superior right cerebellum producing minimal if any edema in the surrounding tissues. No other definite enhancing lesions are seen. No evidence of significant generalized mass effect effect is observed. Numerous scattered foci of white matter T2 hyperintensity are redemonstrated without significant interval change. No evidence of intracranial hemorrhage or any abnormal extra axial fluid collection is seen. Ventricular size and morphology are within normal limits.

Output: 1.A 5 mm enhancing lesion is seen within the superior right cerebellum concerning for metastasis.2.No additional enhancing lesions are detected.3.Findings are seen compatible with moderately advanced chronic microvascular ischemia.


Instruction: Generate impression based on medical findings.

Input: HeadacheClinical question: Please evaluate craniocervical junctionSigns and Symptoms: Headache, dizzy, scintillations, scotomata The CSF spaces are appropriate for the patient's stated age with no midline shift. There is no evidence for Chiari malformation. The lateral ventricles are nondilated. A 3 millimeters cyst is present in the right choroid fissure.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a couple minor opacities. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: No obvious cause for the patient's headache is appreciated. A 3 mm cyst in the right choroid fissure is most likely incidental and of little clinical significance


Instruction: Generate impression based on medical findings.

Input: 69 years, Male. Reason: r/o ileus History: constipation Midline surgical staples. IVC filter in place. Spinal rod and screw device as well as a spacer is noted.Nonobstructive bowel gas pattern. Nondilated loops of large and small bowel are seen. Air and stool is noted in the colon with an average stool burden. A moderate amount of inspissated stool is noted within the rectum. Osseous metastatic disease better seen on prior spinal MRI.

Output: Nonobstructive bowel gas pattern. Moderate amount of inspissated stool is noted within the rectum.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: Knee pain MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There is an area of focal full-thickness cartilage defect involving the femoral trochlea centrally with degenerative cystic changes underlying the defect. Heterogeneous signal within the patellar cartilage likely reflects degenerative change and may be a small partial-thickness defect of the medial femoral condyle. The articular cartilage of the lateral and patellofemoral compartments is intact.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Full-thickness cartilage defect of the femoral trochlea centrally with additional degenerative changes noted in the patellofemoral articulation. The remaining articular cartilage of the medial lateral compartments is intact.2. Small joint effusion.


Instruction: Generate impression based on medical findings.

Input: 38 year old female with metastatic ovarian cancer now with rising LFT's and bilirubin, rule out biliary obstruction or need for stent. Epigastric pain, rising LFTs, and jaundice. Limited examination secondary to extensive motion artifact. ABDOMEN:LIVER, BILIARY TRACT: There is intrahepatic biliary ductal dilation extending to the level of Klatskin's point. There is an associated large perihepatic mass which encases the portal vein at the level of Klatskin's point, measuring approximately 6.9 x 5.6 cm, consistent with the patient's known history of metastatic ovarian carcinoma. There are multiple foci of increased signal abnormality in the liver with associated peripheral enhancement which are also suspicious for metastatic disease. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: IVC filter in place. There is extensive retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.There is a large perihepatic mass which encases the portal vein at the level of Klatskin's point, consistent with the stated history of metastatic disease. There is associated moderate intrahepatic biliary ductal dilation. 2.There is retroperitoneal lymphadenopathy and hepatic lesions consistent with metastatic disease.


Instruction: Generate impression based on medical findings.

Input: There is a pituitary mass that measures up to approximately 12 mm, which is grossly unchanged. The infundibulum is mildly deviated to the right. There is no mass effect on the optic apparatus. The posterior pituitary bright spot is intact. There is no evidence of cavernous sinus invasion. There is partially imaged cerebral volume loss. There is an unchanged 4 mm wide outpouching along the lateral aspect of the left cavernous carotid artery. The known left ophthalmic artery aneurysm is barely discernible on this exam due to technique. There are prominent arachnoid granulations in the right greater wing of the sphenoid with slight herniation or the intracranial contents.

Output: 1. No significant interval change in the pituitary mass that measures up to 12 mm, which likely represents a macroadenoma.2. The small left internal carotid artery aneurysms are better depicted on the recent CTA. 3. Prominent arachnoid granulations in the right greater wing of the sphenoid with slight herniation or the intracranial contents.


Instruction: Generate impression based on medical findings.

Input: 56 year old male with atrial fibrillation PULMONARY VEINS: The right inferior and middle pulmonary vein have a common ostium. The right superior pulmonary vein is normal in appearance.The left superior and inferior pulmonary veins are normal in appearance. No evidence of left atrial thrombus.Right superior pulmonary vein: 24 x 23mmRight middle pulmonary vein: 6 x 8mmRight inferior pulmonary vein: 17 x 25mmLeft superior pulmonary vein: 21 x 18mmLeft inferior pulmonary vein: 19 x 12mmLUNGS AND PLEURA: 4-mm micronodule the right upper lobe, image 58/153. No pleural effusions.MEDIASTINUM AND HILA: Common origin of the brachiocephalic artery and left common carotid artery, and a normal anatomic variant. Heart size is normal without pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: 1. Three pulmonary veins on the right, a normal anatomic variant. Two pulmonary veins on the left.2. 4-mm micronodule in the right upper lobe. If the patient has no risk factors for lung cancer, such as smoking, no further follow up is recommended. If patient has history of smoking, 6 to 12 month follow up with CT is recommended.


Instruction: Generate impression based on medical findings.

Input: New onset numbness, but normal neurological exam . There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is minimal nonspecific cerebral white matter T2 hyperintensity. The brain parenchyma otherwise appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

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


Instruction: Generate impression based on medical findings.

Input: Female; 77 years old. Reason: history of pancreatic cyst 5mm, family history of panc cancer History: see above ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions. Status post cholecystectomy. No biliary ductal dilation.SPLEEN: No significant abnormality noted.PANCREAS: 5-mm round T2 hyperintense lesion in the uncinate process (series 7/20) with probable connection to a side branch pancreatic duct (series 10/70), most likely a side branch IPMN. No mural nodularity or suspicious enhancement. At least two similar but smaller lesions in the pancreatic body and tail are seen on MRCP images, which are most likely additional sidebranch IPMN's (series 11/4).ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: 2.8 x 2.1 cm round mass within the duodenal bulb which is homogeneously T1 hyperintense mass and demonstrates loss of signal on T2 fat saturation sequences, most compatible with duodenal lipoma (series 4/21). No evidence of gastric outlet obstruction. Small hiatal hernia.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Multiple small sidebranch IPMN's.2.Duodenal lipoma.


Instruction: Generate impression based on medical findings.

