Instruction: Generate impression based on medical findings.

Input: Reason: history of fracture History: assess previous fracture. BONE MARROW: Linear T2 hyperintense signal with the bilateral sacral wings compatible with bilateral insufficiency fractures. Otherwise bone marrow signal is diffusely T1 hypointense compatible with red marrow likely secondary to chemotherapy given patient's history. SOFT TISSUES: Diffuse fatty muscle atrophy. Diffuse muscle edema. JOINTS: No significant abnormality noted.ADDITIONAL

Output: Bilateral sacral insufficiency fractures and other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Rule out intracranial pathology. Signs and symptoms: Syncope without head trauma. Non-infused CT of brain:There is diffuse prominence of cortical sulci, CSF cisterns and ventricular system. Patchy areas of periventricular low attenuation region represent small vessel disease of indeterminate age. In comparison with the prior MRI examination no gross interval change is appreciated.There is no evidence of hemorrhage, acute cortical stroke, mass effect or midline shift.

Output: 1.Findings consistent with small vessel disease of indeterminate age.2.Prominence of cortical sulci and ventricular system is stable since prior MRI examination.3.No evidence of acute hemorrhage or cortical stroke.


Instruction: Generate impression based on medical findings.

Input: 11-year-old male with left knee pain and swelling MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: At the anterior aspect of the lateral femoral condyle, there is a focal loss of at least 2.2 cm articular cartilage. A small amount of fluid tracks beneath the remaining superior aspect of the articular cartilage. Bone marrow edema is noted deep to this region in the anterior aspect of the lateral femoral condyle.Articular cartilage of the patella appears intact.LIGAMENTS: The anterior cruciate ligament is intact. The posterior cruciate ligament is intact. The medial collateral ligament is intact. The lateral collateral ligament complex is intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Large focal defect of the articular cartilage along the anterior aspect of the lateral femoral condyle as described above. Loose body within the joint effusion likely represent articular cartilage from lateral femoral condyle. 2.Fluid interposed between the articular cartilage superior to the defect and the bone suggestive of laminar tearing. 3.Large joint effusion with likely layering of blood products.


Instruction: Generate impression based on medical findings.

Input: Severe right shoulder pain The exam is limited by motion artifact and by the patient's body habitus which prevented the use of an optimal shoulder coil.ROTATOR CUFF: There is thickening and increased signal intensity the supraspinatus tendon indicating moderate tendinosis. There is a 5 mm tear involving the insertional fibers of the anterior supraspinatus tendon which may focally disrupt the bursal surface fibers but this is equivocal. The articular surface fibers appear spared. There is an additional 4 mm tear within the supraspinatus tendon more proximally at the 12:00 position which may also focally disrupt the bursal surface fibers but again this is equivocal. The supraspinatus muscle is normal in signal and caliber.The above-mentioned tendinosis of the supraspinatus extends posteriorly to affect the anterior fibers of the infraspinatus tendon but we see no discrete tear of the infraspinatus tendon. The infraspinatus muscle is normal in signal and caliber. The teres minor tendon and muscle are normal. Small cysts are noted on the humeral head at the insertion of the teres minor which are of doubtful clinical significance. There is increased signal intensity of the distal fibers of the subscapularis tendon indicating insertional tendinosis. There is perhaps minimal fatty atrophy of the subscapularis muscle.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. There is more focal edema of the distal clavicle which may be degenerative in nature but could also represent a stress fracture in the appropriate clinical context.GLENOHUMERAL JOINT AND GLENOID LABRUM: The anterior labrum appears attenuated suggesting degenerative tearing. Alignment of the glenohumeral joint is normal and there is no joint effusion.BICEPS TENDON: Evaluation of the intra-articular portion of the biceps tendon is limited by internal rotation; however within the limits of a non-arthrographic study, the biceps appears intact.

Output: 1. Moderate rotator cuff tendinosis with small focal partial-thickness tears of the supraspinatus tendon that may disrupt the bursal surface fibers.2. Mild osteoarthritis of the acromioclavicular joint with more focal edema of the distal clavicle which may be degenerative in nature but could also represent a stress fracture in the appropriate clinical context.3. Additional findings described above.


Instruction: Generate impression based on medical findings.

Input: Left hip pain; prior labral repair, gluteus medius repair, and iliotibial band resection ACETABULAR LABRUM: Cystic changes identified within the anterior superior labrum with a small paralabral cyst that is new from the prior exam (series 801 image images 8-11). This may in part relate to surgical change and degenerative tearing but there is no gross labral detachment. ARTICULAR CARTILAGE AND BONE: There is no abnormal marrow signal intensity within the pelvis. Mild osteoarthritis affects the hip.SOFT TISSUES: There is increased signal intensity of the gluteus medius tendon and its attachment upon the greater trochanter is poorly visualized concerning for partial tearing. There is a small amount of fluid overlying the greater trochanter which may reflect a mild amount of bursitis. There is increased signal intensity within the intrasubstance fibers of the iliotibial tract (series 601 image 15) which may indicate minimal tearing proximal and distal to this area, the band appears relatively intactADDITIONAL

Output: 1. Cystic changes within the anterior superior labrum with a labral cyst which may in reflect a combination of postsurgical change and degenerative tearing.2. Increased signal intensity of the gluteus medius tendon with poor visualization of its attachment on the greater trochanter concerning for partial tearing.3. Increased signal intensity within the intrasubstance fibers of the iliotibial tract but this appears grossly intact otherwise.


Instruction: Generate impression based on medical findings.

Input: There is an unchanged heterogeneously enhancing oval mass in the left inferior temporal gyrus measuring approximately 12 mm with mild stable surrounding vasogenic pattern T2 hyperintensity. This lesion again shows a thin rim of T2 hypointensity probably representing hemosiderin. There is no herniation or midline shift. The ventricles are unchanged. The flow-voids of the skull base are intact.

Output: Preoperative planning MRI as above.


Instruction: Generate impression based on medical findings.

Input: Right foot drop. Evaluation of cause of foot drop, radiculopathy, sensorimotor neuropathy. Five lumbar type vertebral bodies are presumed to be present. The conus medullaris is normal in position. There is depression involving the superior endplate of the L4 vertebral body suggesting a mild chronic compression fracture and Schmorl's node. Vertebral body heights are otherwise maintained. There is minimal retrolisthesis of L1 on L2 and L2 on L3 as well as grade 1 anterolisthesis of L4 and L5. Bone marrow signal is benign. There is moderate to severe disc height loss throughout the lumbar spine, particularly at the L2-L3 and L5-S1 levels where there is severe disc height loss with adjacent edematous endplate marrow signal changes which are on a degenerative basis. Edematous marrow signal changes are also present involving the inferior endplate of the T12 vertebral body. Additional details regarding degenerative changes as described below:T11-T12: No significant spinal canal or neural foraminal stenosis. There appears to be a subligamentous central disc extrusion which extends caudally along the posterior aspect of the T12 vertebral body to the T12-L1 level. T12-L1: No significant spinal canal or neural foraminal stenosis. Minimal disc bulge as well as bilateral facet arthropathy.L1-L2: Mild disc bulge, ligamentum flavum thickening and facet arthropathy. There is no significant spinal canal stenosis. There is mild left neural foraminal stenosis.L2-L3: Prominent disc bulge, ligamentum flavum thickening, as well as facet arthropathy. There is resulting moderate to severe central spinal canal stenosis. There is also effacement of the lateral recesses, particularly on the right. There is moderate left and minimal right neural foraminal stenosis. There may be impingement of the exiting left nerve root extraforaminally.L3-L4: Disc bulge, advanced bilateral facet arthropathy, and ligamentum flavum thickening with moderate to severe spinal canal stenosis including partial effacement of the lateral recesses. There is moderate left neural foraminal stenosis and mild to moderate right neural foraminal narrowing.L4-L5: Advanced facet arthropathy with grade 1 anterolisthesis. There is prominent ligamentum flavum thickening and disc uncovering. There is severe spinal canal stenosis at this level. There is also severe right and mild to moderate left neural foraminal stenosis.L5-S1: There is disc bulge, moderate facet arthropathy, ligamentum flavum thickening. There is no significant central spinal canal stenosis. There is however partial effacement of the right lateral recess with contact of the right S1 nerve root. There is mild to moderate bilateral neural foraminal stenosis.Paraspinous soft tissues are within normal limits. There are multiple bilateral renal cysts. Linear enhancement involving the spinal canal is at least predominantly vascular in etiology. There are no suspicious enhancing lesions.

Output: 1. Advanced degenerative changes throughout the lumbar spine, worst at the L4-5 level where there is grade 1 degenerative spondylolisthesis, severe spinal canal stenosis, and severe right-sided neural foraminal stenosis.2. There is also moderate to severe spinal canal stenosis at the L3-L4 and L2-L3 levels. Additional details including foraminal stenosis at additional levels as detailed above.3. Linear enhancement within the spinal canal is at least predominantly related to normal vascular structures. Possibility that some of the linear enhancing structures represent enhancing cauda equina nerve roots is not entirely excluded, but this can also be related to the high-grade stenosis described above rather than imply an inflammatory process.


Instruction: Generate impression based on medical findings.

