Instruction: Generate impression based on medical findings.

Input: Female, 46 years old, history of small pituitary adenoma now with persistent headache. Assess for growth of lesion. A lesion in the right posterior aspect of the pituitary gland seen on the 2011 examination remains much reduced in size and similar to that noted on the more recent examination from 2014. No discretely measurable lesion is seen. Rather, the right posterior aspect of the pituitary is mildly heterogeneous in T2 signal and pattern of enhancement.The remainder of the pituitary gland is within normal limits. The pituitary stalk sits at midline and enhances normally. No suprasellar lesions are detected. No abnormalities of the visualized optic apparatus are seen.

Output: Stable appearance of the pituitary gland with residual heterogeneity of the right posterior aspect of the gland representing the site of a previously larger lesion.


Instruction: Generate impression based on medical findings.

Input: Abnormal cerebellum and myelomeningocele on antenatal ultrasound. Patient is 22 weeks 4 days gestational age. Please note that imaging is tailored for assessment of the fetal brain and lower spine. The fetal abdomen is not specifically addressed on this study.Dedicated evaluation of the fetal brain demonstrates a small posterior fossa with a small and inferiorly displaced cerebellum which appears to partially enwrap the brainstem (best seen on image #12 of series #9). The appearance is similar to the ultrasound "banana" sign. The fourth ventricle in not clearly visualized which may indicate some compression, and there is a lack of CSF in the posterior fossa. The lateral ventricles are not dilated. However, the occipital horns of the lateral ventricles are angled inferiorly and medially, towards the posterior fossa, and it appears that the occipital poles are inferiorly positioned and possibly encroaching on the posterior fossa. The frontal region of the skull is narrowed due to bilateral frontal bone concavity, similar to the ultrasound "lemon" sign.The corpus callosum is too small to definitively assess at this point. A cavum septum pellucidum is present suggesting that the corpus callosum is present anteriorly. The posterior corpus callosum may be dysgenetic or agenetic. The gyral pattern is within range for reported gestational age. There is no parenchymal signal alteration or intracranial hemorrhage.Dedicated evaluation of the fetal spine demonstrates a dorsal vertebral defect involving the lower lumbar and upper sacral segments (starting at the L3 or L4 level and continuing into the sacrum, measuring 15 mm craniocaudally and 3 mm in transverse). There is suggestion of a neural placode extending across this lumbosacral defect with no clear soft tissue covering, compatible with an open myelomeningocele.

Output: 1. The constellation of small posterior fossa with inferior displacement/tethering of its contents, as well as the lumbosacral myelomeningocele, are compatible with Chiari II malformation.2. Abnormal morphology especially involving the posterior part of the lateral ventricles is probably related to medial and inferior displacement by the tethered posterior fossa structures. A partially dysgenetic or partially agenetic corpus callosum could also be contributing to this appearance. 3. Due to technical limitations, some of the more subtle features of Chiari II may not be detected on this exam. However, the ventricles are not dilated, and the brain otherwise shows a relatively normal volume and normal gyration.


Instruction: Generate impression based on medical findings.

Input: Evaluate left odontogenic tumor seen on recent CT scan. There is a smoothly contoured, but heterogeneous lesion without discernible enhancement that arises from the left maxillary alveolus and projects into the maxillary antrum. The lesions measures up to approximately 40 mm and extends superiorly to abut the floor of the left orbit. There is a small right sphenoid sinuses retention cyst. The other paranasal sinuses and nasal cavity are unremarkable. The nasal septum is essentially midline. The nasopharynx, facial soft tissues, orbits, and imaged intracranial structures appear to be unremarkable.

Output: A lesion measuring up to approximately 40 mm that that arises from the left maxillary alveolus and projects into the maxillary antrum likely represents a form of odontogenic cyst, perhaps with superimposed prior hemorrhage or infection.


Instruction: Generate impression based on medical findings.

Input: 76-year-old male with known liver lesions. Follow-up for interval change. ABDOMEN:LIVER, BILIARY TRACT: 6.9 x 6.1 cm heterogeneous, enhancing mass with restricted diffusion in the right hepatic lobe (series 1003/54), unchanged in size since prior CT when it measured 6.9 x 6.1 cm and again most compatible with metastasis. 1.4 x 1.6 cm heterogeneous, enhancing mass with restricted diffusion in the right hepatic lobe adjacent to the above-described mass (series 100 3/41), unchanged in size since prior CT when it measured 1.4 x 1.6 cm and again most compatible with metastasis.A smaller T2 hyperintense lesion with peripheral enhancement with filling in on delayed phased images and without restricted diffusion in the right hepatic lobe is most compatible with a hemangioma (series 1003/66), not significantly changed in size since prior study.No biliary ductal dilation. Main portal vein and its branches are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable left renal cyst.RETROPERITONEUM, LYMPH NODES: Stable subcentimeter retroperitoneal lymph nodes, which are not pathologically enlarged by size criteria.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Partially visualized cystic lesion near the right L5-S1 neuroforamen, most likely a Tarlov cyst.OTHER: Mild left basilar subsegmental atelectasis, similar to prior study. Trace left pleural effusion.

Output: Stable large right hepatic lesion with adjacent smaller satellite lesion, most likely representing metastases.


Instruction: Generate impression based on medical findings.

Input: Persistent toe-walking, hypotonia, trouble with balance, feet turning in: headaches and lumbosacral area hemangioma. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is scattered paranasal sinus mucosal thickening.Spine: The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. There is no evidence of mass lesions or abnormal enhancement in the spine. The paravertebral soft tissues are unremarkable.

Output: 1. No evidence of Chiari malformation, cerebral infarction, or intracranial tumor.2. No evidence of thoracic or lumbar spine lesions. The lumbosacral skin hemangioma is not discernible.


Instruction: Generate impression based on medical findings.

Input: Concern for acute ischemic stroke: right arm paralysis. There is an area of restricted diffusion with corresponding high T2 signal in the left precentral gyrus that measures up to approximately 20 mm. There also appears to be a small area of restricted diffusion in the white matter adjacent to the left frontal horn and linear restricted diffusion in the right parietal lobe. There is a right transoccipital ventricular catheter that terminates in the left lateral ventricle. There are bilateral cerebral convexity subdural effusions, which measure up to 6 mm in width on the right and 12 mm in width on the left. The ventricular system is unchanged in size. Artifact from the reservoir obscures surrounding structures. There is fluid signal within the bilateral mastoid air cells.

Output: 1. Acute infarction in the left precentral gyrus and perhaps small smaller recent infarcts in the left frontal and right parietal lobes superimposed upon a background of chronic small vessel ischemic white matter disease.2. Bilateral cerebral convexity subdural effusions, which may indicate chronically low intracranial pressure. 3. Unchanged shunted ventricular system.Discussed with Dr. Stern at 1:00 PM on 4/22/15.


Instruction: Generate impression based on medical findings.

Input: 56-year-old male with syncope evaluate for hemorrhage. High attenuation, well-defined lesion within the left thalamus measuring approximately 8 mm x 8 mm without surrounding edema is suspicious for hemorrhage however cavernoma may have a similar appearance. MRI is recommended for further characterization.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and right mastoid air cells are normally pneumatized with left mastoid air cell opacification.

Output: Left thalamic high attenuation lesion is suspicious for hemorrhage, however, cavernoma may have a similar appearance and MRI is recommended for further characterization.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Pain in unspecified hipClinical question: spinal stenosisSigns and Symptoms: thigh pain radiating to lower leg Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. Incidental note is made of perineural cyst within the sacral spinal canal at the S2 to level measuring 11 x 8 mm sagittal dimensions.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a minor disc bulge present at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.The uterus is enlarged , contains multiple low signal foci within it and is fluid-filled.

Output: 1.No compromise to lumbar spinal canal or neural foramina.2.Findings suggest a multiple uterine fibroids and fluid within the uterus (can be seen with menses)which are relatively common findings. This can be confirmed clinically if needed.


Instruction: Generate impression based on medical findings.

Input: Reason: Assess for rotator cuff injury or other cause for left shoulder pain History: Left shoulder pain. ROTATOR CUFF: Perhaps minimal tendinosis of the supraspinatus tendon, but this is equivocal and we see no discrete supraspinatus tendon tear. The supraspinatus muscle appears normal. The infraspinatus tendon and muscle appear normal. The teres minor tendon appears normal. Slight atrophy of the teres minor muscle is of uncertain significance and we see no masses within the quadrilateral space. The subscapularis tendon appears slightly thickened, but we suspect this is due to internal rotation of the humerus and we see no discrete tear. Subscapularis muscle appears normal.SUPRASPINATUS OUTLET: Edema within the distal clavicle as well as a small amount of pericapsular edema along the AC joint. We see no edema within the acromion process. We see no free fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Given the limitations of a non-arthrographic study, the glenoid labrum appears intact. We see no joint effusion. Alignment of the glenohumeral joint is within normal limits. Bandlike signal intensity along and within the anterior aspect of the glenohumeral joint likely represents redundant capsular structures.BICEPS TENDON: Given the limitations of a non-arthrographic study, the tendon of the long head of the biceps appears intact.ADDITIONAL

Output: 1.Edema within the distal clavicle and along the capsule of the AC joint with no edema within the acromial process may represent stress reaction of the distal clavicle such as osteolysis that can be seen in weightlifters, or perhaps a low grade injury to the AC joint.2.No evidence of rotator cuff tear.3.Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Myelopathy: twitching/numbness. There is a C4-C5 anterior cervical discectomy and fusion with an intervertebral device. There is also anterior cervical discectomy and fusion of C5 through C7 with intervertebral disc grafts at C5-C6 and C6-C7. There is no evidence of fracture. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. However, there is a diffusely narrow spinal canal, which measures up to approximately 10 mm in anteroposterior dimension. At C2-3, there is a small uncinate spur with minimal left neural foramen stenosis. At C3-C4, there are small bilateral uncinate spurs, contributing to mild bilateral neural foramen narrowing, and a small posterior disc-osteophyte complex with mild left spinal canal stenosis. Likewise, at C4-C5, there are small bilateral uncinate spurs, contributing to mild left neural foramen narrowing. There is also a posterior disc-osteophyte complex at C6-7 with associated mild spinal canal stenosis. The spinal cord displays normal signal characteristics. The paravertebral soft tissues are unremarkable.