Input: 86 year old man with history of dual chamber pacemaker for sick sinus syndrome, recent worsening atrial fibrillation burden, who presents for pre-ablation cardiac MRI. Left VentricleThe left ventricle is normal in size with moderately reduced systolic function. The overall LV ejection fraction is 37%, the LV end diastolic volume index is 70 ml/m2 (normal range: 74+/-15), the LVEDV is 111 ml (normal range 142+/-34), the LV end systolic volume index is 44 ml/m2 (normal range 25+/-9), the LVESV is 69 ml (normal range 47+/-19), the LV mass index is 34 g/m2 (normal range 85+/-15), and the LV mass is 55 g (normal range 164+/-36). There is global hypokinesis and dyssynchrony of the interventricular septum. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with mild-moderately reduced systolic function. The overall RV ejection fraction is 44%, the RV end diastolic volume index is 100 ml/m2 (normal range 82+/-16), the RVEDV is 160 ml (normal range 142+/-31), the RV end systolic volume index is 57 ml/m2 (normal range 31+/-9), and the RVESV is 90 ml (normal range 54+/-17). There is a pacemaker lead in the right ventricle.Right AtriumThe right atrium is severely dilated. There is a pacemaker lead which terminates in the right atrial appendage. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve leaflet tips are thickened. The valve opens widely and there is at least mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least moderate tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The ascending aorta measured 39 x 41mm.Pulmonary VeinsAll five pulmonary veins drain normally into the left atrium.The pulmonary vein dimensions are as follows:RLPV: 14 x 16mmRUPV: 17 x 21mmRMPV: 11 x 10mmLLPV: 18 x 18mmLUPV: 12 x 17mmPulmonary ArteryArtifact from the pacemaker overlies the main pulmonary artery. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. Pacemaker leads are visualized in the SVC.PericardiumThere is a trivial pericardial effusion.Extracardiac FindingsThere are small bilateral pleural effusions. There are multiple well circumscribed nonenhancing lesions on the kidneys bilaterally; most likely represent cysts. 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. The left ventricle is normal in size with moderately reduced systolic function (37%).2. The right ventricle is normal in size with mild-moderately reduced systolic function (44%). 3. Severe right atrial dilation. 4. Pulmonary vein anatomy and dimensions as noted above. 5. Pacemaker leads visualized in the right atrium and ventricle. 6. At least moderate tricuspid regurgitation. 7. See extracardiac findings. 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: Neuroblastoma with relapse x 2; progression of disease. Extensive diffuse marrow abnormality is seen in the bilateral frontal bones with probable extension into the bilateral parietal bones. Exact extent of tumor is best evaluated with MRI, if clinically indicated. There is a thick band of epidural enhancement in the bifrontal region which measures 7 mm in maximum dimension consistent with epidural spread of tumor (best seen image 15-22). There is minimal mass effect on the superior sagittal sinus which is mildly displaced posteriorly. There is no evidence of intraparenchymal mass or edema. No abnormal leptomeningeal enhancement is seen. The ventricles and basal cisterns are normal in size and configuration.The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Extensive marrow abnormality in the bilateral frontal bones, probably extending to the bilateral parietal bones consistent with osseous metastases. Thick band of epidural enhancement in the bifrontal region consistent with epidural spread of tumor. Extent of disease may be better evaluated with MRI, if indicated clinically.


Instruction: Generate impression based on medical findings.

Input: 66 year old male patient with prostate cancer. PELVIS:PROSTATE:Prostate Size: 3.4 x 4.5 x 3.5 cm (AP x transverse x craniocaudal)Peripheral Zone: There is a 1.9 x 0.6 cm lesion in the left base which demonstrates T2 hypointensity, ADC hypointensity, and enhancement compatible with carcinoma.Central Gland: Hypertrophy of the central gland.Seminal Vesicles: No definite invasion.Extracapsular Extension: Tumor abuts the left base and focal extracapsular extension is not excluded.BLADDER: The bladder is distended.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Tumor in the left base with possible focal extracapsular extension.


Instruction: Generate impression based on medical findings.

Input: headache. There is no evidence of acute ischemic or hemorrhagic lesion on this scan.Significant metallic artifacts with surrounding parenchymal signal loss on the genu of corpus callosum indicating prior pericallosal artery aneurysm clipping status. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate signal loss from the level of right ACA pericallosal artery due to surgical clip related artifacts, otherwise normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion on this scan.2. Significant metallic artifacts on the area of pericallosal artery clipping.3. Segmental non visualization of ACA around the area of surgical clip, otherwise no remarkable brain MRA.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Multiple sclerosisClinical question: please do Dr Javed MS protocol and compare to priorSigns and Symptoms: progression MS MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There are a couple subcortical white matter lesions present without associated contrast enhancement which are high signal on FLAIR and low signal on T1 at the left inferior frontal gyrus and the left superior frontal gyrus. These are stable.There are a couple subcortical white matter lesions present without associated contrast enhancement which are high signal on FLAIR and intermediate signal on T1 at the right inferior frontal gyrus (stable) and the right middle temporal gyrus (new).No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is disk dessication and a disk bulge at this level associated with end plate osteophytes. This is stable since the prior exam.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is disk dessication and a disk bulge at this level. There are end plate reactive changes present. These findings are stable since the prior exam.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.Some subcortical white matter lesions are stable since the prior exam and are non-specific on MRI.2.There are minor degenerative changes in the cervical spine. There are no stigmata of demyelination identified in the cervical spinal cord.


Instruction: Generate impression based on medical findings.

Input: 57-year-old female with history of HCV and HCC. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. Increased T2 reticulation within the liver parenchyma compatible with fibrosis. Large volume ascites.In segment 7 there is a heterogeneous mass with a low signal intensity capsule as well as internal foci of high T1/T2 measuring 5.5 x 4.6 cm (image 34 of series 41). There is no arterial enhancement, however there is diffuse washout extending outside of the boundaries of the capsule likely representing diffusely infiltrative disease.In segment 6, there is a round T2 hypointense lesion with arterial enhancement and washout measuring 2.3 x 2.6 cm (image 24 of series 401).In the lateral segment of the left hepatic lobe there is an ill defined area of signal abnormality with washout.There is a large thrombus within the right portal vein extending into the main portal vein. This thrombus demonstrates foci of enhancement compatible tumor thrombus.Hydropic gallbladder wall thickening likely secondary to hypoproteinemia.Numerous enlarged portal lymph nodes.SPLEEN: Splenomegaly measuring 18 cm.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Gastric and esophageal varices.

Output: 1.Diffuse multifocal HCC as above with tumor thrombus in the right portal vein extending into the distal main portal vein.2.Portal hypertension with gastric and esophageal varices. Splenomegaly.3.Hydropic gallbladder wall thickening likely secondary to hypoproteinemia.


Instruction: Generate impression based on medical findings.

Input: 30-year-old female with BRCA1 mutation as well as BRCA2 variant of uncertain significance. Breast MRI for surveillance There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.High signal intensity round lesion on T2 W sequence in segment 8 of liver has minimally increased in size from 9 mm to 13 mm; could represent a hemangioma; however liver MRI is recommended for confirmation. Also noted is an irregular high signal intensity lesion along the falciform ligament which suppresses on the T1 dynamic fat-suppressed sequence and most likely represents fat along the falciform ligament however not definitely visualized on prior MRI.

Output: No MRI evidence for malignancy in the breast. Interval increase in size of high signal intensity round lesion and irregular high signal intensity along falciform ligament which could represent fat . Further evaluation with liver MRI can be performed.BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on medical findings.

Input: Ms. Roy is a 38 year old female with a personal history of right breast lumpectomy in October 2015 for DCIS. She has no current breast related complaints. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. Multiple cysts are present bilaterally, the largest one of which measures approximately 1.2 cm in the left superior breast. Stable benign morphology enhancing mass in the left lower inner breast.No abnormal lymph nodes are identified in either axillary or internal mammary region.

Output: No MRI evidence for malignancy. Of note, no recent mammogram is present in our system. If patient has had a recent mammogram performed at an outside institution, than this should be submitted for future comparison purposes. Otherwise, patient is due for a bilateral diagnostic mammogram. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old, with history of craniotomy for resection of parafalcine meningioma with progressive weakness. Again seen is evidence of craniotomy at the high vertex. A partially resected falcine meningioma is again seen. Enhancement along the left aspect of the resection cavity has become thicker when compared to the prior examination though it remains nonspecific. Nodular enhancement along the right aspect of the resection cavity has also become thicker than on prior and likely represents residual tumor. The parenchyma of the adjacent superior frontal gyri is edematous, but this appears grossly similar to the prior examination.Evidence of prior left frontal and parietal craniotomy is again seen with the resection cavity evident in the left middle frontal gyrus. Findings are unchanged. An 8 mm nodule of enhancement along the left superior temporal gyrus is unchanged. An enhancing focus within the left squamous temporal bone is also unchanged.On MRV imaging, the superior sagittal sinus directly beneath the craniotomy is flattened and narrowed, largely due to anatomic changes related to craniotomy. However, there does remain a distinct flow related signal throughout the sinus indicating patency. The dural venous sinuses and deep venous structures are otherwise patent.

