Instruction: Generate impression based on medical findings.

Input: Diagnosis: Low back painSigns and Symptoms: RLE neuropathy 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 . There is a left lateral recess disk protrusion at this level which mildly encroaches on the nerve roots at the left lateral recess.At L4-5 there is a right paramedian broad based disk extrusion which effaces the fat at the right lateral recess and compresses the thecal sac. It is associated with bilateral facet and ligamentum flavum hypertrophy as well as moderate spinal stenosis. There is loss of disk space height at this level. There is disk dessication at this level.At L3-4 there is a focal central disk extrusion associated with bilateral facet and ligamentum flavum hypertrophy as well as moderate spinal stenosis. Some disk material tracks behind the L3 inferior endplate and vertebral body There is loss of disk space height at this level. There is disk dessication 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.

Output: 1.There is spinal stenosis at L4-5 affecting the nerve roots at the right lateral recess more than the left lateral recess as described above.2.There is spinal stenosis at L3-4 as described above.3.There is mild encroachment of the nerve roots at the left lateral recess at L5-S1 due to a disk protrusion.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Nontraumatic intracerebral hemorrhage, unspecified. Bladder cancerClinical question: sinus thrombosis underlying cause of hemorrhage MRI of the brainA focus of diffusion weighted imaging signal hyperintensity is present in the left posterior temporal lobe subcortical white matter several foci of diffusion-weighted imaging signal hyperintensity are present in the right temporal lobe subcortical white matter.There is a 62 x 30 mm hematoma centered in left gyrus rectus and extending superiorly from the to the cingulate gyrus. It is associated with surrounding T2 and FLAIR signal hyperintensity compatible with vasogenic edema.On susceptibility imaging there is signal loss along the sulci in the medial aspect of supratentorial hemispheres. Additionally there are punctate foci of signal loss along subcortical white matter in the occipital lobes as well as the posterior temporal lobes and basal frontal lobes subcortical white matter with punctate foci of signal loss also in the cerebellar hemispheres.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a mucous retention cyst. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Some images are degraded due to patient motion artifact.MRV brain:The dural venous sinuses are patent. Straight sinus, internal cerebral veins and basal veins are identified and appear patent. The left jugular vein, sigmoid sinus and transverse sinus are smaller than the right-sided counterparts. There appears to be a fenestration along the superior sagittal sinus posteriorly.

Output: 1.There is a hematoma centered in the left anterior frontal lobe associated with some local mass effect. No underlying mass lesion is appreciated on the current exam.2.There are multiple microhemorrhages scattered predominantly in subcortical white matter. This pattern could suggest amyloid angiopathy.3.There is siderosis present along the supratentorial brain medially which is suggestive of prior subarachnoid blood.4.MR venogram of the brain is within normal limits. There is no evidence for dural venous sinus or deep vein thrombosis5.Several acute microinfarcts may be present and subcortical white matter of the temporal lobes.6.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on medical findings.

Input: Left knee pain MENISCI: There is abnormal signal and morphology of the posterior horn of the medial meniscus which extends into the posterior horn/body junction. The anterior horn is intact. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is mild diffuse thinning of the articular cartilage of the medial compartment with areas of partial-thickness loss of posterior femoral condyle. No discrete full-thickness defects are identified within the medial compartment. Similar although less severe changes are also noted in the lateral and patellofemoral compartments. A small cystic focus is noted within the lateral tibial plateau posteriorly.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Complex but predominantly horizontally oriented tear of the posterior horn of the medial meniscus.2. Mild diffuse thinning of the tricompartmental articular cartilage which is most evident medially.


Instruction: Generate impression based on medical findings.

Input: Low back and right lower extremity pain Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is mild exaggeration of lumbar lordosis. Alignment is otherwise within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.There is congenitally narrow lumbar spinal canal with superimposed degenerative changes as described below: T11-T12: Mild disc bulge with mild to moderate spinal canal stenosis based on sagittal sequences. Moderate right and mild left neural foraminal narrowing.T12-L1: There is mild disc bulge and bilateral facet arthropathy, and ligamentum flavum thickening resulting in mild to moderate spinal canal narrowing. There is mild narrowing of the neural foramina.L1-L2: There is mild to moderate spinal canal stenosis related to bilateral facet arthropathy and ligamentum flavum thickening. There is mild bilateral neural foraminal stenosis.L2-L3: There is moderate spinal canal stenosis related to prominent bilateral facet arthropathy and ligamentum flavum thickening. Minimal disc bulge. There is mild to moderate left and mild right neural foraminal stenosis.L3-L4: There is severe spinal canal stenosis related to advanced bilateral facet arthropathy, ligamentum flavum thickening, and mild disc bulge. There is mild bilateral neural foraminal narrowing.L4-L5: There is moderate spinal canal stenosis related to advanced facet arthropathy and ligamentum flavum thickening. There is effacement of the lateral recesses. Minimal disc bulge. There is no significant neural foraminal stenosis. L5-S1: There is mild to moderate spinal canal narrowing related to bilateral facet arthropathy and minimal disc bulge. There is effacement of the bilateral lateral recesses. There is moderate to severe neural foraminal stenosis bilaterally, right relatively worse in left.There appears to be surgical scar involving the midline lower paraspinous tissues which can be correlated with prior history. Due to the advanced facet arthropathy, small laminectomy defects are difficult to delineate with MRI. Paraspinous soft tissues are otherwise grossly within normal limits.

Output: 1. Advanced multilevel degenerative changes in the lumbar spine. There is severe spinal canal stenosis at L3-L4, moderate spinal canal stenosis at L2-L3 and L4-L5, and mild to moderate at additional levels in the lumbar and lower thoracic spine as described above.2. Moderate to severe neural foraminal stenoses bilaterally at L5-S1, right relatively worse than left.3. Advanced facet arthropathy throughout the lumbar spine.


Instruction: Generate impression based on medical findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The right hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 8 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 16 seconds.

Output: Successful fluoroscopic guided injection of dilute gadolinium into the right hip for subsequent MRI arthrogram examination.


Instruction: Generate impression based on medical findings.

Input: 40 year old woman s/p heart transplant on 3/2012 and LAD stent in 9/2014. Referred to evaluate for transplant vasculopathy. First Pass PerfusionDuring hyperemia, there is a perfusion defect involving the mid septum, anterolateral and inferolateral walls. The overall ischemia score is 3 out of a possible 32. 9% of the myocardium is ischemic.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 70%, the LV end diastolic volume index is 58 ml/m2 (normal range: 65+/-11), the LVEDV is 140 ml (normal range 109+/-23), the LV end systolic volume index is 18 ml/m2 (normal range 18+/-5), the LVESV is 34 ml (normal range 31+/-10), the LV mass index is 47 g/m2, and the LV mass is 93 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is enlarged consistent with transplant morphology. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 65%, the RV end diastolic volume index is 60 ml/m2 (normal range 69+/-14), the RVEDV is 117 ml (normal range 110+/-24), the RV end systolic volume index is 21 ml/m2 (normal range 22+/-8), and the RVESV is 41 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSternal wires are noted. 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. During hyperemia, there is a perfusion defect involving the septum, anterolateral, and inferolateral walls.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 70%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.4. Normal RV size and systolic function (RVEF 65%).


Instruction: Generate impression based on medical findings.

Input: 65-year-old male with prostate cancer. Gleason 6, left mid lateral PELVIS:PROSTATE:Prostate Size: 5.1 x 3.8 x 5.3 cm.Peripheral Zone: Striated T2 hypointensities and T1 hyperintensity in the peripheral zone may reflect post-biopsy blood product. Please note that this precludes the detection of small foci of malignancy. Focus of T2 hypointensity in the left mid gland peripheral zone with corresponding diffusion restriction measuring approximately 8 x 9 mm (series 1001, image 7).Central Gland: Moderate degree benign prostatic hypertrophy.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant lymphadenopathy. Scattered subcentimeter external iliac and inguinal lymph nodes.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Findings of post-biopsy hemorrhage throughout the peripheral zones preclude detection of small foci of malignancy. Within these limitations, there is a suspicious focus ot T2 hypointensity with corresponding ADC restriction in the left midgland peripheral zone as described above.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Evaluate for structural lesions, previous ischemia, previous CEA. Signs and symptoms: Severe tremor. Nonenhanced brain MRI:No acute intracranial process and negative diffusion weighted series.There is a small focus of encephalomalacia in the left occipital lobe consistent with a chronic ischemic stroke. Additionally there are multiple small foci of FLAIR/T2 hyperintensity involving the cortex and subcortical white matter as well as periventricular white matter of bilateral cerebral hemispheres suggestive of multiple prior chronic small vessel ischemic strokes and small cortical strokes. The appearance of the findings could suggest watershed some strokes.There is disproportionate prominence of cortical sulci and to a lesser degree cerebellar and vermin folia patient's stated age of 64. Ventricular system are slightly prominent and with maintained midline.The signal void of major intracranial branches are identified.Unremarkable calvarium and soft tissues of the scalp. Unremarkable images through the orbits.Prostate air cells demonstrate diffuse bilateral patchy nonspecific opacification.Paranasal sinuses demonstrate frontal, sphenoid left greater than right anterior ethmoid sinus disease.

