Instruction: Generate impression based on medical findings.

Input: 61-year-old man with history of testicular seminoma, evaluate for metastatic disease. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mildly prominent right inguinal lymph node is unchanged (series 15, image 41).OTHER: No significant abnormality noted.

Output: No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: 56-year-old female with medial knee pain MENISCI: There is a flap of meniscal tissue flipped anteriorly, situated adjacent to the anterior horn of the medial meniscus, consistent with a displaced tear. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: Mild chondromalacia along the medial patella extending to the median eminence without full thickness cartilage defect visualized. There is also mild thinning of the medial tibial femoral compartment articular cartilage without full thickness defect.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The quadriceps and patella tendons are intact.ADDITIONAL

Output: 1. Medial meniscus tear with meniscal flap displaced anterior to the anterior horn of the medial meniscus.2. Moderate joint effusion and mild chondromalacia as described above.


Instruction: Generate impression based on medical findings.

Input: History of pancreatic cancer, depression with flat affect. Evaluate for metastatic disease. No intracranial mass or mass-effect. No abnormal parenchymal or meningeal enhancement. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. The ventricles are within normal limits in size and configuration. There is evidence of prior small left cerebellar infarct. Several 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 changes. 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 intracranial metastatic disease.2. Minimal global parenchymal volume loss, which appears within normal limits for age.3. Small chronic left cerebellar infarct. 4. Mild chronic small vessel ischemic changes.


Instruction: Generate impression based on medical findings.

Input: 79 years Female (DOB:5/4/1937)Reason: metastatic FT cancer with new prolonged headaches History: headachePROVIDER/ATTENDING NAME: NITA KARNIK LEE NITA KARNIK LEE The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.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 prior exam.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. There is a developmental venous anomaly in the left cerebellar hemisphere.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 2.There is no evidence for brain metastases.3.Examination is limited as a fusion exam.


Instruction: Generate impression based on medical findings.

Input: MRI for preoperative planning of a sphenoid sinus mucocele/fluid filled lesion to sinus near artery with boney erosion. There is a globular T2 hyperintense and T1 hypointense lesion with thin peripheral mucosal enhancement that completely occupies the left sphenoid sinus and measures up to 25 mm. The wall of the left sphenoid sinus are diffusely thinned. The other paranasal sinuses and intracranial structures are unremarkable.

Output: Findings suggestive of left sphenoid sinus mucocele formation.


Instruction: Generate impression based on medical findings.

Input: Brain: There are postoperative findings related to Chiari decompression. There has been interval resolution of the fluid collection overlying the duraplasty. There is persistent mild deformity of the left inferior cerebellum, which contacts the duraplasty material. There is CSF flow across the anterior and posterior portions of the foramen magnum, but persistent focal narrowing of the column of CSF flow through the posterior spinal canal at C2. There is an unchanged T1 hyperintense lesion in the pituitary gland that measures up to 7 mm. The ventricles are unchanged in size and configuration. There is no evidence of acute infarction. Spine: There has also been interval decrease in the caliber of the diffuse cervicothoracic syringohydromyelia, now measuring up to 4 mm in width, previously 7 mm. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis.

Output: 1. Postoperative findings related to Chiari decompression with interval resolution of the fluid collection overlying the duraplasty and interval decrease in the caliber of the diffuse cervicothoracic syringohydromyelia. 2. Persistent mild deformity of the left inferior cerebellum, which contacts the duraplasty material, is suggestive of adhesion formation.3. A subcentimeter lesion in the pituitary gland likely represents a Rathke cleft cyst.


Instruction: Generate impression based on medical findings.

Input: Further assessment of a T11 lytic lesion with possible extension into the spinal canal. Cervical spine: There is reversal of the normal lordosis. The vertebral body height is relatively preserved accounting for the due to spondylosis. The vertebral bone marrow signal is diffusely heterogeneous with loss of the normal fatty signal, but there is no osseous expansion. There is a similar appearance of the clivus and sphenoid body. There is no significant spinal canal stenosis. The spinal cord shows normal signal and morphology.Thoracic spine: The vertebral column alignment is within normal limits. There is mild loss of T2 signal and height at the T4-T5 disc. Otherwise, the disc space heights are preserved. The vertebral bone marrow signal is diffusely heterogeneous, with loss of the normal fatty signal. Similar findings are present in the imaged ribs. There is a more intensely T1-hypointense, T2 hyperintense abnormality replacing the T11 vertebral body/pedicle marrow with mild, predominantly left sided posterior expansion/retropulsion, but no significant spinal canal narrowing. This is also associated with central compression/intravertebral disc herniations along the superior and inferior endplates, but without overall vertebral body height loss. The appearance is unchanged since the CT scan. The other vertebral body heights are preserved. A T1 and T2 hyperintense lesion in T9 vertebral body is probably a hemangioma. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.Lumbar spine: There is minimal anterior subluxation of L4 relative to L5 which is degenerative, without spondylolysis. The alignment is otherwise anatomic. The vertebral body heights are preserved. The marrow is heterogeneous with loss of the normal fatty signal. Similar involvement is present in the included pelvic bones. There is nonspecific mild T1-hypointense, T2 hyperintense signal just posterior to the lumbar vertebral bodies, displacing the epidural fat posteriorly. There is degenerative stenosis of the spinal canal, which is severe at L4-L5 and moderate at L5-S1, superimposed on congenitally narrow spinal canal. The conus medullaris has normal morphology and signal. The tip of the conus medullaris is at mid L1 level. The paravertebral soft tissues are unremarkable.LEVEL-BY-LEVEL

Output: 1.Diffuse marrow infiltrating process with more focal, destructive involvement of the T11 vertebral body and pedicles associated with mild retropulsion, but no spinal cord compression or significant canal narrowing. The appearance is more suggestive of multiple myeloma rather than prostate cancer metastasis, although the assessment is somewhat limited by the lack of intravenous contrast.2.Multilevel cervical and lumbar degenerative spondylosis, including severe spinal canal narrowing at L4-L5.


