Instruction: Generate impression based on medical findings.

Input: Dizziness and giddiness [R42], Reason for Study: ^Reason: etiology of vertigo spells History: dizziness spells Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion.Scattered multifocal bihemispheric periventricular white matter and centrum semiovale T2/flair high signal intensity lesions are seen. These lesions are nonspecific likely represent nonspecific small vessel ischemic disease. Comparing to prior scan, the number and extent of high signal intensity lesions appear to be increased slightly.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. Specifically, there is no evidence of arterial luminal stenosis or intracranial arterial aneurysm.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Slight interval progress of T2/flair high signal intensity lesions which likely represent nonspecific small vessel ischemic disease on bilateral periventricular white matter and centrum semiovale since prior scan. 3. No evidence of significant intracranial arterial luminal stenosis. No evidence of intracranial arterial aneurysm.


Instruction: Generate impression based on medical findings.

Input: Follicular lymphoma, unspecified, unspecified site [C82.90], Reason for Study: ^Reason: assess for brain mets- concern for paraneoplatic syndrome History: symptomatic hypotension No evidence of acute ischemic or hemorrhagic lesion.Multiple scattered patchy bihemispheric T2/FLAIR high signal intensity lesions on periventricular white matter and centrum semiovale indicate non specific small vessel ischemic disease.Minimal diffuse brain atrophy is age appropriate.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Nonspecific small vessel ischemic disease.No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old, with history of metastatic triple negative breast cancer with headache and abnormal CT findings. Pathologic leptomeningeal enhancement is demonstrated most notably in the right frontal lobe, but also along the brainstem and fissures of the cerebellum. Abnormal enhancement is seen along the cisternal segments of the fifth cranial nerves, within the IACs, and along the lower cranial nerve roots arising from the medulla.No evidence of significant parenchymal edema or generalized mass effect is seen. No acute intracranial hemorrhage or any abnormal extra axial fluid collection is detected. The ventricles remain normal in size and shape. There is evidence of widespread osseous metastatic disease.

Output: Diffuse pathologic leptomeningeal enhancement is seen which, given the clinical context, most likely represents leptomeningeal spread of disease.


Instruction: Generate impression based on medical findings.

Input: 63-year-old female with a family history of pancreatic carcinoma. Dilated pancreatic duct on previous MRCP. ABDOMEN:LIVER, BILIARY TRACT: No intra- or extra-hepatic biliary ductal dilation is identified. There is mild dilation of the main pancreatic duct measuring up to 6 mm in diameter. No focal mass lesions are identified. SPLEEN: No significant abnormality noted.PANCREAS: There is mild dilation of the main pancreatic duct measuring up to 6 mm in diameter. No focal mass lesions are identified. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: There is mild dilation of the main pancreatic duct which is of uncertain etiology but may be related to stricture/narrowing at or adjacent to the level of the ampulla, however, there is no focal mass lesions identified. Clinical correlation and follow-up examination is recommended.


Instruction: Generate impression based on medical findings.

Input: Evaluate for spinal cord malformations: Capillary malformation over gluteal cleft with sacral dimple. 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 conus medullaris is situated at the L1 vertebral body level. The paravertebral soft tissues are unremarkable.

Output: No evidence of malformations involving the lumbar spine. The capillary malformation in the gluteal cleft region is not discernible.


Instruction: Generate impression based on medical findings.

Input: History of retroperitoneal fibrosis. Evaluate for disease progression. ABDOMEN: Limited evaluation of the upper abdomen is unremarkable.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Small uterine fibroids.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Best seen on the delayed images (series 11 images 68 through 83) is partially circumferential enhancing soft tissue of the distal abdominal aortic bifurcation and proximal common iliac arteries, unchanged from the recent prior study.

Output: No significant interval change in gradually enhancing partially circumferential soft tissue of the aortobiiliac area.


Instruction: Generate impression based on medical findings.

Input: Left hip pain with long-term steroid use. Evaluate for fracture. There is serpiginous low T1 signal within the superior aspect of the bilateral femurs with a corresponding stripe of high and low T2 signal; these findings are compatible with avascular necrosis. There is no evidence of articular collapse. The remaining bone marrow signal is within normal limits.

Output: Avascular necrosis of the bilateral femoral heads without collapse.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old, with a left temporal tumor, fMRI requested for language lateralization prior to surgery. All tested language paradigms produced reliable language related activity. The highest quality images were obtained with the sentence completion, word generation, and verb generation paradigms. Language cortical activation was strongly right dominant with all paradigms. Putative Broca's area activity localized to the right inferior frontal gyri, and putative Wernicke's area activity localized along the posterior aspect of the right superior temporal sulcus. Strong secondary language related activity was elicited in the right middle frontal gyri, along with robust right SMA activation.

Output: Language related cortical activity is strongly right dominant.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Lung cancer with history of treated brain metastases. Please reassess disease. Signs and symptoms: Same. Enhanced head CT:No additional contrast is given for this exam. This examination was performed immediately post enhanced CT of chest abdomen and pelvis.There is no evidence of metastatic disease of brain parenchyma, leptomeninges or the calvarium. Aexamination demonstrates a developmental venous anomaly of the left anterior temporal lobe as was noted on prior enhanced brain MRI examination.The cortical sulci, ventricular system and CSF cisterns remain operating normal. Very subtle subcortical and periventricular low attenuation of white matter as was noted on prior brain MRI history to represent small vessel ischemic disease of indeterminate age.

Output: 1.No evidence of metastatic disease.2.Minimal small vessel ischemic strokes of indeterminate age.3.Revisualization of the left anterior temporal lobe development of venous anomaly.


Instruction: Generate impression based on medical findings.

Input: Female, 25 years old, with tethered cord, low back pain, scoliosis. Evaluate for changes. Posterior fusion instruments are in place extending from the T4 level down to the L4 level. Associated artifact obscures portions of the spine. Evidence of additional surgery is also seen in the lumbar region where the posterior elements are absent beginning at L2 and continuing down to L5. An S-shaped scoliotic curvature of the spine is seen which is predominantly levoscoliotic in the lumbar region with perhaps a mild dextroscoliosis in the thoracic region. Sagittal alignment is within normal limits. Vertebral body heights are preserved. No evidence to suggest marrow edema or pathologic marrow replacement is seen.Findings compatible with split cord malformation (diastematomyelia) are seen. Partial separation of the hemicords begins at the T7 level. The hemicords become completely separated at T12 and then re-unite at the L2 level. No definite evidence of an intervening osseous spur is seen. Image quality is not adequate to exclude the possibility of a thin fibrous septation.Below the L2 level, the re-united cord becomes closely apposed to the dorsal thecal sac. The spinal cord is low lying and reaches at least to the L3 level. On prone imaging, the distal spinal cord and cauda equina nerve roots remain closely apposed to the dorsal thecal sac.A thin T1 hyperintense cord-like structure is evident dorsally beginning at the L4 level compatible with a fatty filum terminale. At the L5 level, there is a gap of approximately 2 cm where no definite fatty filum is seen. However, the fatty filum reappears at the S1 level (see image 12 series 1301).

Output: 1.A scoliotic curvature of the spine is demonstrated. Long segment thoracolumbar instrumented fusion has been performed.2.Absent posterior elements in the lower lumbar spine likely represent additional postoperative change though this could also potentially represent congenital dysraphism.3.Findings are seen compatible with split cord malformation. The cord begins to separate into two halves at the T7 level with complete separation evident at T12. The hemicords re-unite at the L2 level. No definite evidence of an intervening osseous spur is seen, though image quality is not adequate to exclude the possibility of a fibrous septation.4.A T1 hyperintense cord like structure in the lower lumbar spine along the dorsal thecal sac likely represents fatty infiltration of the filum terminale. It appears that there is a 2 cm long disruption in this structure which could indicate prior surgical detethering. Alternately, the filum terminale may only be intermittently fatty infiltrated.5.Multiple findings are seen suggesting tethered cord including a low-lying spinal cord, the presence of fatty infiltration of the filum terminale, and lack of cord movement on prone imaging.


Instruction: Generate impression based on medical findings.

