Instruction: Generate impression based on medical findings.

Input: Images of the internal auditory canals demonstrate the seventh and eighth nerves to be normal in size and symmetric bilaterally without masses or enhancing lesions along the course of these nerves or in the cerebellopontine angle cisterns bilaterally. The inner ear structures are normal in appearance and symmetric bilaterally without congenital inner ear anomalies identified on either side. There are no vascular anomalies.Limited acquisitions through the brain parenchyma demonstrate T2 hyperintensities within the white matter, primarily periventricular, without associated mass effect. There is also mild diffuse volume loss.

Output: 1.Negative MRI of the internal auditory canals including gadolinium enhancement.2.Limited acquisitions of the brain parenchyma demonstrate small vessel ischemic disease as well as mild diffuse volume loss.


Instruction: Generate impression based on medical findings.

Input: Anterolateral ankle pain TENDONS: No significant abnormality noted.LIGAMENTS: No significant abnormality noted. Specifically, the calcaneofibular ligament is intact (series 701 image 22) and the ATFL is intact (series 301 image 21)ARTICULAR SURFACES AND BONE: No significant abnormality noted. ADDITIONAL

Output: Unremarkable MRI of the left ankle.


Instruction: Generate impression based on medical findings.

Input: There are postoperative findings related to L3-L4 laminectomies and posterior spinal fusion at L2-L5 utilizing bilateral pedicle screws and stabilizing rods with posterior paraspinal fluid collection. There is evidence of L2-L5 kyphoplasty. Susceptibility artifact from metallic hardware and lack of intravenous contrast limits evaluation. There is mild anterolisthesis of L4 on L5. The vertebral bone marrow signal is heterogeneous with multiple lesions throughout the imaged axial skeleton. There is mild anterior wedge deformity of the T11 vertebra without significant retropulsion. There is loss of vertebral body heights at T12 through L5 vertebral bodies with posterior retropulsion with epidural tumor extension. There is moderate loss of disc height at T11-12, with mild loss of disc height at the remaining lumbar levels. There is a left prevertebral mass anterior to L3-L5, centered at L4, measuring approximately 2.2 x 5.0 x 9.0 cm (AP x TR x CC), previously 1.4 x 4.7 x 6.8 cm. The distal spinal cord and conus are within normal limits with the conus terminating at the L1 level. There is a mass arising from the right iliac wing, measuring up to 5.7 cm in AP dimension (5.5 cm on 3/31/2015 and 4.4 cm on 3/13/2015), which is partially imaged. Incidentally noted is mildly prominent common bile duct measuring up to 1.4 cm. Please correlate for cholecystectomy. A 5 cm wide T2 hyperintense lesion in the right kidney, likely represents a cyst, but is incompletely characterized. The bladder is distended.T12-L1: Approximately 25% loss of vertebral body height at T12 with slightly progressed retropulsion compared to 3/13/2015, but similar compared to 3/31/2015, contributing to mild spinal canal stenosis. Small central disc protrusion. No significant neural foramen stenosis. L1-L2: Approximately 25% loss of vertebral body height at L1 with progression of retropulsion compared to 3/13/2015, but similar compared to 3/31/2015, bilateral facet degeneration, and thickening of the ligamentum flavum, contributing to mild spinal canal stenosis and mild left neural foramen stenosis. L2-L3: Approximately 25% loss of vertebral body height at L2 with progression of retropulsion compared to 3/13/2015, but similar compared to 3/31/2015, disc bulge, bilateral facet degeneration, and thickening of the ligamentum flavum, contributing to moderate spinal canal stenosis and moderate right and mild left neural foramen stenosis. L3-L4: Status post laminectomy. Approximately 25% loss of vertebral body height at L3 with retropulsion, disc bulge, bilateral facet degeneration, and thickening of the ligamentum flavum, contributing to severe spinal canal stenosis and moderate bilateral neural foramen stenosis. L4-L5: Status post laminectomy. Approximately 25% loss of vertebral body height at L4 with retropulsion, disc bulge, bilateral facet degeneration, and thickening of the ligamentum flavum, contributing to severe spinal canal stenosis and moderate bilateral neural foramen stenosis. L5-S1: Disc bulge, bilateral facet degeneration, and thickening of the ligamentum flavum, contributing to mild spinal canal stenosis and mild to moderate bilateral neural foramen stenosis.

Output: 1. Status post posterior spinal fusion at L2-L5 with L3-L4 laminectomies.2. Extensive tumor burden involving the imaged axial skeleton with pathologic fractures and retropulsion with epidural tumor extension involving the T12 through L4 vertebral bodies, most prominent at L3-L4 and L4-5 with severe spinal canal stenosis, and variable degrees of multilevel neural foramen stenosis. The degree of retropulsion and spinal stenosis is slightly progressed compared to 3/13/2015, but similar to 3/31/2015.3. A 5.6 cm right iliac wing mass with progression in size compared to 3/13/2015 is compatible with the known leiomyosarcoma deposit.  Important findings conveyed to Dr. Zimmerman through EPIC mail on 4/9/2015 at the time of dictation.


Instruction: Generate impression based on medical findings.

Input: 48-year-old female with known multiple brain metastases and concern for herniation. Redemonstrated are multiple enhancing brain lesions with associated surrounding edema, some of which abut the dural surface. The largest is again seen in the left frontal lobe just deep to the superior frontal sulcus which measures 2.6 x 2.4 cm (series 1201, image 126). There is some susceptibility abnormality indicating intratumoral hemorrhage. The associated vasogenic edema is marked and causes 1 cm of focal rightward subfalcine herniation. A second relatively large intraparenchymal lesion adjacent to the floor the left middle cranial fossa is more heterogeneously enhancing and has more susceptibility abnormality indicating more intratumoral hemorrhage. This lesion also has associated adjacent vasogenic edema, with complete effacement of the left temporal horn. The associated mass-effect results in asymmetric widening of the left ambient cistern and minimal medial displacement of the left uncus. Midline shift to the right measures 6 mm. There is also partial effacement of the remaining left lateral ventricle and third ventricle is not visualized. The right lateral ventricle is slitlike.Other smaller lesions are present in the right parieto-occipital region, posteromedial right temporal lobe in the periatrial location, and the left cerebellar hemisphere. Smaller lesions are seen in the medial right brachium pontis as well. Even smaller lesions are suggested scattered along the gray-white junction diffusely.There is lobulated mucosal thickening within the maxillary sinuses bilaterally. There are no enhancing lesions involving the calvarium.

Output: Multiple supratentorial and infratentorial enhancing lesions consistent with metastatic disease. The largest is in the left frontal lobe with extensive associated vasogenic edema. There is 6 mm rightward midline shift and findings of early uncal herniation.


Instruction: Generate impression based on medical findings.

Input: Headache, migraine. MRI: The anterior portions of the images are somewhat degraded by dental brace artifacts. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. MRA: There is no evidence of significant proximal steno-occlusive lesions or aneurysms.

Output: 1. No evidence of intracranial demyelinating process, infectious lesions, or acute infarct, within the limits of dental brace artifacts.2. No evidence of significant steno-occlusive cerebrovascular lesions or aneurysms.


Instruction: Generate impression based on medical findings.

Input: Evaluate liver mass. ABDOMEN:LIVER, BILIARY TRACT: Heterogeneous expansile mass involving the left hepatic lobe measuring up to 8.8 x 7.4 cm (series 5/29) in axial dimension which extends along its inferior margin laterally to involve the left subhepatic space. In the craniocaudal dimension the lesion measures 9.4 cm (series 4/12). The lesion demonstrates heterogeneous signal intensity with regions of intermediate and high T2-weighted hyperintensity. The lesion has thick peripheral and internal septations which demonstrate enhancement and multiple cystic components. T2 hyperintense foci demonstrate restricted diffusion. The lesion is hypointense on T1-weighted imaging.The liver is otherwise normal in morphology.Cholelithiasis with a gallstone in the gallbladder neck/cystic duct junction. The gallbladder itself is distended without gallbladder wall thickening, pericholecystic fluid or specific evidence of acute cholecystitis.There is mild intrahepatic biliary ductal dilatation. The common bile duct is dilated up to 1.3 cm but tapers smoothly to the level of the ampulla without a definite stone or lesion.SPLEEN: The spleen is normal in morphology size, signal intensity and enhancement without a focal lesion.PANCREAS: The pancreas is normal in morphology and signal intensity without a focal lesion or pancreatic ductal dilatation. Punctate pancreatic head cystic focus measuring 7 mm appears to communicate with the main pancreatic duct and likely represents a sidebranch IPMN.ADRENAL GLANDS: Mild adrenal gland thickening without a discrete lesion.KIDNEYS, URETERS: Kidneys are normal in morphology and enhancement without hydronephrosis or focal lesion.RETROPERITONEUM, LYMPH NODES: No enlarged retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Moderate hiatal hernia with the proximal gastric body within the thorax.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Heterogeneous left hepatic lobe lesion likely represents an abscess, particularly given elevated white count. Follow-up to resolution is recommended. The abscess to appears to have decompressed into the left subhepatic space. The source of infection is not clearly demonstrated.2.Distended gallbladder with gallstone at the hepatic neck/cystic duct junction without additional specific findings of acute gallbladder inflammation. 3.Dilated common bile duct without a definite obstructing lesion or stone. Correlate with LFTs and consider MRCP/ERCP as clinically warranted to evaluate the distal CBD.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old, headache with history of esophageal cancer. Assess for metastases. Patchy periventricular and subcortical T2 hyperintensity is again seen. Lesions are mildly increased in both size and number.No evidence of restricted diffusion is seen. No parenchymal edema or mass effect is detected. On postcontrast images, no pathologic parenchymal or extra-axial enhancement is detected.There is no evidence of intracranial hemorrhage or any abnormal extra axial fluid collection. The ventricles and sulci are within normal limits for size and morphology.