Instruction: Generate impression based on medical findings.

Input: Right shoulder pain and long thoracic nerve palsy, assess for rotator cuff or labral lesion ROTATOR CUFF: There is tendinopathy of the supraspinatus tendon. Otherwise, the rotator cuff appears normal without evidence of tear.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is an irregularly of the anterior inferior labrum that may represent fraying and/or scarring. There is no communication of contrast between the glenohumeral joint and the subacromial/subdeltoid bursas. We see no tears.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1. Tendinopathy of the supraspinatus tendon.2. Irregularity of the anterior inferior labrum that may represent fraying and/or scarring.


Instruction: Generate impression based on medical findings.

Input: There is no evidence of acute infarct. Numerous bilateral supratentorial enhancing lesions have decreased in both size and degree of enhancement although the latter may be secondary to technical factors. For example, a left frontal parafalcine lesion measures up to 13 mm, previously 15 mm, and demonstrates decreased surrounding edema and unchanged susceptibility effect compatible with blood products. As an additional example, a right frontal parafalcine lesion previously measured 6 mm and is not currently visible. There are no new lesions. 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 mucosal thickening within the maxillary sinuses and minimal fluid within the mastoid air cells. There is a right lens implant.

Output: Improvement of intracranial metastatic disease when compared with the March 5, 2015 MRI.


Instruction: Generate impression based on medical findings.

Input: Disorder of brain, unspecified [G93.9], Reason for Study: ^Reason: eval post fossa mass History: ataxia Brain MRI:There is 40 x 38 x 38mm sized heterogenous signal intensity mass arising posterior superior aspect of the 4th ventricle. The infero- mesial aspect of the right cerebellar hemisphere shows high signal intensity on T2/FLAIR but showing minimal or equivocal enhancement, nor restricted diffusion. Thus, this could represent extension of the original mass which are non-enhancing part (the phenotype of the tumor could be different) or could represent compressed right PICA territory with subacute or chronic ischemic infarction. The mass shows mass effects against 4th ventricle which shows compressed from the posterior aspect and cerebellar tonsils appear to be pushed down through the foramen magnum. Post Gad enhanced images show heterogenous enhancement.Ventricular system appears to be enlarged with periventricular high signal intensities on periventricular white matter indicating interstitial edema in obstructive hydrocephalus.Constellation of above findings indicate possible medulloblastoma and the differential diagnosis include ependymoma.The paranasal sinuses and mastoid air cells are clear.Spine MRI:There is 4th ventricular mass with heterogenous enhancement with mass effects towards cerebellar tonsils creating downward herniation.There is normal thoracic kyphosis and lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The cord signal is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal stenosis, cord compression or myelopathy. The conus medullaris terminates at the level of T12-L1.The intervertebral discs demonstrate normal T2 intensity and height with no evidence of disc herniation. The paraspinal soft tissues and musculature are unremarkable.There is no evidence of abnormal enhancement.

Output: 1. 4th ventricular heterogeneous mass with heterogenous enhancement, possible diagnosis include medulloblastoma and ependymoma.2. Normal spine MRI


Instruction: Generate impression based on medical findings.

Input: 79 years, Female, chronic dysarthria, memory loss. Stroke? No restricted diffusion to suggest acute ischemia. No evidence of acute intracranial hemorrhage. No intracranial mass or mass-effect. There is global parenchymal volume loss which is appropriate for age. Multiple foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild-to-moderate chronic small vessel ischemic disease. There is susceptibility effect along the left lateral ventricle wall which may be related to chronic blood products versus mineralization. No hydrocephalus. No extra-axial collections. Calvarium and extracranial soft tissues are grossly unremarkable.

Output: 1. No evidence of acute infarct.2. Mild to moderate chronic small vessel ischemic disease. No findings to suggest a chronic large vascular distribution infarct.3. Global parenchymal loss, which appears appropriate for patient's advanced age.


Instruction: Generate impression based on medical findings.

Input: 71 years Female (DOB:5/30/1945)Reason: metastatic melanoma History: as abovePROVIDER/ATTENDING NAME: ANNE C CRAMER ANNE C CRAMER Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is an enhancing lesion within the L2 vertebral body and the right half of the L2 vertebra prior exam. There is a T1 hyperintense lesion present within the L3 vertebral body splays some contrast enhancement which could represent an atypical hemangioma but it given the other lesions could also represent hemorrhagic metastatic disease. It is unchanged compared to the prior exam. There is some ill-defined lesion in the right sacral alla associated with marrow replacement and contrast enhancement. There are multiple foci of marrow replacement in the left iliac bone. These were also present in the prior exam.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is moderate bilateral facet hypertrophy present at this level predominantly involving the left facet there is disc desiccation and loss of disc space height as well as a mild disc bulge at this level.At L4-5 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with facet ligamentum flavum hypertrophy and overall a mild to moderate degree of spinal stenosis.At L3-4 there is loss of disc space height and disc desiccation and endplate reactive change associated with moderate facet and ligamentum flavum hypertrophy. Overall there is a mild degree of spinal stenosis at this level. There is a right far lateral disc protrusion at this level. There are Schmorl's nodes at this level.At L2-3 there is loss of disc space height, disc desiccation and diffuse disc bulge. There is mild bilateral facet hypertrophy and ligamentum flavum hypertrophy at this level. There is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There are endplate reactive changes present at T11-T12. No marrow replacing lesions are appreciated within the lumbar spine.There are multiple T2 hyperintense lesions scattered throughout the visualized portion of the liver.There is a cyst present in the left kidney measuring 10 mm in diameter.

