Instruction: Generate impression based on medical findings.

Input: 64 year old female with new onset of left proptosis. Thyroid eye disease versus mass. The extraocular musculature remain within normal size and configuration. The retro-orbital fat remains within normal limits. There is a slight prominence of the right optic nerve at the site of its insertion to the right globe. No definitive evidence of enhancement in this region is detected. Review of prior MRI examination of brain without infusion from 2007 demonstrated similar finding with no interval change. The osseous structures of the orbits are unremarkable. There is prominence of bilateral superior ophthalmic veins. MRI examination of this patient from 8 -- 30 -- 2007 was reviewed which also demonstrated prominence of superior ophthalmic veins however no abnormality at the level of cavernous sinus was noted on that exam.The paranasal sinuses are well pneumatized are unremarkable with the exception of a small retention cyst in the dependent portion of right maxillary sinus. No abnormality at the level of the skull base is detected.

Output: 1.No evidence of Graves' ophthalmopathy or mass in the orbit as clinically is questioned.2.Prominence of bilateral superior ophthalmic veins which has remained stable since prior MRI examination of brain without and fusion from 8 -- 30 -- 2007.3.Prominence of right optic nerve immediately posterior to the globe no enhancement as detailed.4.Dedicated MRI examination of orbits and region of the sella with infusion is recommended for further evaluation of the above findings.


Instruction: Generate impression based on medical findings.

Input: 29 year-old male with left-sided weakness, evaluate for CVA.. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Normal brain CT.


Instruction: Generate impression based on medical findings.

Input: 47-year-old male with redness and edema and history of a vascular malformation. No bone marrow signal abnormality is identified. There is no evidence of muscle atrophy or edema. There is a large vascular malformation confined to the subcutaneous tissues along the posterior and lateral aspect of the right upper extremity extending down the axilla and along the lateral aspect of the right hemithorax. There is associated skin thickening in the surrounding area. No focal fluid collection is identified to suggest abscess. There is thickening of the fascial planes in the surrounding area. The vascular malformation is supplied by the arterial branches of the deep brachial, anterior humeral circumflex, and posterior humeral circumflex arteries. The largest vessel which supplies the malformation is identified at the level of the mid humerus where there is also a dominant vein which drains into the cephalic vein. There are multiple other collateral vessels in the surrounding area. There is an additional venous drainage via the axillary and basilic veins.

Output: Complex venous and arterial malformation with details as described above.


Instruction: Generate impression based on medical findings.

Input: Former 30 3/7 week premature infant girl with history of cardiac arrests. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is deficient white matter myelination, which is mainly limited to the brainstem and portions of the cerebellum. In particular, there is no appreciable T1 hyperintensity of the posterior limbs of the internal capsules of peri-Rolandic regions. There is mild patchy symmetric T1 hyperintensity of the bilateral anterior thalami and globi pallidi. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Paucity of white matter myelination, which may be commensurate with corrected age for prematurity. Otherwise, no evidence of mass lesions, acute cerebral infarction, intracranial hemorrhage, hydrocephalus, or encephalomalacia.


Instruction: Generate impression based on medical findings.

Input: History of multiple myeloma: lower extremity weakness. Cervical Spine: There is lack of the usual cervical lordosis. There are multilevel cervical posterior disc-osteophyte complexes, with associated mild indentation upon the spinal cord at C4-5. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal. The paravertebral soft tissues are unremarkable.Thoracic Spine: There is no significant interval change in the infiltrative tumor involving the right aspect of the T7 vertebra with epidural extension, but no spinal cord compression. The focus of enhancement in the posterior T4 vertebral body is less conspicuous. The thoracic spine alignment is anatomic and the vertebral body heights are preserved, aside from minimal anterior wedging of the T11 vertebral body. Lumbar Spine: There is a partially-imaged heterogeneous mass containing areas of probable necrosis within the right sacrum. There is considerable extension of tumor into the spinal canal at the S2 level. There is relatively high T1 signal in the vertebral bone marrow surrounding the tumor, which is likely attributable to prior radiation therapy. There is unchanged mild anterolisthesis of L4 on L5. There is multilevel lumbar degenerative spondylosis. In particular, there is moderate to severe right neural foraminal stenosis at L5-S1 due to a combination of tumor and the degenerative findings. Otherwise, there is no significant spinal canal stenosis in the lumbar spine and the lumbar vertebral body heights are preserved.

Output: 1. Partially-imaged mass involving the right sacrum, with considerable extension into the spinal canal at the S2 level. Please refer to the separate pelvis MRI report for additional details.2. No significant interval change in the infiltrative tumor involving the right aspect of the T7 vertebra with epidural extension, but no spinal cord compression.3. The focus of enhancement in the posterior T4 vertebral body is less conspicuous than in April 2015.4. Multilevel cervical posterior disc-osteophyte complexes, with associated mild indentation upon the spinal cord at C4-5. 5. Multilevel lumbar degenerative spondylosis, including moderate to severe right neural foraminal stenosis at L5-S1 due to a combination of tumor and the degenerative findings.


Instruction: Generate impression based on medical findings.

Input: Female 56 years old Reason: rule out thyroid nodules History: none RIGHT LOBE MEASUREMENTS: 5.3 x 1.7 x 2.1 cmLEFT LOBE MEASUREMENTS: 5.9 x 2.3 x 2.6 cmISTHMUS MEASUREMENTS: 5-mmRIGHT LOBE: Multiple complex appearing predominantly cystic nodules in the right lobe largest measuring 8mm in diameter in the mid right lobe.LEFT LOBE: Multiple complex appearing, predominantly cystic nodules in the left lobe largest measuring 2.3 by 2-cm in the mid left lobe.ISTHMUS: Subcentimeter cystic nodule in the isthmus.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-appearing lymph nodes in the neck.OTHER: No significant abnormality noted.

Output: Multinodular goiter with bilateral multiple complex cystic nodules.


Instruction: Generate impression based on medical findings.

Input: The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. No evidence of aneurysms or vascular malformations.MRV HEAD

Output: 1. No evidence of stenosis in the intracranial arterial vasculature or aneurysm.2. No evidence of venous sinus thrombosis.3. 2 cm extra axial mass along the left anterior temporal convexity is most consistent with sphenoid wing meningioma and demonstrates increase in size since prior MRI from 7/28/2015.


Instruction: Generate impression based on medical findings.

Input: 20-year-old woman with history of abdominal distention and diarrhea. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No findings to explain patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: History of T4N0 adenoid cystic carcinoma of the tongue. There has been interval evolution of post-treatment findings in the oral cavity, with decrease in size of a defect in the dorsum of the oral tongue. There is decreased swelling and diffuse high T2 signal and enhancement in the portions of the oral tongue and tongue surrounding the defect, without a discernible discrete tumor. There is no evidence of significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable. The imaged osseous structures, orbits, and intracranial structures are unremarkable. There are subcentimeter right lung nodules.

Output: 1. Interval evolution of post-treatment findings in the oral tongue with what may represent associated surrounding inflammation and perhaps denervation changes, but no measurable residual tumor.2. No significant cervical lymphadenopathy.3. Subcentimeter right lung metastases. Please refer to the separate chest CT report for additional details.


Instruction: Generate impression based on medical findings.

Input: Back pain, evaluate spinal stenosis. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is mild rightward translation of L2 on L3, leftward translation of L4 on L5, and overall levoscoliosis of the lumbar spine with apex at the L3-L4 level. There is severe loss of disc height involving the right aspect of the L3-L4 level.Bone marrow signal is benign with degenerative endplate changes, relatively more prominent involving the left aspect of the L4-L5 endplates. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Rightward translation of L2 on L3 and moderate disc height loss and disc bulge which is eccentric to the left. There is also mild bilateral facet arthropathy. There is no significant central spinal canal stenosis. There is however mild to moderate left neural foraminal stenosis. Right neural foramen is patent.L3-L4: Severe loss of disc height on the right with subchondral cysts, endplate irregularity, mild disc bulge, and vacuum phenomena. There is also advanced right-sided facet arthropathy with mild distention of the facet joint. There is mild central spinal canal stenosis. There is moderate to severe right-sided neural foraminal stenosis. Left neural foramen is patent.L4-L5: Mild leftward translation of L4 and L5, disc bulge with vacuum phenomena, ligamentum flavum thickening, and moderate to severe bilateral facet arthropathy. There is also a small central disc extrusion. There is partial effacement of the left lateral recess without significant central spinal canal stenosis. There is moderate to severe left and moderate right neural foraminal stenosis.L5-S1: Mild disc bulge with vacuum disc phenomena and significant loss of height involving the left aspect of the disc space. There is a prominent left lateral osteophyte. Moderate bilateral facet arthropathy. There is no significant central spinal canal stenosis. There is moderate to severe left and mild right neural foraminal stenosis.

Output: 1. Degenerative changes throughout the lumbar spine with malalignment including levoscoliosis with apex at the L3-L4 level. 2. There is mild central spinal canal stenosis at L3-L4. No high-grade spinal canal stenosis is present at any level.3. Neural foraminal stenoses are most significant at the right L3-L4 and left L2-L3, L4-L5, and L5-S1 levels. Additional details as above.


Instruction: Generate impression based on medical findings.

Input: 68-year-old male with prostate cancer. PELVIS:PROSTATE:Prostate Size: 3.2 x 4.3 x 4.3 cm.Peripheral Zone: Mild patchy low T2 signal in the peripheral zone bilaterally, suggestive of inflammation. No definite focal lesion suspicious for prostate cancer.Central Gland: Heterogeneous with hyperplastic nodules. Small prostatic utricle cyst noted.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No focal lesion suspicious for prostate cancer.


