Instruction: Generate impression based on medical findings.

Input: Preoperative planning. Spondylolisthesis. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Grade 1 anterolisthesis of L4 and L5 is again seen. Bone marrow signal is benign. The conus medullaris is normal in position.There is developmental narrowing of the lumbar spinal canal with superimposed degenerative changes as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: Disc bulge eccentric to the left contributes to mild left neural foraminal stenosis, progressed since 6/24/2011. No significant spinal canal or right neural foraminal stenosis. L4-L5: Postsurgical changes of left-sided fusion as described on recent CT, new since prior MRI. Vacuum phenomena at this level and absence of fusion better appreciated on recent CT. There is mild spinal canal stenosis. Advanced bilateral facet arthropathy. There is up to moderate bilateral neural foraminal stenosis.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild bilateral facet arthropathy.Paraspinous soft tissues are within normal limits.

Output: 1. Grade 1 anterolisthesis of L4 and L5 with absence of fusion at this level. There is advanced facet arthropathy and up to moderate bilateral neural foraminal stenosis and mild spinal canal stenosis at this level. Hardware loosening better seen on recent CT.2. Mild left L3-L4 neural foraminal stenosis related to eccentric left-sided disc bulge, progressed since prior MRI from 2011.


Instruction: Generate impression based on medical findings.

Input: 19 years old male with history of craniopharyngioma now with increased headache, evaluate ventricular size. Patient is status post right frontal craniotomy, with placement of ventriculostomy catheter having tip in the third ventricle and small amount of encephalomalacia abutting the distal catheter; this is not significantly changed in appearance from the 2007 comparison study. Lateral and third ventricles are effaced secondary to decompression.Cystic focus with internal calcification in the interhemispheric fissure is unchanged in size from recent prior MRI study.There is no evdence of intracranial hemorrhage, mass or edema. The remaining ventricles and basal cisterns are normal in size and configuration. The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No hydrocephalus or change in ventriculostomy catheter position since 2007.


Instruction: Generate impression based on medical findings.

Input: Episodes of left sided weakness and occasional slurred speech. Family reports a stress test with triple vessel disease. Brain MRI: There is an area of high T2 signal and restricted diffusion in the right thalamocapsular junction that measures up to 25 mm. There is also a subcentimeter focus of high T2 signal and restricted diffusion in the right posterior putamen. There is no evidence of intracranial hemorrhage or mass. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Brain MRA: There is no evidence of significant steno-occlusive lesions or aneurysm.Neck MRA: There is no evidence of significant steno-occlusive lesions.

Output: 1. Acute infarcts in the right thalamocapsular junction and putamen without evidence hemorrhagic transformation or midline shift.2. No evidence of significant steno-occlusive disease in the major head and neck arteries, within the limits of MRA.Discussed with nurse Valerio at 5PM on 9/21/15.


Instruction: Generate impression based on medical findings.

Input: Strong family history of breast cancer. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally. Few small enhancing foci are seen in the lateral breasts, left more than right but none of them are uniquely enhancing. No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on medical findings.

Input: This exam is degraded by motion artifact. There is a region of restricted diffusion within the left parietal lobe centered within the post central gyrus but also involving the expected location of Wernicke's area in the left posterior superior temporal gyrus. There is no evidence of intracranial hemorrhage. There are no definite areas of abnormal parenchymal signal. 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 and scalp soft tissues are unremarkable. There is minimal paranasal sinus mucosal thickening.

Output: Acute left parietal and temporal infarct involving Wernicke's area and the left post central gyrus.


Instruction: Generate impression based on medical findings.

Input: Male 52 years old Reason: stem cell transplant patient with dilated bile duct seen on recent abdominal US. History: abdominal pain, nausea, emesis ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. It is unremarkable for unenhanced technique. The gallbladder is mildly distended without calculi. Gallbladder wall is normal in thickness.Common bile duct measures 10 mm near the head of the pancreas. Minimal intrahepatic central biliary ductal dilatation. Probable hepatic cyst in the left hepatic lobe.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic duct is normal in caliber. There is mild to moderate pancreatic atrophy.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Nephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount upper abdominal ascites.

Output: 1.Common bile duct measuring up to a 1 centimeter in the head of the pancreas; the etiology of which is not evident. This may be physiologic in a patient over 50 years of age.2.Mild perihepatic ascites.3.Study was terminated per patient's request.


Instruction: Generate impression based on medical findings.

Input: Alignment of the entire spinal column appears anatomic. Vertebral body heights and disc spaces are preserved. There is diffuse involvement of the spinal cord with mass lesions consistent with metastatic involvement from the patient's known primary malignancy, and multilevel severe spinal cord compression.

Output: There is diffusely abnormal appearance of the spinal cord with mass lesions appreciated throughout the entirety of the cervical, thoracic and lumbar spine. Please refer to the subsequent complete spine MRI for further details.


Instruction: Generate impression based on medical findings.

Input: 55-year-old male with back pain and severe sepsis. Please evaluate for epidural abscess. The exam is limited by motion. No epidural fluid collections are visualized. Five lumbar type vertebral bodies are present. Diffuse signal abnormality within the vertebral bodies is consistent with heterogeneous bone marrow from multiple myeloma involvement. At L2 the retropulsion from compression fracture continues to measure 5 mm and there is moderate effacement of the anterior thecal sac. Vertebral body height is unchanged. Kyphoplasties of T11, L1, and L4 are again seen. The conus appears to terminate at the L1 level.Individual levels are described below:T12-L1: There is a moderate disc bulge with bilateral facet and ligamentum flavum hypertrophy.L1-L2: Ligamentum flavum thickening and bilateral facet hypertrophy are present. There is a left foraminal disc protrusion.L2-L3: There is retropulsion of the L2 vertebral body measuring 5 mm with mild disc bulge with biforaminal prominence. Facet and ligamentum flavum hypertrophy are present. There is a moderate central spinal canal stenosis and mild-to-moderate bilateral neuroforaminal stenosis. L3-L4: Ligamentum flavum and bilateral facet hypertrophy causing mild spinal canal narrowing. There is mild left and mild-to-moderate right neural foraminal stenosis.L4-L5: Ligamentum flavum and bilateral facet hypertrophy. There is mild to moderate bilateral neural foraminal stenosis.L5-S1: There is a left paracentral disc protrusion that causes posterior displacement of the descending left S1 nerve root. Paraspinous soft tissues are within normal limits.

Output: 1. No large epidural fluid collections are seen. 2. Diffuse degenerative changes as described in detail above including retropulsion of the L2 vertebral body with moderate central spinal canal stenosis.3. Left paracentral disc protrusion at L4-5 that causes posterior displacement of the descending left S1 nerve root. 4. Diffusely abnormal marrow signal which is unchanged, and likely related to history of multiple myeloma.


Instruction: Generate impression based on medical findings.

Input: 67-year-old female with episode of staring and confusion, stroke and seizure evaluation. Soft tissue swelling with mild enhancement is noted involving the soft tissues overlying the right forehead. There is no underlying osseous involvement. There is no restricted diffusion to suggest acute ischemia. No acute intracranial hemorrhage. No intracranial mass or mass-effect. No hydrocephalus. There is generalized global parenchymal volume loss, unchanged in extent. Multiple foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic disease. T2 hyperintensity is noted within the bilateral subinsular white matter which is favored to be related to combination of chronic ischemic change and prominent perivascular spaces. Redemonstrated are few punctate foci of susceptibility effect in the bilateral temporal and occipital lobes compatible with chronic microhemorrhages. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved. Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear.

Output: 1.Soft tissue swelling with mild enhancement is noted involving the soft tissues overlying the right forehead. There is no underlying osseous involvement. This is nonspecific and may be secondary to injury, infection, inflammation, and unlikely neoplastic.2.Chronic small vessel ischemic disease.


Instruction: Generate impression based on medical findings.

Input: 30 year old with history of DVT and pulmonary embolism with associated right ventricular dysfunction presenting for cardiac evaluation. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 61%, the LV end diastolic volume index is 83 ml/m2 (normal range: 65+/-11), the LVEDV is 208 ml (normal range 109+/-23), the LV end systolic volume index is 32 ml/m2 (normal range 18+/-5), the LVESV is 81 ml (normal range 31+/-10), the LV mass index is 42 g/m2 (normal range 67+/-11), and the LV mass is 105 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. No evidence of myocardial T2-star.Left AtriumThe left atrium is normal in size.Right VentricleThe right ventricle is normal size and systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 86 ml/m2 (normal range 69+/-14), the RVEDV is 217 ml (normal range 110+/-24), the RV end systolic volume index is 39 ml/m2 (normal range 22+/-8), and the RVESV is 98 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSmall axillary lymph nodes are noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal LV size and systolic function (LVEF 61%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.2. Normal RV size and systolic function (RVEF 55%).3. Mild mitral and tricuspid valve regurgitation.4. See extra-cardiac findings.