Output: 1. Postoperative findings related to C4-5 anterior cervical discectomy and fusion with a cage device as well as anterior cervical discectomy and fusion of C5 through C7 with intervertebral disc spacers at C5-C6 and C6-C7. 2. Mild degenerative cervical spondylosis with mild spinal canal stenosis at C3-4 and C6-7 superimposed upon a diffusely narrow spinal canal.


Instruction: Generate impression based on medical findings.

Input: Please evaluate for brain metastases 70-year-old femaleTechnique: 100 mL Omnipaque 350 was used and injected at two mL/sec via the right wrist using a 22-gauge needle. The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. There are subcortical and periventricular white matter hypodensity is present which are also identified on the MRI from 12/08. A calcific lesion is present along the faults cerebri and the right side measuring 1 cm in size and is suspected to represent a burned out meningioma.No abnormal 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 with the exception of a minor opacity in the left posterior ethmoid air cells unchanged since the 5/03 exam. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Compared to the exam of 5/29/03 there is no change in the appearance of the calvarium.

Output: No evidence for brain metastases.


Instruction: Generate impression based on medical findings.

Input: 25 year old female with MRI findings of subtalar joint coalition. Assess middle facet coalition versus trauma from old fracture.IMAGE ACQUISITIONS: CT examination of the right foot, noncontrast Again seen is the abnormal articulation of the middle facet of the subtalar joint. The middle facet is more vertically oriented than normal with mild atrophy of the sustentaculum. Additionally, there is slight subchondral sclerosis and cyst formation at this joint. It is unclear whether these findings are secondary to fibrous coalition or prior trauma.Small ossicles are again seen distal to the lateral and medial malleoli, compatible with post traumatic sequelae. Please refer to report for recent MRI for further evaluation of soft tissue pathology.

Output: Reidentification of the abnormal articulation at the medial facet of the subtalar joint which again may be secondary to old trauma versus fibrous coalition.


Instruction: Generate impression based on medical findings.

Input: 34-year-old male. Severe low back pain. Normal MRI. Thoracic spine: Alignment is anatomic. Vertebral body heights and intervertebral disk spaces are preserved.Lumbar spine: Minimal retrolisthesis of L4; alignment is otherwise anatomic. Vertebral body heights and intervertebral disk spaces are preserved. Spina bifida occulta affects L4 and L5, also seen on prior MRI.

Output: No evidence of a compression fracture. Minimal retrolisthesis of L4.


Instruction: Generate impression based on medical findings.

Input: 42-year-old male. Rule out RCC metastases. ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter T2 hyperintense foci favored to be cystic (series 1/1/2001 images 36, 30).SPLEEN: Status post splenectomy.PANCREAS: Status post distal pancreatectomy, and no recurrent nodular enhancement is identified. The previously described fluid collection in the left-sided surgical bed has decreased in size and now measures 2.0 x 2.6 cm (series 1001 image 21) (prior 3.1 x 3.2 cm). The fluid collection demonstrates thin peripheral enhancement on the delayed phase (series 1506 image 205), which may represent fibrosis. Small subcentimeter adjacent lymph nodes are noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post right nephrectomy. RETROPERITONEUM, LYMPH NODES: No new lymphadenopathy. Incidental note is made of a retroaortic left renal vein.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Subcentimeter T2 hyperintense focus of the left costochondral junction (series 1001 image 18) correlates with a hypodense focus on the prior CT exam and is of uncertain clinical significance.Tiny foci of susceptibility artifact and linear delayed enhancement of the left ventral abdominal wall (series 1506 image 40) is likely postsurgical in origin and corresponds to the region of subcutaneous emphysema from the prior CT exam.T1 hyperintense linear focus across the anterior abdominal wall (series 1506 image 5) could represent prior ventral hernia repair with mesh, and clinical correlation is needed.OTHER: No significant abnormality noted.

Output: Status post right nephrectomy, distal pancreatectomy, and splenectomy. Decreased size of the previously seen fluid collection in region of surgical bed. No evidence of recurrent nodular enhancement in the residual pancreatic parenchyma. No specific evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Status post kidney transplant c/b MI. PEA arrest, perforated diverticulitis, colon resection, r/o CVA No abnormal diffusion restriction. No acute intracranial hemorrhage is identified. No evidence of intracranial mass, mass-effect, or midline shift. No extra-axial fluid collections. Nonspecific scattered subcortical and periventricular white matter FLAIR hyperintensity. The ventricles and sulci are prominent related to generalized volume loss. Gray-white matter differentiation is preserved. The imaged paranasal sinuses and mastoid air cells are clear. The imaged orbits are intact. The osseous structures are unremarkable.

Output: No evidence of acute ischemia.


Instruction: Generate impression based on medical findings.

Input: New diagnosis of cirrhosis, ascites, elevated LFTs ABDOMEN:LIVER, BILIARY TRACT: Micronodular liver contour, suggesting cirrhosis. Minimal intrahepatic biliary duct prominence. Dilated proximal common bile duct, measuring up to 11 mm, with gradual distal tapering seen. No focus of intraluminal signal void seen to suggest choledocholithiasis. Distended cystic duct. Findings suggestive of underlying benign stricture, no definite obstructing masslesion seen. However, evaluation suboptimal due to inability to perform dynamic postcontrast imaging. Suboptimal evaluation of liver parenchyma secondary to lack of dynamic postcontrast imaging, no suspicious liver lesion seen within these limitations.SPLEEN: No significant abnormality noted.PANCREAS: Mildly prominent pancreatic duct, measuring up her limits of normal, 3 mm. Mildly decreased intrinsic T1 signal pancreas, may be sequela of chronic pancreatitis.ADRENAL GLANDS: Bilateral diffusely enlarged adrenal glands, may reflect underlying adenomatous hyperplasia. KIDNEYS, URETERS: T2 hyperintense renal foci, most likely cysts. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Flattened configuration of the IVC.BOWEL, MESENTERY: Thickened small bowel, likely reactive in the setting of ascites.BONES, SOFT TISSUES, OTHER: Small pleural effusions. Large ascites.

Output: 1. Minimal intrahepatic biliary duct prominence and dilated proximal common bile duct, measuring up to 11 mm, with gradual distal tapering seen. No focus of intraluminal signal void seen to suggest choledocholithiasis. These findings favor underlying benign stricture, no definite obstructing masslesion seen. However, evaluation suboptimal due to inability to perform dynamic postcontrast imaging. Per MRI technologist, patient was claustrophobic and unable to tolerate dynamic series acquisition. Correlation with patient's clinical history/laboratory values recommended and confirmation of benign findings with ERCP should be considered.2. Underdistended and thick walled sludge-containing gallbladder, nonspecific in setting of ascites. 3. Micronodular liver contour, suggesting cirrhosis.4. Mildly decreased intrinsic T1 signal pancreas, may be sequela of chronic pancreatitis.5. Paraaortic and retrocaval soft tissue thickening, may reflect small adenopathy or chronic scarring, further evaluation with CT imaging recommended. 6. Large ascites, small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: 51-year-old female with right hip pain. Evaluate for labral tear. ACETABULAR LABRUM: Note is made of linear increased signal abnormality traversing the anterior superior acetabular labrum, extending from the 1 o'clock to approximately the 3 o'clock position, consistent with a labral tear. ARTICULAR CARTILAGE AND BONE: There is prominence of the anterior right femoral head/neck junction consistent with a CAM deformity. The alpha angle measures 64 degrees (14; series 901). No articular cartilage defects are identified.SOFT TISSUES: The imaged musculature appears normal. ADDITIONAL

Output: CAM deformity with acetabular labral tear as described above.


Instruction: Generate impression based on medical findings.