Output: 1.Lesions in the lumbar spine, sacrum and iliac bones are suspicious for metastatic disease. These were also present on the prior exam.2.There are multilevel degenerative changes present in the lumbar spine with a mild to moderate degree of spondylostenosis at L4-5 and to a lesser degree L3-4.3.There multiple lesions present within the liver which are suspicious for metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old, with history of lower extremity weakness, evaluated at an outside hospital and given the diagnosis of Devic's disease, with subsequent weakness in the upper extremities as well as upper extremity spasms. Brain:A small cystic space in the white matter adjacent to the right frontal horn is seen with minimal if any surrounding T2 hyperintense signal.No discrete white matter lesions are seen in the brain. No evidence of parenchymal edema or mass effect is seen. The corpus callosum is intact and of normal thickness. No additional abnormal extra-axial collections are seen. The ventricles are within normal limits. Mild prominence of the sulci may reflect a variation of normal or mild parenchymal volume loss.Cervical spine:Images are degraded by motion artifact. Spinal cord T2 signal is inhomogeneous, but given the motion artifact, this cannot be definitively confirmed as true signal abnormality. The left aspect of the spinal cord seems to be slightly thinner than the rest (see image 17 of series 19).Spinal alignment is anatomic. Vertebral body heights are preserved. No worrisome marrow signal replacement seen.C2-3: No significant spinal canal or neuroforaminal stenosis. C3-4: Right facet hypertrophy. Posterior disc-osteophyte complex formation asymmetric towards the right foraminal zone. No significant spinal canal stenosis. Moderate right foraminal narrowing. C4-5: Posterior disc-osteophyte complex formation, asymmetric towards the right. Mild generalized spinal canal stenosis without significant impingement of the cord. Moderate to severe bilateral foraminal narrowing. C5-6: Facet hypertrophy. Posterior disc-osteophyte complex formation. Ligamentum flavum thickening. Mild generalized narrowing of the spinal canal without severe cord impingement. Severe bilateral foraminal narrowing. C6-7: Facet hypertrophy. Mild posterior disc-osteophyte complex formation. No significant spinal canal or foraminal stenosis. C7-T1: Unremarkable. Thoracic spine:Again, there is a mild fluctuation in signal intensity through the thoracic spinal cord, which may be artifactual rather than true signal abnormality. The spinal cord is otherwise unremarkable.Exaggerated thoracic kyphosis in. Spinal alignment is otherwise unremarkable. Vertebral body heights are preserved. No worrisome marrow signal abnormality is seen.Mild degenerative disc disease is evident without spinal canal or neuroforaminal stenosis is suspected.

Output: 1.Small cyst or perivascular space in the right frontal white matter. No white matter lesions are seen which would be consistent with a demyelinating etiology.2.Evaluation of the spinal cord is compromised by the presence of motion artifact. Inhomogeneity of the spinal cord T2 signal may therefore represent artifact versus true signal abnormality. There may be mild thinning of the left aspect of the cervical cord at some levels as discussed above. If these findings are indeed real, it is possible that a chronic underlying demyelinating process could have produced them, though the diagnostic certainty of this study is low.3.Scattered cervical degenerative findings are seen as above with areas of spinal canal narrowing but no high-grade canal stenosis or obvious cord impingement. Scattered foraminal narrowing ranges from moderate to severe.


Instruction: Generate impression based on medical findings.

Input: History of grade II oligodendroglioma status post resection, radiation and chemotherapy, now with progression. This is a limited MRI of the brain for presurgical planning. There are postoperative findings related to right craniotomy with confluent high T2 signal surrounding the resection cavity. In particular, there is interval enlargement of an ovoid T2 hyperintense lesion in the anterior right frontal lobe, which measures 24 x 16 mm, previously 15 x 9 mm. In addition, there is an associated cluster of ring enhancing components. The ventricles are unchanged in size and configuration. There are skin-based fiducial markers.

Output: Pre-treatment planning MRI for an enlarging right frontal lobe lesion.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Muscle weakness (generalized)Clinical question: Hand weaknessSigns and Symptoms: weakness The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. These are predominantly adjacent to the trigones of the lateral ventricles. They're likely of little clinical significanceNormal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mucosal thickening in the right maxillary sinus.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.There are small nodules present within the parotid glands bilaterally which could represent small lymph nodes.

Output: No evidence for intracranial mass lesion to explain the patient's weakness


Instruction: Generate impression based on medical findings.

Input: 6 years, Male, Chiari malformation. Yearly follow-up. The cerebellar tonsils are caudally displaced measuring up to 17 mm below the foramen magnum and demonstrate a peglike configuration. Tonsils terminate just inferior to the C1 posterior arch, previously extending to the mid C2 level. There is retroflexion of the dens which contributes to effacement of the ventral thecal sac. There is overall mild crowding at the foramen magnum, which is improved since prior. Sagittal midline CSF flow sequence demonstrates minimally diminished but otherwise preserved biphasic flow ventrally and dorsally through the foramen magnum, as well as into the fourth ventricle.Brain parenchyma is otherwise unremarkable. No evidence of infarct, hemorrhage, mass, or mass effect. Ventricles are normal in size. No extra-axial collections. Sulcation and myelination are unremarkable. Bone marrow signal and extracranial soft tissues are grossly unremarkable.Evaluation of the cervical spine demonstrates no cord signal abnormality or evidence of syrinx. Vertebral body heights and intervertebral discs are unremarkable. Bone marrow signal is unremarkable. No significant spinal canal or neural foraminal stenosis is seen. Paraspinous soft tissues are unremarkable.

Output: 1. Findings consistent with Chiari I malformation are again seen. Cerebellar tonsillar descent has improved since prior from 1/30/2015 as has the associated crowding at the foramen magnum. There is mild crowding on the current study and minimally diminished biphasic flow of CSF.2. No evidence of syrinx in the cervical cord.


Instruction: Generate impression based on medical findings.

