Instruction: Generate impression based on medical findings.

Input: 71 year old female with history of clear cell carcinoma of the uterus, status post chemotherapy. Metastatic uterine cancer with known enlarged retroperitoneal lymph nodes, presents with 3 weeks of progressive bilateral lower extremity edema. Evaluate for IVC clot/compression. CHEST:LUNGS AND PLEURA: Multiple small micronodules are unchanged.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter hypodense focus in the dome the liver is unchanged. There are no other focal lesions. Gallstones are unchanged, but the gallbladder is contracted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Double-J stent in the left kidney collecting system is unchanged. Mild left caliectasis is unchanged. On axial image 58/165 of series 3, a 1.8 x 2 cm left midpole renal cortical mass is found. In retrospect this was present on the prior examination, but the timing of contrast bolus was inadequate to delineate the mass. This mass may represent a metastasis or primary renal neoplasm.RETROPERITONEUM, LYMPH NODES: Left para-aortic mass invading the L4 lumbar vertebral body now measures 4.6 x 4.1 cm image number 83, series number 3. The mass encases the left ureter. Adjacent retroperitoneal adenopathy is also slightly smaller. Increasing distraction of the L4 vertebral segment with compression deformity. Increasing periaortic and left mesenteric adenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Destruction of the L4 vertebral body is increased.OTHER: No IVC obstruction was found. The IVC is narrowed at the inferior hepatic margin, without change from the prior examination.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Increasing periaortic and mesenteric lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is increasing edema within the dependent portion of the lower extremities on this scan which extends to the proximal thighs bilaterally.OTHER: Periaortic/psoas/L4 vertebral body mass with direct invasion of the psoas and vertebral body is approximately unchanged in size. New compression deformity of the L4 vertebral segment. The spinal canal is difficult to evaluate in MRI may be helpful for further evaluation, if cord compression is a concern.

Output: 2-cm diameter left midpole renal mass may be metastasis versus renal cell cancer.Slight increase in the size of the left psoas/L4 mass and retroperitoneal adenopathy. Increased destruction of L4 vertebral body with compression deformity. No other significant change from previous CT.


Instruction: Generate impression based on medical findings.

Input: Cervicalgia [M54.2], Reason for Study: ^Reason: Evaluate for neck pain and bilateral UE radicular pain Cervical Spine MRIThere is normal cervical lordosis. The cranial-cervical junction is normal. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The cord signal is normal. There are disc dessication on cervical intervertebral discs.Opacifications of the right mastoid air cells are seen.Degenerative changes are as follows.C23: Within normal limitsC34: Diffuse bulging of disc which abuts thecal sac. No neuroforaminal stenosis. No spinal stenosis.C45: Minimal bulging of disc otherwise unremarkable.C56: Diffuse bulging of disc which abuts thecal sac and slightly eccentric toward left side results minimal spinal canal stenosis. No neuroforaminal stenosis. C67: Central focal bulging of disc, otherwise unremarkable.C7T1: Within normal limitsLumbar Spine MRIThere is a normal lumbar lordosis and the spine alignment is anatomic.The bone marrow and end plate demonstrate normal MR signal intensity.The vertebral body height is preserved.Spinal cord signal intensity is normal. The conus medullaris terminates at the level of T12-L1.Degenerative changes are as follows:T12-L1: There is focal disc protrusion central to slightly left side abutting thecal sac. Otherwise unremarkable.L1-L2: Disc desiccation. No neuroforaminal narrowing or spinal stenosis. L2-L3: Disc desiccation. No neuroforaminal narrowing or spinal stenosis. L3-L4: Disc desiccation. Minimal bulging of disc. No neuroforaminal narrowing or spinal stenosis. L4-L5: Diffuse bulging of disc. Disc desiccation. Bilateral ligamentum flavum thickening and facet hypertrophy on the right side results minimal spinal canal stenosis. No neuroforaminal narrowing. L5-S1: no neuroforaminal narrowing or spinal stenosis.

Output: 1. Multilevel various degenerative disc disease on both cervical and lumbar vertebral level.2. Spinal cord signal intensity is normal. 3. Vertebral body height is preserved with normal MR signal intensity.


Instruction: Generate impression based on medical findings.

Input: Male, 39 years old, with history of ALL and new bilateral testicular lesions concerning for leukemic involvement. Patient with worsening sciatica for one week, left more than right. Thoracic:No pathologic medullary or leptomeningeal enhancement is seen. No intraspinal masses are detected. Cord signal characteristics and morphology are normal.Spinal alignment is anatomic. Vertebral body morphology is normal. Marrow signal characteristics are slightly heterogeneous but without concerning marrow replacement or pathologic enhancement.A very small central disk protrusion is seen at T10-11. No significant spinal canal stenosis or neuroforaminal narrowing is detected at any level. Scattered small Schmorl's nodes are seen at lower thoracic levels.Lumbar:The distal spinal cord, conus and nerve roots of the cauda equina show normal morphology and signal characteristics. No pathologic enhancement is suspected. No intraspinal masses are seen.Spinal alignment is anatomic. Vertebral body morphology is unremarkable allowing for scattered small Schmorl's nodes. Again, marrow signal is slightly heterogeneous but without concerning areas of marrow replacement or pathologic marrow enhancement.T12-L1: Mild facet hypertrophy. No significant spinal canal or neuroforaminal stenosis.L1-2: Mild facet hypertrophy. Mild loss of disk height and T2 signal. No significant spinal canal or neuroforaminal stenosis. L2-3: Mild facet hypertrophy. Loss of disk T2 signal. No significant spinal canal or neuroforaminal stenosis. L3-4: Mild facet hypertrophy. No significant spinal canal or neuroforaminal stenosis. L4-5: Moderate facet hypertrophy. No significant spinal canal stenosis. Minimal bilateral foraminal narrowing. L5-S1: Moderate facet hypertrophy. Large left subarticular/foraminal disk protrusion with impingement of the transiting left S1 nerve root. Mild effacement of the left ventral spinal canal. Moderate left foraminal narrowing. Mild right foraminal narrowing.

Output: 1. Large left-sided disk protrusion at L5-S1 with impingement of the transiting left S1 nerve root2. Very mild degenerative findings at additional levels.3. No evidence to suggest neoplastic involvement in the spinal canal or bony elements.


Instruction: Generate impression based on medical findings.

Input: On the localizer sequence imaging there is increased edema in the left superior frontal gyrus compared to prior examination.

Output: Nondiagnostic examination with only localizer sequences obtained due to patient intolerance. There appears to be increased edema in the left superior frontal gyrus compared to prior examination. If clinically indicated, repeat imaging can be obtained with sedation.


Instruction: Generate impression based on medical findings.

Input: Previous MRI suggestive of periventricular heterotopias: Head jerking while asleep. There are several subcentimeter nodular foci with grey-matter signal characteristic along the margins of the bilateral lateral ventricles in the temporal and occipital lobes. There appear to be terminal zones of myelination. The degree of myelination is otherwise age-appropriate. There is no evidence of intracranial hemorrhage or infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is extensive diffuse paranasal sinus mucosal thickening and fluid. There is fluid within the right mastoid air cells. The orbits are unremarkable. Enlargement of the right endolymphatic duct is better depicted on the concurrent temporal bone CT.

Output: 1. Multiple nodular foci grey-matter signal within the bilateral periventricular white matter are compatible with grey matter heterotopia. 2. Right mastoid effusions may represent mastoiditis.3. Findings suggestive of acute sinusitis.4. Enlargement of the right endolymphatic duct is better depicted on the concurrent temporal bone CT.


Instruction: Generate impression based on medical findings.

Input: Male, 7 years old, with right sixth nerve palsy and hydrocephalus. Enlargement of the lateral, third and fourth ventricles is unchanged relative to the prior MRI. No parenchymal diffusion restriction is detected. No areas of significant parenchymal signal abnormality, edema or mass effect are detected. No evidence of acute intracranial hemorrhage or any abnormal extra-axial collections are seen. The sella is partially empty.

Output: 1.Redemonstration of diffuse ventriculomegaly without significant change from the prior examination.2.No new or acute findings are seen to account for the patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: Subarachnoid hemorrhage, assess for extensiveness. Diffuse encephalopathy, LUE decorticate posturing. Again seen are numerous foci of microhemorrhage, increased from 3/28/2016 MRI, some of which demonstrate restricted diffusion, including in the left occipital lobe. Multiple new foci of FLAIR signal abnormality are seen in the bilateral occipital lobes, the bilateral inferior frontal lobes, the right anterior frontal lobe and the left anterior temporal lobe at least most of which clearly correspond to adjacent blood products. Some of these FLAIR foci demonstrate restricted diffusion.Increased FLAIR sulcal signal in the superior right parietal lobe, right frontal lobe, left occipital lobe and left temporal lobe representing subarachnoid hemorrhage. Small amount of intraventricular blood product appears similar to 4/18/2016 CT head. Ventricles and basal cisterns are unchanged. There is no mass effect or herniation. There is nonspecific opacification of the mastoid air cells and paranasal sinuses. Partially empty sella.