Output: 1.Sequelae of partial resection of the falcine meningioma are again seen. Nodular enhancement along the right aspect of the resection cavity is favored to represent residual tumor and has become thicker in the interval. Enhancement along the left aspect of the resection cavity has also become thicker but it remains nonspecific and could represent evolving postoperative change with granulation tissue or some residual tumor as well.2.MRV imaging demonstrates mass effect upon the superior sagittal sinus as it passes beneath the high vertex craniotomy. However, the sinus remains patent.3.Findings are redemonstrated compatible with prior left sided surgery. A small presumed meningioma along the left superior temporal gyrus is also unchanged.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Evaluate for intracranial mass or orbit, history of thyroid disease. Signs and symptoms: Biocullar diplopia. Pre-and post-enhanced brain MRI:No diffusion weighted abnormalities. Flair and T2-weighted images demonstrate few small foci of hyperintensity in the subcortical and periventricular white matter, left basal ganglia and pons which are nonspecific and non-hemorrhagic and without detectable abnormal enhancement. Considering patient's provided age of 75 this appearance is suggestive of chronic small vessel ischemic strokes of mild degree. The cortical sulci, ventricular system, CSF spaces and myelination the brain is otherwise unremarkable and with normal signal intensity on all MRI sequences. There is no evidence of abnormal enhancement the brain parenchyma or leptomeninges on is a diffuse series.Calvarium demonstrate normal signal intensity and without abnormal enhancement.Unremarkable images through the orbits and including axial fat sat post enhanced series.Signal void of major intracranial arterial branches are identified.Intracranial venous sinuses demonstrate normal pattern of enhancement.Pre-and post enhanced MRI orbits:Shin demonstrate normal signal intensity of retro-orbital fat without abnormal enhancement.Normal signal intensity, size and pattern of enhancement the extraocular musculature.Normal signal intensity and size of bilateral optic nerves in the retro-orbital spaces and in their cisternal segment without abnormal enhancement.Normal signal intensity and morphology of globes without abnormal enhancement.Normal signal intensity and pattern of enhancement of bilateral cavernous sinuses.

Output: 1.Pre-and post enhanced brain MRI demonstrate no acute intracranial findings. Findings suggestive of mild chronic small vessel ischemic strokes as detailed and unremarkable exam otherwise. No detectable abnormal enhancement of brain parenchyma, leptomeninges, calvarium orbits protocol spaces.2.Unremarkable pre-and post enhanced MRI of orbits.3.Diffuse mild chronic because of thickening and postoperative changes of bilateral endoscopic functional sinus surgery.


Instruction: Generate impression based on medical findings.

Input: Transient cerebral ischemic attack, unspecified [G45.9], Reason for Study: ^Reason: assess vasculature, space occupying lesion? Cerebellar? History: see MRA Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion on this scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Mucosal thickenings on frontal, ethmoid and sphenoid sinus.Brain MRAMotion artifacts degraded image quality significantly.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. No evidence of occlusion or luminal stenosis on bilateral distal ICAs, MCAs, ACAs and vertebrobasilar system. Medium to small vessels (distal to the MCA M1 segment for example) cannot be evaluated with this scan. No evidence of intracranial arterial aneurysm.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. No evidence of intracranial arterial major artery occlusion. No evidence of intracranial arterial aneurysm. Comment: if precise evaluation of intracranial arterial system is clinically indicated, CTA of head can be considered.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Unspecified condition of brain Other convulsions Congenital anomaly of cerebrovascular systemClinical question: cerebral cavernous malformation, MRI presurgical for image guidance during surgerySigns and Symptoms: Surgery, STEALTH for presurgical planning for surgeryComments: The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a 32 x 21 mm axial dimension lesion in the left temporal lobe which has low signal periphery and heterogeneous central portion on T2-weighted imaging which has not changed substantially when compared to the previous examsNormal 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.Findings are compatible with a cavernoma located in the left temporal lobe.2.Please note that this examination was performed through purpose of stereotactic guidance for surgery and is therefore a limited exam.


Instruction: Generate impression based on medical findings.

Input: 52-year-old with known left breast cancer for MRI to evaluate response to neoadjuvant chemotherapy. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Two known proven cancers are again demonstrated in the left breast, and both masses show significant volume reduction. The posterior mass measures 9 x 10 x 18 mm (previously: 22 x 18 x 26 mm). Artifact compatible with a biopsy clip is seen along the lateral aspect of the posterior mass. A small satellite lesion seen on the previous study anterior to this mass is no longer present. The anterior mass measures 12 x 14 x 11 mm (previously: 18 x 19 x 26 mm). Overall extent is 18 x 16 x 35 mm (previously 33 x 18 x 51 mm). No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in either axillary region. Mild surgical changes are present in the left axilla.

Output: Significant reduction in volume of left breast cancerBIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on medical findings.

Input: 66 years Male (DOB:3/9/1950)Reason: GBM. Pt om TMZ+TTF. History: GBM.PROVIDER/ATTENDING NAME: RIMAS V. LUKAS RIMAS V. LUKAS There is 78 by 42 mm mm sagittal dimension heterogenously enhancing mass centered in the deep white matter of the right frontal lobe and the adjacent subcortical white matter of the right parietal lobe . This previously measured similar sagittal dimensions. Cerebral blood volume map indicates that the enhancing component of the lesion within the right centrum semiovale is relatively high whereas other more peripheral components tends to be relatively lower.There is however a little more contrast enhancement within the right basal ganglia. Cerebral blood volume within this component appears to be very low. Contrast enhancement within the basal ganglia component of the lesion currently measures 18 x 17 mm and previously measured 13 x 16 mm. There is adjacentT2/FLAIR signal hyperintensity compatible with vasogenic edema in an area measuring 142 x 60 mm axial dimensions. This previously measured similar axial dimensions. There are satellite foci of enhancement in the adjacent brain. There is susceptibility effect within the mass. There is T2 signal hyperintensity present in the right midbrain and pons on the current exam which was also present on the prior exam. There are multiple microhemorrhages scattered throughout the lesion which were also present on the previous exam.There is associated mass effect with approximately 9 mm shift of the midline towards the left on the current exam which was approximately 9 mm on the prior exam. There is associated uncal herniation which was also previously present. There is also associated dilation of the left lateral ventricle associated with subfalcine herniation and there is a mild degree of transtentorial herniation also present.The patient is status post recent right sided craniotomy. There is an underlying extra-axial collection measuring up to 5mm thickness.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 distal right vertebral artery appears to be hypoplasticThe 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.Since the prior exam the patient's right hemispheric mass consistent with glioblastoma has developed enlargement of the an enhancing component within the right basal ganglia. This component has low cerebral blood volume and is thus suspected to potentially represent radiation necrosis based on perfusion imaging. There is a component with high cerebral blood volume within the central portion of the lesion which based on the perfusion imaging would be more likely related to active neoplasm which has not enlarged since prior exam. 2.There is associated uncal, transtentorial and subfalcine herniation present.


