Instruction: Generate impression based on medical findings.

Input: Knee pain. Lateral joint space pathology versus patellar tendinitis. MENISCI: The anterior horn of the lateral meniscus appears abnormally small with heterogeneous signal representing degeneration and tearing. The tearing extends into the body of the lateral meniscus, and there appears to be a shallow defect of the undersurface of the anterior half of the meniscal body. Increased signal intensity along the undersurface of the inner fibers of the posterior horn of the lateral meniscus likely represents additional fraying/degenerative tearing.There is increased signal intensity within the undersurface of the inner third of the body and posterior horn of the medial meniscus likely representing fraying/degenerative tearing. The anterior horn of the medial meniscus appears intactARTICULAR CARTILAGE AND BONE: There is full-thickness degeneration of the articular cartilage of the lateral tibial plateau beneath and anterior to the posterior horn of the lateral meniscus. There is also full-thickness degeneration of the articular cartilage of the weightbearing portion of the medial tibial plateau between the anterior and posterior meniscal horns with a small amount of underlying degenerative subchondral signal abnormality.. There is focal full-thickness degeneration of the articular cartilage of the patella centrally with underlying subchondral cyst formation. Additional superficial fraying is noted along the articular cartilage of the medial and lateral facets. The articular cartilage of the femoral trochlea appears relatively intact, although the trochlea itself subjectively appears shallow which may reflect dysplasia. There are small tricompartmental osteophytes.LIGAMENTS: The cruciate and collateral ligaments appear intact EXTENSOR MECHANISM: There is slight thickening of the patellar tendon with intermediate signal intensity at its proximal and distal attachment suggesting mild tendinosis. The quadriceps tendon appears intact.ADDITIONAL

Output: 1.Tricompartmental cartilage degeneration as described above.2.Degeneration/tearing of the menisci, lateral greater than medial, as described above.3.Patellar tendinosis.4.Joint effusion and other findings as described above.


Instruction: Generate impression based on medical findings.

Input: 24 years, Female, Reason: determine if crohns active, small bowel and colonic disease. also determine if renal stone present. History: left-sided CVA tenderness. LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No bowel thickening or dilatation. No abnormal enhancement or diffusion restriction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: FemaleUTERUS, 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: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Normal examination without evidence of active disease or complication.


Instruction: Generate impression based on medical findings.

Input: Disorder of brain, unspecified [G93.9] / Vomiting, unspecified [R11.10] / Headache [R51], Reason for Study: ^Reason: Evaluate for brainstem lesion History: HA, vomiting There is no evidence of acute ischemic or hemorrhagic lesion.Previously described left pontine lesion is not shown on today's scan.There is no abnormal enhancement except a developmental venous anomaly on the right posterior basal ganglia.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Previously shown left pontine lesion is not shown on this scan. It was not demonstrated on immediate prior scan either.2. No evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancing lesion.3. No change of right basal ganglia DVA.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old, with unspecified convulsions, status post laser ablation. Compared to 3/25/2016, there has been slight further evolution of postsurgical changes in the medial right temporal lobe related to prior depth electrode placement and laser ablation. There is susceptibility effect related to chronic blood products involving the right hippocampus with slight retraction/evolution since prior. Minimal surrounding FLAIR hyperintensity is seen which may represent gliosis. No significant parenchymal edema or mass effect is appreciated. Mild global parenchymal volume loss including of the left hippocampus again seen. No extra-axial collections. No hydrocephalus. Aside from postsurgical changes, calvarium and extracranial soft tissue structures are grossly unremarkable.

Output: 1. Slight evolution of postsurgical changes related to depth electrode placement and laser ablation of the right hippocampus. Chronic blood products in the right hippocampus are again seen with slight evolution.2. Please note patient had a minor contrast extravasation as detailed in the technique section and post gadolinium images could not be obtained. Patient may return for postgadolinium sequences following placement of a new IV line.


Instruction: Generate impression based on medical findings.

Input: Diplopia. Right ocular pain. History of sarcoidosis, Hashimoto's thyroiditis, discoid lupus, and hypersensitivity pneumonitis. BRAIN:Few nonspecific punctate subcortical and confluent periventricular T2 FLAIR-hyperintense foci are present in both cerebral hemispheres. These are not significant change since the previous examination. A similar lesion involving the dorsal pons just medial to the left middle cerebellar peduncle was present previously. An additional lesion involving the medial aspect of the right middle cerebellar peduncle anterior to the right dentate nucleus was not present previously. This area is obscured by pulsation artifact related to the sigmoid sinuses on the post contrast imaging.There is increased T2 FLAIR signal along the callososeptal interface without separate, intrinsic callosal lesions. The corpus callosum is preserved in volume. There is no acute infarct. There is a linear area of T1/T2 FLAIR hyperintense signal along the undersurface of the left tentorium cerebelli (measures 5 mm x 2 mm on axial image #35 of series #801) which is unchanged since the previous examination and may represent a small meningioma that is calcified. Otherwise, there is no space-occupying or contrast-enhancing brain lesion. The pituitary gland is also within expected. The ventricles and CSF-containing spaces are normal in size. There is mild mucosal thickening involving the paranasal sinuses which is nonspecific. The mastoid air cells are clear.ORBITS:There is no orbital abnormality. Specifically, the optic nerves are symmetric in size and signal characteristics. There is no abnormal orbital contrast enhancement. Slightly prominent contrast enhancement around the optic nerve sheath complex in the posterior aspect of the orbits is unchanged. The optic chiasm is also unremarkable and there is no suprasellar mass.

Output: 1.Multiple cerebral and to a lesser extent cerebellar/brainstem white-matter lesions are nonspecific. One of the lesions which involves the right middle cerebellar peduncle is new since the September 2015 examination. However, enhancement characteristics of the lesion cannot be assessed given pulsation artifact as described above. The other lesions are not significant changed. Similarly, increased signal along the callososeptal interface without separate, intrinsic callosal lesions or volume loss is nonspecific.2.Orbital imaging shows no abnormality.3.Tiny linear area of abnormal signal along the the left tentorium cerebelli is unchanged since the previous examination and may represent a small meningioma that is calcified.


Instruction: Generate impression based on medical findings.

Input: Dizziness and giddiness [R42], Reason for Study: ^Reason: stroke History: stroke 59 years Female (DOB:11/14/1957)Reason: stroke History: strokePROVIDER/ATTENDING NAME: JAMES AHN DAVID G. BEISER Brain MRIThere is well enhancing mass located at the left jugular foramen with irregular margin and associated with adjacent bony erosion. The mass is measured about (32.5 mm x 34.6 mm x 22 mm) with the branching patterned signal void within the lesion indicating hypervascular nature. There is also separate about 8 mm sized round enhancing nodular lesion of the left with the left middle cerebellar peduncle which shows nearly circular thin peripheral T2 low signal intensity. This lesion is associated with the surrounding brain edema.Constellation of above findings indicate hypervascular mass such as glomus jugulare located on the left jugular foramen. Differential diagnosis of the separated enhancing lesion on the left middle cerebellar peduncle include thrombosed vascular structure including arterial aneurysm and acute hemorrhagic lesion.There is evidence of previous left mastoidectomy as well as suboccipital craniectomy with scattered susceptibility lesions surrounding the enhancing mass indicating postoperative status of the enhancing mass lesion.No other abnormal enhancing lesion is seen.There is no evidence of acute ischemic lesion.Scattered T2/FLAIR high signal intensity lesions indicating nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are unremarkable. The paranasal sinuses and right mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.There are multiple branching patterned in flow enhancement is seen on the left skull base indicating hypervascularity of the left the jugular foramen lesion.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries. Left the subclavian artery midportion shows focal signal loss which is likely indicate artifactual.Brain MRV3D MRV brain post-gadolinium with maximum intensity projections of the superficial/deep intracranial venous drainage demonstrate hypoplastic left transverse sinus with nonvisualization of left sigmoid sinus indicating possible occlusion due to enhancing jugular foramen mass. Otherwise, normal flow enhancement in the superior sagittal sinus, right transverse sinuses, right sigmoid sinuses, internal cerebral veins, vein of Galen and straight sinus.

Output: 1. Hypervascular left jugular foramen area lesion with the significant signal void within the mass associated with evidence of left mastoidectomy indicate postoperative status of left glomus jugulare or other hypervascular mass.2. Separated enhancing lesion within the left middle cerebellar peduncle likely represent thrombosed vascular structure such as thrombosed aneurysm or vein, or possible focal hemorrhage. CTA can be considered for further imaging evaluation.2. Non specific small vessel ischemic disease.3. Normal brain MRA with evidence of hypervascular tumor on the left jugular foramen.4. Normal neck MRA with again visualized hypervascular mass on the left jugular foramen area.5. Occlusion of the left sigmoid sinus likely due to the left jugular foramen area mass, otherwise unremarkable brain MRV.


Instruction: Generate impression based on medical findings.