Instruction: Generate impression based on medical findings.

Input: CERVICAL SPINE: There is a patchy focus of T2 hyperintensity in the cervical cord on the right at the upper C5 level and bilaterally at C5-C6 level. No evidence of cord edema or abnormal enhancement.There is straightening of the normal cervical lordosis. There are mild degenerative changes with multilevel small central disc osteophyte complexes with partial effacement of the ventral thecal sac. No significant spinal canal or neural foramina stenosis. The disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The paravertebral soft tissues are unremarkable.THORACIC SPINE: The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. Minimal multilevel disk bulges. There is no significant spinal canal stenosis.The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology with the conus terminating at the inferior L1 endplate. The paravertebral soft tissues are unremarkable.

Output: 1.Prior study is not available for comparison. Patchy T2 hyperintensity within the cervical cord at the C4 to C6 levels may represent residual edema or gliosis from prior demyelination/transverse myelitis. No lesions with enhancement to suggest active demyelination. 2.Minimal cervical and thoracic spine degenerative changes. 3.No lesions within the thoracic cord.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Right orbitozygomatic craniotomy for orbital schwannoma resection. There has been interval evolution of postoperative findings related to orbital tumor resection with minimal residual fluid in the anterior superior extraconal right orbit. There is interval resolution of the edema in the inferior right frontal lobe gyrus along the surgical approach and resolution of dural enhancement along the floor of the right anterior cranial fossa. There is mild protrusion of the right orbitofrontal gyri into the right orbit through a defect in the superior orbital wall and mild deformity of the right superior rectus-levator complex. The right orbital contents are otherwise intact and the left orbit appears unremarkable.

Output: Interval evolution of postoperative findings orbitozygomatic craniotomy without evidence of recurrent tumor.


Instruction: Generate impression based on medical findings.

Input: 46 years Female (DOB:11/23/1970)Reason: headaches and generalized muscle twitches, rule out masses or Arnold Chiari History: headaches and generalized muscle twitches, rule out masses or Arnold ChiariPROVIDER/ATTENDING NAME: THOMAS J. KELLY THOMAS J. KELLY The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: No evidence for intracranial mass lesion or Chiari malformation. MRI of the brain is within normal limits.


Instruction: Generate impression based on medical findings.

Input: Evaluate for bleed. 68-year-old female Examination is suboptimal due to extensive motion artifacts in particular in the posterior fossa. However no definitive abnormality within the posterior fossa is noted in 4 to remains within normal size and location.Several area of low-attenuation is suspected in the left posterior temporal occipital region. This was also partially visualized on the prior examination and may represent area of acute stroke. Several areas of subcortical lucencies are also noted in bilateral cerebral hemispheres. These may represent small vessel disease of undetermined age. An MRI examination is recommended since the quality of both of these recent CT exams are not very good for detection of very acute stroke.

Output: Suboptimal exam however suspected left posterior temporal -- occipital stroke and small vessel disease. MRI is recommended.


Instruction: Generate impression based on medical findings.

Input: Clinical question: History epilepsy and drop attacks. Signs and symptoms: Preoperative planning for laser ablation callosotomy. Pre-and post-enhanced fusion brain MRI:Similar to prior exam there is generalized prominence of cortical sulci and cerebellar -- vermian folia for stated age of 29 and consistent with underlying parenchymal volume loss. Large focus of encephalomalacia in the right anterior temporal and with evidence of a right temporal craniotomy is noted. Smaller focus of primary cortical encephalomalacia in the left anterior temporal lobe under a left temporal craniotomy is also noted. There is no detectable abnormal enhancement the brain parenchyma or the pia- meninges. Examination is performed as surgical planning study and is not a true and complete diagnostic exam.

Output: 1.Large right anterior temporal and a smaller left anterior temporal foci of encephalomalacia and evidence of prior craniatomy.2.Generalized prominence of the cortical sulci and cerebellar -- vermian folia consistent with underlying parenchymal volume loss.3.No detectable abnormal enhancement.


Instruction: Generate impression based on medical findings.

Input: There is 4 mm grade 2 anterolisthesis of C4 on C5 and C6 on C7. Grossly this appears similar to prior counting survey from the thoracic spine MRI. The cervical spine is otherwise in normal alignment, with exaggeration of the normal cervical lordosis. There is mild disc narrowing at C3-C4 with mineralization centrally. There is also mild disc narrowing at C4-C5 and moderate-severe disc narrowing at C5-C6. There is diffuse disc desiccation. The vertebral body and disk heights are otherwise well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal.At C2-C3, there is no significant disk pathology or stenosis. There is minimal ligamentum flavum thickeningAt C3-C4, there is no significant disk pathology or central spinal canal stenosis. There is mild bilateral foraminal stenosis due to diminished disc height.At C4-C5, there is uncovering of the disc with a minimal disc bulge and ligamentum flavum thickening resulting in minimal central spinal canal stenosis. There is mild bilateral foraminal narrowing.At C5-C6, there is mild bilateral uncovertebral hypertrophy without stenosis.At C6-C7, there is uncovering of the disc with a moderate disc bulge and ligamentum flavum thickening, without stenosis.At C7-T1, there is a trace disc bulge without stenosis.Punctate T2 hyperintensity within the central pons is nonspecific but may represent small vessel ischemic change. Incidental note is made of medialized course of the common carotid arteries.LUMBAR SPINE

Output: 1.Degenerative grade 2 anterolisthesis of C4 on C5 and C6 on C7, grossly similar to prior counting survey from MRI thoracic spine. Mild to moderate scattered spondylotic changes without high-grade stenosis.2.Stable moderate chronic compression deformity involving L1 and L4. Multilevel spondylotic changes, most conspicuous at L4-L5 where there is up to moderate-severe right foraminal narrowing. Impingement of the exiting right L4 nerve root. No high-grade central spinal canal stenosis.3.Nonspecific T2 hyperintense lesion off the lower pole the right kidney, statistically most likely a cyst. Ultrasound could be obtained for further evaluation as clinically indicated.


Instruction: Generate impression based on medical findings.

Input: Clinical question: 25 years old male with fevers, vomiting, headaches, mental status change. Rule out intracranial increase pressure, mass, bleed. Signs and symptoms: Altered mental status, vomiting, fever and headaches. Non-enhanced head CT:There is no evidence of intracranial hemorrhage, edema, mass, mass effect, midline shift or hydrocephalus.There is evidence of a prior in the right posterior temporal -- occipital junction with the extensor and inferior to the suboccipital region. There is underlying parenchymal encephalomalacia of right cerebellum and right occipital lobe. Please correlate with history regarding the reason for surgery. Follow-up with an MRI is recommended if there was a recurrence of tumor at this site. No acute finding on the current exam.Images through posterior fossa also demonstrate bilateral patchy and linear calcification that may be result of prior treatment. There is also ex vacuo dilatation of the fourth ventricle. Patchy calcification within the pons is also noted. This finding may be also result of prior treatment or a cavernoma. This finding and may also further evaluated with an MRI examination.Other than above described craniotomy calvarium is intact.Visualized mastoid air cells and middle ear cavities are unremarkable.There is limited view of paranasal sinuses are unremarkable.

Output: 1.No evidence of acute intracranial findings.2.Focal encephalomalacia right occipital and right cerebellum under a right-sided posterior temporal, occipital, suboccipital craniotomy site. Please correlate with past medical history.3.Patchy calcification of bilateral cerebellum may be result of prior treatment.4.Patchy calcification of the pons could result of prior treatment and or a cavernoma.5.If clinical concern persist recommend follow-up with an MRI exam.


Instruction: Generate impression based on medical findings.

Input: 54-year-old male with head and neck cancer, evaluate response to therapy CHEST:LUNGS AND PLEURA: Scattered areas of scarring in both lungs are unchanged. Volume loss in the left lower lobe. No suspicious nodules or masses can be identified. No evidence of pleural effusion. Bronchial wall thickening, particularly at the left lung base is unchanged. The left upper lobe mucoid impaction is stable.Mild paraseptal and centrilobular emphysema.MEDIASTINUM AND HILA: Tracheostomy tube in place. Right Port-A-Cath with its tip in the SVC. Mediastinal lymph node enlargement is stable.CHEST WALL: Right chest port. Soft tissue collection of air is identified in the region of the right subclavian vein may be secondary to recent instrumentation. Increasing areas of sclerosis involving the T1, T2, and T3 vertebrae may be near the radiation therapy. Osseous metastases cannot be definitely excluded. MRI of the cervical and thoracic spine is recommended. Large soft tissue mass in the lower portion of the left neck partially visualized on this exam. Will be evaluated on CT of the head and neckABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedPANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: G-tube in placeBONES, SOFT TISSUES: Sclerotic areas in the upper vertebrae and impending collapse of the T2 vertebrae may represent post radiation changes and/or metastatic disease.OTHER: No significant abnormality noted