Input: 68-year-old male with colon cancer ABDOMEN:LIVER, BILIARY TRACT: Numerous hepatic lesions have increased from the prior MRI but are similar to the recent CT. A left hepatic lobe lesion measures 2.1 x 1.9 cm, similar to the recent CT but new from the prior MRI. Localized intrahepatic ductal dilatation in the left hepatic lobe, similar to the prior exam. There is tumor abutting the right portal vein. Isointense signal within a small portion of the adjacent right portal vein likely represents volume averaging, as this appears patent on the same day CT. The main portal vein vein is narrowed by adjacent lymphadenopathy but is patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple small cysts.RETROPERITONEUM, LYMPH NODES: Portacaval lymph node measures 2.2 x 1.3 cm (10/142), previously 1.8 x 1.1 cm on the prior MRI. Additional para-aortic nodes have increased since the prior exam.BOWEL, MESENTERY: Multiple mesenteric masses with a lesion anteriorly along the surgical scar measuring 2.9 x 3.6 cm (10/170). A left upper quadrant lesion measures 3.4 x 3.1 cm (10/128). An additional lesion is seen involving the descending colon. These are all increased from the prior MRI.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Elevation of left hemidiaphragm. Multiple right lower lobe pulmonary nodules with a prominent subpleural nodule measuring 1.0 x 0 cm (10/207), better evaluated on CT.

Output: 1.Hepatic and mesenteric metastases as well as retroperitoneal lymphadenopathy have increased since the prior MRI but are similar to the recent CT.2.Portal vein is narrowed but patent.3.Lung metastasis are better evaluated on CT.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Multiple sclerosisClinical question: please do Dr Javed MS protocol, c/w priorSigns and Symptoms: progression MS MRI brain: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.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. No abnormal enhancing lesions are identified in the cervical spine. There is a small T2 hyperintense lesion present along the right posterior lateral aspect of the spinal cord at the C3-4 disc space level. There is a small T2 hyperintense lesion along the left posterior lateral aspect of the spinal cord at the C6-7 level. There is a T2 hyperintense lesion measuring 11 mm in superior-inferior length along the posterior aspect of the spinal cord at the T1 vertebral level.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a mild disc bulge present at this level.At C5-6 there is a disc bulge present associated with hypertrophy of the ligamentum flavum and partial effacement of spinal fluid ventral and posterior to the spinal cord. There is some narrowing of the left neural foramen at this level as a result of disc material with encroachment of left-sided exiting nerve roots. Overall there is a mild to moderate degree of spinal stenosis at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a mild disc bulge present at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Thoracic spine:There is a T2 hyperintense lesion measuring 11 mm in superior-inferior length along the posterior aspect of the spinal cord at the T1 vertebral level. This is associated with mild mass effect but no contrast enhancement.There is a T2 hyperintense lesion along the right posterior lateral aspect of the spinal cord at the T6-7 disc space level.A small disc protrusions present along the right paramedian region at the T7-8 level.The thoracic vertebral bodies are appropriate in the overall alignment and height. There is no compromise of thoracic spinal canal or exiting nerve roots. No abnormal enhancing lesions are identified in the thoracic spine.

Output: 1.There are multiple lesions identified in the cervical and thoracic spinal cord which are suspicious for demyelinating lesions. The largest one is at the T1 vertebral level. Lack of contrast enhancement suggests that these are not acute.2.On the available pulse sequences, there are no lesions identified in the brain parenchyma to suggest demyelination.3.There are some degenerative changes present in the cervical spine with mild to moderate spinal stenosis at C5-6 and some encroachment of the left-sided exiting nerve roots at C5-6.


Instruction: Generate impression based on medical findings.

Input: Note that the examination is limited due to patient movement and the lack of intravenous contrast due to poor renal function.There is a mass involving the left posterior cingulate gyrus and corpus callosum measuring 2.2 x 2.2 cm with susceptibility effect compatible with hemorrhagic component and extensive vasogenic edema. Vasogenic edema extends into the left posterior frontal and temporal lobes. There is significant effacement of the left lateral ventricle and up to 6 mm of rightward midline shift. No uncal herniation. No hydrocephalus. There is also a lesion in the right superior frontal gyrus that measures 7 x 8 mm also with extensive surrounding vasogenic edema. There are additional smaller lesions with mild vasogenic edema in the anteroinferior left temporal lobe and right temporal lobe.Atrophy is again noted in the right cerebellum. Normal flow-voids are demonstrated in the major intracranial vascular structures.

Output: 1.Limited examination due to patient motion and absence of intravenous contrast. There are at least four lesions which are seen with extensive surrounding vasogenic edema, the largest of which is in the left posterior cingulate gyrus. These lesions are suspected to represent metastatic disease and biopsy can be considered as clinically warranted.2.Mass effect with up to 6 mm of rightward midline shift. No uncal herniation. No hydrocephalus.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: Per EPIC, past medical history significant for "brain tumor", hepatitis C, epilepsy, alcohol abuse, and hypertension who presents with headaches. There are post-surgical changes related to a remote right temporal craniotomy. There is a surgical cavity with surrounding mild confluent T2 hyperintensity in the right inferior temporo-occipital region. There is ex vacuo dilatation of the right occipital horn. There is mild dural enhancement along the right tentorium, which is likely treatment-related. There is otherwise no evidence of abnormal intraparenchymal enhancement. There is no definite evidence of elevated relative cerebral blood volume. There is no evidence of acute intracranial hemorrhage or acute cerebral infarction. There is diffuse prominence of the cerebellar sulci. There are a few scattered foci of nonspecific susceptibility effect in the right cerebellar hemisphere. There is no midline shift or herniation.

Output: 1. Post-surgical changes in the right temporo-occipital region with mild surrounding signal abnormality that may be treatment-related, but no appreciable mass effect to suggest tumor. However, the evaluation is limited without the availability of prior imaging and without specific information regarding the particular tumor type.2. Diffuse cerebellar atrophy, which may be related to seizure medication or alcohol abuse.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Cerebral infarction, unspecifiedClinical question: rule out ischemic infarct, R MCA distributionSigns and Symptoms: worsening of known dysarthria, left UE, LE weakness There are no foci of diffusion restriction appreciated.There is encephalomalacia involving the right parietal lobe and to lesser degree adjacent right frontal lobe and temporal lobe as well as right insular cortex. This is all in the distribution of the right middle cerebral artery territory predominantly. There is associated loss of volume of the right cerebral peduncle. There is associated ex vacuo effect along the right lateral ventricle.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is no evidence for acute infarction.2.Encephalomalacia involving right middle cerebral artery territory structures predominantly centered in the right parietal lobe but also involving the adjacent brain is most likely related to prior cerebrovascular event.3.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on medical findings.

Input: Female, 19 years old, with weight gain, secondary amenorrhea, elevated urine free cortisol, elevated salivary cortisol, responded to dex suppression CRH stimulation. A 3 x 2 x 2 mm focus of hypoenhancement is seen within the superior left aspect of the pituitary gland. The gland shows generally heterogeneous enhancement posteriorly, but is otherwise normal in size and morphology. The pituitary stalk enhances normally and enters the gland at midline. No suprasellar encroachment is seen. No significant abnormality is detected elsewhere in the visualized brain.

Output: A focal region of hypoenhancement within the superior left aspect of pituitary gland could represent a microadenoma as clinically suspected. Generally heterogeneous enhancement of the posterior aspect of the gland may also be related, or this may be an incidental variation.


Instruction: Generate impression based on medical findings.

Input: There is straightening of the cervical spine which is likely positional. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: Unremarkable and unchangedC3/4: Minimal disc bulge without significant stenosis, unchanged.C4/5: There is a new right paracentral disc protrusion which causes slight anterior right hemicord flattening without intrinsic cord signal abnormality. There is no significant central or foraminal stenosis.C5/6: Redemonstrated is a focal right paracentral disc protrusion causing slight anterior hemicord flattening without intrinsic cord signal abnormality. There is no significant central or foraminal stenosis. These findings are unchanged.C6/7: Progressive mild disc bulge without cord encroachment, cord deformation, or resulting stenosis.C7/T1: Unremarkable and unchanged.

Output: 1.C4/5: There is a new right paracentral disc protrusion which causes slight anterior right hemicord flattening without intrinsic cord signal abnormality. There is no significant central or foraminal stenosis.2.C5/6: Redemonstrated is a focal right paracentral disc protrusion causing slight anterior hemicord flattening without intrinsic cord signal abnormality. There is no significant central or foraminal stenosis. These findings are unchanged.3.C6/7: Progressive mild disc bulge without cord encroachment, cord deformation, or resulting stenosis.


Instruction: Generate impression based on medical findings.