Input: Preterm newborn, gestational age 28 weeks with parenchymal hemorrhage. There is predominantly T1 and T2 hyperintense with surrounding circumferential effect in the bilateral medial parietal and occipital lobes, perhaps with slight extra-axial extension. There also appears to be T1 hyperintensity in the overlying superior sagittal sinus. There are small scattered areas of susceptibility effect in the bilateral temporal lobes, ventricular system, posterior fossa, and right caudothalamic groove. The degree of myelination is within expected limits accounting for prematurity. There is no evidence of acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral artery flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly intact. There is mild dilatation of the left lacrimal sac.

Output: 1. Subacute hemorrhages within the bilateral medial parietal and occipital lobes, perhaps with slight extra-axial extension. Apparent T1 hyperintensity in the overlying superior sagittal sinus may represent artifact versus thrombus and dedicated vascular imaging is recommended for further evaluation. 2. Small scattered areas of chronic hemorrhage in the bilateral temporal lobes, ventricular system, posterior fossa, and right caudothalamic groove.3. Small left lacrimal sac mucocele.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Rule out intracranial hemorrhage, abscess, mass. Signs and symptoms going altered mental status, short-term memory loss. Non-infused head CT:The examination again demonstrates extensive subcortical and periventricular diffuse areas of low-attenuation with no appreciable interval change since prior MRI examination of 3 -- 29 -- 11. Findings likely represent post therapy changes. A shunted right lateral ventricle with no change in the size of ventricular system since prior study. Prominence of cortical sulci for patient's stated age concerning for underlying parenchymal volume loss.No evidence of hemorrhage, edema, mass effect or midline shift. No hydrocephalus.

Output: 1.Shunt in the right lateral ventricle and stable ventricular system since prior exam.2.Post therapy changes of bihemispheric white matter.3.No detectable acute intracranial findings.4.Extensive opacification of paranasal sinuses with fluid levels within bilateral maxillary sinuses.


Instruction: Generate impression based on medical findings.

Input: 45-year-old man with history of ileal carcinoid and hepatic lesion seen on recent CT. ABDOMEN:LIVER, BILIARY TRACT: There is a 22 x 16 mm lesion in the dome of the liver (series 15, image 18) which is mildly hyperintense on T2-weighted images and enhances. No additional hepatic lesions are identified. The gallbladder is normal. There is no intra or extrahepatic biliary duct dilatation.SPLEEN: The spleen is normal.PANCREAS: The patient is normal.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: There is a subcentimeter cyst in the inferior pole of the left kidney (series 5, image 13). The kidneys are otherwise normal and enhance symmetrically.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: Partially visualized small bowel and colon appear normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Single lesion in the hepatic dome which is suspicious for metastasis.


Instruction: Generate impression based on medical findings.

Input: 57-year-old female with abnormal LFTs. Evaluate for PSC. ABDOMEN:LIVER, BILIARY TRACT: Small right hepatic lobe cyst. No suspicious hepatic lesions. No cholelithiasis. No intrahepatic or extrahepatic biliary ductal dilation. Findings are suggestive of low insertion of the cystic duct into the common bile duct.SPLEEN: No significant abnormality noted.PANCREAS: Small T2 hyperintense lesion measuring up to 7 mm (series 5/44) at the posterior aspect of the pancreatic body, most likely due to a small side branch IPMN.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small right renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. No biliary ductal dilation or specific evidence of PSC. Findings suggestive of low insertion of the cystic duct into the common bile duct.2. Probable small pancreatic body side branch IPMN.


Instruction: Generate impression based on medical findings.

Input: Clinical question: History of pituitary cyst. Signs and symptoms: Surveillance scan. Pre-and post-enhanced pituitary MRI:Examination demonstrate a mass within the sella with solid and cystic components without significant change since prior exam. There is resultant enlargement of the sella similar to prior study. The solid component of mass demonstrate enhancement and there is no detectable enhancement of cystic portion of tumor. There is extension of tumor superiorly into the basal cistern and is in contact with the optic chiasm with resultant subtle elevation of the chiasm. This appearance is also similar to prior study. The pituitary stalk demonstrate normal caliber and terminates along the left paramedian dome of the pituitary mass similar to prior exam.Cavernous sinuses demonstrate normal signal intensity and pattern of enhancement.

Output: 1.Partially solid enhancing and partially cystic nonenhancing pituitary mass with resultant expansion of sella and extension into the basal cisterna with subtle elevation of chiasm remains stable since prior exam. No evidence of extension into the cavernous sinuses.


Instruction: Generate impression based on medical findings.

Input: Dementia, rapidly progressive. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is minimal nonspecific cerebral white matter T2 hyperintensity. The hippocampi appear to be intact. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a left maxillary sinus retention cyst.

Output: Minimal nonspecific cerebral white matter T2 hyperintensity, but no evidence of acute intracranial hemorrhage, mass, or territorial infarct.


Instruction: Generate impression based on medical findings.

Input: Chiari malformation, status post decompression with new headaches. Again seen are postsurgical changes of suboccipital craniectomy and resection of the posterior arch of C1 for Chiari decompression. The posterior CSF space at the level of the foramen magnum remains well expanded and similar to the prior exam. The cerebellar tonsils descend to the level of the basion and the demonstrating normal rounded configuration. Normal CSF flow is seen both anterior and posterior to the brainstem at the level of the foramen magnum. There is diminished flow dorsal to the more superior aspect of the cerebellum with suggestion of adhesion but unchanged. The remainder of the brain demonstrates normal morphology. Few foci of T2/FLAIR hyperintensity are seen in the subcortical and periventricular white matter, which are nonspecific, but compatible with mild age-related white matter changes. No new focal abnormalities are detected. The ventricular system is patent and normal in size.There is moderate aspiration of the sphenoid sinus which is increased since 12/11/2014.CERVICAL SPINE MRI

Output: 1.Again seen are postsurgical changes of Chiari decompression with preserved CSF spaces and biphasic flow at the neo-foramen magnum. There is diminished flow dorsal to the superior cerebellum at the margin of the suboccipital craniectomy with suspected adhesion. Finding is unchanged. There is increased opacification of the sphenoid sinus. Otherwise the remainder of the brain parenchyma is within normal limits for age.2. Stable minimal degenerative disk disease in the cervical spine. No cord signal abnormality or syrinx. No spinal canal or neural foraminal stenosis.


Instruction: Generate impression based on medical findings.

Input: 48 years Female (DOB:4/29/1967)Reason: right leg pain bilateral back pain History: right leg pain bilateral back painPROVIDER/ATTENDING NAME: BEN-ZION ROITBERG BEN-ZION ROITBERG Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is mild facet hypertrophy at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is a small broad based right paramedian disk protrusion at this level associated with T1 signal hyperintensity within the L4 vertebral body adjacent to the anterior aspect of the disk space (chronic end plate reaction) and disk dessication.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 Schmorl's nodes at T12-L1. There is a 10 mm T1 hyperintense - fat suppressing on T2 STIR - lesion at T12 most likely representing hemangioma.

Output: There are mild degenerative changes in the lumbar spine without significant compromise to lumbar spinal canal or neural foramina.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Benign neoplasm of cerebral meningesClinical question: Hx of suprasellar meningioma s/p RT, surveillance MRISigns and Symptoms: None The patient is status post right-sided craniotomy for removal of the anterior cranial fossa mass on the right side. There is some mild pachymeningeal enhancement present which is likely reactive in nature given the surgical history. There is redemonstration of encephalomalacia predominantly involving the right orbital gyrus and the gyrus rectus bilaterally. There is some involvement of the lateral aspect of the left orbital gyrus.There is an enhancing extra-axial mass present along the posterior aspect of the planum sphenoidale extending into the suprasellar cistern abutting the infundibulum of the pituitary gland and also abutting the distal internal carotid arteries bilaterally and the cisternal portions of the optic nerves and chiasm. It measures 14 x 10 mm sagittal dimensions on the current exam and previously measured 14 x 10 mm on 1/13/2015.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is redemonstration of a change of an extra-axial mass at the posterior aspect of the planum sphenoidale and the suprasellar cistern which abuts the distal internal carotid arteries and optic nerves. This most likely represents a meningioma.2.Status post right-sided craniotomy.3.There is encephalomalacia present along the right orbital gyrus and gyrus rectus bilaterally as well as a small portion of the left orbital gyrus.


Instruction: Generate impression based on medical findings.

Input: 24 years Female (DOB:9/11/1991)Reason: stroke code activation History: stroke code activation. Left lower extremity weakness status post epidural catheter.PROVIDER/ATTENDING NAME: AMBER TRUEHART AMBER TRUEHART MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.The perfusion acquisition could not be post process on Visage or Olea due to a problem with the data. Post processed perfusion information is available on the MRI Philips machine which shows no obvious defect.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The PCOMAs are fairly large. The LVA is small relative to the RVA. There is extracranial origin of he right PICA.Thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is a linear T1 hyperintense and T2 hypointense focus measuring 20 millimeters in length and 2 millimeters in thickness in the posterior aspect of the thecal sac at the L2 vertebral body level located midline and adjacent to nerve roots of the cauda equina.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is mild loss of disk space height and disk dessication at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There is an early subacute hemorrhagic appearing focus along the posterior aspect of the thecal sac which could be within a nerve sheath or adjacent to nerve roots in the cauda equina.2.There is no evidence for intracranial cerebrovascular occlusive disease.3.There is no evidence for acute cerebral infarction.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Back pain. Signs and symptoms: Back pain. Nonenhanced lumbar MRI:There is normal anatomical alignment of vertebral column. No evidence of fracture.The signal intensity of vertebral column is abnormal with uniformly hypodense T1 and hypo-T2/T2 STIR signal likely due to systemic process. Correlate with history.Minimal degenerative disc disease at L4-L5 is noted and unremarkable at other levels.At L4-L5 there is mild degenerative disc disease and a small far lateral broad-based disc protrusion projecting into the right neural foramina and it is often mild compromise. No spinal stenosis and patent left neural foraminal.Mild hypertrophic changes of the ligamentum flavum at the L5-S1 is noted.Unremarkable images at other levels.Unremarkable perispinal soft tissues.