Output: 1.Mild interval progression of chronic microvascular ischemic disease.2.No acute intracranial abnormality.3.No evidence of intracranial metastases.


Instruction: Generate impression based on medical findings.

Input: History of Crohn's disease status post ileocecectomy with chronic obstructive symptoms, evaluate neoterminal ileum for inflammation or stricturing. ABDOMEN:LIVER, BILIARY TRACT: Liver demonstrates normal parenchymal signal intensity. There is a subcentimeter cyst in the posterior aspect of the right hepatic lobe (series 5, image 35). No suspicious hepatic lesions are identified.SPLEEN: No significant abnormality noted. A splenule is present.PANCREAS: Pancreas is mildly atrophic with fatty atrophy most notable in the pancreatic head.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Several mildly prominent mesenteric lymph nodes are present.BOWEL, MESENTERY: Postsurgical changes of ileocecectomy. The bowel is nondilated without evidence of high-grade obstruction. There is a small right anterior abdominal wall hernia (series 8, image 47) which contains bowel without evidence of associated obstruction. There is a stricture at or near the ileocolonic anastomosis (series 9, image 27 and series 18, image 42) which demonstrates enhancement (series 17, image 20), measures approximately 2.7 cm in length (series 18, image 42), and narrows down to approximately 9 mm in caliber. No additional definite sites of disease are identified in the small bowel or colon. No intra-abdominal fluid collections are identified.BONES, SOFT TISSUES: Degenerative changes affect the spine.OTHER: No significant abnormality noted.

Output: Stricture at or near the ileocolonic anastomosis with associated enhancement suggestive of active inflammatory disease. No associated high-grade bowel obstruction.


Instruction: Generate impression based on medical findings.

Input: History metastatic bladder cancer with dizziness. Image quality is degraded by motion artifact. There is no gross evidence of intracranial metastatic disease. No evidence of infarct or hemorrhage. No intracranial mass or mass effect. No abnormal parenchymal or meningeal enhancement. No extra-axial collections. No hydrocephalus. Skull and extracranial soft tissues are unremarkable.

Output: Study is somewhat limited by motion artifact. However, no evidence of intracranial metastatic disease is appreciated. No evidence of acute infarct or hemorrhage.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: Medial knee pain MENISCI: There is horizontal linear signal across the lateral meniscus involving the posterior horn and body (sagittal series 7 image 23/28) which extends to the superior articular surface. There is globular signal within the posterior horn of the medial meniscus without extension to the articular surface however there is truncation of the body and anterior horn of the medial meniscus suspicious for tearing.ARTICULAR CARTILAGE AND BONE: There is heterogeneous signal intensity of the articular cartilage of the lateral compartment of both the tibial plateau and femoral condyle. There is no full-thickness cartilage defect however. Similar moderate articular cartilage thinning is noted in the medial compartment particularly of the femoral condyle with near full-thickness loss anteriorly. There is marked articular cartilage loss of the patellar facet, lateral greater than medial. Heterogeneous signal of the femoral trochlea is also noted. Degenerative cystic changes noted in the lateral tibial plateau.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Horizontal tearing of the lateral meniscus with findings suspicious for radial tear of the body and anterior horn of the medial meniscus.2. Severe patellofemoral articular cartilage loss with more moderate changes noted in the medial and lateral compartments.3. Moderate suprapatellar effusion.


Instruction: Generate impression based on medical findings.

Input: First time seizure. No findings to suggest seizure focus. No intracranial mass or mass-effect. No sulcation abnormality, heterotopic gray matter, or cortical dysplasia. Bilateral hippocampi are normal in size, signal characteristics, and demonstrate preserved internal architecture. No intracranial hemorrhage. No restricted diffusion to suggest acute ischemia. The ventricles are within normal limits in size and configuration. Low lying cerebellar tonsils which remain rounded with preserved adjacent subarachnoid spaces; no evidence of Chiari. Brain parenchyma is otherwise unremarkable for age.No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. No findings to suggest seizure fossa. 2. Low-lying tonsils cerebellar tonsils incidentally noted without convincing evidence of Chiari 1.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Unspecified disturbances of skin sensationClinical question: rule out right thalamic infarctionSigns and Symptoms: numbness, tingling The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.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 demonstrate minor opacities in the left mastoid air cells. The visualized portions of the orbits are intact.

Output: MRI of the brain is within normal limits. There is no evidence for cerebral infarction to account for the reported numbness and tingling.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Other malignant lymphomas, unspecified site, extranodal and solid organ sites. Other malignant lymphomas, unspecified site, extranodal and solid organ sitesClinical question: Brain metastasesSigns and Symptoms: Head pressure and numbness over the jaw The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.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.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 2.There is no MRI evidence for CNS lymphoma.


Instruction: Generate impression based on medical findings.

Input: 36-year-old female status post Chiari decompression complicated by CSF leak subsequently repaired started on high dose Bactrim IV, now with persistent nausea and vomiting. Evaluate for any bleed or reason for persistent nausea/vomiting. Postoperative changes status post suboccipital craniectomy are again evident. An ovoid fluid density structure is seen superficial to the operative site within the subcutaneous tissues, which appears more prominent compared to the prior CT, grossly unchanged from recent MRI. No definite communication with the posterior fossa is evident. No acute hemorrhage or extra-axial fluid collections are evident. A new focus of hypodensity is seen in the postero-medial aspect of the right cerebellar hemisphere, corresponding to focus of restricted diffusion on recent MRI. The remainder of the cerebral and cerebellar hemispheres demonstrate normal morphology and density. The ventricles are midline, with normal morphology and volume. No abnormal extra-axial fluid collections are evident.Apart from postoperative changes status post suboccipital craniectomy, the remaining calvaria and osseous structures are intact. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Subcutaneous fluid collection superficial to the operative site, with no clear communication with the posterior fossa to suggest a pseudomeningocele.2. Subacute infarction in the right cerebellar hemisphere.


Instruction: Generate impression based on medical findings.

Input: 33 year old male with buttock abscess and tenderness to palpation. Evaluate for perirectal abscess. ABDOMEN:This examination is limited by absence of IV contrast. LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: There is extensive diffuse soft tissue thickening subcutaneously in the right medial buttock that extends to the anus. The enteric contrast has not reached the distal colon and rectum. Without IV and enteric contrast, it is difficult to define an abscess or fistula. No definite abscess was found. No intrapelvic extension. If this condition persists or further evaluation is required, a non-contrast MRI scan may be most helpful.There is diffuse vascular calcifications in the pelvis.

Output: Right buttock subcutaneous inflammatory changes, but no definite abscess. Sensitivity is limited without enteric or IV contrast. Consider MRI if further evaluation is required.


Instruction: Generate impression based on medical findings.

Input: Sudden onset of numbness on the left side finger and pelvis. There is no evidence of acute ischemic or hemorrhagic lesion on the scan.There is about 15 mm x 10 mm sized relatively well marginated but irregularly-shaped signal void lesion based on the left frontal lobe meninges indicating meningeal calcification or calcified meningioma. There is no evidence of associated adjacent brain edema or mass effect. This lesion was seen on prior scan obtained in 2013, no change in terms of signal characteristics, size and configuration since prior exam.The ventricles, sulci and cisterns are symmetric and unremarkable. Minimal several scattered nonspecific high signal intensities on bilateral white matter especially frontal lobeThere is no 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. 15mm x 10mm sized left frontal area meningeal calcifications without evidence of mass effects, no change since prior exam.2. Otherwise no remarkable finding.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old, with encephalopathy. Follow-up for prior read of possible PRES. The previously seen focus of restricted diffusion within the right parietal white matter is still visible though it is less intense and less distinct. However, there is a new focus of diffusion hyperintense signal in the right frontal subcortical white matter. Curvilinear diffusion hyperintense signal along the margin of the left thalamus is of questionable validity.Fairly extensive confluent periventricular T2 hyperintensity without mass effect is again seen, appearing similar to the prior examination. Vague signal abnormality is also demonstrated in the brain stem and cerebellum, similar to prior. Again seen are scattered chronic lacunar infarcts within the basal ganglia and thalami bilaterally.Multiple scattered punctate foci of susceptibility effect are seen in the cerebral hemispheres, particularly in the basal ganglia and medial thalami, brainstem and cerebellum. Most or all of these are accounted for on the prior examination though they are better seen on the present study likely due to imaging at 3T. No evidence of acute intracranial hemorrhage is seen. No abnormal extra-axial fluid collections are detected.