Instruction: Generate impression based on medical findings.

Input: Reason: painful swelling ulnar side of wrist History: pain There is thickening and increased signal intensity of the extensor carpi ulnaris tendon as it courses through the distal ulnar groove and along the ulnar aspect of the wrist. This appears to have progressed when compared to the prior study. There is increased signal intensity within the tendon which extends to the surface indicating partial thickness tearing, but the tendon can be followed to its insertion on the base of the fifth metacarpal. Although there is little, if any, fluid surrounding the tendon, there is enhancement indicating a tenosynovitis with peritendinous inflammation of the adjacent soft tissues. There is a small amount of fluid within the abductor pollicis longus tendon sheath and perhaps mild enhancement which may represent a mild De Quervain's tenosynovitis. The remaining tendons are within normal limits. While this study was not protocoled for detailed evaluation of the intrinsic ligaments of the wrist or the triangular fibrocartilage complex, there is mild increased signal intensity within the triangular fibrocartilage complex at its ulnar styloid attachment likely representing degeneration or a mild synovitis, but we see no fluid-filled tear. We see no findings to suggest a tear of the scapholunate or lunotriquetral ligaments. There is a cluster of small round foci of fluid signal intensity volar to the radial styloid perhaps representing ganglion formation at the attachment of the long radiolunate ligament. There is mild enhancement of the distal radial ulnar joint suggesting a mild synovitis. Mild osteoarthritis affects the basilar joint.

Output: Severe extensor carpi ulnaris tendinopathy and other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Reason: 81 yo F with recent CVA 1 week ago at St. Bernard Hospital p/w mental status changes, evaluate for evolving CVA History: R sided weakness, AMS There is diffusion restriction present which involves the medial aspect of the left parietal lobe, the posterior aspect of the left paracentral lobule and adjacent left cingulate gyrus and corpus callosum.There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Punctate lesions are present in the thalami and basal ganglia.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.Subacute infarction involving the territory of the left superior internal parietal artery as detailed above.2.Periventricular and subcortical white matter changes as well as lesion in the basal ganglia and thalami of a moderate degree are nonspecific. At this age they are most likely vascular related. 3.The exam is significantly degraded by patient motion. This would obscure more subtle abnormalities. and precluded acquisition of susceptibility imaging and postcontrast imaging


Instruction: Generate impression based on medical findings.

Input: 42 year old female. Would like to better evaluate transitional anatomy seen on CT/MRI Note is made of a transitional L5 vertebral body. There is posterior wedging of the L5 vertebral body which may be congenital in etiology. Please refer to the dedicated lumbar spine MRI examination report for additional details. There is minimal anterolisthesis of L4 on L5. There is mild degenerative disc disease at the level of L4/L5 with anterior osteophyte formation. Note is made of a vascular stent at the expected level of the right iliac vein.

Output: Transitional vertebral body and degenerative disc disease of the lumbar spine as described above.


Instruction: Generate impression based on medical findings.

Input: Large liver mass on outside imaging ABDOMEN:LIVER, BILIARY TRACT: Large T2 hyperintense mass replacing nearly the entire right hepatic lobe, internal heterogeneity and septations seen, measures 17.8 x 13.3 x 20.7 cm (series 3, image 18; series 7, image 17). The mass is T1 hyperintense and exerts mass effect upon the right kidney. Additional T2 hyperintense/T1 hypointense nonenhancing foci are noted throughout the liver, likely cysts. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Large cystic mass replacing the right hepatic lobe with imaging characteristics suspicious for a biliary cystadenoma/cystadenocarcinoma (particularly given the internal heterogeneity of the structure evident on T2 imaging) or a giant biliary hamartoma, no associated enhancement seen.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Pilonidal cyst without mention of abscessClinical question: Sacral dimple, evaluate for communication with the spinal canalSigns and Symptoms: Sacral dimple, pain with clear drainage Within the subcutaneous tissues to the right of the coccyx and the posterior to it. It is bright on T2 and dark on T1 It is associated with contrast enhancement. There is infiltration of the fat planes surrounding it. The fluid like portion measures approximately 11 mm x 6 mm axial dimensions. There is a small amount of enhancement of the adjacent bony marrow at the tip of the coccyx, as well as the adjacent periosteum and tissues immediately adjacent to the coccygeal bone. The spinal canal is approximately 3 bone segments above the level of the inflamed marrow.Five lumbar type vertebral bodies are presumed to be present, which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.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.At L2-3 there is no significant compromise to spinal canal or neural foramina.

Output: There is a small fluid collection associated with inflammatory changes presumably representing a small abscess located in the subcutaneous tissues adjacent to the coccygeal bone. There is some associated involvement of the distal tip of the coccyx compatible with osteomyelitis. There is no involvement of the spinal canal appreciated.


Instruction: Generate impression based on medical findings.

Input: Male, 26 years old, with seizures, right lower extremity weakness, and brain lesions status post biopsy. An irregularly marginated, enhancing lesion is redemonstrated centered on the left cingulate gyrus. The lesion is predominately solidly enhancing with a somewhat feathery appearance along its inferior margin which encroaches into the corpus callosum. The lesion is similar in size when compared to the immediate prior Stealth MRI, but has increased relative to the examination of 05/26/16. Associated surrounding edema has also increased.A smaller but similar-appearing, solidly enhancing lesion is again seen within the left parietal lobe. This lesion is also unchanged relative to the immediate prior examination, but increased in size when compared to the older study. Adjacent postbiopsy changes are seen including a burr hole in the left parietal bone and a small biopsy cavity immediately anterior to the enhancing lesion.No other pathologic intracranial enhancement is observed. However, there are scattered small foci of white matter T2 hyperintensity within the right cerebral hemisphere which are not significantly changed. No areas of significant intracranial hemorrhage or any abnormal extra-axial fluid are seen.

Output: 1.Findings are seen compatible with left parietal lobe biopsy. A biopsy cavity is evident just anterior to the enhancing nodule within the left parietal lobe.2.Solidly enhancing lesions within the left parietal lobe and in the left cingulate gyrus are redemonstrated. When compared to the immediate prior Stealth MRI, these lesions and their associated edema have not changed, but when compared to the older MRI, they have increased in size.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Secondary malignant neoplasm of brain and spinal cord(198.3)Malignant neoplasm of bronchus and lung, unspecified siteClinical question: Hx of metastatic lung cancer s/p craniotomy and SRS, surveillance MRI The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient is status post left-sided craniotomy. There is T2 and FLAIR signal hyperintensity centered in the left middle temporal gyrus anteriorly which is associated with some susceptibility effect.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. This is stable compared to the previous exam.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.The patient is status post left-sided craniotomy for left temporal lobe surgery. 2.There is no evidence for intracranial metastases at this time.3.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on medical findings.

Input: 68 year old with history of ischemic cardiomyopathy with biventricular pacing/ICD presenting for cardiac evaluation as part of workup for advanced options. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 29%, the LV end diastolic volume index is 175 ml/m2 (normal range: 74+/-15), the LVEDV is 320 ml (normal range 142+/-34), the LV end systolic volume index is 124 ml/m2 (normal range 25+/-9), the LVESV is 228 ml (normal range 47+/-19), the LV mass index is 110 g/m2 (normal range 85+/-15), and the LV mass is 201 g (normal range 164+/-36). There is global hypokinesis with additional akinesis in the mid to basal inferior and inferolateral wall. There is correlating transmural (>50%) late gadolinium enhancement mid to basal inferolateral wall in a pattern consistent with myocardial infarction. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 33%, the RV end diastolic volume index is 112 ml/m2 (normal range 82+/-16), the RVEDV is 205 ml (normal range 142+/-31), the RV end systolic volume index is 75 ml/m2 (normal range 31+/-9), and the RVESV is 137 ml (normal range 54+/-17).Right AtriumThe right atrium is grossly normal in size.Aortic ValveThe aortic valve opens widely and there is trace significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least moderate mitral regurgitation. The degree of regurgitation is difficult to quantify due to the artifact. Pulmonic ValveNot well seen. Tricuspid ValveNot well seen. AortaNot well seen.Pulmonary VeinsNot well seen. Pulmonary ArteryNot well seen. Venous AnatomyNot well seen. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsLarge bilateral pleural effusions. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 29%. There akinesis in the mid to basal inferior and inferolateral wall. There is correlating transmural (>50%) late gadolinium enhancement mid to basal inferolateral wall in a pattern consistent with myocardial infarction. No MRI evidence to support the diagnosis of cardiac amyloidosis. 2. The right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 33%. 3. Severe left atrial enlargement. 4. At least moderate mitral regurgitation. 5. Marked bilateral pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Reason: questioning bilateral shoulder pain History: bilateral shoulder pain Examination is limited by patient motion artifact.ROTATOR CUFF: There is diffuse mild muscle atrophy, which may be an age-related finding. There is marked atrophy of the supraspinatus muscle, with increased signal within the supraspinatus tendon compatible with tendinopathy. No rotator cuff tear is evident.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a small paralabral cyst of the mid superior labrum. No labral tear is evident.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1. Findings compatible with frozen shoulder.2. Diffuse mild muscle atrophy, and marked atrophy of the supraspinatus muscle, but with no discrete rotator cuff tear evident.3. Moderate osteoarthritis of the acromioclavicular and glenohumeral joints.