Output: 1.Uniformly hypointense T1 and hypointense T2 signal intensity of bone marrow of all visualized bony structures of region of exam suggestive of a systemic process. No fracture or malalignment.2.Mild degenerative disc disease at L4-L5 and a small right lateral disc protrusion with resultant mild compromise of right neural foraminal.3.Minimal degenerative changes of posterior elements in the lower lumbar spine.4.Unremarkable exam otherwise and without evidence of spinal canal or neural foraminal compromise at any level.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old, with visual and auditory hallucinations. History of recurrent granulosa cell tumor of the ovary. Image quality is degraded by motion artifact. In addition, the examination was obtained without contrast at patient request. Within these limitations, no evidence of any significant parenchymal edema or mass effect is observed. No restricted diffusion is seen. There are numerous scattered foci of white matter T2 hyperintensity in both cerebral hemispheres, particularly in the periatrial regions, and in the left cerebellum. These findings have progressed mildly when compared to a prior examination from 2007. No acute intracranial hemorrhage or any abnormal extra axial fluid collection is seen. The ventricles are normal in size and morphology.

Output: Within the limitations of a motion degraded and noncontrast examination, no definite evidence of any acute intracranial process is seen. Moderately extensive scattered white matter lesions are redemonstrated with mild progression noted when compared to the prior examination 2007. These are favored to represent the sequelae of chronic microvascular ischemic disease, though other chronic etiologies could be in play. If clinical concern for encephalitis persists, repeat imaging in one to two weeks may be considered with contrast to improve imaging sensitivity.


Instruction: Generate impression based on medical findings.

Input: Unexplained anorexia and dysgeusia. The postcontrast images are motion degraded. Confluent biparietal deep white matter T2/FLAIR hyperintense, T1-hypointense signal is not associated with diffusion restriction. There are scattered smaller T2/FLAIR hyperintense lesions throughout the cerebral white matter bilaterally also without diffusion restriction. Following contrast injection, there is no contrast enhancement in any of these lesions. An incidental left parietal developmental venous anomaly is present. There is no mass or mass effect. There is no midline shift. The CSF-containing spaces are symmetrically enlarged, reflecting mild volume loss. The vascular flow voids are present. Accounting for probable calcifications in the globi pallidi, there is no susceptibility artifact to indicate intracranial hemorrhage.The paranasal sinuses and mastoid air cells are clear. The orbits are notable for bilateral cataract surgery. There is no destructive skull lesion.

Output: 1.No evidence of acute infarct, intracranial mass, or mass effect. No abnormal enhancement.2.Patchy confluent areas and scattered foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter are nonspecific but compatible with moderate chronic small vessel ischemic disease.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: Headache 2 weeks ago. MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is minimal nonspecific cerebral white matter T2 hyperintensity. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a small left maxillary sinus retention cyst.MRA: There is a 1 to 2 mm outpouching at the origin of the right posterior communicating artery. Otherwise, there is no evidence of significant steno-occlusive lesions.

Output: 1. Minimal nonspecific cerebral white matter T2 hyperintensity. Otherwise, no evidence of acute intracranial hemorrhage, mass, or acute cerebral infarction.2. A 1 to 2 mm outpouching at the origin of the right posterior communicating artery likely represents a prominent infundibulum rather than a saccular aneurysm. Otherwise, no evidence of significant steno-occlusive lesions.


Instruction: Generate impression based on medical findings.

Input: Exam is limited due to lack of contrast.The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The imaged spinal cord displays normal signal and morphology with the conus terminating at L1. The paravertebral soft tissues are unremarkable.L1-L2: Unremarkable.L2-L3: Unremarkable.L3-L4: Unchanged mild disc desiccation and minimal disc bulge with a small posterior probable annular fissure without spinal canal or neural foramen stenosis.L4-L5: There are postoperative findings related to prior laminectomy and discectomy. There is disc desiccation and disc bulge with a moderate superimposed central/left paracentral contiguous material that is mildly decreased in size compared with the prior exam. There is also moderate bilateral facet arthropathy and left sided ligamentum flavum thickening that has progressed since the prior exam. These findings result in moderate spinal canal stenosis that is nonetheless improved compared with the prior exam as well as mild bilateral neural foramen narrowing. There remains bunching of the cauda equina nerve roots.L5-S1: Mild disc desiccation but otherwise unremarkable.

Output: Disc bulge at L4-L5 with a superimposed prominence of tissue along the central/left paracentral location, which could represent residual or recurrent disk versus granulation tissue, as exam is limited due to lack of contrast in this postoperative patient. That in combination with facet arthropathy results in moderate residual spinal canal stenosis that is nonetheless improved compared with the prior exam. A contrast exam is suggested to distinguish between these entities.


Instruction: Generate impression based on medical findings.

Input: 40 year-old female. Kidney vasculitis history. Antopol-Goldman lesion. Hypoperfusion in the right kidney. ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter scattered T2 hyperintense foci in the liver without appreciable enhancement, most likely cysts.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal cyst. Normal enhancement and symmetric size of the kidneys. No renal mass. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of renal infarct. Normal size, enhancement, and morphology of both kidneys.


Instruction: Generate impression based on medical findings.

Input: 48 year-old male with history of profound right and mild left sensorineural hearing loss. Evaluate for possible LEFT cochlear hydrops. The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. There appears to be thinning of the bone overlying the right superior semicircular canal, which is otherwise inconspicuous in some parts. The bilateral endolymphatic ducts are not discernible. The other inner ear structures otherwise appear unremarkable. There is fluid within the bilateral mastoid air cells. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. The bilateral endolymphatic ducts are not discernible. This can be due to technical factors or may be a manifestation of Meniere disease. A dedicated temporal bone CT may be useful for further evaluation.2. Possible dehiscence and dyplasia of the right superior semicircular canal. A dedicated temporal bone CT may also be useful for further evaluation.3. The bilateral cochleas and cochlear nerves are intact. 4. Probable bilateral mastoid air cell effusions.


Instruction: Generate impression based on medical findings.

Input: Known left breast cancer with positive axillary node. MRI for staging and evaluation of opposite breast. There is heterogeneous amount of fibroglandular tissue in both breasts.Marked parenchymal enhancement is noted bilaterally which is a limitation to this examination.In the left upper central breast, there is segmental enhancement extending from the nipple to the mid-posterior depth, with a 1 cm more mass like enhancement seen posteriorly near the biopsy clip. Overall extent of abnormal enhancement is 9.0 x 2.9 x 3.8 cm, inclusive of the nipple. The pectoralis muscle enhances normally. A subcentimeter intramammary lymph node is seen in the left outer breast.A left axillary lymph node contains clip artifact from the recent biopsy and measures up to 1.6 cm. An additional lymph node with a focally thickened cortical region measures 0.9 cm. No suspicious enhancement is seen in the right breast. No abnormal axillary lymph nodes are identified in the right axillary region.

Output: 1. Extensive abnormal enhancement in the left upper central breast measures up to 9 cm AP and includes the nipple. Two abnormal left axillary lymph nodes are present, one containing the biopsy clip. 2. Extreme parenchymal enhancement is a limitation to this exam. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: Alignment is normal. The marrow signal is benign. The cervical and upper thoracic cord is normal in signal without abnormal enhancement. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.Mild inflammatory changes are noted in the mastoid air cells bilaterally.C2/3: UnremarkableC3/4: UnremarkableC4/5: UnremarkableC5/6: Uncinate hypertrophy and ligamentum flavum thickening without stenosis.C6/7: There is a left paramedian disc herniation which abuts the cord surface causing anterior left hemicord flattening, without intrinsic cord signal abnormality and no cord compression.C7/T1: Unremarkable

Output: C6/7: There is a left paramedian disc herniation which abuts the cord surface causing anterior left hemicord flattening, without intrinsic cord signal abnormality and no cord compression.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Evaluate for abnormality; history of sarcoma. Signs and symptoms: None Pre and post enhanced brain MRI:Diffusion weighted images are unremarkable.Examination demonstrates normal anatomical morphology of the brain parenchyma. There is normal signal intensity of brain parenchyma on all MRI sequences. Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.There is no detectable abnormal enhancement of brain parenchyma or the leptomeninges and post enhanced images.Normal visualization of signal void of major intracranial arterial branches.Normal signal intensity of the intracranial venous sinuses and with normal pattern of enhancement.Unremarkable calvarium, soft tissues of the scalp and orbits without abnormal enhancement.All paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal motility position signal patterns.