Input: 50-year-old with left breast IDC and left axillary metastatic lymph node disease. MRI per highest PY to protocol There is an extreme amount of fibroglandular tissue in both breasts. On postcontrast images, moderate parenchymal enhancement is seen bilaterally.The T2 precontrast sequences again demonstrate extensive bilateral cystic disease, right greater than left.LEFT BREAST:The index enhancing irregularly marginated mass lesion in the 3:00 radian mid depth measures 2.3 x 2.2 x 2.4 cm (AP by transverse by CC), previously 2.6 x 2.3 cm. A biopsy clip artifact is present in the center of the mass.There is a satellite enhancing mass in the 6:00 radian anterior to middle depth measuring 11 x 7 x 11 mm, previously 12 mm in maximum dimension. This contains artifact from a biopsy clip.In the anterior breast 7:00 radian there is a satellite enhancing mass measuring 6 x 8 x 8 mm, previously 8 mm in maximum dimension.There is an additional enhancing mass located 14 mm posterior to the index mass in the 2:00 radian mid to posterior depth that measures 9 x 9 x 10 mm. This is more readily visualized than on the previous study.The total extent of disease measures 6.7 cm in craniocaudal dimension and 4.4 cm anterior to posterior.RIGHT BREAST:No suspicious mass lesions or areas of enhancement.AXILLAE: Again noted are two enlarged and enhancing left axillary lymph nodes. The largest of these contains postbiopsy change and metallic clip artifact. It measures 2.5 x 2.1 cm, previously 3 cm in maximum dimension. No abnormalities noted in the right axilla.

Output: 1. Biopsy-proven cancer in the left breast. 3 enhancing satellite nodules are also not significantly changed. Total extent of disease is 6.7 x 4.4 cm.2. Slight interval decrease in size of left axillary lymphadenopathy corresponding to biopsy-proven metastatic disease.3. No abnormal enhancement or mass lesions in the right breast and right axilla.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: Reason: R/O Rupture History: Posterior tibial tendonitis . Pain. Inability to bear weight on right foot x2 years. Right ankle/midfoot:The anterior tendons appear intact. The flexor tendons appear intact. Specifically, the posterior tibialis tendon appears intact. There is a longitudinal split tear of the peroneus brevis at the level of the distal fibular tip, however, the tendon can be traced to the level of its insertion on the tuberosity of the fifth metatarsal. There is, however, linear fluid signal intensity within the tendon just proximal to the level of its insertion, indicating an additional interstitial tear. There is mild subcutaneous edema in the surrounding area. The lateral collateral ligament complex appears intact. The distal tibiofibular syndesmotic complex appears intact. The imaged components of the deltoid ligament appear intact. There is a lobulated focus of fluid signal intensity along the dorsal aspect of the base of the fifth metatarsal which may represent ganglion formation. No osteochondral defect is identified. No bone marrow signal abnormality is seen.Right midfoot/forefoot:Mild osteoarthritis affects the first MTP joint including subchondral cyst formation within the first metatarsal head. There is heterogeneous signal abnormality along the dorsal aspect of the first metatarsal head which likely represents postsurgical change related to prior bunionectomy. There are skin markers in the adjacent area which presumably correspond to the patient's surgical scar, per the technologist note. No enhancing mass lesions are identified. No bone marrow signal abnormality is seen.

Output: Longitudinal split tear and interstitial tearing of the peroneus brevis as described above. The posterior tibialis tendon appears intact. Osteoarthritis and postsurgical changes affect the foot.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Cervical disc disorder with myelopathy, unspecified cervical regionClinical question: history of herniated cervical discSigns and Symptoms: numbness tingling weakness 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 straightening of the normal cervical curvature present. Overall the alignment of the cervical vertebrae is stableAt C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is a diffuse disc bulge present associated with endplate and uncovertebral osteophytes and encroachment of the neural foramina bilaterally with encroachment of the exiting nerve roots. Some disc material extrudes behind the adjacent endplates and encroaches the nerve roots at the right lateral recess and neural foramen more than the left. There is effacement of spinal fluid ventral and posterior the spinal cord with mild to moderate spinal stenosis. Overall when compared to the exam from 11/13/2010 there does not appear to be a substantial change.At C6-7 there is loss of disc space height, disc desiccation, endplate and uncovertebral osteophytes as well as a disc bulge associated with effacement of fat surrounding the exiting nerve roots within the neural foramina bilaterally. There is effacement of spinal fluid ventral and posterior the spinal cord at this level with mild to moderate degree of spinal stenosis. Overall there is very mild progression of the spinal stenosis at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There are degenerative changes present in the cervical spine mainly at C5-6 and C6-7 where there is mild to moderate spinal stenosis and neural foraminal encroachment of exiting nerve roots. There is a subtle progression of the spinal stenosis at C6-7 when compared to the prior exam. The spinal stenosis at C5-6 remains stable.


Instruction: Generate impression based on medical findings.

Input: 49 years Male (DOB:7/31/1967)Reason: evaluate for left lumbar root impingement or left lumbosacral plexus injury/inflammation History: hx of L3-L4 disc placement, chronic back pain, left thigh pain and numbness after surgery 4/15/2016 which was done via anterior approachReferring Attending: SERVICES ANCILLARY Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. No abnormal enhancing lesions are appreciated in the lumbar spine.Since the prior exam patient is undergone lumbar spine surgery anteriorly at the L3-4. There is metallic artifact which obscures the L3-4 level.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge present at this level. There is some facet hypertrophy. Since the prior exam the disc bulge at L5-S1 appears to have extended a little further and now mildly abuts the nerve roots at the lateral recesses.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is a mild disc bulge present this level.At L3-4 there is no significant compromise to spinal canal or neural foramina identified, however, this level is partially obscured by metal artifact..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: The patient status post lumbar spine surgery at the disc space of L3-4. The L3-4 level is obscured by metal artifact. To the extent of visualization there is not appear to be significant compromise to spinal canal at this level.There are degenerative changes present in the lumbar spine worse at L4-5 and L5-S1 where there are disc bulges present without significant compromise to the spinal canal or exiting nerve roots. Since the prior exam a disc bulge at L5-S1 appears to have extended further into now abuts the nerve roots at the lateral recess bilaterally..


Instruction: Generate impression based on medical findings.

Input: 42 year old with history of ALH, LCIS and dense breasts. Family history of breast cancer in her mother at age 54 and sister at age 50. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. Percutaneously placed metallic clip is again noted in the right breast upper outer quadrant. Two circumscribed masses are seen in the right breast, corresponding to the cysts seen on the recent MRI (1/29/15). No suspicious mass, suspicious microcalcifications or suspicious areas of architectural distortion are noted in either breast.

Output: No mammographic evidence of malignancy. As long as the patient's physical examination remains unremarkable, bilateral diagnostic mammogram is recommended annually. Results and recommendations were discussed with the patient. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.


Instruction: Generate impression based on medical findings.

Input: Multiple patellar dislocations MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There is marrow edema within the lateral femoral condyle and medial patellar facet consistent with prior dislocation. Additionally, there is a 1 cm ossicle medial to the patella that likely represents a chronic avulsion fracture fragment. The femoral trochlea is abnormally shallow indicating dysplasia. There is a small full-thickness cartilage defect along the lateral femoral condyle above the junction of the anterior horn and body of the lateral meniscus. The remaining articular cartilage and marrow signal is normal.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The patellar and quadriceps tendons are intact. The Insall Salvati ratio is 1.4 suggesting mild patella alta. The TT to TG distance is 2.3 cm. ADDITIONAL

Output: 1. Findings indicating prior patellar dislocation including an ossicle present along the medial aspect of the patella which is thought to represent a chronic avulsion fracture. Furthermore, there is femoral trochlear dysplasia, an elevated TT to TG distance, and mild patella alta.2. Small but full-thickness articular cartilage defect of the lateral femoral condyle with other findings described above.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Persistent nausea without clear etiology. Rule out mass/neural cause. Signs and symptoms: Nausea Nonenhanced head CT:Examination demonstrates several periventricular and subcortical nonspecific foci of low attenuation of white matter. As was noted on prior MRI examination these findings are suggestive of demyelinating disease. There is no evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus.The cortical sulci and ventricular system remain normal for patient stated age.Calvarium is intact. Visualized paranasal sinuses, mastoid air cells and middle ear cavities are unremarkable.

Output: 1.Periventricular and subcortical white matter low-attenuation and white matter consistent with patient's known multiple sclerosis.2.No evidence of acute intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.


Instruction: Generate impression based on medical findings.

Input: B-cell lymphoma, leg weakness/numbness There are small subcentimeter amorphous foci of increased signal within the left sacral wing on the fat suppressed T2 sequence. These are less conspicuous on T1 sequences and demonstrate minimal enhancement following contrast administration. While we cannot entirely exclude the possibility of small lymphomatous deposits, these may simply represent components of small intraosseous vascular malformation, given their clustering in the sacral wing. Similar but smaller foci are present in the right sacral wing. There are no additional bony lesions within the pelvis. Symmetric intermediate signal intensity within the proximal femora bilaterally are thought to represent areas of red marrow.A small Tarlov cyst is seen posterior to the right S2 nerve root and is not necessarily of any current clinical significance. The muscles of the pelvis are normal in signal intensity and caliber. The hip and sacroiliac joints are normal with no evidence of synovitis or effusion.A fat-containing lesion is noted within the left adnexa perhaps representing a dermoid cyst / mature teratoma.

Output: 1. Small amorphous foci of signal abnormality with minimal enhancement noted within the sacral wings, left greater than right. These may represent small vascular malformations although we cannot entirely exclude the possibility of small lymphomatous deposits. Follow-up with serial imaging may be considered.2. Fat-containing left adnexal lesion which may represent a mature teratoma / dermoid cyst. Referral to gynecology may be considered.