Input: Reason: Right shoulder pain evaluate for SLAP tear History: Right shoulder pain ROTATOR CUFF: The supraspinous, infraspinous, subscapularis, and teres minor tendons appear intact without evidence of tearing or tendinopathy.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is signal irregularity along the anterior superior glenoid labrum which is likely postsurgical. There is no discrete focal linear signal abnormality or additional findings to suggest focal labral tear.BICEPS TENDON: The biceps tendon is intact without evidence of tearing or tendinopathy. ADDITIONAL

Output: Mild irregularity of the anterior superior glenoid labrum is favored to represent postsurgical changes. There are no findings to suggest focal labral tear.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old. Left wrist pain. Evaluate for TFCC tear. LIGAMENTS: The scapholunate and lunotriquetral ligaments appear grossly intact.TRIANGULAR FIBROCARTILAGE COMPLEX: There is a small central perforation of the TFCC with small amount of fluid and debris within the the distal radioulnar joint consistent with synovitis.TENDONS: There is increased signal within the extensor carpi ulnaris tendon indicating an intrasubstance tear and tenosynovitis. The remaining tendons are grossly intact.BONES: There is increased signal within the bone marrow on T2 sequences without corresponding abnormality on T1 sequences. This may represent either red marrow reconversion or bone resorption. No evidence of fracture. Mild osteoarthritis affects the carpometacarpal articulations.ADDITIONAL

Output: 1. Small central perforation of the TFCC with synovitis of the distal radioulnar joint.2. Diffuse increased signal within the bone marrow likely representing osteopenia/osteoporosis. No evidence of fracture.3. Intrasubstance tear and tenosynovitis of the extensor carpi ulnaris tendon. 4. Soft tissue swelling about the ulnar aspect of the hand.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old. Right knee pain. Rule out medial meniscal tear. MENISCI: There is globular signal abnormality within the posterior horn of the lateral meniscus without clear linear signal which may represent intrasubstance degeneration. The anterior horn of the lateral meniscus appears intact. There is a complex tear of the body of the medial meniscus extending into the posterior horn with mild extrusion. The anterior horn of the medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is bone marrow edema presumably due to contusion predominantly within the medial femoral condyle and also within the femoral and tibial metaphyses. There is signal abnormality within the articular cartilage of the medial femoral condyle with underlying osseous changes. There is also a focal defects within the articular cartilage of the anterior femur.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Complex tear of the medial meniscus with additional degenerative changes above.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Unspecified convulsionsClinical question: first time seizureSigns and Symptoms: HIV, first time seizure The CSF spaces are appropriate for the patient's stated age with no midline shift. There is T2 and FLAIR heterogeneous signal hyperintensity in the basal ganglia bilaterally. There is no associated diffusion restriction.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: Bilateral basal ganglia lesions. The differential is fairly broad and includes lymphoma and infections (cryptococcus, toxoplasma and viral) as well as neurodegenerative/metabolic causes such as Wilson disease and Huntington disease . Although included in the differential, its distribution and appearance is not typical for hypoglycemic encephalopathy, ischemia, CJD and extrapontine myelinolysis.


Instruction: Generate impression based on medical findings.

Input: Posterior instability ROTATOR CUFF: No significant abnormality noted.SUPRASPINATUS OUTLET: There are surgical changes relating to subacromial decompression/Mumford procedure. There is slight widening of the acromioclavicular joint with fluid present within the joint itself.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted. The posterior labrum demonstrates a thickened and rounded appearance reflecting mild congenital dysplasia of the posterior glenoid. There is no evidence of a labral tear.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1. No evidence of intra-articular pathology.2. Postsurgical changes relating to subacromial decompression. There is a mild amount of fluid within the acromioclavicular joint which is also widened. These findings are nonspecific but may relate to a mild bursitis or recent intervention.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Evaluate for herniated disc. Signs and symptoms: Right lumbar pain. Nonenhanced lumbar MRI:Unremarkable lower most visualized thoracic spine and cord from T11 inferiorly.T12-L1, L1-L2, L2-L3 levels are unremarkable.L3-L4 demonstrate mild ligamentum flavum hypertrophy and minimal facet disease without spinal stenosis or neural foraminal compromise.L4-L5 demonstrate mild disc desiccation with loss of disc height and mild bilateral facet and ligamentum flavum hypertrophy. There is a central and rightward broad base disc protrusion with resultant mass effect and posterior displacement of the thecal sac causing mild central spinal stenosis. There is also significant right and mild left lateral recess compromise without neural foraminal compromise.5-S1 demonstrate moderate disc disease and loss of disc height, mild bilateral ligamentum flavum and mild facet hypertrophic changes. There is a right lateral disc extrusion resulting in significant right lateral recess compromise and mass effect on the right S1 nerve root (axial T2 series 7 image 44). No spinal stenosis or neural foraminal compromise.The alignment of vertebral column remains within normal and no detectable perispinal soft tissue abnormalities.

Output: 1.L5-S1 demonstrate degenerative changes as well as a right lateral disc extrusion with resultant mass effect on the right lateral recess without spinal stenosis or neural foraminal compromise.2.L4-L5 demonstrates degenerative changes and a broad-based central and rightward disc protrusion resulting in mild central spinal stenosis and bilateral recess compromise (right greater than left) and without neural foraminal compromise.3.Unremarkable images at other levels.


Instruction: Generate impression based on medical findings.

Input: Meningioma. Brain: There are multiple foci of restricted diffusion in the left parietal lobe and to a lesser degree left posterior frontal, left posterior temporal and left occipital lobes. There are areas of associated T2/FLAIR hyperintensity as well as T1 hyperintensity reflecting laminar necrosis, which are new since prior from 3/12/2016. There are also areas of associated parenchymal enhancement. Findings are consistent with acute and subacute infarcts. There is also cortical volume loss in the left parietal lobe likely reflecting chronic infarct, but new since prior. There is no associated mass effect or evidence of hemorrhagic confirmation.Multiple additional scattered chronic infarcts including the right temporal parieto-occipital lobes as well as the right postcentral gyrus and left paramedian pons are again seen. There is T2 hyperintensity along the middle cerebellar peduncles, likely reflective of Wallerian degeneration. Additional nonspecific scattered T2/FLAIR hyperintense foci are compatible with small vessel ischemic disease.There is no appreciable change in the enhancing dural-based mass centered in the right cavernous sinus region that measures up to approximately 25 mm in the AP dimension There is mild extension into the right prepontine cistern posteriorly as well as extension into the right middle cranial fossa inferiorly. Tumor extends to fill the right Meckel's cave. There also appears to be intrasellar extension. There is no midline shift or herniation. No hydrocephalus. The flow-voids of the cavernous internal carotid arteries are somewhat diminutive as is the right vertebral artery flow-void. Arterial stenoses are better assessed on prior CTA from 12/4/2015.Orbits: There is no evidence of intraorbital mass lesions or abnormal enhancement. The bilateral globes, lacrimal glands, optic nerves, and extraocular muscles are unremarkable. Optic chiasm is also unremarkable.

Output: 1. Multiple acute and subacute infarcts in the left parietal lobe and to a lesser degree in the left temporal, occipital, and posterior frontal lobes. Additional chronic infarcts including the right cerebral hemisphere and left pons are also again evident.2. No significant change in right cavernous sinus meningioma.3. Arterial stenosis better assessed on prior CTA from 12/4/2015.Dr. Ali discussed findings of infarcts with Dr. Reeti Greenwald (neurology) at noon on 9/21/2016.


Instruction: Generate impression based on medical findings.

Input: A patient submitted outside study for review. Submitted for review are breast MRI (4/21/16) performed at DuPage Medical Group. For comparison, digital mammographic images (4/18/2016), ultrasound images of right breast (4/18/2016), images from ultrasound guided biopsy of the right breast and postprocedural right mammographic images (4/18/2016) are available. Breast MRI was performed with a protocol outlined in the outside radiology report.There is an irregularly shaped enhancing mass measuring 24 x 22 x 32 mm (AP x LR x CC) at 12:00 position in the right breast, which is a biopsy-proven carcinoma. An artifact from a marker clip is present at posterior aspect within the mass. The lesion is close to the skin on the sagittal view; the distance from the skin is about 4 mm.No abnormal enhancement is seen in left breast. No abnormal lymph nodes are identified in either axillary region.

Output: 1. Unifocal cancer in the right breast at 12:00 position.2. No MRI evidence for malignancy in left breast. 3. No abnormal lymph nodes in either axillary region.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Rule out structural lesion or ischemia. Signs and symptoms: Right-sided weakness. Pre- and post enhanced brain MRI:Diffusion weighted images demonstrate well-demarcated focus of restricted diffusion in the left caudate head measuring at 16 x 17 mm in transaxial dimensions. Additional focus of restricted diffusion in the left paramedian pons measuring at 8 x 21 mm in transaxial dimensions and consistent with acute nonhemorrhagic ischemic strokes.Above findings are also well visualized on both FLAIR and T2-weighted images as foci of hyperintensity.Additionally examination demonstrate extensive periventricular and to a lesser degree subcortical foci of FLAIR hyperintensity consistent with moderate chronic small vessel ischemic strokes with resultant mild ex vacuo dilatation of lateral ventricles. Post enhanced images demonstrate no detectable abnormal parenchymal or leptomeningeal enhancement.The signal voids of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses is normal and mid normal pattern of enhancement.Unremarkable calvarium, paranasal sinuses and mastoid air cells.Images through the orbits demonstrate a chronic blowout fracture of the floor of right orbit with evidence of retro-orbital fat herniation inferiorly of approximately 10 mm.