Input: 45-year-old woman with worsening daily left frontal headaches. Please evaluate for intracranial/anatomic etiology. A large, isodense, apparently extra-axial mass is seen in the right frontal region which measures 31 x 48 mm (image 17/36). The peripheral aspect of the mass appears low density which probably represents multiple superficial cysts. The overlying bony cortex is slightly irregular and appears to be partially absorbed. Findings are most consistent with a cystic meningioma however, the associated bony irregularity is atypical for a meningioma and further evaluation with MRI is recommended to exclude primary brain malignancy or metastases. There is significant associated vasogenic edema in the right frontal parenchyma with minimal, approximately 2 mm, midline shift at the level of the septum pellucidum. No additional mass lesions are seen. No intracranial hemorrhage is present. The ventricles and basal cisterns are normal in size and configuration. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Large, probable extra axial mass with significant associated vasogenic edema which may represent a cystic meningioma, however further evaluation with MRI is necessary to exclude primary brain malignancy or metastases. Findings were discussed with Dr. M. Glather at 10:30am on 3/25/2008.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old. Reason: evaluate thyroid nodule History: incidental thyroid nodule RIGHT LOBE MEASUREMENTS: 2.6 x 2.2 x 5.6 cm.LEFT LOBE MEASUREMENTS: 3.1 x 2.5 x 6 .0 cmISTHMUS MEASUREMENTS: 0.6 cmRIGHT LOBE: Mildly heterogeneous echotexture, with a few benign-appearing subcentimeter cysts.LEFT LOBE: Mildly heterogeneous echotexture. A well marginated, heterogeneous noncalcified solid nodule in the left thyroid lobe, with surrounding hypoechoic rim and mildly increased peripheral blood flow measures 2.7 x 1.4 x 2.4 cm.ISTHMUS: Mildly heterogeneous echotexture without focal lesion.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: A 2-3 cm solid, noncalcified left thyroid nodule is identified as detailed above, and is amenable to biopsy for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Lung cancer with brain metastases treated with WBRT. Punctate enhancing lesions at the grey-white matter junctions of the posterior left occipital lobe, inferior right parietal lobule, and right superior frontal sulcus are slightly more conspicuous and there is a new punctate T2 hyperintense focus adjacent to the right superior frontal gyrus lesion. There is unchanged patchy gyriform enhancement along the medial right occipital lobes and posterior left occipital lobe. There is unchanged diffuse cerebral white matter T2 hyperintensity, particular in a periventricular distribution. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild scattered paranasal sinus mucosal thickening.

Output: Punctate metastatic lesions at the grey-white matter junctions of the posterior left occipital lobe, inferior right parietal lobule, and right superior frontal sulcus are slightly more conspicuous. Otherwise, the patchy gyriform enhancing lesions along the medial right occipital lobes and posterior left occipital lobe appear unchanged.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Hemangioma of intracranial structuresClinical question: CCM Protocol, 3T Scanner, s/p resection,Signs and Symptoms: S/p resection on 7/20Comments: Asthma, 3T Scanner | The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient is status post left frontal craniotomy for left frontal lobe surgery and the left left frontal lobe cavernoma. There are some dural thickening and enhancement at the craniotomy site. There is a cystic cavity associated with susceptibility effect at the surgical site within the left frontal lobe.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.There is partial opacification of the maxillary sinuses with air-fluid levels which were also present in the July exam. There are also scattered opacities in the ethmoid air cells which were also present in the July exam. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Status post left frontal lobe surgery for removal of a left frontal lobe lesion. There are postoperative changes present.


Instruction: Generate impression based on medical findings.

Input: Hepatitis B, AFP 4000, evaluate for HCC ABDOMEN:LIVER, BILIARY TRACT: Liver contour: The liver contour is smooth. Features of portal hypertension: None. Portal vein: Patent. Hepatic veins: Patent.Hepatic artery: Conventional.Lesions: 2.1 x 1.2 cm arterially enhancing lesion in segment IVb demonstrates washout on delayed postcontrast imaging (series 1101, image 247). Contiguous or adjacent punctate focus of parenchymal washout without definite arterial enhancement (series 1101, image 263).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: 1.Segment 4B arterially enhancing lesion meets the criteria for HCC.2.Immediately adjacent punctate focus of parenchymal washout without definite arterial enhancement raises the possibility of a satellite HCC, or is just a poorly imaged tiny portion of the primary mass itself.


Instruction: Generate impression based on medical findings.

Input: Images are somewhat limited by patient motion. The thoracic spine is in normal alignment, with slight straightening of the normal lower thoracic kyphosis. The vertebral body heights are well-maintained. There is multilevel disc narrowing, up to moderate severe in degree at T5-T6 and T3-T4. No worrisome focal marrow signal abnormality is appreciated. Heterogeneous hyperintense T2 and isointense T1 signal is seen in a rounded configuration along the posterior L1 vertebral body extending into the right pedicle, most compatible with a hemangioma. A smaller hemangioma is seen in the posterior superior T10 vertebral body. The spinal cord is of normal caliber and signal.Mild disc bulges are seen from T2-T3 through T5-T6. There is up to moderate foraminal narrowing at these levels. There is mild to moderate central spinal canal stenosis at T5-T6.At T6-T7, there is a left foraminal disc protrusion with left facet arthropathy resulting in moderate-severe left foraminal narrowing.At T7-T8, there is a left paracentral disc extrusion which migrates cranially by approximately 6 mm. There is minimal central spinal canal stenosis.At T8-T9, there is a left paracentral/foraminal disc protrusion which indents the ventral thecal sac with moderate-severe left foraminal narrowing.At T9-T10, there is a right paracentral disc protrusion which indents the ventral thecal sac with mild central spinal canal stenosis.T10-T11, there is a mild disc bulge mild central spinal canal stenosis. There is mild bilateral facet arthropathy and ligamentum flavum thickening resulting in moderate-severe right and left and mild to moderate right foraminal narrowing.At T11-T12, there is a mild diffuse disc bulge with overall moderate central spinal canal stenosis. There is moderate bilateral facet arthropathy and ligamentum flavum thickening resulting in moderate-severe right and severe left foraminal narrowing.At T12-L1, there is a trace disc bulge with right foraminal prominence and mild bilateral facet arthropathy. There is overall moderate central spinal canal stenosis as well as moderate right greater than left foraminal narrowing.The counting image demonstrates interval progression of previously seen cervical multilevel spondylosis along the mid to lower cervical spine, with now a large posterior osteophyte disc complex at C4-C5, with at least moderate-severe central spinal canal stenosis at that level.There is a nonspecific oval T2 hyperintense lesion within the right kidney.

Output: 1. Multilevel thoracic spondylosis with up to moderate central spinal canal stenosis at T11-T12, as well as multiple levels of high-grade foraminal narrowing as detailed above.2. Significant cervical spondylosis partially imaged, now most significant at C4-C5 where there is likely moderate severe central spinal canal stenosis. Dedicated MRI of the cervical spine may be obtained as clinically indicated.


Instruction: Generate impression based on medical findings.

Input: 46 your female with lower back pain. The bony density and vertebral alignment are normal. No central spinal stenosis is apparent on exam. The neural foramen are widely patent. L3/4, L4/5, L5/S1 show minimal disk disease, minimal hypertrophy of the posterior elements, and overall minimal degenerative changes. In the last image of the study at S2, there is expansion of the thecal sac without epidural fat. This is of CSF density and may represent an ectatic thecal sac versus a Tarlov cyst. MRI may further evaluate if indicated.

Output: 1. Minimal degenerative changes, hypertrophy of the posterior element, and disk disease in the lower lumbar spine.2. Expansion of the thecal sac at S2 that may represent an ectatic thecal sac versus a Tarlov cyst. MRI may further evaluate if indicated.


Instruction: Generate impression based on medical findings.

Input: Male 50 years old Reason: knee pain r/o meniscal tear History: same MENISCI: The lateral meniscus is intact. There is an oblique branching tear involving the posterior horn of medial meniscus that extends to the body.ARTICULAR CARTILAGE AND BONE: There is cartilage thinning in the medial and lateral compartments. There is cartilage thinning and fissuring involving the medial and lateral facets of the patella.There is marrow edema involving the medial tibial plateau adjacent to the meniscal tear which is likely reactive.LIGAMENTS: Anterior and posterior cruciate ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Tear of the body and posterior horn of medial meniscus with associated marrow edema involving the medial tibial plateau.Tricompartmental cartilage wear constituting mild osteoarthritis.Small joint effusion.


Instruction: Generate impression based on medical findings.

Input: 32 year-old female with headache rule out masses. There is no evidence of intracranial hemorrhage, mass or edema. There is suspected crowding at the foramen magnum as there is lack of visualization of the subarachnoid space. This may be due to patient positioning for the exam or Chiari malformation. MRI is recommended for further evaluation of the intracranial structures at this level. There is no visualization of the sulci, however, the gray-white junction remains distinct. Ventricular volumes are small but this may be normal for the patient's age. The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Suspected crowding at the foramen magnum may be due to patient positioning or Chiari malformation. Further evaluation with MRI is recommended to further define intracranial structures at this level. 2. Etiology of patient's headache may be due to pseudotumor cerebri, clinical correlation advised.


Instruction: Generate impression based on medical findings.

Input: There has been interval decrease in size and number of enhancing metastatic lesions throughout the brain. For example, a right cingulate gyrus lesion measures 7 mm in diameter, previously 14 mm, and an inferior vermis lesion measures up to 6 mm, previously 12 mm. The degree of associated vasogenic edema has also diminished. Otherwise, a small left parafalcine dural based extra-axial calcified lesion is unchanged. The ventricles and sulci are within normal limits. There is no midline shift. There is no evidence of acute infarction or hemorrhage. There is nonspecific fluid signal in the left mastoid air cells. There is also mild scattered paranasal sinus mucosal thickening. The orbits are unremarkable.

Output: 1. Interval decrease in size and number of the numerous intracranial metastases.2. An unchanged small left parafalcine mass may represent a meningioma.


Instruction: Generate impression based on medical findings.