Output: 1.No evidence of pulmonary metastatic disease. Stable mediastinal adenopathy.2.Low left neck mass better evaluated on CT of the head and neck.3.Sclerotic lesions in the T1, T2, T3 vertebrae with impending collapse of the T2 vertebrae may represent post radiation changes or metastatic disease. Recommend MRI and he cervical and thoracic spine for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Redemonstrated is straightening of the normal cervical lordosis. The vertebral body heights are well-maintained. There is multilevel disk narrowing as demonstrated previously. No worrisome focal marrow signal abnormality is appreciated. There is developmental narrowing of the mid cervical spine canal.At C2-C3,there is no significant disk pathology or stenosis, unchanged.At C3-C4, there is a mild diffuse posterior osteophyte disk complex as well as right greater than left uncovertebral hypertrophy and right-sided facet arthropathy. The previous disk protrusion component has slightly increased as well as ligamentum flavum thickening. These progressive findings now result in severe central stenosis (previously moderate-severe), with new intrinsic T2 cord hyperintensity. Moderate left and moderate-severe right foraminal stenosis is stable.At C4-C5, there is a persistent mild posterior osteophyte disk complex with left greater than right uncovertebral hypertrophy. There is moderate central spinal canal stenosis as well as moderate-severe left and moderate right foraminal narrowing. There is also trace ligamentum flavum thickening. These findings are unchanged.At C5-C6, there is a posterior osteophyte disk complex with mild bilateral uncovertebral hypertrophy, and moderate bilateral foraminal narrowing. These findings are unchanged.At C6-C7, there is a mild posterior osteophyte disk complex and superimposed right paramedian disk protrusion with annular fissure. This flattens the right ventral cord without intrinsic cord signal abnormality. There are no significant stenoses. These findings are unchanged..At C7-T1,there is no significant disk pathology or stenosis, unchanged.Facet arthropathy results in foraminal encroachment on the right at T1/2, T2/3, and T3/4, unchanged.

Output: 1.At C3-C4, there is a mild diffuse posterior osteophyte disk complex as well as right greater than left uncovertebral hypertrophy and right-sided facet arthropathy. The previous disk protrusion component has slightly increased as well as ligamentum flavum thickening. These progressive findings now result in severe central stenosis (previously moderate-severe), with new intrinsic T2 cord hyperintensity. Moderate left and moderate-severe right foraminal stenosis is stable.2.At C4-C5, there is moderate central spinal canal stenosis as well as moderate-severe left and moderate right foraminal narrowing, unchanged.3.At C5-C6, there is moderate bilateral foraminal narrowing, unchanged.4.At C6-C7, there is a mild posterior osteophyte disk complex and superimposed right paramedian disk protrusion with annular fissure. This flattens the right ventral cord without intrinsic cord signal abnormality, unchanged.5.Facet arthropathy results in foraminal encroachment on the right at T1/2, T2/3, and T3/4, unchanged.


Instruction: Generate impression based on medical findings.

Input: 55-year-old man with history of elevated PSA status post prostatectomy. PELVIS:PROSTATE:The patient is status post prostatectomy. There is a 19 x 8 mm soft tissue nodule in the left prostatectomy bed (series 801, image 26) which has low T2 signal, diffusion restriction, and mild enhancement. This nodule appears to extend to the level of the left anterior rectal wall.BLADDER: There is concentric thickening of the bladder wall.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Enhancing soft tissue focus in the left prostatectomy bed suspicious for local recurrence, less likely residual seminal vesicle. Please correlate with patient's operative history.


Instruction: Generate impression based on medical findings.

Input: 3-year-old female with history of intermediate-risk neuroblastoma, off therapy evaluation. Please visualize area of consolidation noted on MRI performed 10/20/10. LUNGS AND PLEURA: Nodular pleural thickening posteromedially in the left apex measures 8 x 6 mm (image 14/59, series #4). This is in the previous location of the large left paraspinal mass. Previously seen consolidation in the right lung base on prior MRI is no longer evident. There are no pulmonary consolidations, nodules, or pleural effusions.MEDIASTINUM AND HILA: Soft tissue density mass in the anterior mediastinum with concave margins and conforming to the contour of the aorta is not significantly changed and consistent with normal thymus. No lymphadenopathy. Normal heart size. No pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: 1. Consolidation in the right lung base on prior MRI has resolved.2. Residual nodular left pleural thickening in the region of the previously described paraspinal mass.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for torn meniscus, foreign body History: right knee pain and locking MENISCI: There is medial extrusion of the body of the medial meniscus. There is globular increased signal intensity within the body of the medial meniscus representing intrasubstance degeneration with blunting of the extruded meniscus likely representing degenerative tearing. The intrasubstance degeneration and degenerative tearing extends posteriorly to involve the posterior horn of the medial meniscus with relative sparing of the anterior horn. There is globular intrasubstance signal within the lateral meniscus indicating intrasubstance degeneration with linear extension of the signal abnormality to the femoral articular surface indicating a horizontal tear of the body and posterior horn.ARTICULAR CARTILAGE AND BONE: There is severe osteoarthritis of the medial tibiofemoral compartment with the weightbearing surface of the medial femoral condyle and medial tibial plateau essentially devoid of articular cartilage. There are also full-thickness cartilage defects involving the patellofemoral joint. There is relatively mild degeneration of the articular cartilage of the lateral compartment. No bone marrow signal abnormalities are identified.LIGAMENTS: Increased signal intensity within the ACL likely represents mucoid degeneration. The PCL and collateral ligaments are intact.EXTENSOR MECHANISM: The quadriceps and patellar tendons are intact.ADDITIONAL

Output: Limited study showing severe osteoarthritis, particularly affecting the medial and patellofemoral compartments, with degeneration and tearing of both menisci and other findings as above. We see no foreign body.


Instruction: Generate impression based on medical findings.

Input: 52-year-old female with recent episode of severe epigastric pain. She has had 2 courses of chemotherapy for Hodgkin's lymphoma in the past. Today colonoscopy and EGD were performed and did not explain her symptoms. ABDOMEN:LIVER, BILIARY TRACT: No discrete hepatic lesions. No intra or extrahepatic biliary ductal dilatation. Tiny hepatic cysts.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic duct is mildly prominent. A tiny cystic lesion of the pancreatic head (coronal series 4 image 25) is favored to represent a tiny sidebranch type IPMN.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Incidental note is made of an infrarenal left IVC. No lymphadenopathy.BOWEL, MESENTERY: No bowel obstruction or ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No acute abnormality is identified.2.Tiny cystic lesion of the pancreatic head is likely a sidebranch type IPMN.


Instruction: Generate impression based on medical findings.

Input: 55-year-old male with left-sided weakness There is no evidence of acute intracranial hemorrhage or midline shift. There has been continued evolution of the previously seen subacute stroke in the distribution of the right MCA with more prominent encephalomalacia (involving the right frontal, parietal and temporal lobes) and associated ex vacuo dilatation of the right lateral ventricle. A second previously noted focus of encephalomalacia in the right occipital lobe is also again seen appearing similar to the prior MRI of the brain from 3/2011. Additional patchy areas of hypodensity are seen in the periventricular and subcortical white matter likely represent small vessel ischemic disease of indeterminant age. A hyperdense proximal right MCA is again noted which may represent intraluminal clot, grossly unchanged.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized. A left ethmoid sinus benign osteoma is again noted.

Output: 1. No acute intracranial hemorrhage. CT is insensitive for the early diagnosis of acute nonhemorrhagic CVA.2. Continued evolution of an old right MCA CVA.


Instruction: Generate impression based on medical findings.

Input: 21-year-old male with history of Crohn's disease and abdominal pain. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The terminal ileum appears normal. There is no evidence of bowel obstruction. No abnormal enhancement after contrast administration.BONES, SOFT TISSUES: Mild scoliosis.OTHER: No significant abnormality noted.

Output: Limited exam due to lack of oral contrast. No evidence of active or chronic disease.


Instruction: Generate impression based on medical findings.

Input: Anaplastic astrocytoma status post chemotherapy and radiation treatment. Headache and weakness. Right parietal temporal craniotomy changes are again seen. There has been interval progression of right parietotemporal lobe enhancing infiltrative tumor with new extension into the right frontal lobe surrounding the anterior horn of the right lateral ventricle with extension superiorly along the midline vertex. There is increased infiltrative tumor extending along the genu, body, and splenium of corpus callosum. New foci of enhancement are demonstrated in the left centrum semiovale. There is overall increased mass effect and effacement of the right lateral ventricle. T2 signal extending inferiorly along the right cerebral peduncle also appears increased since prior examination. A focus of susceptibility along the right precentral gyrus likely represents a biopsy marker. Hemosiderin deposition the surgical bed is similar to prior examination.

Output: Interval unfavorable changes with significant progression of tumor involvement within the right frontal lobe, corpus callosum, with extension into the left cerebral hemisphere.


Instruction: Generate impression based on medical findings.

Input: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are scattered punctate foci of T2 hyperintensity throughout the supratentorial white matter. There is mild global volume loss. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: Mild global volume loss and mild scattered punctate foci of white matter signal abnormality most compatible with chronic small vessel ischemic disease.


Instruction: Generate impression based on medical findings.

Input: History of prostate cancer. PELVIS:PROSTATE:Prostate Size: 2.5 x 4.0 x 4.9 cmPeripheral Zone: The peripheral zone appears scarred.There is a 7 x 6 mm focus of T2 weighted hypointensity in the right apex with associated restricted diffusion. Multiple ill-defined foci of T2 weighted hypointensity in the left apex and right mid gland without significant associated restricted diffusion are noted.Central Gland: No significant abnormality.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular invasion.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.7 mm right transition zone apex lesion may represent a site of prostatic adenocarcinoma. No evidence of seminal vesicle invasion or extracapsular extension.2.Multiple nonspecific foci of T2 weighted hypointensity in the left apex and right mid gland peripheral zones are also noted.