Output: Scattered areas of subarachnoid and intraventricular hemorrhage appear similar to 4/18/2016 CT head. However the numerous foci of microhemorrhage throughout the brain are significantly increased when compared to prior brain MRI from 3/28/2016. Some of these foci demonstrate restricted diffusion which may be related to the blood products themselves although small infarcts with hemorrhagic transformation are not entirely excluded. FLAIR hyperintensity surrounding these foci are compatible with foci of edema related to the hemorrhages. No findings to suggest acute large vascular territory infarct.The numerous foci of small intra and extra-axial hemorrhage may be related to vasculitis as noted previously although thrombocytopenia may also be contributing.


Instruction: Generate impression based on medical findings.

Input: 43 years Female (DOB: 9/24/1972)Reason: MS, eval for progression History: paresthesiasPROVIDER NAME: ADIL JAVED ADIL JAVED MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of small periventricular white matter lesions, a small right internal capsule lesion, a left thalamus lesion and a right deep cerebellar lesion which are bright on FLAIR MRI and low signal on T1 that are smaller on the current exam compared to the prior exam. There is T2 signal hyperintense lesion present at the junction of medulla and spinal cord. This has not changed relative to the prior exam.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. There is T2 signal hyperintense lesion present at the junction of medulla and spinal cord. This has not changed relative to the prior exam.Foci of signal hyperintensity are present along the cervical spinal cord at the C2 vertebral body level measuring 9 mm by 5 mm sagittal dimensions, another located posteriorly at the C2-3 level measuring 4 mm axial dimensions along the left posterolateral aspect of the spinal cord which appears to have regressed relative to the prior exam. Additional smaller lesion is present in the left hemicord at C4 which is stable. Focal signal hyperintensity is also present along the thoracic spinal cord at the T1-2 level measuring 7 mm x 4 mm sagittal dimensions which is stable.At C2-3 there is a small central disk protrusion without significant compromise of spinal canal or exiting nerve rootsAt C3-4 there is redemonstration of a small central disk extrusion which compresses the thecal sac and effaces spinal fluid ventral to the spinal cord and is associated with flattening of the spinal cord. This has regressed relative to the prior exam.At C4-5 there is a diffuse disc bulge at this level associated with partial effacement of spinal fluid ventral to the spinal cord. There is encroachment of the right-sided exiting nerve roots at C4-5. This has progressed relative to the prior with a new encroachment of the right-sided exiting nerve roots.At C5-6 there is a diffuse disk bulge present associated with endplate reactive changes and effacement of spinal fluid ventral and posterior to the spinal cord. This was also present on the prior exam. There is bilateral neural frontal encroachment of the exiting nerve roots at this level. Since the prior exam endplate reactive changes at this level have converted to a chronic stage. Encroachment of the right-sided exiting nerve roots at this level appears to have worsened.At C6-7 there is a diffuse disk bulge present associated with some narrowing of the neural foramina bilaterally. This is stable since the prior examAt C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.There is a T2 hyperintense lesion present within the right lobe of the thyroid measuring 7 mm in size. This was also present on the prior exam and does not appear to have changed substantially.

Output: 1.There is a mild degree of small periventricular white matter lesions, a small right internal capsule lesion and left thalamus lesion which are stable relative to the prior exam from 6/2/15.2.Since the previous examination the patient's spinal cord lesions compatible with demyelination are appear to have remained stable in number. A lesion in the spinal cord at C3 has regressed in size.3.Since the prior examination disc extrusion at C3-4 has regressed and now does not create spinal stenosis.4.Since the prior examination spinal stenosis at C5-6 associated with neural foramina encroachment has endplate reactive changes which are in the chronic phase but is otherwise relatively stable. The neural foramen encroachment at this level is worse on the right relative to the left side.5.Since the prior examination mild to moderate spinal stenosis at C6-7 due to disk protrusion and encroachment of exiting nerve roots remains stable.6.The right thyroid lobe lesion remains stable.


Instruction: Generate impression based on medical findings.

Input: 63 year old female with breast cancer s/p chemotherapy, hx of atrial flutter s/p ablation. Referred for MRI for assessment of function. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 62%. The LVEDV is 129 ml (normal range 109+/-23), LV end diastolic volume index is 71 ml/m2 (normal range: 65+/-11), LVESV is 49 ml (normal range 31+/-10), and LV end systolic volume index is 27 ml/m2 (normal range 18+/-5). The LV mass is 53 g (normal range 114+/-24) and the LV mass index is 29 g/m2 (normal range 67+/-11). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.The native T1 myocardial relaxation time is within normal range. There is no LV thrombus. Left AtriumThe left atrium is normal in size.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 55%. The RVEDV is 141 ml (normal range 110+/-24), the RV end diastolic volume index is 78 ml/m2 (normal range 69+/-14), the RVESV is 63 ml (normal range 35+/-13), the RV end systolic volume index is 35 ml/m2 (normal range 22+/-8).Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1.The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 62%.2.The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 55%. 3.There is no evidence of late gadolinium enhancement suggesting no fibrosis or inflammation.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: 64-year-old female with NF type 2, memory loss, seizures, and vestibular schwannomas. Evaluate for new meningiomas or other tumors. Again seen is evidence of a large prior left fronto-parietal craniotomy. There is also evidence of a previous right mastoidectomy with resection and distortion of the right middle and inner ears structures. Since the prior MRI from 1/11/2014, there has been mild interval increase in size of multiple meningiomas along the dura along the right cerebral hemisphere, falx and tentorium. There is mild increase in parenchymal edema in the right frontal subcortical white matter associated with the increase in size of right anterior frontal meningiomas. Dense calcifications associated with the meningiomas are better seen on prior CT.There has also been significant interval increase in the multiple extra-axial skull base masses especially along the right Meckel's cave, right cerebellopontine angle and anteriorly along the brain stem. For example the right medial temporal/Meckel's cave lesion has increased in size currently measuring 2.0 x 3.0 cm (series 1802, image 93), compared to 1.3 x 2.6 cm previously. This mass is causing mass effect and lateral displacement of the mesial temporal structures. The larger more lateral right CPA tumor measures 2.4 x 2.6 cm (series 1802, image 76), compared to approximately 1.5 x 2.1 cm previously although direct comparison is limited secondary to prior motion degradation. This is causing worsened mass effect on the adjacent cerebellum and brainstem. The smaller more medial CPA tumor is grossly unchanged in size measuring 1.1 x 1.3 cm (1802, image 78). The extra-axial mass anterior to the brainstem has increased considerably compared to the previous exam and now exerts significant mass effect on the adjacent pons and medulla. This lesion measures 2.4 x 2.5 cm (series 1802, image 70), 1.6 x 1.7 cm previously in the axial plane. Also increased is the craniocaudal extent of the tumor which measures 2.6 cm compared to 1.8 cm previously. Additional multiple smaller tumors are seen within the bilateral CPA, right greater than left Meckel's cave, right greater than left cavernous sinus. There is masslike thickening and enhancement involving the left IAC compatible with a vestibular schwannoma which has increased in size and has also extended more medially. Large right greater than left foraminal-based masses are visible at the C1-2 level which have increased in size compared to the prior exam. There is effacement of the lateral aspects of the thecal sac, right greater than left, and mild contour deformity of the upper cervical cord. Soft tissue enhancing lesions in the suboccipital soft tissues are also slightly larger.There is no evidence of intracranial hemorrhage or acute infarct. No hydrocephalus. Aside from the right frontal lobe T2/FLAIR hyperintensity which is increased in the interval, FLAIR hyperintensity in the left frontal lobe likely reflecting gliosis is unchanged. There is also encephalomalacia in the left posterior frontal lobe which is again seen. Mild leftward midline shift is not significantly changed.. The major cerebral flow voids are intact.