Input: 60 female patient with history right arm numbness two days ago with persistent numbness in right hand. Possible infarct on head CT. There is a focus of restricted diffusion within the left thalamus compatible with acute ischemia. There is no associated susceptibility artifact to suggest hemorrhage. There is otherwise patchy subcortical and periventricular abnormal T2/FLAIR signal abnormality corresponding to chronic small vessel ischemic disease. A focus of encephalomalacia within the right thalamus is compatible with a chronic lacunar infarct. 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. There is mucosal thickening within the floor of the right maxillary sinus. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: 1. Left thalamic acute ischemic infarct.2. Chronic small vessel ischemic disease and chronic right thalamic lacunar infarct.Findings were discussed by the RROC with Dr Lu by telephone at 1800 hrs on 9/11/2016.


Instruction: Generate impression based on medical findings.

Input: BRAIN MRI There is normal left ventricular size with normal patency of all the basal cisterns. There is no evidence of hemorrhage or infarction. There are no mass effect. No abnormal signal is seen in T2 or FLAIR. There are no abnormal enhancements. No midline shift. No extra-axial fluid collection.There are no foci of diffusion restriction. There are no abnormalities seen in the susceptibility images.BRAIN MRAThe brain MRA demonstrates wide neck cavernous aneurysm of the left internal carotid artery measuring 11 x 7 mm axial dimensions which originates from the lateral wall of the horizontal segment of the left cavernous internal carotid artery. The neck of the aneurysm measures 7 mm. The aneurysm is extends laterally to the left cavernous sinus lateral wall. There is no change in the size of the aneurysm since the previous study. The aneurysm drapes around the adjacent left anterior clinoid processNo other aneurysms are appreciated intracranially. There is no evidence for intracranial cerebrovascular arterial stenosis. Note is made that the posterior communicating arteries are small bilaterally. The anterior communicating artery is small to medium sized. The left vertebral artery is larger than the right vertebral artery. Basilar artery is of normal caliber.

Output: 1. 11mm left internal carotid artery cavernous segment wide neck aneurysm with a 7 mm neck. The aneurysm is unchanged in size since the previous study of 6/27/2015.2. No evidence for intracranial mass lesion.


Instruction: Generate impression based on medical findings.

Input: Pain and effusion. Check menisci MENISCI: The lateral meniscus demonstrates mildly diminutive posterior horn with a suspected small anterior defect along with associated blunting of the inner image. The body however appears intact without discrete linear components to suggest an associated tear. The medial meniscus is otherwise intact again free of focal abnormality in both menisci are anchored posteriorly.ARTICULAR CARTILAGE AND BONE: Mild edema like changes in the lung involving the tibial plateau, particularly small contusions. Specifically no discrete linear component to support a definite fracture. Mild diffuse thinning of the cartilage without discrete superimposed focal abnormality, changes are most pronounced underlying the patella and the lateral facet. Scattered associated degenerative changes including small early subchondral cysts.LIGAMENTS: Ligaments are uniformly well visualized and no discrete acute abnormality is noted other than mild increased questionable signal along the ACL, representing a possible mild sprain. Intact fibers are observed throughout. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Questionable mild sprain of the ACL and questionable nonspecific signal abnormality involving the anterior aspect of the posterior horn of the lateral meniscus. These findings are associated with possible minimal contusion involving the lateral tibial plateau and a moderate effusion. Scattered mild to moderate degenerative changes larger with cartilaginous thinning and early degenerative osteoarthritic changes.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Other alteration of consciousnessClinical question: Seizure protocol. 1 mm thin cut, coronal flairSigns and Symptoms: New onset seizure on August 23, 2015. The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a mucous retention cyst in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific.


Instruction: Generate impression based on medical findings.

Input: 59 year old female with family history of breast cancer in mother diagnosed at the age of 49 and maternal cousin diagnosed at the age of 43 and personal history of benign left breast Bilateral silicone implants which appear intact, retropectoral in right and retroglandular in left. There is extreme amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.A metallic artifact from prior benign biopsy is again seen in the left lower outer quadrant.No abnormal enhancement is seen in either breast. No abnormal 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: Female, 30 years old, with headache, concern for viral meningitis. Brain parenchymal morphology is within normal limits. A punctate T2 hyperintense lesion is seen along the right lateral ventricle, and there may be one or two additional scattered punctate nonspecific white matter lesions. No evidence of parenchymal edema or mass effect is seen. No restricted diffusion is detected. There are no findings to suggest intracranial hemorrhage or any abnormal extra-axial fluid collection. The ventricular system is normal in size and morphology. Bone marrow signal characteristics are within normal limits. Mild mucosal inflammation is evident in the frontal sinuses and ethmoid air cells.

Output: 1. No definite acute intracranial abnormality or other specific findings to account for the patient's headaches, though please note that a normal imaging exam does not exclude the possibility of meningitis.2. Mild sinus mucosal inflammation.


Instruction: Generate impression based on medical findings.

Input: Seizures and pituitary lesion. Per EPIC: supratherapeutic dilantin, hyperammonia from VPA; Possible toxic-metabolic component: pending workup; Paraneoplastic panel negative; LP negative for infection. Pituitary: There is an intrinsically T1 hyperintense lesion in the pituitary gland that measures up to 9 mm. The infundibulum is intact. There is no mass effect upon the optic apparatus or cavernous sinuses.Brain: There is diffuse T2 hyperintensity of the hippocampi. The rest of the brain parenchyma appears unremarkable. There is no evidence of intracranial heterotopia, hemorrhage, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is a small probable retention cyst in the adenoids. There is a small hemangioma in the left parietal calvarium.

Output: 1. An intrinsically T1 hyperintense lesion in the pituitary gland that measures up to 9 mm likely represents a Rathke cleft cyst. 2. Diffuse T2 hyperintensity of the hippocampi likely represents vasogenic edema, which can be a result of a toxic-metabolic process, such as hyperammonemia, for example.


Instruction: Generate impression based on medical findings.