Instruction: Generate impression based on medical findings.

Input: Thyroid cancer and skull metastasis: delineate bony and parenchymal processes. There is an expansile enhancing mass centered in the right parietal calvarium that measures 39 x 56 mm in axial cross section. There is epidural extension with mass effect upon the underlying right parietal lobe. Portions of the dura appear to be discontinuous, but there does not appear to be gross invasion of the underlying brain parenchyma and slight midline shift to the left, as well as slight effacement of the right lateral ventricle. There is also considerable extension of tumor into the overlying subgaleal space. There is an enhancing nodule that measures up to 5 mm in the right temporal scalp. There are mild nonspecific foci of cerebral white matter T2 hyperintensity, which may represent chronic small vessel ischemic disease. There is no evidence of intracranial hemorrhage or acute infarct. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is mild scattered paranasal sinus mucosal thickening and secretions.

Output: 1. A large metastasis centered in the right parietal calvarium with subgaleal and epidural extension with mass effect upon the underlying right parietal lobe. Portions of the dura appear to be discontinuous, but there does not appear to be gross invasion of the underlying brain parenchyma. 2. A nodule that measures up to 5 mm in the right temporal scalp is nonspecific, but may represent metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Reason: Chiari malformation. Follow-up of cervical spine T2 hyperintensity, syrinx, follow up exam , evaluate for change History: chiari, syrinx , follow up. Images are slightly limited by patient motion. Stigmata of Chiari I malformation are again seen, with peglike tonsils extending up to 22 mm below the level of the foramen magnum. There is again severe crowding at the level the foramen magnum. CSF flow imaging again demonstrates diminished biphasic CSF flow at the level of the foramen magnum, more conspicuous posteriorly, although with focal attenuation along the slightly retroflexed dens tip as well. Overall, this appearance appears similar to prior exam.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.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is mild mucosal thickening throughout the visualized paranasal sinuses.CERVICAL SPINE

Output: 1.Redemonstration of stigmata of Chiari I malformation with significant caudal extension of the cerebellar tonsils. Retroflexed dens also contributes to narrowing at the level of the foramen magnum, with persistent decreased biphasic flow especially posteriorly at this level.2.Stable appearance of ill-defined T1-hypointense and T2 hyperintense signal at the lower C2 level within the cord, unchanged since baseline exam. Given the Chiari I malformation, this most likely relates to soft syrinx. No pathological enhancement identified, although continued follow-up is recommended to exclude possibility of space-occupying lesion.


Instruction: Generate impression based on medical findings.

Input: Low back pain and radicular symptoms Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.Mild degenerative changes are seen, as described below:L1-L2: Minimal disk bulge. No spinal canal or neural foraminal stenosis.L2-L3: Minimal disk bulge. No spinal canal or neural foraminal stenosis.L3-L4: Minimal disk bulge. No spinal canal or neural foraminal stenosis.L4-L5: Dorsal annular fissure with minimal central disk protrusion. No spinal canal or neural foraminal stenosis.L5-S1: Dorsal annular fissure and central disk protrusion. There is partial effacement of the subarticular zones, left greater than right. No central spinal canal stenosis. Mild bilateral neural foraminal stenosis. Mild bilateral facet arthropathy.Paraspinous soft tissues are within normal limits. There is an approximately 3.2 x 2.5 cm lesion involving the uterine wall with low T1 and T2 signal.

Output: 1. Mild degenerative changes with small disk protrusions at L4-L5 and L5-S1. There is effacement of the subarticular zone at the L5-S1 level which contacts the descending left S1 nerve root. There is no significant central canal stenosis at any level. There is mild bilateral neural foraminal narrowing at L5-S1; otherwise, no significant neural foraminal stenosis. 2. Mild facet arthropathy at L5-S1 which may be contributing to patient's low back pain.3. Partially visualized 3.2 x 2.5 cm lesion involving the uterus may represent a fibroid, consider ultrasound for further evaluation as clinically indicated.


Instruction: Generate impression based on medical findings.

Input: Status post curettage of the left calcaneus for aneurysmal bone cyst. Evaluate for local recurrence. Postoperative changes of curettage of an aneurysmal bone cyst appear similar to those seen on the prior study. There is an approximately 7 mm lucency with sclerotic margins in the navicular seen only on the lateral view of the calcaneus which was not seen on prior studies. We cannot entirely exclude the possibility of recurrence. If there is strong clinical concern for recurrence, MRI can be considered for further evaluation.

Output: Postoperative changes of left calcaneal aneurysmal bone cyst curettage. Lucency of the navicular as described above is seen only on one view, but we cannot rule out the possibility of tumor recurrence. If there is high clinical concern for recurrence MRI can be considered for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Clinical question to be answered: Evaluate for intracranial process. Signs and symptoms: 51-year-old female with severe headaches x 4 days, family history of brain aneurysm. MRI CT of brain without and with infusion of contrast.No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Cortical sulci, ventricular system and all CSF cisterns remain within normal. Calvarium, paranasal sinuses and mastoid air cells are unremarkable.Post infusion images demonstrate no abnormal enhancement the brain parenchyma or leptomeninges. This examination cannot exclude possibility of aneurysm. If an aneurysm is highly suspected a CTA of intracranial circulation is the appropriate test for detection of aneurysm.65 cc of Omnipaque was utilized for this study.

Output: Normal CT of brain without and with infusion of contrast.


Instruction: Generate impression based on medical findings.

Input: Ms. Bosby is a 33-year-old female with biopsy-proven left breast cancer presenting for research MRI(I-SPY #3) There is extreme amount of fibroglandular tissue in both breasts. Moderate parenchymal enhancement is noted bilaterally.LEFT BREAST: There has been an interval decrease in size of the known left breast cancer, now measuring 5.7 x 6.1 x 9.8 cm (AP x LR x CC, previously measuring 5.7 x 8.6 x 11.7 cm). In addition, there is an associated decrease in overall enhancement of the tumor, particularly centrally, indicating tumor necrosis. Diffuse edema and skin thickening remains similar to prior examination. A Hydromark clip is identified in the anterior 12:00 position within the known malignancy in the left breast.A known metastatic left axillary lymph node with Hydromark clip now measures 1.4 cm in maximum dimension, previously measuring 1.7 cm.RIGHT BREAST: There is no abnormal enhancement seen in the right breast. Multiple small cysts are present in the right breast. No abnormal axillary lymph nodes are identified in the right axillary region.

Output: Interval decrease in size and enhancement of known left breast cancer and metastatic left axillary lymph node.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Late effects of accidental fallClinical question: eval for malignancySigns and Symptoms: pathologic fractures, weaknessComments: Already had brain without. Needs with only contrast enhance imaging.| MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a small enhancing lesion in the left middle cerebellar peduncle with surrounding T1 hypointensity.There is a large perivascular space in the left basal ganglia possibly related to microhemorrhages when correlation with recent SWI imaging.There is a small right sided subdural effusion present adjacent to the right parietal lobe which is stable since prior exams.Lumbar spine:There is an anterior compression fracture present at L1 associated with mild enhancement. The posterior aspect of the vertebral body is concave in shape. There is a milder superior en-plate compression fracture at T12.Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment. The conus medullaris on sagittal imaging is grossly intact. No abnormal enhancing lesions are identified in the lumbar spine.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a small right paramedian disk protrusion at this level associated with contrast enhancement but no significant compromise to the adjacent nerve roots.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina. There are endplate reactive changes present anteriorly at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There are multiple small renal cysts present.

Output: 1.Left middle cerebellar peduncle lesion demonstrates some associated breakdown of blood brain barrier. This could suggest that this is inflammatory in nature or reaction to a prior a late subacute/early chronic infarction. It is conceivable that this could relate to neoplasm. If the patient has a known primary tumor elsewhere, this could represent metastasis. A follow-up exam in 6-12 weeks would be useful. Please correlate with clinical symptoms.2.There is a benign appearing compression fracture at L1 in the subacute phase.3.There is a mild superior endplate compression fracture at T12 in a more chronic phase.4.Findings suggest a left adrenal gland lesion. Please refer to abdominal CT for further comments.5.Small right subdural effusion.6.Small L5-S1 disk protrusion with signs of acute/subacute stage.


Instruction: Generate impression based on medical findings.

Input: 33-year-old male with perilunate disassociation. Foci of air may represent post-traumatic vacuum phenomena and mildly limits examination. There has been reduction of the previously described peri-lunate dislocation.LIGAMENTS: Signal abnormality within the ulnar collateral ligament with findings compatible with tear. Further, increased scapholunate interval indicates a tear of the scapholunate ligament.TRIANGULAR FIBROCARTILAGE COMPLEX: There is complete disruption of the TFCC with increased fluid visualized within the DRUJ, indicating tear. TENDONS: The flexor tendons appear intact, without significant abnormality of the carpal tunnel. Guyon's canal appears within normal limits. The extensor tendons also appear intact, but there is increased signal within adjacent soft tissues and within some compartments (specifically the third and fourth), likely indicative of reactive edema from recent injury and reduction.BONES: Fractures of the carpus are better described on same-day CT. However, there is no significant bony edema of the carpus. There is signal abnormality of the ulnar styloid, likely secondary to fracture. ADDITIONAL

Output: 1. Findings compatible with TFCC tear as outlined above.2. Increased radiolunate interval, indicative of tear of the the radiolunate ligament.3. Ulnar collateral ligament tear.4. Ulnar styloid fracture. For further fracture findings, please same day CT.5. Diffuse soft tissue infiltration along the dorsum of the wrist, likely reactive edema from recent procedure.