Instruction: Generate impression based on medical findings.

Input: There is no new intracranial mass or abnormal enhancement to suggest progression of metastatic disease. Again seen are postoperative findings related to right temporoparietal craniotomy for resection of metastatic lesion. There is hyperintense T2 signal abnormality in the treatment bed, which appears similar to prior and consistent with posttreatment change. Again seen are areas of encephalomalacia in the left parietal lobe, left basal ganglia and corona radiata, as well as a small focus in the right cerebellar hemisphere. There is ex vacuo dilatation of the left lateral ventricle. No hydrocephalus.There are scattered foci of hyperintense T2 signal abnormality within the periventricular and subcortical white matter, which likely represent combination of chronic small vessel ischemic disease and posttreatment-related change. Again seen is a punctate focus of susceptibility in the left cerebellar hemisphere which is compatible with a chronic microhemorrhage. There is no acute infarct. There is mild opacification of the right mastoid air cells. There are bilateral lens implants. Paranasal sinuses are grossly clear. No suspicious lesions involving the calvarium.

Output: 1. No new or recurrent metastatic lesions. 2. Multiple chronic supra- and infratentorial infarcts as above.


Instruction: Generate impression based on medical findings.

Input: Reason: rule out evidence of recurrent disease History: s/p pelvic exenteration. PELVIS:UTERUS, ADNEXA: Postsurgical changes of an anterior pelvic exenteration. No evidence of recurrence. BLADDER: Postsurgical changes of a cystectomy. LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: Right lower quadrant ileal conduit.BONES, SOFT TISSUES: Right sacral insufficiency fracture, not significantly changed. Stable nonspecific subcentimeter focus of hyperintense T2 signal intensity in the left sacral ala without enhancement. Postradiation changes of the bones. OTHER: Trace free fluid.

Output: Posttreatment changes with no definite evidence of recurrence or metastatic disease.


Instruction: Generate impression based on medical findings.

Input: THORACIC: The thoracic vertebral body alignment and signal are within normal limits with a small probable sclerotic T1/T2 hypointense bone island in T8 vertebral body. There is minimal desiccation and loss of disk height at T7-T8. The remaining disk spaces, and vertebral body heights are preserved. The cord signal and caliber are within normal limits. There is mild posterior epidural lipomatosis which diffusely narrows the spinal canal caliber without significant spinal canal stenosis. There is no evidence of acute cord compression of the thoracic spine.There is a small central disk protrusion at T7-8 which effaces the ventral CSF space without significant cord deformity. There is a small right paracentral disk protrusion at T10-11 without significant spinal stenosis. Otherwise, there is no significant disk herniation, or spinal stenosis.There may be minimal dependent atelectasis in the posterior lungs.LUMBAR: There are 5 lumbar type vertebral bodies. The L5-S1 disk is somewhat diminutive but well formed (when counting from the top of the cervical spine). There is normal alignment of the lumbar spine. The vertebral body heights are preserved. The osseous marrow signal is somewhat heterogeneous without a focal lesion except for scattered benign hemangiomas. The conus terminates at L1. The conus shows normal caliber and signal. There is no filum lipoma.L1-2: No disk herniation or spinal stenosis.L2-3: No disk herniation or spinal stenosis.L3-4: Mild disk bulge and moderate bilateral facet arthropathy with no significant spinal stenosis.L4-5: Mild diffuse disk bulge and facet arthropathy with minimal bilateral neural foraminal narrowing and no significant spinal canal stenosis.L5-S1: No significant disk herniation or spinal stenosis.

Output: 1.No evidence of acute cord compression.2.Small central disk protrusion at T7-8 which effaces the ventral CSF without significant cord deformity.


Instruction: Generate impression based on medical findings.

Input: Reason: rule out PRES History: double vision Examination is limited to postcontrast sequences. Precontrast study was performed earlier same day. There is no abnormal parenchymal or meningeal enhancement. Major vascular structures are patent.

Output: Examination limited to postcontrast sequences. No abnormal enhancement. Please refer to separate MRI brain without contrast report from same day regarding additional findings.


Instruction: Generate impression based on medical findings.

Input: Buttock pain. Radiculopathy, neurogenic claudication. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There are small Schmorl's nodes involving the superior and inferior endplate of L4 with mild associated edema at the superior L4 endplate. There is grade 1 anterolisthesis of L4 and L5 and to a minimal degree also at the L3-L4 level. Alignment is otherwise maintained. There is a nonspecific lesion involving the L2 level with low T1 and low T2 signal. There are multiple additional foci of T1 hyperintensity compatible with foci of fat or small hemangiomas. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Minimal disc bulge, ligamentum flavum thickening, and mild facet arthropathy. No spinal canal or neural foraminal stenosis.L3-L4: There is a disc bulge, ligamentum flavum thickening, and moderate facet arthropathy with distention of the facet joints. There is moderate to severe spinal canal stenosis and mild bilateral neural foraminal stenosis.L4-L5: There is disc uncovering as well as right paracentral protrusion which effaces the lateral recesses, right greater than left. There is overall moderate to severe central canal stenosis. There is moderate bilateral facet arthropathy with distention of the facet joints. There is mild bilateral neural foraminal stenosis.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis. Bilateral facet arthropathy with mild facet distention of the left.Small synovial cysts are noted associated with the facet arthropathy at the L3-L4 and L4-5 levels, primarily posterior to the facet joints although there is a tiny, probable synovial cyst in the dorsal epidural space at the L4-L5 level. Paraspinous soft tissues are otherwise within normal limits.

Output: 1. Multilevel degenerative changes in the lumbar spine with moderate to severe spinal canal stenosis at the L3-L4 and L4-L5 levels.2. Grade 1 degenerative spondylolisthesis of L4 on L5 and to a lesser degree L3 on L4. Facet arthropathy with distended facet joints at these levels.3. Relatively mild neural foraminal stenoses as described above.


Instruction: Generate impression based on medical findings.

Input: Prior MRI spine showing enhancement in pons: left sided decreased sensation, brisk reflexes in LE bilaterally. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is scattered T2 hyperintensity in the cerebral white and pontine matter. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Scattered T2 hyperintensity in the cerebral white and pontine matter likely represents chronic small vessel ischemic disease. No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on medical findings.

Input: History of seizure-like activity. There is no evidence of intracranial hemorrhage, mass, or acute infarct. Brain parenchymal signal is within normal limits. The myelination pattern is within normal limits for age. The hippocampal formations are symmetric. No areas of cortical thickening are identified to suggest cortical dysplasia. The pituitary gland and midline structures 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, and scalp soft tissues are grossly unremarkable. There is trace mucosal thickening within the paranasal sinuses.

Output: No acute intracranial abnormality. No localizing lesions identified to account for patient's seizures.


Instruction: Generate impression based on medical findings.

Input: 68-year-old female with joint pain. Evaluate for fracture.IMAGE ACQUISITIONS: CT through the right ankle performed without contrast enhancement and reformatted images obtained for sagittal, coronal and axial reconstructions. In addition, 3-D reconstruction was done at an independent work station. Non-infused CT of the right ankle shows no evidence of acute fracture. Severe osteoarthritis affects the talonavicular joint, with bone-on-bone apposition and prominent subchondral cysts. Subchondral cysts are also seen at the subtalar and calcaneocuboid joints. Mild osteoarthritis at the tibiotalar joint. There is a large os trigonum posterior to the talus. The navicular appears to be slightly inferiorly subluxed with respect to the talus. There is eversion of the calcaneus with resultant osteoarthritic changes of the calcaneofibular articulation. There are small loose bodies in the lateral gutter of the ankle. Recent radiographs suggest a severe planovalgus deformity.Soft tissue attenuation along the head of the talus and the distal fibula may represent edema or scar tissue, and obscures the ligamentous structures of the ankle. The Achilles tendon is intact and the remaining ankle tendons are grossly intact, given the inherent limitations of CT or examination; however, we cannot exclude a partial-thickness tendon tear on CT, and if further imaging is warranted clinically, MRI can be considered.