Instruction: Generate impression based on medical findings.

Input: Dysarthria following unspecified cerebrovascular disease [I69.922] / Essential (primary) hypertension [I10], Reason for Study: ^Reason: Concern for stroke History: As above There are new restricted diffusion lesions on the brainstem including right side of the lower midbrain, right side middle cerebellar peduncle, anterior aspect of lower pons, and right posterior aspect of medulla indicating acute ischemic infarct.Previously seen multifocal lower pontine and left middle cerebellar peduncle area restricted diffusion lesions has been decreased in signal intensity indicating normal evolution. There is no evidence of hemorrhage transformation.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. 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: New acute ischemic infarcts on the brainstem as described above.Normal evolution of previously seen acute ischemic infarctions.No evidence of hemorrhagic transformation.


Instruction: Generate impression based on medical findings.

Input: Snuffbox tenderness, recent wrist trauma, persistent pain/swelling. Question of scaphoid fracture. LIGAMENTS: The scapholunate and lunotriquetral ligaments appear grossly intact.TRIANGULAR FIBROCARTILAGE COMPLEX: The triangular fibrocartilage complex appears grossly intact.TENDONS: No significant abnormality noted. BONES: There is osteophyte and subchondral cyst formation at the basilar joint compatible with osteoarthritis. Foci of increased T2 signal within the lunate and triquetrum are compatible with cysts. No fracture is evident.ADDITIONAL

Output: 1. No scaphoid fracture is identified.2. Basilar joint osteoarthritis.


Instruction: Generate impression based on medical findings.

Input: 57 years, Female, rule out structural cause of amnesia. There is no restricted diffusion involving the hippocampi or elsewhere in the brain. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. There are patchy foci of T2/FLAIR hyperintensity in the bilateral subcortical and periventricular white matter, particularly in the parieto-occipital region, which are nonspecific. Brain parenchyma is otherwise unremarkable for age. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. No evidence of acute infarct, hemorrhage, mass or mass effect.2. Mild patchy T2/FLAIR hyperintensity involving the bilateral parieto-occipital subcortical and periventricular white matter which is very nonspecific but may reflect gliosis related to prior inflammation, toxic metabolic injury or small vessel ischemia. Brain MRI is otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: 59-year-old female with diplopia, rule out stroke. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Major flow-voids are preserved.Minimal right ethmoid mucosal thickening is seen. Bone marrow signal and extracranial soft tissues are within normal limits. There is an incidentally noted partially visualized cyst within the left longus colli muscle.

Output: No evidence of intracranial mass or acute infarct. No specific findings to explain patient symptomatolgy.


Instruction: Generate impression based on medical findings.

Input: Status post C3-C7 laminoplasty on October 2, 2015. Persistent MRSA bacteremia. New onset right deltoid weakness. Patient was imaged in a neck collar and unable to lie straight in the scanner. There are changes related to previous C3-C7 laminoplasty with bone graft struts at C4 and C6. The osseous findings are better assessed on the most recent CT scan from December 6, 2015. There is fluid within the paraspinal soft tissues along the posterior midline incision with associated extensive surrounding inflammatory change. Axially, the fluid is the largest C4-C5 level where it measures 2.2 cm x 1.8 cm. Craniocaudally, it measures 4.8 cm. Numerous foci of susceptibility artifact within the fluid may relate to the presence of microscopic metallic fragments or less likely gas. Given the timing of the laminoplasty, the inflammatory change is more extensive than expected. This above inflammatory change is associated with abnormal increased T2 signal along the C3-C4 and C4-C5 facets bilaterally. This is new compared to the preoperative MRI. This correlates with erosion involving the left C3-C4 facet which had progressed between the CT scans from October 3, 2015 and December 6, 2015. While this facet abnormality might be partly reactive from the adjacent soft tissue inflammation in the setting of pre-existing degenerative facet disease, the possibility of osteomyelitis should also be considered.There is abnormally increased T2 signal within the C3-C4 disc which is new since the previous preoperative MRI. Associated irregularity focally involving the endplates along the right posterior-lateral aspect of the disc was present on the previous MRI and probably reflect degenerative change. This increased disc T2 signal extends into the epidural space and reflect fluid within the pre-existing central and right posterior-lateral extruded disc. However, compared to the preoperative MRI, this epidural soft tissue thickening has minimally increased if at all from prior. This results in no significant mass effect on the spinal cord given the recent laminoplasty. There is no significant epidural collection at any other level. There is no definite cord signal abnormality. There is edema and fluid in the prevertebral space extending from C5-C6 level cranially to the level of the skull base with abnormal signal involving the left longus coli muscle. This is increased compared to the most recent CT scan from December 2015. The thickness of the prevertebral soft tissues at C3 is 16 mm now, compared to 7 mm on the CT scan from December 2015.The multilevel spinal canal narrowing on the preoperative MRI has improved at C3-C4 and resolved at the other levels, especially C6-C7. Foraminal stenoses are not significantly change since the preoperative MRI.Imaging through the upper thorax, there is dependent signal abnormality which may reflect small pleural effusions and atelectasis. As minimal fluid in the mastoid air cells.C2-C3: There is no spinal canal or foraminal stenosis.C3-C4: Improved, now mild, canal stenosis following laminoplasty. There is a right paracentral disc extrusion which is unchanged to very minimally increased compared to the previous MRI examination. There is unchanged mild left neuroforaminal stenosis.C4-C5: There is no spinal canal stenosis. There is mild bilateral foraminal stenoses.C5-C6: There is a disc-osteophyte complex but no spinal canal stenosis. There is moderate left and mild right foraminal stenosis.C6-C7: Disc-osteophyte complex asymmetric to the right. These changes, however, result in no significant spinal canal stenosis given the recent decompression through laminoplasty. There is moderate left and mild right foraminal stenosis, which are unchanged.C7-T1: There is no spinal canal or foraminal stenosis.

Output: 1.The study was performed without intravenous contrast and is of suboptimal quality.2.The spinal canal has been decompressed following laminoplasty. There is no spinal cord signal abnormality. There is no definite epidural abscess but the study was performed without intravenous contrast.3.Fluid in the paraspinal soft tissues along the posterior midline incision along with extensive surrounding soft tissue inflammatory change is more than expected at this point postoperatively.4.Progressive prevertebral edema, especially on the left, and retropharyngeal effusion are also present. These findings could be infectious in nature.5.Increased T2 signal in the C3-C4 disc with minimal if any increase in the associated ventral epidural thickening, which is at least partly related to disc extrusion and is nonspecific in this postoperative setting. It may relate to degenerative disease or early/treated discitis.6.Abnormal T2 signal at the C3-C4 and C4-C5 facets with associated progressive erosions at the left C3-C4 facet may be related to a combination of degenerative disease and reactive change caused by the adjacent soft tissue inflammation. However, osteomyelitis should also be considered.7.Findings in the included upper chest (pleural effusions and atelectasis) are better assessed on the recent CT scan from December 11, 2015. 8.Also, please refer to the previous CT scan from December 6, 2015 for an assessment of fine osseous detail.


Instruction: Generate impression based on medical findings.