Output: 1.No acute intracranial process and negative diffusion weighted series.2.Multiple small cortical, subcortical and periventricular white matter chronic ischemic strokes of bilateral cerebral hemispheres as detailed above.3.Generalized prominence of cortical sulci, mild prominence of the supratentorial ventricular system and cerebellar- vermian folia for the patient's stated age.4.Chronic sinusitis as detailed.


Instruction: Generate impression based on medical findings.

Input: Left-sided lesion that was visible on only the FLAIR and T2, seizures. There is no evidence of intracranial hemorrhage or acute infarct. There is no significant interval change in the T2 hyperintense lesion in the posterior limb of the left internal capsule that extends superiorly into the corona radiata, accounting for differences in technique. There is perhaps faint patchy associated enhancement, but no discernible hyperperfusion. The ventricles and basal cisterns are unchanged in size and configuration. There are unchanged minimally low-lying cerebellar tonsils. There is no midline shift. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mucosal thickening within the right frontal and anterior ethmoid sinuses.

Output: No significant interval change size of the lesion involving the posterior limb of the left internal capsule with extension into the corona radiata.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old, with altered mental status. The examination is limited due to motion artifact and early termination. Within this limitation, no large areas of restricted diffusion are seen. Encephalomalacia and gliosis are evident affecting the right middle frontal gyrus. No additional large parenchymal defects are seen. There are probably scattered additional foci of nonspecific white matter T2 hyperintensity.

Output: Very limited examination due to motion artifact revealing an area of encephalomalacia and gliosis in the right middle frontal gyrus. No large areas of acute ischemia or large parenchymal lesions are observed.


Instruction: Generate impression based on medical findings.

Input: Reason: delineate renal anatomy History: hx cloaca, duplicate collecting system, renal cysts ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis. Bilateral renal cysts, the largest on the right measures 9 x 8 mm, the largest on the left measures 13 x 14 mm. There is right duplicated kidney with partial duplication of the right ureter, which combines to form a single ureter approximately 2.5 to 3 cm distal to the inferior renal pelvis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: The uterus is deviated to the left, and there is a pigtail drainage catheter noted, which drains via patient's short segment neovagina. Both ovaries are identified, and are normal in morphology and size.BLADDER: Irregularly shaped bladder, incompletely filled, deviated to the right. LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Right kidney duplication with partial duplication of the right ureter.2.Bilateral renal cysts.3.Irregularly shaped bladder, incompletely filled with fluid.4.Drainage catheter within the uterus/neovagina.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Glioblastoma multiforme. Signs and symptoms: Vomiting. Pre and post enhanced brain MRI:Examination demonstrates a large heavily necrotic and ring-enhancing mass with large areas of solid enhancing component along the medial aspect of right posterior frontal-parietal lobe which inferiorly extends into the splenium of the corpus callosum. The tumor abuts the right lateral ventricle and with resultant inferior displacement. It measures at least at 38 x 35 x 38 mm and consistent with patient's known GBM. The tumor has white contact with the right lateral ventricle and inseparable from its ependymal lining.There is no detectable surrounding vasogenic edema exception of minimal edema in the splenium of the corpus callosum. There is a large focus of encephalomalacia along the interhemispheric aspect of right frontal lobe immediately anterior to the tumor. There is mild dilatation of the lateral ventricles however with maintained midline. Ventricular system however remains stable in size since prior head CT from 8-26-15.There are no additional foci of parenchymal signal abnormality or parenchymal/meningeal enhancement.There is postoperative changes of a large posterior frontal and parietal craniotomy which traverses the midline to the left. As was noted on prior head CT exam there is a large extracranial fluid signal intensity collection immediately superior to the craniotomy and consistent with a seroma. It measures approximately 82 mm in transverse axis and 34 mm in height which are measured on coronal reformatted post enhanced images.

Output: 1.Large partially solid and necrotic enhancing GBM along the interhemispheric aspect of the right posterior frontal-parietal lobe as detailed/measured above.There is no significant mass effect and midline is maintained.1.Postoperative changes of a wide parietal craniotomy which extends across the midline to the left and with evidence of a seroma immediately above the craniotomy flap as detailed/measured above.


Instruction: Generate impression based on medical findings.

Input: History of PSC. ABDOMEN:LIVER, BILIARY TRACT: Demonstrated again is markedly irregular beaded dilatation and narrowing of the intra and extrahepatic biliary system. The common bile duct measures up to 8 mm, unchanged. No new dominant stricture or focal lesion is identified. Normally distended gallbladder without gallstones or choledocholithiasis. No abnormal bile duct enhancement.The vessels are patent.SPLEEN: The spleen is normal in morphology and size without a discrete lesion.PANCREAS: The accessory duct is directed towards the main pancreatic duct (series 8 image 24 and series 9 image 18) suggesting normal variant ansa pancreatica. The pancreatic parenchyma is normal in morphology and signal intensity. Normal pancreatic duct caliber.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal superior pole simple cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No significant change in the multifocal biliary ductal dilatation and stricturing of PSC without evidence of a dominant stricture, thickened biliary ductal walls or focal hepatic mass.


Instruction: Generate impression based on medical findings.

Input: Male 62 years old with malignant melanoma s/p 6 cycles of immunotherapy. Please evaluate disease status and provide measurements for all lesions. ABDOMEN:LIVER, BILIARY TRACT: There are multiple subcentimeter T2 hyperintense, circumscribed nonenhancing hepatic lesions are consistent with simple cysts. The referenced right hepatic dome lesion is not seen on today's exam. A small area of enhancement within hepatic segment 7 is unchanged and consistent with a portal to hepatic venous shunt. Normal morphology of liver with no suspicious lesion. No biliary ductal dilatation. The hepatic vasculature appears patent.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas enhances homogeneously. The pancreatic duct is not dilated.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: The reference celiac bifurcation lymph node measures 2.6 x 0.8 cm (series 11, image 53), previously 2.6 x 1.0 cm.BOWEL, MESENTERY: Moderate hiatal hernia.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Multiple subcentimeter hepatic cysts and stable hepatic venous shunt. No suspicious liver lesion.2.Stable reference celiac bifurcation lymph node.3.No new sites of disease.


Instruction: Generate impression based on medical findings.

Input: A 28 year old female with personal history of mild asthma recently with dyspnea and atypical chest pain during exercise. A recent echocardiography showed mildly reduced right ventricular systolic function with flattened septum. Referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is severely dilated with low normal systolic function. The overall LV ejection fraction is 52%, the LV end diastolic volume index is 117 ml/m2 (normal range: 65+/-11), the LVEDV is 186 ml (normal range 109+/-23), the LV end systolic volume index is 56 ml/m2 (normal range 18+/-5), the LVESV is 89 ml (normal range 31+/-10), the LV mass index is 58 g/m2 (normal range 67+/-11), and the LV mass is 92 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is normal wall thickness. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The native myocardial T1-time are in the upper-normal range (~1060-1080ms). The global relative enhancement (GRE) and extracellular volume fraction are within normal ranges. These findings suggest the absence of an underlying infiltrative, inflammatory, or fibrosis process in the myocardium.Left AtriumThe left atrium is normal in size (97ml).Right VentricleThe right ventricle is severely dilated with low normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 132 ml/m2 (normal range 69+/-14), the RVEDV is 209 ml (normal range 110+/-24), the RV end systolic volume index is 66 ml/m2 (normal range 22+/-8), and the RVESV is 105 ml (normal range 35+/-13). The heart is shifted into the left thorax as a consequence of the decreased sternum to spine dimension. The sternum is extrinsically compressing on the RV free wall, distorting its shape and causing variation in the regional motion. However, there is no evidence that this extrinsic compression is hemodynamically significant. Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC drain normally into the right atrium. IVC is grossly normal. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is significant scoliosis and decreased space between the sternum and spine without evidence of a classical pectus deformity. 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 severely dilated with low normal systolic function, the LVEF is 52% without evidence of underlying myocardial fibrosis, inflammation, or infiltration.2. The right ventricle is severely dilated with low normal systolic function, the RVEF is 50%. 3. Significant changes of scoliosis are noted. Although there is no classical pectus deformity of the sternum, the anterior-to-posterior dimension between the sternum and spine is as small as 4.5cm. The reduced space has caused the heart to be shifted into the left thorax and distorted the shape of the right ventricle. This extrinsic compression of the right ventricle does not appear to be causing any hemodynamically significant changes. 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: 64-year-old female history of OA and RA now with right groin pain. ARTICULAR CARTILAGE AND BONE: Severe osteoarthritis affects the hip with flattening of the femoral head superiorly, bulky osteophytes, and subchondral cysts. There is asymmetric edema type signal within the right femoral head and neck which is nonspecific. While we see no evidence of a discrete fracture, a subchondral stress fracture can have this appearance. Severe osteoarthritis also affects the left hip as seen on the large field-of-view images.ACETABULAR LABRUM: There is diffuse degeneration of the acetabular labrum.SOFT TISSUES: There is fat signal abnormality within the anterior aspect of the right gluteus minimus which may represent focal atrophy or less likely an intramuscular lipoma.ADDITIONAL