Output: Innumerable extra-axial enhancing masses consistent with meningiomas and schwannomas involving the supra and infratentorial brain, greatest along the frontal lobes, right medial temporal lobe, right cerebellopontine angle, anterior to the pontomedullary junction, within the left IAC and along the bilateral C1-2 foramina, most of which have increased in size compared to the prior exam from 2014. In particular, the meningioma anterior to the brainstem has increased significantly and is now causing extensive mass effect on the ventral lower pons and upper medulla. There is also increase in parenchymal T2/FLAIR hyperintensity compatible with edema associated with the right anterior frontal meningiomas. Please see additional details above.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 distal tibia and distal femur osteomyelitis after old MVA. Evaluate for acute changes. Two views of the right femur show deformity of the femoral diaphysis likely due to old healed fractures, appearing similar to the prior study, with anterior bowing deformity of the mid-diaphysis. Screw fragments are noted within the mid-femoral diaphysis. Two screws affix a patella fracture in near-anatomic alignment. Heterotopic calcification is noted in the soft tissues lateral to the ilium, unchanged. Moderate osteoarthritis affects the knee. We see no acute process in the femur.Two views of the right tibia/fibula show old postoperative deformity of the right tibia/fibula reflecting healed fractures, appearing similar to the prior study. There is a geographic lucency within the distal tibial metadiaphysis that corresponds to an intramedullary lesion of near fluid signal intensity on a recent outside hospital MRI. This appears more prominent on the current study than the prior study and we cannot exclude an intramedullary abscess.

Output: 1. Post-traumatic deformities as described above.2. Geographic lucency in the right distal tibial metadiaphysis corresponding to a fluid signal intensity lesion on prior OSH MRI appears more prominent on this examination; we cannot exclude an intramedullary abscess.


Instruction: Generate impression based on medical findings.

Input: 64 year old male with a history of coronary artery disease, myocardial infarction, and new onset systolic heart failure who presents today for a second opinion regarding heart failure management. First Pass PerfusionDuring hyperemia, there were perfusion defects in the basal inferior, inferolateral, and inferoseptal walls; the mid inferoseptal, inferolateral, and anteroseptal walls; and in the apical inferior and septal walls.  Viability/ Myocardial ScarThere was transmural myocardial infarction involving the basal anteroseptal wall, mid anterior, anteroseptal, and inferoseptal walls, and the apical anterior and septal walls. The segments are unlikely to be viable. The remainder of the myocardium is viable. Left VentricleThe left ventricle is severely dilated with severely systolic function. The overall LV ejection fraction is 18%, the LV end diastolic volume index is 159 ml/m2 (normal range: 74+/-15), the LVEDV is 343 ml (normal range 142+/-34), the LV end systolic volume index is 130 ml/m2 (normal range 25+/-9), the LVESV is 281 ml (normal range 47+/-19), the LV mass index is 54 g/m2, and the LV mass is 116 g. There is thinning and akinesis of the LAD territory. There is hypokinesis of the remainder of the other other coronary territories. There is no LV thrombus. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 62%, the RV end diastolic volume index is 53 ml/m2 (normal range 82+/-16), the RVEDV is 115 ml (normal range 142+/-31), the RV end systolic volume index is 21 ml/m2 (normal range 31+/-9), and the RVESV is 44 ml (normal range 54+/-17).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 mild 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 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.There is significant amount of ischemia and viability in the RCA and LCx territories.2.There is a very large myocardial infarction in the LAD territory which is not viable. 3.Severely dilated LV with severe systolic dysfunction (LVEF 18%). There is a large akinetic region involving much of the LAD territory.4.Normal RV size and systolic function (RVEF 62%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: History of echogenic lesion in cervix and lower uterine segment and ultrasound. History of pelvic pain. PELVIS:UTERUS, ADNEXA: There is an ill-defined 3.5 x 3.4 cm T2 hypointense mass in the uterine fundus with small focus of T2 hyperintensity suggestive of a focal adenomyoma. The junctional zone measures approximately 5 mm. No significant endometrial fluid.Additional small well-defined T2 hypointense enhancing 1.6 cm left uterine body subserosal lesion, likely a fibroid.BLADDER: Contracted urinary bladder without a discrete lesion.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild enhancement of the left adductor musculature suggesting nonspecific muscle edema.OTHER: No significant abnormality noted.

Output: 1.3.5 cm uterine fundus adenomyoma. 2.Left uterine body subserosal 1.6 cm fibroid.3.Nonspecific mild left adductor musculature suggesting muscle edema.


Instruction: Generate impression based on medical findings.

Input: 34-year-old male with NF1 and multiple plexiform neurofibromas. Please delineate the margins of his tumors. There are innumerable masses of low signal intensity on T1-weighted images and high signal intensity on T2-weighted images, some of which have a target appearance, compatible with nerve sheath tumors and the stated history of neurofibromatosis type I. Plexiform lesions are noted in the soft tissues adjacent to the right lung apex with a smaller concentration of neurofibromas noted in the soft tissues adjacent to the left lung apex. Please note that the brachial plexus is not included in its entirety on this chest study. Neurofibromas are noted along all thoracic nerve roots bilaterally with additional neurofibromas involving the intercostal nerves at all levels. Additional solitary neurofibromas of varying size are noted within the musculature and soft tissues of the chest wall. For reference purposes, a tumor in the right anterolateral chest wall is approximately 2.4 x 1.3 cm in transverse dimension and 3.5 cm in oblique craniocaudal dimension. There are a couple of right-sided paraspinal lesions at the level of the thoracic inlet measuring approximately 3 x 2.1 x 3.5 cm and 3 x 1 x 2.5 cm. There may also be a few small mediastinal nerve sheath tumors. Small nerve sheath tumors are also noted within the arms bilaterally. We see no specific imaging findings to suggest malignancy.

Output: Findings compatible with neurofibromatosis as described above.


Instruction: Generate impression based on medical findings.

Input: Other disturbances of skin sensation [R20.8], Reason for Study: ^Reason: Concern for neurodegenerative disease History: numbness, weakness There is no evidence of abnormal enhancement.There is normal cervical lordosis. The cranial-cervical junction is normal. There is normal thoracic kyphosis and lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The cord signal is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal stenosis, cord compression or myelopathy. The conus medullaris terminates at the level of L1. No change of central protrusion of L5S1 disc.

Output: No evidence of abnormal enhancement on this scan.No change of L5S1 disc protrusion since prior scan.


Instruction: Generate impression based on medical findings.

Input: Multiple sclerosis. Brain: There are numerous, greater than 10, T2 hyperintense lesions in the supratentorial and infratentorial white matter. Many of the lesions also display T1 hypointensity. There is no discernible associated enhancement. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild diffuse cerebral volume loss. 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.Spine: There are multiple areas of T2 hyperintensity in the cervical spinal cord without appreciable associated enhancement or spinal cord expansion. The thoracic spinal cord appears unremarkable. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal or neural foramen stenosis. However, there are multiple subcentimeter perineural cysts within the cervical neural foramina. The paravertebral soft tissues are unremarkable.

Output: Numerous intracranial and spinal cord white matter lesions are compatible with demyelinating disease.


Instruction: Generate impression based on medical findings.

Input: History of pituitary adenoma, with recent blurred vision in both eyes over last month. Pituitary: There appears to be a punctate focus of hypoenhancement in the posterior right pituitary lobe. Otherwise, the pituitary gland is not enlarged and there is no evidence of pituitary macroadenoma. The infundibulum and optic apparent are intact. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Apparent punctate focus of hypoenhancement in the posterior right pituitary lobe may represent artifact or perhaps a microadenoma, but no evidence of macroadenoma or other mass lesions compromising the optic apparatus.2. No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on medical findings.

Input: Reason: L knee meniscus tear History: L knee pain MENISCI: There is a branching linear signal abnormality within the posterior horn of the medial meniscus extending to both the tibial and femoral articular surfaces indicating a complex tear with both horizontal and vertical components predominantly involving the inner half of the posterior horn. Signal abnormality extending into the body of the medial meniscus suggests intrasubstance degeneration. The anterior horn appears normal. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is mild degeneration of the articular cartilage of the patellofemoral joint with underlying small subchondral cyst formation. A small full-thickness low intensity focus is also seen in the articular cartilage of the trochlea with underlying cyst formation. There is mild degeneration of the articular cartilage of the medial tibiofemoral compartment with mild edema type signal in the medial tibial plateau, which is presumably degenerative.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Medial meniscal tear as described above.2. Mild osteoarthritis as described above.


Instruction: Generate impression based on medical findings.

Input: Female; 69 years old. Reason: R/o Osteo History: fever MRI right foot:There is soft tissue ulceration at the medial and posterior aspect of the heel with abnormal signal and enhancement extending from the ulcer to the underlying calcaneus. However, there is no signal abnormality within the calcaneus itself to indicate osteomyelitis. No fluid collections to suggest abscess. A rounded focus of increased signal in the navicular bone may represent a cyst, ganglion, or small enchondroma. Mild osteoarthritis affects the ankle and midfoot. The visualized tendons appear intact. The visualized ligaments appear grossly intact, although lack of striations of the deep fibers of the deltoid ligament may represent an old sprain. Fatty atrophy of the plantar musculature noted.MRI left foot:No evidence of osteomyelitis. Mild nonspecific edema seen in the pre-Achilles fat pad. No fluid collections or evidence of abscess. The visualized tendons appear intact. The visualized ligaments appear grossly intact, although lack of striations of the deep fibers of the deltoid ligament may represent an old sprain. No abnormal enhancement.