Output: Unremarkable pre and post enhanced brain MRI.


Instruction: Generate impression based on medical findings.

Input: History of liver lesions. History of cirrhosis. ABDOMEN: Susceptibility artifact in the left upper quadrant slightly limits evaluation of the lateral hepatic segment.LIVER, BILIARY TRACT: Cirrhotic fibrotic liver morphology. Several punctate siderotic nodules are noted on the in phase imaging.Demonstrated again is the arterially enhancing lesion in the inferior aspect of the right hepatic lobe measuring 1.6 x 1.5 cm (series 1501/107), compared to 1.4 x 1.3 cm previously. There is no definite washout of the lesion. The lesion is associated with mild T2-weighted hyperintensity and restricted diffusion. The lesion bulges the capsule.The segment 8 focus with mild intrinsic T1 weighted hyperintensity with questionable arterial enhancement with suspected washout, measuring approximately 8 mm (series 1 501/2 37), unchanged.There are several additional punctate foci of arterial enhancement some of which are better seen than on the prior study, but are grossly unchanged, dating back to 8/18/2015.The hepatic vasculature is unremarkable.No intra or extrahepatic biliary ductal dilatation. Normally distended gallbladder.Trace perihepatic ascites. Recannulated periumbilical vein.SPLEEN: The spleen measures 13.1 cm in length. In the superior dorsal aspect of the spleen there is a small wedge-shaped signal abnormality likely reflecting a small chronic infarct.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Several bilateral T2-weighted hyperintense foci some of which are too small to characterize, likely simple cysts. Mild right renal cortical scarring/thinning.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild bilateral gynecomastia. Compression deformity of a midthoracic vertebral body is incompletely evaluated and only seen on the coronal images. Cardiomegaly.OTHER: No significant abnormality noted.

Output: 1.Cirrhotic fibrotic liver with a 1.6 cm segment 5 arterially enhancing lesion without definite washout demonstrating T2-weighted hyperintensity and restricted diffusion. In 2015 the lesion measured approximately 1.2 cm. The lesion is suspicious for HCC but does not meet AASLD imaging criteria for HCC.2.Stable additional arterial enhancing subcentimeter foci, including a segment 8 lesion; attention to these on follow-up imaging is recommended.3.Borderline splenomegaly, trace perihepatic ascites and recanalized umbilical vein.4.New mid thoracic vertebral body compression deformity.


Instruction: Generate impression based on medical findings.

Input: Female, 27 years old, 27 weeks gestational age, with fetal brain lesion identified on ultrasound. A space occupying lesion is present centered on the right ambient cistern measuring 22 x 18 x 16 mm. The lesion displaces adjacent structures including the right thalamus, internal cerebral veins, right medial temporal lobe, and brainstem, without clearly arising from any of them. As such, the lesion could potentially be extra-axial. The margins of the lesion are well circumscribed without evidence of parenchymal infiltration or edema. Internally, the lesion is homogeneously T2 hyperintense and markedly T1 hyperintense, with a moderate degree of restricted diffusion. The margins of the lesion show susceptibility effect, with little if any susceptibility internally.Brain parenchymal morphology, and the degree of sulcal development, are appropriate for gestational age. The corpus callosum is present and within normal limits. The cavum septum pellucidum is present. The left ventricular atrium measures top normal in size at 10 mm, but the remainder of the ventricular system is within normal limits. The posterior fossa structures are unremarkable. The right globe is hypoplastic or absent with dysmorphic or rudimentary orbital structures.

Output: A well circumscribed, space occupying lesion is present centered on the right ambient cistern. The lesion displaces adjacent structures without infiltration or parenchymal edema. The origin of the lesion is not clear, but it could potentially be extra-axial. Internally, the lesion is homogeneous and T2 hyperintense, but also markedly T1 hyperintense with rim susceptibility. This could indicate hemorrhagic products, fatty material, or viscous/proteinaceous material.The differential for this lesion remains broad, but overall, the characteristics are relatively non-aggressive, and as such, a benign etiology is favored. The lesion could represent pure hemorrhage, or a hemorrhagic cyst. Developmental cysts including epidermoid and dermoid should be considered as well. A neoplastic process is not excluded, though the imaging features on the present study are not typical of a teratoma, which would be the most common fetal tumor. Also noted is hypoplasia or absence of the right globe, with dysmorphic/rudimentary orbital structures. Please note that this interpretation is made without the benefit of comparison to ultrasound images. As soon as these images can be obtained, a comparison will be made, and if a change to the interpretation is warranted, an addendum to this report will be issued.


Instruction: Generate impression based on medical findings.

Input: Ms. McDonnell is a 50-year-old female presenting with right breast erythema and palpable mass. She had diagnostic imaging workup on 4/22/2016 which revealed a cyst corresponding to the patient's palpable area of concern. She presents today for MRI for further evaluation of these clinical symptoms. Family history of breast cancer in mother, diagnosed at age of 30. There is heterogeneous amount of fibroglandular tissue in both breasts. There is asymmetric background parenchymal enhancement (right greater than left) noted. The right breast enhancement is seen only within the breast parenchymal tissue and is greater in volume and intensity when compared to the contralateral left breast. However, no one area is more suspicious than the rest. Given clinical history, findings likely reflect mild mastitis versus normal physiological finding. Of note, there is no abnormal skin thickening seen in either breast. Numerous nonenhancing cysts of varying sizes are present bilaterally.No abnormal axillary lymph nodes are identified in either axillary region.

Output: (1) Asymmetric background parenchymal enhancement (right > left) identified, which may reflect mild mastitis versus normal physiological findings. Recommend correlation with clinical history and physical exam findings. (2) No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed.


Instruction: Generate impression based on medical findings.

Input: Syncope. History of meningioma and breast and thyroid cancer. The small left posterior temporal meningioma remains unchanged compared to the previous examinations, as remote as November 2009. It measures up to 11 mm, craniocaudally. No parenchymal signal abnormality. Remainder of the brain parenchyma appears unremarkable for age. No restricted diffusion is seen. No new lesions. No intracranial mass effect, midline shift, or herniation. Ventricular size is normal. Major flow-voids are preserved.

Output: Stable left posterior temporal meningioma with unchanged size since MRI studies dated September 5, 2015 and November 2, 2009. Remainder of the brain parenchyma appears within normal limits for age.


Instruction: Generate impression based on medical findings.

Input: 30-year-old man with history of firm material in semen. PELVIS:PROSTATE:Prostate Size: 50 x 29 mm.Peripheral Zone: There is diffusely decreased T2 signal within the peripheral zone bilaterally along with intermediate signal on ADC maps. Additionally, there are more pronounced focal areas of T2 hypointensity in the right lateral and midline peripheral zone (series 801, image 16). Within the left para midline mid prostatic peripheral zone, there is a 10 x 6 mm focus of T2 hyperintensity, T1 hypointensity, and no diffusion restriction (series 801, image 14), suggesting a cystic focus.Central Gland: No significant abnormality noted.Seminal Vesicles: There is a focus of high T1 signal and markedly low T2 signal within the right seminal vesicle (series 1201, image 85) measuring 8.5 mm.BLADDER: No significant abnormality noted.LYMPH NODES: No significant lymphadenopathy noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of pelvic free fluid is noted.

Output: 1.Diffusely decreased T2 signal in the peripheral zone suspicious for prostatitis, correlate with patient's clinical history/laboratory values; findings may be followed up as clinically warranted.2.Small amount of blood products in the right seminal vesicle.


Instruction: Generate impression based on medical findings.

Input: There is a punctate focus of diffusion hyperintensity in the right inferior parietal periventricular white matter with T2 hyperintensity which is new since remote MRI from 5/14/2007. There is isointense corresponding ADC signal.Again seen is evidence of extensive chronic small vessel ischemic disease with patchy T2/FLAIR hyperintensities in the periventricular and subcortical white matter as well as in the pons, minimally progressed in the interval. Again seen are areas of encephalomalacia involving the left temporo-occipital lobe. Lacunar infarct involving the left frontal corona radiata is unchanged. Confluent FLAIR hyperintensity in the right frontal corona radiata and centrum semiovale is also similar to prior. There is small infarct involving the right cerebellar hemisphere which appears chronic but is new since prior study from 2007.There is linear area of encephalomalacia with susceptibility involving the right basal ganglia and internal capsule consistent with prior hemorrhagic infarct. In addition, punctate susceptibility signal is again seen in the left basal ganglia as well as associated with the left temporo-occipital infarct compatible with chronic blood products. There is evidence of Wallerian degeneration with volume loss along the right corticospinal tract. There is volume loss with enlarged ventricles and sulci, slightly progressed since the previous study. There is no midline shift. Basal cisterns are patent. No evidence of herniation.There is opacification of the right sphenoid sinus. Evidence of intraocular lens replacement.

Output: 1. Punctate focus of diffusion hyperintensity in the right inferior parietal periventricular white matter which is suspected to represent a tiny subacute infarct.2. Evidence of advanced chronic small vessel ischemic disease which has minimally progressed since prior study from 2007. Again seen are multiple chronic infarcts including at the left temporal-occipital lobe junction and right basal ganglia/internal capsule. Small right cerebellar lacunar infarct appears chronic but new since prior study from 2007. Please see additional details above.