Output: 1.A focus of acute ischemia seen previously in the right parietal lobe appears less distinct compatible with expected evolution.2.A new focus of acute ischemia is suspected within the right frontal subcortical white matter. Curvilinear diffusion hyperintense signal along the left thalamus is of questionable validity and could be artifactual.3.Extensive T2 hyperintense white matter lesions are again seen without significant interval change from the prior examination. No evidence of any significant associated edema or mass effect is seen which would argue against an ongoing acute process.4.Numerous scattered foci of microhemorrhage are also unchanged from the prior exam. No acute intracranial hemorrhage is seen.


Instruction: Generate impression based on medical findings.

Input: Left buccal angiosarcoma.Additional history from EMR: submucosal lesion of the left buccal mucosa inferior to the punctum of the salivary gland. It is non-friable. It seems to be adherent to the mucosa but is slightly pigmented and firm, measuring about 1 cm in greatest dimension. 3/10/16, wide local excision of left buccal lesion with primary closure. Brain:There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are scattered T2-hyperintense foci in the cerebral white-matter. There is also symmetric globular T2-hyperintensity in the globi pallidi. The brain parenchyma and pituitary gland appear unremarkable otherwise. 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 accounting for hypoplastic right vertebral artery, small right internal carotid artery and probably absent right A1 segment. There is mild ethmoid mucosal thickening. Globes show very mild staphylomas, which can be associated with myopia.Neck:The patient was imaged deeply sedated and the study is at least mildly limited by patient breathing motion. There is asymmetric increased STIR signal and contrast enhancement in the left posterolateral buccal mucosa but no discernible mass (15/23-27). These findings are nonspecific and may relate to recent tumor resection. There is no significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are grossly unremarkable. The major cervical vessels are patent accounting for a nondominant right vertebral artery. An artificial airway is present in the oral cavity/oropharynx. Otherwise, the airway is patent. There are findings of remote internal fixation of right clavicle fracture with associated susceptibility. There are bilateral injectable facial fillers.

Output: 1.The patient was imaged deeply sedated and the study is at least mildly limited by patient breathing motion. 2.No brain metastasis. A few T2-hyperintense lesions in the cerebral white-matter are nonspecific but may represent chronic microvascular ischemia.3.Symmetric T2-hyperintensity in the globus pallidi may represent sequela of prior metabolic injury.4.Asymmetric contrast enhancement and STIR signal in the left lateral buccal region without discernible mass is nonspecific and may reflect postoperative change. No discrete mass or cervical lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: 19-year-old male with Crohn's disease and previously described active TI disease. Evaluate for progression of Crohn's involvement since the last exam. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Persistent wall thickening of the terminal ileum with early and persistent mural enhancement extending for approximately 9 cm. On the T2 series, there is mild submucosal edema. Mild restricted diffusion of the terminal ileum is also noted. The length of involvement has decreased compared to the prior exam. There is a short segment focal narrowing of the distal terminal ileum (axial series 7 image 16). No obvious fistulization. No drainable fluid collection.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Persistent thickening and enhancement of the terminal ileum suggestive of acute on chronic Crohn's disease. The length of involvement has decreased compared to the 5/12/2014 MRI exam.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Sudden onset of right wrist extensor weakness. Signs and symptoms: As above. Nonenhanced brain MRI:Examination demonstrates several tiny foci of restricted diffusion in bilateral cerebral hemispheres. Findings are present in the right occipital lobe, few in right hemispheric periventricular white matter and a tiny focus in the left hemispheric parietal white matter consistent with acute ischemic stroke lesions demonstrate no associated susceptibility signal changes.Additionally there are diffuse confluent FLAIR and T2 hyperintensity of bilateral hemispheric white matter as well as bilateral basal ganglia and minimally in the right thalamus and mild to moderate in the pons all consistent with advanced chronic nonhemorrhagic small vessel ischemic strokes.Incidental note is made of a tiny well-demarcated near CSF signal intensity lesion of the pituitary on the left highly suggestive of a cyst or pituitary adenoma. Finding measures approximately 6 x 4 mm and without detectable mass effect.Mild prominence of supratentorial ventricular system and diffuse uniform prominence of cortical sulci which are believed to be at least partially secondary to underlying parenchymal volume loss secondary to chronic small vessel ischemic strokes.There is no detectable cortical signal abnormality.Signal void of all major intracranial arterial branches are identified and unremarkable.Unremarkable images through the orbits, paranasal sinuses, mastoid air cells and middle ear cavities. Significant leftward deviation of nasal septum and highly suspected leftward projecting bony septal spur is noted.

Output: 1.Several scattered hemispheric white matter (R>L) tiny foci of restricted diffusion/acute stroke without hemorrhage as detailed.2.Extensive chronic nonhemorrhagic small vessel ischemic strokes with resultant mild ex vacuo ventriculomegaly and prominence of cortical sulci.3.T2 hyperintense lesion 6 x 4 mm of pituitary likely a cyst or adenoma without mass effect.


Instruction: Generate impression based on medical findings.

Input: Reason: assess for tenosynovitis or other injury History: left hand pain, weakness There is 1.2 x 1.1 x 2.4 cm nonspecific mass adjacent to the flexor tendons (series 1501 image 21, series1401 image 14), most likely ganglion cyst, but other pathology cannot be ruled out. There is mild mass effect on the adjacent flexor digitorum profundus and flexor digitorum superficialis. This lesion slightly extends into the carpal tunnel (series 1501 image 15), and may have mass effect on median nerve, although this is equivocal. We see no increased signal in the tendons to suggest tendinosis. Extensor tendons appear within normal limits. The bone marrow signals are within normal limits. Osseous alignment is anatomic.

Output: Nonspecific lesion adjacent to flexor digitorum tendons, most likely ganglion cyst, but other pathology cannot be ruled out. Contrast enhanced MRI may be helpful for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Chiari decompression several years ago, syrinx, no follow-up since 2010. Patient with new symptoms, evaluate for change, performed CSF flow study. Signs and symptoms: Headache, neck and middle back pain. Nonenhanced brain MRI: Negative diffusion weighted series.Examination demonstrates stable post operative changes of Chiari decompression. There is expansion of subarachnoid space at the surgical site however there is inferior sagging of the cerebellar into the expanded subarachnoid space which remains identical to prior study from 2010.The anatomical morphology of the brain is otherwise within normal limits and with normal signal intensity on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain margination. No evidence of any new finding since prior exam.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.Nonenhanced cervical spine MRI:Stable expected postoperative changes Chiari decompression since prior exam. Mild dorsiflexion of the dens is again noted. Normal signal intensity and caliber of the cervical cord without evidence of syrinx. Normal signal intensity and alignment the vertebral column without spinal canal or neural foraminal compromise at any level. Unremarkable perispinal soft tissues. CSF flow study demonstrate presence of biphasic flow through the foramen magnum both anteriorly and posteriorly. There is also detectable biphasic flow through the fourth ventricle and the aqueduct.Nonenhanced thoracic spine MRI:The signal intensity in the alignment the vertebral column is unremarkable.The signal intensity and caliber of thoracic cord is unremarkable.There is no evidence of spinal canal or neural foraminal compromise at any level.There is termination of the cord at mid L1 level.Nonenhanced lumbar MRI:There is normal anatomical development, signal intensity and alignment of vertebral column.There is normal signal intensity and morphology of cauda equina.There is no detectable perispinal soft tissue abnormalities.

Output: 1.Nonenhanced brain MRI demonstrate no evidence of new finding since prior exam. Stable postoperative changes of Chiari decompression as detailed. Unremarkable brain MRI otherwise.2.Unremarkable nonenhanced MRI of the cervical, thoracic and lumbosacral spine as detailed. 3.CSF flow study demonstrate presence of biphasic flow through the foramen magnum anteriorly and posteriorly as well as the fourth ventricle and the aqueduct.


Instruction: Generate impression based on medical findings.

Input: Oral ulcers. Evaluate for small bowel disease. 11/13/2015: Colonoscopy biopsies demonstrated focal nonspecific chronic enteritis of the terminal ileum. 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: Note is made of a partially duplicated right collecting system with the upper and lower pole moiety ureters merging at the pelvic inlet.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The small bowel is adequately distended with oral contrast. The small bowel fold pattern is maintained.The terminal ileum is well seen. There is no abnormal small bowel wall thickening, enhancement or restricted diffusion. No perienteric inflammatory changes such as fibrofatty proliferation.The small bowel is normal in caliber. No fixed luminal narrowing or prestenotic/upstream dilatation to suggest a flow-limiting stricture.No evidence of sinus tract or fistula formation.No free fluid or loculated fluid collection.The colon is unremarkable.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: See discussion above.BONES, SOFT TISSUES: No active perianal disease is identified.OTHER: No significant abnormality noted.

Output: No findings to suggest active small bowel inflammation, fibrostenotic or fistulous disease.


Instruction: Generate impression based on medical findings.

