Instruction: Generate impression based on medical findings.

Input: Clinical question: Rule out intracranial bleed. Signs and symptoms: Stroke. CT of brain without infusion:Crowding of the cerebellar tonsils at the level from the magnum is again identified. Images through posterior fossa demonstrates minimal encephalomalacia along the medial aspect of right cerebellum. This area demonstrated acute stroke on prior MRI examination off January 29 of 2010. There is no evidence of any hemorrhage within the posterior fossa. Fourth ventricle remains normal and in midline. Images through the supratentorial space are essentially unremarkable and no evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus.Paranasal sinuses, mastoid air cells, middle ear cavities and calvarium are unremarkable.

Output: 1.Small area of low attenuation likely encephalomalacia or edema in the distribution of the right pica is consistent with patient's known prior right pica stroke.2.No evidence of any new area of stroke or hemorrhage is detected.


Instruction: Generate impression based on medical findings.

Input: New diagnosis of lung cancer. Initial staging. There is no contrast enhancing or space-occupying brain lesion. There is no midline shift. There is no intracranial hemorrhage. The ventricles and sulci are mildly enlarged, compatible with volume loss. The dural venous sinuses and major intracranial arteries appear to be patent. There is no destructive skull lesion. The mastoid air cells are unremarkable. There is mild mucosal thickening in the paranasal sinuses. The lenses are replaced, bilaterally.

Output: No evidence of intracranial metastasis.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: Multiple Sclerosis on Tysabri for 15 months. Several sequences are motion degraded.BRAIN: There are multiple T2 hyperintense lesions in the periventricular and subcortical white matter, which have not significantly changed in number or size. Many of the lesions demonstrate T1 hypointensity. There are no enhancing lesions. There is no evidence of intracranial mass or mass effect. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. CERVICAL SPINE: There are multiple stable small demyelinating plaques primarily in the upper cervical spine without abnormal enhancement or interval progression since the prior study. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.THORACIC SPINE: There are several T2 hyperintense lesions in the thoracic cord from T8 to T12 which are similar to prior examination No new lesions are seen. There is no abnormal enhancement. The vertebral body heights in the thoracic spine are intact and the alignment is normal. There is disc desiccation, small bulge and Schmorl's node at the T9-T10 level. There is no significant spinal canal or neural foraminal stenosis. The paravertebral soft tissues are unremarkable.

Output: 1.No significant interval change in the demyelinating lesion in the brain and cervical and thoracic spinal cord.2.No evidence of PML.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: Reason: lumbar spinal stenosis and neuroforaminal stenosis History: b/l low back pain and groin numbness 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 multilevel disk desiccation presentAt L5-S1 there is no significant compromise to neural foramina. There is bilateral facet hypertrophy present at this level. There is partial effacement of the fat at the lateral recess and left worse than right at this level This has not changed since prior exam.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is a minor disk bulge at this level associated with disk dessication.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is a minor disk bulge at this level associated with disk dessication.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is a minor disk bulge at this level associated with disk dessication.At L1-2 there is no significant compromise to spinal canal or neural foramina. There is a mild left lateral disk protrusion at this level.

Output: 1.There is mild encroachment of the nerve roots of the left lateral recess at L5-S1 related to a combination of disk disease and facet hypertrophy.


Instruction: Generate impression based on medical findings.

Input: 30 year-old male with perianal mass/wart. Status post excision of condyloma with flap closure on 1/9/08. Postop day 6. Presents with feculent material at wound. Evaluate for fistula communication or abscess formation. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: There are multiple small to borderline enlarged retroperitoneal and mesenteric lymph nodes.BOWEL, MESENTERY: There are multiple mildly dilated loops of large and small bowel throughout the abdomen, probably due to ileus. This may be exacerbated by air swallowing and spasm in the sigmoid and rectum.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: The sigmoid and rectum are minimally distended, possibly due to spasm.BONES, SOFT TISSUES: No significant abnormality notedOTHER: There are bilateral surgical drains in the dorsolateral buttocks with subcutaneous soft tissue air and multiple superficial skin staples. These findings are compatible with history of recent surgical procedure. No abscess or fistula was found. There is subcutaneous fat stranding in the buttocks medially which may be due to a minimal cellulitis.In some cases, small fistulas are very difficult to demonstrate, especially with CT. If symptoms persist, MRI examination of the buttocks and perineum with Crohn's protocol may be helpful for further evaluation.

Output: No evidence of abscess or fistula. Recent surgical changes in the superficial buttocks, as described above. Ileus.


Instruction: Generate impression based on medical findings.

Input: 56-year-old female with bilateral lower extremity weakness status post L3 perispinal tumor resection, L3 left hemilaminectomy and hemipediculotomy and fusion. Evaluate for cord compression. The spinal cord has normal signal characteristics and overall morphology. There is no compromise of the spinal cord. Degenerative changes are also seen involving the cervical spine most prominently in the affecting the C4-5 level where there is grade 1 anterolisthesis of C4 on C5 and disc height loss. At this level there is also mild to moderate spinal canal stenosis but no compromise of the spinal cord. Redemonstrated are postoperative findings compatible with resection of the tumor from the left L3 paraspinal region which are unchanged and better characterized on the dedicated lumbar spine MRI from 12/2/2016. There is some additional neural foraminal encroachment involving the lumbar spine mainly at L2-3. There is mild posterior subluxation of L3 on L4 which is unchanged since the prior exam.

Output: This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No cord compression is identified.Postoperative findings involving previous resection of a left L3 paraspinous tumor are grossly unchanged although not completely evaluated. Refer to the dedicated lumbar spine MRI performed on 12/3/2016 for further characterization. There is encroachment of the left-sided exiting nerve roots at L3-4.Additional degenerative changes are seen in the cervical spine including grade 1 anterolisthesis of C4 on C5 with at most mild-to-moderate spinal canal stenosis.


Instruction: Generate impression based on medical findings.

Input: 59 years Male (DOB: 7/30/1956)Reason: c/f R cervical radiculopathy History: painPROVIDER/ATTENDING NAME: HELENE G RUBEIZ HELENE G RUBEIZ The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is straightening of the normal cervical curvature present.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 a right lateral recess broad-based disc protrusion present which extends into the right neural foramen and encroaches on the right-sided exiting nerve roots within the neural foramen. There is also a disc bulge present at this level. There is some partial effacement of spinal fluid ventral to the spinal cord at this level. There are right-sided uncovertebral osteophytes present this level.At C5-6 there is some loss of disc space height and a diffuse disc bulge associated with effacement of the fat surrounding the exiting nerve roots within the neural foramina and encroachment of the exiting nerve roots. There are bilateral uncovertebral osteophytes present this level.At C6-7 there is no loss of disc space height, disc desiccation and diffuse disc bulge, right-sided uncovertebral osteophytes and encroachment of the exiting nerve roots within the left neural foramen. There is some effacement of the spinal fluid ventral and posterior the spinal cord and some mild flattening of the spinal cord this level. Overall there is moderate spinal stenosis at this level.At C7-T1 there is no significant compromise to the spinal canal. There are some encroachment of the left-sided exiting nerve roots at this level due toThe vertebral artery flow voids appear to be intact.There is some ill-defined lesion present within the right thyroid lobe which is not adequately imaged on this exam.

Output: 1.There are multilevel degenerative changes present in the cervical spine worse at C6-7 where there is a moderate degree of spinal stenosis. There is also encroachment of the left-sided exiting nerve roots at C6-7, the right-sided exiting nerve roots at C4-5 and bilateral exiting nerve roots at C5-6.2.There is some ill-defined lesion present within the right thyroid lobe which is not adequately imaged on this exam. Please note that MR is not accurate in evaluation of thyroid lesions.


Instruction: Generate impression based on medical findings.

Input: 69 years, Male, history of metastatic RCC to brain, status post SRS and WBRT. There is no significant change in size of treated, hemorrhagic lesion adjacent to the trigone of the left lateral ventricle measuring approximately 19 x 25 mm in the axial plane. There is mild peripheral enhancement which is not significantly changed.6 mm hemorrhagic right parietal lesion remains unchanged. There are unchanged additional foci of susceptibility effect related to chronic blood products at the site of prior lesions. Also unchanged postoperative appearance of the right frontal lobe resection bed including minimal curvilinear enhancement.No significant change in multifocal areas of FLAIR hyperintensity likely related to combination of posttreatment change and chronic small vessel ischemic disease. No new mass or mass affect. No new foci of abnormal enhancement to suggest disease progression in the brain. No hydrocephalus. No midline shift or herniation.Enhancing lesion involving the left masticator space demonstrates enlargement measuring approximately 19 x 18 mm, previously 14 x 10 mm.