Instruction: Generate impression based on medical findings.

Input: Bladder cancer with new left lower extremity weakness Cervical: Craniocervical junction is unremarkable. Vertebral body heights in the cervical spine are normal. Alignment is maintained aside from straightening. No cord signal abnormality. There is moderate disc height loss at the C5-C6 level, particularly anteriorly. There is abnormal signal involving the left aspect of the C7 vertebral body with extension into the posterior elements suspicious for metastasis. No gross evidence of epidural tumor within the limits of noncontrast study.There is developmental narrowing of the cervical spinal canal with superimposed degenerative changes as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Mild spinal canal stenosis which is on a developmental basis. Neural foramina are patent.C4-5: Developmental narrowing of the cervical spinal canal with superimposed small central disc protrusion. Mild facet arthropathy. There is moderate spinal canal stenosis. Neural foramina are patent.C5-6: Disc osteophyte complex with bilateral uncovertebral hypertrophy as well as ligamentum flavum thickening. There is moderate spinal canal stenosis and mild to moderate bilateral neural foraminal stenosis.C6-7: Disc osteophyte complex and uncovertebral hypertrophy as well as ligamentum flavum thickening. There is moderate spinal canal stenosis and mild to moderate bilateral neural foraminal stenosis.C7-T1: No significant compromise to the spinal canal or neural foramina.There is a 14 x 17 mm right lower cervical/level 4 lymph node which is also present on recent chest abdomen pelvis CT from 10/4/2016.Limited thoracolumbar spine evaluation on the cord compression protocol MRI: Scattered foci of osseous signal abnormality are seen including a 14 mm focus involving the L2 vertebral body as well as a lesion involving the spinous process of L5. There is also signal abnormality involving the posterior superior aspect of the T6 vertebral body.Vertebral bodies heights are maintained. Alignment in the thoracolumbar spine is maintained. There is T1 shortening involving the bone marrow of the pelvis and L5 level consistent with prior radiation. No large infiltrating lesions, pathologic fractures, or gross evidence of epidural tumor. No obvious cord signal abnormality. There are fairly mild multilevel degenerative changes with mild to moderate neural foraminal stenosis at the L4-L5 level. There is nonspecific edema involving the posterior paraspinous musculature from L3 to L5 level.

Output: 1. Examination of the spine includes sequences per acute cord compression protocol with additional noncontrast sagittal and axial T2-weighted sequences of the cervical spine. There is no evidence of acute cord or cauda equina compression.2. Scattered likely osseous metastatic lesions, relatively more prominent involving the C7 and L2 levels. No large destructive osseous lesions, pathologic fractures, or gross evidence of epidural tumor is appreciated.3. Developmental narrowing of the cervical spinal canal with superimposed degenerative changes resulting in moderate spinal canal stenosis at the C4-C5, C5-C6, and C6-C7 levels. No cord signal abnormality. 4. Enlarged lymph node in the right lower neck likely representing metastatic disease.5. Note due to the screening nature of the cord compression protocol details are not as evident on imaging as dedicated protocols of the spine.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old, with intracranial abscesses. For numbering purposes, there appear to be 13 rib-bearing vertebral bodies. No evidence of acute cord compression is seen. There is mild to moderate chronic degenerative narrowing of the spinal canal in the cervical region. A small focus of linear cord T2 signal abnormality at the C4-5 level may reflect myelomalacia. Elsewhere, no significant compromise of the spinal canal is seen. Reversal of the cervical lordosis is noted. Elsewhere, spinal alignment is anatomic. Vertebral body heights are preserved. Mild endplate edema and facet arthropathy are seen in the lower lumbar region. A 1 cm focus of enhancement within the L1 vertebral body is nonspecific but may represent a hemangioma.

Output: 1.No evidence of acute cord compression.2.Chronic degenerative narrowing of the spinal canal in the cervical region can be better assessed with dedicated imaging when clinically appropriate.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Unspecified convulsions Unspecified convulsionsClinical question: Evaluate for possible new metastatic lesionSigns and Symptoms: New onset seizures, known brain mets There is redemonstration of multiple enhancing lesions in both hemispheres of the brain as well as the cerebellum most of which are associated with susceptibility effect. Compared to the prior exam from July, there has been some interval change. One in the left periventricular white matter which ring-enhancing and previously measured 21 x 13 mm axial dimensions now measures 15 x 11. One in the anterior aspect of the left frontal lobe previously measuring 23 x 15 mm now measures 25 x 18 mm. One in the left inferior parietal lobule has also increased in size and measures 10 mm axial dimensions whereas it previously measured 7 mm axial dimension. A right temporal lobe lesion currently measures 19 x 10 mm and previously measured 17 x 13 mm. One in the left cerebellar hemisphere previously measured 13 mm and now measures 19 mm. One in the right cerebellar hemisphere measures 8 mm and now measures 15 mm. Since the prior exam diffuse periventricular confluent white matter T2 and FLAIR signal hyperintensity has progressed.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening in the right maxillary sinus and right ethmoid air cells. There are is partial opacification of the right sphenoid sinus. The visualized portions of the mastoid air cells are partially opacified. The visualized portions of the orbits are intact.

Output: 1.Since prior examination multiple hemorrhagic brain parenchymal lesions compatible with metastases have overall increased in size and number.2.Since prior exam T2 and FLAIR signal hyperintensity involving the white matter has progressed. Most likely this white matter signal change is treatment related.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old, with left frontotemporal GBM status post biopsy then radiotherapy which was completed in 6/2016. Evaluate for progression/response. Postoperative findings are seen compatible with a left parietal approach stereotactic biopsy. Again seen is an irregularly marginated enhancing lesion which spans the left frontal operculum, insula, sylvian fissure and perhaps the temporal. Since the pretreatment evaluations, the superior portion of the lesion has become more centrally necrotic while the enhancing medial rim seems to have thickened. The overall size of this component has increased with an AP dimension of up to 5 cm, previously 3.5 cm. The more inferior portion of the lesion which involves the insula and temporal lobe has also become centrally necrotic and perhaps minimally larger. There may be some subarachnoid spread from the lesion into the sylvian fissure. The enhancing portions of the lesion correlate with clear elevated rCBV.Surrounding T2 hyperintensity within the left cerebral hemisphere has increased in geographic extent. The degree of generalized mass effect has also increased with progressive effacement of the left lateral ventricle and a midline shift to the right of 11 mm, previously about 6 mm. The right lateral ventricle has increased in caliber suspicious for entrapment.Periventricular T2 hyperintensity is seen on the right along with a few scattered nonspecific foci of FLAIR hyperintensity. No definite evidence of contralateral tumor spread is seen. The core of the tumor demonstrates susceptibility compatible with blood product. However, no frank intracranial hematoma is identified.

Output: Since the prior pretreatment examinations, the overall size of the patient's left frontotemporal tumor has increased. While this at least partly represents development of central necrosis, which could reflect response to treatment, areas of progressively thicker rim enhancement are also seen. There is also a generalized increase in mass effect with progressive midline shift to the right and developing entrapment of the right lateral ventricle. Overall, the findings are concerning for progressive tumor with perhaps a minor component of treatment effect.


Instruction: Generate impression based on medical findings.

Input: Cramp of limb [729.82] / Pain in limb [729.5] / Sarcoidosis [135] / Brachial neuritis or radiculitis NOS [723.4], Reason for Study: ^Reason: eval for cause of right hand cramping pain x 1 month; hx of abnormal c-spine MRI and neurosarcoid, normal EMG. The cranial-cervical junction is normal. There is normal cervical lordosis. The cervical spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. Degenerative changes are specified by the intervertebral level as follows: C2-C3: no neuroforaminal narrowing or spinal stenosis. C3-C4: central focal disc protrusion which abuts thecal sac, no change of the degree of disc protrusion since prior scan. C4-C5: central focal disc protrusion which abuts thecal sac, slightly progressed disc protrusion since prior scan. C5-C6: minimal central focal disc protrusion which abuts thecal sac, no change of the degree of disc protrusion since prior scan. C6-C7: no neuroforaminal narrowing or spinal stenosis. C7-T1: no neuroforaminal narrowing or spinal stenosis.

Output: 1. Multilevel disc herniations without spinal cord signal abnormality as described above.2. C45 central disc herniation appears to be slightly progressed since prior scan.3. Other levels including C34 and C45 disc herniations do not show any significant interval change since prior scan.


Instruction: Generate impression based on medical findings.

Input: Reason: assess for medial meniscal injury History: knee pain for 10 months. MENISCI: The medial and lateral menisci are intact without discrete tears.ARTICULAR CARTILAGE AND BONE: The articular cartilage is intact without focal defects. No bone marrow edema. Glenohumeral joint alignment is normal.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Normal examination with no specific findings to account for the patient's pain.


Instruction: Generate impression based on medical findings.