Input: 75-year-old male with right upper quadrant abdominal pain, obstructive jaundice, metastatic small cell prostate cancer. Evaluate for biliary obstruction. ABDOMEN:LIVER, BILIARY TRACT: Extensive metastatic lesions of the liver with luminal narrowing of the intrahepatic IVC are again noted. There are prominent periportal lymph nodes. A 2.2 x 3 cm peripancreatic lymph node causes compression of the adjacent common bile duct and results and intra and extrahepatic biliary ductal dilatation (axial series 8 image 42, series 7 image 90).Hydropic gallbladder without wall thickening or inflammatory changes to suggest acute cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: No pancreatic ductal dilatation. Trace ascites including trace peripancreatic fluid, nonspecific. Peripancreatic adenopathy demonstrating restricted diffusion. However no definite restricted diffusion related to pancreatic parenchyma itself to support acute pancreatitis.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Mild left-sided hydroureteronephrosis, which is again felt to be related to the enlarged pelvic lymph node compressing the distal ureter (coronal series 3 image 18). The enlarged pelvic lymph node is only partially visualized at the anterior aspect of the coronal T2 sequence. A punctate intraluminal hypointense focus seen only on the coronal T2 sequence (series 3 image 18) could represent a nonobstructive stone versus artifact and is not the cause of the left hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Trace ascites.BONES, SOFT TISSUES: Stable appearance of the known sclerotic osseous metastatic lesions (coronal series 3 images 6, 12).OTHER: Known pulmonary metastatic nodules of the lung bases are appreciated on the diffusion weighted series.

Output: 1.Extensive metastatic lesions of the liver. Periportal and peripancreatic adenopathy likely metastatic also present; as seen on prior CT study, an enlarged peripancreatic lymph node compresses the adjacent distal common bile duct and results in mild intra and extrahepatic biliary ductal dilatation.2.Mild left hydroureteronephrosis related to the known enlarged pelvic nodal lesion compressing the distal ureter (partially imaged on current exam but well depicted on earlier CT study).3.Metastatic pulmonary nodules and osseous metastatic lesions are better evaluated on the recent CT exam.


Instruction: Generate impression based on medical findings.

Input: Right arm pain Within the anterolateral subcutaneous tissues overlying the mid diaphysis of the humerus is a solid nodule measuring 1 x 0.6 x 1.3 cm in the greatest transaxial and craniocaudal dimensions. The mass is isointense to skeletal muscle on T1 sequences and hyperintense to skeletal muscle on fat suppressed T2 sequences. Following contrast administration, there is a homogeneously solid enhancement. No additional lesions are identified. The marrow signal of the humerus is normal as is the caliber and signal intensity of the surrounding musculature.

Output: Solid nodule within the anterolateral subcutaneous tissue overlying the mid diaphysis of the humerus. Although the imaging characteristics are nonspecific, given the patient's history, this may represent a peripheral nerve sheath tumor. Referral to orthopedic oncology is recommended.


Instruction: Generate impression based on medical findings.

Input: Reason: degenerative disc disease? History: neck pain with neuropathic arm pain The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is straightening of the normal cervical curvature present. There is multilevel disk desiccation.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. There are uncovertebral osteophytes present at this level right more than left with some mild encroachment of the right-sided exiting nerve rootsAt C4-5 there is loss of disk space height a diffuse disk bulge and endplate and uncovertebral osteophytes resulting in effacement of spinal fluid ventral posterior the spinal cord and some deformity of the spinal cord . There is some posterior ligamentous hypertrophy present. Overall there is a moderate degree of spinal stenosis at this level.At C5-6 there is no significant compromise to the spinal canal . There are bilateral virtual osteophytes present at this level associated with disk material and encroachment of the exiting nerve roots bilaterally.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.At T1-T2 and T2-T3 there disk bulge is present associated with some minor narrowing of the neural foramina.The vertebral artery flow voids appear to be intact. The right vertebral artery is larger than the left vertebral artery and is suspected to have an aortic arch origin.

Output: 1.There are multilevel degenerative changes present in the cervical spine which are worse at C4-5 where there is a moderate degree of spinal stenosis and bilateral neural foramen encroachment due to degenerative changes as detailed above. There is some encroachment of exiting nerve roots at the C3-4 and C5-6 due to degenerative changes as well.


Instruction: Generate impression based on medical findings.

Input: Dense breasts, right MRI on 6/3/2015. Final path IDC grade 2, 2.1 cm 7 out of 27 nodes positive, largest tumor deposit is 5 mm, extranodal extension noted is 2 mm. ER positive PR negative HER-2 positive by IHC. Status post neoadjuvant chemotherapy status post radiation (8/2015). ypT 2(m), N2 MX There is heterogeneous amount of fibroglandular tissue in the left breast. Patient is status post right mastectomy.Mild parenchymal enhancement is noted in the left breast.No abnormal enhancement is seen in left breast or right chest wall. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on medical findings.

Input: There is minimal retrolisthesis at C5-6, which appears to be new. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. Spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. At C2-3, there is mild disc osteophyte complex, with no significant spinal canal or foraminal stenosis. At C3-4, there is disc bulge, with moderate to severe spinal canal stenosis, but no neural foraminal stenosis. At, C4-5, there is an eccentric left disc bulge, with mild spinal canal stenosis. At C5-6, there is moderate to severe spinal canal stenosis due to disc bulge and grade 1 retrolisthesis at C5-6. There is mild left neural foraminal stenosis. At C6-7, there is no significant spinal canal or neural foraminal stenosis. The right thyroid lobe is absent. There is a retropharyngeal right internal carotid artery.

Output: Multilevel degenerative spondylosis with moderate to severe canal stenosis at C3-4 and C5-6 due to disc-osteophyte complexes.


Instruction: Generate impression based on medical findings.

Input: Reason: patient with sub-acute weakness, and muscle wasting, elevated CK, CRP c/f myositis. Obtaining MR to look for myositis. History: above Left femur:On the fat-saturated T2-weighted images, there is edema type signal abnormality within the adductor musculature of the left hip and thigh as well as within the hamstrings, with relative sparing of the semitendinosus muscle. There is perhaps also mild edema within the rectus femoris and vastus medialis, proximally, but we see no additional edema within the quadriceps musculature. Overall the muscles appear slightly atrophic, which is not unusual considering the patient's age. Severe osteoarthritis affects the left knee. Moderate osteoarthritis affects the left hip. There is patchy intermediate signal intensity within the proximal femur likely representing residual islands of red marrow. There is a small to moderate knee joint effusion.Right femur:On the fat saturated T2-weighted images there is edema of the adductor musculature of the right hip and thigh as well as within the hamstring musculature, with relative sparing of the semitendinosus muscle. There is mild edema of the vastus medialis, proximally. The remainder of the quadriceps appears spared. The sartorius appears spared. Severe osteoarthritis affects the right knee. There is a moderate sized right knee joint effusion. There is fatty atrophy of the musculature of the hip and thigh which is not unusual considering the patient's age. There is prominence of fat along the anterolateral aspect of the distal femur deep to the lateral retinaculum, representing a lipoma.

Output: Largely symmetric myositis pattern of the hip and thigh musculature as described above.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old, status post stem cell transplant with progressive a standing muscle weakness, now the level of the diaphragm. Spinal alignment is anatomic. Vertebral body height and morphology are normal. No concerning areas of marrow replacement or marrow edema are seen. The pattern of marrow enhancement is within normal limits.The visualized spinal cord shows normal signal intensity and caliber. On postcontrast images, there is the suggestion of enhancement along some of the cervical nerve roots. The cord itself shows no evidence of pathologic enhancement.C2-3: Facet hypertrophy. Minimal posterior disk osteophyte formation. No significant spinal canal or neuroforaminal stenosis. C3-4: Facet hypertrophy. Minimal posterior disk osteophyte formation. No significant spinal canal or neuroforaminal stenosis.C4-5: Facet hypertrophy. No significant disk degeneration, spinal canal stenosis or neuroforaminal narrowing. C5-6: Facet hypertrophy. Mild posterior disk osteophyte formation. No significant spinal canal or neuroforaminal stenosis.C6-7: Posterior disk osteophyte formation with asymmetric osteophytic ridging and or disk protrusion in the left foraminal and subarticular zones. Minimal displacement of the adjacent spinal cord is seen without cord signal abnormality. The left neural foramen is moderately narrowed. C7-T1: Facet hypertrophy. No significant disk degeneration, spinal canal or neuroforaminal stenosis.

Output: 1. Mild scattered enhancement of some of the cervical intradural nerve roots is suspected, though it is possible that this appearance may be due in part to imaging artifact. If further imaging evaluation is warranted, a dedicated pre- and post contrast study of the lumbar spine might be considered as subtle nerve root enhancement is usually more reliably diagnosed among the nerve roots of the cauda equina. If real, the differential for this finding would include post infectious and autoimmune phenomenon, non infectious inflammatory/granulomatous diseases, among numerous other etiologies.2. Relatively mild degenerative disk disease most severely affecting the C6-7 level where asymmetric left-sided osteophytic ridging and/or a disk protrusion results in mild cord deformation. No areas of high-grade spinal canal stenosis are seen.


Instruction: Generate impression based on medical findings.

Input: There is no diffusion abnormality to suspect acute stroke. There is a small area of encephalomalacia in the posterior right cingulate gyrus with punctate foci of susceptibility artifact, perhaps related to prior ischemia or trauma. There are bilateral, scattered areas of subcortical white matter T2 signal hyperintensity. The ventricles and sulci are normal in size and configuration. Parenchymal volume appears normal. There are no abnormal foci of enhancement. The major intracranial vascular structures enhance normally. There is no midline shift or mass effect.