Output: 1. Compared to 2/9/2016, there is no evidence of progression of metastatic disease in the brain. Multiple treated lesions are again seen, including a relatively larger left peritrigonal lesion.2. Enlarging soft tissue metastasis in the left masticator space.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old, with transient right arm weakness and vertigo. Scattered small foci of T2 hyperintensity are seen within the cerebral hemispheres without significant interval change. No restricted diffusion is evident. No significant edema or mass effect is detected. There are no findings to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collections. The ventricles are normal in size and morphology.

Output: 1.No evidence of acute ischemia.2.Scattered foci of T2 hyperintensity are redemonstrated, a nonspecific finding which may reflect chronic microvascular ischemia.


Instruction: Generate impression based on medical findings.

Input: Left knee pain. Evaluate for lateral meniscus tear. MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There is near full thickness degeneration of the articular cartilage of the inferior aspect of the lateral facet of the patella. The articular cartilage of the medial facet of the patella is preserved. Articular cartilage of the tibiofemoral compartment is intact.Bone marrow signal intensity is within normal limits.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. No evidence of meniscal tear.2. Degeneration of the articular cartilage along the lateral facet of the patella.3. Baker's cyst.


Instruction: Generate impression based on medical findings.

Input: 61 years Male (DOB:4/1/1955)Reason: pars defect History: pars defectPROVIDER/ATTENDING NAME: MICHAEL J LEE MICHAEL J LEE 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. There is loss of disc space height, disc desiccation and diffuse disc bulge at this level.At L4-5 there is a right lateral recess disc protrusion which effaces the fat at the right lateral recess and compresses the nerve root at the right lateral recess. There is no endplate reactive changes appreciated. There is loss of disc space height and disc desiccation present at this levelAt L3-4 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation present at this levelAt L2-3 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation present at this levelAt L1-2 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation present at this level

Output: There is a right lateral recess disc protrusion at L4-5 which compresses the nerve root at the right lateral recess at this level (probably the right L5 nerve root).


Instruction: Generate impression based on medical findings.

Input: Reason: Eval for progression, cervical stenosis History: arm numbness and weakness Cervical spine:The cervical vertebral bodies are appropriate in overall height. The patient is status post laminectomies at C2, C3, C4, C5, C6 and C7. There is anterior fusion of C5, C6 and C7. There is reversal of the normal cervical curvature in the upper cervical spine especially at C3-4 and C4-5. There is mild anterior subluxation of C3 on C4 of approximately 4 mm with resultant spinal stenosis. There is myelomalacia present along the lower cervical spinal cord .At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is bilateral facet hypertrophy present at this level.At C3-4 there is 4 mm subluxation of C3 on C4 associate bilateral facet hypertrophy and narrowing of the spinal canal with effacement of spinal fluid ventral posterior the spinal cord. There are uncovertebral osteophytes present at this level as well as disk bulge. There is bilateral neural foramen encroachment of the exiting nerve roots at this level.At C4-5 there is disk desiccation as well as uncovertebral osteophytes and a disk bulge associated with bilateral facet hypertrophy. There is encroachment of the exiting nerve roots within the neural foramina bilaterally at this level.At C5-6 there is no significant compromise to the spinal canal. There are uncovertebral osteophytes present at this level with some narrowing of the neural foramina bilaterally.At C6-7 there is no significant compromise to the spinal canal. There are uncovertebral osteophytes present at this level with some narrowing of the neural foramina bilaterally.At C7-T1 there is no significant compromise to the spinal canal. There are uncovertebral osteophytes present at this level with some narrowing of the neural foramina bilaterally.The vertebral artery flow voids appear to be intact.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact. There is a levocurvature to the lumbar spine.There is a heterogeneously hyperintense lesion present within the distal sacral spinal canal was also present on the prior exam as well as an exam from 2/8/13 that does not appear to have changed substantially. This is associate with some expansion of the sacral spinal canal. At L5-S1 there is a redemonstration of anterior subluxation of L5 on S1 associated with a diffuse disk bulge and bilateral facet hypertrophy. There is effacement of the fat at the lateral recesses bilaterally at this level and mild narrowing of the neural foramina bilaterally. The exiting nerve roots within the neural foramina are surrounded by fat. Overall there is moderate to severe spinal stenosis at this level.At L4-5 there is a redemonstration of anterior subluxation of L4 on L5 associated with a diffuse disk bulge and bilateral facet hypertrophy. There is effacement of the fat at the lateral recesses bilaterally at this level. There is obliteration of spinal fluid surrounding the nerve roots at this level. There is mild narrowing of the neural foramina bilaterally. The exiting nerve roots within the neural foramina are surrounded by fat. Overall there is severe spinal stenosis at this level.At L3-4 there is loss of disk space height, disk desiccation and diffuse disk bulge associated with a moderate degree of facet hypertrophy there is partially effacement of the fat at the lateral recesses at this level with triangulation of the thecal sac. The exiting nerve roots within the neural foramina are surrounded by fat. Overall there is a mild to moderate degree of spinal stenosis at this levelAt L2-3 there is no significant compromise to spinal canal or neural foramina. There is disk desiccation and a disk bulge at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina. There is disk desiccation and a disk bulge at this level.There is mild retropulsion of T12 on L1. There is no significant compromise to the spinal cord at this level

Output: 1.The patient is status post multilevel laminectomies from C2 down to C7 and anterior fusion from C5 through C7.2.There is subluxation with spinal stenosis associated degenerative changes at C3-4 which appears stable when compared to the prior exam.3.There are multilevel degenerative changes present with neural foramen encroachment at multiple levels.4.There is reversal of the normal cervical curvature present. There is a mild levocurvature to the lower cervical spine .5.There is myelomalacia present in the lower cervical spinal cord.6.There are multilevel degenerative changes in the lumbar spine due to disk disease and facet disease resulting in severe spinal stenosis at L4-5 associated with mild subluxation and moderate to severe spinal stenosis at L5-S1 associated with mild subluxation. These findings are stable when compared to the previous exam.7.There is a lesion present in the distal sacral spinal canal centered at the S3 level which appears to be long-standing and associated with expansion of the spinal canal. It appears to be partly hemorrhagic in nature. It affects the nerve roots in the distal sacral spinal canal.


Instruction: Generate impression based on medical findings.

Input: Diffuse pain and weakness, evaluate for cervical or segmental cord compression. Examination is obtained per screening adult cord compression MRI protocol. There is 6 mm anterolisthesis of C7 on T1 with severe loss of intervertebral disk space and T2 hyperintensity within the disc space. There is low T1 and T2 signal involving the adjacent endplates compatible with sclerosis. There is moderate loss of height involving the anterior aspect of the T1 vertebral body and minimal loss of height involving the C7 vertebral body.There are degenerative changes throughout the cervical spine with disk osteophyte complexes and moderate spinal canal stenosis at C3-C4, C4-C5, C5-C6, and moderate to severe spinal canal stenosis at C7-T1. There is T2 hyperintensity within the cervical cord at the C7-T1 level. Advanced facet arthropathy is also seen at the C7-T1 level bilaterally. There is bone marrow edema which extends into the posterior elements at C7 and T1. There is severe neural foramina stenosis at C7-T1, worse on the right than the left.Remainder of the cervical, thoracic, and lumbar vertebral body heights appear preserved. There is straightening of the lumbar spine curvature. Advanced degenerative changes are noted at the L3-L4 and L4-L5 levels and to a lesser degree at L2-L3 and L5-S1. Axial images were not obtained, however, there may be up to moderate spinal canal stenosis. There is up to severe neural foraminal narrowing at the L3-L4, L4-L5, and L5-S1 levels.

Output: Limited exam for cord compression protocol demonstrating degenerative changes throughout the cervical spine, worst at the C7-T1 level, where there is 6 mm of anterolisthesis, severe loss of intravertebral disk space, endplate sclerosis, and mild anterior wedging of the T1 vertebral body. These findings are most likely related to advanced degenerative changes. Given the advanced degenerative/destructive changes at the C7-T1 level described above including the anterior and posterior elements, Charcot/neuropathic joint can also be considered, although uncommon, in the appropriate clinical setting.Moderate to severe spinal canal stenosis at C7-T1 with T2 hyperintensity within the cord compatible with edema.Degenerative changes also noted in the lumbar spine, worst at the L3-L4 and L4-L5 levels. There is T2 hyperintensity within the disk space and adjacent endplates which may be on a degenerative basis. There may be up to moderate spinal canal stenosis which is difficult to evaluate without axial images. Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine. Consider dedicated cervical and lumbar spine imaging.


Instruction: Generate impression based on medical findings.

Input: 34 years Female (DOB:11/30/1981)Reason: evaluate structural lesion History: seizurePROVIDER/ATTENDING NAME: JAMES X. TAO JAMES X. TAO There is right-sided soft tissue isn't separately present which appears to be open lip. There appears to be an adjacent cortical dysplasia or polymicrogyria present. The septum pellucidum appears to be absent. The pituitary appears to be within normal limits. The optic nerves appear intact to the extent of visualization.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: Right-sided schizencephaly associated with absence of the septum pellucidum and some adjacent cortical dysplasia..