Output: Asymmetric edema type signal within the right femoral head/neck may simply be degenerative in etiology, although with the presence of an effusion and mild flattening of the superior aspect of the femoral head, a subchondral stress fracture cannot be entirely excluded; if an acute concern remains suspected.


Instruction: Generate impression based on medical findings.

Input: Localized swelling, mass and lump, head [R22.0] / Cellulitis of face [L03.211], Reason for Study: ^Reason: eval infection History: abscess Re-demonstration of right paraorbital sinus inflammation with subperiosteal abscess formation along the lamina papyracea with proptosis. There is 8.8mm x 33mm sized extra axial fluid collection with internal air at the right anterior cranial fossa just above the cribriform plate with peripheral enhancement indicating extension of ethmoid sinus lesion extension. Right frontal and temporal area dura and the left frontal dural enhancement indicating local inflammatory reaction.Subtle high signal intensity on FLAIR/T2 at the right mesial orbital gyrus indicating possible reactive inflammatory changes of the brain parenchyme. There is no evidence of acute ischemic or hemorrhagic lesion on this scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.

Output: 1. Right paraorbital-paranasal abscess with intracranial extension results right side anterior cranial fossa extra-axial fluid collection as described above associated with reactive changes of right mesial orbital gyrus and overlying dura.2. No evidence of brain parenchymal abscess, no acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on medical findings.

Input: Reason: compare aneurysm History: TIA MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal 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. The left eyeball lens is thin.Incidental note is also made of congenital fusion of C2 on C3.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.No intracranial stenosis is appreciated. There is a 2.8 x 2 mm right communicating segment aneurysm present which is directed laterally and anteriorly. This is stable compared to the September exam. There is a 3 mm x 2.5 mm left posterior communicating artery aneurysm present. This is stable compared to the September exam. The origin of the left posterior communicating artery comes off the base of the aneurysm along its medial aspect. There is a 2.5mm infundibulum at the origin of the right PCOMA. There is an extracranial origin of the right posterior inferior cerebellar artery.The anterior communicating artery is a small to medium-sized and the posterior communicating arteries are identified and are small but are intact.

Output: 1.Findings indicate small bilateral communicating segment aneurysms. These are stable since 1/31/13.2.No evidence for acute ischemic cerebral infarction.3.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on medical findings.

Input: 18 year-old male with sickle cell crisis and severe headache There is no evidence of intracranial hemorrhage, mass or edema. Crowding of the foramen magnum with the cerebellar tonsils extending inferiorly off the image corresponding to a Chiari 1 malformation as seen on the previous MRI.There is a subtle hypoattenuation in the region of the right external capsule, also seen on the previous MRI without surrounding gliosis or edema, and appears to represent prominent CSF space.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: No acute intracranial abnormality. Chiari 1 malformation is again noted.


Instruction: Generate impression based on medical findings.

Input: 69-year-old female presents with biopsy proven right breast carcinoma (two sites), locally advanced to lymph nodes. There is scattered fibroglandular tissue with mild background parenchymal enhancement noted bilaterally.In the far posterior slightly lower outer left breast, there is a 3.4 x 3.3 x 3.1 cm circumscribed enhancing mass which contained susceptibility artifact from biopsy clip, compatible with the patients known malignancy at the 9 o'clock position. This resides approximately 0 .4 cm anterior to the pectoralis muscle. A second mass is present within the central slightly upper outer right breast measuring 1.4 x 1.0 x 1.2 cm, corresponding to the patient's known malignancy at the 10 o'clock position. Non-mass enhancement is present extending anterior and lateral to the masses, spanning 7.8 cm AP. Total AP extent of enhancement inclusive of masses and non-mass enhancement is 11.4 cm.Multiple prominent right axillary lymph nodes are present. One node contains a Hydromark clip from prior biopsy. Of note, prominent nodes are appreciated at the lateral border of the pectoralis muscle. No areas of abnormal enhancement are present within the left breast. No enlarged lymph nodes are present within the left axilla.

Output: 1. Two enhancing masses within the upper outer right breast, compatible with the patient's known malignancy. Non-mass enhancement is noted extending anterior and lateral the the masses. Total extent of enhancement in the right breast is 11.4 cm AP. 2. Multiple prominent right axillary lymph nodes, one of which contains a biopsy clip.3. No MRI evidence of malignancy in the left breast.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: 65-year-old woman with history of alcoholic cirrhosis and liver lesion seen on 2015 MRI. ABDOMEN:LIVER, BILIARY TRACT: Liver appears cirrhotic in signal and morphology. In segment 4A (20/371), there is a 9 x 8 mm area of washout which appears similar in size to prior examination, previously 9 x 7 mm. This area does not demonstrate early arterial enhancement, abnormal T2 signal, or abnormal diffusion signal. This region does contain fat as evidenced by signal dropout on opposed phase imaging.Additionally, there is a new geographic focus of arterial enhancement in segment 4A (20/166). This area does not washout on delayed phase imaging and is isointense to liver on T2 without restricted diffusion.The portal vein is patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter right renal cysts noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stable nonspecific segment 4A lesion.2.New arterially enhancing segment 4A lesion which is also nonspecific but not characteristic of HCC and can be followed on subsequent imaging.


Instruction: Generate impression based on medical findings.

Input: Clinical question: h/o ALL s/p chemo and cranial radiation. Small, enhancing extra-axial mass along the right frontal lobe on recent MRI, monitor for changes. Signs and Symptoms: recent onset eye squinting Pre and post enhanced brain MRI:Unremarkable diffusion weighted series.Examination redemonstrate stable mild patchy foci of flair hyperintensity in the periventricular and few in subcortical white matter of cerebral hemispheres without change. Although nonspecific this appearance could represent post treatment/ radiation change.The cortical sulci are mildly prominent for age however less conspicuous since prior study. Mild prominence of the lateral ventricles with maintained midline similar to prior study. There is also prominence of the cerebellar and vermian folia for age without change since prior exam..Post enhanced images demonstrate a small dural based appearing enhancing lesion along the inner table of right paramedian anterior frontal bone without change since prior study. This finding could represent a meningioma. There is no associated parenchymal edema or mass effect which is a similar observation as prior exam. Unremarkable calvarium, orbits and well pneumatized paranasal sinuses/mastoid air cells/middle ear cavities.

Output: 1.No acute intracranial findings and no convincing evidence of new finding since prior study.2.Stable mild patchy foci of flair hyperintensity in periventricular and subcortical white matter likely representing post therapy change. 3.Stable small focus of dural based right paramedian inferior frontal enhancement since prior which could represent a meningioma. Further follow up is recommended.4.Prominence of cerebral and cerebellar/vermian folia as mentioned above.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old, history of left submandibular mass, FNA was likely adenoid cystic. A well circumscribed T1 hypointense, T2 hyperintense and uniformly enhancing mass is present within or adjacent to the left submandibular gland. This lesion measures 18 x 11 mm in the axial plane and up to 16 mm in the coronal plane.Although there are no pathologically enlarged lymph nodes in the neck, a 7-mm node just posterior to the left submandibular gland (image 23 series 1401), and even smaller nodes more posteriorly (image 26 series 1401) do enhance more than other lymph nodes in the neck.The remaining salivary glands and thyroid are unremarkable. The aerodigestive mucosal tissues are free of mass lesions. Signal characteristics are within normal limits.