Input: History of hepatocellular carcinoma status post TACE/RFA. ABDOMEN:LIVER, BILIARY TRACT: Liver is cirrhotic in morphology with atrophy of the right lobe, widening of the intrahepatic fissures, and surface nodularity. Recanalized umbilical vein and other portosystemic collaterals indicate portal hypertension.Within hepatic segment 8, anterior to the right hepatic vein the previously described arterially enhancing lesion with washout has been replaced by an ablation cavity which measures 12 x 20 mm (series 904, image 194). There is equivocal thin rim enhancement surrounding the ablation cavity which may be a posttreatment change. Otherwise, the ablation cavity does not enhance. There is a new wedge-shaped area of arterial enhancement in the periportal aspect of segment 8 (series 901, image 252) which does not washout and may represent a posttreatment transient hepatic intensity difference. No new suspicious arterial enhancing lesions are identified in the liver.There is cholelithiasis and mild gallbladder wall thickening which is nonspecific in the setting of chronic liver disease appearing similar to prior. No intra or extrahepatic biliary ductal dilatation.SPLEEN: Moderate splenomegaly with spleen measuring up to 18.5 cm in the craniocaudal dimension. Perisplenic collaterals.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple renal cysts the largest of which arises from the inferior pole of the left kidney measuring up to 6.4 cm. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is a 1.7 x 3.4 cm focus of non mass-like enhancement within the left breast (series 901, image 412) which demonstrates T2 hyperintensity as well as restricted diffusion.OTHER: Trace amount of ascites is seen along the inferior aspect of the liver.

Output: 1.Interval ablation of segment 8 hepatocellular carcinoma without evidence of residual or recurrent disease. Continued follow-up is recommended.2.Cirrhosis with splenomegaly and portal hypertension and trace amount of ascites.3.Cholelithiasis with gallbladder wall thickening appearing similar to prior; in the absence of symptomatology suggesting acute gallbladder disease, gallbladder wall thickening is common in patients with cirrhosis and not indicative of acute disease.4.Findings suggestive of gynecomastia of the left breast; correlation with mammography can be considered as clinically warranted.


Instruction: Generate impression based on medical findings.

Input: 63 year old with hypertension and congestive heart failure presenting for evaluation of etiology of heart failure. Left VentricleThe left ventricle is severely dilated with moderately reduced systolic function. The overall LV ejection fraction is 37%, the LV end diastolic volume index is 122 ml/m2 (normal range: 65+/-11), the LVEDV is 263 ml (normal range 109+/-23), the LV end systolic volume index is 77 ml/m2 (normal range 18+/-5), the LVESV is 166 ml (normal range 31+/-10), the LV mass index is 50 g/m2 (normal range 67+/-11), and the LV mass is 109 g (normal range 114+/-24). The LV dysfunction is global. There is mid myocardial late gadolinium enhancement in the septum which can be seen with nonischemic cardiomyopathy to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. This pattern is atypical for myocardial infarction. The native T1 times are mildly elevated at 1160 ms. Left AtriumThe left atrium is mild to moderately dilated.Right VentricleThe right ventricle is mildly dilated with mildly reduced systolic function. The overall RV ejection fraction is 47%, the RV end diastolic volume index is 106 ml/m2 (normal range 69+/-14), the RVEDV is 229 ml (normal range 110+/-24), the RV end systolic volume index is 56 ml/m2 (normal range 22+/-8), and the RVESV is 120 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least mild to moderate tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is severely dilated with moderately reduced systolic function. The overall LV ejection fraction is 37%. The LV dysfunction is global. There is mid myocardial late gadolinium enhancement in the septum which can be seen with nonischemic cardiomyopathy to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. This pattern is atypical for myocardial infarction. The native T1 times are mildly elevated at 1160 ms. This can be re-evaluated on MRI follow up in 6-12 months for reassessment.2. The right ventricle is mildly dilated with mildly reduced systolic function. The overall RV ejection fraction is 47%.


Instruction: Generate impression based on medical findings.

Input: 54-year-old man with history of prostate cancer, evaluate prior to possible focal ablation therapy. Additional history as per chart indicates a needle biopsy in the left mid prostate gland which identified prostate adenocarcinoma (Gleason grade 3+3) involving approximately 5% of a 1 mm tissue sample. PELVIS:PROSTATE:Prostate Size: 42 x 29 mmPeripheral Zone: There is a questionable focus of T2 hypointensity and diffusion restriction in the left apex measuring approximately 2 x 3 mm (series 1101, image 8). A prostatic utricle cyst is noted.Central Gland: The central gland is unremarkable.Seminal Vesicles: Seminal vesicles are unremarkable.Extracapsular Extension: 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: Subcentimeter focus of signal abnormality in the left prostatic apex which may represent a very small focus of adenocarcinoma, however this finding is equivocal.


Instruction: Generate impression based on medical findings.

Input: Male 16 years old Reason: Change in pelvic mass s/p 4 cycles of consolidation History: 15 year old with metastatic Ewing's sarcoma The mass around the left iliac bone is slightly decreased in size. When using a similar measuring technique, the medial component of the mass now measures 5.5 x 1.0 x 7.0 cm, previously 6.6 x 1.1 x 8.1 cm, and the lateral component measures 6.3 x 1.0 x 6.0 cm, previously 7.7 x 1.0 x 6.9 cm. The mass again demonstrates avid enhancement and increased T2 signal.Innumerable nearly confluent osseous metastases are again seen within the lower lumbar spine, pelvis and femurs, without substantial interval change. New small volume ascites is noted.

Output: 1.Mass around iliac bone, slightly decreased in size compared to the prior examination.2.Innumerable confluent osseous metastatic lesions, without substantial change.3.New small volume ascites.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Kidney transplant status End stage renal disease Other symptoms and signs involving the musculoskeletal systemDiagnosis Edits: ||Clinical question: Leg weakness, neuro consult recommendations. No contrast as is s/p kidney transplantSigns and Symptoms: as above Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. There is multilevel disc desiccation present. There appears to be hypertrophy of the ligamentum flavum extending from C1 down to the C4-5 disc space level.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is a diffuse disc bulge present associated with hypertrophy of the ligamentum flavum. There is flattening of the spinal cord associated with T2 signal hyperintensity within the spinal cord at this level. Overall there is severe spinal stenosis at this level.At C4-5 there is a diffuse disc bulge present associated with some ligamentous hypertrophy. There is effacement of spinal fluid ventral and posterior the spinal cord and mild flattening of the spinal cord. Overall there is moderate spinal stenosis at this level.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.Exam is compromised by patient motion.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. Exam is compromised by patient motion.

Output: 1.There are degenerative changes present in the cervical spine with severe spinal stenosis at C3-4 and moderate spinal stenosis at C4-5. There is associated cord signal change at C3-4 and flattening the spinal cord.2.Exam is compromised by patient motion. This may obscure more subtle abnormalities.


Instruction: Generate impression based on medical findings.

Input: 17 year old man with dilated cardiomyopathy with LGE on previous CMR referred for evaluation of interval change. Left VentricleThe left ventricle is normal in size with moderately reduced systolic function. The overall LV ejection fraction is 38%, the LV end diastolic volume index is 99 ml/m2 (normal range: 74+/-15), the LVEDV is 177 ml (normal range 142+/-34), the LV end systolic volume index is 61 ml/m2 (normal range 25+/-9), the LVESV is 109 ml (normal range 47+/-19), the LV mass index is 53 g/m2 (normal range 85+/-15), and the LV mass is 95 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is epicardial late gadolinium enhancement involving the basal to mid anterior, anterolateral, inferolateral, and inferior walls. The finding is atypical for prior myocardial infarction and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 47%, the RV end diastolic volume index is 70 ml/m2 (normal range 82+/-16), the RVEDV is 125 ml (normal range 142+/-31), the RV end systolic volume index is 37 ml/m2 (normal range 31+/-9), and the RVESV is 68 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is a small circumferential pericardial effusion.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal LV size with moderately reduced systolic function (LVEF 38%) with extensive late gadolinium enhancement as described above. There is no late gadolinium enhancement on the apical half of the interventricular septum, reducing the diagnostic yield of right ventricular endomyocardial biopsy.2. Normal RV size with mildly reduced systolic function (RVEF 47%).3. When compared to prior cardiac MRI, the LVEF is a little better but there is no significant change in the burden of late gadolinium enhancement.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: H/o right frontal meningioma and posterior fossa medulloblastoma. S/p resections. Examination demonstrates postoperative changes status post right frontal craniotomy, including right frontal pneumocephalus, edema and small amount of blood products and extra-axial fluid collection.Imaging through posterior fossa shows postoperative changes status post suboccipital craniotomy and craniectomy. There is a hyperdense mass in the left cerebellum and adjacent meningeal calcification, which is consistent with the finding on the previous MRI. The previously identified lesion in the left cerebellar peduncle is not visualized because of lack of contrast. There is hypoattenuation bilaterally in the periventricular white matter, which likely represents post radiation change. There is no mass effect or midline shift. The ventricles are normal in size and symmetric.The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Postoperative changes status post right frontal craniotomy, including right frontal pneumocephalus, edema and small amount of blood products and extra-axial fluid collection.2. Left cerebellar mass. Postoperative changes status post suboccipital craniotomy and craniectomy.3. Postradiation change in the periventricular white matter.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o osteo History: back, hip, buttocks pain with h/o bowel leak There is a focus of enhancing signal abnormality in the presacral space corresponding to the findings of a fluid collection seen on prior CT examination, measuring approximately 3.1 x 3.5 cm. There are foci of signal void internally which may reflect gas density. These findings are suspicious for phlegmon/early abscess formation in the correct clinical context, although no encapsulated/drainable collection is identified. Note is made of increased signal abnormality with enhancement within the anterior aspect of all of the 5 sacral segments as well as the 3 coccygeal segments suspicious for osteomyelitis. No definite cortical destruction is identified. The remainder of the bones of the pelvis are unremarkable. The imaged musculature of the pelvis is unremarkable. There is marked distention of the bladder.