Output: 1.Acute ischemic stroke of the left caudate head and left paramedian pons as detailed/measured above.2.Extensive chronic small vessel ischemic strokes with resultant mild ex vacuo dilatation of lateral ventricles.3.No detectable abnormal enhancement.4.Chronic blowout fracture of the right orbital floor with 10 mm inferior herniation of retro-orbital fat.


Instruction: Generate impression based on medical findings.

Input: Hand and wrist pain x1 month. There is a positive ulnar variance and there is a cyst on ulnar side of the lunate. These findings can be associated with ulnar impaction syndrome in the correct clinical context. This can be confirmed with an MRI of the wrist.No fracture or dislocations.

Output: Positive ulnar variance and cyst formation in the lunate suggestive of ulnar impaction syndrome. Further evaluation with an MRI should be considered.


Instruction: Generate impression based on medical findings.

Input: 70 years Female (DOB:10/7/1945)Reason: evaluate olfactory bulb/clefts History: anosmia x 7-8 years of unknown etiologyPROVIDER/ATTENDING NAME: SAMANTHA M ZUNICH ROBERT M NACLERIO The CSF spaces are appropriate for the patient's stated age with no midline shift. Findings suggest a developmental venous anomaly in the left frontal lobe. On susceptibility imaging and postcontrast imaging there is a lesion with a cap reduce a appearance within the left frontal lobe white matter directed towards the left inferior frontal gyrus.There are several periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Given the patient's stated age of 70 0 little clinical significance.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. The eyeball lenses are thin.

Output: No intracranial mass lesion is appreciated and no explanation for the patient's and nausea can be ascertained based on this exam.


Instruction: Generate impression based on medical findings.

Input: MS flare versus new ischemia. There is redemonstration of multiple hyperintense T2/FLAIR foci in the periventricular region. Two large lesions are seen in the right peri-atrial white matter, which demonstrates progressive T1 hypointensity, suggestive of chronic evolution and tissue loss. A high T2 signal lesion is seen in the splenium and posterior aspect of the corpus callosal body. High T2 signal is also seen in the hypothalamus, left greater than right. Additional high T2 signal is seen in the left periventricular region of the temporal horn with tiny lesions in the right greater than left cerebellum. There are a few subcortical high signal lesions. There is high T2 right cerebellar peduncle. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. There is interval progression of mucosal thickening of the visualized paranasal sinuses. There is a partially empty sella.

Output: 1. Multiple scattered white matter lesions without significant interval change. No enhancing lesion to suggest active demyelination.2. No evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on medical findings.

Input: Biopsy-proven DCIS in 2015 presents for staging. History of nipple discharge. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Spanning the anterior to posterior depth of the left upper outer quadrant is suspicious nonmass enhancement compatible with known DCIS. This extends from near the chest wall to the level of the nipple. Overall extent measures 13.7 x 4.6 x 3.8 cm. Given the nonmass enhancement pattern, this is favored to represent DCIS rather than invasive malignancy.In the right inferior breast near 6:00, a 5 mm enhancing focus with areas of high T2 signal adjacent to it may represent a cluster of cysts with rim enhancement versus a small papilloma with adjacent dilated fluid filled duct. An enhancing skin lesion is also present on the right inferior breast, likely benign, though suggest correlation with physical exam.No abnormal axillary lymph nodes are identified in either axillary region. Normal sized symmetric lymph nodes are in each axilla.

Output: 1. Extensive nonmass enhancement in the left breast spanning over 13 cm compatible with the patient's known DCIS. This extends from near the chest wall to near the level of the nipple.2. Enhancing focus in the right inferior breast is low suspicion. However, correlation with ultrasound is recommended, and if a solid vascular mass is seen, then biopsy should be performed. If only cysts are seen, or if ultrasound is negative, then a 6 month follow up MRI would be reasonable.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: MRI BRAIN: There is focus of diffusion hyperintensity in the right parietal subcortical white matter with suggestion of some areas with high ADC and low ADC. As such this may represent a subacute infarct. Otherwise no restricted diffusion in the remainder of the brain and no evidence of parenchymal edema. No intracranial mass or mass effect.Again seen is susceptibility artifact related to subdural hemorrhage involving the posterior falx and bilateral tentorial leaflets. Component of the subdural hemorrhage also demonstrates T1 hyperintensity.No evidence of intracranial mass effect. No hydrocephalus. Paranasal sinuses and mastoid air cells are clear. Bone marrow signal and extracranial soft tissues are unremarkable.MRA BRAIN:There is intracranial internal carotid arteries are widely patent with no evidence of aneurysm or flow-limiting stenosis. The anterior, posterior, and middle cerebral arteries are widely patent. There is normal circle of Willis. The basilar artery and the bilateral vertebral arteries are widely patent. MRV BRAIN:MR venogram is technically limited and not adequate to exclude thrombosis. Major dural venous flow voids are not clearly identified to confirm patency.

Output: 1. Subdural hemorrhage along the falx and tentorial leaflets is again seen. No associated mass effect.2. Small focus of diffusion hyperintensity and T2/FLAIR hyperintensity with some component suggesting low ADC although part of it is definitely high on ADC. As such this may represent a subacute infarct. No definite evidence of acute infarcts in the remainder of the brain.3. No evidence of parenchymal hemorrhage or parenchymal edema. MR venogram is technically limited and not adequate to exclude thrombosis. Major dural venous flow voids are not clearly identified to confirm patency. Recommend MR venogram with contrast with inclusion of postgadolinium 3D FSPGR sequence to exclude venous sinus thrombosis.4. MRA demonstrates no evidence of flow-limiting stenosis or aneurysms in the intracranial circulation.Dr. Ali discussed findings with Dr.Derani at 925 hrs on 9/6/2015I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Prostate cancer. Evaluate for high risk features. PELVIS:PROSTATE:Prostate Size: 2.9 x 5.6 x 4.2 cmPeripheral Zone: In the left medial apex there is a 1.0 x 0.5 cm lesion with decreased T2/ADC signal (series 1001/11) as well as diffusion restriction (series 1104/1 84).In the right lateral mid gland there is a 9 x 7 mm focus with decreased T2/ADC signal (series 801/68) as well as associated restricted diffusion (series 1104/224).There is atrophy at the right base with ill-defined decreased T2 signal but no associated abnormal signal on ADC/DWI.Central Gland: Mild benign prostatic hyperplasia. No discrete suspicious lesion.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: Small left external iliac lymph nodes are nonspecific. No additional enlarged pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Dominant 1.0 cm left medial apex and 0.9 cm right lateral mid gland lesions, suspicious for prostatic adenocarcinoma.2.Indeterminate ill-defined lesion at the right base. 3.No evidence of extracapsular extension or pelvic lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: Female 73 years old status post History of Roux-en-Y hepaticojejunostomy with new transaminitis and elevated bilirubin. Evaluate for biliary obstruction. ABDOMEN:LIVER, BILIARY TRACT: No focal liver lesion or ascites. Status post Roux-en-Y hepaticojejunostomy. The common duct measures up to 7 mm in diameter. There is mild intrahepatic biliary ductal dilatation which has improved slightly compared to the prior outside exam. No biliary stones or other obstructing lesions identified. There are no intrahepatic biliary strictures. The hepaticojejunostomy is widely patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There are numerous simple appearing bilateral renal cysts. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post Roux-en-Y hepaticojejunostomy.BONES, SOFT TISSUES: T10 vertebral body hemangioma.OTHER: No significant abnormality noted.

Output: Status post Roux-en-Y hepaticojejunostomy with no evidence of choledocholithiasis or biliary stricture.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Lumbar radiculopathy. Signs and symptoms: Right sciatica. Nonenhanced lumbar MRI:Examination demonstrates mild dextroscoliosis centered at L3-L4 level and weight grade 1 right lateral listhesis at L3-4 level.On sagittal images there is also evidence of grade 1 anterolisthesis at L3-L4 level.T11-T12 is unremarkable.T12-L1 is unremarkable.L1-L2 demonstrate mild disc disease and facet/ligamentum flavum hypertrophy and result in mild central spinal stenosis without neural foraminal compromise.L2-L3 demonstrate moderate disc disease and loss of disc height, moderate bilateral ligamentum flavum hypertrophy without significant facet hypertrophy. There is however bilateral facet space widening and effusion. Constellation of changes results seen moderate central spinal stenosis with mild right and moderate to significant left neural foraminal compromise.L3-L4 demonstrate advanced degenerative disc with significant loss of disc height, moderate bilateral ligamentum flavum hypertrophy, mild bilateral facet disease. There is evidence of grade 1 anterolisthesis as well as right lateral listhesis at this level. Constellation of changes results in significant central spinal and bilateral (L>R) stenosis.L4-L5 demonstrate mild disc disease, moderate bilateral ligamentum flavum hypertrophy without significant facet hypertrophic changes. There is however mild bilateral facet effusion present. There is increased dorsal epidural fat at this level and constellation of changes results in mild central spinal stenosis at this level with mild to moderate left and significant right neural foraminal compromise.L5-S1 demonstrate mild disc disease and mild bilateral facet and ligamentum flap and degenerative changes without spinal stenosis or neural foraminal compromise.