Instruction: Generate impression based on medical findings.

Input: 68 year old female with abdominal pain. Evaluate for colitis, diverticulitis, appendicitis. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal mass measures 3 cm in diameter. This may be further characterized with noncontrast CT or MRI examination, if indicated.KIDNEYS, URETERS: Fat stranding surrounding the right kidney. Focal decreased areas of attenuation, especially in the right upper pole and left upper pole regions are most consistent with pyelonephritis. Multiple punctate nonobstructing right renal calculus. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes in the lumbosacral spine and pelvis.OTHER: No significant abnormality noted.

Output: Nonenhancing lesions of the renal parenchyma bilaterally are most compatible with pyelonephritis. No hydronephrosis. Nonobstructing right nephrolithiasis. 3-cm diameter left adrenal mass.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old. Left leg sarcoma. Evaluate for response/progression. A lobulated, heterogeneous solid mass lesion within the anterior subcutaneous soft tissues of the thigh measures 4.5 x 2.6 x 4.7 cm (series 7, image 20; series 12, image 23), with increased signal on T2 images, diffuse enhancement, and mild surrounding soft tissue edema. The mass appears entirely located within the subcutaneous fat and does not appear to extend into the deep fascial spaces. The underlying muscles and tendons are unremarkable.The visualized osseous structures are unremarkable, with normal cortical thickness and marrow signal.

Output: A 4 to 5 cm mass within the anterior subcutaneous soft tissues of the thigh is compatible with a known history of sarcoma.


Instruction: Generate impression based on medical findings.

Input: Metastatic melanoma with brain metastases following 4th cycle of immunotherapy. There has been interval decrease in size of the multiple treated supratentorial and infratentorial brain metastases, which contain T1 hyperintense components with susceptibility effect. For example, a left inferior frontal gyrus lesion measures up to 15 mm, previously 19 mm, and a right lateral cerebellar hemisphere lesion measures up to 8 mm, previously 10 mm. There is diffuse nonspecific periventricular white matter T2 hyperintensity. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Interval decrease in size of the treated supratentorial and infratentorial brain metastases.


Instruction: Generate impression based on medical findings.

Input: Reason: Pain in the right shoulder, concern for biceps tendinitis ROTATOR CUFF: The supraspinatus, infraspinatus, teres minor, and subscapularis muscles and tendons are intact without evidence of tearing.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There are multiple large subchondral cysts in the humeral head. There is a moderate amount of fluid in the AC joint with associated degenerative changes.BICEPS TENDON: The biceps tendon is intact without evidence of tearing. ADDITIONAL

Output: Acromioclavicular joint osteoarthritis and multiple subchondral cysts.


Instruction: Generate impression based on medical findings.

Input: History of CVA x 2, complaining of weakness and acute mental status changes. Rule out CVA. There is no evidence of intracranial hemorrhage, mass or midline shift. Areas of subcortical and periventricular white matter hypodensity and an area of lacunar infarction in the left basal ganglia indicate advanced small vessel ischemic disease of indeterminate age. This appears slightly more prominent than on the prior examination. If there is concern for an acute stroke, an MRI may be considered for further evaluation.Prominence of the ventricles and sulci indicate corticomedullary volume loss.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.Foci of increased density of the right globe are identified. These may represent dystrophic calcification or may be artifactual. The right eye is only partially included in the field of view.

Output: Advanced small vessel ischemic disease of indeterminate age. If there is concern for an acute stroke, an MRI may be considered for further evaluation.


Instruction: Generate impression based on medical findings.

Input: 42 year-old female status post craniotomy with headache. Postsurgical changes from bilateral craniotomies are again seen with diffuse edema in the cerebral white matter appearing similar to the recent MRI. Expected pneumocephalus is seen in the right parietal region. Ring of hyperdensity in the left frontal lobe with small amount of adjacent blood products likely corresponds to left frontal lobe mass seen on prior MRI.The ventricles and basal cisterns are normal in size and configuration. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Postsurgical changes and diffuse edema in cerebral white matter as above


Instruction: Generate impression based on medical findings.

Input: Meningitis, unspecified [G03.9], Reason for Study: ^Reason: known c3-c7 signal abnormality , change? Enhancement? History: meningeal signs, RUE flaccid weakness and Left sided increased tone Previously seen T2/STIR high signal intensity lesions in the cervical spinal cord from C3 to C7 level are not as conspicuous as prior. In addition, subtle expansion of the cervical cord from C3 and C7 level has been resolved. There is no evidence of abnormal enhancement within the spinal cord.Leptomeningeal enhancements of cervical spinal cord slightly prominent that normal which is seen again and are unchanged since prior. Minimal bulge of disc at the level of C45 is seen. Central to left minimal bulging of disc is seen at the level of C56 without evidence of lateral recess stenosis.There is normal cervical lordosis. The cranial-cervical junction is normal. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance.

Output: 1. Interval improvement of C3 to C7 spinal cord T2 high signal intensity and subtle spinal cord expansion since prior scan. Diagnostic possibility include transient congestive myelopathy. The possibility of demyelinating disease is slim.2. Slightly prominent leptomeningeal enhancement indicate possible meningitis, unchanged since prior scan. 3. Degenerative disc disease seen at the level of C45 and C56.


Instruction: Generate impression based on medical findings.

Input: There is rightward convexity of the mid lumbar spine with apex of the curvature at L2. Vertebral body heights are unchanged. There is stable grade 1 retrolisthesis of L2 over L3 and L4 over L5. There has been mild progression of multilevel disc narrowing, moderate to severe in degree. There is multilevel disc desiccation. Severe multilevel degenerative changes of the lumbar spine is again demonstrated, with endplate irregularity and endplate marrow signal changes. No worrisome focal marrow signal abnormality is appreciated. The distal spinal cord and conus are within normal limits with the conus terminating at the L1-L2 level.Multilevel degenerative changes are seen, as described below:At T9-T10: On sagittal images, minimal disc bulge is seen. There is mild stenosis of the central canal. There is ligamentum flavum thickening.At T10-T11: On sagittal images, there is no definite abnormality.At T11-T12: On sagittal images, there is mild disc bulge. There is significant ligamentum flavum thickening. There is mild stenosis of the spinal canal.At T12-L1: There is a mild ventrolateral disc protrusion. There is ligamentum flavum-thickening. No foraminal narrowing or spinal canal stenosis.At L1-L2: This is a left far lateral disc osteophyte complex. There is mild left foraminal stenosis. There is moderate spinal canal stenosis. There is ligamentum flavum thickening and facet joint hypertrophy. No change from previous.At L2-L3: There is uncovering of the disc. There is narrowing of the lateral recesses and moderate left foraminal stenosis at this level. There is mild right foraminal stenosis. There is mild spinal canal stenosis. There is facet joint arthropathy.At L3-L4: There is posterior osteophyte disc complex causing moderate bilateral foraminal stenosis. There is moderate spinal canal stenosis. There is ligamentum flavum thickening and facet arthropathy. At L4-L5: There is uncovering of the disc with superimposed disc bulge with superimposed right foraminal/far lateral protrusion. There is moderate to severe right foraminal stenosis and moderate left foraminal stenosis. There is moderate spinal canal stenosis. There is ligamentum flavum thickening. There is facet arthropathy which has progressed in the interim trace facet joint effusions. At L5-S1: There is disc bulge causing moderate foraminal narrowing on the right and mild foraminal narrowing on the left. There is ligamentum flavum thickening and facet arthropathy. There is moderate spinal canal stenosis improved from previous.Tiny T2 hyperintense focus is seen in the posterior cortex of the left kidney, likely a small cyst. The left adrenal gland is minimally prominent and unchanged from previous. There is layering T2 hypointense debris in the dependent portion of the gallbladder. Paraspinous soft tissues are within normal limits.

Output: 1. Very minimal progression of multilevel severe degenerative changes of the lumbar spine, with findings most prominent at L4-L5 with moderate-severe right foraminal stenosis and moderate left foraminal stenosis. There has been interval progression in the facet arthropathy at this level.2. Moderate spinal canal stenosis at various levels, slightly improved at L5-S1.3. Minimal layering debris within the gallbladder which may represent stones or sludge. Further evaluation with ultrasound may be considered if clinically indicated.


Instruction: Generate impression based on medical findings.

Input: Fall status post head trauma. Patchy hypodensity within the periventricular and subcortical white matter represent small vessel disease of indeterminate age. There is hypodensity of the right thalamus, possibly representing subacute ischemia.There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration. The calvaria and skull base are radiographically normal. The paranasal sinuses and mastoid air cells are normally aerated.

Output: Small vessel ischemic disease of indeterminate age. Possible acute/subacute ischemia of the right thalamus. MRI can be obtained for further evaluation if clinically indicated.


Instruction: Generate impression based on medical findings.