Instruction: Generate impression based on medical findings.

Input: Reason: r/o tear of ACL graft History: pain, swelling MENISCI: There is linear decreased signal abnormality which traverses the posterior horn of the lateral meniscus and extends to the tibial articular surface indicating an oblique tear which extends into the body of the meniscus, new from prior examination. The anterior horn appears intact. The there is undersurface fraying of the posterior horn of the medial meniscus which otherwise appears intact.ARTICULAR CARTILAGE AND BONE: No full-thickness or near full-thickness articular cartilage defects are identified. There is thinning of the articular cartilage of the patellofemoral articulation. There is bone marrow signal abnormality within the lateral femoral condyle and lateral tibial plateau likely representing bone contusions. Note is made of osseous tunnels from prior ACL graft reconstruction.LIGAMENTS: Note is made of postsurgical changes of prior ACL graft reconstruction. There is near complete to complete rupture through the mid substance and distal fibers of the ACL graft, although some of the fibers of the graft may be intact. The PCL appears intact. The LCL appears intact. The imaged components of the anterolateral ligament appear intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Near complete to complete rupture of the ACL graft as described above. 2. Tearing of the lateral meniscus as described above. 3. Bone contusions and other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Knee pain MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Normal MRI of the knee.


Instruction: Generate impression based on medical findings.

Input: HCV cirrhosis. Evaluate for HCC. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology without a focal lesion biliary ductal dilatation or vascular abnormality.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: Scattered retroperitoneal and porta hepatis lymph nodes are not pathologically enlarged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Cirrhosis without a suspicious lesion.


Instruction: Generate impression based on medical findings.

Input: Weakness and numbness. Brain: The anterior part of the head is partly obscured by dental brace artifact. Within this limitation, there is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Cervical Spine: The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct, although the exam is partly degraded by dental brace artifact.2. No evidence of cervical spinal cord compression or lesions.


Instruction: Generate impression based on medical findings.

Input: Mental status changes, homicidal thoughts. Off Zoloft. Patchy areas of subcortical and periventricular white matter hypodensity likely represent small vessel ischemic disease, age indeterminate by CT. There is no evidence of intracranial hemorrhage, mass, midline shift or extra axial fluid collection. The ventricles and basal cisterns appear symmetric.A fixation plate in the left periorbital region is noted which would not preclude the patient from getting an MRI. An old buckle fracture of the right zygomatic arch is again noted. There is partial opacification of the left maxillary sinus. The remaining visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Stable examination without acute intracranial abnormality. Small vessel ischemic disease, age indeterminate.


Instruction: Generate impression based on medical findings.

Input: Ms Neher submitted outside study for review. Submitted for review are:- Bilateral screening mammogram dated 10/21/2016- Left breast ultrasound dated 10/25/2016- Stereotatic biopsy dated 10/25/2016- Bilateral MRI without and with contrast dated 10/31/2016- MRI biopsy dated 11/8/2016- Postprocedure mammogram dated 11/8/2016These imaging studies were performed at Northwest community health care. For comparison,bilateral screening mammograms dating back to 9/7/2013 are available. BILATERAL SCREENING MAMMOGRAM DATED 10/21/2016:Bilateral CC and MLO views were acquired, though only the CAD overlay image is available. Further evaluation was performed for developing calcifications in the left breast and probable cysts on the right based on these mammograms. LEFT BREAST ULTRASOUND DATED 10/25/2016:Targeted ultrasound of the left upper breast at 12:00 3 cm from the nipple reveals clustered microcysts spanning 0.6 x 0.4 x 1.0 cm.Targeted ultrasound of the left upper outer breast at 1:00 3 cm from the nipple, reveals a 0.6 x 0.4 x 0.5 cm oval parallel circumscribed anechoic mass with posterior acoustic enhancement compatible with simple cyst.At the 1:30 position 2 cm from the nipple and oval parallel circumscribed 0.9 x 0.4 x 0.7 cm homogenous isoechoic mass is identified, benign in appearance and stable since ultrasound of 2015. Immediately adjacent to it is another 1.8 x 1.3 x 1.3 cm oval mass with lobulated margin and slightly heterogeneous internal echotexture. This latter finding also appears stable in volume and appearance as compared with ultrasound study of 2015.Targeted ultrasound of the left breast at the 2:00 position 2.5 cm from the nipple reveals an oval parallel nearly anechoic mass with posterior acoustic enhancement measuring 1.0 x 0.6 x 1.0 cm, likely a complicated cyst. At 2:30 4cm from the nipple, there is an oval parallel circumscribed hypoechoic mass measuring 1.0 x 0.4 x 0.7 cm, benign in appearance. Immediately adjacent to it is a circumscribed parallel anechoic 2.4 x 0.7 x 1.4 cm mass compatible with simple cyst. These findings appears stable as compared with ultrasound study of 2015.Targeted ultrasound of the left breast at the 4:00 position 4 cm from the nipple reveals another oval parallel circumscribed anechoic mass measuring 0.8 x 0.5 x 1.2 cm, with posterior acoustic enhancement compatible with simple cyst.STEREOTACTIC BIOPSY RIGHT BREAST DATED AND POSTPROCEDURE MAMMOGRAM 10/25/2016:Images from a stereotactic right breast biopsy were provided demonstrating adequate targeting. Calcifications were present on 2 out of 4 samples.A Hydromark biopsy clip marker was deployed.Postprocedure mammogram reveals a Hydromark clip in the expected location in the right outer breast, mid depth. Extensive residual microcalcifications and a small hematoma are noted.BILATERAL BREAST MRI DATED 10/31/2016:Bilateral breast MRI without and with IV contrast was performed according to outside protocol. Images were reviewed using Dyna CAD software.There is heterogeneous fibroglandular tissue, associated with moderate/marked background parenchymal enhancement slightly limiting the sensitivity and specificity of this study.Scattered cysts are identified in both breasts. Multiple similar benign appearing masses are present in both breasts, largest measuring 1.4 x 1.2 cm in the left outer mid breast. This mass was identified on prior ultrasound studies and has been stable sonographically. RIGHT BREAST: Within the right outer breast, there is a segmental area of clumped nonmass enhancement measuring 6.7 x 3.8 x 5.2 cm (AP x transverse x IS), with extension into the subareolar region (approximately 1.4 cm from the nipple), at the central aspect of which, focal susceptibility artifact from a biopsy clip marker is present from prior stereotactic biopsy. Intrinsic high T1 signal from blood products is present along the biopsy clip tract. This area of nonmass enhancement correlates to the mammographically detected right outer segmentally distributed microcalcifications.LEFT BREAST:There is no suspicious mass, or non mass enhancement in the left breast. See above discussion of multiple benign masses. No axillary or internal mammary lymphadenopathy.RIGHT MRI BIOPSY AND POSTPROCEDURE MAMMOGRAM DATED 11/8/2016:Images from a right breast MRI guided biopsy are provided.The inferior aspect of the right breast nonmass enhancement was targeted.Postprocedure mammogram reveals a new biopsy clip marker within the right inferior central anterior breast. Distance between the two clips is 4.1 cm on the ML view.PATHOLOGY:Pathology slides were reviewed at the University of Chicago.Results for the biopsies are as follows:Right breast upper outer with calcs (stereotactic biopsy dated 10/25/2016): Lobular carcinoma in situ.Right breast lower outer (MRI biopsy dated 11/8/2016): focal atypical ductal hyperplasia.

Output: 1. Extensive right outer breast calcifications extending into the periareolar region, correlating with extensive NME on prior MRI guided biopsy, corresponding to biopsy proven ADH. 2. Multiple bilateral benign-appearing masses, largest measuring 1.4 cm in the left breast. No MRI evidence of left breast malignancy.3. No axillary or internal mammary lymphadenopathy.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: 13-month-old male with DiGeorge syndrome and traumatic brain injury. Per the electronic medical record, the patient was born prematurely and subject to abuse with prior subdural hematoma. There are subdural hematomas along the bilateral cerebral convexities without significant mass effect. The collections are predominantly T1 isointense and T2 hyperintense with the right slightly larger than the left. The right subdural collection also contains a small amount of T1 hyperintense signal, which suggests a recent component. There is marked cystic encephalomalacia in the parietal, occipital, and temporal lobes bilaterally. Milder encephalomalacia changes are present in the right superior frontal lobe. There is severely diminished supratentorial white matter. The lateral and third ventricles are markedly enlarged. No restricted diffusion to suggest acute ischemia. No intracranial mass or mass-effect. Major flow-voids are preserved.Bilateral cleft lip with a cleft defect in the maxilla is noted. However, the maxillofacial structures are incompletely evaluated.