Output: 1.Advanced degenerative changes at L3-L4 and including grade 1 anterolisthesis as well as right lateral listhesis results in significant central spinal stenosis and significant bilateral neural foraminal compromise.2.Degenerative changes at L2-L3 results in moderate central spinal stenosis and bilateral neural foraminal compromise as detailed above.3.Degenerative changes at L4-L5 level results in mild central spinal stenosis with significant right and mild to moderate left neural foraminal compromise.4.Please review detailed report per level above for additional findings.


Instruction: Generate impression based on medical findings.

Input: 44-year-old female with history of right hip pain. Evaluate for avascular necrosis. ARTICULAR CARTILAGE AND BONE: Moderate osteoarthritis affects the right hip with articular cartilage thinning particularly along the anterior/superior aspect of the joint with cyst formation in the underlying acetabulum along with osteophyte formation. We see no specific features of avascular necrosis.There is slight prominence of the anterolateral aspect of the femoral head/neck junction with an alpha angle of approximately 60 degrees compatible with mild CAM deformity.Osteoarthritis affects the left hip to a slightly lesser degree.ACETABULAR LABRUM: There is branching signal abnormality within the anterior labrum likely representing extensive degenerative tearing that extends into the superior labrum as well. The posterior labrum appears relatively intact.SOFT TISSUES: The ligamentum teres is intact. The visualized musculature appears normal.ADDITIONAL

Output: Moderate osteoarthritis of the right hip with extensive degenerative tearing of the anterior labrum. We see no specific imaging features of avascular necrosis.


Instruction: Generate impression based on medical findings.

Input: Medial pain, check for meniscal tear MENISCI: Bilateral menisci appear intact without focal internal abnormality.ARTICULAR CARTILAGE AND BONE: The medial and lateral compartments are otherwise intact with normal-appearing cartilage and underlying osseous structures, however there is mildly thickened medial patellar plica with a large full thickness defect of the patellar cartilage involving the medial facet. The irregularity measuring approximately 1 cm in diameter.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Changes correlating with thickened medial patellar plica with an associated underlying cartilaginous defect of the medial patellar facet. Please see details


Instruction: Generate impression based on medical findings.

Input: Evaluate for ganglion cyst LIGAMENTS: No significant abnormality noted.TRIANGULAR FIBROCARTILAGE COMPLEX: No significant abnormality noted.TENDONS: No significant abnormality noted. BONES: No significant abnormality noted.ADDITIONAL

Output: Dorsal soft tissue mass consistent with a ganglion cyst


Instruction: Generate impression based on medical findings.

Input: There is a nodular focus measuring up to 17 mm in maximal dimension along the lateral aspect of the left lateral ventricle atrium, which is isointense to gray matter on all sequences without enhancement.There are scattered foci of T2 hyperintensity within the periventricular and subcortical white matter without mass effect, restricted diffusion, susceptibility and rounded, or enhancement.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There is no 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. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Mucosal thickening within specific secretions is noted within posterior ethmoid air cells. The remaining paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain. Coronal images of the temporal lobes demonstrate the temporal horns, hippocampal formations and parahippocampal gyri to be normal in morphology bilaterally without signal abnormalities, masses, or abnormal enhancement identified within the medial temporal lobes on either side. There is no evidence of mesial temporal sclerosis.

Output: 1.There is a focus of nodular gray matter heterotopia along the lateral aspect of the left lateral ventricle atrium.2.Nonspecific scattered foci of T2 hyperintensity are present within the periventricular and subcortical white matter. The differential diagnosis would most likely include small vessel disease, migraine sequelae, or less likely demyelinating disease.


Instruction: Generate impression based on medical findings.

Input: 14-year-old male with soft tissue sarcoma of the left thigh status post resection. Evaluate At the medial aspect of the left vastus lateralis muscle below the greater trochanter (at the site of the skin marker), there is infiltrative/linear region of increased T2/STIR signal (series 8, images 45 through 51). This region demonstrates infiltrative/linear enhancement (series 10, images 43 through 50). Additionally, there is increased T2/STIR signal in the overlying subcutaneous tissues consistent with inflammatory changes. Areas of metallic susceptibility artifact correspond to the surgical clips present on the recent radiograph. No abnormality of the visualized left femur.

Output: Infiltrative/linear T2 hyperintensity with enhancement involving the left vastus lateralis muscle. These findings are more likely secondary to postoperative changes and granulation tissue than residual tumor.


Instruction: Generate impression based on medical findings.

Input: BRAIN: There postoperative findings related to suboccipital craniectomy for Chiari I malformation. There is bilateral inferior cerebellar tenting towards the overlying dura. There is intact biphasic flow across the neo-foramen magnum, although there appears to be mild flow turbulence posteriorly along the inferior cerebellum. There is unchanged flexion of the brainstem configuration. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles are unchanged in size and configuration. The major cerebral flow voids appear to be intact. The clivus is hypoplastic and associated with platybasia. SPINE: The holocord syringohydromyelia has decreased in caliber, measuring up to 3 x 7 mm in cross section, previously 7 x 12 mm. There is more pronounced thoracolumbar scoliosis and straightening of the vertebral column in the sagittal plane. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis.

Output: 1. Postoperative findings related to Chiari decompression with evidence of adhesion formation between the inferior cerebellum and overlying dura in the surgical bed and persistent craniocervical junction malformation manifesting with platybasia.2. Interval decrease in caliber of the holocord syringohydromyelia.3. More pronounced thoracolumbar scoliosis, perhaps attributable to the absence of a brace during the scan.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: History of T11 spinal lesion, urinary incontinence and lack of direction. There is minimal periventricular and subcortical, as well as pontine white matter T2 hyperintensity. There is a prominent perivascular space in the right caudothalamic groove. There is no evidence of intracranial hemorrhage or mass. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or mass effect. There are small left sphenoid and ethmoid sinus retention cysts. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Nonspecific white matter abnormality, which most likely represents chronic small vessel ischemic disease rather than demyelinating disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Reason: hx of HPRCC, evaluate increase in size of 4 renal lesions RIGHT KIDNEY: Right kidney measures 12.2 cm and is normal in echogenicity without hydronephrosis. No evidence of renal calculi.Interval increase in the right mid kidney hypoechoic lesion measuring 2.2 x 2.4 x 2.5 cm, previously 1.8cm on MRI. Right inferior pole hypoechoic lesion measures 1.0 x 1.0 x 0.8 cm and appears without significant change from prior MRI. Hyperechoic foci noted in the right mid kidney measuring 1.5 x 1.2 x 1.6 cm.LEFT KIDNEY: Left kidney measures 11.9 cm and is normal in echogenicity without hydronephrosis. No evidence of renal calculi. No lesion identified. URINARY BLADDER: No significant abnormalities noted.OTHER: No significant abnormalities noted.

Output: Interval increase in the right mid hypoechoic lesion. Right inferior pole lesion appears stable. Fourth lesion is not identified on US.


Instruction: Generate impression based on medical findings.

Input: Unspecified psychosis Unspecified psychosisClinical question: strokeSigns and Symptoms: confusionHistory of obesity, anemia, headache, bacteremia, fall, gastroesophageal reflux, fever, anxiety, sleep disorder, depression, constipation, hemodialysis, Benign lymphogranulomatosis of Schaumann, Diabetes mellitus type 2, noninsulin dependent, H/o kidney transplant, Disseminated lupus erythematosus The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear to the extent of visualization possible on this limited exam. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Examination is degraded by patient motion.

Output: 1.Examination is limited due to patient's inability to cooperate and motion artifact. As a result any small or subtle lesions would be easily overlooked. If there is persistent concern an examination the patient is able to cooperate or with the help of anesthesia may be helpful.2.There is no evidence for acute cerebral infarction.3.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related (most likely given the PMH), related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific.


Instruction: Generate impression based on medical findings.