Input: 59-year-old female with history of ampullary carcinoma status post Whipple. Now with abdominal pain and nausea. ABDOMEN:LIVER, BILIARY TRACT: No hepatic masses identified. Status post Whipple procedure. The hepaticojejunostomy is patent, though the common hepatic bile duct is irregular. The intrahepatic biliary ducts demonstrate multifocal stenoses. The gallbladder is surgically absent.SPLEEN: No significant abnormality noted.PANCREAS: Status post Whipple procedure. There is a short stricture of the distal pancreatic duct at the pancreaticojejunostomy, with mild diffuse dilation of the pancreatic duct proximally. No focal pancreatic without focal mass identified. Response to secretin is identified. No peripancreatic fluid collections are present.ADRENAL GLANDS: Right adrenal adenoma. Left adrenal gland thickening.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Short stricture of the postsurgical distal pancreatic duct near the pancreaticojejunostomy, with mild diffuse dilation of the pancreatic duct proximally.2.Multifocal stenoses of the hepatic biliary system, which may represent autoimmune cholangiopathy or primary sclerosing cholangitis.3.No hepatic or pancreatic mass identified.4.Pancreatic response to secretin identified.


Instruction: Generate impression based on medical findings.

Input: Evaluate for progression of metastatic disease. Images through the skull base and including cavernous sinuses remain free of malignancy. Paranasal sinuses and mastoid air cells are unremarkable.Images through the soft tissues of the neck demonstrate a cluster of large nonenhancing mass is in the left supraclavicular region. The transverse diameter of this cluster of tumors measures 21-mm x 40 3-mm on axial image 74. On coronal reformatted image 37 the cranial cervical and the transverse axises of the tumor measures 40-mm. There are no prior examinations for comparison. There is evidence of mass effect and medial deviation of the left common carotid artery and left internal jugular vein by the cluster of nodes. There is no evidence of bony destruction with this finding.Metastatic lesion to vertebral body of C6 with near complete collapse of vertebrae and enhancing extra osseous extension of tumor into the ventral epidural space is noted. Sagittal reformatted images demonstrate mass effect and deviation of the cord posteriorly. Metastatic lesion to the posterior body of C7 also demonstrates epidural extension of tumor into the ventral epidural space. No compression deformity of C7 is detected. These findings can be further evaluated with a dedicated MRI of the spine. No evidence of any additional osseous metastases in the area of exam is identified.Limited images of the apices of the lungs demonstrates extensive scarring (left greater than right). A non-calcific nodule measuring approximately 7 mm times 15-mm is identified in the posterior aspect of right upper lung field (axial image 94). No mediastinal lymphadenopathy is detected.

Output: 1.Cluster of metastatic nodes in the left supraclavicular region as detailed above.2.Metastatic lesion to C6 with significant compression deformity and metastatic lesion to the posterior aspect of C7 vertebrae. There is extraosseous epidural spread of tumor at this level into the cervical spinal canal.3.Metastatic nodule in the right upper lung field.4.Mass-effect and posterior deviation of the cord at C6 is noted. This area can be further evaluated with a dedicated MRI of spine.5.No prior examinations from this institution for comparison.


Instruction: Generate impression based on medical findings.

Input: Congenital malformation of circulatory system, unspecified [Q28.9], Reason for Study: ^Reason: evaluate for vascular malformation History: headache; history of vascular malformation Brain MRI:There is no evidence of acute ischemic or hemorrhagic lesion on the scan. There is no abnormal enhancing lesion intracranially.There is a however 10.5 mm x 17.9 mm sized well circumscribed ovoid enhancing lesion on the left anterior aspect of temporalis muscle. The lesion showed high signal intensity on T2 weighted image and iso signal intensity on T1 weighted image. The lesion shows internal susceptibility artifacts on gradient echo images. The MR findings of this lesion suggest possible venous vascular malformation or hemangioma.The cerebellar tonsils are low lying through the foramen magnum about 6mm. No evidence of syrinx. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. There is mucosal thickening on the right maxillary sinus.Neck MRI:There are multiple variable sized lesions showing high signal intensity on T2, lower or iso signal intensity comparing to adjacent muscle on T1 with evidence of Gad enhancement. The lesions are located on bilateral anterior aspects of tongue (series 1501, image 24 and 27) and anterior aspect of the right SCM muscle at the level of vocal cord (series 1501, image 32). Based on MR signal characteristics, these lesions are likely represent venous vascular malformation. Otherwise oro.nasopharynx, hypopharynx, larynx and subglottic airways are unremarkable. The epiglottis, vallecula, piriform sinuses, and vocal cords are normal. The parotid, submandibular, and thyroid glands are unremarkable. The carotid arteries and jugular veins are patent.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion of brain.2. No evidence of intracranial vascular lesion on this scan.3. Low lying cerebellar tonsils about 6mm through the foramen magnum. 4. Multifocal lesions with high signal intensity on T2, low or iso signal intensity on T1 with evidence of Gad enhancement on left anterior aspect of temporalis muscle, bilateral anterior aspect of tongue and anterior aspect of the right SCM muscle at the level of vocal cord indicating possible venous vascular malformation.


Instruction: Generate impression based on medical findings.

Input: Recent laser ablation of the corpus callosum. There has been interval laser ablution of the corpus callosum via right transparietal and transfrontal approaches. There is expected peripheral restricted diffusion associated with the ablation zones, but no evidence of acute territorial infarction. There is no evidence of gross intracranial hemorrhage. There is no midline shift.

Output: Expected findings related to interval laser ablation of the corpus callosum.


Instruction: Generate impression based on medical findings.

Input: Male 53 years old; Reason: known osteomyelitis in R foot, now septic with unclear source. Red, painful leg. RIGHT FOOT: The patient is status post amputation of the fourth ray through the fourth metatarsal, and status post amputation of the distal half of the fifth metatarsal. There are associated soft tissue changes including scarring and foci of metallic susceptibility artifact. Soft tissue defect at the lateral aspect of the forefoot near the site of the fifth metatarsal amputation with underlying signal abnormality in the soft tissues possibly represents a combination of scarring and inflammation. No discrete fluid collection is seen to suggest abscess. No marrow signal abnormality is seen to confirm osteomyelitis. Edema is present in the dorsal soft tissues of the foot. Mild edema and atrophy of the plantar musculature of the foot is noted. There are foci of metallic susceptibility artifact in the plantar soft tissues beneath the first metatarsal neck, which limit evaluation of the surrounding structures.RIGHT TIBIA/FIBULA: There is edema within the subcutaneous fat. Mild signal abnormality in the musculature likely represents a combination of atrophy and edema. No fluid collection is seen to suggest abscess. The bone marrow signal is normal. No findings are seen to confirm osteomyelitis. A knee joint effusion is seen, though incompletely imaged on this exam. Similar findings are noted in the contralateral leg on the large FOV series.

Output: Postoperative and soft tissue inflammatory changes, as described above. No findings to suggest osteomyelitis.


Instruction: Generate impression based on medical findings.

Input: Pain in right knee [M25.561], Reason for Study: ^Reason: right leg pain History: right leg pain For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. The spine alignment is anatomic. The vertebral body height is preserved. The signal of the visualized cord is normal. The conus medullaris terminates at the L1-2 level.The paraspinal soft tissues are unremarkable.Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: minimal bulging of disc. no neuroforaminal narrowing or spinal stenosis. L4-L5: diffuse bulging of disc associated with bilateral minimal facet joint hypertrophy and ligamentum flavum thickening result minimal spinal canal stenosis and bilateral neuroforaminal stenosis. Unchanged since prior scan.L5-S1: diffuse bulging of disc results minimal neuroforaminal stenosis bilaterally. No spinal stenosis. Unchanged since prior scan.

Output: 1. Degenerative changes of Lumbar spine 2. Minimal spinal stenosis with minimal bilateral neuroforaminal stenosis at the level of L45, unchanged since prior scan. 3. Minimal bilateral neuroforaminal stenosis at the level of L5S1, unchanged since prior scan.


Instruction: Generate impression based on medical findings.

Input: Reason: 72M with history of Gleason 6 prostate cancer, with rising PSA History: rising PSA PELVIS:PROSTATE:Prostate Size: 4.4 x 2.5 x 3.2 cmPeripheral Zone: There is diffuse low T2/ADC signal surrounding the TURP defect which demonstrates early enhancement. This is most prominent along the left mid gland transitional and peripheral zones (704/284) and is suspected to represent fibrosis. There are more focal lesions which also surrounding the TURP defect which are also low signal on T2/ADC measuring 0.5 x 0.7 cm in the right lateral mid gland (601/18) and 0.4 x 0.4 cm in the right para median mid gland (601/17).Central Gland: A TURP defect comprises the majority of the central gland.Seminal Vesicles: No evidence of seminal vesicle in relation.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: Bilateral fat-containing inguinal hernias.

Output: 1.TURP defect with diffuse surrounding low T2/ADC signal which is suspected to represent prostatitis/fibrosis, particularly in light of the low grade Gleason biopsy.2.There are two more focal regions of low T2/ADC signal in the right mid gland surrounding the TURP defect which are indeterminate and have been marked for biopsy.


Instruction: Generate impression based on medical findings.

Input: 27-year-old male with previous small bowel surgeries including multiple stricturoplasties currently with diarrhea. Evaluate for Crohn's disease. ABDOMEN:LIVER, BILIARY TRACT: No suspicious focal hepatic lesions. No intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No pancreatic ductal dilatation or evidence of a pancreatic lesion.ADRENAL GLANDS: Adrenal glands are normal in size and morphology bilaterally.KIDNEYS, URETERS: Kidneys enhance symmetrically without evidence of hydronephrosis.RETROPERITONEUM, LYMPH NODES: Scattered mesenteric subcentimeter lymph nodes are nonspecific.BOWEL, MESENTERY: No evidence of bowel wall thickening, diffusion restriction, or enhancement to suggest active Crohn's disease. No evidence of strictures or ulcerations.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: As above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No MRI evidence of active Crohn's disease.2.No evidence of strictures.