Input: 18 years, Female, status post occipital craniectomy for Chiari malformation, C1 laminectomy and dural graft. Evaluate for postoperative changes. BRAIN: Interval postsurgical changes of Chiari decompression are seen with suboccipital craniectomy and resection of the posterior arch of C1. There is increased fluid/CSF space dorsally at the C1 level. There are foci of hemorrhage. The CSF spaces, both ventrally and dorsally, are improved. There are new areas of restricted diffusion within the inferior aspect of the cerebellum bilaterally, right greater than left, consistent with acute infarcts. The ventricles are unchanged in size and configuration. There is no evidence of hydrocephalus. The corpus callosum appears mildly dysmorphic, but fully formed unchanged from prior. Major flow-voids are preserved. Sella and orbits are grossly within normal limits. There are secretions within the bilateral mastoid air cells. There is mild mucosal thickening of the ethmoid air cells, unchanged. There is decreased opacification of the bilateral maxillary sinuses and persistent left mucous retention cyst. CERVICAL SPINE: There is decrease in size of the cervical cord related to improved edema. There is mild ill-defined hyperintense T2 signal within the upper cervical spinal cord including a small syrinx, markedly decreased compared to May 13, 2015 and slightly decreased compared to June 15, 2015. The cervical spine alignment is within normal limits, with preserved cervical lordosis. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis.

Output: 1.Postsurgical changes of Chiari decompression with improvement in CSF spaces and flow at the foramen magnum. 2.Interval development of acute infarcts involving the bilateral cerebellar hemispheres, right greater than left, in a PICA distribution. 3.Edema within the cervical cord including a small syrinx is markedly improved from May 13, 2015 and slightly decreased from the prior study June 15, 2015.Findings were discussed with Advanced Practice Nurse Gina Bradley at 4:54 PM on July 2, 2015.


Instruction: Generate impression based on medical findings.

Input: Reason: Evaluation of soft tissues of the pelvis and lumbar spine. Please extend scan proximally to lumbar spine to eval soft tissue for involvement of infection History: Osteomyelitis of L lumbar spine in pt with spinal hardware Extensive metallic susceptibility artifact from the patient's lumbosacral fixation device limits evaluation of the lumbar spine and sacrum as well as the surrounding soft tissues. Again seen is a postoperative deformity of the right hip. There is increased bone marrow signal abnormality within the right femoral head which is likely degenerative in etiology. There is a small amount of fluid within the right hip which is likely of no current clinical significance. There is fatty atrophy of the imaged musculature of the right hip and iliacus muscles bilaterally.There is increased signal abnormality within the subcutaneous tissue along the posterior aspect of the sacrum on the left, best seen on coronal STIR sequences indicating nonspecific inflammatory change. There is increased signal abnormality within the paraspinal musculature as well which is nonspecific but may be postsurgical in etiology. Extensive metallic susceptibility artifact severely limits our ability to evaluate for hardware complication. Please see the dedicated MRI lumbar spine report for additional details.

Output: Extensive metallic susceptibility artifact severely limits evaluation, particularly in the area of the orthopedic hardware and surrounding soft tissues. Nonspecific subcutaneous inflammatory change along the posterior aspect of the sacrum, on the left, with other findings as described above. Please see the dedicated MRI lumbar spine report for additional details.


Instruction: Generate impression based on medical findings.

Input: Right-sided weakness and paresthesia. There is severe degenerative disc disease at C6-7, and moderate degenerative disease at C5-6. There is mild (grade 1) anterolisthesis of C5 which is stable between flexion, extension, and neutral positioning. There is heterotopic ossification in the soft tissues posterior to the lower cervical spine. Note is made of a broken sternotomy wire and what is presumably an embolization coil overlying the upper thorax.

Output: Degenerative disc disease of the lower cervical spine with mild C5 anterolisthesis and no frank instability.


Instruction: Generate impression based on medical findings.

Input: Clinical question: History of cervical cancer, new lower extremity weakness concern for spine metastases and cord compression. Signs and symptoms: As above. Pre and post enhanced cervical MRI:There is normal anatomical alignment of cervical spine and with normal signal intensity without abnormal enhancement to suggest metastatic disease. The signal intensity and caliber of cervical cord is also within normal and without abnormal enhancement.There is generalized smaller than expected caliber of the spinal canal which is believed to be at least partially secondary to congenitally small canal. This finding in combination with mild degenerative disease results in multilevel mild central spinal stenosis.Foramen magnum is unremarkable.C2-C3 demonstrate mild degenerative changes with resultant mild central spinal stenosis without neural foraminal compromise.C3-C4 demonstrate mild degenerative changes, tiny central disc protrusion and mild buckling of the hypertrophy ligamentum flavum. Constellation of a marked changes results in mild central spinal stenosis without neural foraminal compromiseC4-C5 demonstrate mild degenerative changes with resultant mild central spinal stenosis.C5-C6 demonstrate moderate disc disease and mild facet/ligamentum flavum hypertrophy with resultant moderate left and mild right neural foraminal compromise.C6/C7 demonstrate moderate disc disease and loss of disc height, moderate left neural foraminal compromise and no central spinal stenosis.C7-T1 demonstrate no spinal stenosis or neural foraminal compromise.The post enhanced thoracic MRI:Examination demonstrates mild exaggeration of thoracic kyphosis likely secondary to degenerative disease. The alignment and the signal intensity of vertebral column remains within normal and there is no evidence of abnormal enhancement to suggest metastatic disease.The signal intensity and caliber of the thoracic cord is also within normal limits and without abnormal enhancement.There is no evidence of spinal canal compromise/stenosis or cord compression at any level. No significant degenerative disease and no evidence of neural foraminal compromise.Note is made of a bilateral pleural effusion measuring at least 27 mm on the right and 34 mm thick on the left.Pre and post enhanced lumbar MRI:Examination demonstrates normal anatomical alignment of vertebral column. There is no evidence of spinal canal compromise at any level.There is normal signal intensity and caliber of the lower most visualized thoracic cord, conus and the cauda equina without abnormal enhancement to suggest metastatic disease.There is uniform marrow signal abnormality of L5 through S4 with T1 hyperintense and T2 hyperintense signal pattern consistent with prior radiation therapy for cervical cancer.There is also extensive soft tissue along the presacral space with enhancement. Although it is difficult to precisely compare this exam with prior CT of abdomen and pelvis there is suggestion of possible interval increase in size of the soft tissue. Several irregularity within the S2 vertebral body with enhancement is also present which could represent post radiation change/necrosis however possibility of localized tumor or an infectious process cannot be entirely excluded considering patient's history of post radiation therapy complication and endovaginal fistula.

Output: 1.Examination of cervical spine demonstrate no evidence of metastatic disease or cord compression. Multilevel mild central spinal stenosis secondary to mild degenerative disc disease and suspected congenitally small canal as detailed.2.Examination of the thoracic spine demonstrate no evidence of metastatic disease. No evidence of spinal canal compromise, stenosis or cord compression. Bilateral pleural effusion (left greater than right) is noted as detailed/measured above.3.Examination of the lumbosacral spine demonstrate no evidence of spinal canal compromise or mass effect on the conus and cauda equina. No detectable abnormal enhancement of the conus or the cauda equina. Uniform signal changes of L5 through S2 consistent with prior radiation therapy. Increased presacral soft tissues at the site of prior surgery and radiation changes for cervical cancer. Small focus of irregularity within the S2 vertebral body with subtle enhancement could represent postradiation change/necrosis with other differentials of localized tumor recurrence or infection as possibilities. This finding is not associated with any epidural soft thickening or enhancement.


Instruction: Generate impression based on medical findings.

Input: 52-year-old female with back and leg pain The signal intensity of vertebral column demonstrate changes related to degenerative disk disease and is unremarkable otherwise. There are no fractures or subluxations. The conus is normal in signal and morphology and terminates at appropriate level. The visualized paraspinal contents are unremarkable.Examination at T12/L1, L1/L2, and L2/L3 levels demonstrate no central spinal stenosis or neural foraminal compromise. Mild degenerative disk disease and hypertrophic changes of posterior elements however are again noted. There has been no significant interval change.At L3/L4 there is new asymmetric bulge to the left causing new mild left neural foraminal stenosis.At L4/L5 there is advanced degenerative disk disease with loss of intervertebral disk height, broad based bulge of disk with new asymmetric prominence to the right and mild to moderate hypertrophic changes of the posterior elements. There is mild central, mild left lateral recess, moderate right lateral recess, mild left neural foraminal, and moderate right neural foraminal stenosis. Right lateral recess and neural foraminal stenosis has progressed, whereas the other stenoses are stable.L5/S1 demonstrates mild degenerative changes with mild left neural foraminal stenosis, unchanged.

Output: 1.At L3/L4 there is new asymmetric bulge to the left causing new mild left neural foraminal stenosis.2.At L4/L5 there is mild central, mild left lateral recess, moderate right lateral recess, mild left neural foraminal, and moderate right neural foraminal stenosis. Right lateral recess and neural foraminal stenosis has progressed, whereas the other stenoses are stable.3.L5/S1 demonstrates mild mild left neural foraminal stenosis, unchanged.


Instruction: Generate impression based on medical findings.

Input: Clinical question: subarachnoid hemorrhage. Signs and symptoms :subarachnoid hemorrhage. Nonenhanced head CT:Residual blood within the fourth ventricle with interval decrease since prior study.Interval decrease in the supratentorial subarachnoid hemorrhage. Extensive residual hemorrhage is still present.Hematoma in the interhemispheric fissure measuring 28.7-mm in transverse axis not significantly changed since prior study. There is effacement of all cortical sulci. There are one suspected areas of cortical low attenuation in the left frontal and parietal region concerning for air the onset of ischemic stroke. Follow-up with an MRI is recommended.Shunted lateral ventricles remain stable in size since prior study and no evidence of hydrocephalus. Residual blood within the lateral ventricles demonstrate no definitive interval change.