Input: Female 67 years old with Hx of bulging disk Hypoplastic ribs are noted at the T12 level, smaller on the left. There 5 lumbar-appearing vertebrae.6 mm of grade 1 anterolisthesis of L5 on S1. The left-sided L5 pars interarticularis is not well visualized, however, if there is clinical concern for defect, recommend further evaluation with CT lumbar spine. The vertebral body heights are preserved, with a small Schmorl node noted at the inferior L2 endplate. No vertebral body marrow abnormalities noted. Mild loss of disc height at L2-3 with diffuse disc desiccation most prominent in the lower lumbar spine. The distal spinal cord and conus demonstrate normal signal morphology and terminates at the mid L1 level. Incidental nonenhancing T2 hyperintense right renal cyst measuring up to 3.5 x 3.1 cm as well as multiple bilateral subcentimeter parapelvic cysts noted. T11-12: No significant central or foraminal stenosis noted on sagittal images.T12-L1: No significant central or foraminal stenosis.L1-L2: Mild bilateral facet arthropathy without significant central or foraminal stenosis.L2-L3: Mild disc bulging and bilateral facet arthropathy with partial flattening of the ventral thecal sac without significant central or foraminal stenosis.L3-L4: Disc bulging with mild ventral indention of the thecal sac and prominence of the epidural fat. Moderate bilateral facet arthropathy. Mild central and mild bilateral foraminal stenosis.L4-5: Disc bulging and prominence of the epidural fat with moderate bilateral facet arthropathy and ligamentum flavum hypertrophy. Moderate-severe central and mild-moderate bilateral foraminal stenosis.L5-S1: Grade 1 anterolisthesis with uncovering of the disc and disc bulging as well as severe bilateral facet arthropathy causing impingement of the descending left S1 nerve root on the facet joint. There is narrowing of the left lateral recess. Ventral left-sided annular fissure noted. Moderate central and mild left foraminal stenosis.

Output: Spondylosis as described above with moderate-severe central stenosis at L4-5 as well as moderate central stenosis at L5-S1 causing impingement of the descending left S1 nerve root. Correlate clinically for left S1 radiculopathy.


Instruction: Generate impression based on medical findings.

Input: Left thoracic curve scoliosis. Assess for spinal cord abnormalities. The patient did move during the examination. This have limited the ability to cross reference the images and findings between different planes. Also, the patient did refuse to complete the lumbar part of the examination. Therefore, a tethering lesion of the cord cannot be ruled out with confidence.Cervical Spine:Alignment is anatomic. Vertebral bodies are preserved in height and morphology. There is no significant marrow abnormality. The intervertebral discs are preserved in height. The spinal canal is preserved. The spinal cord shows normal morphology and signal. Included brain shows no significant abnormality. Included cervical soft tissues show no signal abnormality. Lymph nodes in the upper neck on both sides are nonspecific but likely reactive.C2-C3: There is no spinal canal or foraminal stenosis.C3-C4: There is no spinal canal or foraminal stenosis.C4-C5: There is no spinal canal or foraminal stenosis.C5-C6: There is no spinal canal or foraminal stenosis.C6-C7: There is no spinal canal or foraminal stenosis.C7-T1: There is no spinal canal or foraminal stenosis.Thoracic Spine:There is a broad-based, leftward convex curvature centered in the lower thoracic spine (T9/T10). There is a well-circumscribed, fluid-intensity (but no contrast was administered) structure that occupies and expands the right T10-T11 neural foramen and extends medially into the epidural space mildly displacing the thecal sac and spinal cord the left. However, the cord shows normal signal characteristics. Also, there is still a thin rim of fluid/subarachnoid space around the cord. This is also associated with mild scalloping of the posterior vertebral body on the right as well as thinning of the right pedicle. There is no associated marrow edema. The remainder of the thoracic spine shows preserved vertebral morphology, marrow signal and no significant degenerative disease.There is no spinal canal or foraminal stenosis, otherwise.

Output: 1.Limited examination; because of patient's motion and inability to complete the examination as described above.2.Leftward convex curvature in the lower thoracic spine without congenital, morphologic abnormality of the thoracic spine. 3.There is a cystlike structure involving the right T10-T11 neural foramen with medial extension into the epidural space causing mild mass effect on the thecal sac and spinal cord. This also causes smooth osseous scalloping without edema. This may represent an arachnoid cysts or a perineural root cyst with epidural extension but then the relationship to the scoliosis would be more difficult to explain as these are not usually associated with scoliosis unless there compression of the nerve root (are there radicular symptoms related to the right T10 nerve root?). Contrast myelography might provide additional information (regarding wall permeability) of these lesions. While a nerve sheath tumor would be difficult to reliably exclude without intravenous contrast, it seems unlikely given the signal characteristics of the lesion. This is a consideration otherwise, a contrast-enhanced examination is needed. A small lateral thoracic meningocele is an even less likely consideration unless the patient has neurofibromatosis type I.4.Cervical spine is normal. Small lymph nodes in the upper neck are nonspecific.5.The lack of lumbar spine imaging does not allow for reliable exclusion of cord tethering.


Instruction: Generate impression based on medical findings.

Input: Metastatic esophageal cancer: please assess for CNS involvement. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are numerous scattered T2 hyperintense foci within the cerebral white matter. There is no abnormal intracranial enhancement. There is mild cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a small right sphenoid sinus retention cyst.

Output: Numerous nonspecific scattered T2 hyperintense foci within the cerebral white matter, but no evidence of intracranial metastases.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Secondary malignant neoplasm of brain and spinal cordClinical question: characterization of brain metsSigns and Symptoms: gait instability, newly diagnosed lung cancer There is an 18 x 24 mm axial dimension mass redemonstrated at the left cerebellopontine angle cistern which is associated with some adjacent dural thickening and has a broad-based towards the dura. Some susceptibility effect is associated with this lesion suggesting blood products lesion. It appears to have partial extra-axial location and may be exophytic from the adjacent cerebellumThere is a 6 x 8 mm axial dimension enhancing lesion present at the periphery of the left cerebellar hemisphere which was also present on the prior exam and is associated with susceptibility effect.There is redemonstration of a 16 x 21 mm sagittal dimension and 16 x 21 mm axial dimension ring-enhancing mass centered in the right cingulate gyrus which is associated with adjacent vasogenic edema and has also not changed substantially compared to the previous exam and is associated with susceptibility effectThere is a 3 mm enhancing focus in the right cerebellar hemisphereNormal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate partial opacification of the left frontal sinus The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.

Output: There are multiple hemorrhagic intracranial lesions present which are stable compared to prior exam. One in the left cerebellopontine angle cistern appears to be exophytic. There are others in the left cerebellar hemisphere and right cingulate gyrus. Metastatic disease is not most likely consideration under the circumstances.


Instruction: Generate impression based on medical findings.

Input: Concern for cirrhosis seen on ultrasound with increasing alkaline phosphatase. ABDOMEN:LIVER, BILIARY TRACT: There is mild relative hypertrophy of the left hepatic and caudate lobe with mild fissural prominence. No focal lesion. The signal intensity of the liver is normal without significant fatty infiltration. No intrahepatic or extrahepatic periductal dilatation. Partially contracted gallbladder. The vessels are patent.SPLEEN: Marked splenomegaly measuring 18 cm in craniocaudal dimension without a focal lesion. The splenic vein is patent.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Marked splenomegaly without a focal lesion or splenic vein occlusion. 2. Morphologic changes very suggestive of chronic liver disease without a focal liver lesion.


Instruction: Generate impression based on medical findings.

Input: 66-year-old male with new diagnosis of cutaneous B cell lymphoma. Scalp lesions. Staging evaluation. CHEST:LUNGS AND PLEURA: Multiple bilateral circumscribed lung nodules. In the left lung at image 42 of series 6 there is a 1 x 1.4 cm left upper lobe and a nodule. A right middle lobe lateral segment nodule measures 7 x 8 mm at image 69 of series 6.MEDIASTINUM AND HILA: Multiple subcentimeter mediastinal lymph nodes. No measurable lymphadenopathy.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: 1.5 cm diameter right adrenal nodule is indeterminate. If indicated, obtain an adrenal MRI to exclude metastasis. Appearance and size, however, suggest this is a benign adenoma. KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.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: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Bilateral small lung nodules. No lymphadenopathy. Right adrenal nodule.


Instruction: Generate impression based on medical findings.