Output: 1. No evidence of acute fracture.2. Arthritic changes as described above, including eversion of the calcaneus and plantar subluxation of the navicular, which may reflect a neuropathic arthropathy or chronic posterior tibialis tendon dysfunction.


Instruction: Generate impression based on medical findings.

Input: Reason: Thumb-CMC and MCP pain-possible UCL injury History: pain and injury There is a tear of the ulnar collateral ligament from its attachment to the base of the proximal phalanx of the thumb. There is mass-like low signal intensity along the ulnar aspect of the first metatarsal head, underlying the adductor aponeurosis, suggestive of a Stener lesion. There is mild edema within the surrounding soft tissues about the first MTP joint as well as a small amount of fluid within the joint. The proximal phalanx of the thumb appears to be slightly volarly subluxed. The radial collateral ligament appears intact. The basilar joint is normal. There is a small cyst within the capitate which is probably of no clinical significance.

Output: Ulnar collateral ligament tear with probable Stener lesion.


Instruction: Generate impression based on medical findings.

Input: This is a motion degraded exam. The cervical spine is in normal alignment, with reversal of cervical lordosis which could be positional. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the cervical spine. THORACIC SPINE

Output: The T4 vertebral body lesion demonstrates signal characteristics compatible with posttreatment effect. No new lesions in the cervical, thoracic or lumbar spine. Partially visualized left iliac bone lesion. Please refer to MRI pelvis performed on the same date for more details.


Instruction: Generate impression based on medical findings.

Input: The exam is degraded by motion and other artifacts, which considerably limit the evaluation of the thoracic spine. There are diffuse osseous metastases throughout the thoracic spine. There is epidural extension of tumor at the T6 level, which appears to result in spinal cord compression, but no gross signal abnormality in the spinal cord. Due to the limited nature of the exam, more subtle epidural extension of tumor elsewhere in the thoracic spine cannot be excluded. The vertebral body heights are intact and the alignment is anatomic. There is multilevel spondylosis in associated with degenerative changes in the cervical spine with spinal canal stenosis, which is incompletely characterized.

Output: The exam is degraded by motion and artifact, but there is widespread metastatic disease involving the imaged axial skeleton with apparent epidural extension of tumor at the T6 level with compression of the spinal cord. More subtle epidural tumor extension may be present at other levels of the thoracic spine, but the exam is limited for detailed assessment of this possibility. Spinal canal stenosis associated with multilevel degenerative cervical spondylosis is incompletely characterized on this exam. Please refer to the recent prior spine MRI report for additional details.The services (Dr. Boyle, pager 1006) was notified of the limited quality of the exam and spread of tumor into the epidural space.


Instruction: Generate impression based on medical findings.

Input: Lewy body dementia with worsening symptoms, including left neglect and worsening gait. There is a moderate degree of global parenchymal volume loss with slightly greater involvement of the bilateral parietal lobes appearing similar to the MRI from 2/18/2013. There is no disproportionate volume loss in the hippocampus, brainstem, or cerebellum. There is no evidence of mass effect. There are no abnormal extra-axial collections. There is no significant vascular disease. There is prominent mineralization/calcification involving the bilateral cerebellar hemispheres as well as the basal ganglia as seen before. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no hydrocephalus. There is partial opacification of the bilateral ethmoid air cells and minimal opacification elsewhere in the paranasal sinuses. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: 1. No acute findings. Specifically, no evidence of infarct or intracranial mass effect.2. Moderate global parenchymal volume loss with slightly greater involvement of the bilateral parietal lobes appearing similar to the prior MRI.3. Prominent mineralization/calcification involving the cerebellar hemispheres and basal ganglia appearing similar to prior studies. This finding is nonspecific but can be seen in a variety of acquired and inherited metabolic disorders, for example.


Instruction: Generate impression based on medical findings.

Input: 41-year-old female with abdominal pain. ABDOMEN:LIVER, BILIARY TRACT: Nonenhancing T2 hyperintensities compatible with benign cysts.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Above average stool burden.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Nonspecific airspace opacity in the left lung base.PELVIS:UTERUS, ADNEXA: Nabothian cysts are present.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Above average stool burden.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Above average stool burden.2.No abnormal enhancement is noted in the bowel.


Instruction: Generate impression based on medical findings.

Input: Male 71 years old with NASH cirrhosis. IPMN and HCC screening. ABDOMEN:LIVER, BILIARY TRACT: Nodular liver contour, widening of the fissures and left lobe hypertrophy are consistent with cirrhosis. There is trace perihepatic ascites. No focal hepatic lesion.Improved but small residual nonocclusive superior mesenteric vein thrombosis. The portal vein is patent.Cholelithiasis. No intra or extrahepatic biliary ductal dilatation.SPLEEN: Splenomegaly and subcentimeter splenic cyst. Splenic varices and splenorenal shunting are redemonstrated.PANCREAS: There are two dominant multilobulated cystic lesions extending exophytically from the pancreatic head measuring 3.2 x 2.7 cm (series 5, image 36 and) and 1.7 x 1.6 cm (series 5, image 30). Additional, much smaller cystic foci are also seen. The main pancreatic duct appears normal in size.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal sinus and parenchymal cysts. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is mild thickening of the hepatic flexure suggestive of portal colopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cirrhotic liver morphology with splenic varices and splenorenal shunting. No focal liver lesion.2.Improved nonocclusive superior mesenteric vein thrombosis.3.Thickening of the hepatic flexure suggestive of portal colopathy.4.Interval increase in size of cystic pancreatic head lesions. Based on size criteria, cyst aspiration should be considered for the 3.2 cm cyst.


Instruction: Generate impression based on medical findings.

Input: MRI Brain: Cerebellar tonsils are ectopic with inferior displacement of the tonsils by approximately 6 mm below the foramen magnum. There is minimal if any crowding of the CSF spaces at the foramen magnum. There is preserved bidirectional pulsatile CSF flow ventral and dorsal to the cord.FLAIR images are motion degraded but demonstrate no significant signal abnormality in the brain. Stable 8 mm pineal cyst is again seen. The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. There is minimal mucosal thickening involving the maxillary sinuses with small mucous retention cysts. MRI Cervical spine: The cervical cord is normal in caliber and signal. There is no evidence of syrinx. Vertebral bodies are well aligned. There is no neural foraminal or spinal canal narrowing. Alignment of the vertebral bodies is unremarkable. There is mild straightening of the cervical spine which may positional in nature. The paravertebral tissues are unremarkable.

Output: 1.Stable mild cerebellar tonsillar ectopia/Chiari 1 malformation. CSF spaces and bidirectional CSF flow at the foramen magnum are preserved. No evidence of syrinx in the cervical cord.2.Stable small cystic lesion in the pineal gland.


Instruction: Generate impression based on medical findings.

Input: 29 year-old male with left-sided weakness, evaluate for CVA.. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Normal brain CT.


Instruction: Generate impression based on medical findings.