Instruction: Generate impression based on medical findings.

Input: 53 years, Male, Reason: cirrhosis. rising AFP. evaluate for liver lesion History: rising AFP. ABDOMEN:LUNG BASES: Moderate left pleural effusion is new.LIVER, BILIARY TRACT: Cirrhotic liver morphology. Multiple nonenhancing cysts are unchanged.There are two enhancing lesions in segment 8 which washout on delayed phase imaging measuring 1.2 cm (802/262) and 1.1 cm (802/297), consistent with hepatocellular carcinoma.Re-cannulization of the umbilical vein.SPLEEN: Splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Enlarged portacaval node measuring 2.0 x 1.1 cm (701/308).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Left posterior eighth and ninth rib fractures with decreased size of adjacent fluidOTHER: Large amount of increased ascites.

Output: 1.Two enhancing lesions with washout in segment 8, consistent with hepatocellular carcinoma.2.Large amount of ascites is increased.3.Cirrhotic liver morphology with enlarged portacaval nodes.4.New small left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: History of cervicothoracic laminectomy for tumor resection. Evaluate for infection. There are postsurgical changes of laminectomy from C7 to T2 and resection of previously seen intramedullary hemorrhagic lesion. Prior postoperative MRI was of the thoracic spine and in comparison with the limited view of the cervical spine on the sagittal sequence, there is interval development of a fluid collection in the paraspinous soft tissues at the C4-C5 to mid T1 level and a second component from which extends inferiorly to the T3 level which is in continuity. Total fluid collection measures approximately 5.8 x 5.7 x 8.1 cm in the AP, transverse, and craniocaudal dimensions. There are fluid-fluid levels. Fluid collection demonstrates predominantly low T1 signal with some areas of T1 hyperintensity and T2 hyperintensity indicative of at least some component of blood products.Fluid collection mostly involves the subcutaneous soft tissues with a smaller component extending into the paraspinous soft tissues and tracking along the surgical incision site into the extrathecal space from C6 to the upper T2 level. There is anterior displacement of the cervical cord. Examination is slightly motion degraded. There is T2 hyperintensity within the cord associated with the resection cavity. No new cord edema is appreciated. Vertebral body heights and alignment are maintained. No evidence of diskitis osteomyelitis. There is mild thin enhancement surrounding the fluid collection with relatively greater enhancement involving the paraspinous soft tissues.

Output: 1. Comparison with prior postoperative thoracic spine study is slightly limited. There is however interval development of a large fluid collection measuring 5.8 x 5.7 x 8.1 cm with fluid levels primarily involving the subcutaneous soft tissues with extension into the paraspinous soft tissues and a small component within the spinal canal. Signal intensity is indicative of at least some blood products. Fluid collection extends from the C4-C5 to the T3-T4 levels. There is a fluid-fluid level which may be related to hematocrit effect and raises possibility of active bleeding. There is some enhancement surrounding the paraspinous soft tissues which may be postsurgical. Overall signal features are not consistent with simple pseudomeningocele although some of the fluid may be CSF admixed with blood products. Mild enhancement in the surgical bed may be postsurgical; superimposed infection cannot entirely be excluded and aspiration can be considered as clinically warranted.2. Mild mass-effect on the upper thoracic cord which is anteriorly displaced. There is some T2 hyperintensity within the cord which was seen on prior and may be related to the resection cavity. No definitive evidence of new cord edema.Dr. Ali discussed findings with Dr. Lesniak at 945 hrs on 2/25/2015.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Evaluate for nerve impingement/radiculopathySigns and Symptoms: Patient with LUE limited ROM, shooting pains from nape of neck down into arm The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is mild reversal of the normal cervical curvature present. There is mild loss of disc space height and disc desiccation at C3-4 and C4-5.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There is no compromise of cervical spinal canal or exiting nerve roots. There are minor degenerative disc changes present.2.Mild reversal of normal cervical curvature is nonspecific. It could relate to muscle spasm or patient positioning in the magnet.


Instruction: Generate impression based on medical findings.

Input: There is unchanged patchy nonenhancing increased T2 signal in the medulla extending into the posterior pons. There is unchanged mild increased T2 signal in the right cuneus without mass effect. There are scattered subcortical and periventricular white matter T2 hyperintensities again seen. The ventricles are unchanged with no hydrocephalus. There is no acute infarct, mass effect or midline shift. There are unchanged postoperative findings the occipital scalp. There is a stable small CSF intensity collection likely postsurgical adjacent to the lateral right cerebellar hemisphere without significant change. There are retention cysts in the bilateral maxillary sinuses.

Output: Stable exam with no significant change in patchy T2 hyperintense signal in the brainstem. Of note, overall appearance is much improved since remote MRI from 8/2/2011.


Instruction: Generate impression based on medical findings.

Input: Knee pain MENISCI: There is minimal fraying of the undersurface of the posterior horn and body of the medial meniscus but we see no discrete medial or lateral meniscal tear.ARTICULAR CARTILAGE AND BONE: Again seen is moderate degeneration of the articular cartilage of the patella with foci of near full-thickness to full-thickness degeneration affecting both the lateral and medial facets with associated subchondral marrow signal abnormality appearing similar to the prior exam. There is also near full-thickness to full-thickness cartilage loss of the posterior aspect of the medial femoral condyle, also appearing similar to the prior exam. Subjectively, the articular cartilage of the weightbearing portion of the medial compartment appears thinned. Subchondral cysts are noted in the lateral tibial plateau with degeneration of the overlying cartilage. Edema type signal within the intercondylar eminence appears less prominent than on the prior exam.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Possible mild undersurface fraying of the medial meniscus with no discrete medial or lateral meniscal tear.2. Tricompartmental cartilage degeneration as detailed above which overall appears similar to the prior exam.


Instruction: Generate impression based on medical findings.

Input: Reason: intracranial lesion on OSH imaging History: intracranial lesion on OSH imaging, p/w episode of syncope The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a uniformly enhancing mass present along the anterior cranial fossa centered at the midline measuring 44 x 50 mm axial dimensions and 30 x 50 mm sagittal dimensions. It contains a few flow voids. It displaces the inferior aspects of the frontal lobes posteriorly. It displaces the corpus callosum and anterior cerebral arteries superiorly and posteriorly. Within the adjacent brain parenchyma there is no significant signal change. The mass extends into the olfactory grooves. The olfactory bulbs are not separately identified. There is a large vein which courses along the right aspect of the mass anteriorly and laterally.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 superior ophthalmic veins are large .

Output: 1.Large anterior fossa extracranial masses most likely represents a meningioma.


Instruction: Generate impression based on medical findings.

Input: History of von Hippel-Landau syndrome. Evaluate renal lesions. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, signal intensity and size measuring 13.8 cm in craniocaudal dimension. Scattered subcentimeter hepatic cysts. No focal suspicious liver lesion, biliary ductal dilatation or vascular abnormality. No biliary ductal dilatation.SPLEEN: The spleen is normal in size, morphology and signal intensity without a focal lesion.PANCREAS: The main pancreatic duct is prominent up to 5 mm, slightly increased from the prior where it measured up to 3 mm. There is suggestion of pancreatic divisum. The main pancreatic duct is irregular and tortuous with a transition point at the level of the pancreatic head which may represent a benign stricture, as there is no evidence of a discrete mass lesion. The parenchyma is normal in morphology, signal intensity and enhancement.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple and minimally complex right renal cyst the largest measuring 1.9 x 1.6 cm with several thin non-enhancing septations, not significantly changed from prior MR. Punctate left renal simple cyst. Partially exophytic left renal inferior pole intermediate T2-weighted signal intensity lesion measuring 1.8 x 1.9 cm demonstrates no postcontrast enhancement and is compatible with a minimally complex proteinaceous or hemorrhagic cyst, unchanged from the prior.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. Simple and minimally complex renal cysts. No suspicious renal lesion.2. Increasing dilatation of the main pancreatic duct up to 5 mm without a discrete lesion evident. This may be related to a focal stricture. Possible pancreas divisum. ERCP/US as clinically indicated should be considered.


Instruction: Generate impression based on medical findings.

Input: 31-year-old female with history of pancreatic pseudocyst status post cyst gastrostomy in March 2015. Patient now with abdominal pain, nausea, vomiting, and elevated lipase. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions. No biliary ductal dilation. Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: There is fullness of the pancreatic head with an apparent rounded area measuring up to 2.7 x 2.2 cm (series 1204/63) demonstrating low T2 signal and relative hypoenhancement on delayed phase images. There is mild relative upstream dilation of the main pancreatic duct measuring up to 3-4 mm with multiple side branches visualized with transition point in the pancreatic body, appears to be upstream from the pancreatic head findings. Definite restricted diffusion is not seen. Cyst gastrostomy tube is present, but there are no significant peripancreatic fluid collection seen.There appears to be occlusion of the portal confluence with the splenic vein not visualized. The main portal vein appears to be reconstituted by collateral vessels.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Prominent peripancreatic lymph nodes are seen around the pancreatic head, but these are not pathologically enlarged by size criteria.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Overall, pancreatic head findings as detailed above are nonspecific and may relate to sequela/devascularization or necrosis from pancreatitis, focal type autoimmune pancreatitis another differential consideration, underlying masslesion not entirely excluded. Clinical and endoscopic correlation is suggested.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: There is a focus of T1 hyperintensity and T2/FLAIR hyperintensity involving the posterior limb of the internal capsule on the left abutting the lateral aspect of the thalamus. No associated susceptibility effect. Remainder of the brain parenchyma appears unremarkable without findings to suggest traumatic encephalomalacia or hemosiderin deposition in the brain related to prior trauma. No evidence of recent infarct or hemorrhage. No intracranial mass or mass effect. No extra-axial collections. No hydrocephalus. The major cerebral flow voids are intact. There is small focus of T2 hyperintensity and restricted diffusion involving the subcutaneous soft tissues in the left temporal occipital region which may represent a sebaceous cyst. The orbits, skull, paranasal sinuses, and scalp soft tissues are otherwise grossly unremarkable.