Output: Findings suspicious for osteomyelitis of the sacrum and coccyx as described above. Enhancing focus of signal abnormality in the presacral space likely represents phlegmon/early abscess formation. Marked distention of the urinary bladder.


Instruction: Generate impression based on medical findings.

Input: Status post fall with subdural hematoma. Evaluate presence of subdural hematoma. Nonenhanced head CT:Examination again demonstrates a thin acute subdural hematoma in the left posterior parietal region. Compared to prior exam there is evidence of reduction in density and size of these subdural. In the current exam the thickest portion of subdural measures approximately 4.7 mm compared to prior measurements of 5.8-mm.Small amount of acute subdural blood is also present along the posterior aspect of falx on the left in the occipital region. This finding was present on prior study and is believed to represent continuation of left parietal subdural as was noted on prior MRI exam. There is no evidence of new hemorrhage. A minute amount of blood in the dependent portion of occipital horn is again identified.Prominence of lateral ventricles is similar to prior study. Area of vasogenic edema in the right posterior frontal is again identified and unchanged.The left posterior temporal cortical stroke is again identified.

Output: 1.No evidence of new hemorrhage since prior exam.2.Smaller size of left parietal subdural. No significant change in the left parafalcine component of subdural.3.Stable right frontal -- parietal vasogenic edema.4.Left posterior temporal lobe cortical stroke.5.Stable prominent size of the lateral ventricles.


Instruction: Generate impression based on medical findings.

Input: Left knee pain MENISCI: The lateral meniscus is normal. Examination of the medial meniscus reveals a subtle vertical tear of the posterior horn.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Vertical tear the posterior horn of the medial meniscus. Popliteal cyst.


Instruction: Generate impression based on medical findings.

Input: 73-year-old male with rectal polyp near anal verge, new rectal adenocarcinoma Overall image quality: GoodPELVIS:PROSTATE/SEMINAL VESICLES: Nonspecific T2 hypointense focus in the right apical peripheral zone. BLADDER: No significant abnormality noted. LYMPH NODES: Lymph nodes in the perirectal space, within the mesorectal fascia: None.Lymph nodes outside the mesorectal fascia: None. BOWEL, MESENTERY: Rectal Tumor: A lesion is not clearly visualized although a crescentic region of asymmetric enhancement is noted at the level of the puborectalis muscle. Size: 1.6 x 0.7 cm (image 15/series 63)Tumor appearance on T2-weighted images: Not clearly visualized although the region measured above demonstrates enhancement at the level of the puborectalis muscle. Tumor location: Right rectal/anal wall. (For lower rectal tumors):Distance of the lower edge of the tumor to the anal verge (lower edge of the anal canal): 0Distance of the lower edge of the tumor to the pelvic floor (relationship of the tumor to the anal sphincter complex): extends up to the level of the sphincterCircumference of the rectum involved: 180Relationship and proximity of the tumor to adjacent structures (prostate, seminal vesicles): None.MRI T-stage: likely T2Tumor Distance to Mesorectal Fascia: Not applicable as this lesion is low and extends to the level of the puborectalis muscles. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.A rectal lesion is not clearly visualized. A crescentic region of enhancement is noted in the anus at the level of the puborectalis muscle that may represent the lesion in question2.Nonspecific T2 hypointense lesion in the right apical peripheral zone. Correlation with PSA is recommended.


Instruction: Generate impression based on medical findings.

Input: 40 year old with history of left modified radical mastectomy in January 2015 for left breast IDC with DCIS and metastatic left axillary lymph node, presents for MRI study. Status post left mastectomy.There is extreme amount of fibroglandular tissue in the right breast.Minimal parenchymal enhancement is noted in the right breast.No abnormal enhancement is seen in right breast or in the left mastectomy bed. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on medical findings.

Input: There are postsurgical findings from multiple osteotomies of the bilateral frontal bones. The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.

Output: 1.No findings to account for patient's headaches.2.Postsurgical findings from multiple osteotomies of the bilateral frontal bones.


Instruction: Generate impression based on medical findings.

Input: Back pain with pain radiating into her right leg; dragging right leg Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.Individual levels, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis.L5-S1: Minimal disc bulge. Otherwise, no significant disc disease. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits. Small perineural cyst along the left S2 nerve root incidentally noted.

Output: Examination is essentially unremarkable. Specifically no significant spinal canal or neural foraminal stenosis in the lumbar spine at any level to explain patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: A 13 year old female with a history of valve-sparing repair of Tetralogy of Fallot and closure of VSD. Operative notes from repair aged 10 months obtained, showing bovine monocuspid valve was positioned in the pulmonic position and a second patch to the entire main pulmonary artery, extended across the area of the annulus into the infundibulum. A small PFO was left intact. A Congenital Cardiac MRI performed on 7/8/2013 showed normal LV size and systolic function, severely dilated RV with normal systolic function, at least mild-moderate pulmonic regurgitation. Findings consistent with status post Tetralogy of Fallot repair.  Normal cardiac situs.  Normal Qp:Qs (1.27 according).Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 86 ml/m2 (normal range: 65+/-11), the LVEDV is 114 ml (normal range 109+/-23), the LV end systolic volume index is 39 ml/m2 (normal range 18+/-5), the LVESV is 51 ml (normal range 31+/-10). There is diastolic septal flattening. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. No interventricular septal defect was seen.No intracavitary thrombus was seen.Right VentricleThe right ventricle is severely dilated with normal systolic function. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 130 ml/m2 (normal range 69+/-14), the RVEDV is 171 ml (normal range 110+/-24), the RV end systolic volume index is 60 ml/m2 (normal range 22+/-8), and the RVESV is 79 ml (normal range 35+/-13). AtriaThe left atrium is normal in size. The right atrium is severely dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is at least moderate pulmonic regurgitation (regurgitant fraction 37%). No pulmonic stenosis. The subpulmonic cuff measures 13 mm diameter on dedicated 3D reconstruction views. Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root, ascending aorta, aortic arch and descending aorta are normal in size. No coarctation was seen.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryOn dedicated 3D reconstruction views, the main pulmonary artery is mildly small in calibre measuring 16 mm compared to 12 mm in the sagittal plane on previous study; differences in measurement technique likely explain the differences in quantitative size. There are postsurgical changes in the pulmonic trunk, a patch is positioned in the pulmonic position and a second patch to the entire main pulmonary artery, extended across the area of the annulus into the infundibulum.The right pulmonary artery has a diameter of 15mm. The left pulmonary artery has a diameter of 13mm.Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsIncidental note made of aberrant right subclavian artery. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: Compared to previous cardiac MRI from 2013, no significant changes were noted:1. Changes consistent with status post repair of Tetralogy of Fallot. 2. LV size and systolic function are normal, LVEF 55%. Previously, quantitative LVEF was calculated at 67%. Qualitatively, there is no difference in left ventricular ejection fraction implying that quantitative differences are due to different measurement technique.3. RV is severely dilated with normal systolic function, RVEF 54%. 4. There is at least moderate pulmonic regurgitation, with 37% regurgitation fraction.5. Aberrant right subclavian artery, a known aortic branch variant.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Reason: known large sacral decubitus ulcer, arrived with fever and AMS, r/o OM History: see above There is soft tissue irregularity along the posterior aspect of the coccyx consistent with the stated history of ulceration. The ulceration extends anteriorly to the level of the coccyx. There is increased signal abnormality within the coccyx on fluid sensitive sequences without decrease signal abnormality on T1-weighted images. These findings are most consistent with a reactive osteitis. There is no convincing evidence of osteomyelitis. The remainder of the bone marrow signal is within normal limits. There are foci of signal void within the subcutaneous tissue along the left gluteal crease and left perianal region suspicious for subcutaneous gas density/sinus tract formation. There is apparent extension of increased signal abnormality/inflammation from the level of the ulceration into the presacral space and left perianal area. There is diffuse subcutaneous edema about the pelvis most pronounced posteriorly, which is nonspecific. Some of this edema becomes more confluent, posteriorly, however, there is no encapsulated fluid collection to suggest abscess formation. No enhancing mass lesions are identified. There is increased signal abnormality within the gluteal musculature bilaterally and adductor musculature which is nonspecific, but may represent a myositis. There is a small amount of fluid within both hips, left greater than right, without evidence of a large effusion. There is a small amount of fluid in the right peritrochanteric region which may represent trochanteric bursitis. There is a Foley catheter in place.