Output: 1.No evidence of new hemorrhage since prior study.2.Slight interval decrease in the amount of subarachnoid hemorrhage and blood within the fourth ventricle.3.Stable size of ventricular system and intraventricular hemorrhage in the lateral and third ventricle.4.Suspected areas of low attenuation of the cortex in the left hemisphere concerning for possible early onset of ischemic strokes. For further evaluation an MRI exam is recommended.


Instruction: Generate impression based on medical findings.

Input: Seizures, behavior disorder. 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 diffuse paranasal sinus mucosal thickening and secretions. There is also a small amount of fluid signal in the left mastoid air cells.

Output: 1. No seizure focus identified.2. Extensive paranasal sinus inflammatory changes.3. A small amount of fluid signal in the left mastoid air cells may represent mastoiditis in the appropriate clinical setting.


Instruction: Generate impression based on medical findings.

Input: This 37-year-old female with two days headache. Rule out subarachnoid hemorrhage. There is a hyperdense extra-axial mass in the left subarachnoid space of the high convexity. There is suspected communication between this mass and a hyperdense tubular structure that extends from the high left convexity into the brain parenchyma. Intraparenchymal hypodensity around this tubular structure may represent edema. An MRI is recommended for further evaluation of this mass.There is no evidence of intracranial hemorrhage or midline shift. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.These findings were discussed with Dr. Jeffrey Kuo at the time of interpretation.

Output: Hyperdense extra-axial mass and tubular structure extending into the brain parenchyma. An MRI is recommended for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Stage IV lung adenocarcinoma with brain metastasis. There are postoperative findings related to resection of a left occipital mass with decrease in size of the heterogeneously enhancing mass with areas of susceptibility effect along the margins of the resection cavity. There is also decreased confluent T2 hyperintensity surrounding the resection cavity, which may represent residual vasogenic edema. The ventricles are unchanged in size and configuration. There is an unchanged peripherally enhancing lesion in the right orbitofrontal region, which measures up to 14 mm and an unchanged punctate enhancing lesion in the right postcentral gyrus. However, there is a new punctate enhancing lesion in the left middle frontal gyrus. There is no midline shift or herniation. There are multiple new punctate foci of restricted diffusion in the bilateral cerebral hemispheres and right cerebellar hemisphere with corresponding high T2 signal. Aside from the expected postoperative findings, the skull and extracranial structures are unremarkable.

Output: 1. Postoperative findings in the left occipital lobe with decrease in size of the lesion in the resection cavity and associated surrounding vasogenic edema. 2. Unchanged right orbitofrontal and right postcentral gyrus metastases.3. New punctate lesion in the left middle frontal gyrus likely represents a metastasis.4. Multiple punctate foci of restricted diffusion in the bilateral cerebral hemispheres and right cerebellar hemisphere likely represent recent infarcts. Discussed with Dr. Luke at 11:20 AM on 10/16/15.


Instruction: Generate impression based on medical findings.

Input: 63 years, Female, Reason: 63 yo female has a small body of pancreas mass with mural nodule. Pt noted on OSH imaging to have renal artery aneurysms. Pt needs secretin stimulating MRCP to evaluate pancreas lesion. History: abdominal pain. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Common bile duct is prominent measuring up to 1.2 cm proximally, however no choledocholithiasis, stricture or mass is evident. There is mild intrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: There are multiple outpouchings from the pancreatic duct including a 1.4-cm outpouching in the pancreatic head and a 1.3-cm outpouching in the pancreatic body, both of which appear to communicate with main pancreatic duct. There are multiple smaller subcentimeter outpouchings along the course of the duct. There is a blunted response upon secretin administration. No enhancing pancreatic lesions are evident.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Saccular left renal artery aneurysm measuring 2.4 x 1.9 cm (10/11).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.Multiple small outpouchings along the course of the pancreatic duct likely represent side branch IPMNs.2.Saccular left renal artery aneurysm measuring up to 2.4 cm.


Instruction: Generate impression based on medical findings.

Input: Female 39 years old Reason: HIV, recurrent fevers, eval splenic fluid collection (abscess vs hematoma) History: see above ABDOMEN:LIVER, BILIARY TRACT: The liver is enlarged. The gallbladder wall is thickened with gallbladder wall edema and some mild pericholecystic fluid. No gallstones are evident. No biliary ductal dilatation. There is a focal mildly T2 hyperintense lesion in segment 5/8 of the liver along its periphery measuring 3.5 x 2.3 cm (image 26/series 601). The lesion shows mild enhancement on portal venous phase imaging. Imaging features are not specific.The hepatic and portal veins are patent.SPLEEN: Spleen is enlarged. Along the posterior aspect of the spleen there is a small fluid collection possibly containing within its capsule measuring 4.1 x 1.7 cm (image 27/series 601). There is a wedge-shaped area of poor perfusion within the splenic parenchyma adjacent to the fluid collection.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.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.Subcapsular splenic fluid collection possibly representing a peripheral infarction with abscess or hematoma.2.3.5 cm right hepatic lobe lesion with nonspecific imaging features.3.Gallbladder wall edema and associated pericholecystic fluid. Imaging findings are nonspecific but acalculus cholecystitis or cholangiopathy can't have similar features.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old, with metastatic breast cancer to the brain, treatment planning MRI for radiation therapy. A hemosiderin stained resection cavity is present in the right paramedian parietal lobe compatible with prior resection of a metastatic lesion from this location. The surgical cavity is approximately the same size as that seen on the immediate postoperative exam. Since the immediate postoperative examination, patchy peripheral enhancement has developed along the margins of the cavity which, in some areas, appears rather gyriform in nature. Redemonstrated is a heterogeneously but briskly enhancing lesion within the inferior left cerebellum. This lesion measures approximately 22 x 17 mm which is unchanged from the preoperative evaluation. The lesion is associated with fairly strong susceptibility artifact which may reflect internal blood product.No new enhancing lesions are identified. No new or significant generalized mass effect is seen. The ventricular system is within normal limits.

Output: 1.Interval development of patchy somewhat gyriform enhancement around the margins of the right parietal resection cavity. This is nonspecific but favored to represent postoperative granulation rather than residual/recurrent tumor.2.No significant interval change in the size or appearance of a second metastatic lesion in the left cerebellum.3.No evidence of any new intracranial lesion is seen.


Instruction: Generate impression based on medical findings.

Input: Ankle pain TENDONS: No significant abnormality noted.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: There is mild amount of increased signal intensity within the posterior calcaneus best seen on series 6 image 16. No discrete fracture line is identified. Additionally, there is a small focus of marrow signal abnormality within the posteromedial talus.ADDITIONAL

Output: 1. Small focus of marrow signal intensity within the posteromedial talus suggest the presence of an overlying chondral defect.2. Mild amount of increased edema within the posterior calcaneus suggesting the presence of stress injury without discrete fracture line.


Instruction: Generate impression based on medical findings.

Input: Male 56 years old Reason: fall on 3/21; radiograph negative but severe pain; cannot bear weight BONE MARROW: There is a T1 hypointense linear signal through the right sacral ala, with corresponding T2 hyperintense signal, consistent with nondisplaced sacral fracture. There is also T1 hypointense linear signal with corresponding T2 hyperintense signal through the right ischium near the pubic symphysis, and as well as in the right ischial tuberosity consistent with additional nondisplaced fractures.SOFT TISSUES: No significant abnormality noted. JOINTS: No significant abnormality noted.ADDITIONAL

Output: Nondisplaced right sacral, and right ischial fractures as described above.


Instruction: Generate impression based on medical findings.

Input: History of acute cholecystitis secondary to biliary stricture status post biliary stent placement. History of pancreatitis. ABDOMEN:LIVER, BILIARY TRACT: There is moderate intrahepatic biliary ductal dilatation to the level of the common hepatic duct, increased from the prior especially in the right hepatic lobe. The visualized common hepatic duct demonstrates diffuse circumferential wall thickening and a focal region of enhancement and thickening centrally (series 1203, image 428). The common bile duct stent is noted resulting in surrounding susceptibility artifact.Contracted gallbladder with percutaneous cholecystostomy tube.Small cyst near the right hepatic dome. No suspicious focal lesion. Transient hepatic intensity difference noted in the posterior segment of the right hepatic lobe. The vessels are patent.SPLEEN: No significant abnormality noted.PANCREAS: Atrophic pancreas. There is mild prominence of the main pancreatic duct at the level of the pancreatic body with an abrupt transition point without a focal lesion, suspicious for a stricture although an underlying neoplasm cannot be excluded (series 801/57).ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Several round regions of decreased T2 weighted signal intensity in the kidneys bilaterally with decreased enhancement and associated striated nephrograms, similar to prior CT. No hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Mild basilar atelectasis.

Output: Long segment peripherally thickened enhancing stricture of the proximal common hepatic duct with increasing upstream biliary ductal dilatation. Given the history of negative EUS/ERCP bile duct brushings (as cholangiocarcinoma/malignancy can appear similarly) and constellation of findings in the kidneys and pancreas auto-immune sclerosing cholangiopathy should be considered.Prominence of the main pancreatic duct with abrupt transition at the pancreatic body without a focal lesion, suspicious for a stricture (similar etiology as above) although underlying neoplasm cannot be excluded.The renal findings described could also be a manifestation of IgG4 related autoimmune disease.


Instruction: Generate impression based on medical findings.