Instruction: Generate impression based on medical findings.

Input: Female 63 years old Reason: eval for osteomyelitis History: ischemia of digits 1-3 Irregularity of the cortex of the distal tuft of the great toe corresponding to osteomyelitis on subsequent MRI. The bones appear demineralized.

Output: Irregularity of the distal tuft of the great toe corresponding to osteomyelitis on subsequent MRI.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Malignant neoplasm of unspecified ovary Disorder of brain, unspecifiedClinical question: 45yo female with ovarian cancer and nonspecific brain lesion seen on PET, recommended f/u MRI to further characterizeSigns and Symptoms: brain lesion on PET There is a mass measuring 19 x 23 mm sagittal dimensions and 17 x 17 mm axial dimensions located along the right occipital pole. It is associated with foci of susceptibility effect as well as a vasogenic pattern of edema.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 maxillary sinuses with more mucosal thickening in the right maxillary sinus compared to the left.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: A hemorrhagic mass in the right occipital lobe is suspicious for metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Migraine without aura, not intractable, without status migrainosusClinical question: assess for thrombusSigns and Symptoms: headache with right visual field loss, h/x of hemiplegic migraines MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There appears be an arachnoid granulation in the junction of the left transverse sinus with the sigmoid sinus. This appearance has not changed since the MRI from 2/19/2016.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.MRV brain:The dural venous sinuses are patent. Straight sinus, internal cerebral veins and basal veins are identified and appear patent. The left jugular bulb and left sigmoid sinus are small. The left transverse sinus does not opacify. CT exam demonstrates congenitally small left jugular bulb and sigmoid sinus groove.

Output: 1.Hypoplastic left transverse sinus associated with congenitally small left sigmoid sinus and jugular bulb. There is no convincing evidence for dural sinus thrombosis.2.No abnormal lesions are identified within the brain parenchyma to explain the patient's right visual field loss


Instruction: Generate impression based on medical findings.

Input: Female 80 years old with left shoulder biceps tendonitis, rotator cuff strain. Evaluation is somewhat limited by patient motion artifact.ROTATOR CUFF: There is marked tendinopathy of the supraspinatus and infraspinatus with a partial-thickness articular surface tear of the supraspinatus (series 1501, image 9). Moderate tendinopathy affects the subscapularis. The teres minor tendon is intact. There is no significant fatty atrophy of the musculature. There is no significant fluid within the subacromial subdeltoid bursa.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenoid labrum demonstrates some degenerative changes but is grossly intact. There are severe degenerative changes of the glenohumeral joint with joint space narrowing, chondral loss, and subchondral cyst formation.BICEPS TENDON: The biceps tendon is intact and normally located within the bicipital groove. ADDITIONAL

Output: 1.Marked supra and infraspinatus tendinopathy. Moderate tendinopathy of the subscapularis. 2.Partial-thickness articular surface tear of the supraspinatus tendon.3.Nonvisualization of the coracohumeral ligament consistent with frozen shoulder.4.Degenerative changes at the glenohumeral and acromioclavicular joints.


Instruction: Generate impression based on medical findings.

Input: Right sphenoid meningioma: headache. Brain: There is an enhancing dural based right paraclinoid mass that measures up to 27 mm, which is not significantly changed. The tumor abuts the right cisternal optic nerve and exerts mild mass effect upon the adjacent right medial temporal lobe. There is no evidence of intracranial hemorrhage or acute infarct. There are scattered cerebral white matter T2 hyperintense foci. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There are prominent arachnoid granulations in the bilateral greater wings of the sphenoid bones. There is mild scattered mucosal thickening in the paranasal sinuses.Orbits: The bilateral globes and ocular adnexa are unremarkable. There is no evidence of abnormal intraorbital enhancement or mass lesions.

Output: 1. No significant interval change in the right paraclinoid meningioma.2. Chronic small vessel ischemic white matter disease.


Instruction: Generate impression based on medical findings.

Input: The spinal cord is of normal caliber and signal. The cervical spine is in normal alignment. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the cervical spine. No abnormal enhancement.Partially imaged posterior fossa demonstrates a mega cisterna magna, which is a normal variantTHORACIC SPINE

Output: 1. No signal abnormalities in the spinal cord to suggest demyelinating disease. 2. Tiny right paracentral disc protrusion at the T6-T7 level which slightly deforms the right ventral aspect of the cord. There is no significant spinal canal or neural foraminal stenosis at any level in the cervical or thoracic spine.3. Patient had a mild contrast reaction to gadolinium and was transferred to the ED. Recommend premedication per department protocol with future postgadolinium studies.


Instruction: Generate impression based on medical findings.

Input: History of SLE and chronic low back pain assess for disk disease On sagittal reconstructed images there is disk space narrowing with vacuum disk phenomena at the L4-5 disk space.The remainder of the visualized levels demonstrate preservation of disk height. Vertebral bodies are within normal limits in height.Axial images through the L1-2 level demonstrate minimal facet hypertrophic changes no significant central or foraminal stenosis.At the L2-3 level there is no significant central or foraminal stenosis. Incidental note is made of a stent within the left renal artery at this level.At the L3-4 level mild facet hypertrophic changes with mild bulge of the disk causing minimal effacement of ventral thecal sac but no significant central or foraminal stenosis.At L4-5 there is a diffuse bulging disk as well as ligamentous hypertrophy and facet joint hypertrophic changes. These result in a mild to moderate degree of central canal stenosis as well as mild bilateral foraminal narrowing.At the L5-S1 level central bulging disk is present with mild effacement of ventral thecal sac but no significant central canal stenosis.

Output: Degenerative changes of the lumbar spine which are most severe at L4-5 where there is disk space narrowing and vacuum disk phenomena. Diffuse bulge of the disk is present which in conjunction with ligamentous hypertrophy and facet hypertrophic changes causing mild to moderate degree of central canal stenosis and mild bilateral foraminal narrowing. These findings are without significant change in comparison to the prior study.At the L5-S1 level small central disk protrusion is present without significant confines of the central canal or neural foramen.


Instruction: Generate impression based on medical findings.

Input: Female, 35 years old, with low back and left leg pain and back spasms. Thoracic:Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or marrow edema is observed.The visualized spinal cord demonstrates normal morphology and signal characteristics. No epidural abnormalities are detected.The intervertebral discs are preserved with no evidence of significant disc bulging or disc herniation. The spinal canal and neural foramina are patent.Lumbar:Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or marrow edema is seen.The visualized distal spinal cord, conus and nerve roots of the cauda equina are unremarkable. No epidural abnormalities are suspected.The intervertebral discs are preserved with no evidence of significant disc bulging or disc herniation. The spinal canal and neural foramina are patent.

Output: Unremarkable evaluation of the thoracic and lumbar spine with no specific findings to account for the patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: Chiari malformation, pseudotumor cerebri with LP shunt: headache, neck pain. Thre is unchanged extension of the cerebellar tonsils inferior to the foramen magnum up to 5 mm. Nevertheless, the cerebellar tonsils display rounded morphologies. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles are unchanged in size and configuration. There is no midline shift. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Unchanged mildly low lying cerebellar tonsils.


Instruction: Generate impression based on medical findings.

Input: Reason: sports injury knee pain History: pain MENISCI: There is linear increased signal abnormality within the peripheral fibers of the posterior horn of the medial meniscus which extends to the femoral articular surface indicating a longitudinal tear. There is linear signal abnormality within the posterior horn of the lateral meniscus which extends to the tibial and femoral articular surfaces which may represent superficial fraying or tiny longitudinal tears. ARTICULAR CARTILAGE AND BONE: There is increased bone marrow signal abnormality within the lateral femoral condyle and posterior lateral tibial plateau likely representing bone contusions. There is depression along the weightbearing surface of the lateral femoral condyle indicating an impaction fracture "lateral notch sign". There is an associated full-thickness articular cartilage fissure along the posterior aspect of the aforementioned impaction fracture.LIGAMENTS: There is complete disruption of the ACL involving its proximal and midsubstance fibers. The PCL appears intact. The superficial band of the MCL appears intact. There is increased signal abnormality along the medial aspect of the medial femoral condyle indicating disruption of the meniscofemoral coronary ligament. The LCL appears intact. There is increased signal abnormality in the expected location of the oblique popliteal ligament which may indicate a sprain or disruption, however, this is equivocal. The posterior oblique ligament appears intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Disruption of the ACL through its proximal and midsubstance fibers.2. Longitudinal tear through the posterior horn of the medial meniscus. Probable superficial fraying or tiny longitudinal tearing of the posterior horn of the lateral meniscus as well.3. Disruption of the meniscofemoral coronary ligament of the deep component of the MCL.4. Bone contusions along the lateral femoral condyle and lateral tibial plateau including a lateral notch sign and full-thickness articular cartilage fissure in the adjacent area, as described above.5. Large joint effusion with fluid fluid levels likely representing a hemarthrosis. Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Cavernoma resection. There are postoperative findings related to left posterior midbrain cavernous malformation resection with a small amount of susceptibility effect along the margins of the surgical cavity. There is also a punctate focus of enhancement along the medial aspect of the surgical cavity as well. However, the surrounding edema has essentially resolved. There is no evidence of acute infarction. There is a prior right transfrontal ventricular shunt tract. The ventricles are unchanged in size. 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 evolution of postoperative findings related to left posterior midbrain cavernous malformation resection with what likely represents a small amount of residual peripheral components of the otherwise grossly resected cavernous malformation, but the surrounding edema has essentially resolved.