Output: A well circumscribed, homogeneously enhancing nodule within or immediately adjacent to the left submandibular gland is clearly of different tissue composition than the gland itself and is therefore highly suspicious for tumor. Both benign and malignant tumors would be in the differential.There are no pathologically enlarged lymph nodes in the neck. However, two small lymph nodes at level 2 on the left do show enhancement which is more intense than that of other normal-appearing lymph nodes, and as such these nodes are suspicious.


Instruction: Generate impression based on medical findings.

Input: PELVIS:PROSTATE:Prostate Size: 5.0 x 6.3 x 7.5 cmPeripheral Zone: Dominant lesion in the left mid gland measuring 2.5 x 1.3 cm with low T2-weighted signal intensity, restricted diffusion and arterial enhancement.1.1 x 0.6 cm right paramedial apex lesion with similar imaging characteristics. 1.6 x 1.4 cm lesion in the left base with similar imaging characteristics.Central Gland: Benign prostatic hyperplasia.Seminal Vesicles: The left base lesion as well as the left mid gland region appear to extend into the left seminal vesicle.Extracapsular Extension: Suspected extracapsular extension of the left mid gland lesion posterolaterally.BLADDER: No significant abnormality noted.LYMPH NODES: Multiple enlarged left pelvic lymph nodes in the common, external and internal iliac chains. The largest lymph node measures 3.1 x 1.9 cm (series 1 901/104 ). Nonspecific left perirectal fossa lymph node.BONES, SOFT TISSUES: Large left inguinal hernia containing sigmoid colon.MRI PROSTATE BIOPSY PROCEDURE

Output: 1. Foci suspicious for prostatic adenocarcinoma in the left mid gland, right apex and left base with suspected left seminal vesicle invasion and extracapsular extension. Successful MRI guided core-biopsies of the dominant 2.5 cm left mid-gland peripheral zone lesion.2. Pelvic lymphadenopathy.3. Large left inguinal hernia containing sigmoid colon.


Instruction: Generate impression based on medical findings.

Input: Ms. Vondriska is a 59-year-old female with a personal history of occult primary adenocarcinoma status post complete axillary lymph node dissection in 2006, neoadjuvant chemotherapy and radiation therapy. Family history of breast cancer in sister, diagnosed at the age of 39. There is heterogeneous amount of fibroglandular tissue in both breasts. Moderate parenchymal enhancement is noted bilaterally.Scattered foci of enhancement are seen in the right breast, appearing stable when compared to multiple prior examinations. Stable enhancing circumscribed mass in the right breast, likely representing a fibroadenoma. No abnormal enhancement is seen in either breast. Stable postoperative changes are present along the left axilla. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on medical findings.

Input: 52-year-old male patient with refractory hand pain. Evaluate for subclinical synovitis. There is mild synovitis adjacent to the second metacarpal head. A small collection of fluid signal intensity along the volar surface of the second metacarpal head may represent a small synovial cyst or ganglion. Mild osteoarthritis affects the first metacarpophalangeal joint with minimal synovitis and a small cyst or erosion in the first metacarpal head. The remaining metacarpophalangeal joints and interphalangeal joints appear normal.Enhancement along the volar aspect of the carpus likely represents synovitis, but is incompletely visualized on this hand study. Small enhancing foci in the capitate may represent cysts or erosions. The visualized tendons and remaining soft tissues appear normal.

Output: Mild synovitis of the first and second metacarpophalangeal joints and wrist with other findings as described above.


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: 76-year-old male patient status post fall with pain on right side with moving. Question of occult hip fracture. Some sequences are limited by patient motion artifact and the patient was not able to complete study. Given this limitation, we see the following findings:There is vertically oriented linear signal abnormality within the right greater trochanter indicating a nondisplaced fracture with edema extending from the fracture into the intertrochanteric region, but the lesser trochanter itself appears intact. Mild edema is noted in the adjacent soft tissues. Mild osteoarthritis affects the right hip with a small amount of fluid in the right hip joint. Please note this study was not protocoled for detailed evaluation of the labrum.Mild osteoarthritis affects the left hip. Degenerative arthritic changes affect the lower lumbar spine.

Output: Non-displaced fracture of the greater trochanter of the right femur.


Instruction: Generate impression based on medical findings.

Input: Right elbow locking. Prior MRI dated 1/30/2011 demonstrated an old osteochondral defect/degenerative cyst. Prior MRI also demonstrated prominence of synovial fat versus intra-articular loose bodies. There is no significant elbow effusion.The noncontrast CT appearance of the common flexor and extensor tendons is normal. The noncontrast CT appearance of the biceps, brachialis, and triceps is normal.No fluid collections within the soft tissues.Small subchondral lucencies in the anterior aspect of the capitellum are again seen, and given differences in technique appear unchanged from the prior MRI. These may represent degenerative cysts, or old osteochondral defects. The overlying bone plate is intact, suggesting stability. A small defect more posteriorly in the capitellum may represent a normal variant "pseudodefect."No new osseous defects. No fractures.The trochlea, olecranon, and radial head appear normal.Adherent to the posterior wall of the olecranon fossa are a cluster of small 3-mm foci with central fat density, and a rim of calcification. These correspond to the finding on the prior MRI and in keeping with small intra-articular loose bodies. No additional intra-articular loose bodies are seen.

Output: 1. Cluster of small 3-mm foci with central fat density and rim calcification adherent to the posterior wall of the olecranon fossa. These correspond to the finding on prior MRI and are in keeping with small intra-articular loose bodies.2. Small unchanged subchondral cysts in the anterior aspect of the capitellum representing degenerative cysts or old osteochondral defects. The overlying bone plate is intact, suggesting stability.


Instruction: Generate impression based on medical findings.

Input: PLEASE INCLUDE FAT SATURATION WITH THIS MRAReason: eval for dissection and any other vascular abnormalities in neck with fat sats. . Please compare to the CTA in PACS History: syncope11/21/196154 yearsFemale MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mild mucosal thickening in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Incidental note is made of partial empty sellaMRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. Signal from the left middle cerebral artery vasculature is lower than that of the right middle cerebral artery vasculature suggesting less flow. There is mild asymmetry in the cortical veins signal intensity with left being somewhat lower than right.There is a 6 x 8 mm aneurysm present at the distal right internal carotid artery at the communicating segment. It is directed laterally inferiorly and posteriorly. It has a small neck.The anterior communicating artery is identified and is medium size. The right A1 segment is larger than the left A1 segment. The right posterior communicating artery is tiny. The left posterior communicating artery is fairly large.The left internal carotid artery is diminutive at the cervical segment and above. The left internal carotid artery beginning at the cavernous segment is very small and enlarges the communicating segment. There is no associated mural thrombus appreciated.The vertebral arteries are mildly asymmetric with the right being larger than the left.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the right carotid bifurcation. There is no significant stenosis along the course of the vertebral arteries. The left internal carotid artery abruptly measures 1.5 to 2 mm diameter beginning approximately 12 mm above the bifurcation where there is a high-grade stenosis present.

Output: 1.No evidence for acute ischemic cerebral infarction.2.There is a high-grade stenosis present approximately 1.5 cm above the level of the left internal carotid artery origin associated with a diminutive left internal carotid artery. The intracranial anterior circulation is predominantly supplied from the left posterior communicating artery. The left A1 segment is hypoplastic. There is indirect evidence that there is relatively lower flow in the left middle cerebral artery territory compared to the right middle cerebral artery territory based on the MRA and the susceptibility weighted imaging.3.There is an 8 mm right ICA communicating segment aneurysm present.4.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.


Instruction: Generate impression based on medical findings.

Input: 64 years, Female, persistent photophobia and headaches/migraines. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Few foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild age-related white matter changes. Brain parenchyma is otherwise unremarkable for age.No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.There is possible symmetric smooth uveoscleral thickening involving the bilateral globes posteriorly without nodularity or mass. Partially empty sella is seen which can be normal variant. Bone marrow signal and extracranial soft tissues are otherwise within normal limits.

Output: 1. MRI of the brain is within normal limits for age. Specifically no intracranial mass or abnormal enhancement is appreciated.2. Questionable symmetrical, smooth uveoscleral thickening involving the bilateral globes. Finding is suspected to be artifactual but suggest correlation with ophthalmologic findings.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Dizziness and giddinessClinical question: please do Dr. Javed pMS protocol on 3 T MRISigns and Symptoms: dizziness, fatigue MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical white matter lesions present which are hyperintense on T2 and FLAIR MRI.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. There is multilevel disk dessication present.There is a 12x12mm T2 and T1 hyperintense enhancing lesion within the right anterolateral portion of the C6 vertebral body.There is a 12x12mm T2 and T1 hyperintense enhancing lesion within the right posterolateral portion of the T2 vertebral body.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. There are small uncovertebral osteophytes present bilaterally associated with disk material and narrowing of the neural foramina bilaterally.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a mild disk bulge at this level. There are small left sided uncovertebral osteophytes at this level.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. There is a left lateral recess disk protrusion at this level associated with small uncovertebral osteophytes.The vertebral artery flow voids appear to be intact.