Input: 67-year-old female status post fall with traumatic subarachnoid hemorrhage and small subdural/epidural. Reidentified along the right high parietal convexity, is a high density focus within the cortex with additional focus of high density seen on image 19/28 which is mostly resolved. These findings remain consistent with cortical hemorrhage given the history. No new areas of hemorrhage or associated extra-axial hemorrhage. Otherwise, there is no evidence of mass or edema. Bifrontal prominence of the subdural space within the high convexity appears slightly more dense than expected and may represent chronic bifrontal subdural hematomas or prominent extra-axial space. MRI may be considered for further evaluation as clinically warranted.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Resolving hematomas as described above.2. Prominence of the bifrontal extra axial space may represent chronic subdural hematomas or prominent extra-axial space. MRI may be considered for further evaluation as clinically warranted.


Instruction: Generate impression based on medical findings.

Input: Hip pain ACETABULAR LABRUM: Focal tear along the anterosuperior aspect at approximately 1-2 o'clock without evidence of significant displacement or additional labral findings throughout the remainder. ARTICULAR CARTILAGE AND BONE: Intact and without focal defects. No abnormal discrete signal abnormality. Marrow signal is consistent with red marrow replacement scattered throughout the pelvis and visualized portions of the proximal femur; unremarkable for age.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Antero superior labral abnormality, as described. No additional superimposed additional abnormality. Please see concomitant CT for CAM measurements.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: Clinical question: Evaluate for brain lesion in posterior fossa. Signs and symptoms: Occipital neuralgia pain right side. Blurry vision. Nonenhanced brain MRI:Negative diffusion weighted images.Images through posterior fossa are unremarkable. Images through supratentorial space demonstrate two tiny nonspecific foci of flair hyperintensity in right frontal subcortical white matter. Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF ascites is and brain myelination otherwise.The signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses are unremarkable.Unremarkable images through the orbits. No detectable calvarial or soft tissues of the scalp abnormalities.Bilateral mastoid air cells and middle ear cavities are unremarkable in signal intensity.Frothy content of the left larger chamber of the sphenoid sinus and complete opacification of right chamber are consistent with sinusitis and likely acute on the left. The rest of the paranasal sinuses are unremarkable.Nonenhanced cervical MRI:There is normal anatomical alignment the vertebral column similar to prior exam.There is moderate degenerative disease throughout the cervical spine.There is mild retroflexion of dense similar to prior study. There is hypertrophic changes of the dens and surrounding ligaments which results in subtle mass-effect and posterior displacement of cervicomedullary junction of the cord. There is progression of hypertrophic changes since prior exam. There is however no evidence of spinal stenosis at this level and the with normal signal intensity of the cord. There is extensive degenerative and hypertrophic changes at the level of right occipital condyle and C1 articulation. This finding could explain patient's right sided occipital neuralgia.C2 -- C3 demonstrate mild degenerative changes and unremarkable otherwise.C3 -- C4 demonstrate degenerative changes with resultant moderate left neural foraminal compromise.C4 -- C5 demonstrate degenerative disk disease with loss of disk height and mild hypertrophic changes of posterior elements. There is resultant significant left and moderate right neural foraminal compromise. C5 -- C6 demonstrate moderate disk disease and loss of disk height and mild facet and ligamentum flavum degenerative changes. No spinal stenosis or neural foraminal compromise.C6 -- C7 demonstrate moderate disk disease, shallow broad-based bulging disk, mild facet and ligamentum flavum degenerative changes. No spinal stenosis and moderate left neural foramina compromise.C7 -- T1 demonstrate moderate asymmetric left facet hypertrophic changes without spinal stenosis or neural foraminal compromise.Upper most visualized thoracic spine and cord is unremarkable with the exception of mild degenerative disk disease. Unremarkable paraspinal soft tissues.

Output: 1.Nonenhanced brain MRI demonstrate no acute intracranial process, two tiny nonspecific foci of flair hyperintensity in the subcortical white matter right frontal lobe and unremarkable nonenhanced brain MRI otherwise and in particular no detectable abnormality in the posterior fossa as clinically is questioned. Sphenoid sinusitis.2.Nonenhanced MRI of cervical spine demonstrate mild dorsiflexion of the dens, hypertrophic changes of the dens and the surrounding ligaments with interval progression since prior study however without spinal stenosis. There is asymmetric extensive degenerative and hypertrophic changes of right occipital condyles / C1 articulation which could explain patient's right occipital neuralgia. Moderate degenerative changes of the disks and to a lesser degree posterior elements throughout the cervical spine without central spinal stenosis. Neural foraminal compromise however are present as detailed per level above.


Instruction: Generate impression based on medical findings.

Input: 25-year-old female with positive ulnar variance, ulnar abutment, and clinical concern for triangular fibrocartilage complex tear. LIGAMENTS: No contrast is present within the mid carpal joint, consistent with intact lunotriquetral and scapholunate ligaments.TRIANGULAR FIBROCARTILAGE COMPLEX: No contrast is evident within the distal radioulnar joint, consistent with an intact triangular fibrocartilage complex.TENDONS: Iatrogenic contrast is present within the extensor tendons. BONES: Cystic changes in the ulnar side of the lunate are consistent with ulnar abutment syndrome.ADDITIONAL

Output: 1.Intact triangular fibrocartilage complex as well as intact lunotriquetral and scapholunate ligaments.2.Cystic changes in the ulnar side of the lunate are consistent with ulnar abutment syndrome.


Instruction: Generate impression based on medical findings.

Input: Right foot pain TENDONS: The Achilles tendon, flexor tendons, and extensor tendons are intact.LIGAMENTS: The superomedial portion of the spring ligament appears slightly thickened but is otherwise intact. The inferoplantar longitudinal and medioplantar oblique portions of the ligament are not well seen on the axial images however these components are occasionally not well visualized on MRI. What is suspected to be the inferoplantar longitudinal component is noted on the sagittal sequences and what is thought to be the medioplantar oblique component is suggested on the oblique coronal sequences. The tibiospring component of the deltoid ligament appears intact as does the posterior tibiotalar component. The anterior talofibular ligament appears thickened but is likely intact. The calcaneofibular and posterior talofibular ligaments are intact. The distal tibiofibular complex appears intact. The plantar fascia and ligaments of the sinus tarsi appear intact.ARTICULAR SURFACES AND BONE: Mild osteoarthritis affects the talonavicular joint with subchondral cysts noted in the head of the talus. There is mild osteoarthritis of the midfoot articulations with mild degenerative signal abnormalities noted within the cuneiforms. There is no fracture or osteochondral defect. ADDITIONAL

Output: 1. Slight thickening of the superomedial component of the spring ligament which might reflect prior sprain but there is no discrete tear. 2. Mild osteoarthritis of the midfoot.3. Mild nonspecific subcutaneous edema surrounding the ankle.


Instruction: Generate impression based on medical findings.

Input: Reason: choledocholithiasis History: RUQ pain ABDOMEN:LUNG BASES: Trace left and minimal right pleural effusions are present.LIVER, BILIARY TRACT: Cirrhotic liver morphology. There is marked extrahepatic and mild intrahepatic biliary ductal dilatation, with common duct measuring up to 1.6 cm. Round filling defect in the distal common bile duct measures 1.8 x 1.0 cm suggests choledocholithiasis (best seen on series 701, image 19). Findings of adenomyomatosis in the gallbladder are redemonstrated.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal cyst. Otherwise no suspicious focal renal lesion on limited imaging.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.Choledocholithiasis. Common duct stone measures up to 1.8 cm. 2.Intra- and extrahepatic biliary ductal dilatation, as above.3.Cirrhotic liver morphology.


Instruction: Generate impression based on medical findings.

Input: Lung cancer. Headache. Evaluate for metastasis. There is no evidence of intracranial hemorrhage, mass, or acute infarct. Confluent and patchy T2/4 hyperintense signal is present in both cerebral hemispheres. There is mild expansion of the CSF-containing spaces, reflecting mild global parenchymal volume loss. The brain parenchyma and pituitary gland appear unremarkable otherwise. There is no abnormal intracranial enhancement. There is no midline shift or herniation. The major cerebral flow voids are preserved, accounting for hypoplastic left vertebral artery with PICA termination. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild scattered mucosal thickening in the paranasal sinuses relatively greater involving the left frontal sinus and left anterior ethmoid air cells.

Output: 1.No evidence of intracranial metastatic disease.2.Mild-to-moderate chronic small vessel ischemic disease.3.Mild mucosal thickening in the paranasal sinuses.


Instruction: Generate impression based on medical findings.

Input: Right hip pain Exam is slightly limited by motion artifact.ACETABULAR LABRUM: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Normal MR arthrogram of the right hip.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Evaluate for intracranial abnormality. Signs and symptoms: Gait disturbance, tremor in LE. Pre-and post-enhanced brain MRI:Negative diffusion weighted series.Examination demonstrates numerous periventricular foci of hyperintensity in bilateral cerebral hemispheres, minimal similar signal changes in the subcortical white matter of the hemispheres are also present. Tiny foci of flair hyperintensity in bilateral external capsules and pons are also identified. Findings are nonspecific however considering patient's stated age of 72 the likely represent chronic microvascular ischemic changes. These findings demonstrate no susceptibility signal changes. No detectable signal abnormality of cerebral cortex, cerebellum or vermis detected.Slight generalized prominence of hemispheric cortical sulci are noted. Correlate with history and neurological evaluation. Ventricular system remains within normal and with maintained midline. The signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses are within normal.Post enhanced images are negative for any abnormal enhancement of brain parenchyma, leptomeninges, calvarium, soft tissues of the scalp or the orbits.Unremarkable signal intensity of all paranasal sinuses and bilateral mastoid air cells and middle ear cavities.