Output: Right heel soft tissue ulceration and inflammatory changes, but no evidence of osteomyelitis.


Instruction: Generate impression based on medical findings.

Input: Headache, retroorbital pain/pressure in right eye, diplopia, and decreased visual acuity. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Orbits: The bilateral globes and optic nerves are intact. The lacrimal glands, extraocular muscles, orbits fat, and vessels are unremarkable bilaterally. There is no evidence of intraorbital mass lesions.

Output: Unremarkable brain and orbits.


Instruction: Generate impression based on medical findings.

Input: 30 year-old female with nausea, vomiting, and abdominal distention. 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: Simple cyst in the interpolar region of the right kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Multiple subcentimeter foci of fluid signal intensity are identified within the adnexa bilaterally, consistent with follicles. There is a 2.6 cm focus of fluid signal intensity in the left adnexa which may represent a physiologic cyst. A nabothian cyst is seen.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No findings to account for the patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Localized swelling, mass and lump, neckClinical question: right supraclavicular mass , low grade vascular neoplasmSigns and Symptoms: eval extent of mass to vessels MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. MRI neck:There is a 48 x 28 mm heterogeneous mass centered in the right supraclavicular area which is surrounded by adjacent vasculature including the subclavian artery and vein as well as thyrocervical trunk. Along its superior medial aspect there is a 12 x 9 mm axial dimension fluid collection present there is infiltration of the surrounding fat planes. There are punctate foci of signal loss within this lesion with slight susceptibility effect. The skin surface superficial to the lesion is irregular and somewhat disrupted. Some blood products are present within the adjacent subcutaneous tissues.Within the suprahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated. Within the infrahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated.Within the visceral space the thyroid gland appears intact.The airway appears patent.The visualized intracranial structures which include the posterior fossa are intact. The visualized portions of the orbits and paranasal sinuses are intact. The paranasal sinuses and mastoid air cells are clear.The parotid and the submandibular glands appear intact.The carotid and vertebral vasculature visualized on this exam appears intact.The cervical vertebral bodies in general are intact with no evidence for canal stenosis.

Output: 1.There is a right supraclavicular mass associated with surrounding inflammatory changes and findings suggesting recent surgery. No arterial blood supply is appreciated. A biopsy of this lesion indicates that this represents a hemangioma. Given this biopsy information, certainly the findings are consistent with a recent biopsy of a hemangioma. A follow-up cross-sectional exam after the inflammatory changes regress may help further evaluate this.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Abnormal involuntary movements(781.0)Clinical question: tremor, history of traumatic brain injurySigns and Symptoms: as above The patient is status post ventriculostomy tube placement which courses to the right frontal lobe into the right lateral ventricle and has its tip on the medial aspect of the right lateral ventricle.On susceptibility imaging there are multiple punctate foci of signal loss scattered throughout the subcortical white matter of the supratentorial brain. Punctate foci of hypointensity are also present in the brainstem and the cerebellar hemispheres. Some of these are associated with T2 and FLAIR signal hyperintensities.There is a small subdural effusion present. There is generalized brain atrophy present.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There are multiple microhemorrhages scattered throughout the brain predominantly in subcortical white matter and to lesser there are also present in the brainstem and cerebellar hemispheres.2.There is a mild degree of brain atrophy present.3.Status post ventriculostomy tube placement. The ventricles are rather large but to some degree this is probably related to atrophy.


Instruction: Generate impression based on medical findings.

Input: Left orbital mass. There is a smoothly expansile mass involving the left superior lateral orbit extending into the left frontal sinus measuring approximately 2.4 x 2.8 x 2.8 cm in the AP, transverse, and craniocaudal dimensions. Mass exhibits diffuse T1 hyperintensity without fat suppression. No associated enhancement is demonstrated. Smooth expansile osseous changes are better appreciated on recent CT. There is mass effect on the left globe which appears inferiorly displaced and mildly compressed. There is mild left-sided proptosis. Adjacent structures including the lacrimal gland and superior rectus muscle are also displaced. No abnormal signal within the optic nerves.There is dehiscence of the left orbital roof. The inner table of the left frontal calvarium is severely thinned based on recent CT. There is partial opacification of the left anterior ethmoid air cells and minimal elsewhere.No significant mass effect on the adjacent left frontal lobe parenchyma. Brain parenchyma is unremarkable without evidence of edema, infarct, or hemorrhage. No abnormal parenchymal or meningeal enhancement. No hydrocephalus or extra-axial collections. Major flow-voids are preserved. Remainder of the bone marrow signal and extracranial soft tissues are unremarkable.

Output: 1. Smoothly expansile mass involving the left superolateral orbit and left frontal sinus is most consistent with a mucocele. There is mass effect on the left globe which is inferiorly displaced and mildly compressed.2. There is dehiscence of the left orbital roof and significant thinning/questionable dehiscence of the inner table of the left frontal bone.


Instruction: Generate impression based on medical findings.

Input: unresponsive episodes, known prior infarctions. No evidence of acute ischemic or hemorrhagic lesion.There are lenticular shaped tissue losses on bilateral external capsules, associated with susceptibility artifacts on gradient echo images indicating chronic hemorrhagic lesions.Left basal ganglia and bilateral pons lesions show increased signal intensities on FLAIR images indicating chronic ischemic infarctions.Bilateral centrum semiovale high signal intensities on FLAIR images indicate non specific small vessel ischemic lesions.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Likely chronic hemorrhagic lesions on bilateral external capsules and left basal ganglia.3. Likely chronic ischemic lesions on bilateral pontine lesions.4. Non specific small vessel lesions on bilateral centrum semiovale.


Instruction: Generate impression based on medical findings.

Input: 49-year-old woman with history of left mastectomy in 2010 for IDC, status post hormonal therapy. Additional history of benign right breast biopsy for PASH in 2010 and benign left chest wall lymph node in 2011. Family history of breast cancer in her mother. The patient is status post left mastectomy, with bilateral retropectoral silicone implants. There is heterogeneous amount of fibroglandular tissue in the right breast. Moderate parenchymal enhancement is noted in the right breast. The silicone implants are not significantly changed in contour and position.No abnormal enhancement is seen in either breast. Right simple breast cysts are noted. The previously-seen enhancing masses at the 7:00 and 3:00 positions of the left breast are slightly decreased in size. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on medical findings.

Input: Pain and weakness. Cannot hold arm up. Rule out rotator cuff tear. ROTATOR CUFF: There is a full-thickness near-complete to complete tear of the subscapularis tendon with retraction of the tendon to the level of the glenoid. Small foci of heterotopic ossification are seen within the retracted tendon. There is severe fatty atrophy of the subscapularis muscle. There is thickening and intermediate signal intensity of the anterior fibers of the supraspinatus tendon at their insertion indicating mild to moderate tendinosis. A tiny (2 mm) focus of high signal intensity within the bursal surface fibers of the anterior supraspinatus tendon insertion may represent a tiny insertional tear, but this is equivocal. More posteriorly, there is intermediate signal intensity along the undersurface fibers of the cuff at the junction of the supraspinatus and infraspinatus tendons measuring approximately 1 cm in diameter involving approximately 50% of the thickness of the tendon. I suspect that this represents an undersurface tear. Although the remainder of the infraspinatus tendon can be traced to its insertion on the greater tuberosity, the intramuscular portion of the infraspinatus tendon appears unusually thickened, and there is moderate fatty atrophy of the infraspinatus muscle; these findings may reflect an old tear that I cannot otherwise discern on this study. There is minimal fatty atrophy of the supraspinatus muscle. The teres minor muscle and tendon appear normal.SUPRASPINATUS OUTLET: There is a small amount of fluid within the acromioclavicular joint. Small osteophytes indicate mild osteoarthritis. I see no frank fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. There is a small amount of fluid in the joint but no large effusion. Mild osteoarthritis affects the glenohumeral joint. Branching signal within the superior labrum indicates tearing which appears to extend into the superior half of the anterior labrum. A couple of tiny foci of intermediate signal intensity within the glenohumeral joint may represent small cartilage fragments.BICEPS TENDON: A structure of the intermediate signal intensity within the bicipital groove presumably represents the biceps tendon, but it becomes indistinct within the superior aspect of the groove and I see no definite tendon within the rotator interval nor do I see the biceps anchor. These findings suggest rupture of the tendon of the long head of the biceps in the absence of prior surgery.