Output: 1.Moderate scattered white matter signal abnormality suggestive of small vessel ischemic disease.2.No evidence of acute ischemic infarct, hemorrhage, mass, or degenerative process.


Instruction: Generate impression based on medical findings.

Input: 50-year-old man with medial ankle pain and swelling. TENDONS: There is a small amount of fluid within the sheath of the posterior tibialis tendon, flexor digitorum tendon, and flexor hallucis tendon. We see no findings to suggest a tendon tear. There is a small amount of fluid adjacent to the distal fibers of the posterior tibialis tendon just proximal to its insertion on the navicular bone, which may represent a very mild peritendinitis, but this is equivocal. The Achilles tendon appears normal, however, there is distention of the retrocalcaneal bursa indicating a bursitis. There are small quantities of fluid within the peroneal tendon sheaths, not necessarily of any clinical significance. There is increased signal intensity along the posterior margin of the peroneus brevis tendon as it courses beneath the fibular tip, which may represent a small partial-thickness longitudinal tear, but the clinical significance of this finding is uncertain. The peroneus longus tendon appears intact. The extensor tendons appear intact.LIGAMENTS: The lateral collateral ligament complex appears intact. The distal tibiofibular syndesmotic complex appears intact. The visualized components of the deltoid ligament are intact.ARTICULAR SURFACES AND BONE: There is a tibiotalar joint effusion, but the ankle joint otherwise appears normal without evidence of an osteochondral defect. There is also a small amount of fluid extending into the anterior and posterior recesses of the subtalar joint. Mild osteoarthritis affects the ankle and midfoot. We see no fracture.ADDITIONAL

Output: 1. Small amount of fluid within the posterior tibialis tendon sheath and possible mild peritendinitis of the distal fibers of the posterior tibialis tendon. We see no evidence of tendon tear/rupture.2. Hematoma within the subcutaneous fat medial to the posterior tibialis tendon.3. Retrocalcaneal bursitis and tibiotalar joint effusion along with diffuse subcutaneous edema.4. Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: This exam is mildly degraded by motion artifact. There are multiple scattered small foci of T2 hyperintensity within the periventricular white matter and centrum semiovale as well as linear lesions within the corpus callosum, perpendicular to the long axis of the lateral ventricles. There is also a single juxtacortical lesion towards the convexity. Some of these lesions demonstrate T1 hypointensity. No infratentorial lesions are identified. There is mild global volume loss. There is no evidence of acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is paranasal sinus mucosal thickening.

Output: Multiple white matter lesions involving the periventricular and juxtacortical white matter, centrum semiovale, and corpus callosum. No infratentorial lesions are identified. There is also mild global volume loss. While these findings are nonspecific, they do meet the dissemination in space component of the MRI McDonald criteria for MS.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate for patellar tendon rupture, other intra-articular knee pathology History: R knee injury, inability to extend, effusion. Due to the patient's body habitus, the high-definition knee coil could not be used. An alternative coil was used resulting in suboptimal image quality.MENISCI: No fluid-filled meniscal tears are evident.ARTICULAR CARTILAGE AND BONE: Evaluation of the articular cartilage is limited. There is moderate degeneration of the articular cartilage of the medial facet of the patella with near full-thickness to full-thickness fissuring. The remainder of the articular cartilage is unremarkable, given the aforementioned limitations.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: There is rupture of the patellar tendon at its attachment to the patella with a small portion of the tendon remaining attached to the patella, laterally. There is thickening and increased signal intensity of the tendon likely reflecting underlying moderate to severe tendinosis. The rupture results in a gap of just under 1 cm. There is also thickening and intermediate signal intensity within the distal quadriceps tendon suggesting tendinosis. There is also disruption of the lateral retinaculum with fluid from the joint insinuating between the torn retinacular fibers. The medial retinaculum also appears abnormally thickened with linear increased signal intensity traversing its anterior fibers suggesting a tear.ADDITIONAL

Output: 1. Limited study as described above.2. Patellar tendon rupture with additional tearing of the medial and lateral retinacula and tendinosis of the quadriceps and patellar tendons.3. Degeneration of the articular cartilage of the medial facet of the patella.


Instruction: Generate impression based on medical findings.

Input: Reason: history of renal transplant concern for infection, previous MRI with findings concerning for left clavicle osteomyelitis, please include this in views to evaluate for osteomyelitis. LUNGS AND PLEURA: Moderate to large bilateral pleural effusions, not significantly changed compared 8/15/2016 PET with a small amount of associated compressive atelectasis. MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. No mediastinal lymphadenopathy identified.CHEST WALL AND SOFT TISSUES: There is redemonstration of edema/fluid signal as well as increased enhancement within the fascial planes of the left upper chest wall surrounding the proximal and middle third of the left clavicle which is compatible with an inflammatory process such as cellulitis. There is also abnormal bone marrow signal, cortical indistinctness, and increased enhancement involving the proximal and to a lesser extent middle third of the left clavicle which is compatible with osteomyelitis which has progressed compared to the 8/15/2016 MRI neck. No associated discrete drainable abscess is identified.Degenerative changes affect the spine. There is a fat-containing structure within the T3 vertebral body which likely represents a benign hemangioma. There is redemonstration of a nonspecific T2 hyperintense nodule in the subcutaneous soft tissues of the left upper back.UPPER ABDOMEN: Cholelithiasis.

Output: 1.Signal abnormality and increased enhancement involving the proximal and middle third of the left clavicle compatible with osteomyelitis, progressed compared to 8/15/2016. Surrounding inflammatory changes compatible with cellulitis.2.Moderate to large bilateral pleural effusions.3.Please see recent dedicated MRIs of the soft tissues of the neck and left shoulder for additional details regarding those structures.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old, with known brain metastases. Preparing for radiotherapy. Numerous, at least 15, solidly enhancing parenchymal metastases are demonstrated. Lesions are seen within both cerebral hemispheres and within the left cerebellum. The largest lesion, in the left frontal lobe, measures 34 x 28 mm and induces significant regional edema. There is associated sulcal effacement, deformation of the left lateral ventricle and a slight midline shift to the right. The other intracranial lesions range in size from punctate up to about 2 cm and cause variable but milder degrees edema.Encephalomalacia of the right inferior frontal lobe is seen. The overlying calvarium demonstrates changes suggestive of prior surgery. No findings to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collections are seen. Apart from contour deformity related to regional edema, the ventricular system is unremarkable with no evidence of hydrocephalus.

Output: Numerous parenchymal metastases are identified ranging in size from punctate up to several centimeters. The largest lesion is found in the left frontal lobe.


Instruction: Generate impression based on medical findings.

Input: Clinical question : Status post craniotomy for posterior fossa lesion. Signs and symptoms: As above. Nonenhanced head CT:There is expected postoperative changes of the right paramedian suboccipital craniotomy. Residual vasogenic edema in the right cerebellum is again noted. There is no evidence of parenchymal hemorrhage. Air filled surgical cavity measures approximately 17 times 12-mm in size. Fourth ventricle is in normal position and normal in size. The residual air in the subarachnoid space is also present.Focus of encephalomalacia in the left occipital lobe is likely result of an old stroke and unchanged since prior MRI exam.Prominence of cortical sulci and ventricular system for patient's stated age is similar to the preoperative study.

Output: 1.Expected postoperative changes of right paramedian suboccipital craniectomy.2.Residual vasogenic edema in the right cerebellum similar to prior study.3.Prominence of cortical sulci and ventricular system for patient's stated age of 56 similar to prior exam.4.Focus of encephalomalacia in the left occipital lobe as was seen on prior MRI study.


Instruction: Generate impression based on medical findings.

Input: History of multifocal prostate cancer. Patient presents for focal laser ablation of the 3+4 disease in the left mid gland and apex peripheral zone disease. Patient used prophylactic antibiotics before and after the procedure asprescribed. The patient received antibiotic prophylaxis with oral Ciprofloxacin 500 mg bidstarting the night before the procedure. He took 2 tablets of Ciprofloxacin 500 mg beforethe procedure and will take two tablets after the procedure. Following the discussion ofthe risks, benefits, and alternatives of the procedure, informed consent was obtained forthe research study. The procedure was performed under moderate conscious sedation.MRI focus in the left mid-gland and apical peripheral zone suspicious for patient's known cancer waslocalized with T2 weighted MR images. Following sterile preparation, Visualase laserablation template was placed in the perineum on the patient and localized on MR images andregistered to the MR images where prostate lesion could be visualized.Following local anesthesia with lidocaine, 14-gauge MR- compatible needles were insertedinto the left side of the prostate to stabilize the prostate. Upon confirmation of thetip of the needle on the left side close to the known lesion, a total of 6 laser ablationswith 30-W, 90 % power was performed within the left mid-gland and apical peripheral zone of theprostate zone. The patient tolerated the procedure well without any immediate complications.Pre-and postcontrast axial MR images are obtained before and after administration of 20 ccMultiHance, upon completion of the procedure. On MR images of ablation defect was notedwithin and around the ablated region. COMPLICATIONS: No immediate complications.BLOOD LOSS: < 3 ml

Output: MR guided laser ablation of the left mid-gland and apical peripheral zone of theprostate.PLAN: Patient was sent to the post-procedural area for observation to ensure voiding versus Foley catheter placement. Will follow-up with urology.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate for new infarction, emboli, evolving lesion History: new left leg weakness, right arm weakness There is redemonstration of multiple punctate foci of diffusion restriction in both cerebral and cerebellar hemispheres predominantly in subcortical locations. There is a new punctate focus in the right cerebral hemisphere.There is a redemonstration of a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There is redemonstration of multiple foci of punctate SWI signal loss in the thalami and to a lesser degree right cerebellar hemisphere, pons and basal ganglia. There is a punctate focus of diffusion restriction in the left temporal lobe.There is redemonstration of patchy and serpiginous signal loss on SWI in the right centrum semiovale associated with patchy T2/FLAIR signal hyperintensity.To a lesser degree this is also present in the left centrum semiovale.There is redemonstration of patchy signal loss on SWI in the right parietal lobe subcortical white matter associated with patchy T2/FLAIR signal hyperintensity..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 redeomnstration of multiple punctate foci of infarction in the cerebral and cerebellar hemispheres with at least one new focus since the prior exam.2.There is redemonstration of multiple mucrohemorrhages in the thalami and to a lesser degree right cerebellar hemisphere, pons and basal ganglia. The pattern suggests hypertensive cause.3.Patchy foci of encephalomalacia are present in the right centrum semiovale, right parietal cortex and subcortical white matter and to a lesser degree left subependymal region and adjacent centrum semiovale. These likely represent encephalomalacia from prior events possibly associated with evidence of mineralization or hemosiderin deposition suggesting they are related to prior vascular events.