Instruction: Generate impression based on medical findings.

Input: Per EPIC, 21year-old female with Chiari status post multiple surgeries (first in 11/'07, last in 06/'09), ED, fibromyalgia with recurrent Chiari symptoms including headache, clumsiness, and dysphagia status post re-do Chiari decompression on 6/9/2015. BRAIN: There are postoperative findings related to revision of Chiari decompression with release as well as prior suboccipital craniectomy and resection of the posterior arch of C1. There is mild focal expansion of the thecal sac at the level of surgery. The previously seen lobule of pseudomeningocele just below the level of the neo-foramen magnum is no longer visualized. There is persistent dorsal tenting of the cervicomedullary junction but increased CSF space at the dorsal aspect of the cervical cord at the C2 level. The rounded cerebellar tonsils again extend to the approximate level of the upper margin of C2.CSF flow is not visualized and may be due to technical limitations. The ventricles and sulci are unchanged in size and morphology. The basal cisterns remain patent. There is no midline shift or mass effect. There are new foci of susceptibility in the right greater than left ambient cisterns, likely related to pneumocephalus. Susceptibility with associated FLAIR hyperintensity is seen in a linear fashion in the right frontal lobe, which may relate to previous catheter tract. There is no diffusion abnormality. No extra-axial fluid collection is identified. There is a left maxillary sinus mucosal retention cyst.Normal flow-voids are demonstrated in the major intracranial vascular structures.CERVICAL SPINE: The cervical spine is in normal alignment, with a normal cervical lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. There is stable small spinal cord syrinx from T3 extending inferiorly.There is no significant disc bulge, spinal canal or foraminal stenosis within the cervical spine.

Output: 1. Postoperative findings related to revision of Chiari decompression and probable lysis of adhesions as well as repair of pseudomeningocele with slight increased CSF space posterior to the proximal cervical spinal cord. CSF flow study is technically limited. Repeat CSF flow may be obtained as clinically warranted.2. Stable appearance of partially visualized tiny thoracic spinal cord syrinx.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Pituitary microadenoma. Signs and symptoms: Cushing's disease. Pre- and post enhanced pituitary MRI:Examination is degraded due to motion artifact. Multiple sequences were repeated however without significant improvement.Within these limitations there is no convincing evidence of a pituitary mass. However suboptimal quality of images precludes detection of subtle small pituitary lesions. Pituitary gland demonstrate fairly homogeneous pattern of enhancement and with normal enhancement of the pituitary stock in midlinePituitary gland measures approximately 3.2 mm in the midline.No detectable abnormality within the basal cistern or the hypothalamic region. No detectable abnormality of the cavernous sinuses.Extensive sphenoid and ethmoid sinus disease with intense mucosal enhancement is noted.Additional axial fat sat post enhanced images of entire brain is also acquired which demonstrate a small right posterior temporal-occipital cortical enhancement (series 1701 image 11 through 13) which could represent a focus of enhancing subacute stroke or infection/inflammatory process. There are no prior exams for comparison. Follow-up with dedicated brain MRI with contrast is recommended. There is no additional detectable foci of parenchymal or leptomeningeal enhancement.

Output: 1.Suboptimal exam due to motion artifact without improvement after repeat sequences.2.Within this limitation there is no convincing evidence of pituitary mass. Please see above comments.3.Incidental note is made of a small focus of cortical or leptomeningeal enhancement in the right posterior temporal/occipital region. Finding could represent an enhancing subacute ischemic stroke or representing a focus of leptomeningeal enhancement of unknown etiology. Recommend follow-up with dedicated pre and postcontrast enhanced brain MRI.


Instruction: Generate impression based on medical findings.

Input: Left salivary duct carcinoma ex pleomorphic adenoma status post chemotherapy and left deep lobe parotidectomy and neck dissection with pathology showing metastatic carcinoma in 4/19 lymph nodes. There are post-treatment findings in the neck, including left deep lobe parotidectomy and neck dissection. There is diffuse edema in the remaining portions of the left parotid gland, likely related to treatment effects, but no measurable tumor in the parotidectomy bed. The left submandibular gland also appears to be mildly edematous. The right-sided salivary glands are unremarkable. There is no residual significant cervical lymphadenopathy. The thyroid gland is unremarkable. The osseous structures are intact. There is mild ethmoid and left maxillary sinus mucosal thickening. The imaged intracranial structures are unremarkable.

Output: Post-treatment findings in the neck without evidence of measurable residual left parotid tumor or significant cervical lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: 21 years Male (DOB:8/7/1995)Reason: evaluate structural changes. Abnormalities History: medically refractory epilepsy, increase in night sweating, increase in seizure activityPROVIDER/ATTENDING NAME: PATRICIA OGDEN PATRICIA OGDEN There is interval development of right frontal temporal parietal craniotomy. In addition, there are encephalomalacia involving right frontal lobe, right temporal lobe with associated ex vacuo changes of the right lateral ventricle.There is no evidence of acute ischemic or hemorrhagic lesion.There is no evidence of abnormal enhancement.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Interval development of right frontal parietotemporal craniotomy ostomy with underlying encephalomalacia involving right frontal and temporal lobes.2. No evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement.


Instruction: Generate impression based on medical findings.

Input: 7 year old female with seizures with febrile illness: focal epileptiform discharges on EEG. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No potential seizure foci are identified.


Instruction: Generate impression based on medical findings.

Input: Lumbar radiculopathy. Evaluate for lumbar stenosis. There are 5 rib-less, lumbar-type vertebrae. The last well-formed disc is at L5-S1. Alignment is notable for straightening which may reflect patient position. The vertebral bodies are preserved in height. Focal signal abnormalities involving the T11 and T10 vertebral bodies, which contain fat are most compatible with hemangiomas. The marrow otherwise shows no suspicious lesion. There is mild loss of disc T2-signal and height at L3-L4 through L5-S1, associated with small posterior bulges as detailed below. The tip of the conus medullaris is at the upper L2 level. The conus medullaris and the included lower spinal cord show normal signal and morphology. The right kidney is laterally rotated. Subcentimeter T1-hypointense, T2-hyperintense lesions in the kidneys and liver may represent cysts but are not completely assessed on this examination. T12-L1, L1-L2 and L2-L3: There is no significant disc herniation. There is no spinal canal or foraminal stenosis. There is mild facet arthropathy.L3-L4: Minimal disc bulge is present along with mild ligamenta flava thickening and mild facet arthropathy. There is no significant spinal canal or foraminal stenosis.L4-L5: Mild disc bulge only flattens the ventral thecal sac. There is mild ligamenta flava thickening and mild-to-moderate facet arthropathy. There is mild-to-moderate left neural foraminal stenosis. There is no spinal canal or right foraminal stenosis.L5-S1: Minimal disc bulge is associated with moderate to severe, left worse than right facet arthropathy. There is also mild ligamenta flava thickening. There is no significant spinal canal stenosis. There is mild bilateral foraminal stenosis.

Output: 1.Mild lower lumbar degenerative spondylosis results in no significant spinal canal stenosis and only mild left L4-L5 and bilateral L5-S1 neural foraminal stenoses.2.Facet arthropathy is significant in the lower lumbar spine and might be contributing to back pain, especially the left L5-S1 facet.3.Subcentimetric liver and kidney lesions are not completely assessed but may represent cysts.


Instruction: Generate impression based on medical findings.

Input: 37-year-old female with history of leiomyoma of the uterus. UTERUS, ADNEXA: Multiple intramural leiomyomas demonstrating T1 and T2 heterogeneous signal and enhancement. The largest measures approximately 7.5 x 7.0 cm. Additionally, the endometrium is not well visualized but appears to be displaced inferiorly by the largest intramural fibroid.Nabothian cysts are noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small fat-containing umbilical hernia.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Uterine intramural leiomyomas.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Evaluate brain, abnormal VNG- upbeating nystagmus. Dizziness. Signs and symptoms: Dizziness. Pre-and post enhancement MRI:No diffusion weighted abnormalities.Examination demonstrates patchy foci of flair hyperintensity in the periventricular and subcortical white matter of bilateral cerebral hemispheres, bilateral basal ganglial, bilateral thalamus and a single focus in the pons. Considering patient's stated age of 69 the findings are highly suggestive of chronic small vessel ischemic strokes and mild to moderate decreased.There is mild prominence of supratentorial ventricles and subtle prominence of cortical sulci.Susceptibility MRI images demonstrate several punctate foci of susceptibility in bilateral cerebellar hemispheres, pons and bilateral cerebral hemispheres consistent with chronic microhemorrhages.Post enhanced images demonstrate no abnormal parenchymal or meningeal enhancement. There is normal enhancement of intracranial venous sinuses. No abnormal enhancement of the calvarium or the orbits.The signal voids of major intracranial arterial branches are identified.