Output: 1. Extensive cystic encephalomalacia involving the bilateral cerebral hemispheres which may be related to prior diffuse anoxic brain injury. 2. Marked dilatation of the lateral and third ventricles, likely primarily due to ex vacuo dilatation. However, a component of hydrocephalus cannot be completely excluded. Comparison with prior examinations would be beneficial if available.3. Bilateral, right greater than left, cerebral convexity subdural hematomas with a small areas of T1 hyperintensity indicating a subacute component. No significant associated mass effect.


Instruction: Generate impression based on medical findings.

Input: Pain and decreased range of motion. ROTATOR CUFF: Abnormally increased signal within the supraspinatus tendon near its insertion indicates moderate tendinosis. No discrete full-thickness tears are identified. The supraspinatus muscle does not exhibit significant atrophy. The remaining tendons and muscles of the rotator cuff are grossly unremarkable.SUPRASPINATUS OUTLET: Moderate-severe osteoarthritic changes affect the acromioclavicular joint with fluid signal present within the joint. A small amount of fluid is present within the subacromial/subdeltoid bursa which in the absence of full-thickness rotator cuff tear suggests bursitis.GLENOHUMERAL JOINT AND GLENOID LABRUM: Degenerative changes affect the glenohumeral joint with several subchondral cysts within the humeral head most prominent subjacent to the subscapularis and infraspinatus tendon insertions. The remaining bone marrow signal is within normal limits with some foci of red marrow reconversion. The labrum and articular cartilage of the glenohumeral joint are grossly intact.BICEPS TENDON: The long head biceps tendon is grossly intact. ADDITIONAL

Output: 1.Supraspinatus tendinosis without discrete full-thickness rotator cuff tears.2.Additional degenerative changes as described above.


Instruction: Generate impression based on medical findings.

Input: There are postoperative findings related to right frontal craniotomy with no significant change in the area of confluent T2 hyperintensity within the right superior frontal gyrus surrounding the surgical cavity. However, there is no evidence of associated abnormal intraparenchymal enhancement. The ventricles and sulci are stable. There is no midline shift or mass effect. There is no evidence of acute infarct. The skull and extracranial soft tissues appear to be unchanged.

Output: Post-treatment findings involving the right frontal lobe without evidence of interval tumor progression.


Instruction: Generate impression based on medical findings.

Input: 36-year-old female with shooting pain down to shoulders There is straightening of the cervical spine, which may be positional, otherwise alignment is anatomic. Vertebral body heights and disc spaces are intact with tiny anterior osteophytes. No acute fracture is evident. The osseous neural foramina are patent. Borderline anterior translation of the right C3 facet relative to C4 is likely may be due to patient positioning, however MRI may be helpful to look for ligamentous injury. Possible extruded disc seen on the prior MRI would not be evident by conventional radiographs.

Output: Minimal degenerative changes. Possible extruded disc seen on prior MRI would not be evident on conventional radiographs. For further evaluation, an MRI cervical spine may be considered.


Instruction: Generate impression based on medical findings.

Input: 61 year old female with palpitations, history of atrial fibrillation/flutter. Referred to cardiac MRI prior to ablation to evaluate pulmonary venous anatomy. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 63%, the LV end diastolic volume index is 63 ml/m2 (normal range: 65+/-11), the LVEDV is 111 ml (normal range 109+/-23), the LV end systolic volume index is 24 ml/m2 (normal range 18+/-5), the LVESV is 41 ml (normal range 31+/-10), the LV mass index is 25 g/m2 (normal range 67+/-11), and the LV mass is 44 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 57%, the RV end diastolic volume index is 53 ml/m2 (normal range 69+/-14), the RVEDV is 93 ml (normal range 110+/-24), the RV end systolic volume index is 23 ml/m2 (normal range 22+/-8), and the RVESV is 40 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium. Each pulmonary vein has a distinct ostia. Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size and systolic function (LVEF 63%). No evidence of late gadolinium enhancement. 2. The right ventricle is normal in size and systolic function (RVEF 57%). 3. All four pulmonary veins drain normally into the left atrium. Each pulmonary vein has a distinct ostia. 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: Possible primary biliary cirrhosis. Abnormal LFTs. ABDOMEN:LIVER, BILIARY TRACT: The liver is mildly lobular in contour with patchy reticular T2 weighted hyperintensity suggestive of cirrhosis with fibrotic changes. These regions demonstrate increasing enhancement on delayed phase imaging without a discrete mass lesion, biliary ductal dilatation or capsular retraction.The vessels are patent.The common bile duct measures up to 10 mm, yet tapers smoothly at the level of the ampulla without an obstructive lesion evident. Normally distended gallbladder.SPLEEN: The spleen is normal in size without a focal lesion.PANCREAS: Normal morphology. The main pancreatic duct is normal in caliber. No focal lesion.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal interpolar intraparenchymal T2-weighted hypointense subcentimeter focus is not clearly a cyst but is too small to characterize otherwise.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. Chronic liver disease morphology with fibrotic changes. No discrete mass lesion.2. Right renal intraparenchymal subcentimeter T2 weighted lesion is not clearly a cyst; dedicated renal CT in 1 year is suggested to confirm stability.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Evaluate for progression of known GBM, new cranial nerve involvement. Signs and symptoms: Fossa bulge. Pre-and post-enhanced brain MRI:Diffusion weighted images demonstrate patchy irregular foci of restricted diffusion surrounding patient's known right hemispheric tumor.This finding is nearly identical to prior exam from January of 2015.Examination demonstrates post operative changes of a right-sided frontal -- temporal craniotomy and resection of a large segment of right anterior and mid temporal lobe similar to prior exam.A CSF signal intensity surgical cavity at the site of surgical resection remains identical in size and signal intensity to prior exam.Significant flair hyperintensity posterior to the surgical cavity in the right posterior temporal lobe and with extension to the right occipital lobe and splenium of corpus callosum with extension across the midline remain grossly identical to prior exam. There is no evidence of an acute new finding since prior study.Post enhanced images demonstrate a solid thick band of enhancement along the posterior edge of surgical cavity in the right posterior temporal lobe and extending along the medial aspect of the resection cavity along the medial aspect of left temporal lobe which demonstrate no appreciable change.Post enhanced images also demonstrate extensive nodular pattern of enhancement posterior to the surgical cavity in the right posterior temporal -- occipital region. Compared to prior exam there is increased nodularity of foci of enhancement. This observation could possibly be technique related. Ill-defined patchy enhancement of corpus callosum demonstrate no convincing evidence of change. Mild to moderately enlarged lateral ventricles (right greater than left demonstrate no significant change.There is no detectable foci of parenchymal signal abnormality or enhancement.

Output: 1.No convincing evidence of an acute or definite acute new finding since prior exam.2.Stable residual enhancing tumor in the right posterior temporal lobe with extension into the splenium of corpus callosum and along the medial aspect of left temporal lobe in signal intensity, extent, size and pattern of enhancement. Please see above comments.


Instruction: Generate impression based on medical findings.

Input: 79-year-old female with bilateral hip pain status post fall. Well-circumscribed lucency in the diaphysis of the left proximal femur corresponds to chronic erosions from an adjacent soft tissue mass as seen on MRI of the femur dated 11/3/2015. Mild osteoarthritis affects both hips as well as mild degenerative disc disease affecting the visualized lower lumbar spine. No acute fracture or malalignment is identified.

Output: Mild osteoarthritis of bilateral hips without acute fracture or malalignment.


Instruction: Generate impression based on medical findings.

Input: Persistent headache, awaking the patient from sleep. Associated double vision, nausea and vomiting. The post contrast images are mildly limited by patient motion.BRAIN:There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Prominent lymph nodes in the included upper neck are nonspecific in this age group. There is trace mucosal thickening in the ethmoid sinuses, which is also nonspecific.BRAINSTEM/CRANIAL NERVES:There is no brainstem or root entry zone lesion. There is no abnormal contrast enhancement in the brainstem or along the cranial nerve roots. There is no skull base destructive lesion. The cavernous sinuses are symmetric. Carotid arterial flow voids are preserved.

Output: Normal examination. Specifically, there is no brainstem or cranial nerve abnormality.


Instruction: Generate impression based on medical findings.

Input: Right cerebellopontine angle mass, likely meningioma: vertigo. Internal Auditory Canals: There is a lobulated, partially enhancing, T2 hypointense mass that appears to be dural based in the right cerebellopontine angle cistern with slight extension into the right internal auditory canal, which measures up to approximately 9 mm. There is mass effect upon the right cranial nerve 7 and 8 complex, but no mass effect upon the pons. The left bilateral cranial nerve 7 and 8 complex are intact. The bilateral inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable.Brain: There is no evidence of intracranial hemorrhage or acute infarct. The brain parenchyma appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: An unchanged subcentimeter mass in the right cerebellopontine angle cistern with slight extension into the right internal auditory canal, which appears to be dural based, may represent a meningioma.