Instruction: Generate impression based on medical findings.

Input: Male, 16 years old, with history of ligamentous injury to the neck in 2008, status post halo fixation and fusion from the axis to C3, now presenting with new neck pain. Cervical spine:Posterior fusion instruments are evident from the occiput to the C3 level. Osseous fusion of the craniocervical junction is demonstrated with incorporation of the basiocciput, odontoid process, lateral masses of C1 and C2 and the anterior C1 arch, as well as the posterior occiput and the posterior elements of C1-C3.Apart from the fusion-induced straightening of the cervical lordosis, sagittal alignment is otherwise unremarkable. Vertebral body heights are preserved. No evidence of marrow edema or marrow replacement is seen.The visualized spinal cord shows normal signal intensity and morphology throughout. No epidural abnormalities are suspected. The paraspinal and ligamentous soft tissues are unremarkable.At C7-T1, loss of disc T2 signal is demonstrated as well as a small left foraminal protrusion. The spinal canal is not significantly compromised. However, there is moderate left and mild right foraminal narrowing. The remaining levels are free of significant stenosis.Brain:Brain parenchymal morphology and signal characteristics are within normal limits. No focal lesion, edema or mass effect is detected. No evidence of acute intracranial hemorrhage or any abnormal extra-axial fluid is seen. The ventricles are normal in size and morphology.

Output: 1.Findings compatible with successful osseous fusion of the craniocervical junction.2.No evidence of any acute cervical spine injury. Disc degeneration at C7-T1 results in moderate left and mild right foraminal narrowing.3.Unremarkable evaluation of the brain.


Instruction: Generate impression based on medical findings.

Input: 64-year-old male with prostate cancer Gleason 7 (3+4) PELVIS:PROSTATE:Prostate Size: 4.7 x 2.4 x 3.7 cm.Peripheral Zone: Heterogenous foci in the left aspect of the peripheral zone without discrete or dominant nodule. Central Gland: T2 hypointense lesion measuring 1.2 x 1.2 cm (series 601, image 15) is noted within the right of the central/ transitional region anteriorly. This lesion demonstrates diffusion restriction and early enhancement. Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No extracapsular extension is evident.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: Susceptibility artifact from a right hip arthroplasty. Mild asymmetric atrophy of the right obturator internus.OTHER: No significant abnormality noted.

Output: 1.Lesion in the right central/transitional region with early enhancement and diffusion restriction may represent the known prostate cancer. 2.Additional heterogenous foci in the left aspect of the peripheral zone is nonspecific without discrete or dominant nodule.


Instruction: Generate impression based on medical findings.

Input: Male 52 years old left knee "popping" post twisting weeks x-ray with mild OA MENISCI: There is mild intrasubstance degeneration involving the posterior horn of medial meniscus. No discrete tear is evident.There is linear signal involving the posterior horn of lateral meniscus that extends to the periphery as seen on image 9/701 and is suspicious for a small peripheral tear.ARTICULAR CARTILAGE AND BONE: There is full-thickness cartilage loss involving the central weightbearing zone of the medial femoral condyle and tibial plateau. There is reactive marrow edema involving the medial tibial plateau and medial femoral condyle adjacent to the site of cartilage loss.There is diffuse chondral thinning involving the lateral compartment.There is surface irregularity and chondral fibrillation with some undersurface mining involving the medial and lateral facets of the patella.LIGAMENTS: Anterior and posterior cruciate ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Moderate osteoarthritis involving the medial femoral tibial compartment with full-thickness cartilage loss.2.Mild osteoarthritis involving the extensor compartment.


Instruction: Generate impression based on medical findings.

Input: Male 63 years old Reason: evaluate for metastasis History: hx of renal cell carcinoma, high risk, sp nephrectomy, CKD Evaluation of solid and hollow abdominal viscera is limited without intravenous contrast.ABDOMEN: LIVER, BILIARY TRACT: Liver is normal in morphology. Probable hepatic cysts. No biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post right nephrectomy.Duplicated left renal collecting system. The left upper pole moiety is dilated was previously shown to drain into the prostatic urethra. The lower pole moiety is normal in caliber.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Status post right nephrectomy without definite evidence of recurrent or metastatic disease.


Instruction: Generate impression based on medical findings.

Input: History of hepatitis C cirrhosis and hepatocellular carcinoma. Surveillance examination. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology of liver with a nodular surface contour.Immediately adjacent to the segment 2/3 ablation cavity there is a 1.6 x 1.3 cm lesion with restricted diffusion, as increased T2 signal, demonstrates early arterial enhancement as well as venous washout compatible with hepatocellular carcinoma.There are multiple patchy wedge-shaped areas of transient hepatic intensity difference on the arterial phase postcontrast images, however none of these areas show early washout to suggest hepatocellular carcinoma.The portal vein, hepatic veins, and hepatic artery are patent.No ascites. Numerous gastric and esophageal varices appearing similar to prior.Cholelithiasis. No intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: The spleen is surgically absent.PANCREAS: Status post distal pancreatectomy.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Unchanged simple cyst in the lower pole of the right kidney. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Tortuous but nondilated abdominal aorta.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.1.6 cm hepatocellular carcinoma immediately adjacent to the segment 2/3 ablation cavity.2.Prominent gastric and esophageal varices. Similar to prior.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old, history of epilepsy and laser ablation. Surveillance scan. Sequelae of prior right temporal depth electrode placement and right medial temporal laser ablation are seen. This includes several right-sided burr holes, small areas of curvilinear parenchymal gliosis, and a small T2 hyperintense mildly hemosiderin stained medial temporal ablation bed.Low lying cerebral tonsils compatible with Chiari I malformation are demonstrated. Otherwise, cerebral morphology and signal characteristics are within normal limits. No significant parenchymal edema or mass effect is detected. No acute intracranial hemorrhage or any abnormal extra axial fluid is seen. The ventricles are normal in size and morphology.

Output: Expected findings status post right temporal depth electrode placement and right mesial temporal laser ablation.


Instruction: Generate impression based on medical findings.

Input: Male, 18 years old, with history of sickle cell disease and old infarct on CT. Assess for areas of ischemia, evidence of new or old infarcts. MRI:Foci of T2 hyperintensity are again seen along the perfusional watershed region of the deep right cerebral white matter. Small foci of T2 hyperintensity and/or encephalomalacia are also demonstrated along the right caudate nucleus, unchanged. A 5 mm non specific focus of T2 hyperintensity within the left temporal lobe just lateral to the temporal horn is new or larger compared to the prior examination. No restricted diffusion is seen to suggest acute ischemia.The cerebellar tonsils are pointed and descends 7-8 mm below the level of the foramen magnum. There is significant crowding of the CSF space at the level of the foramen magnum. Platybasia is demonstrated. Also seen is progressive expansion of the calvarial marrow space likely related to sickle cell disease.No evidence of parenchymal edema or mass effect is seen. No intracranial hemorrhage or any abnormal extra axial fluid collection is detected. The ventricular system is normal in size and morphology. On postcontrast images, no pathologic parenchymal or extra-axial enhancement is detected.The right periorbital soft tissues are mildly edematous.MRA:Normal flow related signal is seen within the anterior and posterior circulations. No evidence of significant vascular stenosis or occlusion is seen. A complete circle of Willis is evident with prominent ACOM and PCOM arteries.

Output: 1.No evidence of acute ischemia or any other definite acute intracranial abnormality.2.Small lesions are seen most likely representing chronic ischemia along the perfusional watershed of the deep right cerebral white matter, and within the right caudate nucleus. A subtle focus of signal abnormality within the left temporal lobe is nonspecific.3.Findings compatible with Chiari malformation are demonstrated.4.Unremarkable MRA of the brain.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Patient with bilateral upper extremity weakness and recent fall. Rule out hemorrhage/other acute processes. Signs and symptoms: Bilateral upper extremity weakness. Nonenhanced head CT:No detectable acute intracranial process. CT however is insensitive for the attention of acute nonhemorrhagic ischemic strokes.Cerebral cortex, cortical sulci and the ventricular system are within normal for patient stated age.The gray -- white matter differentiation is preserved.Calvarium and soft tissues of the scalp are unremarkable.Visualized paranasal sinuses, mastoid air cells and middle ear cavities are pneumatized and unremarkable. Very small retention cyst in the left maxillary sinus however is present.Nonenhanced cervical CT:There is no detectable bony fracture of the cervical spine.There is very significant degenerative changes of cervical spine with resultant near complete fusion of C3 and C4 , significant loss of intervertebral disk at C4 -- C5 and advanced degenerative changes at C5 -- C6 and C6 -- C7 levels. There is reversal of cervical lordosis centered at C3 there C4. There is highly suspected central spinal stenosis at C3, C4 and C5 levels.There are also bilateral multi-level neural foraminal compromise at C3 there C4, C4 -- C5 and to a lesser degree at C5 -- C6 and C6 -- C7 levels.No detectable paraspinal soft tissue abnormalities.Heavy vascular calcification of the right carotid bifurcation is noted.Enlargement of thyroid lobes with inhomogeneous pattern is concerning for goiter. There is no deviation or compromise of the trachea.