Input: 59-year-old woman with right knee instability. Evaluate for ligamentous injury. MENISCI: There is marked degeneration of both menisci.ARTICULAR CARTILAGE AND BONE: Severe osteoarthritic changes affect the knee, most prominently affecting the medial tibial plateau. There is severe degeneration of the articular cartilage diffusely, affecting the articular surfaces of the femur, tibia and patella. Tricompartmental osteophytes are noted, most prominent in the medial tibiofemoral compartment.LIGAMENTS: Anterior and posterior cruciate ligaments are intact. Medial collateral ligament and lateral collateral complex are intact. Mild edema around the lateral collateral ligament may represent a mild sprain.EXTENSOR MECHANISM: The quadriceps tendon and patellar tendon are intact.ADDITIONAL

Output: Severe degenerative changes affect the knee. There is a small joint effusion.


Instruction: Generate impression based on medical findings.

Input: Headache [R51], Reason for Study: ^Reason: Pt with hx of migraines, but worsening and some change in character History: see above Brain MRINo evidence of acute ischemic or hemorrhagic lesion. No evidence of abnormal enhancement.There is about 4 mm dominant displacement of right cerebellar tonsil through the foramen magnum.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.

Output: 1. Borderline cerebellar tonsillar dominant displacement through the foramen magnum.2. No evidence of acute ischemic or hemorrhagic lesion. No evidence of abnormal enhancement.3. Normal brain MRA


Instruction: Generate impression based on medical findings.

Input: There is an extra-axial mass in the left posterior frontal convexity that measures 5.2 x 4.5 cm in anteroposterior and transverse dimensions and 4.5 cm in craniocaudal dimension. The tumor infiltrates the overlying calvarium with associated hyperostosis. There is mass effect upon the left superior frontal gyrus and approximately 3 mm of midline shift to the right. There is infiltration of tumor into the superior sagittal sinus and compression of underlying cortical vein. There are areas of susceptibility effect within the mass related to calcifications and hemorrhage. In addition, there is susceptibility effect within adjacent sulci, which is suggestive of prior subarachnoid hemorrhage or superficial siderosis. There is no evidence of intraparenchymal edema or acute infarct. The ventricles are normal in size and configuration. However, there is a partially-empty sella. The adenoids are prominent and contain several retention cysts.

Output: 1. An extra-axial parasagittal mass that measures up to 5.2 cm along the left frontal convexity with invasion of the superior sagittal sinus and infiltration of the overlying calvarium likely represents a meningioma. 2. Susceptibility effect within left frontal lobe sulci is suggestive of prior subarachnoid hemorrhage or superficial siderosis associated with the tumor.


Instruction: Generate impression based on medical findings.

Input: Chiari malformation, no decompression or surgery, worsening headaches. Brain: The cerebellar tonsils extend up to approximately 5 mm inferior to the foramen magnum. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift. 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 and morphology. There is lack of cervical lordosis, but no spondylolisthesis. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: 1. The cerebellar tonsils extend up to approximately 5 mm inferior to the foramen magnum. 2. No evidence of syringohydromyelia.


Instruction: Generate impression based on medical findings.

Input: Male, 22 years old, with left insular brain lesion, functional MRI requested for surgical planning purposes. Sensorimotor cortical activation of the hand, foot and face maps as expected along the pre- and post-central gyri. Likewise, visual cortical stimulation maps as expected along the bilateral calcarine sulci. Bilateral activation of the lateral geniculate nuclei is also seen.Of the tested language paradigms, the most reliable language related cortical activation is seen with the word generation, verb generation, and sentence completion paradigms. Language is left dominant on all tested paradigms. Broca's area is identified within the pars opercularis and pars triangularis of the inferior frontal lobe, and Wernicke's area is identified overlapping the posterior aspect of the superior temporal sulcus. Variable language contributions are noted from the right cerebral hemisphere, most prominently on the word generation and sentence completion paradigms.Regarding the positioning of functional domains relative to the patient's left insular lesion, cortical activation likely related to Broca's area is seen within the cortex immediately anterior and superior to the insular signal abnormality. Secondary language related activation is also seen within the frontal lobe operculum which sits immediately lateral to the insula.

Output: Sensorimotor cortical activation maps as expected along the pre and postcentral gyri. Visual cortical activation maps as expected along the bilateral calcarine sulci.Language related cortical activation is left dominant with variable, paradigm dependent contributions from the right cerebral hemisphere.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old. Pain. MENISCI: The medial and lateral menisci are intact, without evidence of tear. ARTICULAR CARTILAGE AND BONE: There is generalized thinning of the patellar cartilage. Focal irregularity along the medial patellar facet, compatible with partial-thickness tearing/defects.LIGAMENTS: The cruciate and collateral ligaments are unremarkable. The medial patellar retinaculum is not well seen and may be torn. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1.Joint effusion with possible associated inflammatory changes.2.Possible tear of the medial patellar retinaculum.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Rule out hemorrhage. Signs and symptoms: Facial droop. Nonenhanced head CT:There is no detectable acute intracranial process. CT however is insensitive for detection of acute nonhemorrhagic ischemic stroke.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation.Unremarkable calvarium and soft tissues of the scalp.Unremarkable orbits.All visualized paranasal sinuses and bilateral mastoid air cells/middle ear cavities are well pneumatized.

Output: Negative nonenhanced head CT.


Instruction: Generate impression based on medical findings.

Input: 49-year-old female with left mastectomy and sentinel biopsy in 2004 with reconstruction for invasive ductal carcinoma with tamoxifen with left silicone implant. History of benign right breast MR guided biopsy 2010. RIGHT BREAST:On postcontrast images, mild parenchymal enhancement is seen.No abnormal enhancement is seen in the right breast. A few nonspecific enhancing areas in the central right breast are stable compared to the prior exams, especially prior 3T studies. RECONSTRUCTED LEFT BREAST:No abnormal enhancement is present within the reconstructed left breast. Status post left mastectomy. Left breast silicone implant is intact. Stable skin irregularity is likely post surgical in etiology. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on medical findings.

Input: Headache. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, 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: Lumbago. Spinal stenosis, lumbar region, without neurogenic claudication Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is some mild disc desiccation at this level and a minor disc bulge. There is a Schmorl's node at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is some mild disc desiccation at this level and a minor disc bulge. There is a Schmorl's node at this level.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. There is a Schmorl's node at this level.

Output: No compromise to lumbar spinal canal or neural foramina. There are mild degenerative changes present in the lower lumbar spine.


Instruction: Generate impression based on medical findings.

Input: Fall. Loss of consciousness. Head laceration. Question bleed. There is no evidence of intracranial hemorrhage, edema, or midline shift. In the intrahemispheric aspect of the right parietal lobe there is either an area of encephalomalacia or a cyst with a thick wall of calcification. An MRI is recommended to exclude the possibility of a dermoid. The ventricles and basal cisterns are normal in size and configuration. The calvaria and skull base are radiographically normal without evidence of fracture. Soft tissue irregularity and subcutaneous emphysema are present in the left frontal region consistent with the history of laceration. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Soft tissue injury without evidence of fracture.2. Encephalomalacia versus cystic structure with thick wall of calcification in the right parietal lobe. An MRI is recommended for further evaluation to exclude the possibility of a dermoid.


Instruction: Generate impression based on medical findings.