Output: 1.Near-complete/complete full-thickness tear of the subscapularis tendon with retraction to the level of the glenoid. Additional tendinopathy/tearing of the supraspinatus/infraspinatus as described above.2.Osteoarthritis.3.Superior labral tearing.4.Rupture of the tendon of the long head of the biceps assuming no prior surgery.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Low back pain. Signs and symptoms: Same. Nonenhanced lumbar MRI:The lowermost visualized thoracic spine demonstrate extensive disk disease and loss of disk height with resultant central spinal stenosis at T10 -- T11 level. Moderate bilateral neural foraminal compromise is also detected.T12 -- L1 demonstrate advanced disk disease and loss of disk height, mild grade 1 retrolisthesis, mild bilateral facet and ligamentum flavum hypertrophy. There is no central spinal stenosis however moderate right neural foraminal compromise is present.L1 -- L2 is unremarkable.L2 -- L3 demonstrate mild degenerative changes and without spinal stenosis or neural foraminal compromise.L3 -- L4 demonstrate mild disk desiccation and loss of height, moderate bilateral facet and ligamentum flavum hypertrophy. Constellation of changes results in mild central spinal stenosis and mild to moderate right neural foraminal compromise.L4 -- L5 demonstrate mild disk disease and loss of disk height, broad based bulging disk, significant bilateral facet and ligamentum flavum hypertrophic changes. There is resultant significant central spinal stenosis and with severe right and moderate left neural foraminal compromise.L5 -- S1 demonstrate mild degenerative disk disease and mild bilateral facet and ligamentum flavum hypertrophy. There is moderate right neural foraminal compromise and unremarkable otherwise.

Output: 1.Extensive degenerative changes at L4 -- L5 with resultant significant central spinal stenosis as detailed.2.Degenerative changes at T10 -- T11 resulting in central spinal stenosis and neural foraminal compromise.3.No evidence of central spinal stenosis at any other level.4.Multi-level neural foraminal compromise however is noted as detailed per level above.


Instruction: Generate impression based on medical findings.

Input: Headache No evidence of acute ischemic or hemorrhagic lesion on the scan.No evidence of abnormal enhancement.There are patch high signal intensities on periventricular white matter and scattered white matter high signal intensities indicate minimal nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Minimal nonspecific small vessel ischemic disease.Otherwise unremarkable MRI.


Instruction: Generate impression based on medical findings.

Input: A 29 year old male with end stage renal disease on dialysis, now diagnosed with hear failure with biventricular dysfunction and echocardiographic suspicion of non-compaction cardiomyopathy. Referred to cardiac for further evaluation. Left VentricleThe left ventricle is severely dilated with moderate to severe systolic dysfunction. The overall LV ejection fraction is 33%, the LV end diastolic volume index is 158 ml/m2 (normal range: 74+/-15), the LVEDV is 275 ml (normal range 142+/-34), the LV end systolic volume index is 106 ml/m2 (normal range 25+/-9), the LVESV is 185 ml (normal range 47+/-19), the LV mass index is 98 g/m2 (normal range 85+/-15), and the LV mass is 170 g (normal range 164+/-36). There is global dysfunction with regional variation. There is mild hypertrophy (up to 12mm). The trabeculation pattern does not meet criteria for noncompaction.Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is mildly dilated with mild to moderate systolic dysfunction. The overall RV ejection fraction is 40%, the RV end diastolic volume index is 125 ml/m2 (normal range 82+/-16), the RVEDV is 218 ml (normal range 142+/-31), the RV end systolic volume index is 75 ml/m2 (normal range 31+/-9), and the RVESV is 131 ml (normal range 54+/-17).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 trace pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace tricuspid regurgitation.AortaThere is a left sided aortic arch with a common origin of innominate and left common carotid artery. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is a small pericardial effusion.

Output: 1. The left ventricle is severely dilated with moderate to severe systolic dysfunction, the LVEF is 33%. There is global dysfunction with regional variation. There is mild hypertrophy (up to 12mm). Prominent trabeculae without meeting criteria for non-compaction cardiomyopathy.2. The right ventricle is mildly dilated with mild to moderate systolic dysfunction, the RVEF is 40%. 3. The left atrium is moderately dilated. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Unsteadiness on feetClinical question: ?cerebellar deficit or subacute combined deficiencySigns and Symptoms: unsteady gait 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.There are several periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. At this age they're likely of little clinical significance and can be considered age related.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are partially opacified. The visualized portions of the orbits are intact. The eyeball lenses are thin.Incidental note is made of partial empty sella. Incidental note is made of a developmental venous anomaly in the left superior frontal gyrus.

Output: 1.There is no evidence for intracranial mass lesions. Please note that subacute combined degeneration may manifest itself in the cervical spinal cord. Although there is no evidence of that on this exam of the brain, MRI of the cervical spinal cord may be helpful to assess the spinal cord.


Instruction: Generate impression based on medical findings.

Input: Male 55 years old Reason: R/o CBD stones History: GB stones, elevated LFT and continued abd pain. Hx of pancreatitis ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. There is diffuse fatty infiltration of the hepatic parenchyma. No suspicious hepatic lesions. Hepatic and portal veins are patent.Gallbladder wall is thickened without pericholecystic fluid. There are multiple stones within the gallbladder lumen and possibly within the cystic duct. The common bile duct, common hepatic duct and intrahepatic bile ducts are normal in caliber. No choledocholithiasis is evident.There is hyperemia in segment 5 of the liver near the gallbladder fossa.SPLEEN: Pancreas is normal in morphology. No evident interstitial or peripancreatic fluid.Duct is normal in caliber and morphology.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Multiple small mesenteric pericolonic lymph nodes.BOWEL, MESENTERY: Nonspecific mild hyperemia of the colon.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cholelithiasis with gallbladder wall thickening and mild gallbladder distention. Imaging features most suggestive of acute on chronic cholecystitis.2.No evidence of choledocholithiasis or acute pancreatitis.3.Fatty infiltration of the liver.4.Findings suspicious for a nonspecific colitis.


Instruction: Generate impression based on medical findings.

Input: 56 years Female (DOB:4/3/1959)Reason: Evaluate for stenosis, spondylolisthesis, scoliosis History: Pain, deformityPROVIDER/ATTENDING NAME: MICHAEL J LEE MICHAEL J LEE MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. There is a dextrocurvature to the thoracic spine. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is a compensatory levocurvature to the lumbar spine. There is a T1 hyperintense lesion present within the T12 vertebral body measuring 10 mm in size. Most likely this represents a vertebral body hemangioma. A similar lesion is present at T11.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation present at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation present at this level. There is mild ligamentum flavum hypertrophy at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation present at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There are mild degenerative changes present lumbar spine without significant outlet spinal canal or neural foramina.2.There is a sigmoid curvature present to the thoracolumbar spine without significant compromise to the spinal canal or exiting nerve roots.


Instruction: Generate impression based on medical findings.

Input: Left orbit/sinus solitary fibrous tumor status post subtotal resection twice. There is no significant interval change in size of the mass centered within the left orbit with extension into the adjacent paranasal sinuses, premaxillary space, and masticator space. Overall, the tumor measures approximately 45 mm in width, 50 mm in height, and 40 mm in length. There is marked left proptosis and compression of the optic nerves and most of the extraocular muscles, with relative sparing of the superior rectus. There are postoperative findings in the left maxillary sinus, with moderate mucosal thickening and new secretions. The right orbit is unremarkable. There is no evidence of intracranial extension of tumor.

Output: 1. No appreciable change in size of the solitary fibrous tumor involving the left orbit with extension into the adjacent paranasal sinuses, premaxillary space, and masticator space. 2. Findings suggestive of acute sinusitis.


Instruction: Generate impression based on medical findings.

Input: 64 years Female (DOB:6/22/1952)Reason: pre dbs for parkinsons History: tremorPROVIDER/ATTENDING NAME: PETER C. WARNKE PETER C. WARNKE 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 demonstrate minor opacities. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: MRI of the brain is within normal limits. Examination is limited and was performed the purpose of stereotactic guidance.


Instruction: Generate impression based on medical findings.

Input: 63-year-old male with a soft tissue mass/possible lipomas. Note is made of multiple vitamin E capsules along the lateral and posterior aspect of the distal left humerus presumably representing the patient's palpable area of concern. There is slight prominence of the subcutaneous fat in the surrounding area, however, no discrete mass lesion is identified. This may be related to lack of contrast with the adjacent subcutaneous fat, which can be seen in patient's with palpable lipomas. There is a subcentimeter focus of enhancement along the lateral aspect of the distal right humerus, which is nonspecific but may represent a sebaceous cyst or perhaps a lymph node. This finding does not correspond to any of the markers denoting the palpable areas of concern. Note is made of a 6.5 cm lobulated focus of fat signal intensity along the lateral aspect of the right 11th and 12th ribs likely representing a lipoma although this is incompletely imaged on this examination.