Input: 10-month-old female status post tumor biopsy. Evaluate for hemorrhage. Status post right frontotemporal craniotomy with expected postoperative pneumocephalus and subcutaneous gas. Small amount of extra-axial fluid is seen in the operative field. No evidence of intra-or parenchymal or subarachnoid hemorrhage. The mixed cystic and solid attenuation suprasellar mass, which extends superiorly to the level of the foramen of Monro and posteriorly to the interpeduncular fossa, appears not significantly changed from recent MRI. There is mild compression of the anterior aspect of third ventricle, unchanged. The lateral and fourth ventricles appear unchanged from prior exam. No significant midline shift or evidence of herniation. The visualized paranasal sinuses and mastoid air cells are normal for age.

Output: 1.Expected postoperative pneumocephalus, subcutaneous gas, and small amount of extra-axial blood in surgical field. No evidence of intraparenchymal or subarachnoid hemorrhage.2.Known suprasellar mass appears not significantly changed.


Instruction: Generate impression based on medical findings.

Input: 50-year-old female with history of partial left nephrectomy for renal cell carcinoma. ABDOMEN:LIVER, BILIARY TRACT: Scattered subcentimeter T2 hyperintense lesions are benign.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Postoperative changes in the left kidney of partial nephrectomy.There is a 1.2 cm cystic lesion within the interpolar region of the left kidney with layering high T1 material and no significant enhancement compatible with a benign cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Status post bilateral breast augmentation.

Output: 1.Postoperative changes in the left kidney with no evidence of disease recurrence. 2.Stable left interpolar benign cyst.


Instruction: Generate impression based on medical findings.

Input: Progressive pain for 3 months. Suspect rotator cuff tear ROTATOR CUFF: There is a partial articular sided tear of the supraspinatus near its insertion. No evidence is seen of retraction. The subscapularis and infraspinatus tendons and muscles are normalSUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Partial articular sided tear of the supraspinatus


Instruction: Generate impression based on medical findings.

Input: 2-month-old male with a reported history of an enlarging perianal mass.EXAMINATION: MRI Pelvis without and with IV contrast 6/30/2016 8:39 Focus of high T2 signal (series 801, image 22) with an arrowhead configuration and several branching curvilinear tendrils arising from the 6:00 position of the anal verge. The focus measures approximately 1.5 cm in length, 0.3 cm in thickness, and demonstrates enhancement (series 1001, image 26). Bilateral hydroceles are noted.

Output: Enhancing abnormal signal adjacent to the anal verge is favored to represent a vascular lesion. A sonogram is recommended for further characterization.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Rule out intracranial lesion, evaluate for bitemporal visual field cut and pale optic disc and blurry vision. Signs and symptoms: As above. Pre- and post enhanced brain MRI:Unremarkable diffusion-weighted images.Examination demonstrate a small focus of FLAIR hyperintensity in the right centrum semiovale measuring 7 x 8 mm in transaxial dimensions. Finding is without detectable susceptibility signal changes or enhancement.Small well demarcated focus of FLAIR and T2 hyperintensity is noted in the right cerebral peduncle measuring 5 x 5 mm in transaxial dimensions. This finding also demonstrate no associated susceptibility signal changes or enhancement and no detectable mass effect.There is a very poorly defined small focus of FLAIR/T2 hyperintensity in the subcortical white matter of left posterior frontal lobe (axial FLAIR and T2 image 11) with subtle enhancement and measuring at approximately 8 mm in transaxial dimensions. The finding demonstrates faint enhanced (coronal post enhanced series 11 image 17 and axial post enhanced series 19 image 12).Post enhanced images demonstrate a small linear vascular enhancement in the right basal ganglia along the course of the right lenticulostriate branches. The enhancement is nonspecific and could represent an intravascular enhancement due to distal occlusion and lacunar infarct. Lack of any visible vasculature and susceptibility MR images precludes possibility of a developmental venous anomaly however this possibility cannot be entirely excluded. Additionally examination demonstrate a well demarcated uniformly enhancing focus immediately anterior to the temporal horn of left lateral ventricle measuring at 6 x 7 mm in transaxial dimensions. This finding demonstrate no signal abnormality on any other MRI sequence and cannot be detected with certainty. This is a nonspecific finding however possibilities of an occult arteriovenous malformation, demyelinating plaque or remote possibility of a metastatic disease cannot be entirely excluded.Unremarkable images through the orbits and including axial fat sat post enhanced series.Calvarium is intact and without abnormal enhancement.All paranasal sinuses and bilateral mastoid air cells and middle ear cavities are well pneumatized however a small retention cyst in the left maxillary sinus is noted.Pre- and post enhanced pituitary MRI:There is normal anatomical morphology, signal intensity, size and pattern of enhancement of pituitary gland, pituitary stalk and bilateral cavernous sinuses without evidence of mass. Unremarkable images through the basal cistern and hypothalamic region without abnormal mass or enhancement. Unremarkable images through the paranasal sinuses and skull base.

Output: 1.Pre- and post enhanced pituitary MRI is unremarkable.2.Pre and post enhanced brain MRI demonstrate 2 small foci of FLAIR hyperintensity in the right centrum semiovale and right cerebral peduncle without enhancement. Small focus of FLAIR hyperintensity in subcortical white matter of right posterior frontal lobe with faint enhancement measuring 5 mm in transaxial dimensions. Focus of well demarcated enhancement measuring 6 x 7 mm anterior to the tip of the left temporal horn which cannot be identified on any other MRI sequence as detailed. Faint focus of enhancement in the left frontal subcortical white matter with subtle FLAIR/T2 hyperintensity as detailed. Constellation of findings are confusing as some are detectable on FLAIR and T2 weighted series with enhancement and some demonstrate enhancement without any detectable FLAIR/T2 signal changes. Considering patient's age and symptomatology demyelinating disease should be considered. Correlate with history and risk factors is recommended since possibility of small vessel ischemic strokes although unusual for age cannot be entirely excluded. Please review detailed report above.3.A linear vascular enhancement in the right basal ganglia along the course of the right lenticulostriate branches is noted. Possibilities of a nonspecific finding, an intravascular enhancement secondary to distal vascular occlusion/lacunar infarct or a developmental venous anomaly should be considered.


Instruction: Generate impression based on medical findings.

Input: Ms. Jenkins is a 51 year old female with known left breast cancer (IDC grade III). She presents for MRI staging preoperatively. There is scattered fibroglandular tissue in both breasts. Minimal parenchymal enhancement is noted bilaterally.In the left lower inner breast, approximately 7:00 location, there is patchy enhancement identified measuring approximately 1.6 cm in maximal dimension. Susceptibility artifact from biopsy marker clip is seen in the central aspect of this enhancement, compatible with biopsy-proven malignancy. There is no additional abnormal enhancement seen in the left breast.In the right breast, there is no abnormal enhancement seen. Specifically, there is no abnormal enhancement in the area of the loosely scattered calcifications in the right upper outer breast, as identified on the outside mammogram. No abnormal axillary lymph nodes are identified in either axillary region.

Output: (1) Unifocal malignancy in the left lower inner breast. If breast conservation therapy is desired, biopsy marker clip can be used for targeting.(2) No MR evidence of malignancy in the right breast. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: Reason: Evaluate for labral tear/other pathology, previous removal of heterotopic ossification with capsulotomy History: Pain ACETABULAR LABRUM: Mild heterogeneity is seen within the superior acetabular labrum in the area of the previously observed (superioanterior) and described labral tear along with suspected postoperative changes. There are no additional new findings, specifically no discrete defects or fluid outlined abnormality within the labrum to suggest an acute tear.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Heterogeneity of the superior acetabular labrum is suspected to be post-surgical. No acute new labral tear or additional abnormality identified.


Instruction: Generate impression based on medical findings.

Input: 56-year-old male with hip pain ACETABULAR LABRUM: There is blunting of and increased signal intensity within the anterior superior labrum indicating a complex tear from the twelve o'clock to three o'clock position. Mild undersurface fraying of the posterior labrum is also noted.ARTICULAR CARTILAGE AND BONE: Moderate osteoarthritis affects the hip. Subchondral cysts are present along the anterior aspect of the acetabular dome as well as the posterior acetabular wall. There is also subchondral cyst within the anterior medial femoral head with degeneration of the overlying articular cartilage. There is a CAM deformity involving the superior and anterior femoral head/neck junction with an alpha angle of 60 degrees.SOFT TISSUES: Increased signal is noted within the anterior soft tissues likely reflecting contrast material / lidocaine. ADDITIONAL

Output: Osteoarthritis, CAM deformity and labral tearing of the right hip as described above.


Instruction: Generate impression based on medical findings.

Input: Clinical question: 60-year-old female with left lateral leg and foot numbness that courses with walking. Eased with sitting. Mild back pain. Signs and symptoms: Back pain, left leg radicular symptoms. Nonenhanced lumbar MRI:Examination at T11-T12 through L2-L3 levels are unremarkable with the exception of mild degenerative changes.L3-4 demonstrate moderate disc disease and loss of disc height, and mild bilateral (right greater than left) facet and ligamentum flavum hypertrophy. There is a far lateral broad-based shallow disc protrusion on the right with resultant mild right neural foraminal and lateral recess compromise. No spinal stenosis.L4-L5 demonstrate mild disc disease and loss of disc height, shallow asymmetric right-sided lateral and far lateral bulging disc with resultant moderate right neural foraminal compromise without central spinal stenosis and patent left neural foramina.L5-S1 demonstrate moderate disc disease and loss of disc height, moderate left and mild right facet hypertrophy changes and mild bilateral ligamentum flavum hypertrophy. There is no central spinal stenosis however severe left neural foraminal and mild left lateral recess compromise is present. Right neural foramina remains patent.Visualized SI joints demonstrate no significant degenerative changes.There is spinal soft tissues are unremarkable.