Output: 1.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.2.No intrinsic cervical spinal cord lesions are detected.3. There are mild degenerative changes in the cervical spine as detailed above worse at C4-5 where there is mild to moderate encroachment of exiting nerve roots bilaterally.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Rule out intracranial mass. Signs and symptoms: Proximal muscle weakness. Nonenhanced head CT:There are few very subtle nonspecific foci of low attenuation in the subcortical white matter of the cerebral hemispheres. Considering patient's age possibility of a small was ischemic disease and demyelinating disease should be considered. Recommend further follow-up with a dedicated brain MRI.There is no evidence of hemorrhage, edema, mass effect or midline shift or hydrocephalus. Calvarium, paranasal sinuses and mastoid air cells are unremarkable.

Output: Very few subtle nonspecific foci of subcortical low attenuation of bilateral cerebral hemispheres. Please follow-up with an MRI exam.


Instruction: Generate impression based on medical findings.

Input: Back pain, r/o abscess History: Focal spinal tenderness, HIV+, urinary incontinence Vertebral body heights in the thoracic spine are normal. Alignment is normal. No abnormal signal is seen within the thoracic cord. No evidence of epidural or paraspinous fluid collections. No significant spinal canal or neural foraminal stenosis. Bone marrow is heterogeneous similar to prior which is nonspecific without focal suspicious lesions.Vertebral body heights in the lumbar spine are normal. Alignment is normal. Bone marrow is heterogeneous, which is nonspecific, without focal suspicious lesions. Conus is in normal position. No evidence of epidural or paraspinous fluid collections. No significant spinal canal or neural foraminal stenosis.

Output: Slightly limited evaluation for infection in the absence of intravenous gadolinium. There is however no appreciable edema or fluid collections in the thoracolumbar spine or paraspinous soft tissues to suggest infection or abscess. No spinal canal or neural foraminal stenosis in the thoracic or lumbar spine. No cord signal abnormality.


Instruction: Generate impression based on medical findings.

Input: History of bilateral ventriculomegaly of Triplet C in the patient's current dichorionic-tri amniotic triplet gestation. 21 weeks gestational age. Images are tailored for evaluating the ventricles of fetus which is located in the maternal left pelvis. The other fetuses are only partially visualized on this exam. Within the limitations of significant fetal motion, there appears to be mild ventriculomegaly of fetus C with the ventricular atria measuring up to 12 mm on the left and 11 mm on the right. No other gross abnormalities are identified. The degree of cortical development appears appropriate for stated age.The known maternal complex adnexal cystic lesion is partially visualized.

Output: Mild ventriculomegaly in fetus C.


Instruction: Generate impression based on medical findings.

Input: Hemangioma of intracranial structures [D18.02], Reason for Study: ^Reason: CCM Protocol, 3T Scanner, QSM/permeability, known DVA and cavernoma, please evaluate History: tingling in hands, feet, weakness in L arm, numbness on L side of tongue, severe pain About 8mm sized round T2 low signal intensity, T1 iso intensity with significant susceptibility artifacts indicating cavernous malformation at the right inferoanterior basal ganglia and adjacent developmental venous anomaly. There is no evidence of surrounding edema of the lesion.There is no evidence of acute ischemic or hemorrhagic lesion on this scan.There is no other abnormal enhancement except the DVA.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 paranasal sinuses and mastoid air cells are clear.Cervical spine MRISpinal cord signal intensity is normal.The spine alignment is anatomic.Bone marrow and spinal cord signal intensity are normal.There is central focal disc protrusion which abuts thecal sac at the level of C56 with mild bilateral ligamentum flavum thickening result minimal spinal canal narrowing. No neuroforaminal stenosis is seen at this level.Diffuse bulging of disc is seen at the level of C45.Other cervical disc levels appear to be within normal limits.

Output: 1. About 8mm sized right inferoanterior basal ganglia cavernous malformation associated with DVA.2. No other lesion is seen.3. Central disc herniation (focal protrusion) at the level of C56 and diffuse bulging of disc at the level of C45 as described above.


Instruction: Generate impression based on medical findings.

Input: 64-year-old female with bloody discharge from the left nipple. Examinations performed at an Christ hospital were submitted for interpretation. BILATERAL MAMMOGRAM (4/4/2016): 2 standard views of both breasts with repeat left MLO were submitted for review. The breast parenchyma is heterogeneously dense, which may obscure small masses (BiRads Density Category C). Note is made of multiple bilateral subcentimeter masses for which long term stability should be confirmed. There is a focal asymmetry in the upper outer quadrant of the right breast, at posterior depth, which should also be evaluated for stability and can be further evaluated on MRI if that is performed for her nipple discharge. Note is made of bilateral benign morphology calcifications, including arterial calcifications. The left nipple appears inverted. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. TARGETED BILATERAL BREAST ULTRASOUND EXAMINATION (4/4/2016):Right Breast:Targeted right breast ultrasound examination demonstrates no focal mass lesion or cyst at images labeled at 9:00 to 11:00.Left Breast:Targeted ultrasound examination demonstrates ectatic ducts in the retroareolar region of the left breast. No focal mass lesion or cyst is identified.

Output: 1. Ectatic ducts in the retroareolar region of the left breast. Otherwise no findings to account for the patient's left sided bloody nipple discharge. Surgical consultation and consideration of further imaging with MRI are recommended for further evaluation.2. Multiple bilateral subcentimeter masses for which long-term stability should be confirmed. While multiplicity suggests benignity, submission of prior examinations for comparison is recommended. 3. Focal asymmetry in the upper outer quadrant of the right breast with a negative ultrasound. Comparison study submission would be helpful for this area as well, and it can also be further evaluated on MRI if that is performed for her nipple discharge.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: 69 years Female (DOB:12/22/1946)Reason: metastatic breast cancer History: complaints of stiffness/soreness in neck and armPROVIDER/ATTENDING NAME: RITA NANDA RITA NANDA There is a severe compression fracture present T1 with associated subluxation at C7-T1. This compression fracture is new since the prior exam. There is previously a marrow replacing mass at this level. There are marrow replacing lesions identified within the thoracic spine. One at T2 measures 18 x 12 mm axial dimensions and previously measured significantly smaller. Another one is present at T4 which extends through the left pedicle of T4 and measures approximately 32 mm AP dimension on sagittal imaging and 14 mm in height. There is a mild superior endplate compression of T4 present.There are marrow replacing lesions present along the spinous processes of C5 and C6 as well as the spinous process of T1. These are associated with contrast enhancement.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. There is a disc bulge present this level.At C5-6 there is loss of disc space height, disc desiccation, disc bulge, endplate and uncovertebral osteophytes as well as hypertrophy ligamentum flavum resulting in effacement of spinal fluid ventral and posterior the spinal cord and overall a moderate degree of spinal stenosis. This is spinal stenosis was not readily evident on the prior exam however it may be exaggerated in this exam due to extended position of the patient's neck.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is anterior subluxation of C7 on T1 associated with T1 compression fracture and there is some effacement of spinal fluid ventral and posterior the spinal cord at this level. There is encroachment of the exiting nerve roots within the neural foramina at T1-T2. The vertebral artery flow voids appear to be intact.

Output: 1.Since the prior examination the patient has developed a severe compression fracture at T1 associated with subluxation and narrowing of the spinal canal. This is most likely related to malignant compression fracture.2.There is a mild compression fracture present at T4. This is also likely a malignant compression fracture3.There are multiple marrow replacing lesions present at C5, C6, T1, T2 and T4 which are compatible with metastatic disease. This appears to have progressed compared to the prior exam.4.There is a moderate degree of spinal stenosis present at C5-6 related to degenerative changes. Compared to the prior exam the patient is currently in the extended neck position whereas previously the patient's neck was in a somewhat flexed position. This difference in position may account for the differences of appearance of the degree of spinal stenosis between the current prior exam and the prior exam.


Instruction: Generate impression based on medical findings.