Output: 1.Negative nonenhanced head CT.No evidence of acute posttraumatic findings of cervical spine. Very advanced degenerative changes of cervical spine with resultant reversal of cervical lordosis and multilevel neural foraminal compromise and suspected central spinal stenosis.


Instruction: Generate impression based on medical findings.

Input: There is grade 1 anterolisthesis of L4 on L5 measuring up to 6 mm. The vertebral body heights are well-maintained. There is loss of disc height most pronounced at L1/2, L2/3, L4/5 and L5/S1. There is increased T2 signal at the endplates at multiple levels consistent with degenerative changes. The distal spinal cord and conus are within normal limits with the conus terminating at the L1 level. At T12/L1, there is no significant spinal canal or neural foraminal stenosis. At L1-L2, there is a disc bulge with a protrusion eccentric to the right with moderate right neural foraminal and left lateral recess stenosis, but no left neural foraminal stenosis. At L2-L3, there is a a disc bulge with facet hypertrophy and ligamentum flavum thickening without significant spinal canal or neural foraminal stenosis. At L3-L4, there is facet hypertrophy and ligamentum flavum thickening without significant spinal canal or neural foraminal stenosis. At L4-L5, there is degenerative anterolisthesis with facet hypertrophy and ligamentum flavum thickening causing severe spinal canal stenosis with compression and buckling of the nerve roots and moderate right and severe left neural foraminal stenosis. At L5-S1, there is facet hypertrophy and ligamentum flavum thickening without significant spinal canal or neural foraminal stenosis.

Output: Multilevel degenerative spondylosis that is most pronounced at L4-5 with severe spinal canal stenosis, moderate right and severe left neural foraminal stenosis, and grade 1 anterolisthesis.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: Alignment is anatomic. 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: UnremarkableC3/4: There is left central disc protrusion which indents the anterior cord surface without intrinsic cord signal abnormality and no resulting stenosis.C4/5: Mild disc bulge containing a posterior central annular tear without cord abutment and no resulting stenosis.C5/6: Left paracentral disc protrusion which causes slight anterior left hemicord flattening without intrinsic cord signal abnormality and no resulting stenosis.C6/7: Tiny left paramedian disc protrusion without cord abutment and no resulting stenosis.C7/T1: Unremarkable

Output: 1.C3/4: Left central disc protrusion which indents the anterior cord surface without intrinsic cord signal abnormality and no resulting stenosis.2.C4/5: Mild disc bulge containing a posterior central annular tear without cord abutment and no resulting stenosis.3.C5/6: Left paracentral disc protrusion which causes slight anterior left hemicord flattening without intrinsic cord signal abnormality and no resulting stenosis.4.C6/7: Tiny left paramedian disc protrusion without cord abutment and no resulting stenosis.


Instruction: Generate impression based on medical findings.

Input: 40-year-old patient with cirrhosis, jaundice. Evaluate liver lesions, masses, biliary structure, and hepatic vasculature. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology of the liver. Cholelithiasis without evidence of intra- or extrahepatic biliary ductal dilatation. Arterially timing is suboptimal, however, there are no focal hepatic lesions that demonstrate washout on delayed imaging. The hepatic veins and portal veins are patent. SPLEEN: Splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Anasarca.OTHER: Moderate ascites. There are splenic varices and a splenorenal shunt. There are bilateral pleural effusions and patchy bilateral airspace opacities.

Output: 1.Cirrhotic morphology of the liver with stigmata of portal hypertension. Limited study secondary to motion artifact and poor arterial timing, however, no focal hepatic lesion demonstrating washout to suggest hepatocellular carcinoma; CT should be considered for subsequent evaluation given inherent sensitivity of MRI to motion artifact.2.Bilateral pleural effusions and bibasilar airspace opacities; chest radiograph may be considered for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Left C8 radiculopathy. There is straightening of the cervical lordosis, which may relate to patient position. The vertebral bodies are preserved in height. Marrow signal show no suspicious abnormality. There is loss of the disc heights from C3-C4 through C6-C7 associated with disc-osteophyte complexes indenting the anterior aspect of the thecal sac as described below. The spinal cord shows no abnormal signal or significant compression. Major neck vessels are patent. Small lymph nodes in the upper neck are nonspecific.C2-C3: There is no spinal canal or foraminal stenosis.C3-C4: Disc osteophyte complex minimally indents the thecal sac. Right more than left uncovertebral and facet proliferative changes result in mild-to-moderate right foraminal stenosis.C4-C5: Disc osteophyte complex mildly narrows the spinal canal. There is mild to moderate bilateral foraminal stenosis by uncovertebral and facet proliferative change.C5-C6: Disc osteophyte complex also mildly narrows the spinal canal. Left more than right uncovertebral proliferative change is associated with severe left and moderate right foraminal stenosis.C6-C7: Disc osteophyte complex causes no significant spinal canal narrowing. Mild uncovertebral and facet reactive change cause mild-to-moderate left and mild right foraminal narrowing.C7-T1: There is a disc bulge that mildly indents the anterior aspect of the thecal sac causing mild narrowing of the canal. There is left more than right facet and uncovertebral proliferative change associated with mild left foraminal stenosis. T1-T2: There is no spinal canal or foraminal stenosis.

Output: Multilevel cervical spondylosis is most pronounced at C5-C6 where there is severe left and moderate right foraminal stenosis. At C7-T1, there is mild left foraminal stenosis. Spinal canal narrowing is at most mild, as described above.


Instruction: Generate impression based on medical findings.

Input: Multiple myeloma.. The marrow is diffusely heterogeneous in signal which can be reflective of involvement by multiple myeloma and/or reactive red marrow. There is no pathologic compression fracture. Mild posterior height loss at L5 is probably degenerative in nature given the associated endplate/matter typeII. Degenerative signal.There is a posterior epidural T2-hyperintense, mildly T1-hyperintense (relative to muscle) which anterior displaces and mildly compresses the spinal cord. This extends from C6-C7 level to the mid T5 level (craniocaudal length of 12.5 cm) and has a maximum anteroposterior diameter of 1.0 cm. The compressed spinal cord signal shows a subtle increase in STIR signal but this can also be artifactual. There is no significant compression of the thecal sac otherwise. While this may represent epidural hemorrhage, it is more likely to represent epidural involvement by multiple myeloma especially given the below-described paraspinal mass, which has similar signal characteristics. Partially imaged is a left sided paraspinal mass at T3 level with superior extension to T2 level with extension towards the left T2-T3 and T3-T4 neural foramina. This is probably related to extraosseous involvement by multiple myeloma. These were not present on the previous examination from December 2014.

Output: 1.Cervicothoracic (C6-C7 through mid T5) posterior epidural soft tissue with compression of the thecal sac/spinal cord is most probably related to involvement by the known multiple myeloma. There is suggestion of subtle increase in cord STIR-signal. However, the study was limited to T1 and STIR sequences in the sagittal plane and therefore cannot accurately assess for cord edema.2.Thoracic left paraspinal soft tissue mass has similar signal characteristics and is also most compatible with extraosseous involvement by multiple myeloma.Contrast-enhanced thoracic spine MRI would more definitively assess the above described epidural component and the mass effect it causes on the spinal cord.Dr. Monther Qandeel discussed the above findings and recommendations with Dr. Anubha Ganjoo over the phone on Oct 31, 2015 at 1044 hours.


Instruction: Generate impression based on medical findings.

Input: 28 years, Female, Reason: 28 yo female with cystic mesenteric mass; please evaluate for any abnormalities History: cystic mesenteric mass. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mesenteric fluid containing lesion with thin walls is now positioned more inferiorly within the left lower quadrant and measures 6.0 x 2.7 x 8.0 cm (11/45 and 5/9), unchanged in size. There are no solid enhancing components or other suspicious features.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of free fluid in the pelvis is likely physiologic.

Output: Mesenteric cyst without suspicious features, likely a lymphangioma, enteric cyst or other benign mesenteric cystic lesion.


Instruction: Generate impression based on medical findings.

Input: 38 years Female (DOB: 6/14/1978)Reason: assess for demyelinating disease History: intermittent paresthesiasPROVIDER NAME: KOUROSH REZANIA KOUROSH REZANIA 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.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine.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 small central disc protrusion present at this level associated with some mild ligamentum flavum hypertrophy.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a small central disc protrusion present at this level associated with some mild ligamentum flavum hypertrophy.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.No convincing evidence for demyelinating disease involving the brain or cervical spine on this exam.2.There is some minor degenerative changes present in the cervical spine.


Instruction: Generate impression based on medical findings.