Instruction: Generate impression based on medical findings.

Input: Ms. Broughton is a 68-year-old female with a personal history of right breast lumpectomy for IDC/DCIS along with personal history of LCIS/ALH in right breast and focal ALH/UDH in left breast in 2007. She has no current breast related complaints. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild background parenchymal enhancement is noted bilaterally.Susceptibility artifact is seen in the upper right breast, corresponding to the surgical clips from patient's prior lumpectomy. There is no abnormal enhancement seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: Stable postsurgical changes of the right breast. No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on medical findings.

Input: Male 14 years old Reason: R knee cartilage injury vs. ligament tear History: R knee swelling MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: No articular cartilage defect. No abnormal signal within the bone. No evidence of osseous contusion. Apparent bone island is present within the medial femoral condyle near the physis.LIGAMENTS: The ACL, PCL, MCL, and lateral collateral complex are intact. No abnormal signal within the posterior lateral corner. EXTENSOR MECHANISM: Extensor mechanism is intact. No abnormal joint effusion.ADDITIONAL

Output: Medial fluid collection separate from the joint likely represents a small Morel Lavelle injury.


Instruction: Generate impression based on medical findings.

Input: A 40 year old male with Crohn's disease, s/p collectomy, atrial flutter after ablation and after cardiac arrest post-cardioversion. Now presents with new onset biventricular heart failure and referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with moderate to severely reduced systolic function. The overall LV ejection fraction is 36%, the LV end diastolic volume index is 97 ml/m2 (normal range: 74+/-15), the LVEDV is 255 ml (normal range 142+/-34), the LV end systolic volume index is 66 ml/m2 (normal range 25+/-9), the LVESV is 165 ml (normal range 47+/-19), the LV mass index is 55 g/m2 (normal range 85+/-15), and the LV mass is 138 g (normal range 164+/-36). There is hypokinesis of the entire septum and inferior wall at the base, middle and apical segments, there is hypokinesis of the anterior wall at the middle and apical segments. There is late gadolinium enhancement sparing the endocardium in the entire septum and inferior wall at the base, middle and apical segments, and in the anterior wall at the middle and apical segments. These findings suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process and are atypical for myocardial infarction. The T1-mapping times are normal.There is no myocardial iron overload.There is no intracavitary thrombus.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with severely reduced systolic function. The overall RV ejection fraction is 27%, the RV end diastolic volume index is 108 ml/m2 (normal range 82+/-16), the RVEDV is 271 ml (normal range 142+/-31), the RV end systolic volume index is 79 ml/m2 (normal range 31+/-9), and the RVESV is 199 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with moderate to severely reduced systolic function, the LVEF is 36%, though this has improved since previous study. There is hypokinesis of the entire septum and inferior wall at the base, middle and apical segments, there is hypokinesis of the anterior wall at the middle and apical segments. 2. There is late gadolinium enhancement sparing the endocardium in the entire septum and inferior wall at the base, middle and apical segments, and in the anterior wall at the middle and apical segments, similar in distribution to previous study. These findings suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process and are atypical for myocardial infarction. The T1-mapping times are normal. There is no myocardial iron overload. There is no intracavitary thrombus.3. The right ventricle is normal in size with severely reduced systolic function, the RVEF is 27%, though improved from previous study. 4. The right atrium is mildly dilated, improved from previous study.5. The main pulmonary artery is mildly dilated.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: Right knee stiffness MENISCI: There is abnormal signal intensity and morphology of the posterior horn of the medial meniscus which extends into the body and is consistent with complex tearing. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is full-thickness loss of the articular cartilage of the weightbearing portion of the medial femoral condyle particularly posteriorly with areas of less severe diffuse loss. There is diffuse thinning of the articular cartilage of the lateral femoral condyle but without discrete full-thickness defect. There is severe articular cartilage loss of the patellofemoral compartment with areas of full-thickness loss particularly affecting the medial compartment. Areas of full-thickness degeneration are also evident within the femoral trochlea, particularly laterally. There are small tricompartmental osteophytes and associated degenerative marrow changes within the femoral condyles bilaterally. A 2 cm ovoid focus is identified within the intercondylar notch best seen on series 5 image 18 which may represent a displaced chondral fragment.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Complex tearing of the medial meniscus.2. Tricompartmental osteoarthritis with areas of full-thickness articular cartilage loss affecting the medial and patellofemoral compartments. A 2 cm ovoid focus within the intercondylar notch may represent a displaced chondral fragment.3. Nonaggressive appearing chondroid lesion within the head of the fibula with possible adjacent ganglion cyst at the tibiofibular articulation.


Instruction: Generate impression based on medical findings.

Input: 56-year-old female with fall with leg pain. Concern for hamstring tear, assess muscle/tendon. Complete avulsion of the hamstring tendons (semimembranosus and conjoint tendon) from their ischial origin. Gap of approximately 3 cm between the retracted tendon edge and the ischium. Edema within the hamstring muscles as well as within the gluteus maximus and adductor magnus muscles and surrounding the sartorius and adductor muscles of the hip, perhaps representing strain.Mass of heterogeneous signal intensity situated between the semimembranous tendon and adductor magnus muscle, representing a hematoma.Edema within the surrounding soft tissues and around the sciatic nerve, although the nerve itself is intact.Bone marrow signal intensity is normal. Mild osteoarthritis affects the knee.

Output: Complete avulsion of the hamstring tendons from their origin on the ischium as described above.


Instruction: Generate impression based on medical findings.

Input: Left calf pain The muscles and tendons of the calf appear normal. The marrow signal of the tibia and fibula is also normal. A small Baker's cyst is present which is incompletely imaged.

Output: Small Baker's cyst which is incompletely imaged but otherwise no specific findings to account for the patient's pain.


Instruction: Generate impression based on medical findings.

Input: Newly diagnosed prostate cancer. PELVIS:PROSTATE:Prostate Size: 2.7 x 4.3 x 5.0 cmPeripheral Zone: The dominant lesion is noted in the left mid gland measuring 1.2 x 1.0 cm demonstrating low T2 weighted signal (series 701/19) and restricted diffusion (series 904/344). This lesion demonstrates relative washout.Additional lesion in the right base with similar characteristics (series 904/384).An additional 5 mm lesion is noted in the right lateral mid gland (series 701/17).Central Gland: Changes of BPH.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: There is suspected extracapsular extension of both the right and left mid gland lesions. On the left there is broad-based abutment and loss of definition of the prostate margin. On the right the lesion extends beyond the margins of the prostate.BLADDER: No significant abnormality noted.LYMPH NODES: No enlarged pelvic lymph nodes.BONES, SOFT TISSUES: No definite enhancing osseous lesion is identified.OTHER: No significant abnormality noted.

Output: Multifocal disease including bilateral mid gland lesions with suspected extracapsular extension as described above. No evidence of seminal vesicle invasion or enlarged pelvic lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: Stage IVb lung adenocarcinoma with progressive headache and anxiety-related memory deficits surveillance for brain metastases. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are minimal nonspecific cerebral white matter T2 hyperintense foci. There are subcentimeter right choroid fissure cysts. The ventricles and basal cisterns are otherwise 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: Incidental right subcentimeter right choroid fissure cysts. Otherwise, no evidence of intracranial metastases.


Instruction: Generate impression based on medical findings.

Input: 39 year-old female with painless jaundice. Rule out pancreatic mass. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Cholelithiasis without cholecystitis. Several small gallstones are present in the neck of the gallbladder. Infiltrative changes in the periportal fat and lymphadenopathy in the hepatic hilum. There is extensive periportal edema. These infiltrative findings surround the superior mesenteric artery and vein, confluence and main portal vein, possibly representing infiltrative neoplasm. The hepatic vasculature is patent. No biliary duct dilatation.SPLEEN: No significant abnormality notedPANCREAS: There is an area of ill-defined hypoenhancement in the pancreatic head seen on axial image 40/161 of series 4, which could represent a primary pancreatic neoplasm. For further evaluation with contrast-enhanced MRI and M.R.C.P. may be helpful, if indicated.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Large right upper pole simple benign cyst. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Ill-defined hypodensity in pancreatic head with associated fat infiltration and lymphadenopathy in the hepatic hilum. Periportal edema. Findings may be due to pancreatic neoplasm. Cholelithiasis without cholecystitis.


Instruction: Generate impression based on medical findings.