Output: Slight prominence of the subcutaneous fat adjacent to the skin markers which may represent lipoma formation, although no discrete mass is identified. Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: There is no acute cord compression.Chronic cord compression at C3/4 with T2 cord intrinsic changes secondary to a large disc extrusion have improved compared to the 2013 comparison. Degenerative results elsewhere in the cervical spine appear stable. Scattered facet hypertrophy is evident throughout the thoracic and lumbar spine. There is no intrinsic abnormality of the conus. Degenerative disease at L5/S1 including disc degeneration, endplate spurring, and facet hypertrophy result in bilateral foraminal stenosis.

Output: 1.No acute cord compression.2.Chronic cord compression at C3/4 with T2 cord intrinsic changes secondary to a large disc extrusion have improved compared to the 2013 comparison.


Instruction: Generate impression based on medical findings.

Input: 76-year-old female with glioblastoma. Three weeks into RT. Decreasing mental status and increasing somnolence. Recent fall. Evaluate for bleed, shift or edema Minimal edema and hemorrhage at the site of patient's known left temporal lobe tumor and postoperative site is noted. Extensive periventricular and subcortical areas of low attenuation is believed to represent advanced small vessel disease of indeterminate age. A very small area of increased density measuring approximately 3 mm in left parietal is concerning for small amount of hemorrhage. No subarachnoid hemorrhage or midline shift or hydrocephalus.Postoperative changes of calvarium are noted in calvarium is otherwise unremarkable.Limited view of paranasal sinuses and mastoid air cells are also unremarkable.

Output: 1.Diffuse a small vessel disease of indeterminate age.2.Small area of hemorrhage edema and postoperative change in the left temporal lobe which were present on prior MRI.3.Very small area of suspected hemorrhage in the parenchyma in the left parietal which is a new finding.


Instruction: Generate impression based on medical findings.

Input: Knee pain MENISCI: There is a small, peripheral, intrasubstance tear of the posterior horn of the medial meniscus which is superimposed on intrasubstance degeneration. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: A small focus of near full-thickness cartilage loss is seen along the medial femoral condyle anteriorly (series 3 image 14/33). The remaining articular cartilage of the medial, lateral, and patellofemoral compartments is otherwise preserved.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Small intrasubstance tear of the posterior horn of the medial meniscus.2. Small focus of near full-thickness cartilage loss of the medial femoral condyle. The remaining articular cartilage is otherwise relatively preserved.3. Mild soft tissue signal abnormality along the knee medially which may represent resolving contusion/hematoma.


Instruction: Generate impression based on medical findings.

Input: Forearm mass Within the dorsal soft tissues of the distal wrist is a fairly well-circumscribed mass measuring 2.6 x 2.8 x 2.5 cm in the greatest transverse, AP, and craniocaudal dimensions. Mass appears increased in T1 signal although demonstrates central areas of low T1 signal. On T2, the mass is predominantly hyperintense. There is no significant surrounding soft tissue edema. The underlying bone marrow and surrounding muscular signal is normal. Gradient echo imaging demonstrates no obvious blooming artifact.

Output: Well-circumscribed mass within the dorsal soft tissues of the wrist demonstrate imaging characteristics suggestive of a peripheral nerve sheath tumor.


Instruction: Generate impression based on medical findings.

Input: The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The imaged spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.L1-L2: There is no significant spinal canal or neural foraminal narrowing.L2-L3: There is mild disc desiccation, loss of disc height, and a mild disc bulge without spinal canal or neural foramen stenosis. L3-L4: There is mild disc desiccation, loss of disc height, and a mild disc bulge with a superimposed right lateral recess and foraminal zone disc extrusion. These findings result in mild spinal canal stenosis, moderate right, and mild left neural foramen stenosis.L4-L5: There is a minimal disc bulge that results in mild bilateral neural foramen narrowing.L5-S1: There is no significant spinal canal or neural foraminal narrowing.

Output: 1.At L3-L4 there is a mild disc bulge with a superimposed right lateral recess and foraminal disc extrusion that results in mild spinal canal stenosis, as well as moderate right, and mild left neural foramen stenosis. Please correlate for right L3 and L4 radiculopathy. 2.Additional mild degenerative changes at L2-L3 and L4-L5 as detailed above.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Patient with increasing headache and vertigo, evaluate for structural cause. Signs and symptoms: Headache and vertigo. Nonenhanced brain MRI:No diffusion weighted abnormalities.The anatomical morphology and signal intensity to brain parenchyma is within normal on all MRI sequences.Unremarkable surgical cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.Signal void of intracranial arterial branches are identified. The signal intensity of intracranial venous sinuses are unremarkable.Unremarkable calvarium, soft tissues of the scalp, orbits, paranasal sinuses and mastoid air cells.

Output: 1.Unremarkable nonenhanced brain MRI.2.Normal signal intensity of paranasal sinuses and mastoid air cells.


Instruction: Generate impression based on medical findings.

Input: 37-year-old male with a salivary cancer. Status post 4 cycles of treatment. Compare and provide measurement. CT of soft tissues of the neck with infusion:Large destructive mass involving the left ethmoid air cells and with extension into the left orbit is again noted. In comparison with the prior exam there may be slight increase in the size of tumor in the retro-orbital space. Extensive tumor across the midline into the right ethmoid air cells with extensive bony erosion is also noted. This section of tumor demonstrates no definitive interval change. Erosion of the anterior wall of the sphenoid sinus with extension of tumor remains a stable. Increased soft tissue density on the lateral aspect of right orbit and right infratemporal fossa also remains a stable. Extensive posttherapy/surgical changes remains stable. No evidence of pathologic adenopathy in the neck. Limited images of the apices of the lungs are negative. Limited images of the mediastinum are negative on this study. Please review the dictated report of CT of chest that visualizes both these sections with more accuracy.CT of brain with infusion.No evidence of hemorrhage, edema, mass effect, midline shift or hydrocephalus. No evidence of abnormal enhancement of brain parenchyma or leptomeninges. To better evaluate patient's known tumor at the skull base in particular for epidural spread into the intracranial space an MRI is recommended.

Output: 1. With the exception of possible minimal increase in the left the retro-orbital tumor this is study remains a stable.2.Unremarkable CT of brain. Three see above comments.


Instruction: Generate impression based on medical findings.

Input: Reason: Right shoulder pain with concern for SLAP tear; History: recent football injury ROTATOR CUFF: The supraspinatus, infraspinatus, subscapularis, and teres minor tendons are intact. There is no muscular atrophy.SUPRASPINATUS OUTLET: The acromioclavicular joint appears normal. There is no fluid in the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Although we see no fluid signal intensity within the superior labrum, there is intermediate signal intensity within the anterior portion of the superior labrum that likely represents a SLAP tear. Supporting this diagnosis are small cysts adjacent to the anterior superior labrum (see image #16 of series 9). Furthermore, the superior half of the anterior labrum is separated from the underlying glenoid which we expect represents an extension of the SLAP tear but could represent a normal variant sublabral foramen. The labrum appears intact inferiorly. We see no joint effusion. The glenohumeral joint alignment is normal.BICEPS TENDON: The biceps tendon appears intact. ADDITIONAL

Output: SLAP tear and other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Reason: occipital neuralsgia History: headahe, neck pain The CSF spaces are appropriate for the patient's stated age with no midline shift. Exam is degraded by patient motion.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.No evidence for intracranial mass or infarction. To the extent of visualization this MRI of the brain is within normal limits. 2.Exam is degraded by patient motion. This may obscure more subtle abnormalities.


Instruction: Generate impression based on medical findings.

Input: There is a small T2 hyperintesity in the right occiptal cortex that is T1 hypointense, with blooming centrally on the gradient echo which may represent prior small infarct with hemorrhagic products. Cerebral cavernous malformation is felt to be less likely. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. There is partial opacification of the left maxillary sinus. The right mastoid air cells are opacified. The The remaining paranasal sinuses are clear. There is no abnormal enhancement within the brain. There is antegrade flow within the distal bilateral vertebral arteries, within the basilar artery, distal bilateral internal carotid arteries and carotid siphons and bilateral anterior, middle and posterior cerebral arteries. No arterial stenoses, occlusions, arteriovenous malformations, or aneurysms are identified.

Output: 1.There is a small T2 hyperintesity in the right occiptal cortex that is T1 hypointense, with blooming centrally on the gradient echo which may represent prior small infarct with hemorrhagic products. Cerebral cavernous malformation is felt to be less likely.2.Normal MRA of the brain.


Instruction: Generate impression based on medical findings.