Input: There is an unchanged peripherally enhancing lesion measuring up to 25 millimeters centered within the left basal ganglia with suggestion of an eccentric target sign with surrounding edema and resultant mild mass effect upon the left lateral and third ventricles. There are areas of diffusion restriction within both the lesion and the adjacent corona radiata. There is a low relative cerebral blood volume within the lesion, but mildly increased perfusion in the adjacent corona radiata, near prominent perforating lenticulostriate vessels, which therefore likely represents luxury perfusion. There is an unchanged subcentimeter focus of T2 hyperintensity in the left caudate nucleus, which is compatible with a chronic lacunar infarct. There are multiple additional unchanged subcentimeter foci of supratentorial intrinsic T1 hyperintensity and susceptibility effect that correspond to calcifications. There is mild diffuse enhancement and thickening of the dura along the left cerebral convexity that likely represents residual reaction to prior subdural hemorrhage. However, there is no evidence of acute intracranial hemorrhage. There are multiple patchy areas of T2 hypertensity throughout the cerebral white matter predominantly in a subcortical distribution, which have gradually progressed. There is gradually progressive global volume loss. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: 1. A peripherally-enhancing lesion centered in the left basal ganglia that measures up to 25 mm has features most suggestive of toxoplasmosis and less likely lymphoma, perhaps with associated acute ischemia in the adjacent corona radiata due to vasculitis from inflammation or compression intraparenchymal vessels. Further evaluation via Thallium 201 Chloride SPECT may be useful for further characterization, if clinically warranted.2. Gradually progressive global volume loss may represent AIDS dementia.3. Multiple progressive scattered patchy areas of T2 hypertensity in the cerebral white matter may represent sequela of HIV-associated opportunistic infections, such as progressive progressive multifocal leukoencephalopathy or vasculopathy, for instance.4. Multiple unchanged intra-axial and extra-axial calcified lesions likely represent sequela of prior opportunistic infection.


Instruction: Generate impression based on medical findings.

Input: An episode of incontinence in September. Continued left lateral hip pain. For the purpose of numbering, 5 lumbar type vertebrae are present with the last rib being at T12. In addition to straightening, there is lumbar levoscoliosis which can be better assessed with standing radiographs if indicated. The grade 1 anterolisthesis of L3 on L4 is grossly similar to prior with severe loss of disc height at the right aspect of the disc space and contributing to the levoscoliosis. Severe disc height and T2 signal loss at L3-L4 and L4-L5 has not significantly changed. Less severe degenerative disease at L1-L2, L2-L3 and L5-S1 discs is stable to minimally worse as described below. Heterogeneity of the marrow is most pronounced at L3, L4 and L5 vertebral bodies and is most likely degenerative in nature. Small Schmorl's node at the superior endplate of L4 is new since the previous examination. There is no suspicious marrow abnormality. The tip of the conus medullaris is at the mid L2 level, which is unchanged. The conus medullaris shows normal signal and morphology, as well as the included caudal spinal cord. Partially exophytic T1-hypointense, T2-hyperintense lesion arising from the inferior pole of the left kidney is incompletely assessed but was present previously and has not significantly changed in size.T10-T11, T11-T12 and T12-L1 (only in the sagittal plane): There are minimal disc bulges but no significant spinal canal stenosis. There is mild left T11-T12 neural foraminal stenosis.L1-L2: There is a minimal disc bulge associated with a tiny left foraminal protrusion but no significant spinal canal or left foraminal stenosis. There is mild, right more than left, facet arthropathy but no significant foraminal stenosis.L2-L3: Disc bulge is eccentric to the left. There is also ligamenta flava thickening and facet arthropathy. There is no significant spinal canal stenosis. There is no foraminal stenosis.L3-L4: Small disc bulge and disc uncovering related to grade 1 anterolisthesis which combined with advanced bilateral facet arthropathy and ligamentum flavum thickening result in moderate spinal canal stenosis which is stable to minimally worse in the interval. There is also no significant change in moderate to severe right and mild left foraminal stenosis, with possible impingement on the right L3 nerve root.L4-L5: Mild disc bulge and endplate osteophytes. The left greater than right facet arthropathy and the ligamenta flava thickening are not significantly changed. Mild central spinal and left subarticular recess stenoses are unchanged. There is moderate-to-severe left and mild right foraminal stenoses, which are unchanged with possible impingement of the left L4 nerve root. L5-S1: There is a disc bulge associated with a left foraminal and extraforaminal extrusion. Ligamentum flavum thickening and facet arthropathy with mild joint distention again seen. There is resulting in mild spinal canal stenosis. Severe left and mild-to-moderate right foraminal stenoses are also present. There may be impingement of the left L5 nerve root.

Output: Multilevel degenerative changes in the lumbar spine are again seen which are stable to minimally worse in the interval. There is up to moderate spinal canal stenosis at the L3-L4 level. There is also significant neural foraminal stenosis on the right at L3-L4 and on the left at L4-L5 and L5-S1. There may be impingement of the left L4 and L5 nerve roots. Please see details above.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: LumbagoClinical question: rule out diskitis, likely herniated diskSigns and Symptoms: low back pain, elevated esr, crp 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. No abnormal enhancing lesions are appreciated in the lumbar spine. There is multilevel disk dessication present. There is mild fatty replacement along the paraspinous musculature.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is loss of disk space height, disk dessication, diffuse disk bulge and mild to moderate facet hypertrophy. The fat surrounding the nerve root sleeves at the lateral recesses and the fat surrounding the nerve roots within the neural foramina are preserved. There is contrast enhancement and T2 signal hyperintensity along the facet joints at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is a 7mm focus of T2 hyperintensity associated with contrast enhancement at the posterior aspect of the L4 vertebral body at the inferior endplate adjacent to the disk annulus at the midline. There is loss of disk space height, disk dessication, diffuse disk bulge and a minor degree of facet hypertrophy. The fat surrounding the nerve root sleeves at the lateral recesses and the fat surrounding the nerve roots within the neural foramina are preserved.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is loss of disk space height, disk dessication, a minor diffuse disk bulge and mild facet hypertrophy. The fat surrounding the nerve root sleeves at the lateral recesses and the fat surrounding the nerve roots within the neural foramina are preserved.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is loss of disk space height, disk dessication and a minor diffuse disk bulge.At L1-2 there is no significant compromise to spinal canal or neural foramina. There is loss of disk space height, disk dessication and a minor diffuse disk bulge. There is some endplate reactive change present which is bright on T1 and dark of Fat sat imaging suggesting chronic stage.There is a 21x22mm right renal cystic lesion present most likely representing a simple cyst.