Output: There is a focus of T1 and T2 hyperintensity involving the posterior limb of the internal capsule on the left which is nonspecific and of uncertain etiology. Finding may represent mineralization related to prior trauma if there was history of prior injury in this region. Prior inflammation or other toxic metabolic injury also remain a possibility. Comparison with prior studies is suggested if available.Remainder of the brain appears otherwise unremarkable without evidence of traumatic encephalomalacia or hemosiderin deposition related to chronic hemorrhage.


Instruction: Generate impression based on medical findings.

Input: 31 year old with BRCA mutation, screening MRI. A patient submitted outside study for review. Submitted for review is a breast MRI performed at Parkview Outpatient Service Center on 6/6/2016. For comparison, a breast MRI from 4/30/2015 also performed at Parkview Outpatient Service Center is available, this exam was performed with the patient was postpartum and is limited due to postpartum and lactation changes. Outside hospital MRI pre and post contrast images were processed by DynaCad for interpretation.There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There is a 5 x 4 x 7 mm enhancing focus in the right breast at the 12:00 position with a thin septation which most likely represents a benign fibroadenoma unchanged compared to the prior MRI. A benign intramammary lymph node is identified in the right breast at the 10:00 position and has a T2 and STIR correlate. Small enhancing foci in both breasts are noted, none of which are uniquely enhancing. No abnormal axillary lymph nodes are identified in either axillary region. No abnormal enhancement noted in the left breast.

Output: 1.No MRI evidence for malignancy. 2.Benign morphology stable lesion in the 12:00 position in the right breast most likely a fibroadenoma for which no further intervention is recommended given its stability and benign features. Ultrasound may be performed for confirmation but if no definite correlate is found, annual screening mammogram and MRI is recommended.3.Benign intramammary lymph node in the right breast at the 10:00 position.BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on medical findings.

Input: Reason: Evaluate for labral tear, rotator cuff tear, biceps pathology History: Left shoulder pain, worsens with abduction ROTATOR CUFF: There is scalloping of the undersurface of the distal supraspinatus tendon, just proximal to its insertion, compatible with a partial-thickness undersurface tear, measuring approximately 1 cm in length and involving less than 50% of the tendon thickness. The supraspinatus muscle appears intact. The infraspinatus muscle and tendon appear intact; there is a tiny cyst within the underlying humeral head of doubtful clinical significance. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. We see no fluid within the subacromial/subdeltoid bursa to indicate a full-thickness rotator cuff tear.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is within normal limits. On the fat-saturated T1-weighted coronal oblique images (series 9), the superior labrum beneath the biceps anchor is indistinct, as seen on image 12, compatible with a superior labral tear. The inferior labrum appears intact.BICEPS TENDON: The tendon of the long head of the biceps appears intact. ADDITIONAL

Output: 1. SLAP tear.2. Shallow undersurface tear of the supraspinatus tendon.3. Normal-appearing tendon of the long head of the biceps.4. Acromioclavicular joint osteoarthritis.


Instruction: Generate impression based on medical findings.

Input: Continued right knee pain 6 months status post microfracture of patella, trochlea and medial femoral condyle. No improvement with surgery, physical therapy, injections. Evaluate healing of microfracture. MENISCI: The anterior horn and body of the lateral meniscus appear more attenuated on the current study that on the prior study which I suspect reflects interval partial meniscectomy, although I cannot entirely exclude the possibility of progression of attritional tearing. Persistent enlargement of the peripheral aspect of the body of the lateral meniscus may reflect displaced meniscal tissue in the lateral gutter, but this appears similar to that seen on the prior study. The posterior horn appears slightly attenuated, likely reflecting prior meniscectomy, appearing similar to the prior study.There is blunting of the anterior horn of the medial meniscus that appears similar to that seen on the prior study and may represent an old tear or partial meniscectomy. The signal abnormality seen within the anterior horn of the medial meniscus on the prior study, however, is less prominent on the current study which may reflect interval surgery. The remainder of the medial meniscus is unremarkable.ARTICULAR CARTILAGE AND BONE: There is moderate degeneration of the articular cartilage of the patella lateral to the median eminence that appears more pronounced on the current study than on the prior study. There is also a full-thickness cleft through this degenerated cartilage, best seen on the sagittal images, that was not clearly evident on the prior study. I see no underlying bone marrow signal abnormality. Heterogeneity of the articular cartilage of the femoral trochlea centrally appears to have progressed when compared with the prior study, which may reflect interval surgery; however, there remain near-full-thickness/full-thickness clefts of the articular cartilage. Underlying bone marrow signal intensity is normal. Focal signal abnormality within the articular cartilage of the medial femoral condyle just posterior to the anterior horn of the meniscus with mild degenerative edema type signal in the underlying subchondral bone appears similar to that seen on the prior study, compatible with focal cartilage degeneration. The previously seen focus of full-thickness cartilage degeneration along the posterior aspect of the lateral femoral condyle with degenerative signal abnormality in the underlying subchondral bone is less pronounced on the current study on the prior study; however, there is new focal delamination of the articular cartilage of the lateral femoral condyle just above the free edge of the posterior horn of the lateral meniscus.LIGAMENTS: The anterior cruciate ligament graft appears intact. The previously seen presumably bioabsorbable anchor in the tibia is now partially replaced with fluid signal intensity. Signal abnormality within the marrow along the femoral tunnel appears similar to the prior study and is of doubtful significance. Intermediate signal intensity seen along the anterior aspect of the graft on the prior study is no longer evident, perhaps due to interval surgery. The posterior cruciate ligament appears intact. The medial collateral ligament appears intact. The lateral collateral ligamentous complex appears intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1.Tricompartmental cartilage degeneration as described above, with most of degenerative foci showing progression or no change when compared with the prior study.2.Meniscal abnormalities as described above that I suspect reflect prior meniscectomy; I see no definite new or recurrent tear.3.Anterior cruciate ligament reconstruction and other findings as described above.


Instruction: Generate impression based on medical findings.

Input: 3-D T1 images are slightly degraded by artifact.There is an elongated appearance of the head shape in the AP dimension, which relates to scaphocephaly from premature fusion of the sagittal suture. Mild prominence of the ventricles and subarachnoid space anteriorly bilaterally. Questioned mild delay of myelination in the frontal and temporal lobes, provided corrected age.Stable cavum septum pellucidum. Basal cisterns are patent. No midline shift or mass effect. There is no diffusion abnormality, acute hemorrhage, or abnormal enhancement. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.

Output: No focal abnormality. Mild prominence of anterior subarachnoid spaces and ventricles likely relates to benign external hydrocephalus of infancy, which usually resolves by two years of age. Follow-up imaging may be obtained as clinically indicated.


Instruction: Generate impression based on medical findings.

Input: Treated nasopharyngeal carcinoma with headaches. There is encephalomalacia and susceptibility effect in the left cerebellar hemisphere. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles are unchanged in size. There are post-treatment findings in the left nasopharyngeal region with soft tissue deficiency involving the pharyngeal mucosal and left parapharyngeal spaces, where there is diffuse enhancement of the residual soft tissues, but no discernible tumor. There is persistent diffuse T2 hyperintensity and enhancement in the central skull base. There are postoperative findings related to left mastoidectomy with fluid in the remaining mastoid air cells. There also a small amount of fluid signal within the right mastoid air cells. There is moderate mucosal thickening involving most of the paranasal sinuses, with possible secretions in the right maxillary sinus. There are bilateral subcentimeter lacrimal gland cysts. The orbits are grossly unremarkable.

Output: 1. Chronic infarct in the left cerebellar hemisphere, but no evidence of acute infarction or intracranial tumor.2. Post-treatment findings in the left nasopharyngeal region with no definite evidence of gross tumor.3. Findings related to prior central skull base osteomyelitis and osteoradionecrosis.4. Postoperative findings related to left mastoidectomy with nonspecific fluid in the remaining mastoid air cells.5. Findings suggestive of acute sinusitis.6. Bilateral subcentimeter lacrimal gland cysts.


Instruction: Generate impression based on medical findings.

Input: There is asymmetric increased signal in the left hippocampus in the FLAIR images. There is loss of the internal architecture of the left hippocampus and the left temporal horn is slightly asymmetrically prominent. The left temporal lobe cortex appears slightly greater in signal overall than the right, although this may be artifactual.No diffusion or susceptibility abnormalities. The ventricles and sulci are prominent. There is no midline shift. The gyri and the sulci are not thickened. No evidence of bleed, edema, or mass effect. There is normal gray-white matter differentiation. Myelination appears normal. There is scattered mucosal thickening in the sinuses and fluid is seen in the mastoids.Flow voids of the cerebral arteries and the visualized internal carotid arteries appears normal.