Output: 1.Negative diffusion weighted images.2.Findings of mild to moderate chronic small vessel ischemic strokes as detailed. Several small foci of susceptibility in bilateral cerebral, cerebellar hemispheres and pons consistent with chronic microhemorrhages.3.No detectable abnormal enhancement of brain parenchyma, leptomeninges, calvarium or the orbits.


Instruction: Generate impression based on medical findings.

Input: Clinical question: possible stroke. Signs and Symptoms: as above. Nonenhanced brain MRI:There is no evidence of an acute ischemic stroke.Examination demonstrate diffuse left hemispheric periventricular and subcortical FLAIR hyperintensity of brain parenchyma and to a lesser degree of the left basal ganglia associated with mild ex vacuo dilatation of left lateral ventricle suggesting chronic ischemic changes in the microvascular distribution. Compared to prior exam there is significant interval progression of finding in the left hemisphere.Very minimal similar finding on the right side is also noted. Significant discrepancy of the findings on the left suggest possibility of proximal large vessel vascular stenosis. There is mild left-sided medullary and degeneration.Cortical sulci are prominent for patient's stated age however without detectable signal abnormality.Images through posterior fossa demonstrate focus of encephalomalacia in the right middle cerebellar peduncle without significant change since prior exam. Also similar to prior exam there is prominence of cerebellar and vermian folia for patient's stated age of 49.The signal void of major intracranial arterial branches are identified. There is persistent low signal changes in the left vertebral and basilar artery with decreased caliber as was noted on prior MRI and CTA examinations.

Output: 1.No acute intracranial process and negative diffusion weighted series.2.Extensive left hemispheric periventricular / subcortical and to a lesser degree left basal ganglia FLAIR hyperintensity with volume loss suggesting progression of small vessel distribution ischemic strokes since prior MRI exam. Minimal similar changes in the right hemisphere is also noted. Stable focus of encephalomalacia/chronic stroke in the right middle cerebellar peduncle.3.Asymmetrical (L>R) extent of left hemispheric findings is suggestive of a larger proximal vessel stenosis or occlusion.4.Prominence of cortical sulci and cerebellar-vermian folia for patient of stated age and consistent with underlying parenchymal volume loss.5.Redemonstration of signal changes in the left vertebral artery and proximal basilar with decreased caliber consistent with findings on prior CTA examination.


Instruction: Generate impression based on medical findings.

Input: Only dementia. Myoclonus, concern for normal pressure hydrocephalus versus subdural fluid collection. No evidence of acute ischemic or hemorrhagic lesion.Minimal to mild diffuse brain atrophy.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion.Minimal to mild diffuse brain atrophy.No abnormal enhancement. No mass.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old. Enthesopathy of the lower limb. The left hamstring origin appears normal, without tendinopathy or tear. The right hamstring origin likewise appears normal. There is minimal edema along the greater trochanters bilaterally, which is not necessarily of any clinical significance. The gluteal tendons appear normal. The musculature appears normal.Small tubular foci of low signal intensity in the left acetabulum presumably reflect prior labral repair. Although lack of intra-articular contrast limits evaluation of the acetabular labrum, we see no fluid-filled tear. Bone marrow signal intensity is otherwise within normal limits.

Output: Surgical changes compatible with prior labral repair. We see no proximal hamstring tendinopathy.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old, with cervical myelopathy. Image quality is slightly degraded by motion artifact. Within this limitation the following observations are made.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No marrow replacement or marrow edema is suspected.The visualized spinal cord demonstrates normal signal intensity and morphology. No epidural abnormalities are suspected.C2-3: Facet hypertrophy. No significant spinal canal stenosis. Mild left foraminal narrowing. C3-4: Intimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Moderate left foraminal narrowing. C4-5: Unremarkable. C5-6: Left greater than right facet hypertrophy. No significant spinal canal stenosis. Mild left foraminal narrowing. C6-7: Left greater than right facet hypertrophy. Posterior disc-osteophyte complex formation with a left paracentral extrusion which just barely contacts the cord but causes no significant cord deformation. Mild generalized spinal canal narrowing. Mild bilateral foraminal narrowing. C7-T1: Unremarkable.

Output: Relatively mild degenerative disease is seen in the cervical spine. No areas of high-grade spinal canal stenosis are detected. There is a left paracentral disc extrusion at C6-7 which may barely contact the cord but causes no significant cord deformation. Moderate foraminal narrowing is seen on the left at C3-4.


Instruction: Generate impression based on medical findings.

Input: 68 year-old female. MDS and right leg skin rash concerning for leukemia cutis. She now has blistering, swelling, and exquisite tenderness to palpation concerning for superimposed NSTI or abscess. There is thickening of the skin along the dorsum of the foot. There is also extensive edema-type signal in the subcutaneous fat of the dorsum of the foot extending into the toes. This edema becomes confluent dorsal to the metatarsals and the visualized bones of the midfoot. While this confluent edema does not enhance following contrast administration and although we see no discrete rim enhancement, the possibility of a phlegmon or a developing abscess is a consideration. This collection appears to extend to the skin surface dorsal to the middle cuneiform. Overall, this collection measures approximately 1.5 cm in depth, 9 cm in length (extending off the field of view proximally), and 7 cm in the mediolateral dimension. There is enhancement of the subcutaneous fat surrounding this collection indicating inflammation. The extensor tendons lie deep to this collection and we see no specific findings to suggest extensor tenosynovitis. There is edema of the plantar musculature of the foot that does not appear to enhance following gadolinium administration. There is slight tenosynovial enhancement of the flexor hallucis longus tendon at the knot of Henry, which is of questionable current clinical significance. The bone marrow signal intensity is within normal limits.

Output: Inflammatory changes of the forefoot, as described above, particularly affecting the dorsum of the forefoot where there is a nonenhancing collection that may either represent extensive confluent edema or a phlegmon/developing abscess; however we see no well-defined rim enhancing abscess at this time. We also cannot exclude the possibility of a superficial necrotizing infection on the basis of this exam.Findings were communicated to clinical service Dr. Parker, over the phone at time of dictation.


Instruction: Generate impression based on medical findings.

Input: 71 year-old female with hip pain for two months after fall. We see no signal abnormality in the bones to suggest a fracture. Mild osteoarthritis of the right hip. Signal abnormality within the labrum likely a combination of degeneration and tearing. No joint effusion is present.The gluteus minimus tendon on the right appears slightly thickened with mild fatty atrophy of the gluteus minimus muscle. The remaining musculature appears intact. There is small amount of fluid along the soft tissues adjacent to the right greater trochanter which may reflect very mild bursitis.One of the larger field of view images, mild osteoarthritis affects the left hip. There is an elongated and lobulated fluid signal along the the anterior aspect of the hip which extends superiorly along the pelvic side wall posterior to the iliopsoas which may reflect fluid in the iliopsoas bursa or paralabral cyst. There is increased signal intensity at the origin of the hamstrings on the left which may reflect tendinosis and mild tearing but is not necessarily of current clinical significance. Severe degenerative arthritic changes affect the lower lumbar spine.

Output: 1.No fracture is evident.2.Degenerative arthritic changes as above.3.Atrophy of the right gluteus minimus muscle with thickening of the right gluteus minimus tendon which could represent tendinosis or alternatively an old tear that has undergone scarring.4.Small thin collection of fluid along the right greater trochanter may reflect mild bursitis but is not necessarily of current clinical significance.5.Other findings as above.


Instruction: Generate impression based on medical findings.

Input: 56 year old female with brain mass, most likely meningioma. Rule out systemic involvement. Expressive aphasia. CHEST:LUNGS AND PLEURA: Atelectasis at the right lung base. MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Right breast mass with macrocalcification at image 30 of series 5 measures 2 cm in diameter. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Laparoscopic band at gastroesophageal junction is in the expected position. Normal appendix in the right lower quadrant. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: Foley catheter in decompressed bladder. LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Right breast mass.2. Lap band at GE junction.3. No occult malignancy was found.


Instruction: Generate impression based on medical findings.

Input: Alignment of the lumbar spine is anatomic. There are 5 lumbar type vertebral bodies. The vertebral body heights are preserved. The bone marrow signal is normal. Mild degenerative spondylosis affects the lower lumbar spine L4-5 and L5-S1 where there is disc desiccation. The conus is normal in signal and morphology and terminates at L1. The visualized intra-abdominal and paraspinal contents are unremarkable.No spinal canal stenosis or neural foraminal narrowing at T11/12 or T12/L1 as seen on the sagittal images.L1/2: Mild facet arthropathy without spinal canal stenosis or neural foraminal narrowing.L2/3: Mild facet arthropathy without spinal canal stenosis or neural foraminal narrowing.L3/4: Minimal disc bulge, facet arthropathy and ligamentum flavum thickening with minimal bilateral neural foraminal narrowing. No spinal canal stenosis.L4/5: Small annular fissure. Minimal disc bulge, facet arthropathy, and ligamentum flavum thickening with minimal left and no right neural foraminal narrowing. No spinal canal stenosis.L5/S1: Small annular fissure. Disc bulge, eccentric to the right, which contacts the right L5 nerve extraforaminally without clear impingement. Mild facet arthropathy without spinal canal stenosis or neural foraminal narrowing.