Input: History of meniscal repair in 2001 with subsequent injury in 2009. Now complains of right knee pain. Due to the patient's body habitus, the high resolution coil could not be used. An alternative coil was used which results in slightly suboptimal image quality.MENISCI: There is marked deformity of the posterior horn of the lateral meniscus with fluid signal intensity in its substance indicating extensive complex tearing. This tearing extends into the body of the lateral meniscus and there is anterior extrusion of the anterior horn. We see no discrete tearing of the medial meniscus.ARTICULAR CARTILAGE AND BONE: There is full-thickness degeneration of the articular cartilage of the lateral femoral condyle and lateral tibial plateau posteriorly with underlying subchondral cysts. There is also more focal degeneration and tearing of the articular cartilage of the medial femoral condyle and medial tibial plateau adjacent to the posterior horn of the medial meniscus. There is also moderate degeneration of the articular cartilage of the patellofemoral joint with subchondral cysts in the patella. There are tricompartmental osteophytes.LIGAMENTS: Cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: 1.Extensive complex tearing of the lateral meniscus.2.Tricompartmental osteoarthritis.3.Collection of fluid signal intensity along the posteromedial aspect of the proximal tibia which may represent a ganglion or pes anserine bursitis.


Instruction: Generate impression based on medical findings.

Input: 12-year-old male patient with left knee injury/pain and swelling. MENISCI: The posterior horn and body of the lateral meniscus are detached from the underlying tibial plateau and displaced superior to the anterior horn. The medial meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is patchy edema within the distal femur most predominantly on the medial and lateral aspects of the medial and lateral femoral condyles. Edema is also noted within the lateral aspect of the lateral tibial plateau and the fibular epiphysis.There is subtle curvilinear low T1 signal within the subchondral bone of the weight-bearing portion of the lateral femoral condyle and slight cortical depression with associated bone edema compatible with an impaction injury. There is low T1 signal and associated edema about the lateral aspect of the lateral tibial plateau which is suspicious for a non-displaced fracture.The articular cartilage of all three compartments is intact.LIGAMENTS: There is a complete midsubstance tear of the anterior cruciate ligament. The posterior cruciate ligament is intact. The popliteus muscle and tendon are intact. The collateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Findings compatible with a pivot shift mechanism of injury with complete ACL tear, lateral meniscus tear, and associated bone injuries.


Instruction: Generate impression based on medical findings.

Input: Syncope. Suspicion of seizure. There is a punctate focus of susceptibility effect in the subcortical right superior frontal talus is not associated with edema. Otherwise, there is moderate T2 signal involving the frontoparietal white-matter. There are also small linear foci of encephalomalacia in the cerebellar hemispheres. There is no intracranial mass or acute infarct. There is no abnormal intracranial enhancement. There is no midline shift or herniation. There is mild diffuse cerebral volume loss and a partially empty sella. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. The eye lenses are replaced bilaterally. There is degenerative spondylosis in the upper cervical spine, with mild indentation of the spinal cord by a C4-5 disc-osteophyte complex.

Output: 1.No evidence of acute intracranial hemorrhage, mass, or acute infarct. 2.Non-specific diffuse patchy cerebral white matter may represent small vessel ischemic disease.3.Small chronic cerebellar infarcts.4.Chronic focus of microhemorrhage in the right frontal lobe.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: Redemonstrated are multiple foci of susceptibility abnormality within the supratentorial brain, consistent with the diagnosis of cerebral cavernous malformations. None demonstrate perilesional edema. There are no associated developmental venous anomalies. Previously identified lesions which had enlarged on the comparison exam demonstrates some change of internal signal characteristics, however none currently have significantly enlarged.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. The pituitary gland is normal in size. There is no evidence for 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 mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: Redemonstrated are multiple foci of susceptibility abnormality within the supratentorial brain, consistent with the diagnosis of cerebral cavernous malformations. None demonstrate perilesional edema. Previously identified lesions which had enlarged on the comparison exam demonstrates some change of internal signal characteristics, however none currently have significantly enlarged.


Instruction: Generate impression based on medical findings.

Input: 42-year-old female with left and right knee pain. Evaluate for osteoarthritis Weightbearing radiographs of the right knee reveal medial joint space narrowing as well as osteophyte formation along the lateral and medial femoral condyle and superior portion of the patella. Weightbearing radiographs of the left knee reveal lateral joint space narrowing as well as osteophyte formation along the lateral and medial femoral condyle and along the superior portion of the patella.Overall findings appear similar to prior study.

Output: Moderate osteoarthritis with no significant interval change from prior study.


Instruction: Generate impression based on medical findings.

Input: 55 years Female (DOB:8/18/1960)Reason: Ph + ALL with intracranial relapse - possible seizure and noted to have increased ventricle size History: AMSPROVIDER/ATTENDING NAME: EHTASHAM G KHATTAK WENDY STOCK The lateral and third ventricles are mildly dilated.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Motion artifact degrades the exam.

Output: 1.The ventricles are mildly dilated. In isolation this is non-specific. An underlying cause is not identified on this exam.2.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific. 3.Exam is degraded due to patient motion artifact which may obscure more subtle abnormalities. For example it is unclear if there is underlying mild ependymal or leptomeningeal disease or this appearance is a product of artifact.


Instruction: Generate impression based on medical findings.

Input: Headache(784.0) [784.0], Reason for Study: ^Reason: headache x 3 months, vision changes in R eye History: see above Brain MRIThe ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRV3D MRV brain using 3D Phase Contrast technique with velocity encoding as 5cm/sec and 15cm/sec were obtained. Due to inadequate demonstration of the dural sinuses on this MRV most likely related to technical issues, overall image quality is poor.However, major dural sinuses appear to be patent especially on MRV obtained with venc=15. There are possible venous sinus stenosis or intra-luminal filling defects especially on bilateral transverse- sigmoid sinus junctions. Further evaluation with Gadolinium enhanced MR venography can be considered for more precise evaluation of dural sinuses.In addition, diagnostic angiography with dural sinus pressure mapping can be considered for identifying endovascularly manageable idiopathic intracranial hypertension through Neurointerventional radiology consultation (page:9287).

Output: 1. Normal brain MRI2. Patent major dural sinuses. Possible stenosis or intra luminal filling defects on bilateral transverse-sigmoid junctions. Contrast enhanced MRV can be considered for further evaluation. Intra dural sinus pressure mapping can also be considered for identifying luminal stenosis which may show significant pressure gradient.


Instruction: Generate impression based on medical findings.

Input: Relapsed AML, evolving HA. There are postoperative findings related to right parieto-occipital craniotomy. There are unchanged scattered punctate foci of supratentorial and infratentorial susceptibility effect. There is no evidence of mass or acute infarct. There is no abnormal intracranial enhancement. The ventricles and sulci are unchanged in appearance. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits and paranasal sinuses are grossly unremarkable. There is diffuse low T1 signal in the bone marrow.

Output: 1. The unchanged scattered punctate foci of supratentorial and infratentorial susceptibility effect are nonspecific. Otherwise, no evidence of intracranial metastases.2. The diffuse bone marrow signal abnormality may be related to leukemia.


Instruction: Generate impression based on medical findings.

Input: Hemangioma of intracranial structures [D18.02], Reason for Study: ^Reason: 3T scanner, QSM/permeability, CCM Protocol, had pons hemorrhage in 1982, 2008 began having eye/facial nerve problems, HA, 2016 trouble swallowing, cavernous angioma diagnosed. There is about 15.0mm(RL) x 10.8mm(AP) x 6.7mm(CC) T2 low signal intensity, T1 mainly low signal intensity with susceptibility artifacts on the lower pons indicating likely diagnostic possibility of cavernous malformation. There are evidence of craniotomy on the right temporo occipital bone indicating postoperative status.On Gad enhanced images, There is focal enhancing tubular structure especially on the right anterior aspect of the lesion. The lesion is likely represent associated Developmental venous anomaly, however, other vascular malformations such as associated occult AVM cannot be completely excluded.There is no other abnormal enhancement seen on this scan. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. The right maxillary sinus shows subtle T2 high signal intensity and non enhancing low/iso T1 images at the bottom of the sinus cavity which most likely represent partial volume averaging artifact. Other paranasal sinus appear to be normal.