Output: 1. Soft tissue ulceration with extension anteriorly to involve the perianal and presacral space with associated inflammatory changes. 2. Reactive osteitis of the coccyx. No convincing evidence of osteomyelitis.3. Findings indicating a right trochanteric bursitis.4. Nonspecific inflammatory change within the subcutaneous tissue and gluteal musculature as described above. Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Left knee pain and swelling. Evaluate for meniscus tear versus a loose body. MENISCI: There is a bucket handle tear of the medial meniscus with the displaced fragment along the medial tibial spine.Again seen is attenuation and irregularity of the free edge of the posterior horn of the lateral meniscus that likely represents a combination of prior surgery and chronic tearing. There is also a partial thickness radial tear of the body of the lateral meniscus. These findings are similar to those seen on the prior study. ARTICULAR CARTILAGE AND BONE: Again seen is full thickness loss of articular cartilage along the lateral femoral condyle above and anterior to the torn posterior horn of the lateral meniscus appearing similar to that seen on the prior study with mild signal abnormality in the underlying subchondral bone. Also again seen is a depression of the articular surface of the lateral femoral condyle just above the anterior horn of the lateral meniscus compatible with an old impaction fracture with focal loss of overlying cartilage. Articular cartilage of the medial and patellofemoral compartments is relatively intact. LIGAMENTS: Again seen are postoperative changes of ACL reconstruction using a bone-patellar-tendon-bone graft. The graft appears slightly thickened but intact. The posterior cruciate ligament is intact. The medial and lateral collateral ligamentous complexes are intact.EXTENSOR MECHANISM: There is mild thickening of the proximal patellar tendon and mild edema within the inferior pole of the patella appearing similar to the prior study. ADDITIONAL

Output: 1.New bucket handle tear of the medial meniscus 2.Additional findings as described above appear similar to the prior study.


Instruction: Generate impression based on medical findings.

Input: 71 years Male (DOB:11/24/1944)Reason: 71 y/o male with worsening pain History: neck painPROVIDER/ATTENDING NAME: SERVICES ANCILLARY SERVICES ANCILLARY The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is hypertrophy of the posterior longitudinal ligament predominantly along the upper cervical spine extending from C2 down to C4.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is loss of disc space height, disc desiccation, diffuse disc bulge as well as some endplate uncovertebral osteophytes and some hypertrophy of posterior longitudinal ligament. There is also some hypertrophy of the ligamentum flavum at this level. There is narrowing of the spinal canal and some atrophy of the spinal cord associated with signal change at this level. There is only mild narrowing of the right neural foramen at this level. There is moderate encroachment of the left-sided exiting nerve roots at this level.At C4-5 there is no significant compromise to the spinal canal. There is some disc desiccation and some hypertrophy of the posterior longitudinal ligament. There is a disc bulge at this level with narrowing of the neural foramina bilaterally. There are some encroachment of the left-sided exiting nerve roots within the neural foramen.At C5-6 there is no significant compromise to the spinal canal . There is some loss of disc space height, desiccation and uncovertebral osteophyte formation at this level as well as a disc bulge and narrowing of the neural foramina bilaterally with encroachment of the exiting nerve roots.At C6-7 there is loss of disc space height, disc desiccation as well as endplate uncovertebral osteophyte formation and narrowing of the neural foramina bilaterally but worse on the left side compared to the right. There is hypertrophy of the ligamentum flavum at this level and partial effacement of spinal fluid ventral and posterior the spinal cord. Overall there is a moderate degree of spinal stenosis at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There are multilevel degenerative changes present in the cervical spine without moderate spinal stenosis at C6-7 as a result of degenerative changes and an neural foramina encroachment of exiting nerve roots predominantly on the left-sided C6-7, C4-5 and C3-4 and bilaterally at C5-6.2.There are some spinal cord myelomalacia present at the C3-4 level where there is narrowing of the spinal canal and spinal stenosis.3.There is hypertrophy of the posterior longitudinal ligament predominantly along the upper cervical spine. This contributes to narrowing of the spinal canal especially at the C3-4 level.


Instruction: Generate impression based on medical findings.

Input: Brain MRI: The presence of braces cause significant artifact anteriorly.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain. Sagittally acquired CSF flow demonstrates normal biphasic both anteriorly and posteriorly, maintained at the level of the foramen magnum and cerebellar tonsils.Complete spine MRI:Subtle enhancement is noted along the anterior surface of the distal conus involving the adjacent anterior nerve roots with questionable nerve root thickening.Numbering the complete spine beginning at C2 and progressing inferiorly demonstrates there is transitional anatomy with lumbarization of S1 resulting in a rudimentary S1/2 disc.There are no osseous dysplasias. There are no fractures or subluxations. The marrow signal is benign. The spinal cord and conus are normal in signal and morphology. The conus terminates at L2. There is no fatty filum. There are no findings of tethered cord. The visualized intra-abdominal and paraspinal contents are unremarkable.Slight reversal cervical curvature accentuates disc bulges within the cervical spine without morphologic abnormality of protrusion.Mild disc bulges are noted at T11/12 and T12/L1 without morphologic abnormality of protrusion.A Schmorl's node is present involving the superior endplate of L1.Abnormality within the spinal CSF spaces is felt to be secondary to CSF flow artifact and not AVM.There are no stenoses throughout the spine.Upon prone positioning, the conus and proximal cauda translate anteriorly.

Output: 1.The presence of braces cause significant artifact anteriorly. Given this caveat, negative MRI of the brain including gadolinium enhancement.2.Subtle enhancement is noted along the anterior surface of the distal conus involving the adjacent anterior nerve roots with questionable nerve root thickening. This is nonspecific and may be secondary to infectious or inflammatory etiologies. Given a negative contrast enhanced study of the remaining neuraxis, neoplastic etiologies are felt to be less likely.3.Abnormality within the spinal CSF spaces is felt to be secondary to CSF flow artifact and not AVM.4.No MRI evidence of Chiari malformation, fatty filum, or tethered cord.5.There are no stenoses throughout the spine.6.Findings were discussed with Dr. Frim on 3/23/2015 approximately 4:45 p.m.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Evaluate for extent of right nasal mass. Signs and symptoms of right nasal mass. CT of maxillofacial region without infusion:Complete opacification of right chamber of sphenoid sinus consistent with sinusitis. There is no associated bony changes.There is extensive opacification of right ethmoid air cells and right nasal cavity. There is possible partial erosion of the lamina papyracea and bony remodeling and elevation of the floor of the orbit and anterior lamina papyracea. No definitive destructive bony lesion is detected. There is no evidence of extension of soft tissues through the moderate floor of the orbit into the retro-orbital space. There is extensive remodeling of the medial wall of the right maxillary sinus but continuity of the soft tissues within the sinus into the right nasal cavity. There is also deviation of nasal septum to the left with thinning however no destruction. The above findings are believed to represent chronic sinus disease with expansion of the right maxillary sinus and right nasal cavity. Excessive soft tissue within the nasal cavity may indicate polyposis. Possibility of malignancy is considered less likely however further studies with an MRI is recommended to exclude this possibility. Patchy areas of mucoperiosteal thickening within the left chamber of the sphenoid sinus and left maxillary sinus is also present. Limited view of the mastoid air cells demonstrate complete opacification bilaterally however the middle ear cavities are well pneumatized. Soft tissue density within the left external auditory canal is believed to represent debris.

Output: 1.Complete opacification of right frontal sinus, right ethmoid sinuses, right nasal cavity and right maxillary sinus with extensive bony remodeling however no bony destruction. Findings are believed to represent long-standing chronic sinus disease with possible nasal polyposis on the right. To exclude the less likely possibility of malignancy and MRI is recommended.2.Chronic sinus disease of the left sided sinuses.


Instruction: Generate impression based on medical findings.

Input: Headache and possible meningitis. MRI obtained to evaluate for parameningeal abscess. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is a mega cisterna magna. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of intracranial abscess.


Instruction: Generate impression based on medical findings.