Output: 1.Degenerative changes of lumbar spine primarily at L5-S1 level and to a lesser degree at L4-L5 and L3-4 levels are present.2.There is no evidence of central spinal stenosis at any level.3.Multilevel neural foraminal and lateral recess compromise as detailed per level above.


Instruction: Generate impression based on medical findings.

Input: 37 years Male (DOB:5/24/1979)Reason: liposarcoma vs lipoma History: lipomaPROVIDER/ATTENDING NAME: ANNEMARIE O'CONNOR ANNEMARIE O'CONNOR Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment. There is mild anterior superior endplate compression at L4. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, disc desiccation and mild anterior superior endplate compression of L4.. There is adjacent T2 and T1 signal hyperintensity and some mild contrast enhancement associated with this.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.There is a 14 x 22 x 51 mm lipoma present within subcutaneous tissues behind the left paraspinous tissues at the L3 vertebral level.

Output: 1.There is a mild anterior superior endplate compression fracture at L4 which appears to be in the subacute phase.2.No compromise to lumbar spinal canal or neural foramina.3.There is a subcutaneous lipoma present adjacent to the left paraspinous tissues at the L3 vertebral body level does not have any significant solid component associated with it.


Instruction: Generate impression based on medical findings.

Input: Chiari malformation, right arm pain Examination is mildly motion degraded. There are postoperative changes of suboccipital craniectomy and removal of posterior arch of C1 for Chiari decompression. There is dorsal angulation of the dens. There is minimal residual effacement of the CSF spaces at the neo-foramen magnum with preserved biphasic CSF flow. Dorsal cerebellum abuts the dural surface where there may be scarring. The cervical vertebral bodies are appropriate in height. There is mild loss of cervical lordosis and minimal anterolisthesis of C5 on C6; these changes are progressed since remote MRI from 2003.. Bone marrow signal is benign.The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: No significant compromise to the spinal canal. There is mild right neural foraminal narrowing related to uncovertebral hypertrophy. No significant left neural foraminal narrowing. Mild facet arthropathy, worse on the right.C5-6: Small disc bulge without significant spinal canal or left neural foraminal stenosis. Mild right neural foraminal narrowing related to uncovertebral hypertrophy. Mild facet arthropathy, worse on the right.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: 1. Postoperative changes of Chiari decompression with preserved biphasic CSF flow at the foramen magnum.2. Mild degenerative changes in the cervical spine which have progressed since remote MRI from 2003. There is mild right C4-C5 and C5-C6 neural foraminal narrowing. No high-grade neural foraminal stenosis or spinal canal stenosis at any level. Please see details above.


Instruction: Generate impression based on medical findings.

Input: Examination is again limited by lack of intravenous contrast. Redemonstrated is diffuse destruction and replacement of the L1-2 disc space, destruction of the adjacent endplates, and significant collapse of the L1 greater than L2 vertebral bodies. There is no significant change in residual abnormal T2/STIR hyperintensity involving the bone marrow and intervertebral disc. The degree of moderate retropulsion appears similar at the L1 level with unchanged moderate spinal canal stenosis and bilateral L1-L2 foraminal stenosis. No other worrisome marrow signal is appreciated. Again seen are areas of T1 and T2 hypointensity involving the right greater than left psoas musculature which are again seen and not significantly changed compared to 4/1/2015; these correspond to sites of previously seen abscesses and may represent areas of cavitation/necrosis. No discrete fluid collections to suggest abscess. More extensive diffuse STIR hyperintensity in the iliopsoas and paraspinous musculature similar to prior and compatible with combination of atrophy and edema. The lumbar spine is otherwise in stable alignment. The vertebral body and disc heights are otherwise unchanged. The distal spinal cord and conus are within normal limits with the conus terminating at the L1 level. The previously described degenerative changes appear similar. Again noted is prominence of the epidural fat including focal epidural fat along the right lateral aspect of the thecal sac at the L3-4 level. Partially imaged are bilateral renal atrophy with innumerable microcysts. There is clumped appearance of the cauda equina nerve roots suggestive of arachnoiditis and present previously.

Output: 1. Lack of contrast again limits evaluation. Compared to 6/3/2015 and 5/6/2015, there is no significant change in residual signal abnormalities related to L1-L2 discitis-osteomyelitis. Please note imaging findings often lag behind clinical response and do not necessarily imply residual discitis-osteomyelitis. No worsening marrow or disc signal abnormalities to suggest progression of infection. 2. No significant change in compression fractures of the L1 greater than L2 vertebral bodies. No significant change in osseous retropulsion at L1 with associated moderate spinal canal stenosis as well as moderate to severe bilateral L1-L2 neural foraminal stenosis. 3. Extensive signal abnormality involving the iliopsoas and paraspinous musculature as described above compatible with combination of atrophy and edema. No convincing evidence of residual abscess. No new fluid collections.


Instruction: Generate impression based on medical findings.

Input: BRAIN: There is no evidence of intracranial hemorrhage or acute infarct. There is mild global volume loss and patchy regions of T2 hyperintensity within the periventricular white matter that are most compatible with mild chronic small vessel ischemic disease. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. There are bilateral staphylomas.MRA HEAD: The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.

Output: 1.No evidence of intracranial aneurysm.2.Mild global volume loss and mild chronic small vessel ischemic disease.3.Bilateral staphylomas.


Instruction: Generate impression based on medical findings.

Input: Slurred speech [R47.81], Reason for Study: ^Reason: eval for acute infarct, assess lesion burden History: stroke/tia (see MRA order) Brain MRINo evidence of acute ischemic or hemorrhagic lesion on this scan.Multiple scattered high signal intensity lesions on periventricular white matter, centrum semiovale and bilateral external capsule indicate non specific 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, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate multifocal various degree intracranial arterial luminal stenosis including distal right ICA and bilateral MCA M1 and M2 segments indicating atherosclerosis. Some of stenosis degree appear to be more than 50%, however, since the TOF MRA can exaggerate the degree of stenosis, if precise evaluation of the degree of stenosis is necessary, CT angiography can be considered.There is no evidence of intracranial major arterial branch occlusion or intracranial arterial aneurysm on this scan.Bilateral PCAs are fetal origin and Acom artery is patent.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Intracranial atherosclerotic changes of multifocal various degree arterial luminal narrowings as described above. No aneurysm was seen.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old, with bone Hippel-Lindau disease and history of cerebellar hemangioblastomas. Assess for growth of existing lesions and for any new lesions. Attention to the inner ears/petrous temporal bone to assess for endolymphatic sac tumor. A 6 mm enhancing nodule is evident within the left cerebellar hemisphere adjacent to the foramen of Luschka. A 3 mm focus of enhancement is evident within the inferior medial right cerebellar hemisphere. These lesions are associated with mild surrounding T2 hyperintensity but no significant mass effect is observed.No evidence of any supratentorial enhancing lesion is seen. Multiple scattered foci of white matter T2 hyperintensity are identified in the cerebral hemispheres, a nonspecific finding which most likely represents chronic microvascular ischemic disease. No evidence of restricted diffusion is seen. No abnormal extra-axial fluid collection or acute intracranial hemorrhage is observed. The ventricles and sulci are mildly prominent compatible with underlying parenchymal volume loss.Dedicated imaging of the internal auditory canals shows normal morphology of the fluid filled compartments of the inner ears. No evidence of any destructive or enhancing inner ear lesion is seen to suggest the presence of an endolymphatic sac tumor. The cranial nerve VII and VIII complexes are within normal limits. No masslike lesions are seen in the CP angle cisterns.

Output: 1.Two enhancing nodules are evident within the cerebellum compatible with hemangioblastomas. These are associated with mild signal abnormality in the surrounding parenchyma, but no significant mass effect. A complete outside MRI for comparison was not available at the time of this interpretation. If such an exam can be made available, we will be happy to make a comparison and addend this report.2.No evidence of any supratentorial enhancing lesion is seen. Scattered foci of white matter signal abnormality likely reflect chronic microvascular ischemic disease.3.Evaluation of the internal auditory canals is within normal limits. Specifically, no evidence of an endolymphatic sac tumor is seen.


Instruction: Generate impression based on medical findings.