Input: 52-year-old female status post liver transplant with elevated bilirubin. Evaluate biliary tree. ABDOMEN:LUNG BASES: Moderate right and small left pleural effusions with underlying bibasilar atelectasis, partially visualized.LIVER, BILIARY TRACT: Postsurgical changes from liver transplantation. No focal hepatic lesions.Mild to moderate bilobar intrahepatic biliary ductal dilation with dilation of the common duct measuring up to 8 mm. There is an apparent transition point at the biliary enteric anastomosis, which appears narrowed.Hepatic and portal veins are patent.SPLEEN: No significant abnormality noted.PANCREAS: Mild atrophy of the pancreas. There are multiple small cystic foci throughout the pancreas, several of which demonstrate connection to the main pancreatic duct. These are most compatible with small branch type intraductal papillary mucinous neoplasms. No suspicious features. Normal caliber of the main pancreatic duct. For future reference, the largest at the posterior aspect of the pancreatic head measures 16 x 13 mm (series 5/26).ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal simple cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Enteric tube tip in distal duodenum.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Mild upper abdominal ascites and body wall anasarca.

Output: 1.Intra and extrahepatic biliary ductal dilation with narrowing at the biliary enteric anastomosis, which may be due to edema given recent transplantation.2.Multiple small pancreatic branch type IPMNs, for which follow-up imaging is recommended.


Instruction: Generate impression based on medical findings.

Input: 47 year old with known cardiac sarcoid and history of premature ventricular contraction and nonsustained ventricular tachycardia presenting with palpitations. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 63%, the LV end diastolic volume index is 78 ml/m2 (normal range: 65+/-11), the LVEDV is 145 ml (normal range 109+/-23), the LV end systolic volume index is 29 ml/m2 (normal range 18+/-5), the LVESV is 54 ml (normal range 31+/-10), the LV mass index is 40 g/m2 (normal range 67+/-11), and the LV mass is 75 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 56 %, the RV end diastolic volume index is 84 ml/m2 (normal range 69+/-14), the RVEDV is 156 ml (normal range 110+/-24), the RV end systolic volume index is 37 ml/m2 (normal range 22+/-8), and the RVESV is 88 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is trace mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsMediastinal lymph nodes are noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal LV size and systolic function (LVEF 63%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.2. Normal RV size and systolic function (RVEF 56%).3. See extra-cardiac findings.


Instruction: Generate impression based on medical findings.

Input: Left lumbar radiculopathy since 2 months Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. Small Schmorl's nodes are noted at T11-T12 endplates. Minimal disc bulges in the lower thoracic spine are also evident. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Mild disc bulge, facet arthropathy, and ligamentum flavum thickening. There is minimal central canal stenosis. Neural foramina are patent.L3-L4: There is a disc bulge which is eccentric to the left, with associated effacement of the left lateral recess and moderate left-sided neural foraminal stenosis. There is is also mild to moderate central canal stenosis related to disc bulge, ligamentum flavum thickening, and facet arthropathy. Mild right neural foraminal narrowing.L4-L5: There is mild disc bulge as well as ligamentum flavum thickening and facet arthropathy contributing to mild to moderate central canal stenosis. There is mild to moderate left and minimal right neural foraminal stenosis. L5-S1: No significant disc disease. There is moderate bilateral facet arthropathy. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: Multilevel degenerative changes in the lumbar spine with mild to moderate central canal stenosis at L3-L4 and L4-L5. There is also multilevel neural foraminal narrowing, worst at the left L3-L4 and to a slightly lesser degree left L4-L5 levels, with possible impingement of the exiting left L3 and L4 nerve roots, respectively. Additional details as above.


Instruction: Generate impression based on medical findings.

Input: 12 year old male with intractable epilepsy, evaluate for structural abnormality A small focus of susceptibility-weighted artifact is seen within the right corona radiata (image 43, series 8). There is no other perilesional signal abnormality. A second subcortical focus is present in the inferior right temporal lobe (image 21, series 5) which is T2 hyperintense and T1 hypointense. Neither lesion demonstrates associated mass effect. No diffusion restriction is seen to suggest acute ischemia. The CSF spaces are appropriate for the patient's stated age with no midline shift. The ventricles are normal in size and shape. Normal vascular flow voids are present in the major intracranial vasculature. 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.Nonspecific focus of susceptibility artifact in the right corona radiata may represent prior micro-hemorrhage, residua from prior trauma, or a small cavernoma. Given the patient's age, hemorrhagic metastasis is considered unlikely.2.Right temporal lobe T2 hyperintense T1 hypointense focus is favored to represent a neuroglial cyst or prominent perivascular space.3.Follow-up 3T MRI brain with contrast is recommended in 3 months to evaluate for stability.


Instruction: Generate impression based on medical findings.

Input: 65 years, Male, with nontraumatic subarachnoid hemorrhage. Additional patient history includes multiple myeloma, status post treatment four years prior, thrombocytopenia, and current bacterial endocarditis. MRI BRAIN

Output: 1. Multiple acute to subacute supra and infratentorial infarcts in multiple vascular territories, some of which are associated with scattered areas of intracranial hemorrhage and suboptimally evaluated nodular enhancement. For example restricted diffusion in the left parieto-occipital region with adjacent hemorrhage may represent hemorrhagic conversion of an embolic infarct (perhaps related to infective endocarditis). Subarachnoid hemorrhage is most evident in the left frontal and opercular regions, possibly related to thrombocytopenia. No intracranial abscess or empyema. 2. Note MRA centered at the circle of Willis does not include the entire head. No intracerebral aneurysm however is identified in the field-of-view within limits of mild motion degradation. If clinically appropriate CTA may be considered to evaluate the more peripheral vasculature (for possible pseudoaneurysms).


Instruction: Generate impression based on medical findings.

Input: 40 year-old male status post fall. Experiencing left-sided numbness/tingling. Evaluate for ICH/C-spine fracture There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. Mucosal thickening in the ethmoid sinuses representing mild sinus disease. Mastoid air cells are normally pneumatized.Cervical spine demonstrates normal alignment and no fracture. Neuroforamina are patent. No prevertebral soft tissue swelling. Questionable disc protrusion at the C5/C6 level to the left of midline. An MRI would be warranted if clinically indicated.

Output: 1. No evidence of intracranial process or cervical spine fracture.2. Questionable protruding disc to the left of midline at the level of C5/C6. MRI would provide more detail if clinically warranted.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Newly diagnosed small cell lung cancer. Initial CNS staging. Signs and symptoms: No CNS symptoms. Pre-and post-enhanced brain MRI:Examination demonstrate multiple small nonhemorrhagic enhancing metastatic lesions in the supra-and infratentorial brain parenchyma.There is a left posterior frontal metastatic lesion measuring at approximately 11 mm sized with minimal associated surrounding edema and no mass effect (post-enhanced SPGR series 13 image 147).There is a small 7.9-mm metastatic lesion in the left anterior temporal lobe on series 13 image 66.There is a left posterior temporal -- occipital metastatic lesion measuring approximately 6 mm on series 13 image 51.There is a right cerebellar metastatic lesion measuring at 4.9-mm on series 13 image 36.There is a 7.7-mm metastatic lesion in the inferior left cerebellum on series 13 image 26.There are a few nonspecific small foci of flair hyperintensity in the subcortical and periventricular white matter which could represent mild chronic small vessel ischemic strokes.Ventricular system and the CSF spaces are within normal and with maintained midline.Unremarkable images through the orbits.Mild diffuse chronic sinusitis more severe in the right chamber of the sphenoid and bilateral maxillary sinuses (left greater than right).No convincing evidence of calvarial metastatic lesions.

Output: 1.Multiple small supra-and infratentorial parenchymal metastatic lesions as detailed/measured above. The lesions demonstrate minimal surrounding edema and no mass effect. No convincing evidence of osseous metastatic lesions.2.Negative diffusion weighted images and findings suggestive of very minimal chronic small vessel ischemic strokes.3.Mild diffuse chronic sinusitis more severe in the right chamber of the sphenoid sinus and the maxillary sinuses (left greater than right).


Instruction: Generate impression based on medical findings.

Input: 83 year old female with right side neck mass. Again identified is a well-defined, heterogeneous soft tissue mass involving the superficial lobe of the right parotid gland. This lesion measures approximately 1.5 x 1.3 cm (image 43 series 3), unchanged. There is mild enhancement of the soft tissue component anteriorly. No definite additional masses are abnormal enhancement. The left parotid, sublingual, and submandibular glands are unremarkable. The oral cavity, oro/nasopharynx, hypopharynx, larynx and subglottic airways are unremarkable. The epiglottis, vallecula, piriform sinuses, and vocal cords are normal. No abnormal lymphadenopathy is noted. Calcified atherosclerosis affects both carotid arteries at the bifurcation, left greater than right. Small hypodense nodules are present within left thyroid gland. The jugular veins are patent. The osseous structures are unremarkable. The prevertebral and paraspinal soft tissues are unremarkable.  The visualized intracranial structures demonstrate ventriculomegaly, unchanged since prior brain MRI. The intraorbital structures are unremarkable. Degenerative changes affect the cervical spine. No suspicious focal osseous lesions are seen. Limited views of the chest are unremarkable.