Output: 1.There is no evidence that is convincing for diskitis.2.There are multilevel degenerative changes present mostly in the chronic stage but in an acute/subacute stage at L4-5 (L4 endplate)and L5-S1 (facets) without compromise to spinal canal or neural foramina.


Instruction: Generate impression based on medical findings.

Input: 59 year old male with history of thyroid cancer with metastases. Status post resection, brain irradiation, chemotherapy. On clinical trial. CT of the soft tissues of the neck.Images through the skull base including cavernous sinuses are within normal limits.Images through the soft tissues of the neck demonstrate a well demarcated enhancement involving the posterior wall of nasopharynx (axial image 24 through 28). There is no evidence of an increased soft tissue mass with this finding. All of the prior studies where re-examined and demonstrated the same finding with no interval change. The exact etiology of this finding is not clear. Possibility of a tumor would be considered very low considering its stable appearance since 4 -- 28 -- 2008. An MRI may be helpful to precisely determine the etiology of this finding. This finding does not appear as a postsurgical change.An enhancing right posterior triangular lymph nodes on axial image 35 is again identified and no interval change since prior study. This node measures identical to the prior exam and is 10 mm times 11.8-mm in size.A smaller enhancing right posterior triangular lymph nodes is again also identified with no interval change. Enhancement could appearance of a central necrosis immediately medial to the right internal carotid artery is believed to represent a Trumbull was to jugular vein. This finding is also stable since prior exam (axial image 34 through 39).Extensive post therapy changes of the soft tissues of the neck with distortion of anatomy is again identified. No definitive evidence of recurrence of tumor or pathologic adenopathy. Extensive metastatic lesion two bilateral upper lung fields are noted. Please review the dictated report of CT of chest. No osseous metastatic lesion.CT of brain with infusion.Multiple small supra-and infratentorial foci of increased density (cannot be certain whether they represent small calcific post treated metastases or enhancement) are again identified and with no interval change. No evidence of new lesions is identified. No evidence of hemorrhage, edema, midline shift or hydrocephalus.

Output: 1.Stable CT examination of soft tissues of the neck and with no definitive evidence of recurrence of tumor or pathologic adenopathy. Please see above comments.2.Stable findings on CT of brain which may represent post treated metastatic lesions.


Instruction: Generate impression based on medical findings.

Input: Unspecified abnormalities of gait and mobility, evaluate for hemorrhagic lesion. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are scattered punctate foci and confluent areas of abnormal T2 hyperintensity within the periventricular and subcortical white matter and in the pons. There is no abnormal intracranial enhancement. The ventricles and cortical sulci are mildly prominent compatible with mild volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. There is minimal mucosal thickening in the anterior ethmoidal air cells. The skull, and scalp soft tissues are grossly unremarkable. There is a left lens implant.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct.2. Scattered bilateral cerebral and pontine white matter hyperintensity including pons may relate to mild chronic small vessel ischemic disease.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: Coccydynia BONE MARROW: No significant abnormality noted.SOFT TISSUES: No significant abnormality noted. JOINTS: No significant abnormality noted. Specifically, alignment of the lower lumbar spine is anatomic with no evidence of pars defect.ADDITIONAL

Output: Unremarkable MRI of the pelvis.


Instruction: Generate impression based on medical findings.

Input: T2 versus T3 glottic carcinoma. Neck CT:There is a mass at the larynx, involving the left vocal cord, extending superiorly to the false cord with partial infiltration of the left paraglottic fat, and inferiorly to the subglottic region. There is thickening of the anterior commissure and the right true cord, suggesting extension across midline to the right. There is sclerosis of the left arytenoid cartilage, which may be involved. There is minimal soft tissue thickening overlying the left lamina of the thyroid cartilage, which is also thinner compared to the right. Very early extralaryngeal extension therefore cannot be excluded; this can be further evaluated with MRI.There is slightly prominent lymph node at left level 2, measuring approximate 10-mm in short axis. A 11-mm node is seen at level 5B. These nodes may be involved.There is a 6-mm cystic lesion at the left tonsil.There is a 9-mm lytic lesion in the left scapular glenoid. It is well marginated, and is likely benign.Degenerative disease of cervical spine is noted.

Output: 1. Left laryngeal mass, with supraglottic and subglottic involvement, and extension across midline to the right. There is suggestion of involvement of the left arytenoid cartilage and left thyroid cartilage, and very early extralaryngeal extension. These findings can be further confirmed with MRI.2. Well marginated lytic lesion at the left scapular glenoid, likely benign given its imaging appearance.3. Small left tonsillar cyst.4. Borderline adenopathy at the left level IIA, and level 5B.


Instruction: Generate impression based on medical findings.

Input: [26-year-old female patient with left pectoral swelling and pain.] [There is near fluid signal intensity between the left aspect of the manubrium and the superior fibers of the left pectoralis muscle extending over a 2.7 cm distance in the craniocaudal dimension (image 17, series 23) and 2.2 cm in the transverse dimension (image 17, series 5) consistent with tearing of superior left pectoralis muscle origin. There is approximately 1 cm of retraction of the muscle fibers in this region. Furthermore, there is asymmetric thickening, increased signal on T2-weighted images, and enhancement of the left pectoralis muscle in this region and extending laterally consistent with inflammation. There is underlying low T1 signal, increased T2 signal, and enhancement of the manubrium which likely represents reactive osteitis.