Output: 1.No acute intracranial process.2.Findings of mild chronic nonhemorrhagic small vessel ischemic strokes more prominent in the periventricular white matter and minimally in the subcortical, bilateral external capsules and pons.3.Mild generalized prominence of cortical sulci without signal abnormality and unremarkable pre-and post enhanced brain MRI otherwise.


Instruction: Generate impression based on medical findings.

Input: 44 years Female (DOB:1/4/1972) PROVIDER/ATTENDING NAME: SERVICES ANCILLARY SERVICES ANCILLARY The patient status post suboccipital craniectomy for Chiari decompression. Since prior exam postoperative inflammatory changes have resolved. Previously noted extracranial collections have resolved. There are several periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. These are stable since prior exams and likely of little clinical significance given the small number.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.The patient is status post decompressive posterior fossa craniectomy for Chiari I malformation. CSF flow at the level of the foramen magnum is biphasic. Previously noted extracranial collections have resolved.


Instruction: Generate impression based on medical findings.

Input: Reason: P53 History: P53. History of breast and endometrial cancer Bilateral breast implants. Linear signal in the left implant. Prominent inguinal, axillary and supraclavicular lymph nodes are nonspecific. Left chest wall port catheter. Cholelithiasis without evidence cholecystitis. Common bile duct measures 7 mm without an obstructing lesion evident. There is a T2 hyperintense lesion in the right hepatic lobe measuring 5.0 x 4.3 cm. This is increased in size since the prior exam where lesion measured 3.7 x 3.4 cm and had characteristics of a hemangioma. Right renal cyst. Please note that evaluation of spine not optimal on this nondedicated study.

Output: 1.No evidence of metastatic disease.2.Right hepatic lobe lesion has increased in size, previously characterized as a hemangioma.3.Curvilinear signal within the left breast implant may be seen in the setting of intracapsular rupture, correlate with physical exam.


Instruction: Generate impression based on medical findings.

Input: Bilateral muscle weakness Left: There is mild diffuse edema of the thigh musculature, particularly affecting the anterior and lateral compartments. Following contrast administration, there is enhancement of the muscles of the thigh most notably the rectus femoris and vastus lateralis. There is mild diffuse subcutaneous edema evident as well. The muscle caliber is consistent with the patient's age. The bone marrow signal of the femur is normal and there is no focal fluid collection.Right: There is mild diffuse edema of the thigh musculature, particularly affecting the anterior and lateral compartments. Following contrast administration, there is enhancement of the muscles of the thigh most notably the rectus femoris and vastus lateralis. There is mild diffuse subcutaneous edema evident as well. The muscle caliber is consistent with the patient's age. The bone marrow signal of the femur is normal and there is no focal fluid collection.

Output: Symmetric edema and enhancement of the thigh musculature consistent with active myositis.


Instruction: Generate impression based on medical findings.

Input: Left leg numbness and tingling. There is straightening of the vertebral column in the sagittal plane. The vertebral body heights are preserved. There is multilevel degenerative spondylosis. At T12-L1 and L1-L2, there is mild facet arthropathy, but no significant spinal canal or neural foraminal stenosis. At L2-L3, L3-L4 and L4-L5, disc bulges, mild ligamentum flavum thickening, and mild facet arthropathy result in mild spinal canal and neural foraminal stenoses. At L5-S1, a left paracentral disc extrusion narrows the subarticular recess and posteriorly displaces the traversing left S1 nerve root. Otherwise, the disc bulge and the facet arthropathy result in mild central spinal canal and mild bilateral neural foraminal stenosis. In addition to multilevel degenerative, there is suggestion of mild congenital spinal canal stenosis. The tip of the conus medullaris is located at the lower L1 level, which is normal. A 1 cm well-circumscribed, homogeneously T2-hyperintense, T1-hypointense lesion along the anterior aspect of the left kidney may represent an exophytic renal cyst, but is not completely assessed.

Output: Multilevel degenerative lumbar spondylosis is most pronounced at L5-S1, where a left paracentral disc extrusion displaces the traversing left S1 nerve root. Furthermore, the disc bulges superimposed on congenitally narrow spinal canal result in mild spinal canal and neural foraminal stenoses at L2-L3 through L4-L5.


Instruction: Generate impression based on medical findings.

Input: Reason: Evaluate for ACL tear, meniscus injury and possible MCL injury History: left knee pain MENISCI: There is curvilinear signal abnormality within the peripheral half of the posterior horn of the medial meniscus extending to the tibial articular surface indicating an undersurface tear that extends into the body of the meniscus. Additionally, there is blunting of the free edge of the posterior horn of the medial meniscus likely representing a radial tear in the absence of prior partial meniscectomy. The anterior horn appears intact. The body of the lateral meniscus is abnormally prominent suggesting a discoid morphology, but we see no tear.ARTICULAR CARTILAGE AND BONE: We see no focal articular cartilage defects. The bone marrow signal intensity is normal.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Abnormal signal intensity and morphology of the medial meniscus suggesting tearing in the absence of prior partial meniscectomy.2. Discoid lateral meniscus and other findings as described above.3. The MCL is normal in appearance.


Instruction: Generate impression based on medical findings.

Input: Female, 30 years old, status post spinal cord injury at T7 with back pain. Bilateral posterior instrumented fusion is seen with stabilization rods affixed to bilateral pedicle screws at T4, T5, T6, T9 and T10.There is an exaggeration of the normal thoracic kyphosis. The T7 and T8 vertebral bodies are fused with obliteration of the intervening disc space. Elsewhere vertebral body morphology is relatively normal and there is no evidence of any concerning marrow replacement or marrow edema. No pathologic enhancement is seen.Beginning in the cervical region, severe septated syringohydromyelia is seen continuing inferiorly to the T9 level. The spinal cord parenchyma through this region is maximally thinned and the syrinx cavity fills the entire spinal canal. Below T9, the spinal cord demonstrates a normal appearance.Minimal degenerative disc disease is seen at T2-3 and T3-4. No significant spinal canal stenosis is seen. The T7-8 neural foramina are narrowed due to vertebral body fusion at this level. Otherwise, the neural foramina are within normal limits.

Output: 1.Evidence of instrumented posterior spinal fusion from T4 through T10.2.Fusion of the T7-8 vertebral bodies may reflect prior trauma or a congenital anomaly.3.Severe septated syringohydromyelia affects the spinal cord from the cervical region down to the T9 level. Below T9, the spinal cord shows a relatively normal morphology.


Instruction: Generate impression based on medical findings.

Input: Female, 30 years old, with three weeks of persistent headache and visual changes, six months postpartum, family history of aneurysm at young age. MRI brain:The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen.A 2 mm focus of enhancement deep within the right internal auditory canal is of uncertain significance. No other pathologic parenchymal or extra-axial enhancement is observed.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. Signal intensity of the bone marrow is unremarkable. No significant abnormalities of the paranasal sinuses are detected.MRA brain:No evidence of any intracranial aneurysm is seen within the limitations of MRA technique. No significant vascular stenosis or occlusion is identified.MRV brain:The dural venous sinuses and deep venous structures of the brain are patent.

Output: 1.A 2 mm focus of enhancement deep within the right internal auditory canal is of uncertain etiology and significance. Correlation with cranial nerve VII or VIII dysfunction is suggested.2.Evaluation of the brain is otherwise within normal limits.3.No intracranial aneurysm is detected.4.The intracranial venous structures are patent.


Instruction: Generate impression based on medical findings.

Input: 68 year old female with history of coronary artery disease diagnosed during stress test, now status post TECAB with LIMA to LAD (known to be atretic) and RCA stenting in 12/2013 x 2 presenting with abnormal stress echocardiogram. MEDICATIONS: metoprolol succinate, clopidogrel, aspirin, rosuvastatin First Pass PerfusionDuring hyperemia, no perfusion defects were present; however, acquisition of the stress images was significantly delayed and mild to moderate severity defects may not have been seen.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 62%, the LV end diastolic volume index is 85 ml/m2 (normal range: 65+/-11), the LVEDV is 136 ml (normal range 109+/-23), the LV end systolic volume index is 33 ml/m2 (normal range 18+/-5), the LVESV is 52 ml (normal range 31+/-10), the LV mass index is 41 g/m2, and the LV mass is 65 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 67%, the RV end diastolic volume index is 76 ml/m2 (normal range 69+/-14), the RVEDV is 121 ml (normal range 110+/-24), the RV end systolic volume index is 25 ml/m2 (normal range 22+/-8), and the RVESV is 41 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia; however, a technical error occurred during image acquisition and defects of mild to moderate severity may have been missed. 2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 62%).4. Normal RV size and systolic function (RVEF 67%).When compared to the prior study, the perfusion defect previously noted is no longer seen; however, the above mentioned caveat exists.


Instruction: Generate impression based on medical findings.

Input: There are no diffusion-weighted abnormalities to suggest acute ischemia. There is minimal susceptibility weighted abnormality corresponding to the region of prior infarct in the left post central gyrus which was visible on the MRI of the brain from 12/9/2015. There is minimal volume loss in this region when compared to the prior images. There is no gross evidence of recurrent cortical vein thrombus based on the SWI sequence. The ventricles and sulci are normal in size. There is no mass, mass effect, midline shift or extraaxial fluid collection. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear.

Output: Subtle sequela of prior likely venous infarct involving the left postcentral gyrus, well seen on outside MRI from 12/9/2015. No new infarct or hemorrhage.