Input: Reason: Lesion suspicious for HCC on CT scan History: HCV ETOH cirrrhosis, 2.8 cm R lobe mass ABDOMEN:LIVER, BILIARY TRACT: Nodular cirrhotic morphology. Two subcentimeter adjacent nodules in the right lobe that are nonenhancing, but low on T2 and high on T1 (12:269, 8:15, 11:81) suspicious for dysplastic nodules.2.7 x 2.8 cm T1 hyperintense lesion in the posterior right hepatic lobe (11:85) is isointense on T2. This lesion has arterial enhancement with subsequent washout, and is compatible with hepatocellular carcinoma.SPLEEN: Splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Fat-containing umbilical hernia.OTHER: No significant abnormality noted.

Output: 1.2.8 cm hepatocellular carcinoma in the posterior right hepatic lobe.2.Two subcentimeter probable dysplastic nodules on a background of nodular cirrhosis and likely portal hypertension, as above.


Instruction: Generate impression based on medical findings.

Input: Urinary difficulties. Evaluate for cord re-tethering. Multiple prior untethering. More recent repair of dural defect and pseudomeningocele in June 20, 2015. Again seen are findings related to prior tethered cord release. Unchanged appearance of the ectatic thecal sac at the lumbosacral junction. The distal spinal cord syrinx shows no significant interval change from the prior examination, which begins at approximately the T12 level and continues to the L4 level with a maximum caliber of approximately 3 x 4 mm, not significantly changed allowing for differences in measurement technique. As on the prior examination, the distal spinal cord is closely opposed and may be adherent to the posterior thecal sac. The cord terminus is difficult to ascertain but it appears to be at the lumbosacral junction. Prone images demonstrate no significant ventral motion.The lumbar lordosis is straightened. Vertebral body height, morphology and signal characteristics are otherwise unremarkable. No evidence of marrow edema or pathologic marrow enhancement is seen. No significant compromise of the spinal canal or neural foramina is seen at any level. No new fluid collections in the paraspinous soft tissues.

Output: 1. Postoperative changes related to multiple prior cord untetherings. There is no significant change in appearance and position of the distal cord and cauda equina nerve roots which abut the dorsal thecal sac. No significant motion on the prone sequences. Findings would be compatible with cord re-tethering in the appropriate clinical setting.2. No significant change in small syrinx involving the distal cord.


Instruction: Generate impression based on medical findings.

Input: The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified. There is unknown susceptibility artifact near the skull base which somewhat limits evaluation of lower intracranial structures, but this appears similar to the previous MRI.There is hypoplastic appearance of the right A1 segment of the anterior cerebral artery which results in asymmetric prominence of the left ICA, likely of no clinical significance. Otherwise, normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.

Output: Normal MRI of the brain. No evidence of metastatic lesions.


Instruction: Generate impression based on medical findings.

Input: T1N2 EBV-associated poorly differentiated nasopharyngeal squamous cell carcinoma status post treatment. There are post-treatment findings in the nasopharyngeal region without evidence of measurable tumor in the treatment bed. There is no significant region lymphadenopathy. There appears to be mild patchy edema in the right aspect of the clivus, which may be treatment-related. The skull base otherwise appears to be intact. The imaged intracranial structures and orbits are unremarkable. There is scattered nonspecific bilateral mastoid fluid signal. There is scattered paranasal sinus mucosal thickening.

Output: No evidence of measurable residual or recurrent nasopharyngeal tumor.


Instruction: Generate impression based on medical findings.

Input: Evaluate for cord compression, patient presenting with bilateral lower extremity, left greater than the right weakness and decreased sensation below umbilicus. The vertebral bodies are appropriate in the overall alignment and height. The spinal cord has normal signal characteristics and overall morphology. There is no compression of the spinal cord. Disc osteophyte complex and mild spinal canal stenosis is noted at the cervical spine level. There is slight loss of height of C5 vertebral body, likely degenerative in nature. Mild narrowing of the spinal canal due to disc abnormalities in the lumbar spine are better evaluated on the MRI of the lumbar spine. Hyperintense focus in the T1 vertebral body is nonspecific but is suggestive of a hemangioma.

Output: 1.This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No cord compression is identified. 2.Multilevel degenerative findings in the cervical and lumbar spine, as above. Please refer to the concomitant dedicated MR of the lumbar spine for additional findings.


Instruction: Generate impression based on medical findings.

Input: 62-year-old male with prostate cancer, repeat biopsy PELVIS:PROSTATE:Prostate Size: 5.4 x 3.7 x 5.2 cm.Peripheral Zone: There is a dominant T2 hypointense focus in the right apex peripheral zone measuring 8 x 6 mm (series 901, image 10) with corresponding restricted diffusion and early arterial enhancement.Central Gland: Moderate degree prostatic hypertrophy.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No extracapsular extension is present.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.T2 hypointense focus in the right apex peripheral zone suspicious for malignancy.


Instruction: Generate impression based on medical findings.

Input: History of PSC. Evaluate for cholangiocarcinoma. ABDOMEN:LIVER, BILIARY TRACT: Stable narrowing of the distal common bile duct with mild upstream dilatation. No focal lesion or new dominant stricture visualized. Multiple prominent porta hepatis lymph nodes are nonspecific in the setting of chronic liver disease. The liver measures 20 cm in length. Partially contracted gallbladder with mild wall thickening, nonspecific.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Several punctate simple-appearing cysts. No hydronephrosis. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Trace right paracolic gutter fluid, nonspecific.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Without significant change narrowing of the distal common bile duct with minimal proximal ductal prominence, unchanged. No new dominant stricture or focal lesion seen.


Instruction: Generate impression based on medical findings.

Input: Redemonstrated is near-complete compression deformity of T12 centrally and anteriorly with retropulsion of fragments posteriorly abutting the distal thoracic cord causing anterior flattening, however without cord compression. These findings are unchanged when compared to the 2008 MRI.There are no acute fractures. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. The visualized intra-abdominal and paraspinal contents are unremarkable.L1/2: Unremarkable and unchangedL2/3: Mild disc bulge, ligamentum flavum thickening, and mild bilateral facet hypertrophy which appears similar although there is new mild right lateral recess stenosis.L3/4: Mild disc bulge, ligamentum flavum thickening, and mild bilateral facet hypertrophy. There are no stenoses. These findings are unchanged.L4/5: Grade 1 anterolisthesis L4 on L5, asymmetric bulge to the right with disc uncovering, ligamentum flavum thickening, severe bilateral facet hypertrophy, and small bilateral facet effusions. There is severe central, severe bilateral lateral recess, and moderate bilateral neural foraminal stenosis which have progressed.L5/S1:Unremarkable and unchanged

Output: 1.L2/3: New mild right lateral recess stenosis.2.L4/5: Severe central, severe bilateral lateral recess, and moderate bilateral neural foraminal stenosis, which have progressed.


Instruction: Generate impression based on medical findings.

Input: Other intervertebral disc degeneration, lumbar region [M51.36], Reason for Study: ^Reason: radicular pain, back pain History: radicular pain, back pain. The lumbar lordosis is preserved. There is minimal retrolisthesis of L2 over L3 and mild anterolisthesis of L3 over L4, L4-L5, and L5 over S1. The vertebral body heights are maintained. Mild multilevel loss of intervertebral disc space is demonstrated. The conus terminates at L1. There is a small focus of T2 hyperintensity involving the spinal cord at T8-T9 level. Redundancy of the cauda equina is noted. There are multilevel degenerative changes of the lumbar spine as described below in detail. Of note, T8-T10 levels are only imaged in sagittal plane. T8-9: There is a disc bulge resulting in moderate central and mild bilateral neuroforaminal stenosis.T9-T10: There is a disc bulge with mild central and mild to moderate bilateral neuroforaminal stenosis, slightly worsened since prior examination.T10-T11: There is a disc bulge and small extrusion with superimposed hypertrophy of the ligamentum flavum resulting in mild spinal and mild to moderate bilateral neuroforaminal stenosis not significant changed from prior examination.T11-T12: Minimal disc protrusion, hypertrophic degenerative changes of the facets and ligamentum flavum without significant foraminal or central spinal stenosis.T12/L1: Facet disease and ligamentum flavum hypertrophy without significant central canal or neural foraminal stenosis.L1/2: Facet disease and ligamentum flavum hypertrophy without significant central canal or neural foraminal stenosis.L2/3: There is a disc bulge with hypertrophic degenerative changes of the posterior facet and ligamentum flavum resulting in moderate central and moderate bilateral neuroforaminal stenosis, not significantly changed since prior examination.L3/4: There is a disc bulge with advanced hypertrophic degenerative changes of the facets and ligamentum flavum resulting in severe spinal and bilateral neuroforaminal stenosis, slightly progressed since prior examination.L4/5: Disc bulge and hypertrophy of the facets and ligamentum flavum result in mild to moderate bilateral neuroforaminal and mild central spinal stenosis.L5/S1: Disc bulge with superimposed facet/ligamentous hypertrophic degenerative changes resulting in moderate left and mild to moderate right neuroforaminal stenosis.There are bilateral simple appearing renal cysts.