Input: 80-year-old female with HCC status post TACE/RFA ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. The post ablation zone is seen along the right hepatic dome, segment eight. No abnormal enhancement suspicious for HCC. Nodular subcentimeter foci of enhancement without definitive washout seen on the prior exam is not as well noted on the current study and is felt to reflect perfusional defects related to dysplastic changes. Further attention on subsequent studies is recommended.No new focal liver lesions. Portacaval varices.SPLEEN: No significant abnormality noted.PANCREAS: Diffuse pancreatic parenchymal atrophy with dilated main pancreatic duct with side branch ectasia, unchanged compared to prior exam. Cystic lesions in the head and body of the pancreas compatible with IPMNs, unchanged. Stones are noted within the pancreatic duct.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Scattered porta hepatis lymph nodes are unchanged. BOWEL, MESENTERY: Large hiatal hernia.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No evidence of local recurrence within the right hepatic dome ablation zone. 2.Nodular subcentimeter foci of enhancement without definitive washout seen on the prior exam is not as well noted on the current study and is felt to reflect perfusional defects related to dysplastic changes. Further attention on subsequent studies is recommended.3.No significant change in diffuse pancreatic parenchymal atrophy with dilated main pancreatic duct, side branch ectasia, and IPMNs as described above. Pancreatic stones are noted.


Instruction: Generate impression based on medical findings.

Input: 44-year-old female with diffuse large B-cell non-Hodgkin's lymphoma. Completed 4 cycles cycles of CHOP/R chemotherapy on 10/17/07. Restaging. CHEST: LUNGS AND PLEURA: Probable intrapulmonary lymph node (image 53; series 5) stable.MEDIASTINUM AND HILA: No significant abnormality noted. CHEST WALL: No significant abnormality noted. ABDOMEN: LIVER, BILIARY TRACT: Multiple enhancing lesions scattered throughout all lobes liver which have been discussed at length previously appear stable in size. Again these were thought to represent multiple FNHs verses hepatic adenomas. These could be further differentiated using MRI as clinically indicated. No intrahepatic biliary ductal dilatation. Hepatic vessels appear to be patent.SPLEEN: No significant abnormality noted. PANCREAS: No significant abnormality noted. ADRENAL GLANDS: No significant abnormality noted. KIDNEYS, URETERS: No significant abnormality noted. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted. BOWEL, MESENTERY: No significant abnormality noted. BONES, SOFT TISSUES: No significant abnormality noted. OTHER: No significant abnormality noted. PELVIS: UTERUS, ADNEXAE: No significant abnormality noted. BLADDER: No significant abnormality noted. LYMPH NODES: Slight interval decrease in size of previously noted pelvic adenopathy. Reference left external iliac node (image 168; series 4) difficult to measure on the current examination. An approximate measurement is 1.8 x 1.1 cm, decreased in size compared to prior. BOWEL, MESENTERY: No significant abnormality noted. BONES, SOFT TISSUES: No significant abnormality noted. OTHER: No significant abnormality noted.

Output: Slight interval regression in size of pelvic adenopathy. No new adenopathy appreciated. Stable enhancing liver lesions as noted above.


Instruction: Generate impression based on medical findings.

Input: Ms. Mills is a 55-year-old woman, part of the Alan Penn research protocol, presenting for an MR-directed ultrasound of the right breast. Upon physical exam at the MR directed area of concern, no discrete abnormality is palpated.A targeted right ultrasound was performed at the area of concern detected on the MRI in the lower outer quadrant. In the right breast 8:00 position, approximately 7 cm from nipple, there is a 0.7 x 0.7 x 0.8 cm reniform shaped mass with hilar vascular flow, consistent with a lymph node. This correlates with the finding on MRI. No abnormal sonographic findings are seen.

Output: Benign intramammary lymph node correlating with the MRI-detected mass in the right breast. No sonographic evidence for malignancy.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: 12 year old female with right anterior trapezial pain. Evaluate for compressive lesion. A marker was placed along the anteromedial aspect of the shoulder near the base of the neck. We see no abnormalities of the musculature deep to this marker. The signal intensity of the musculature is within normal limits. Please note that this study was not protocoled for detailed evaluation of the rotator cuff. We see no abnormal enhancement of the shoulder joint. There is increased signal intensity within the lower scapula and STIR sequences which likely reflects prominent red marrow. The bone marrow signal intensity is otherwise within normal limits.There are prominent level II cervical lymph nodes of the right neck that are incompletely imaged on the coronal STIR sequence, however, on the axial sequences they appear within normal limits. If clinically warranted, MRI of the neck may be considered, particularly if there is palpable lymphadenopathy.

Output: 1. No specific findings to account for the patient's right anterior trapezial pain.2. Prominent level II cervical lymph nodes of the right neck that are incompletely imaged. If clinically warranted, MRI of the soft tissues of the neck may be considered, particularly if there is palpable lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old, history of meningioma, one year follow-up. Evidence of prior left-sided craniotomy is again seen. A homogeneously enhancing mass is redemonstrated along the left greater sphenoid wing showing no significant interval change in size with a measurement of 13 x 11 mm.No new intracranial lesions are detected. No evidence of edema or mass effect is seen. Scattered small foci of FLAIR hyperintensity in the cerebral white matter are nonspecific and unchanged. No evidence of new hemorrhage or any abnormal extra-axial fluid is seen. The ventricles are normal in size and morphology.

Output: Stable left sphenoid wing meningioma.


Instruction: Generate impression based on medical findings.

Input: Ms. Muzzarelli is a 67 year old female with a personal history of right breast mastectomy in April 2013 for IDC and reduction surgery in the left breast (July 2014). She received radiation chemotherapy and hormonal therapy. Family history of breast cancer in her sister (diagnosed at age 50), maternal cousin (diagnosed at age of 40), maternal aunt and two paternal aunts. There is heterogeneous amount of fibroglandular tissue in the left breast. Mild parenchymal enhancement is noted. Patient is status post right breast mastectomy with DIEP-flap reconstruction.Multiple enhancing foci are identified in the left breast, none of which are more suspicious than the rest. No abnormal enhancement is identified in the left breast.No abnormal enhancement is identified in the right reconstructed breast. Previously identified seroma in the right axillary region is smaller when compared to prior examination.No abnormal axillary 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: The cervical spine is in normal alignment, with straightening of the normal cervical lordosis. The vertebral body heights are well-maintained. There is multilevel disc narrowing, most conspicuous at C4-C5 where it is moderate-severe in degree. There is increased ventral disc bulge at C5-C6. Ventral osteophytes are again noted. No worrisome focal marrow signal abnormality is appreciated. There is redemonstration of abnormal signal social with the right T1 vertebral body extending into the posterior elements with mild pedicular expansion, consistent with a known intraosseous hemangioma. The spinal cord is of normal caliber and signal.At C2-C3, there is no significant disk pathology or stenosis.At C3-C4, there is slight increased prominence of a central disk extrusion migrating cranially by 3 mm. There is overall moderate-severe central spinal canal stenosis with indentation of the ventral cord.At C4-C5, there is a mild posterior osteophyte disk complex with moderate-severe central spinal stenosis, with slight further effacement of CSF space within the thecal sac. There is bilateral uncovertebral hypertrophy contributing to moderate-severe right greater than left foraminal narrowing.At C5-C6, there is a stable posterior osteophyte disk complex with bilateral uncovertebral hypertrophy, with slightly progressed now moderate-severe central spinal stenosis as well as moderate-severe right greater than left foraminal narrowing.At C6-C7, there is a minimal posterior osteophyte disk complex, with moderate left and mild-moderate right foraminal narrowing. There is mild central spinal stenosis.At C7-T1, there is a stable trace disk bulge. There is mild ligamentum flavum thickening. Mild bilateral foraminal stenosis is present.LUMBAR SPINE

Output: 1.Slight progression of cervical spondylotic changes as detailed above with further effacement of CSF space sac, with moderate severe central spinal canal stenosis from C3-C4 through C5-C6 although scattered high-grade foraminal narrowings do not appear significant changed.2.Limited evaluation of the lumbar spine due to artifact from postoperative changes, although no significant interval change is appreciated. No high-grade central spinal canal stenosis at any level.3.Trace fatty filum again questioned which can be an incidental finding although has been associated with tethered cord. Please correlate clinically.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Secondary malignant neoplasm of brain and spinal cordClinical question: 58 yo F with metastatic NSCLC to brain, eval for number of mets The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a punctate enhancing lesion present in the right cerebellar hemisphere in the inferior semilunar lobule. A similar sized lesion is present in the left inferior semilunar lobule of the left cerebellar hemisphere. Another punctate lesion is present along the posterior aspect of the right pons which was also present on the prior exam.A couple lesions along the right inferior parietal lobule are not readily identified on the current exam.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 several punctate lesions present in the cerebellar hemispheres and pons which are suspicious for metastatic disease. Lesions previously identifiable in the right inferior parietal lobule are not readily identified on the current exam. Please note that the visualized lesions are less conspicuous on the current exam versus the prior exam.2.Please note that this examination is somewhat limited and specifically acquired for the purpose of stereotactic guidance during treatment.


Instruction: Generate impression based on medical findings.

Input: 64-year-old man with history of prostate cancer on surveillance. Additional history as per chart: Biopsy on 10/5/2015 revealed Gleason 6 adenocarcinoma, last PSA of 8.1. PELVIS:PROSTATE:Prostate Size: 53 x 43 mm.Peripheral Zone: There is a very small 5 x 4 mm T2 hypointensity in the right peripheral apex (series 801, image 53) which demonstrates restriction on diffusion weighted images and mild enhancement. No additional tumor is identified.Central Gland: There is hypertrophy of the transitional zone.Seminal Vesicles: The seminal vesicles appear normal.Extracapsular Extension: There is no evidence of extracapsular extension.BLADDER: The bladder is normal.LYMPH NODES: No significant lymphadenopathy noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Very small focus of abnormal signal in the right prostatic apex without extracapsular extension which may represent adenocarcinoma.