Input: 36-year-old female with sciatica. Rule out cord compression. Five lumbar type vertebral bodies are presumed to be present. Again seen is trace grade 1 retrolisthesis of L5 on S1, without significant interval change. The remainder of the lumbar spine is normal in alignment, with straightening of the normal lumbar lordosis. Bone marrow signal is benign. Degenerative endplate bone marrow changes are noted at the L5-S1 level. Vertebral body heights are within normal limits. There is disc desiccation at the L4-L5 and L5-S1 levels with mild loss of intervertebral disc height at the L5-S1 level. The spinal cord is normal in signal. The conus medullaris is normal in position. Multilevel degenerative changes are seen, as described below:T12-L1: No significant disc disease. No spinal canal or neural foraminal stenosis.L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Mild facet arthropathy. No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: Mild facet arthropathy. No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: Mild disc bulge and facet arthropathy without significant spinal canal or neural foraminal stenosis.L5-S1: There are interval postoperative changes from left hemilaminectomy and microdiscectomy. Again seen is a disc bulge with large leftward central disc extrusion, the original component of which appears smaller than the prior exam. However, there is new, ill-defined soft tissue material contiguous with the L5-S1 disc effacing the left aspect of the spinal canal and causing at least moderate spinal canal stenosis. There is possible impingement of the left L5 and sacral nerve roots with mild left neural foraminal stenosis. Mild facet arthropathy is also noted.There is a small amount of fluid in the laminectomy bed, as well as a small amount of dorsal epidural fluid just superior to the laminectomy, which may be within normal limits in the recent postoperative period. The epidural fluid contributes the spinal canal stenosis.

Output: 1. Findings compatible with interval L5-S1 left hemilaminectomy and microdiscectomy. While the original leftward central disc extrusion at this level appears somewhat smaller, there is new, ill-defined soft tissue contiguous with the disc which effaces the left thecal sac and potentially impinges the adjacent nerve roots. Differential diagnosis includes scar tissue versus recurrent disc.2. Fluid in the laminectomy bed and a small amount of dorsal epidural fluid just above the laminectomy level. Findings may be within normal limits in the recent postoperative period.


Instruction: Generate impression based on medical findings.

Input: 67 year-old female history of RCC. ABDOMEN:LIVER, BILIARY TRACT: Stable bilobar subcentimeter nonenhancing simple cysts. No suspicious hepatic lesions.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post left nephrectomy. Subcentimeter nonenhancing right renal cysts.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: Postoperative changes of left nephrectomy with no evidence of recurrent or metastatic disease.


Instruction: Generate impression based on medical findings.

Input: 56-year-old woman with history of pancreatic mass. Additional history as per chart: 3/2016 CT abdomen with 4.4 mm hypodense lesion at the junction of the neck and body of the pancreas. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in signal and morphology. A few subcentimeter hepatic cyst identified, otherwise no focal hepatic lesions seen.The gallbladder is normal. There is no intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic duct is normal in size. The pancreatic parenchyma is normal without focal lesion.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter bilateral renal cysts noted. Kidneys otherwise appear normal and enhance symmetrically. There is no hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No significant abnormality noted, specifically no pancreatic mass.


Instruction: Generate impression based on medical findings.

Input: 43 years, Male, chronic left-sided headache, mild left Horner's. Rule out structural lesion. Brain: Multiple sequences are mildly motion degraded. There is no restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Few scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with minimal chronic small vessel ischemic changes. There are two small foci of T2 hyperintensity in the right cerebellar hemisphere favored to represent chronic infarcts. Brain parenchyma is otherwise unremarkable for age.No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella is grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits. Orbits: Multiple sequences are mildly motion degraded. No abnormal mass or abnormal enhancement is seen. The optic nerves are normal in size and signal intensity, and are symmetric bilaterally. No retrobulbar mass, chiasmatic mass, or parasellar abnormality is seen. Extraocular muscles are unremarkable. Cavernous sinuses are also unremarkable.

Output: 1. No evidence of acute infarct, hemorrhage, or intracranial mass effect.2. Two small foci of T2 hyperintensity and volume loss in the right cerebellar hemisphere favored to represent small chronic infarcts. Brain parenchyma is otherwise unremarkable for age.3. MRI of the orbits is also unremarkable.


Instruction: Generate impression based on medical findings.

Input: Reason: Multiple hypodense renal cysts and hematuria with a h/o bladder cancer s/p cystectomy and ileal conduit. ABDOMEN:LIVER, BILIARY TRACT: The liver demonstrates normal signal intensity without suspicious focal lesions. Status post cholecystectomy. No biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Please note that evaluation is somewhat limited by motion causing misregistration on subtraction images which limits evaluation for enhancement. Multiple small simple renal cysts are present bilaterally. There are several additional lesions corresponding to the high attenuation lesions described on recent CT. An exophytic right midpole lesion (series 701, image 48) measures 1.6 x 1.7 cm, demonstrates low T2 signal and high T1 signal, does not appear to enhance, and is compatible with a complicated cyst. An exophytic left upper pole lesion (series 61, image 22) measures 1.9 x 1.5 cm, demonstrates intermediate T2 signal and increased T1 signal, does not appear to enhance, and is also compatible with a complicated cyst. Additional smaller complicated cysts are present bilaterally none of which display suspicious features. No hydronephrosis. The kidneys enhance and excrete symmetrically without visualized collecting system filling defects.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes of cystectomy and ileal conduit. Herniation of the colon is noted at the ostomy site without evidence of obstruction. Colonic diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes affect the spine.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: The uterus is atrophic or surgically absent.BLADDER: Status post cystectomy.LYMPH NODES: Status post bilateral lymph node dissection. No pelvic or inguinal lymphadenopathy.BOWEL, MESENTERY: See above. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Bilateral complicated renal cysts without definite enhancement, however, evaluation is somewhat limited by motion and follow-up is recommended in 6 months to ensure stability.2.No specific evidence of residual or recurrent malignancy.3.Parastomal hernia at the ileostomy site containing nonobstructed colon.


Instruction: Generate impression based on medical findings.

Input: Malignant neoplasm of brain, unspecified [C71.9], Reason for Study: ^Reason: 42 yo M with hx of L frontal PXA s/p surgery then RT, eval for progression/recurrence History: none The examination is limited by motion artifact. Postsurgical changes with multiple left frontal bone burr holes are again demonstrated. The left frontal lobe resection cavity appears similar to prior examination with a small amount of surrounding T2/FLAIR signal. The head of the caudate is atrophic and has intrinsic high T1 signal, without significant enhancement, likely postoperative in etiology. Small area of enhancement involving the inferomedial aspect of the cavity (series 11, image 17) appears similar to prior examinations. No new or enlarging enhancing lesions are identified. No midline shift is appreciated. There is no evidence for acute ischemia. Blood degradation products are again demonstrated in the left frontal lobe subarachnoid space and surgical resection cavity. No new areas of hemorrhage are identified. Scattered areas of T2/FLAIR hyperintensity, more prominent in the left cerebral hemisphere are again seen. Prominent vascularity versus leptomeningeal enhancement involving the middle left frontal lobe gyrus appears similar to prior examination.

Output: Postsurgical changes related to left frontal lobe mass resection without evidence for tumor progression. A small nonspecific focus of enhancement at the surgical site remains similar to prior examinations.


Instruction: Generate impression based on medical findings.

Input: 29-year-old man with history of pancreatic pseudocyst. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal. Gallbladder is normal.SPLEEN: Spleen is normal.PANCREAS: A cystgastrostomy is again seen. Persistent small amount of fluid immediately anterior to the stomach has decreased. Additionally, there is a fluid collection in the pancreatic tail (series 3, image 17) that measures 14 x 14 mm, previously 29 x 25 mm. There is stable, mild prominence of the pancreatic duct.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Decreased size fluid focus in pancreatic tail and decreased perigastric fluid.


Instruction: Generate impression based on medical findings.

Input: 3-year-old female in status epilepticus There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Normal brain CT.


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old, with history of brainstem cavernoma, severe motor deficits after craniotomy. Six month follow-up. Evidence of left temporal craniectomy is again seen. Distortion and encephalomalacia within the adjacent left temporal parenchyma has become more prominent. However, no evidence of parenchymal edema is seen. Rather, there is ex vacuo dilatation of the left temporal and occipital horns. The parenchyma adjacent to the craniectomy site herniates mildly through the craniectomy defect.A partially resected cavernoma within the left dorsal brainstem at the junction of the midbrain and pons is redemonstrated. The lesion is stable to slightly smaller in size with some interval change in the pattern of internal T1 hyperintensity. No evidence of significant surrounding parenchymal edema is seen. No findings to suggest continued interval bleeding are noted.A small focus of encephalomalacia within the left dentate nucleus is unchanged from prior. Bilateral T2 hyperintensity and swelling of the inferior olivary nuclei is unchanged as well.No new intracranial lesions are seen. A small venous structure is redemonstrated running along the right aspect of the residual cavernoma. No other pathologic enhancing lesions are seen. The ventricular system is stable in size and morphology.