Input: 30-year-old female with lateral knee pain. Evaluate for ligamentous injury. MENISCI: There is increased linear signal abnormality within the posterior horn of the lateral meniscus which extends to the tibial and femoral articular surfaces, consistent with a vertical tear, involving the insertion of the Wrisberg ligament suggesting a "Wrisberg rip". The anterior horn of the lateral meniscus appears intact. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is bone marrow edema type signal abnormality within the medial femoral condyle and medial tibial plateau. There is a focal articular cartilage defect and delamination along the medial aspect of the medial facet of the femoral trochlea. There is a subcentimeter focus of decreased signal abnormality just anterior to the medial facet of the femoral trochlea which likely represents an articular cartilage fragment within the joint space. There is underlying subchondral marrow signal abnormality suggesting bone contusion or subchondral fracture.LIGAMENTS: There is irregularity and increased signal abnormality about the midsubstance and distal fibers of the ACL consistent with at least a partial tear of the ACL. The PCL appears intact. The lateral collateral ligament proper and the distal biceps femoris tendon are indistinct suspicious for LCL rupture. There is no significant retraction of the biceps femoris. The MCL appears intact.EXTENSOR MECHANISM: The extensor mechanism appears intact. ADDITIONAL

Output: 1. Tearing of the ACL and components of the LCL as described above.2. Vertical tear of the posterior horn of the lateral meniscus extending from the insertion site of the Wrisberg ligament, consistent with a "Wrisberg rip".3. Articular cartilage defect and delamination along the medial facet of the femoral trochlea. 4. Small joint effusion. Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Meningioma surveillance. There is no significant interval change in the extra-axial enhancing mass overlying the right frontoparietal convexity with extension into the overlying calvarium, although the associated cerebral edema appears to have slightly increased in extent. There is no evidence of acute infarct. There is a background of nonspecific scattered cerebral and brainstem white matter T2 hyperintensity. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The paranasal sinuses, orbits, and scalp soft tissues are unremarkable.

Output: No significant interval change in size of the mass that may represent a meningioma overlying the right frontoparietal convexity with intraosseous extension, although the associated cerebral edema appears to be slightly increased.


Instruction: Generate impression based on medical findings.

Input: 51 years Female (DOB:3/19/1965)Reason: 51F with recurrent lung cancer, OSH transfer for Strep pneumo bacteremia and respiratory failure requiring intubation, now with left-sided paralysis and right MCA CVA, ?embolic, ?ischemic, ?other lesions History: 51F with recurrent lung cancer, OSH transfer for Strep pneumo bacteremia and respiratory failure requiring intubation, now with left-sided paralysis and right MCA CVA, ?embolic, PROVIDER/ATTENDING NAME: BRYAN A CAMPBELL ANSHU A VERMA MRI of the brainThere is cortically based diffusion restriction present along the right middle frontal gyrus as well as the medial lateral aspect of the right superior frontal gyrus and along the left middle frontal gyrus as well as the precentral gyri bilaterally and the right postcentral gyrus. This associated with it T2 signal hyperintensity in the underlying white matter. These findings are new when compared to the prior examThe CSF spaces are appropriate for the patient's stated age with no midline shift. On susceptibility imaging there is vascular or dilation along the high convexities of the right frontal lobe.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.The anterior communicating artery and the posterior communicating arteries are identified and are intact.There is extracranial origin of the left posterior inferior cerebellar artery.. There is extracranial origin of the right posterior inferior cerebellar artery. There is effectively an azygos A2 segment left anterior cerebral arteries smaller than the right anterior cerebral artery at the level of the A1 segments. The anterior communicating artery is present. The left frontopolar artery originates from the left A1-ACOMA junction.The superior division of the right middle cerebral artery is dominant whereas the inferior division of the left middle cerebral artery is dominant.

Output: 1.Findings suggest a cortically based infarction associated with underlying edema which is new since the prior exam explanations may include RCVS, vasculitis as well as encephalitis and ischemia. This is new since the MRI from 8/27/2016.2.There is a vascular microdilation along the high convexities of the right hemisphere. One possible explanation is that this represents a collateral recruitment with associated distal branch occlusions. A conventional angiogram would help differentiate.3.Please note that there is an azygos A2 segment predominately supplied from the right internal carotid artery.4.At the time of this dictation we attempted to contact the clinical service to discuss the findings (pager 3658) We are awaiting a callback


Instruction: Generate impression based on medical findings.

Input: Sagittal T2 weighted sequence was performed and, due to extensive artifact from surgical hardware, the exam was terminated.

Output: Aborted nondiagnostic examination due to extensive artifact from surgical metallic hardware.


Instruction: Generate impression based on medical findings.

Input: Right renal mass. Assess for interval change. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in size, morphology, and signal characteristics. Note is made of several hepatic cysts. No intrahepatic or extrahepatic biliary ductal dilatation. Gallbladder is normal in size without evidence of cholelithiasis. Note is made of focal adenomyosis in the gallbladder fundus. The portal vein and hepatic arteries are patent.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas is normal in size, morphology, and signal characteristic. The main pancreatic duct remains minimally prominent, however it is better visualized today extending all the way into the pancreatic tail. No evidence of stricture as previously questioned.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Redemonstration of a T1 intrinsically hyperintense lesion in the interpolar region of the right kidney. This is not significantly changed in size from prior measuring 1.6 x 1.2 cm in the coronal plane, previously 1.5 x 1.1 cm. There is no appreciable enhancement on the postcontrast images. This is compatible with a benign proteinaceous or hemorrhagic cyst. There are additional simple renal cysts bilaterally. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stable nonenhancing intrinsically T1 bright lesion in the right kidney compatible with a hemorrhagic/proteinaceous cyst.2.No evidence of pancreatic duct stricture as previously questioned.


Instruction: Generate impression based on medical findings.

Input: History of metastatic adenocarcinoma, signet cell type.Omental resection 11/25/2015 showed metastatic signet renal cell carcinoma. ABDOMEN:LIVER, BILIARY TRACT: Widening of the hepatic fissures and prominent caudate lobe compatible with chronic liver disease. Several subcentimeter hepatic cysts. No suspicious hepatic mass. No biliary ductal dilatation. The vessels are patent.SPLEEN: The spleen is normal in size.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: Postsurgical changes from transverse colectomy. Right lower quadrant end colostomy. Left lower quadrant mucocutaneous fistula. The sigmoid colon demonstrates wall thickening and hyperenhancement with mild adjacent fat stranding.BONES, SOFT TISSUES: Postsurgical changes of anterior abdominal wall and omentum. No discrete soft tissue mass.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes from transverse colectomy. Right lower quadrant end colostomy. Left lower quadrant mucocutaneous fistula. The sigmoid colon demonstrates wall thickening and hyperenhancement with mild adjacent fat stranding.BONES, SOFT TISSUES: Mild presacral fluid.OTHER: No significant abnormality noted.

Output: 1. Sigmoid colon wall thickening and hyperenhancement with mild adjacent fat stranding, worrisome for a colitis of uncertain etiology. No discrete measurable sites of disease.2. Mild morphologic changes of chronic liver disease without a suspicious liver lesion.


Instruction: Generate impression based on medical findings.

Input: Evaluate for cervical spine stenosis. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. There is a partially-empty sella. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a right maxillary sinus retention cyst. Cervical Spine: There is straightening of the usual cervical lordosis. There is multilevel degenerative cervical spondylosis with up to mild spinal canal and neural foramen stenosis. The vertebral body are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Multilevel mild degenerative cervical spondylosis.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Status post ETV. Signs and symptoms: Status post ETV. Nonenhanced head CT:There is evidence of a small right recumbent AP paramedian frontal burr hole since prior study. Small punctate focus of air density immediately under the burr hole is present. Linear low attenuation traversing the right frontal lobe and terminating into the right lateral ventricle likely result of recent instrumentation. Punctate focus of air within the right frontal horn is also present.There is no radiopaque catheter in place.No convincing evidence of any change in size of ventricular system.Periventricular low attenuation of white matter is similar to prior exam corresponding to regions of small muscle ischemic strokes on prior MRI study. Possibility of underlying periventricular exudate of CSF should also be considered.

Output: 1.No convincing evidence of interval change in the size of the supratentorial enlarged ventricular system.2.Evidence of interval right frontal burr hole, minimal intracranial air, small linear low-attenuation across the frontal lobe likely along the track of instrumentation.3.No radiopaque ventricular catheter / shunt is present.


Instruction: Generate impression based on medical findings.