Output: [Tearing of the superior left pectoralis muscle at its origin from the manubrium with surrounding inflammation within the muscle and bone. CT can be considered to further evaluate the bony anatomy.Findings communicated via telephone to M. Sandoval at 1131 hrs on 1/6/2016.


Instruction: Generate impression based on medical findings.

Input: 70 year old male with history of prostate cancer, atrial fibrillation, hypertension who presents for cardiac MRI for evaluation of pulmonary vein anatomy prior to possible RF ablation Left VentricleThe left ventricle is normal in size with moderately reduced systolic function. The overall LV ejection fraction is 34%, the LV end diastolic volume index is 94 ml/m2 (normal range: 74+/-15), the LVEDV is 216 ml (normal range 142+/-34), the LV end systolic volume index is 62 ml/m2 (normal range 25+/-9), the LVESV is 143 ml (normal range 47+/-19), the LV mass index is 75 g/m2 (normal range 85+/-15), and the LV mass is 170 g (normal range 164+/-36). There is global diffuse hypokinesis. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 36%, the RV end diastolic volume index is 82 ml/m2 (normal range 82+/-16), the RVEDV is 186 ml (normal range 142+/-31), the RV end systolic volume index is 52 ml/m2 (normal range 31+/-9), and the RVESV is 120 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve opens widely and there is at least mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least 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. The ascending aorta is mildly dilated, measuring 38x39 mm.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium. The ostia of the pulmonary veins were measured and found to be: RUPV = 28 x 22 mmLUPV = 25 x21 mmLLPV = 22 x15 mmRLPV = 20 x 18 mm.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 normal in size with moderately reduced systolic function[LVEF 34%]. No late gadolinium enhancement noted.2. The right ventricle is normal in size with moderately reduced systolic function [RVEF 36%]3. Pulmonary vein anatomy and measurements as above4. Mild ascending aorta dilation5. Moderate right atrial dilationI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Complex febrile seizure. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma, brainstem, and cerebellum appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, mastoid air cells, and scalp soft tissues are grossly unremarkable. There is a small amount of fluid in the right maxillary sinus.

Output: No evidence of potential seizure foci.


Instruction: Generate impression based on medical findings.

Input: 61-year-old female with history of IO placement within the right tibia now with concern for cellulitis and osteomyelitis. There is branching signal abnormality and enhancement within the proximal tibia extending from the tibial plateau into the proximal diaphysis over a craniocaudal distance of approximately 11 cm compatible with osteomyelitis. There is less well-defined signal abnormality which is appreciated within the distal tibia along with small round foci of enhancement which may also represent infection.There is a large knee joint effusion with mild synovial enhancement. Please note that we cannot exclude the possibility of a septic joint. There is a small Baker cyst.There is edema and enhancement of the soft tissues of the upper leg appearing similar to the prior MRI exam. A small fluid collection is present within the subcutaneous fat adjacent to the tibial tuberosity measuring approximately 1.5 x 0.7 cm in the transverse dimension and 2.5 cm craniocaudally which may represent a small abscess. There is also edema within the soft tissues of the distal thigh particularly between the vastus lateralis and biceps femoris.

Output: 1.New signal abnormality within the bone marrow of the tibia compatible with osteomyelitis.2.Soft tissue inflammatory changes as described above including a small abscess along the medial aspect of the tibial tuberosity.Findings discussed with Dr. Davey at 0930 on 1/13/15.


Instruction: Generate impression based on medical findings.

Input: Causes of dysautonomia: syncope, weakness, and gastroparesis. Many of the images are degraded by patient motion. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of acute intracranial hemorrhage, mass, or acute infarct, although the exam is partly limited by patient motion.


Instruction: Generate impression based on medical findings.

Input: Evaluate for metastasis and recurrent tumor. Again seen is a scarlike deformity involving the right lower thorax paraspinous soft tissues similar to prior. No discrete mass is seen to suggest recurrent tumor.No suspicious osseous lesions within the thoracic spine are appreciated. No evidence of epidural tumor. No abnormal signal within the thoracic cord.The vertebral column alignment is within normal limits. The vertebral body heights are preserved. There is a T1 and T2 hyperintensity in the left third and seventh ribs compatible with small hemangiomas. Degenerative changes with mild disc bulges are again seen throughout the thoracic spine. There is mild spinal canal stenosis at T11-T12 related to facet arthropathy and prominent ligamentum flavum thickening. There is mild right and moderate left neural foraminal stenosis at T11-T12. levels. Mild bilateral foraminal narrowing at T9-T10 and T10-T11 also again noted.Moderate degenerative changes in the cervical spine related to multiple disc osteophyte complexes at C3-C4, C4-C5, and C5-C6 with associated moderate cervical spinal canal stenosis suspected on the sagittal counting sequences covering the cervical spine.

Output: 1. Post-surgical changes of thoracic right paraspinous soft tissue tumor excision without evidence of recurrent tumor. No evidence of metastatic disease in the thoracic spine.2. Degenerative in the thoracic spine as above as well as involving the partially imaged cervical spine with up to moderate spinal canal stenosis suspected from C3-C4 to C5-C6.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Follow-up for polyradiculopathy and nerve root enhancement. Signs and symptoms: Neuropathic pain in lower extremities. Pre-and post-enhanced lumbar MRI:Examination redemonstrates uniformly mild thickening of cauda equina without convincing evidence of change since prior exam. There is however noticeable interval decrease enhancement of the cauda equina since prior examination. Trace residual enhancement however is noted.There is normal signal intensity and alignment the vertebral column without any appreciable degenerative changes. There is no evidence of central spinal stenosis or neural foraminal compromise.Unremarkable perispinal soft tissues.

Output: 1.Uniform mild thickening of cauda equina without significant change since prior exam however the enhancement of cauda equina is significantly less conspicuous.2.Unremarkable pre-and post enhanced lumbar MRI otherwise.


Instruction: Generate impression based on medical findings.