Output: 1.A partially resected left dorsal brainstem cavernoma is stable to slightly reduced in size. No evidence of interval bleeding is seen, and there is no edema in the surrounding parenchyma.2.Encephalomalacia has progressed at the left temporal craniectomy site.3.Findings compatible with hypertrophic olivary degeneration are unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 2 years old, with history of hypoxia in the setting of respiratory distress, extubated on 4/12 with lip smacking and eye twitching. Assess for evidence of hypoxic injury or other abnormality. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen. No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology.

Output: Unremarkable examination.


Instruction: Generate impression based on medical findings.

Input: Polyradiculopathy, rule out compressive cervical myelopathy. Decreased mobility and neuropathy. Cervical spine: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Multilevel degenerative changes are seen in the cervical spine with multilevel disc height loss and small disc osteophyte complex formation. Individual levels as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Small disc osteophyte complex and ligamentum flavum thickening. No significant compromise to the spinal canal or neural foramina.C4-5: Small disc osteophyte complex. No significant compromise to the spinal canal or right neural foramen. Mild left neural foraminal narrowing related to uncovertebral hypertrophy and facet arthropathy.C5-6: Small disc osteophyte complex. No significant compromise to the spinal canal or right neural foramen. Mild left neural foraminal narrowing related to uncovertebral hypertrophy.C6-7: Disc osteophyte complex and uncovertebral hypertrophy. No significant compromise to the spinal canal. Minimal bilateral neural foraminal narrowing.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.Lumbar Spine:Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is levocurvature of the lumbar spine with apex at the L2-L3 level. Bone marrow signal is benign. The conus medullaris is normal in position. Multiple small perineural cysts in the sacrum are incidentally noted.Multilevel degenerative changes are seen with disc height loss from L2-L3 to L5-S1 with suggestion of vacuum phenomena at the L2-L3, L4-L5, and L5-S1 levels. Individual levels as described below:L1-L2: Minimal disc bulge, ligamentum flavum thickening, and facet arthropathy. There is no significant spinal canal or neural foraminal stenosis.L2-L3: Moderate disc height loss and mild bulge. There is also ligamentum flavum thickening and facet arthropathy. There is no significant spinal canal stenosis. There is mild right neural foraminal stenosis. Left neural foramen is patent.L3-L4: There is disc height loss and disc bulge with a right dorsal annular fissure. There is also ligamentum flavum thickening and facet arthropathy. Partial effacement of the right lateral recess. No significant central canal stenosis. There is mild to moderate right and mild left neural foraminal stenosis.L4-L5: There is moderate to severe disc height loss and disc bulge including a small central protrusion component. Ligamentum flavum thickening and bilateral facet arthropathy. There is partial effacement of the lateral recesses. No significant central canal stenosis. There is mild to moderate right and mild left neural foraminal stenosis. There may also be impingement of the extraforaminal left L4 nerve root at this level. L5-S1: There is disc height loss with mild bulge. Ligamentum flavum thickening and bilateral facet arthropathy. No significant spinal canal stenosis. There is moderate bilateral neural foraminal stenosis.

Output: 1. Mild multilevel degenerative changes in the cervical spine. There is no significant spinal canal stenosis at any level or cord signal abnormality. Mild multilevel neural foraminal narrowing as detailed above.2. Mild to moderate multilevel degenerative changes in the lumbar spine. There is no significant spinal canal stenosis at any level. There is neural foraminal narrowing at multiple levels as detailed above. At the L4-L5 level, there may also be impingement of the extraforaminal left L4 nerve root.


Instruction: Generate impression based on medical findings.

Input: Reason: hx of migraine, now with change in HA pattern with new neuro deficits History: above 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.

Output: MRI of the brain is within normal limits


Instruction: Generate impression based on medical findings.

Input: Memory loss for 3 years. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild scattered cerebral and pontine white matter T2 hyperintensity. There are also scattered bilateral cerebral hemisphere mildly prominent perivascular spaces. 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. There is multilevel degenerative spondylosis of the imaged portions of the cervical spine.

Output: 1. Mild scattered cerebral and pontine white matter T2 hyperintensity is nonspecific, but may represent chronic small vessel ischemic disease, for example.2. No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on medical findings.

Input: Metastatic carcinoma, preop planning for tumor resection. There are postoperative findings related to right frontal and right suboccipital craniotomy. There is minimal linear intrinsic T1 hyperintensity versus enhancement along the margin of the right temporal lobe resection cavity. There is a lesion in the right cerebellar hemisphere that measures up to 10 mm. There is also a lesion in the right occipital lobe that measures up to 20 mm. There is a small right middle frontal gyrus developmental venous anomaly. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. Skin-based fiducial markers are present.

Output: Pre-treatment planning sequences demonstrate postoperative findings in the right anterior temporal lobe and right cerebellar hemisphere, with a subcentimeter lesion in the right cerebellar hemisphere treatment bed, and a lesion in the right occipital lobe compatible with metastases, but no convincing evidence of recurrent tumor in the right temporal lobe.Discussed with Dr. Chmura at 11:45 AM on 5/14/15.


Instruction: Generate impression based on medical findings.

Input: There is mild straightening of the normal lumbar lordosis and suggestion of incomplete formation of the posterior elements at S2 and S3. The vertebral body and disc heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The distal spinal cord and conus are within normal limits with the conus terminating at the L2 level. There is no evidence of fibrofatty filum. There is mild lumbosacral epidural lipomatosis with prominence of the epidural venous plexus, but no significant disc bulge, herniation, spinal canal or foraminal stenosis within the lumbar spine. The paraspinal soft tissues and subcutaneous tissues are unremarkable.

Output: 1. Suggestion of mild spina bifida occulta at S2 and S3. A focused CT of this region may be useful for further characterization, if clinically indicated.2. No evidence of myelomeningocele or fibrofatty filum.3. Mild lumbosacral epidural lipomatosis.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: 33-year-old female with recent C-section delivery with fetal demise. Patient with hepatic lesions who presents for MRI evaluation. ABDOMEN:LIVER, BILIARY TRACT: Multiple T2 hyperintense, T1 hypointense lesions within the right and left lobes demonstrating peripheral nodular discontiguous enhancement. The largest in the right hepatic lobe measures 11 x 14 cm (series 1001, image 401). Findings compatible with hemangiomas.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multiple hepatic hemangiomas with the largest measuring 14 cm in the right hepatic lobe.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old, with dizziness and facial droop for five days. No restricted diffusion, edema or mass effect is seen. There are no findings to suggest intracranial hemorrhage. The pattern of intracranial enhancement is normal. There may be a very small incidental arachnoid cyst along the anterior left temporal lobe versus a prominent sulcus. The ventricles are normal in size and morphology. Bone marrow signal characteristics are unremarkable.

Output: No significant abnormalities are detected, and in particular, there are no findings to account for the patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: Status of intracranial injury. Seizure. There is a small amount of scattered T1 hyperintense subdural hemorrhage along the posterior falx cerebri and cerebelli that measures up to 3 mm in thickness. There is no significant associated mass effect or midline shift. There is minimal prominence of the subarachnoid CSF spaces in the bilateral anterior frontal and temporal regions, which likely represent hygromas. The brain parenchyma appears unremarkable without evidence of acute infarction or contusion. The ventricles are unchanged in size and configuration. There is minimal deformity of the occipital bone. The orbits and scalp soft tissues appear to be unremarkable. There is a subcentimeter T1 hypointense and T2 hyperintense lesion in the midline tongue base region.

Output: 1. Mild subacute subdural hemorrhage along the posterior falx cerebri and cerebelli without associated significant mass effect or cerebral contusion. 2. A subcentimeter T1 hypointense and T2 hyperintense lesion in the midline tongue base region is incompletely characterized, but may represent a thyroglossal duct cyst or vallecular retention cyst. An ultrasound may be useful for further evaluation.


Instruction: Generate impression based on medical findings.

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

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


Instruction: Generate impression based on medical findings.

Input: Pre-operative planning for choroid plexus papilloma. There are postoperative findings related to suboccipital craniotomy. There is a lobulated enhancing mass within the inferior portion of the fourth ventricle that measures up to 27 mm. There is persistent dilatation of the superior portions of the fourth ventricle, as well as the third and lateral ventricles, with associated diffuse periventricular T2 hyperintensity. There is a right transfrontal ventricular catheter that terminates in the left lateral ventricle. There is mild high T2 signal in the parenchyma surrounding the catheter. There is no evidence of acute cerebral infarction or intracranial hemorrhage. There is a 6 mm wide arachnoid cyst anterior to the anterior temporal pole. There is a retention cyst in the left maxillary sinus. Scalp fiducial markers are present.

Output: Preoperative planning MRI demonstrates a fourth ventricular choroid plexus tumor associated with persistent obstructive hydrocephalus and transependymal edema, with a right transfrontal ventricular shunt catheter in position.