Input: 43 year old woman with MR detected left breast mass at 12:00 position. MR directed left ultrasound identified a sonographic correlate for an enhancing mass on MRI at 12 o'clock position in the left breast. This is a hypoechoic mass measuring 1.8 x 0.7 cm at the 12 o’clock position with mildly increased vascularity, 1 cm from the nipple. The lesion was readily visible.PROCEDURE: The procedure and its risks, including bleeding, infection, and failure to diagnose, and expected benefits of ultrasound-guided core biopsy with percutaneous placement of a marking clip and post-procedure unilateral mammogram were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time-out form was completed to confirm patient identity and side/type of procedure.The left breast was cleansed with chlorhexidine over the target area. Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially, with 1% lidocaine with 1:100,000 epinephrine at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a lateromedial approach, two 14-gauge core needle (InRad) specimens were obtained of the lesion. Targeting was judged very good. All specimens sank to the bottom of the prefilled container of 10% formalin. Specimen quality was judged very good.Specimens were sent to Pathology with an accompanying history sheet. Using continuous ultrasound-guidance a Bard ribbon clip was placed into the lesion in the usual manner. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. Post-procedure digital left CC and ML views revealed the percutaneously placed clip to be in the expected location in the peripheral posterior aspect of the lesion. No evidence of hematoma or other complication.A pressure dressing was positioned over the biopsy site and an ice pack positioned over the pressure dressing. Post-procedure instructions were reviewed with the patient both verbally and in writing. She tolerated the procedure well with no evident complications and continued to stereotactic biopsy in stable condition.The procedure was performed by Drs. Abe and Patel. Dr. Abe was present during the procedure at all times.

Output: Successful ultrasound-guided core biopsy of the left breast lesion and ribbon clip placement. Pathology is pending at this time.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on medical findings.

Input: 40 year-old female with history of sinus congestion. Sinusitis, head pain. The paranasal sinuses are well pneumatized and demonstrate no evidence of acute or chronic inflammatory sinus disease. The OMUs of the maxillary sinuses are patent bilaterally. The bony density of area of exam is unremarkable. There is prominence of subarachnoid space in the bifrontal region (left greater than right). This is more than is expected for patient's stated age of 39. This examination utilizes bone algorithm for study of the sinuses and is not proper test for evaluation of soft tissues of intracranial content. The above findings are concerning for possible parenchymal volume loss or small chronic subdurals, dedicated CT of brain or an MRI is recommended.These findings were relayed to Anne Forsythe number 8158. The findings are also left on an answering machine at the level number 24851 at the time of interpretation.

Output: 1.No evidence of acute or chronic sinus disease.2.Prominence of the subarachnoid space in bifrontal region left greater than right as detailed. 3.4.


Instruction: Generate impression based on medical findings.

Input: 30-year-old female presents with right shoulder pain, evaluate for a labral tear. ROTATOR CUFF: No significant abnormality noted.SUPRASPINATUS OUTLET: The acromioclavicular joint appears normal. There is no fluid in the subcoracoid/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is normal. There is mild deformity of the posterior superior labrum with high signal partially undercutting the labrum suggestive of a small SLAP tear. A small focus of linear signal intensity between the anterior superior labrum and the adjacent articular cartilage may represent a sublabral sulcus, a normal anatomic variant. Increased signal intensity within the anterior labrum above the equator is comparable to that seen on the prior study and may represent a normal variant rather than a tear. The inferior labrum appears normal.BICEPS TENDON: The tendon of the long head of the biceps appears normal. ADDITIONAL

Output: Findings suggestive of a small SLAP tear of the posterior superior labrum and other findings as described above.


Instruction: Generate impression based on medical findings.

Input: 14-year-old male, evaluate for piriformis syndrome or hypertrophy of the piriformis muscle The piriformis muscles are symmetric in size with normal signal intensity. The sciatic nerves coursing anterior to the muscles appear normal.Note is made of a cystic structure to the right of the midline in the prostate, which may represent a prostatic utricle or Mullerian duct cyst. The BMI is elevated.

Output: Normal symmetric appearing piriformis muscles without evidence of piriformis syndrome.


Instruction: Generate impression based on medical findings.

Input: Female 37 years old Reason: evaluate for osteonecrosis History: hip pain Femoral heads are well formed and seated within well formed acetabula. No acute fracture, dislocation or avascular necrosis of the femoral heads are noted. No joint effusion. The tendinous insertions of the hamstring and gluteal musculature are intact.The joint spaces are normal.The sacroiliac joints, pubic symphysis and lower lumbar spine are unremarkable.No pelvic ascites.On the postcontrast imaging, no abnormal enhancement is noted.There is symmetric marrow changes involving the femoral diaphysis without a sclerotic margin on the T1 weighted image. Findings more more likely due to fatty marrow changes rather than medullary infarcts.

Output: No MR evidence of avascular necrosis of the femoral heads.


Instruction: Generate impression based on medical findings.

Input: There are foci of hypodensity in subcortical and periventricular white matter locations without mass effect or enhancement which match T2 abnormality identified by previous brain MRI. The ventricles and sulci are normal in size without evidence of obstruction or hydrocephalus. There are no masses, mass effect or midline shift. There is no evidence for intracranial hemorrhage or acute cerebral or cerebellar cortical infarction. There are no extraaxial fluid collections or subdural hematomas. The visualized portions of the paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain or evidence of metastatic disease.

Output: 1.Mild to moderate small vessel ischemic disease, which given differences in technique is unchanged compared to previous MRI.2.There is no abnormal enhancement within the brain or evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Multiple sclerosis with weakness. Follow up progression. There are scattered punctate and confluent areas of abnormal T2/FLAIR hyperintensity within the supratentorial periventricular and subcortical white matter in a pattern compatible with known demyelinating disease. There are multiple new foci of T2/FLAIR signal abnormality such as the left superior frontal gyrus subcortical white matter, bilateral frontal and parietal corona radiata, and left anterior temporal subcortical white matter. Multiple lesions with T1 hypointensity again seen. There is mild volume loss involving the corpus callosum, similar to prior. There is no evidence of intracranial mass or mass effect. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: Interval progression of known demyelinating disease compared to 4/25/2013 with multiple new lesions as described above.


Instruction: Generate impression based on medical findings.

Input: 60 years, Female, Reason: elevated liver enzyme, r/o gallstone History: elevated liver enzyme, abd pain. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Moderate intrahepatic biliary ductal dilatation is slightly increased from the prior MRI but likely unchanged from the recent CT. Status post cholecystectomy. Common bile duct is dilated to 1.3 cm (801/11), previously 1.1 cm. No choledocholithiasis. No suspicious hepatic lesions.SPLEEN: No significant abnormality noted.PANCREAS: Prominent pancreatic duct.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Renal cysts are unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes of gastric bypass.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Increased intrahepatic and extrahepatic biliary ductal dilatation, likely due to benign stricture at the level of the ampulla.


Instruction: Generate impression based on medical findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The left hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 12 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 1 minute and 38 seconds.

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


Instruction: Generate impression based on medical findings.

Input: 55-year-old male with pain MENISCI: Limited evaluation of the menisci due to patient motion. There is abnormal signal within the anterior horn, body, and posterior horn of the medial meniscus, extending to the articular surface with meniscal tissue displaced laterally and anteriorly, likely representing a displaced flap or fragment. The medial meniscus is intact.ARTICULAR CARTILAGE AND BONE: A focal full-thickness articular cartilage defect on the lateral tibial plateau measures approximately 1 cm in AP diameter, and 7 mm in transverse diameter. Subchondral cyst is noted beneath the medial tibial spine.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The patella tendon and quadriceps tendon are intact. There is mild prepatellar tendon soft tissue edema.ADDITIONAL

Output: Focal articular cartilage defect along the lateral tibial plateau and medial meniscal tear with displaced fragment as described above.


Instruction: Generate impression based on medical findings.

Input: There is straightening of the cervical curvature, likely positional. There are no fractures or subluxations. The marrow signal is benign. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: UnremarkableC3/4: Posterior osteophyte disc complex indents the anterior cord surface. There is also bilateral uncinate hypertrophy. There is minimal central, mild to moderate left neural foraminal, and moderate right neural foraminal stenosis.C4/5: Posterior osteophyte disc complex asymmetric to the left causes left anterior hemicord flattening. There is also bilateral uncinate hypertrophy. There is mild to moderate leftward central stenosis and mild bilateral neural foraminal stenosis.C5/6: Posterior osteophyte disc complex asymmetric to the left causes left anterior hemicord flattening. There is also bilateral uncinate hypertrophy. There is moderate leftward central stenosis, moderate to severe left neural foraminal, and mild right neural foraminal stenosis..C6/7: Posterior osteophyte disc complex causes anterior cord flattening. There is also bilateral uncinate hypertrophy. There is mild to moderate central, mild to moderate left neural foraminal, and moderate right neural foraminal stenosis.C7/T1: Unremarkable

Output: 1.C3/4: Minimal central, mild to moderate left neural foraminal, and moderate right neural foraminal stenosis.2.C4/5: Mild to moderate leftward central stenosis and mild bilateral neural foraminal stenosis.3.C5/6: Moderate leftward central stenosis, moderate to severe left neural foraminal, and mild right neural foraminal stenosis..4.C6/7: Mild to moderate central, mild to moderate left neural foraminal, and moderate right neural foraminal stenosis.5.Multilevel cord flattening is present from C3/4 through C6/7 without convincing intrinsic cord signal abnormality.