Input: Male, 25 years old, with bilateral lower extremity paresthesias. Alignment is anatomic. Vertebral body morphology is within normal limits with mild transitional anatomy of the L5 vertebral body. No evidence of pathologic marrow replacement, edema or enhancement is seen.The visualized distal spinal cord, conus and nerve roots of the cauda equina are unremarkable. No pathologic spinal cord or leptomeningeal enhancement is seen. No epidural abnormalities are suspected.L1-2: Unremarkable. L2-3: Unremarkable. L3-4: Facet arthropathy. Loss of disc T2 signal and minimal loss of disc height. Mild disc bulging with a small superimposed central disc protrusion. No significant spinal canal stenosis. Mild right foraminal narrowing. L4-5: Facet arthropathy. Loss of disc T2 signal and minimal loss of disc height. Disc bulging with central annular fissuring. No significant spinal canal stenosis. No significant foraminal narrowing. L5-S1: Facet arthropathy. No significant spinal canal stenosis. No significant foraminal narrowing.

Output: Mild disc degeneration at L3-4 and L4-5 with no significant spinal canal stenosis and only mild foraminal narrowing as above.


Instruction: Generate impression based on medical findings.

Input: Patient with past medical history of SLE, presenting with bilateral lower extremity, left greater than the right weakness and decreased sensation below umbilicus. Alignment is anatomic. There is multilevel loss of T2 signal of the intervertebral discs. Conus medullaris terminates at the level of L1-L2. Vertebral body heights are preserved. A hemangioma is noted in the L5 vertebral body.At L1-L2, there is mild bulging of the disc and mild bilateral neural foraminal narrowing. At L2-L3, there is hypertrophy of the ligamentum flavum and facet joint arthropathy with mild disc bulge, resulting in mild spinal canal stenosis and bilateral mild neural foraminal narrowing. At L3-L4, there is facet joint arthropathy and a diffuse disc bulge resulting in effacement of the thecal sac and moderate narrowing of the spinal canal, along with moderate left and mild right neural foraminal stenosis. At L4-L5, there is facet joint arthropathy, small facet effusions, and a diffuse disc bulge resulting in moderate to severe spinal canal stenosis and severe right and moderate left neural foraminal stenosis. Epidural fat appears to contribute to the narrowing of the spinal canal at this level. There is mild loss of intervertebral disc space at this level. At L5-S1, there is facet joint arthropathy and mild disc bulge with no significant spinal canal stenosis. Moderate bilateral neural foraminal narrowing is noted at this level.Large probable fibroid uterus is present. Otherwise the visualized soft tissues are unremarkable.

Output: 1.Multilevel degenerative changes of the lumbar spine, with severe spinal canal and right neural foraminal stenoses at the L4-L5 level.2.Large probable fibroid uterus.


Instruction: Generate impression based on medical findings.

Input: 72 y/o male with systemic amyloidosis, diastolic dysfunction, ESRD, multiple myeloma, HTN and HLD. Patient is referred for MRI evaluation pre-inguinal hernia repair. Left VentricleThe left ventricle is normal in size and systolic function. There is mild concentric left ventricular hypertrophy (IVSd=12 mm; previously 14mm). The overall LV ejection fraction is 64%. The LVEDV is 110 ml (normal range 142+/-34), the LV end diastolic volume index is 52 ml/m2 (normal range: 74+/-15), the LVESV is 39 ml (normal range 47+/-19) and the LV end systolic volume index is 19 ml/m2 (normal range 25+/-9). The LV mass is 95 g (normal range 164+/-36) and the LV mass index is 45 g/m2 (normal range 85+/-15). There are no regional wall motion abnormalities present. The native T1 myocardial relaxation times are 1100 ms in the left ventricular lateral wall and 1157 ms in the interventricular septum. These values are elevated and consistent with his diagnosis of suspected cardiac amyloidosis and have improved from his previous cardiac MRI 9/25/2015 (1215 ms).There is no myocardial iron overload. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size. The overall RV ejection fraction is 52%. The RVEDV is 157 ml (normal range 142+/-31), RV end diastolic volume index is 75 ml/m2 (normal range 82+/-16), the RVESV is 76 ml (normal range 54+/-17), and the RV end systolic volume index is 36 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is severely dilated.Aortic ValveThe aortic valve is trileaflet and opens widely. 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 mild-moderate regurgitation.AortaThere is a left sided aortic arch with a pseudobovine pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated (30.7 mm).Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. A catheter is noted in the SVC.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is a large right sided pleural effusion. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal LV size and systolic function, LVEF 64%. Mild left ventricular hypertrophy. LV wall thickness and native myocardial T1 have improved when compared to the previous cardiac MRI of 2015.2. Normal RV size with mildly reduced systolic function, RVEF 52%.3. Biatrial dilatation. 4. Large right pleural effusion. 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: Male, 60 years old, history of L1-2 diskitis with bilateral psoas abscesses. Assess for improvement on IV antibiotics. Redemonstrated is destruction and replacement of the L1-2 disk space with T2 hyperintense signal along with destruction of the adjacent endplates and significant collapse of the L1 vertebral body. Moderate retropulsion of the L1 vertebral body continues to result in narrowing of the spinal canal this level. Findings are not changed since prior. Extension of inflammation into the ventral epidural space at L2 casuses tenting of the dura and some narrowing of the thecal sac, also unchanged.Additional patchy areas of largely T1 hyperintense marrow signal are stable in the remaining vertebral bodies. No new or concerning marrow space lesions are seen.Extensive edema persists within the bilateral psoas musculature. Loculated collections within the right psoas are definitely smaller than on the prior examination. Loculated collections within the left psoas muscle are also probably slightly smaller but the change is less dramatic than on the right.The kidneys are atrophic and contain numerous cysts compatible with renal failure.T12-L1: Mild facet hypertrophy and ligamentum flavum thickening. No significant spinal canal stenosis. No significant neuroforaminal narrowing. No significant interval changes.L1-2: Moderate facet hypertrophy and ligamentum flavum thickening. Disk destruction and vertebral body retropulsion result in a moderate generalized canal stenosis with crowding of the cauda equina. The neural foramina are mildly narrowed as well. No significant interval changes. L2-3: Mild facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. Prominence of the epidural fat and ventral epidural inflammation as above. Mild thecal sac narrowing. No significant foraminal narrowing. No significant interval changes.L3-4: Mild facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. Prominence of the epidural fat. Mild thecal sac narrowing. No significant neuroforaminal narrowing. No significant interval changes.L4-5: Moderate facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. Prominence of the epidural fat. Mild thecal sac narrowing. No significant neuroforaminal narrowing. No significant interval changes.L5-S1: Mild facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. No significant generalized spinal canal stenosis. No significant neuroforaminal narrowing. No significant interval changes.

Output: 1. Findings of osteomyelitis diskitis at L1-2 show no significant interval change. This includes destruction of the disk and adjacent endplates with significant collapse of the L1 vertebral body. The overall process results in narrowing of the spinal canal at the L1 and L2 levels which is also unchanged.2. Significant edema persists within the bilateral psoas musculature. However, loculated collections compatible with abscess have significantly improved on the right, with probable mild improvement on the left.


Instruction: Generate impression based on medical findings.

Input: The thoracic spinal cord has a smooth contour and normal signal without focal atrophy, edema, or myelomalacia. There is a mildly exaggerated kyphotic angulation of the thoracic spine at T6/T7; otherwise normal alignment of the thoracic spine is maintained. The vertebral body heights and disc spaces are maintained. Marrow signal intensity is benign throughout with a small hemangioma within the T2 vertebral body incidentally noted. There is no significant spinal canal stenosis or neural foraminal stenosis. There is prominence of the subcutaneous fat.

Output: No abnormal signal within the thoracic cord to suggest demyelination.


Instruction: Generate impression based on medical findings.

Input: 37 year old with known right breast cancer and metastatic right axillary lymph node presents for research MRI on the I-SPY protocol. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.A faint 4 mm focus on enhancement is seen in the posterior depth of the right breast, 11 o'clock position. On the most recent comparison, the mass at this site measured 8 x 8 x 9 mm. No new enhancing breast lesion. The reference lymph node now measures only 6 mm in long axis, previously this had a maximum diameter of 9 mm. No abnormal enhancement is seen in left breast. No abnormal axillary lymph nodes are identified in left axillary region.

Output: Near resolution of enhancement at the site of known cancer in the right breast.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on medical findings.

Input: Myelopathy Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is mild straightening of the cervical spinal curvature. Alignment is otherwise maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology. There is mild developmental narrowing of the mid cervical spine. There are mild superimposed degenerative changes as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Minimal disc bulge. No significant compromise to the spinal canal or neural foramina.C4-5: Minimal disc bulge. Minimal narrowing of the left neural foramen. No significant compromise to the spinal canal or right neural foramen.C5-6: Minimal disc bulge eccentric to the right. Mild left neural foraminal stenosis. Minimal right neural foraminal narrowing.C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: There is developmental narrowing of the mid cervical spinal canal with mild superimposed degenerative changes including minimal disc bulges at C3-C4, C4-C5, C5-C6. There is no high-grade spinal canal or neural foraminal stenosis at any level. No cord signal abnormality.