Output: Stable partially-enhancing right parotid mass. Benign etiology, such as pleomorphic adenoma, is favored.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Unspecified convulsionsClinical question: infective cause of seizure MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.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.A small fatty sessile lesion is present adjacent to the right frontal bone probably a small lipoma measuring 5 mm x 20 mm coronal dimensionsMRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is small. The left posterior communicating artery is small the right posterior communicating artery is tiny.. The vertebral arteries are similar in size.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.

Output: 1.There is no evidence for acute ischemic cerebral infarction.2.There is no evidence for intracranial or extracranial cerebrovascular occlusive disease.3.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old, history of anaplastic astrocytoma, status post radiation, on temozolomide. The T2 hyperintense lesion within the thalamus shows no significant interval change in size or morphology over multiple prior examinations. A biopsy marker remains evident in the center of the lesion. The lesion demostrates intrinsic T1 hyperintensity with little if any true superimposed enhancement.A subcentimeter enhancing focus along the margin of the left ventricular atrium has decreased in size and conspicuity relative to prior exams.Ill-defined periventricular white matter T2 hyperintensity along the left lateral ventricle is stable when compared to the immediate prior examination, but shows slight expansion in geographic extent when compared to older exams. Some of this signal abnormality was evident on the patient's initial pretreatment studies.A 6 mm curvilinear area of T2 hyperintensity is seen within the left paramedian precentral gyrus, not definitely changed in size when compared to the immediate prior examination but slightly more prominent than on older studies. Of note, however, is the fact that this lesion now enhances whereas previously it did not.Numerous additional scattered small foci of T2 signal abnormality are seen throughout both cerebral hemispheres, without significant or convincing interval change. No new mass effect or parenchymal edema is detected. Ventricles are stable in size including mild ex vacuo dilatation of the left lateral ventricle.

Output: 1.No significant interval change in the size or appearance of the left thalamic lesion.2.Decrease in size and enhancement of a nodule of enhancement along the left lateral ventricular atrium.3.Ill-defined left periventricular white matter T2 hyperintensity is stable relative to the immediate prior examination but slightly more extensive when compared to older exams. It should be noted that some of this signal abnormality was present on the initial pretreatment examinations and therefore it cannot be attributed entirely to treatment effect. The possibility that some of this signal abnormality may reflect non-enhancing tumor must be considered.4.A curvilinear region of T2 hyperintensity within the left paramedian precentral gyrus is unchanged in size relative to the immediate prior examination but slightly more conspicuous when compared to older studies. Of note, however, is the fact that this lesion shows new enhancement on today's examination. The lesion is too small to accurately characterize, but for the reasons indicated in impression point number 3, the possibility of viable tumor in this location must be considered. Other etiologies including treatment related vascular injury are not excluded. Close interval follow-up is suggested.


Instruction: Generate impression based on medical findings.

Input: Reason: patient with b/l knee ulcerations and zygomycetes infection. Eval for extension of infection History: above There are multiple ulcerations including one situated anterior to the proximal tibia that extends deep to disrupt the superficial fibers of the distal patellar tendon, however, we see no findings to suggest patellar tendon rupture. There is also signal abnormality within the subcutaneous fat anterior to the patella likely representing additional ulceration with enhancement of the underlying soft tissues. Although there is perhaps mild edema within the underlying patella, we suspect this may reflect reactive osteitis and we see no frank bone destruction to confirm osteomyelitis. There is edema within the subcutaneous fat that becomes confluent, but we see no well-defined drainable fluid collection. There is a small joint effusion, but we see no findings to suggest a synovitis. The medial and lateral meniscus appear intact. The cruciate and collateral ligaments appear intact. The quadriceps tendon appears intact.

Output: Anterior soft tissue ulceration with focal disruption of the superficial fibers of the distal patellar tendon and other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Gait imbalance and brisk deep tendon reflexes. Brain MRI with and without Contrast:There are scattered, punctate T2/FLAIR hyperintense foci in the cerebral white matter, most numerous in the frontal and parietal white matter. They show no diffusion restriction or contrast enhancement. These are nonspecific but likely represent mild chronic small vessel ischemic changes. Postcontrast images are notable for developmental venous anomalies in the left occipital lobe and in the left cerebellar hemisphere. There is no abnormal parenchymal contrast enhancement, otherwise. There is no mass or midline shift. The CSF-containing spaces are mildly enlarged reflecting mild global volume loss. There is no susceptibility artifact to indicate intracranial hemorrhage. Major cranial vessels are patent.Mastoid air cells are clear. Mucosal thickening is moderate in the anterior ethmoid sinuses and mild to minimal in the other paranasal sinuses. The orbits are notable for bilateral cataract surgery.Cervical Spine MRI without Contrast:There is exaggeration of the cervical lordosis. The vertebral bodies are preserved in height. Marrow signal is mildly heterogeneous and benign. The intervertebral discs show loss of height and T2 signal at multiple levels, most pronounced at C5-C6 and C6-C7 levels. The spinal cord shows normal morphology and signal (down to the lower T5 vertebral level). Small right thyroid nodule. The imaged cervical soft tissues show no gross abnormality.Multilevel degenerative changes as described below:C2-C3: There is no spinal canal or foraminal stenosis.C3-C4: Small disc-osteophyte complex slightly eccentric to the left. There is no significant spinal canal or foraminal stenosis.C4-C5: Left uncovertebral proliferative change causes mild left foraminal narrowing. There is no spinal canal or right foraminal stenosis.C5-C6: Disc osteophyte complex is associated with left more than right uncovertebral proliferative change. This results in moderate left and mild right foraminal stenoses. Ligamentum flavum thickening. There is mild spinal canal stenosis.C6-C7: Disc osteophyte complex is minimal. Ligamentum flavum thickening. Mild spinal canal narrowing. Uncovertebral and facet proliferative change results in mild to moderate bilateral foraminal narrowing.C7-T1: There is no spinal canal or foraminal stenosis.

Output: 1.No evidence of intracranial mass or mass effect. No evidence of acute infarct or hemorrhage. Mild chronic small vessel ischemic changes.2.Mild degenerative changes in the cervical spine without high-grade spinal canal stenosis at any level. No cord signal abnormality. Individual levels as above including relatively mild spinal canal narrowing at C5-C6 and C6-C7.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: Neoplasm of unspecified behavior of brain [D49.6], Reason for Study: ^Reason: brain lesion. Preop planning for biopsy History: headaches. Multiple fiducial markers attached on the scalp during the scan.There is ill defined mainly non enhancing, T2 high signal intensity mass on the left mesial temporal lobe involving para hippocampal and fusiform gyri although more sequences will be helpful for precise anatomical localization. The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Left mesial temporal lobe ill-defined nonenhancing mass which shows T2 high signal intensity is described above.


Instruction: Generate impression based on medical findings.

Input: 51-year-old woman with left shoulder pain. Assess for labral tear. ROTATOR CUFF: The rotator cuff appears normal.SUPRASPINATUS OUTLET: The AC joint is normal. There is no fluid or gadolinium in the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. The articular cartilage of the glenohumeral joint is normal. The glenoid labrum appears normal with no evidence of tear.BICEPS TENDON: The tendon of the long head of the biceps appears normal.

Output: Normal left shoulder MRI with no evidence of glenoid labrum tear.


Instruction: Generate impression based on medical findings.

Input: Male 65 years old Reason: restaging liver disease - poorly differentiated carcinoma, behaving like neuroendocrine. no treatment since Feb 2014 (RT) last chemo 2/2013-4/2013 ABDOMEN:LIVER, BILIARY TRACT: Confluent large hepatic mass in the region of the hilum consistent with the patient's history of cholangiocarcinoma. This has increased in size compared to prior study. It measures approximately 8.2 x 6.5 cm ( series 16, image 118), previously 6.3 x 5.2 cm.Two peripherally enhancing reference lesions, which may represent necrotic components are stable/mildly increased compared to prior study.The hepatic dome lesion measures 3.1 x 1.9 cm (series 16, image 109), previously 3.0 x 2.3 cm.The segment 4 lesion measures 3.1 x 2.7 cm (series 16, image 119), previously 3.1 x 2.9 cm.The mass invades the hepatic veins and there is hepatic vein occlusion. The hepatic arteries and portal veins are patent. No biliary dilatation.Diffuse hepatic steatosis. Cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Renal cysts are unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Increase in size in large confluent hepatic mass, consistent with patient's known poorly differentiated carcinoma.


Instruction: Generate impression based on medical findings.

Input: Redemonstrated are cystic structures within the right parietal white matter demonstrating CSF isointensity on all sequences without enhancement or adjacent parenchymal abnormality. When compared to the recent CT, there are more of these foci within this small cluster given the better soft tissue discrimination of MRI. These have no associated mass effect.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. Myelination is mature. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The mastoid air cells are clear. There are no abnormal enhancing foci.