Output: 1. Multi-level marked degenerative disk disease as detailed above, most severe at L3-L4 and L4-L5, including spinal canal stenosis and neural foraminal stenosis. These findings are slightly progressed since 2012.2. Degenerative changes of the visualized lower thoracic spine included probable spinal cord impingement at T8-T9 where there is a small area of cord signal suggestive of myelomalacia or edema. Dedicated thoracic imaging can be obtained as clinically warranted.


Instruction: Generate impression based on medical findings.

Input: Dizziness. There are numerous T2 hyperintense foci in the cerebral white matter and basal ganglia. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. However, there is fluid within the left mastoid air cells. There are bilateral lens implants. There is also an incompletely characterized T2 hyperintense focus in the left parapharyngeal space.

Output: 1. Chronic lacunar infarcts and small vessel ischemic disease, but no evidence of acute infarct.2. Nonspecific fluid within the left mastoid air cells may represents mastoiditis.3. Incompletely characterized T2 hyperintense focus in the left parapharyngeal space. Dedicated imaging of this region may be useful for further evaluation.


Instruction: Generate impression based on medical findings.

Input: 22-year-old female with tuberous sclerosis. Evaluate subependymal giant cell astrocytoma. Redemonstrated is a large enhancing mass/giant cell astrocytoma at the left foramen of Monro, which measures 16 x 14 x 17 mm (AP x TR x CC), previously 15 x 14 x 18 mm and 17 x 13 x 16 mm on 5/12/2005. There is no significant interval change in the size and configuration of the ventricles and sulci. Again seen are several small enhancing subependymal nodules, which are unchanged in size. The larger ones at right foramen of Monro measures up to 4 mm and at the level of the right lateral ventricle trigone measures up to 6 mm, which are unchanged. There are also multiple foci of increased T2/FLAIR signal within the cortical and subcortical regions, which are unchanged from the prior study. There is no evidence of intracranial hemorrhage or acute infarct. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: 1. Findings are consistent with known tuberous sclerosis with stable subependymal giant cell astrocytoma, subependymal nodules, cortical/subcortical tubers and radial migrational lines. 2. Stable size of the ventricular system without evidence of ventriculomegaly.


Instruction: Generate impression based on medical findings.

Input: Cirrhosis, evaluate for HCC ABDOMEN:LIVER, BILIARY TRACT: Liver contour: The liver contour is smooth.Features of portal hypertension: None. Portal vein: Patent. Hepatic veins: Patent.Hepatic artery: Conventional.Lesions: No suspicious arterially enhancing parenchymal lesions. Right hepatic lobe cysts.Status post cholecystectomy.SPLEEN: Status post splenectomy. Postsurgical changes and nodular enhancing foci in the left upper quadrant suggestive of splenosis. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Probable duodenal diverticulum. Postsurgical changes consistent with gastrojejunostomy.BONES, SOFT TISSUES: No significant abnormality noted.

Output: No suspicious focal hepatic lesions to suggest HCC.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old, history of metastatic prostate cancer with pain and numbness in the lower pelvis and perineum. All the visualized osseous structures of the lumbar spine and sacrum demonstrate diffuse patchy abnormal marrow signal along with heterogeneous enhancement compatible with widespread osseous metastatic disease.Trace retrolisthesis of L2 relative to L3 and L3 relative to L4 are seen. The T11 vertebral body demonstrates mild central compression with approximately 40% loss of vertebral body height centrally. No retropulsion is seen. The remaining vertebral bodies demonstrate aspiration of height.No evidence of any significant epidural tumor encroachment is seen within the lumbar spine. In the sacral spine, however, there are several areas of nodular and plaque-like epidural thickening which involves the sacral spinal canal and some of the sacral foramina which result in significant narrowing and potential nerve root compression.Superimposed level specific degenerative findings are as follows:L1-2: Unremarkable. L2-3: Bulging disc. Mild generalized spinal canal narrowing. Mild bilateral foraminal narrowing. L3-4: Bulging disc. Minimal generalized spinal canal narrowing. Mild bilateral foraminal narrowing. L4-5: Mild facet hypertrophy. Mild bulging disc. No significant generalized spinal canal narrowing. Mild to moderate bilateral foraminal narrowing. L5-S1: Facet hypertrophy. Mild bulging disc. No significant generalized spinal canal narrowing. Moderate left and mild right foraminal narrowing.

Output: 1. Diffuse osseous metastatic disease.2. Relatively mild central compression deformity of T11 vertebral body without retropulsion.3. No definite or significant epidural disease spread in the lumbar spine.4. Plaque-like and nodular areas of epidural tumor are highly suspected within the sacral spinal canal and some of the sacral foramina. These lesions result in narrowing of the spinal canal and possible compression of adjacent nerve roots. These findings could potentially account for the patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: 57-year-old male with elevated PSA. Evaluate prostate. PELVIS:PROSTATE:Prostate Size: 4.6 x 2.6 x 3.9 cm.Peripheral Zone: There is abnormal T2 hypointensity with corresponding low ADC signal in the left anterior apex measuring approximately 1.6 x 0.7 cm (series 603, image 184). This region demonstrates enhancement. Central Gland: Central gland is heterogeneous in appearance, consistent with benign prostatic hypertrophy.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Lesion in the left anterior apex suspicious for carcinoma.


Instruction: Generate impression based on medical findings.

Input: Chiari malformation, status post decompression, occipital neuralgia, hemangioblastoma, benign tumor of the pituitary: yearly followup. There are stable postoperative findings related to Chiari decompression and fourth ventricular stenting. The cerebellum displays an unchanged morphology and signal characteristics. There is cerebrospinal fluid flow across the foramen magnum and through the fourth ventricular stent. There is an unchanged 5 mm diameter T1 hyperintense nodule along the superior aspect of the pituitary gland. There are unchanged minimal nonspecific scattered punctate foci of T2 hyperintensity in the cerebral white matter. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits and paranasal sinuses are grossly unremarkable. There is no evidence of pseudomeningocele.

Output: 1. Stable postoperative findings related to Chiari decompression and fourth ventricular stenting with flow of cerebrospinal fluid across the foramen magnum and into the fourth ventricular stent.2. An unchanged 5 mm diameter T1 hyperintense nodule along the superior aspect of the pituitary gland likely represents a Rathke cleft cyst.


Instruction: Generate impression based on medical findings.

Input: 55-year-old female with ulcer along foot, evaluate for osteomyelitis Extensive soft tissue swelling about the ankle and midfoot. TENDONS: The extensor and flexor tendons are grossly intact with extensive edema in the surrounding soft tissues.LIGAMENTS: The ATFL is grossly intact.ARTICULAR SURFACES AND BONE: There is marked edema within the anterior aspect of the talus and dorsal displacement of the navicular relative to the talus with abnormal T1 hypointense and T2 bright bone marrow signal in the navicular and cuneiform bones. Multifocal bone marrow edema is noted throughout the mid foot without discrete fracture line or erosion.ADDITIONAL

Output: Extensive soft tissue swelling, multifocal bone marrow edema and talonavicular dislocation as described above more likely representing neuropathic joint, although infection cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: Seizures and new onset headaches. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are mild scattered foci of T2 hyperintensity in the cerebral white matter. The hippocampi are intact and there is no evidence of heterotopia. 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: Mild scattered foci of T2 hyperintensity in the cerebral white matter are nonspecific, but may represent chronic small vessel ischemic disease, for example, Otherwise, no evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on medical findings.

Input: Medial left knee pain MENISCI: Within the posterior horn of the medial meniscus, there is faint linear signal extending to the articular surface concerning for small meniscal tear. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is moderate diffuse thinning of the articular cartilage of the medial compartment, particularly the femoral condyle with scattered areas of near full-thickness loss. There is mild heterogeneous signal of the articular cartilage of the lateral compartment without discrete tear. The articular cartilage of the patellofemoral compartment is intact.LIGAMENTS: There is minimally increased signal surrounding the MCL which is otherwise intact. The remaining cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Small tear of the posterior horn of the medial meniscus.2. Grade 1 MCL sprain. 3. Moderate cartilage thinning of the medial compartment with scattered areas of near full-thickness loss anteromedially.