Output: Mild degenerative changes in the lumbar spine without significant spinal canal stenosis or clear evidence of nerve root impingement at any level. Minimal neural foraminal narrowing as described above.


Instruction: Generate impression based on medical findings.

Input: 38 years Female (DOB:6/19/1978)Reason: previous c5-c6 hnp History: lue radiculopathyPROVIDER/ATTENDING NAME: MICHAEL J LEE SERVICES ANCILLARY The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is some loss of disc space height and disc desiccation as well as a left lateral recess disc protrusion which impresses on the ventral aspect of the thecal sac and encroaches on the left hemicord and nerve roots at the left lateral recess and the left neural foramen. There are associated uncovertebral osteophytes. This was present on the prior exam and does not appear to have changed substantially.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 a left lateral recess disc protrusion associated with uncovertebral osteophytes at C5-C6 which encroaches on the left hemicord and the nerve roots at the left lateral recess.


Instruction: Generate impression based on medical findings.

Input: Reason: 40yo F w/ persistent foot discoloration, swelling, pain and concern for deep tissue infection History: as above The flexor and extensor tendons appear intact. The peroneal tendons appear intact. The Achilles tendon is normal in appearance. There is a small amount of fluid within the tendon sheaths as well as slight enhancement of the extensor digitorum longus, posterior tibialis, and flexor digitorum longus tendon sheaths indicating a mild tenosynovitis. There is a small amount of enhancing fluid within the tibiotalar and subtalar joints which may represent a mild synovitis. No bone marrow signal abnormalities are identified. The imaged musculature of the ankle and midfoot is unremarkable. There is nonspecific subcutaneous edema most pronounced along the dorsal aspect of the metatarsals. No focal fluid collection is identified to suggest abscess formation. There are no findings to suggest osteomyelitis. The distal tibiofibular syndesmotic complex appears intact. The ATFL is poorly visualized and likely disrupted. The PTFL appears intact. The calcaneofibular ligament appears intact. The imaged components of the deltoid ligament appear intact. There is a small amount of fluid within the retrocalcaneal bursa which may be of no clinical significance.

Output: 1. Nonspecific subcutaneous edema along the dorsal aspect of the foot may reflect a cellulitis in the correct clinical context.2. Findings indicating a mild tenosynovitis affecting the extensor digitorum longus, posterior tibialis, and flexor digitorum longus tendons. Other findings as described above.3. Probable disruption of the ATFL which may be chronic in etiology.


Instruction: Generate impression based on medical findings.

Input: 58-year-old female with shoulder pain, evaluate for rotator cuff pathology, frozen shoulder ROTATOR CUFF: There is diffusely increased T2 signal within the supraspinatus tendon suggesting a tendinopathy. There is focal partial thickness tearing along the bursal surface measuring approximately 1 cm with areas of full-thickness perforation and fluid in the subacromion subdeltoid bursa. The superior fibers of the subscapularis are also likely involved with the remainder of the subscapularis intact. The infraspinatus and teres minor are intact. The rotator muscles appear normal. Reactive marrow edema is present within the humeral head at the greater tuberosity.SUPRASPINATUS OUTLET: Small amount of fluid is noted in the subacromion subdeltoid bursa. Mild osteoarthritis affects the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is degeneration of the anterior and superior labrum.BICEPS TENDON: Biceps tendon is intact with underlying tendinosisADDITIONAL

Output: 1.Tendinopathy and partial-thickness tearing of the supraspinatus with small areas of full-thickness perforation.2.Degeneration of the anterior glenoid labrum.


Instruction: Generate impression based on medical findings.

Input: 44-year-old male history of left parietal temporal lobe grade normal excised in 2003. Very poor quality exam due to extensive motion artifacts. Large area of encephalomalacia in the left posterior temporal with ex vacuo dilatation of the left lateral ventricle is again demonstrated with no interval change. Focal area of encephalomalacia in the right frontal lobe along its inferior aspect is again identified and with no interval change. Large left parietal craniotomy is again noted. Considering provided clinical history of malignancy an MRI examination of brain is recommended.No evidence of hemorrhage, edema, midline shift, hydrocephalus is detected. Punctate calcification within the thalamus on the left remains a stable.

Output: No definite evidence of new finding since prior study of 2003.


Instruction: Generate impression based on medical findings.

Input: 71 years, Female, worsening dementia and thalamic mass. Examination is limited to 3-D T2 sequence for operative planning. Again demonstrated is expansile T2 signal abnormality centered within the medial aspects of the bilateral thalami extending into the midbrain as well as laterally into the lateral aspect of the thalamus on the right. Additional signal abnormality involving the splenium of the corpus callosum on the right is also noted. Subtle T2 hyperintensity along the right paramedian frontal lobe along the cingulate gyrus is also noted. Chronic appearing T2 signal abnormality involving the left medial temporal lobe has remained unchanged across multiple prior studies. No midline shift or herniation. No hydrocephalus.

Output: Note examination is limited to 3-D T2 sequence for operative planning. Infiltrative mass centered on the thalami is incompletely evaluated but remains highly suspicious for neoplasm such as glioma or lymphoma. Patient will return for repeat study with sedation including postcontrast sequences for further evaluation.


Instruction: Generate impression based on medical findings.

Input: 41-year-old female presents with numbness tingling to the right lower extremity, decreased sensation, and urinary retention; evaluate for cauda equina syndrome. The vertebral bodies are appropriate in the overall alignment and height. The spinal cord has grossly normal signal characteristics and overall morphology. There is no compromise of the spinal cord.There is straightening of the cervical and lumbar lordosis. There is a disc osteophyte complex at C5-C6 with indentation of the ventral thecal sac, but no high grade stenosis.Multilevel thoracic disc bulges and ligamentum flavum thickening which contribute to mild to moderate spinal canal stenosis at several levels, but appear grossly similar to the prior exams. Minimal retrolisthesis at the lumbosacral junction. No gross change in additional multilevel spondylosis of the lumbar spine without high grade spinal canal stenosis. Evaluation of the spinal canal is better assessed on prior dedicated spine studies from 11/2015.

Output: 1. This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No cord or cauda equina compression is identified. 2. Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine. Multilevel spondylosis in the cervical, thoracic, and lumbar spine has not significantly changed since the prior examination and is discussed in detail above.The above findings were discussed with Tifuh Ambah, APN by Arun Nagaraju, MD at 5:15 PM on 10/5/2016.


Instruction: Generate impression based on medical findings.

Input: Clinical question : Status post craniotomy for removal of a seizure focus. Now with seizures. Signs and symptoms: Possible. Nonenhanced head CT:Examination the most postoperative changes of a large right frontal /temporal craniotomy. Epidural fluid -- air collection under the craniotomy flap is present. This finding is within the expected postop changes. There is evidence of partial right anterior temporal lobectomy with residual air and minimal postoperative hemorrhage. There is a area of low-attenuation in the inferior aspect of right frontal lobe and to a lesser degree of the left frontal lobe consistent with areas of encephalomalacia as was noted on prior MRI examination from 3 -- 24 -- 11.Superior to the surgical site focal area of edema is noted in the right frontal lobe. Residual small amount of subarachnoid blood within the cortical sulci of bilateral cerebral hemispheres are noted. A thin CSF density right parafalcine subdural measures approximately 2 mm in thickness. Prominent bilateral basal ganglial calcification and left frontal periventricular calcification is noted.

Output: 1.Expected postoperative changes of a large right frontal and temporal craniotomy.2.Small area of edema lungs immediately superior to the surgical site which may be postop change.3.Residual subarachnoid blood from surgery both in supero-and infratentorial spaces.4.Extensive bilateral basal ganglial calcification.5.Extensive inferior bifrontal encephalomalacia unchanged since prior studies.


Instruction: Generate impression based on medical findings.

Input: Reason: shoulder pain, h/o previous labral repair History: shoulder pain. ROTATOR CUFF: The tendons and muscles of the rotator cuff are within normal limits.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: Irregularity of the anterior and posterior labrum compatible with degeneration. BICEPS TENDON: The biceps tendon is intact. ADDITIONAL

Output: Degeneration of the labrum without discrete tear.


Instruction: Generate impression based on medical findings.

Input: Headache. Rule out bleed/mass. Areas of high-density line the ependyma of the frontal horns of the lateral ventricles bilaterally with associated edema that crosses the corpus callosum. The lateral ventricles appear enlarged while the third and fourth ventricle are normal in appearance indicating mass effect at the level of the foramen of Monro. There is prominence of the pineal gland. These findings are highly suspicious for lymphoma. A germ cell tumor is in the differential but less likely. An MRI is recommended for further evaluation.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.These findings were discussed with Dr. Glickman at the time of interpretation.

Output: Lateral ventricular enlargement with high density lining the ependyma and edema crossing the corpus callosum is highly suggestive of lymphoma, with a germ cell tumor also in the differential. An MRI is recommended for further evaluation.