Input: Dysphonia [R49.0], Reason for Study: ^Reason: neuro History: same Brain MRINo evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The mastoid air cells are clear. Retention cyst is seen on the left maxillary sinus.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate about 5 mm sized right paraophthalmic aneurysm.Otherwise, bilateral MCAs and ACAs appears to be normal., Vertebrobasilar system appears to be normal. No evidence of significant luminal stenosis.Neck MRA3D 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.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. About 5 mm sized right paraophthalmic aneurysm. No other intracranial aneurysm is seen. 3. No evidence of arterial luminal stenosis on both intracranial and extracranial arterial system.


Instruction: Generate impression based on medical findings.

Input: Orbits: The right lacrimal gland is enlarged diffusely, with hyperenhancement. There is increased fluid signal adjacent to the right lacrimal gland, likely related to increased lacrimation. There is mild right posterolateral uveoscleral thickening and enhancement. In addition, there is inferotemporal low T2 and intermediate T1 signal material that appears to be subretinal and measures up to 5 mm in thickness. There is mild mucosal thickening and fluid signal in the anterior ethmoids and nasal cavity. The right extraocular muscles and optic nerve are unremarkable. There is no involvement retro-orbital fat. The left orbit is unremarkable. Brain: There are few scattered foci of subcortical and periventricular white matter, as well as pontine high T2 signal. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The pituitary gland and stalk appear to be unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are grossly unremarkable.

Output: 1.Right lacrimal gland enlargement, mild preseptal inflammation, right uveoscleral thickening, and what may represent an associated right subretinal collection. Differential considerations include IgG4-associated orbital and ocular inflammation, perhaps related to rheumatoid arthritis, sarcoidosis, or other granulomatous or autoimmune disorders and less likely neoplasm or atypical infection.2.Scattered mild nonspecific cerebral white matter signal abnormality may represent chronic small vessel disease. Otherwise, no evidence of intracranial meningeal disease or tumors.


Instruction: Generate impression based on medical findings.

Input: Ms. Lettiere is a 35-year-old female with a strong family history of breast cancer in her mom, maternal aunt, maternal grandmother, and two maternal cousins. Known BRCA1 mutation carrier. History of left cyst aspiration in 2011. 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.

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


Instruction: Generate impression based on medical findings.

Input: Please note: On the prior exam, the level with the worst degenerative findings was stated to be C4-5, however it is in fact at C3-4. There is mild edema within the C4, C5 and C6 vertebral bodies with mild loss of height as noted before. There is a congenitally narrowed spinal canal with superimposed findings as described below.C2-3: No spinal canal or neural foraminal stenosis.C3-4: Posterior disk osteophyte complex causing persistent focal indentation of the spinal cord without significant change. There is stable focal T2 signal abnormality within the cord, with associated ill-defined long segment T2 signal abnormality within the cord above and below this level and mild expansion of the cord caliber without significant change. However, there is more conspicuous predominantly peripheral enhancement along the spinal cord at this level. There is mild bilateral neural foraminal compromise.C4-5: Posterior disk osteophyte complex causing mild/moderate spinal canal stenosis, and mild bilateral neural foraminal compromise. No significant change in T2 signal abnormality within the cord at this level. No significant enhancement within the cord at this level.C5-6: Posterior disk osteophyte complex causing mild spinal canal stenosis and severe left neural foraminal stenosis. No significant change in T2 signal abnormality within the cord at this level. No significant enhancement within the cord at this level.C6-7: Posterior disk osteophyte complex with no significant spinal canal stenosis, and mild right neural foraminal stenosis. No significant change in T2 signal abnormality within the cord at this level. No significant enhancement within the cord at this level.C7-T1: No spinal canal or neural foraminal stenosis. No significant change in T2 signal abnormality within the cord at this level. No significant enhancement within the cord at this level.

Output: 1.Persistent cervical myelopathy most pronounced at C3-4 level where there is focal impingement of the cord from a posterior disk osteophyte complex. Compared to the prior study, there is more conspicuous peripheral enhancement at this level which does not appear masslike. Differential diagnosis includes reactive changes secondary to chronic spondylotic impingement of the cord, demyelination, non-infections inflammation, and less likely a chronic infection. Neoplasm is felt to be unlikely given the imaging characteristics.2.Persistent degenerative changes in the cervical spine contributing to multilevel cervical spinal canal and neural foraminal stenoses, without significant change.


Instruction: Generate impression based on medical findings.

Input: 52-year-old female with right knee popping/pain for one and a half years with standing. Evaluate right knee for lateral meniscus tear. MENISCI: There is blunting of the free edge of the body of the lateral meniscus corresponding to a small radial tear. There is also increased signal intensity within the peripheral half of the anterior horn of the lateral meniscus indicating intrasubstance degeneration and degenerative tearing with several small adjacent parameniscal cysts. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is thinning of the articular cartilage along the medial facet of the patella indicating moderate degeneration with what appears to be delamination. There is a small cleft of low signal intensity within the articular cartilage of the femoral trochlea, centrally, which likely represents a non fluid filled defect. There is also a focus of low signal intensity within the articular cartilage of the medial facet of the femoral trochlea, more inferiorly, that likely represents an additional focus of degeneration with underlying subchondral cysts. There is heterogeneity of the articular cartilage of the lateral tibial plateau with foci of increased signal intensity suggesting full-thickness cartilage degeneration. There is a focus of low signal intensity along the posterior cortex of the distal femoral metaphysis medially, that may reflect a former cortical desmoid of doubtful clinical significance.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Small radial tear of the body of the lateral meniscus along with degeneration and degenerative tearing of the anterior horn of the lateral meniscus with tiny adjacent parameniscal cysts.2. Cartilage degeneration as described above.


Instruction: Generate impression based on medical findings.

Input: 26-year-old female with AML in remission There is mild edema and enhancement along the myotendinous fibers of the iliopsoas and distal piriformis that is nonspecific, but may represent mild strain or inflammation. No fluid collection is evident. No joint effusion or evidence of synovitis. The remaining musculature is within normal limits. Again seen is increased marrow signal abnormality within the subtrochanteric femur that is predominantly isointense to muscle on T1-weighted sequences and hyperintense to muscle on T2 weighted sequences, which is nonspecific and could reflect the patient's known leukemia or sequelae of its treatment. The region of signal abnormality is slightly smaller on the current study compared with the prior dated 11/15/14. There is also a subcentimeter focus of signal abnormality within the supraacetabular right ilium that was likewise present on the prior study.

Output: 1. Edema and enhancement of the distal iliopsoas and piriformis myotendinous fibers that is nonspecific, but could represent strain or inflammation. We see no fluid collection or abscess.2. Marrow signal abnormality as described above, appearing similar or slightly less extensive than on the prior study.


Instruction: Generate impression based on medical findings.

Input: Left shoulder pain. ROTATOR CUFF: Intermediate signal within the supraspinatus tendon at its insertion is compatible with mild tendinosis. No discrete tears of the supraspinatus tendon are identified. The supraspinatus muscle is unremarkable. The remaining tendons and muscles of the rotator cuff are unremarkable.SUPRASPINATUS OUTLET: The acromioclavicular joint is within normal limits. No abnormal fluid is present within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The cartilage of the glenohumeral joint is grossly intact. The labrum appears intact.BICEPS TENDON: The tendon of the long head of the biceps is intact. ADDITIONAL

Output: Mild supraspinatus tendinosis without discrete rotator cuff tears.


Instruction: Generate impression based on medical findings.