Output: Asymmetrically increased FLAIR signal in the left hippocampus with loss of the internal architecture, with mild volume loss at this time, consistent with left mesial temporal sclerosis.


Instruction: Generate impression based on medical findings.

Input: Seizure like activity. There is no evidence of heterotopia or mesial temporal sclerosis. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is a mega cisterna magna. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is extensive diffuse paranasal sinus mucosal thickening. There is patchy fluid signal within the bilateral mastoid air cells.

Output: 1. No discernible seizure foci.2. FIndings suggestive of sinusitis and mastoiditis.


Instruction: Generate impression based on medical findings.

Input: History of recurrent acute pancreatitis in the setting of pancreas divisum presenting with chronic abdominal pain. ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology and size. There is diffuse fatty infiltration with focal periportal sparing. No biliary ductal dilatation with the common bile duct measuring 5 mm.Normally distended gallbladder.SPLEEN: No significant abnormality noted.PANCREAS: Findings of pancreas divisum. The main pancreatic duct is normal in caliber. The pancreas parenchyma demonstrates normal transit T1 weighted signal intensity and postcontrast enhancement. No peripancreatic inflammatory changes. No peripancreatic fluid collections. The peripancreatic vessels are unremarkable without evidence of pseudoaneurysm or thrombosis.Normal excretory response to secretin administration. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Pancreas divisum without evidence of acute pancreatitis. Normal excretory response to secretin.


Instruction: Generate impression based on medical findings.

Input: 60 year-old male with lung cancer and brain metastases now with acute onset left hemiparesis evaluate for stroke. Hyperdense focus identified in the right occipital region corresponds to hemorrhagic metastatic lesion on recent MRI. Other lesions from MRI heart difficult to identify on the current examination. No definite new lesions are identified. No evidence of new bleed. 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: Hyperdense focus corresponding to hemorrhagic metastatic lesion seen on recent MRI seen in right occipital lobe. No other acute findings are seen.


Instruction: Generate impression based on medical findings.

Input: History of Crohn's disease with a J-pouch excision presenting with deep perineal pain. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post proctocolectomy. Interval J-pouch resection. In the resection/surgical bed there is a small amount of fluid measuring 2.8 x 1.9 cm (series 501/61) in maximal cross-section extending 10 cm in the craniocaudal dimension (series 901/27). On the sagittal images the fluid appears space-occupying without mass effect, however there is questionable peripheral rim enhancement on postcontrast imaging. No restricted diffusion or adjacent inflammatory changes to suggest inflammation/infection.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Fluid in the proctectomy/surgical bed appears space-occupying without mass effect, however there is questionable peripheral rim enhancement on postcontrast imaging which may be surrounding peritoneal reflection enhancement as opposed to an organizing capsule. No restricted diffusion or adjacent inflammatory changes to specifically suggest inflammation/infection.


Instruction: Generate impression based on medical findings.

Input: Status post craniotomy for tumor resection. Assess tumor. Non-infused CT of brain:Extensive postoperative changes of right frontal craniotomy for removal of tumor. A small area of hemorrhage along the most medial aspect of the surgical cavity is a new finding since prior exam. This finding is best appreciated on axial image 12. The hemorrhage measures approximately 7 mm times 8-mm in transaxial dimension. Additional small patchy areas of high density material along the dorsal aspect of the surgical cavity are also believed to represent hemorrhage. I suspect possible minimal increase in these areas of hemorrhage as well. The foci of hemorrhage along the dorsal aspect of the surgical cavity are very small and slice positioning differences between the two studies may contribute to the difference in their appearance. There is interval absorption of air within the epidural space under the craniotomy flap since prior study. Epidural thickening along the inner table of bony flap is within the expected range of postop change.The brain parenchyma immediately posterior to the surgical cavity demonstrates subtle low attenuation this is also new finding since prior exam. I recommend further follow-up with an MRI examination to evaluate for residual/recurrence. Mass-effect and midline shift has improved since prior study. No significant midline shift is detected and ventricular system remains stable.

Output: 1.Subtle small areas of new hemorrhage in the most medial aspect of the surgical cavity.2.New low-attenuation of brain parenchyma surrounding the surgical cavity is concerning for new vasogenic edema or ischemic change.3.Follow-up with an infused MRI examination is recommended.4.Improvement in postoperative changes of right frontal craniotomy.


Instruction: Generate impression based on medical findings.

Input: Unresponsive Non-enhanced CT of brain:Examination demonstrate a left parietal craniectomy. There is a large area of encephalomalacia involving the left posterior frontal -- parietal region under the craniectomy site.There is no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus. There is ex vacuo dilatation of left lateral ventricle adjacent to the above described foci of encephalomalacia. The gray -- white matter differentiation is preserved. Calvarium is intact. Visualized paranasal sinuses and mastoid air cells are unremarkable. The provided clinical data low follow-up with an MRI is recommended.

Output: 1.No evidence of the acute intracranial process.2.Left parietal craniectomy and underlying parenchymal encephalomalacia of unknown etiology.3.Unremarkable calvarium otherwise and normal visualized paranasal sinuses and mastoid air cells.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old, with diffuse large B-cell lymphoma, presenting with weakness and tingling sensation no signs. Assess for compressive lesions. Extensive enhancing soft tissue infiltration of the dorsal and lateral epidural space is seen beginning at the C5 level and extending caudally down to the T4 level. The bulkiest disease is seen between C6 and T2 where it causes complete or near complete effacement of the CSF space and slight flattening of the dorsal spinal cord. No evidence of cord signal abnormality is seen.Tumor infiltrates the left C7-T1 neural foramen; the bilateral T1-2 neural foramina with extensive extraforaminal tumor on the right; and the left T2-3 neural foramen.Spinal alignment is anatomic. Vertebral body height and morphology are preserved. No definite areas of pathologic marrow replacement are seen. Mild marrow heterogeneity is evident within the T1 and the T12 vertebral bodies without obvious edema or pathologic enhancement.Very mild spondylosis is seen at C4-5 and C5-6 without significant spinal canal stenosis or foraminal narrowing. The remaining disc levels are preserved without significant disc degeneration, spinal canal or neuroforaminal narrowing. Right paracentral annular fissuring is seen at L5-S1.Patchy marrow heterogeneity is seen within the right iliac bone, partially visualized on this examination.

Output: 1.Extensive tumor infiltration of the dorsal and lateral epidural space beginning at C5 and continuing caudally to the T4 level. The bulkiest disease exists between C6 and T2 where it causes complete thecal sac effacement and slight flattening of the dorsal spinal cord. No evidence of spinal cord edema is seen.2.Elsewhere, the spinal cord is unremarkable. No evidence of pathologic intrathecal enhancement is seen to suggest leptomeningeal disease.3.No definite evidence of marrow space disease is seen in the spine. Mild marrow heterogeneity at two vertebral body levels as discussed above is nonspecific. More significant marrow heterogeneity involving the right iliac bone is, however, concerning for tumor involvement.4.Findings discussed with Dr. Patel at 11:15 AM on 8/7/2015


Instruction: Generate impression based on medical findings.

Input: Reason: characterize left wrist mass History: increasing in size left wrist mass, more proximal than typical ganglion There is a well-defined, nonenhancing lesion with multiple thin septa abutting the volar aspect of the distal radius, which measures 2.4 x 1.9 cm in its axial dimensions. The lesion is iso-intense to muscle on T1-weighted imaging and hyperintense on T2 weighted imaging. The bones, bone marrow, ligaments, and tendons are within normal limits.

Output: Lesion abutting the volar aspect of the distal radius is most consistent with a ganglion cyst.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o R ethmoid sinus herniating encephalocele seen on MRI There is a focal 9-mm defect along the right ethmoid sinus roof with apparent herniation of a small focal portion of the inferior right frontal lobe cortex into the defect. There is associated T2 signal change in the immediately adjacent cortex. The right olfactory and medial orbital sulci are effaced.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.The pituitary fossa is enlarged and deformed. The right lobe of the pituitary is asymmetrically larger than the left.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 mucosal thickening in the left maxillary and ethmoid sinuses which has improved since the prior exam. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Findings suggest a small encephalocele along the anterior cranial fossa extending into the ethmoid air cells. The patient will be brought back to obtain additional Coronal 3D Fiesta and coronal T2 2mm thin slices through the anterior cranial fossa which were not done and will be part of this study.2.The pituitary gland is asymmetrically enlarged along its right lobe.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: Male, 40 years old, with left-sided numbness. Evaluate for cord compression at C5-6. No evidence of cord compression is seen. Spinal alignment is anatomic. Vertebral body height and morphology are within normal. No evidence of marrow replacement or marrow edema is seen. No significant compromise of the spinal canal or neural foramina is detected.

Output: No evidence of cord compression.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old, with headache and nausea, history of breast cancer status post metastasis. Since the prior examination, numerous small enhancing lesions have diminished in size or become undetectable. For reference, the left temporal lobe lesion which previously measured up to 7 mm now measures only 3 mm.No new enhancing lesions are detected. No significant parenchymal edema or mass effect is seen. A single small focus of T2 hyperintensity is seen within the right frontal white matter which may reflect a prior treated lesion or treatment effect. No intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. The ventricular system is normal in size and morphology.Bone marrow signal characteristics are unremarkable. Patchy opacification of the mastoid air cells is seen.

Output: Since the prior examination, multiple parenchymal metastatic lesions have diminished in size or become undetectable. No new lesions are seen. No intracranial findings are noted to account for the patient's symptoms.