Instruction: Generate impression based on medical findings.

Input: Hereditary hemorrhagic telangiectasia [I78.0], Reason for Study: ^Reason: eval for AVM's History: HHT, nosebleeds Brain MRINo evidence of acute ischemic or hemorrhagic lesion on the scan.Multifocal scattered high signal intensity lesions on bilateral white matters on FLAIR imaging indicate nonspecific small vessel ischemic disease.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, 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.Brain MRA:3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.No evidence of intracranial aneurysm. No evidence of intracranial arterial significant luminal stenosis.

Output: 1. Minimal nonspecific small vessel ischemic disease. Otherwise no evidence of acute ischemic or hemorrhagic lesion.2. Normal brain MRA. Comment: Further imaging investigation with Gad enhanced MRI can be considered if small brain AVM is suspected.


Instruction: Generate impression based on medical findings.

Input: 48-year-old female with family history of breast cancer, positive BRAC1 mutation presents for high-risk screening. There is heterogeneous amount of fibroglandular tissue in both breasts. Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region. Biopsy clip artifact is again noted in the right posterior central breast.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on medical findings.

Input: Evaluate progression of multiple sclerosis, optic neuritis. Brain:There are innumerable T2 hyperintense lesions throughout the supratentorial and infratentorial white matter compatible with the patient's history of multiple sclerosis. There are several new T2 hyperintense lesions. For example, one is located within the subcortical white matter adjacent to the right central sulcus (series 501, image 50) and another within the left caudothalamic groove (series 501, image 43). Most of the lesions demonstrate low T1 signal, unchanged. A previously seen ring-enhancing lesion in the right superior frontal gyrus has resolved with residual T1 low signal (series 1701, image 65). Nonspecific enhancing foci in the the left caudate head (series 1701, image 41) and subcortical white matter of the left temporal lobe (series 1701, image 35) are nonspecific and may even be potentially artifactual. There is no restricted diffusion to suggest acute ischemia. The ventricles and sulci are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.Orbits:The optic nerves and chiasm are normal in caliber and signal without abnormal enhancement. The globes are intact. The extraocular muscles are within normal limits. There is no periorbital soft tissue abnormality.

Output: 1.Innumerable supratentorial and infratentorial white matter lesions compatible patient's history of multiple sclerosis with several new lesions as described above.2.Interval resolution of ring enhancing lesion in the right superior frontal gyrus.3.No imaging evidence of optic neuritis.4.No evidence for an acute intracranial abnormality.


Instruction: Generate impression based on medical findings.

Input: Radiating left side pain. Evaluate for foraminal stenosis. The vertebral column alignment is within normal limits. There is exaggerated lordosis with minimal grade 1 anterolisthesis of L4 on L5. The vertebral body and disc space heights are preserved. There is disc desiccation at the L3-4 and L4-5 levels. Heterogeneous bone marrow signal is visualized which is nonspecific. The spinal cord displays normal signal and morphology and terminates at the L1-L2 level. The paravertebral soft tissues are unremarkable. T11-12: As seen on sagittal view there is a trace disc bulge but no neural foraminal or central canal stenosis.T12-L1: There is no significant compromise to spinal canal or neural foramina.L1-L2: There is no significant compromise to spinal canal or neural foramina.L2-L3: There is a trace disc bulge without neuroforaminal or central canal stenosis.L3-L4: There is a trace disc bulge with mild-to-moderate facet hypertrophy and ligamentum flavum thickening. No neuroforaminal or central canal stenosis.L4-5: There is a mild disc bulge. Facet and ligamentum flavum hypertrophy is seen which along with prominent dorsal epidural fat causes mild to moderate central canal stenosis. There is also bilateral mild neural foraminal stenosis.L5-S1: There is a small disc bulge with mild facet and ligamentum flavum hypertrophy but there is no neural foraminal or central canal stenosis.Bilateral adrenal nodules are identified with thickening of the adrenal gland limbs bilaterally. The right adrenal nodule measures 1.1 x 2.0 cm and the left adrenal nodule measures 1.3 x 1.6 cm.

Output: 1.Degenerative changes mostly involving the lower lumbar spine, most prominent at the L4-5 level, where there is mild bilateral neural foraminal and mild-to-moderate central canal stenosis.2.Minimal degenerative grade 1 anterolisthesis of L4 on L5.3.Bilateral adrenal nodules which are nonspecific. If further evaluation is indicated, dedicated CT or MRI imaging may be obtained of the abdomen.


Instruction: Generate impression based on medical findings.

Input: History of BRCA2 mutation and 2 first degree relatives with history of pancreatic cancer. Evaluate for tumor. ABDOMEN:Extensive respiratory motion artifact limits evaluation, particularly of the postcontrast images.LIVER, BILIARY TRACT: The liver is normal in morphology and the background parenchyma has normal signal characteristics. There are multiple T2 bright cystic lesions without definite enhancement. One cyst in the subcapsular right lobe of has intrinsic high T1 signal ingesting hemorrhage or proteinaceous material.There are multiple round hepatic lesions with mildly increased T2 signal and restricted diffusion measuring up to 6 mm in diameter (series 3 image 13, 17, 21). It is unclear if these lesions enhance due to their small size and extensive motion artifact on the postcontrast images, however given the clinical history and appearance, these are highly suspicious for metastases.SPLEEN: No significant abnormality noted.PANCREAS: No pancreatic mass is evident within the limits of the exam. There is minimal diffuse fatty atrophy of the gland. The main pancreatic duct is nondilated.ADRENAL GLANDS: Slight nodularity of the left adrenal gland.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No upper abdominal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Numerous foci of increased T2 signal throughout the visualized thoracolumbar spine compatible with metastases.OTHER: Partially visualized large left pleural effusion with associated left lung atelectasis. There are numerous pulmonary nodules in the right lower lobe which are not significantly changed from prior accounting for differences in technique and compatible with metastases. There is associated pleural thickening.

Output: 1.Multiple round subcentimeter lesions within the liver as described. Evaluation is somewhat limited due to the small size and extensive respiratory motion artifact, but the appearance is highly suspicious for metastases.2.No evidence of a primary pancreatic mass within the limits of this severely motion degraded exam. 3.Partially visualized large left pleural effusion and multiple right lung metastatic lesions better evaluated on recent CT scan. Additionally there are numerous foci of signal abnormality in the thoracolumbar spine compatible with metastases.


Instruction: Generate impression based on medical findings.

Input: Female 50 years old Reason: evaluate for lateral meniscal tear History: knee pain playing sports and history of prior partial menisectomy. MENISCI: There is attenuation and blunting of the anterior horn and body of the lateral meniscus consistent with stated history of prior partial meniscectomy. There is slight lateral extrusion of the body of the lateral meniscus. There is intrasubstance signal in the body and anterior horn which likely represents degeneration. Within the anterior horn this signal extends to the tibial articular surface but appears similar to before and may not be of clinical significance. We see no fluid signal intensity within the meniscus or other findings to suggest an unstable meniscal tear.The medial meniscus is of normal signal intensity and morphology.ARTICULAR CARTILAGE AND BONE: There is abnormal signal intensity within the weight-bearing aspect of the lateral femoral condyle likely representing a combination of degenerative cyst formation and post microfracture changes. The overlying cartilage is thinned and heterogeneous indicating moderate degeneration with what appears to be a full thickness or near full thickness cleft, best seen on coronal T2 weighted sequence. Overall the articular cartilage appears similar to prior study. Edema within the lateral femoral condyle seen on prior study has largely resolved. There is edema in the posterior aspect of the medial femoral condyle which is new but nonspecific. The overlying cartilage appears intact.There is mild heterogeneity of the articular cartilage of the patella indicating mild degeneration but we see no fluid-filled defects. There is a small partial thickness defect centrally and superiorly within the cartilage of the femoral trochlea.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Lateral meniscus abnormalities as described above are favored to be post operative in etiology. We see no findings to suggest unstable lateral meniscal tear.2. Cartilage degeneration, loose bodies and other findings as described above.


Instruction: Generate impression based on medical findings.

Input: 31-year-old male with right handed weakness and numbness. Evaluate for disease. There is straightening of the cervical spine, but no spondylolisthesis. The cervical vertebral bodies are appropriate in height. There is mild disc height loss involving the C5-6 level where there is a trace diffuse disc bulge. The bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology. There is mild facet and uncovertebral hypertrophy involving the C3-4 through C5-6 levels and trace disc-osteophyte formation at C4-5, with at most mild right neural foraminal narrowing involving the right C4-5 level. There is no significant spinal canal stenosis at any level of the cervical spine. The vertebral artery flow voids appear to be intact. The paraspinous soft tissue structures appear within normal limits.