Input: 65-year-old male, sore and thickened. Suspected partial complete left acute Achilles tendon. TENDONS: There is marked thickening of the Achilles tendon, most pronounced approximately 5 cm proximal to its insertion on the calcaneus tuberosity with associated intrasubstance intermediate signal intensity on T1, STIR and T2-weighted images coursing longitudinally along the tendinous fibers most compatible with a longitudinal split tear with internal fluid; there is no transverse component. There is mild edema within the peritendinous region. The remaining tendons of the ankle are intact.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: Oval/round structure within the posterior process of the talus which demonstrates low signal intensity on T1 and right signal on T2-weighted images most compatible with a small cyst. Otherwise no significant abnormalities noted.ADDITIONAL

Output: Findings are most compatible with a longitudinal split tear of the Achilles tendon with internal fluid. There is associated mild peritendinous edema.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Evaluate known metastatic lesions. Signs and symptoms: Headache and nausea/vomiting. Pre-and post-enhanced brain MRI:Examination demonstrate multiple nonhemorrhagic supratentorial and infratentorial metastatic lesions as was seen on prior exam.A large necrotic enhancing metastatic focus with extensive surrounding vasogenic edema is present in the cingulate gyrus of the right mid frontal lobe. It measures 19 x 24-mm thin cuts axial post enhanced images. There is resultant mass effect on the corpus callosum on the adjacent cortical sulci.Second largest supratentorial metastatic enhancing necrotic tumor is in the anterior tip of the right temporal lobe and measuring 21 times 19-mm in size. This finding also demonstrate extensive surrounding vasogenic edema length result of regional mass effect.Third largest supratentorial metastatic lesion is in the right basal ganglia measuring at 15 times 11-mm in transaxial dimension which also demonstrates central necrosis and surrounding vasogenic edema. Multiple additional small scattered metastatic lesions involving the cerebral hemispheres and including lesions at the level of ependymal lining of the ventricle.Mass effect on the right lateral ventricle the resultant significant collapse of the ventricle and deviation of midline to the left of approximately 7.5 mm at the level of the septum pellucidum is noted. The left lateral ventricle remains normal in size.Images through posterior fossa demonstrates a single tiny enhancing metastatic lesion in the inferior right cerebellum in paramedian location measuring approximately 6 mm in transaxial dimensions. No significant mass effect is associated with this finding.There is no evidence of leptomeningeal enhancement and no detectable calvarial abnormal enhancement.Unremarkable images through the orbits and including axial fat sat post enhanced series.The signal intensity of paranasal sinuses and all mastoid air cells and middle ear cavities are within normal.

Output: 1.Multiple varying size necrotic, rim enhancing metastatic lesions in bilateral cerebral hemispheres with resultant approximately 7.5 mm deviation of midline to the left as detailed/measured above. Tiny right inferior cerebellar metastatic focus without appreciable mass effect.2.No detectable abnormal enhancement of the leptomeninges, calvarium, soft tissues of the scalp over the orbits.


Instruction: Generate impression based on medical findings.

Input: Five lumbar type vertebral bodies are presumed to be present. The patient is status post fusion with integrated anterior plate, screw, and intervertebral spacer devices at L3/L4 and L4/L5. Additionally, there is spinous process fixation of L3/L4 and L4/L5. Vertebral body heights are preserved. There is straightening of the lumbar spine. There are no fractures or subluxations. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. There is slight increase T2 signal in the paraspinal muscles and subcutaneous tissues posteriorly, expected in the postoperative setting. The visualized intra-abdominal and paraspinal contents are unremarkable. Vertebral body heights are within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.L1/2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2/3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3/4: Minimal disc bulge. Spinal canal and the neural foramina are patent.L4/5: No significant disc disease. No spinal canal or neural foraminal stenosis.L5/S1:No significant disc disease. No spinal canal or neural foraminal stenosis.Mild multilevel facet arthropathy. The sacroiliac joints demonstrate mild degenerative changes but are otherwise unremarkable.

Output: Postsurgical changes of L3 to L5 fusion without significant spinal canal or neural foraminal stenosis at any level. Hardware integrity may be better assessed with radiography or CT.


Instruction: Generate impression based on medical findings.

Input: 33-year-old female patient with small retrorectal cyst detected on prior exam, patient is asymptomatic. Assess for interval growth. Lack of IV contrast limits evaluation.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is a single septated T2 hyperintense lesion posterior to the rectum and anterior to the coccyx which measures 1.3 x 1.4 cm (image 33, series 10). BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Single septated T2 hyperintense lesion posterior to the rectum presumably represents a cyst within limitations of a non-contrast study.


Instruction: Generate impression based on medical findings.

Input: 38 year old male pre op planning for L cerebellar cavernoma resection. Limited sequences are provided for the purpose of surgical planning. Redemonstrated is a heterogeneous intermediate to high T1 signal and mixed low and high T2 signal lesion centered in the left middle cerebellar peduncle with diffuse central and peripheral susceptibility effect, which measures up to 20 mm. There is surrounding vasogenic edema. There is partial effacement of the fourth ventricle, but the third and lateral ventricles are not particularly enlarged. There is no evidence of acute infarct. There is peripheral enhancement of the left cerebellar peduncle lesion which could represent inflammation or lack of a intact blood brain barrier in this region. There is no midline shift or herniation. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a retention cyst in the left maxillary sinus.

Output: Findings remain suggestive of a recently hemorrhagic left middle cerebellar peduncle cavernous malformation with associated developmental venous anomaly.


Instruction: Generate impression based on medical findings.

Input: Pain lateral left knee. Question of new or recurrent damage to the articular cartilage of the lateral condyle or lateral meniscus. MENISCI: There is slight blunting of the free edge of the posterior horn of the lateral meniscus which may reflect mild inner edge fraying or interval partial meniscectomy. However, we see no findings of an unstable lateral meniscal tear. The medial meniscus appears intact. The root is slightly ill-defined, but this is unchanged from the prior study.ARTICULAR CARTILAGE AND BONE: The articular cartilage of the lateral tibial plateau anterior to the posterior meniscal horn appears slightly thickened on the current study compared to the prior study, likely reflecting results from interval microfracture. There is heterogeneity and increased signal intensity of the articular cartilage in this region which could reflect degeneration but the clinical significance remains uncertain. We see no definite fluid-filled defect of the cartilage. A small subchondral focus of signal abnormality in the lateral tibial plateau is likely related to a combination of microfracture and degeneration. There is progression of thinning of the articular cartilage along the weight-bearing portion of the lateral femoral condyle indicating degeneration although we see no definite fluid-filled full thickness defects. Small foci of signal abnormality in the underlying bone likely represent sequela of microfracture. The medial compartment articular cartilage is normal. There is a full thickness fissure through the articular cartilage of the medial trochlea, which was not present previously.LIGAMENTS: The patient is status post ACL reconstruction. The graft appears intact. The posterior cruciate ligament is intact. The collateral ligaments are intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Findings compatible microfracture of the lateral tibia/femur as described above.2. Minimal blunting of the free edge of the posterior horn of the lateral meniscus may represent mild fraying or interval surgery, but we see no evidence of an unstable tear.3. New full-thickness fissure of the trochlear cartilage as described above.4. Other findings as above.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Rule out cauda equina. Signs and symptoms: Back pain, lumbar pain, urinary incontinence. Non-enhanced total spine MRI:This examination is performed as a work compression protocol and no axial images were acquired. Images through the cervical region on sagittal plane demonstrate normal anatomical alignment and signal intensity of the vertebral column. Degenerative changes results in multilevel mild central spinal stenosis without significant change since prior exam from 2014. There is a small focus of T2 hyperintensity likely representing myelomalacia in the right aspect of cord at C4 -- C5 level without interval change since prior exam from 2014.Images through the thoracic region demonstrate normal signal intensity and alignment the vertebral column. There is mild exaggeration of thoracic kyphosis similar to prior exam.There is normal signal intensity and caliber of the cord and without evidence of any mass effect on the cord.Sagittal images through the lumbosacral spine demonstrate and post operative changes of posterior laminectomy at L3 and L4 levels. There is no evidence of spinal canal compromise at any level and no evidence of mass effect on the cauda equina or conus.

Output: No evidence of cord compression. Revisualization of a small focus of cord T2 hyperintensity likely myelomalacia in the right side of the cord at C4 -- C5 without change since 2014 exam.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Radiculopathy, cervical regionClinical question: evaluate for left sided radiculopathySigns and Symptoms: left upper extremity pain The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is multilevel disc desiccation present.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal. There is right-sided facet hypertrophy present at this level. There are some uncovertebral osteophyte formation at this level associated with some encroachment of the right-sided exiting nerve roots.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is mild bilateral facet hypertrophy at this level.At C5-6 there is no significant compromise to the spinal canal. There is a disc bulge at this level associated with endplate and uncovertebral osteophytes. There is mild ligamentum flavum hypertrophy at this level. There is mild to moderate encroachment of the left-sided exiting nerve roots at this level. There is mild encroachment of the right-sided exiting nerve roots.At C6-7 there is no significant compromise to the spinal canal. There is a disc bulge at this level associated with endplate and uncovertebral osteophytes. There is mild ligamentum flavum hypertrophy at this level. There is mild to moderate encroachment of the left-sided exiting nerve roots at this level. There is mild encroachment of the right-sided exiting nerve roots.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: There are multilevel degenerative changes present in the cervical spine associated with some mild to moderate encroachment of left-sided exiting nerve roots at C6 and C6-7.


Instruction: Generate impression based on medical findings.

Input: 21-month-old female patient with tuberous sclerosis. Evaluate for renal cysts or angiomyolipoma. 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 fat-containing lesions. There are multiple small subcentimeter bilateral cortically based cysts. No pathologically enhancing lesions.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multiple small cortical based cysts bilaterally without evidence of angiomyolipomas.