Output: Redemonstrated are cystic structures within the right parietal white matter demonstrating CSF isointensity on all sequences without enhancement or adjacent parenchymal abnormality. This constellation of features is consistent with dilated perivascular spaces which have no clinical significance.


Instruction: Generate impression based on medical findings.

Input: The thoracic spine is in normal alignment, with a normal thoracic kyphosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal.Surrounding the tip of the T1 spinous process, there is ill-defined enhancement and corresponding T1 hypointensity. There is no significant STIR hyperintensity within the marrow at this level. The cortex of the spinous process tip is somewhat ill-defined on 1201/16.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine. There is a nonenhancing oval lesion in the anterior interpolar right kidney which appears grossly similar to previous MRI lumbar spine images. This is nonspecific but most likely represents a small cyst.

Output: 1. Subtle ill-defined enhancement associated with the T1 spinous process tip with questioned ill-defined cortical margin, although no marrow signal abnormality is appreciated. CT could be obtained to evaluate for subtle osseous changes, or bone scan could be considered as clinically indicated.2. No definite T4 level abnormality appreciated.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Evaluate disk herniation. Signs and symptoms: LBP for months; cannot run. Also has tailbone pain. Nonenhanced lumbar MRI:Examination extends from T9 -- T10 disk level inferiorly through mid S3 and does not include the distal sacral spine.There is normal anatomical development, signal intensity and alignment of vertebral column.There is no evidence of any appreciable degenerative disk disease, no evidence of spinal canal compromise or stenosis at any level and no evidence of neural foraminal compromise. The alignment of the vertebral column is within normal and there is no evidence of marrow space T2/T2 stir hyperintensity to suggest edema in particular in the lower lumbar spine to suggest presence of pars defect.Lowermost visualized thoracic spine and thoracic cord is unremarkable. The signal intensity of conus and cauda equina is within normal and with normal termination of the cord at mid L1 level.No detectable perispinal soft tissue/musculature abnormalities. Visualized kidneys are unremarkable. Visualized SI joints are unremarkable.

Output: Unremarkable nonenhanced lumbar MRI.


Instruction: Generate impression based on medical findings.

Input: 76-year-old male with prostate cancer PELVIS:PROSTATE: Suboptimal examination due to the brachytherapy seeds.Prostate Size: 4.0 x 4.4 x 3.1 cm.Peripheral Zone: Scattered susceptibility artifact of prostate brachytherapy. T2 hypointensity in the right mid gland at the junction of the transitional and peripheral zone measuring 15 x 15 mm abuts the capsule with indistinct margins. Left mid gland 7 mm T2 hypointense lesion of the junction of the peripheral and transitional zone demonstrating early enhancement and early washout. A 4 mm T2 hypointense in the left gland base.Central Gland: Scattered susceptibility artifact of prostate brachytherapy. Moderate degree of benign prostatic hypertrophy.Seminal Vesicles: Asymmetry of the seminal vesiclesExtracapsular Extension: No extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Mild sigmoid diverticulosis without evidence of diverticulitis.

Output: 1.Multiple T2 hypointense lesions centered in the mid gland at the junction of the transitional zone and peripheral zone as well as the left base as described above.


Instruction: Generate impression based on medical findings.

Input: Male 58 years old; Reason: L ulnar sided wrist pain (TFCC) LIGAMENTS: The ligaments of the wrist are intact, without abnormal signal characteristics.TRIANGULAR FIBROCARTILAGE COMPLEX: The triangular fibrocartilage complex is intact, without features to suggest tearing. TENDONS: No significant abnormality noted. The tendons of the wrist are intact without abnormal signal characteristics.BONES: No significant abnormality noted. Note is made of a subcentimeter bone island in the distal ulna.ADDITIONAL

Output: Intact triangular fibrocartilage complex. No specific findings to account for the patient's pain.


Instruction: Generate impression based on medical findings.

Input: Chronic vomiting concerning for increased intracranial pressure. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

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


Instruction: Generate impression based on medical findings.

Input: Complex partial seizure: acute memory impairment. Brain MRI: There is a punctate focus of restricted diffusion in the right hippocampus. There is no evidence of intracranial hemorrhage or mass. There are minimal nonspecific scattered foci of cerebral white matter T2 hyperintensity. 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 orbits, skull, and scalp soft tissues are grossly unremarkable. There is a left maxillary sinus retention cyst.Brain MRA: There is no evidence of significant steno-occlusive lesions or aneurysms.Neck MRA: There is no evidence of significant steno-occlusive lesions.

Output: 1. A punctate focus of restricted diffusion in the right hippocampus likely represents an acute ischemic lesion related to "transient global amnesia".2. No evidence of significant steno-occlusive lesions involving the major head and neck arteries.


Instruction: Generate impression based on medical findings.

Input: 74-year-old female with right hemiparesis. Brain: There is no evidence of intracranial hemorrhage, mass or edema. There is a punctate focus of restricted diffusion in the left paramedian ventral pons, which likely represents an area of acute ischemia. Scattered periventricular and subcortical hypertense FLAIR signal abnormalities are compatible with chronic small vessel ischemic disease. Two subcentimeter foci of CSF signal intensity are seen in the right periventricular white matter, which likely represent old lacunar infarcts or prominent perivascular spaces. There is a wedge-shaped area of encephalomalacia in the right medulla, compatible with evolution of the prior infarction identified on the MRI dated 1/20/15. The ventricles and sulci appear prominent, compatible with parenchymal volume loss. No abnormal extra-axial fluid collection is identified. There is no midline shift or mass effect. The midline structures and craniocervical junction are within normal limits. Normal flow-voids are demonstrated in the major intracranial vascular structures. The paranasal sinuses are clear. There is partial opacification of the left mastoid sinus. There is a left lens replacement. The orbits are otherwise unremarkable. There is a non-specific right parotid gland nodule as seen on the recent CTA. Cervical Spine: The cervical spine demonstrates a normal alignment without evidence of subluxation or fracture. No significant marrow abnormalities are suspected. There is a focal, central disc protrusion at C2-C3 with mild narrowing of the central spinal canal. There is a focal, central disc protrusion at C3-4 with mild narrowing of central spinal canal and mild narrowing of the left neuroforamina. There is eccentric disc protrusion C4-5 with mild narrowing of the central spinal canal. At C5-6, there is mild disc bulge with mild narrowing of the right neuroforamina but no significant central spinal canal stenosis. At C6-7, there is mild disc bulge and mild bilateral neuroforaminal stenosis, left slightly greater than right, but no significant central spinal canal stenosis. There is no cord signal abnormality. There is an exophytic soft tissue nodule noted within the left neck, which is of uncertain clinical significance.

Output: 1.Punctate focus of restricted diffusion in the left paramedian ventral pons is compatible with acute ischemia. 2.Chronic infarct of the right medulla is seen.3.Cervical spondylosis is seen but no acute spinal abnormalities are detected.These findings were discussed with Dr. Kamson at the time of this dictation.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old, with paresthesias and dysesthesias with new onset muscle cramps in the right leg, status post cervical fusion from C3 through C6 in 2009. Numerous scattered small foci of T2 hyperintensity are demonstrated within the periventricular and subcortical white matter. The overall size and number of these lesions do not appear to have changed significantly from the prior examination.No evidence of parenchymal edema or mass effect is detected. A focus of susceptibility is evident along the right caudate head which is unchanged and compatible with chronic blood products or mineralization.No abnormal extra axial fluid collections are detected. The ventricular system is patent and within normal limits including mild asymmetry at the level of the frontal horns.On postcontrast images, no pathologic parenchymal or extra-axial enhancement is detected.Bone marrow signal characteristics are within normal limits. Minimal mucosal thickening is evident within the ethmoid air cells. Artifact related to orthopedic instrumentation is partially visualized in the upper cervical spine.

Output: 1.Scattered small foci of T2 signal abnormality are redemonstrated in the subcortical and periventricular white matter. The size and number of these lesions have not significantly changed. They are nonspecific and could reflect the sequelae of prior inflammation, gliosis, demyelination or a vascular process.2.No new or acute intracranial abnormalities which would account for the patient's new symptoms.


Instruction: Generate impression based on medical findings.

Input: Female 38 years old with abdominal pain, nausea and vomiting. Evaluate common duct for stone/sludge. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in size and has a smooth contour. There is no focal liver lesion.There is cholelithiasis but no gallbladder wall thickening or surrounding edema to suggest acute cholecystitis. No filling defects are seen within the normal diameter common duct. No intrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: 1.6 x 1.2 hyperintense focus along the right posterior mediastinum may represent a bronchogenic or pericardial cyst.

Output: Cholelithiasis without evidence of acute cholecystitis or choledocholithiasis.