Output: Mild degenerative spondylosis involving the C3-4 through C5-6 levels, with at the most mild right neural foraminal narrowing involving the right C4-5 level, but no significant spinal canal stenosis at any level in the cervical spine.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Clinical question: 69-year-old female with back/trunk pain and intermittent incontinence. Signs and symptoms: As above. Pre and postcontrast enhanced thoracic MRI:Examination demonstrates normal signal intensity and the alignment of vertebral column.Examination demonstrates mild degenerative changes of disc and the posterior elements are present.There is no evidence of a spinal canal or neural foraminal compromise or stenosis at any level.There is normal signal intensity and caliber of the thoracic cord.There is no detectable abnormal enhancement of the vertebral column, cord or the meninges.No detectable. Spinal soft tissue abnormalities.Pre- and post enhanced lumbar MRI:There is normal anatomical alignment of vertebral column.T12-L1 is unremarkable.L1-L2 demonstrate mild degenerative changes and which shallow bulging disc however without spinal stenosis or neural foraminal compromise.L2-L3 demonstrate mild disc disease and loss of disc height, shallow broad-based bulging disc, moderate ligamentum flavum and mild facet hypertrophic changes. There is a tiny right perimedian disc protrusion with expected minimal enhancement.Constellation of changes results in moderate central spinal stenosis however without neural foraminal compromise.L3-L4 demonstrate moderate disc disease and loss of disc height, moderate ligamentum flavum and mild bilateral facet hypertrophic changes. Constellation of changes results in moderate central spinal stenosis without neural foraminal compromise.L4-L5 demonstrate moderate disc disease and loss of disc height, mild to moderate left ligamentum flavum hypertrophy and mild bilateral facet hypertrophic changes. There is evidence of a right-sided prior laminectomy with resultant expansion of thecal sac and no central spinal stenosis. There is a large right lateral disc osteophyte at this level which results in right lateral recess compromise however without neural foraminal compromise.L5-S1 demonstrates significant loss of disc height and suggestion of fusion of L5 and S1. There is evidence of prior laminectomy with resultant expansion of thecal sac and without spinal stenosis or neural foraminal compromise.Unremarkable post enhanced images.

Output: 1.Pre- and post enhanced thoracic MRI demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise. Normal signal intensity of the cord. No detectable abnormal enhancement.2.Pre- and post enhanced MRI of lumbar spine demonstrate degenerative changes at L2-L3 and L3-L4 levels with resultant moderate central spinal stenosis (worse at L2-L3) without neural foraminal compromise. Postoperative changes of laminectomy at L4-L5 and L5-S1 levels without evidence of central spinal stenosis. Right lateral disc-osteophyte complex at L4-L5 with resultant right lateral recess compromise.


Instruction: Generate impression based on medical findings.

Input: This limited planning MRI reveals unchanged postsurgical findings related to left parietal craniotomy including subjacent volume loss and gliosis. There is a small left frontal lobe developmental venous anomaly. There is also unchanged volume loss and signal abnormality within the medial left temporal lobe. There are grossly unchanged dysplastic left A1 and M1 segments without evidence of aneurysm. There is fluid within left mastoid air cells. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation.

Output: 1.Unchanged findings suggestive of left mesial temporal sclerosis.2.Unchanged post surgical changes within the left parietal lobe.3.Grossly unchanged dysplastic left A1 and M1 segments.4.Nonspecific fluid within the left mastoid air cells.


Instruction: Generate impression based on medical findings.

Input: History of prolactinoma. There is an unchanged 5 x 7 mm nodular lesion along the right anterior aspect of the pituitary gland with slight protrusion into the right cavernous sinus. The infundibulum is situated in the midline and not thickened. The optic apparatus is intact.

Output: Unchanged subcentimeter lesion along the right anterior aspect of the pituitary gland, which may represent a prolactinoma.


Instruction: Generate impression based on medical findings.

Input: Headache. The cerebellar tonsils extend up to 5 mm inferior to the foramen magnum, but display rounded morphologies. The posterior fossa capacity appears to be relatively small. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift. The major cerebral flow voids are intact. The orbits are grossly unremarkable.

Output: 1. The cerebellar tonsils extend up to 5 mm inferior to the foramen magnum, but display rounded morphologies, and the posterior fossa capacity appears to be relatively small. MRI with CSF flow study may be useful for further evaluation of potential Chiari I malformation.2. No evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on medical findings.

Input: 37 year old with history of right mastectomy for IDC and DCIS. There is heterogeneous amount of fibroglandular tissue in the left breast. The patient is status post right mastectomy. Mild parenchymal enhancement is noted in the left breast.No abnormal enhancement is seen in the left breast or right chest wall. No abnormal lymph nodes are identified in either axillary region. Post-surgical changes are seen in the right axilla.

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


Instruction: Generate impression based on medical findings.

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

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


Instruction: Generate impression based on medical findings.

Input: Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is no evidence for syrinx. The cerebellar tonsils are low lying and extend 5 mm below the level of the foramen magnum. There is some multilevel disc desiccation present and mild reversal of the normal cervical curvature.CSF flow at the level of the foramen magnum appears intactAt C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a small left lateral recess disc protrusion present at this level.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. The left vertebral artery is larger than the right vertebral artery.MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots.

Output: 1.No evidence for syrinx.2.There is a Chiari I malformation present.3.There is no compromise of the cervical or thoracic spinal canal.4.There are mild degenerative changes present in the cervical spine.


Instruction: Generate impression based on medical findings.

Input: Unspecified visual disturbance [368.9], Reason for Study: ^Reason: cause of vision loss History: vision loss Brain MRI:There is no evidence of acute ischemic or hemorrhagic lesion.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.Neck MRA:3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries. Brain MRV3D MRV brain post-gadolinium with maximum intensity projections of the superficial/deep intracranial venous drainage demonstrate normal flow enhancement in the superior sagittal sinus, transverse sinuses, sigmoid sinuses, internal cerebral veins, vein of Galen and straight sinus.Orbit MRIThere is pre-septal soft tissue swelling which shows high signal intensity on T2 weighted image and enhancement indicating possible cellulitis.The globes, optic nerves, extraocular muscles and retroglobal spaces are symmetric and normal. The lacrimal glands are normal.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion on this scan.2. Normal brain MRI, Neck MRA and Brain MRV.3. Possible pre-septal cellulitis on the right as described above.


Instruction: Generate impression based on medical findings.

Input: 25 year old male with Tetralogy of Fallot, Absent pulmonary valve. Status post bioprosthetic pulmonary valve replacement in 2001. Referred for a research protocol cardiac MRI to evaluate right ventricular volume and pulmonary regurgitation. Left VentricleThe left ventricle is mildly dilated with normal systolic function. The overall LV ejection fraction is 61%, the LV end diastolic volume index is 108 ml/m2 (normal range: 74+/-15), the LVEDV is 164 ml (normal range 142+/-34), the LV end systolic volume index is 42 ml/m2 (normal range 25+/-9), the LVESV is 63 ml (normal range 47+/-19), the LV mass index is 62 g/m2 (normal range 85+/-15), and the LV mass is 94 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is septal flattening during diastole, suggesting elevated right ventricular diastolic pressure.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is severely dilated with mildly reduced systolic function. The overall RV ejection fraction is 45%, the RV end diastolic volume index is 148 ml/m2 (normal range 82+/-16), the RVEDV is 224 ml (normal range 142+/-31), the RV end systolic volume index is 81 ml/m2 (normal range 31+/-9), and the RVESV is 123 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately enlarged.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation. The right coronary cusp appears mildly thickened, but moves freely.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThere is a prosthetic pulmonary valve in place, with moderate stenosis and severe insufficiency.Peak velocity is 3.2 m/s, suggesting peak systolic gradient of 41 mmHg.Pulmonic regurgitant fraction at the level of the valve could not be calculated accurately due to artifact associated with the prosthetic valve.RPA flow 48 mL (5 mL regurgitation)LPA flow 32 mL (18 mL regurgitation)Regurgitant fraction based on branch pulmonary artery measurements is 29%, which may underestimate the regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch. The left carotid arises from a common trunk with the innominate artery. The aortic root is normal in size.Aortic annulus 28 mmAortic Sinuses 42 mm x 44 mm (Z-score +5)S-T Junction 34 mm x 34 mmTransverse arch 21 mm x 21mmProximal descending aorta 17 mm x 18 mmDescending aorta at diaphragm 16 mm x 16mmPulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.MPA 39 mm x 42 mmRPA 31 mm x 37 mmLPA 31 mm x 38 mmVenous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no pericardial effusion.

Output: 1. Mildly dilated left ventricle, with normal systolic function.2. Severely dilated right ventricle with mildly reduced systolic function. (RVEDV 148 mL/m2, RVEF 45%)3. Severe regurgitation of prosthetic pulmonary valve.4. Severely dilated aortic root.5. Severely dilated main and branch pulmonary arteries.


Instruction: Generate impression based on medical findings.

Input: 42 year-old female with a strong family history of breast cancer, including breast cancer in her mother, maternal grandmother, and maternal and paternal great grandmothers. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.No suspicious enhancement is seen in either breast. Numerous areas of focal parenchymal enhancement are unchanged. No abnormal axillary lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.