Instruction: Generate impression based on medical findings.

Input: The intracranial internal carotid arteries are normal in course and caliber. Along the proximal petrous right internal carotid artery, there is slight attenuation of flow-related enhancement, which is favored to relate to asymmetric bone along the petrous canal and focal tortuosity of the vessel at this level. The middle and anterior cerebral arteries are unremarkable. The PComm arteries are not visualized bilaterally. The vertebral arteries and basilar artery are normal in course and caliber. There is stable minimal irregularity involving the right P2 and P3 segments and left P2 segment. There is no evidence of flow-limiting stenosis or aneurysm.Encephalomalacia and ex vacuo dilatation of the occipital horn of the left lateral ventricle in the left parieto-occipital region is better assessed on the recent prior brain MRI.

Output: Stable minimal irregularity of the distal PCAs bilaterally without evidence of flow limiting stenosis.


Instruction: Generate impression based on medical findings.

Input: Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. Old ischemic changes are again identified within the right cerebellar hemisphere. Left supraclavicular adenopathy is no longer evident.C2/3: Mild posterior osteophyte disc complex, mild left facet hypertrophy, and moderate right facet hypertrophy. There is mild bilateral neural foraminal stenosis.C3/4: Posterior osteophyte disc complex, ligamentum flavum thickening, and bilateral uncinate hypertrophy. There is intrinsic abnormal T2 hyperintensity within the cord at this level, extending inferiorly, associated with focal cord atrophy. There is moderate central, moderate to severe left neural foraminal, moderate right neural foraminal stenosis.C4/5: Posterior osteophyte disc complex, ligamentum flavum thickening, and bilateral uncinate hypertrophy (right much greater than left). There is subtle intrinsic T2 hyperintensity within the cord as well as focal cord atrophy. There is mild central, moderate to severe left neural foraminal, and severe right neural foraminal stenosis.C5/6: Posterior osteophyte disc complex eccentric to the left causing anterior left hemicord flattening without intrinsic cord signal abnormality. There is also slight ligamentum flavum thickening and bilateral uncinate hypertrophy. There is no central stenosis, however there is moderate to severe bilateral neural foraminal stenosis.C6/7: Posterior osteophyte disc complex eccentric to the right causes anterior right hemicord flattening without intrinsic cord signal abnormality. There is also ligamentum flavum thickening and bilateral uncinate hypertrophy. There is borderline central, moderate severe left neural foraminal, and severe right neural foraminal stenosis.C7/T1: Posterior osteophyte disc complex, severe ligamentum flavum thickening (left greater than right), and endplate spurring. There is cord flattening anteriorly as well as posterolaterally (bilaterally) with effacement of CSF but no intrinsic cord signal abnormality. Overall, there is moderate central, severe left neural foraminal, and moderate right neural foraminal stenosis.T1/2: Bilateral facet hypertrophy encroaches bilateral neural foramina.

Output: 1.C2/3: Mild bilateral neural foraminal stenosis.2.C3/4: There is intrinsic abnormal T2 hyperintensity within the cord at this level, extending inferiorly, associated with focal cord atrophy, a pattern most suggestive of myelomalacia. There is moderate central, moderate to severe left neural foraminal, moderate right neural foraminal stenosis.3.C4/5: There is subtle intrinsic T2 hyperintensity within the cord as well as focal cord atrophy, a pattern most suggestive of myelomalacia. There is mild central, moderate to severe left neural foraminal, and severe right neural foraminal stenosis.4.C5/6: Moderate to severe bilateral neural foraminal stenosis.5.C6/7: Borderline central, moderate severe left neural foraminal, and severe right neural foraminal stenosis.6.C7/T1: Moderate central, severe left neural foraminal, and moderate right neural foraminal stenosis.7.T1/2: Bilateral facet hypertrophy encroaches bilateral neural foramina.


Instruction: Generate impression based on medical findings.

Input: 25 years Male (DOB:8/30/1990)Reason: communicating hydrocephalus, autism, shunt , new headaches evaluate for changes History: new headaches, aggressive behaviorPROVIDER/ATTENDING NAME: DAVID M. FRIM DAVID M. FRIM The exam is degraded by metal artifact which obscures partial visualization of left hemisphere orbits and paranasal sinuses.The patient status post left-sided ventriculostomy tube placement. The ventriculostomy tube courses in the left frontal lobe into the left lateral ventricle with tip in the third ventricle. It is stable compared to the previous exam.Patient is status post right-sided craniotomy. The patient is status post right anterior temporal lobectomy and There is a defect present along the anterior aspect of the right middle frontal gyrusThe visualized portions of the paranasal sinuses are clear to the extent of visualization possible. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.The exam is limited due to metal artifact. This would obscure more subtle abnormalities. To the extent of visualization there is a no evidence for acute intracranial hemorrhage, mass effect or edema.2.The patient status post ventriculostomy tube placement. The lateral ventricles are not enlarged and are stable compared to the prior exam.3.The patient is status post right-sided craniotomy for right frontal and temporal lobe surgery.


Instruction: Generate impression based on medical findings.

Input: Numbness and tingling in left fifth digit after basketball injury. Suspect hamate fracture. Evaluation of ulnar nerve neuropathy. Evaluation of the wrist is limited on some sequences by patient motion artifact. There is a minimally displaced fracture through the hook of the hamate with edema in the adjacent marrow. I see no additional fractures. Tiny rounded foci of signal abnormality within the lunate, triquetrum, and capitate, best seen on the T1 weighted sequences, are of doubtful current clinical significance.Evaluation of the intrinsic ligaments of the wrist and triangular fibrocartilage is limited by patient motion artifact and noise; given these limitations, I see no defects.The tendons of the wrist are unremarkable. There is mild edema within the soft tissues volar to the distal ulna which extends both superficial and deep to the distal flexor digitorum musculature. The ulnar nerve can be followed along its course and is unremarkable. The median nerve is unremarkable. The remaining visualized soft tissue structures are unremarkable.

Output: Fracture through the hook of the hamate. The ulnar nerve is unremarkable.


Instruction: Generate impression based on medical findings.

Input: 61-year-old female with bladder cancer, status post ileostomy. Fever and shock. Indiana pouch with ileostomy. Evaluate for GI source of infection. Pulmonary embolism CT scan examination was performed in conjunction with this study, but will be reported separately. ABDOMEN:LUNG BASES: CT scan of the thorax for pulmonary embolism was performed and will be reported separately.LIVER, BILIARY TRACT: There are multiple benign-appearing simple hepatic cysts, unchanged from the recent MRI examination. There is diffuse gallbladder wall thickening with mucosal enhancement suggesting cholecystitis.SPLEEN: There is a splenic hemangioma unchanged since the recent MRI examination.PANCREAS: No evidence of pancreatitis was found.KIDNEYS, URETERS: Mild left hydronephrosis is found, as expected in this patient who is status post Indiana pouch ilial conduit. There is a focal left mid pole cortical thinning, probably due to prior infarct. No acute changes are found and compared with the prior examination.ADRENAL GLANDS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: There is focal fat stranding in the right or quadrant, especially axial image 81/162, adjacent to the ilial conduit and a drainage tubing at axial image 97 / 162.PELVIS:UTERUS, ADNEXAE: Status post hysterectomy.BLADDER: Status post cystectomy.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: There is a left lower quadrant ileostomy at axial image 91/ 158.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: New gallbladder wall thickening suggests interval development of cholecystitis. Multiple postoperative changes. No abscess or ascites. Multiple additional findings, as described above.


Instruction: Generate impression based on medical findings.

Input: 69-year-old female with nystagmus and ataxia. Evaluate for cerebellar degeneration or ischemia. MRI brain:There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRI C-spine:The craniovertebral junction appears within normal limits. The cervical spine alignment is maintained and the cervical vertebral bodies and disc spaces are appropriate in height. The bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.Interspace observations:C2-3 and C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: Small disc osteophyte complex and mild facet hypertrophy. Mild left neuroforaminal narrowing. No right neuroforaminal or spinal canal stenosis.C5-6: Small disc osteophyte complex and left greater than right facet hypertrophy which causes mild to moderate left and mild right neuroforaminal narrowing. There is no spinal canal stenosis.C6-7: Small disc osteophyte complex and mild facet hypertrophy without significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.

Output: No evidence of intracranial hemorrhage, mass, or acute infarct. Mild cervical degenerative changes most prominent at C4-5 and C5-6 levels where there is at most mild/moderate left neural foraminal narrowing. There is no spinal canal stenosis at any point in the cervical region.