Output: 1. Cavernous malformation at the lower pons as described above.2. Tubular enhancing lesion on the right anterior aspect of the lesion indicate associated DVA but the possibility of associated occult AVM cannot be completely excluded.3. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on medical findings.

Input: 62 years, Male, Reason: L hemispheric lesion? History: recent syncopal/ possible seizure episode; R hyperreflexia; h/o colon CA. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Extensive patchy foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter as well as in the brainstem which are compatible with moderate to severe chronic small vessel ischemic disease. Scattered lacunar infarcts are also evident including the centrum semiovale, corona radiata, right anterior putamen, and right subinsular region. Focus of FLAIR signal abnormality in the left thalamus may also be related to prior ischemia. Several scattered foci of susceptibility are compatible with chronic microhemorrhages and in a nonspecific distribution.No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Minimal paranasal sinus mucosal thickening. Calvarium and extracranial soft tissues are grossly unremarkable.

Output: 1. No evidence of intracranial metastatic disease. No evidence of acute infarct.2. Moderate to severe chronic small vessel ischemic disease.


Instruction: Generate impression based on medical findings.

Input: 51-year-old female with knee pain. Evaluate for meniscal tear. Suboptimal evaluation secondary to artifact and patient inability to tolerate further imaging, particularly affecting the coronal PD fat saturated sequence.MENISCI: The medial and lateral meniscus appear intact.ARTICULAR CARTILAGE AND BONE: No bone marrow signal abnormalities are identified. There is superficial fraying of the articular cartilage along the lateral facet of the patella. There is a full-thickness cleft along the medial facet of the femoral trochlea, centrally.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Borderline tibial tubercle to trochlear groove distance with a full-thickness articular cartilage cleft along the femoral trochlea as described above.2. Small knee joint effusion.


Instruction: Generate impression based on medical findings.

Input: 54 years, Female, Reason: 3 t scanner moyamoya unilateral History: headache and tingling in upper extremities. MRI BRAIN

Output: 1. No evidence of acute infarct. Chronic infarct involving the left frontal corona radiata with mild extension into the basal ganglia. There are additional mild chronic small vessel ischemic changes.2. Cystic lesion involving the right aspect of the sella which also appears to present on remote CT from 2009. Further delineation with pituitary MRI can be considered as clinically warranted.3. The left internal carotid artery is moderately diminutive developmentally with suspected superimposed high-grade stenosis/occlusion involving the left distal supraclinoid ICA extending into the left M1 and to a lesser degree proximal left A1 segments. There are mildly prominent left-sided lenticulostriate collateral vessels. Overall findings are consistent with a moyamoya pattern. 4. Left parieto-occipital scalp defect.


Instruction: Generate impression based on medical findings.

Input: Bilateral arm radicular symptoms, rule out cervical pathology/herniated disc. Left shoulder pain. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is mild loss of cervical lordosis. There is mild retrolisthesis of C6 on C7. 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: No significant compromise to the spinal canal or neural foramina.C3-4: Small disc osteophyte complex and uncovertebral hypertrophy. No significant spinal canal stenosis. Mild right greater than left neural foraminal narrowing.C4-5: Small disc osteophyte complex and uncovertebral hypertrophy, particularly on the right. No significant canal stenosis. There is moderate to severe right neural foraminal stenosis and mild left neural foraminal narrowing.C5-6: Small disc osteophyte complex and mild bilateral uncovertebral hypertrophy. No significant spinal canal stenosis. Mild left greater than right neural foraminal stenosis.C6-7: Small disc osteophyte complex, uncovertebral hypertrophy, and mild retrolisthesis. No significant spinal canal stenosis. There is mild to moderate left and mild right neural foraminal stenosis. C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Multilevel degenerative changes in the cervical spine with multi-level neural foraminal narrowing as described above, relatively worse at the right C4-C5 and left C6-C7 levels. No significant spinal canal stenosis.


Instruction: Generate impression based on medical findings.

Input: Metastatic lung cancer. There is no evidence of acute intracranial hemorrhage or infarct. There are scattered areas of T2 hyperintensity in the cerebral white matter, which are nonspecific. There are multiple unchanged punctate foci of susceptibility effect in the bilateral cerebral hemispheres, without associated enhancement. There is no evidence of acute infarction. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. There are bilateral lens implants.

Output: Post-treatment findings without evidence of recurrent intracranial metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Right hip pain. ACETABULAR LABRUM: There is abnormal signal intensity within the anterior labrum from approximately the 1:00 to 4:00 position, indicating a tear. The remainder of the labrum appears normal.ARTICULAR CARTILAGE AND BONE: There is edema within the femoral neck and intertrochanteric region concentrated medially with a small cortically based focus of low signal intensity along the medial aspect of the femoral neck, indicating a stress fracture. No cam deformity is seen. The bone marrow signal intensity is otherwise normal.SOFT TISSUES: There is edema type signal of the distal iliopsoas, likely iatrogenic secondary to the contrast injection. The musculature appears otherwise normal.

Output: 1. Right femoral neck stress fracture.2. Right acetabular anterior labral tear.Findings were relayed to Dr. Birnie's nurse Ashley Fraction by Dr. J. Dickherber on 9/20/2016 at 14:40.


Instruction: Generate impression based on medical findings.

Input: Memory loss. Many of the sequences are degraded by patient motion. There is moderate diffuse cerebral white matter T2 hyperintensity and left basal ganglia encephalomalacia with susceptibility effect. There is also right occipital lobe encephalomalacia. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is diffuse cerebral volume loss, which is particularly pronounced in the medial temporal lobes bilaterally. 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. There is a small atlanto-axial articulation effusion.

Output: 1. Diffuse cerebral volume loss, which is particularly pronounced in the medial temporal lobes bilaterally may be a manifestation of Alzheimer's disease. 2. Moderate diffuse chronic small vessel ischemic disease and chronic right occipital lobe infarct and left basal ganglia hemorrhagic lacunar infarct, but no evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on medical findings.

Input: 64 years Female (DOB:11/12/1952)Reason: eval for worsening osteomyelitis History: eval for worsening osteomyelitisPROVIDER/ATTENDING NAME: YASMIN H. KARIMI Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Exam is degraded due to motion artifact.Incidental note is made of partial empty sella.MRI thoracic spine:At T11-T12 there is erosion of the endplates and T2 signal hyperintensity within the T11-T12 vertebral bodies as well as the T11-T12 disc. There appears to be some adjacent epidural thickening which is not well imaged on this exam. This involves predominantly in the right hemicord canal and right anterior aspect of the spinal canal. Compared to the 11/23/2016 exam the epidural component appears to be slightly thicker..A lesion adjacent to the aorta at the L3 vertebral level is not well imaged on this exam. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. There is a large left renal cyst present measuring 46 x 34 mm axial dimensions which is incompletely visualized on this exam.

Output: 1.Findings are suspicious for T11-T12 discitis osteomyelitis and possibly epidural involvement. Compared to the prior exam the subdural component appears to be thicker on the current exam.2.A periaortic lesion is not well demonstrated on this exam because it is at the periphery of the imaging. It is not clear if this has progressed.3.To the extent of visualization is no compromise of the cervical spinal cord or exiting nerve roots. Please note that the cervical spine exam is degraded by patient motion and lack of axial imaging.4.Thoracic spine exam is degraded due to patient motion and likely of intravenous contrast administration.