Input: Left frontal mass with edema. Rule-out metastatic lesion. A non-infused CT examination of brain from St. Catherine Hospital dated 2 -- 18 -- 08 is submitted for interpretation. Patient's name is confirmed on the images.Large area of vasogenic edema in the left frontal lobe with mass effect on the frontal horn and possible extension of edema into the corpus callosum is noted. Within the area of edema a necrotic appearing tumor in the loculated fashion measuring approximately 32 by 19 mm in transaxial dimension.This is highly suspected of the tumor and can be further evaluated with a dedicated MRI.No hemorrhage or hydrocephalus is detected.

Output: Necrotic left frontal lobe tumor with extensive surrounding vasogenic edema


Instruction: Generate impression based on medical findings.

Input: 85 years Female (DOB: 8/1/1931)Reason: Evaluate for cervical spinal stenosis or neuroforaminal stenosis causing cervical radiculopathy. History: Left upper extremity radicular pain with neck painPROVIDER/ATTENDING NAME: DIONNE J. BLACKMAN DIONNE J. BLACKMAN Cervical spine:There is reversal of the normal cervical curvature centered at C3-4 and C4-5. There is osseous bridging across the C3 and C4 vertebral bodies. To a lesser degree there is some osseous bridging present at C4-5 and C5-6. There appears to be some loss of vertebral body height at C4.At C2-3 there is a diffuse disc bulge associated with thickening of the ligamentum flavum and effacement of spinal fluid ventral and posterior the spinal cord. This appears to have mildly progressed since 5/13/2014. There is associated hypertrophy of the right facet and encroachment of right-sided exiting nerve roots is also present on the prior examAt C3-4 there are large endplate osteophytes present and uncovertebral osteophytes associated with effacement of spinal fluid ventral to the spinal cord but not posterior the spinal cord. There is redemonstration of encroachment of left-sided exiting nerve roots related to endplate osteophytes and uncovertebral osteophytes this level.At C4-5 there is no significant compromise to the spinal canal. There are endplate uncovertebral osteophytes present this level with narrowing of the neural foramina bilaterallyAt C5-6 there is no significant compromise to the spinal canal. There are endplate uncovertebral osteophytes present this level with narrowing of the neural foramina bilaterally but worse on the right side.At C6-7 there is no significant compromise to the spinal canal. There are endplate uncovertebral osteophytes present this level with narrowing of the neural foramina bilaterally. There is some encroachment of the exiting nerve roots at this level. This appears to have been present on the prior exam as wellAt 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 is redemonstration of multilevel degenerative changes in the cervical spine with findings compatible with mild to moderate spinal stenosis at C2-3 as well as neural foraminal encroachment of exiting nerve roots worse at C2-3 and C6-7 bilaterally as well as the left side at C3-4. The C2-3 stenosis appears to have progressed relative to the prior exam.2.There is reversal of the normal cervical curvature in the upper cervical spine with some loss of vertebral body height at C4 and some osseous bridging along some of the upper cervical spine vertebrae.


Instruction: Generate impression based on medical findings.

Input: Transverse myelitis There is signal abnormality on the STIR sequence extending throughout the cervical cord which is less apparent than on remote study from 6/19/2010, when it also demonstrated enhancement. There is also suspected abnormal T2 hyperintensity involving the thoracic cord at the T9-T10 level, without prior thoracic spine MRI available for comparison. Degenerative changes are evident at the L4-L5 level with disc height loss, bulge, and mild bilateral neural foraminal narrowing. Vertebral body heights and alignment are grossly maintained. There is mild diffuse narrowing of the cervical spinal canal. There is no evidence of cord compression or significant spinal canal stenosis in the cervical, thoracic, or lumbar spine.

Output: 1. Please note this examination is limited to sequences per cord compression protocol. There is no evidence of cord compression or high-grade stenosis in the cervical, thoracic, or lumbar spine.2. Extensive signal abnormality throughout the cervical cord appears less prominent than prior cervical spine MRI from 2010, when it also demonstrate enhancement. Abnormal signal in the lower thoracic cord is also suspected. If there is suspicion for recurrence of transverse myelitis, suggest dedicated cervical and thoracic spine MRI with gadolinium.


Instruction: Generate impression based on medical findings.

Input: 81-year-old female with CBD dilation and liver cysts on ultrasound. Rule out malignancy. Exam limitations are related to respiratory motion artifact and the paucity of intra-abdominal fat.ABDOMEN:LIVER, BILIARY TRACT: Few scattered simple hepatic cysts. No suspicious enhancing parenchymal lesions. There is stable tortuosity and mild dilatation of the common bile duct measuring 1.1 cm in diameter, and there is stable mild dilatation of the left intrahepatic bile duct. No obstructing lesion is identified. Elongated gallbladder containing tiny stones.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic duct is mildly dilated at the ampulla. No obstructing lesion is identified.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple left upper pole renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Thoracolumbar scoliosis. Artifact from lower sternotomy wire.OTHER: No significant abnormality noted.

Output: 1.There is stable tortuosity and mild dilatation of the common bile duct measuring 1.1 cm in diameter, and there is stable mild dilatation of the left intrahepatic bile duct. No obstructing lesion is identified. May be due to stricture at the ampulla.2.Few simple hepatic cysts.


Instruction: Generate impression based on medical findings.

Input: 26 year old male status post olecranon osteotomy for osteochondral defect, compare cartilage surface with previous exams. Review of the patient's first mri examinations reveals a subchondral lesion within the distal humerus centrally compatible with a "trochlear osteochondral defect," which has since undergone surgery (bone grafting). The majority of the defect is now filled with signal intensity similar to normal bone marrow with exception of a 5-mm subchondral focus of low signal intensity centrally that appears identical to prior. Irregularity of overlying articular surface with overlying cartilage loss also appears similar to prior. There is a small focus of abnormal signal intensity within the trochlear groove of the olecranon in the approximate location of the trochlear ridge that was not seen on prior examination. This could represent a small degenerative subchondral cyst. There is also mild focal edema-type signal within the medial aspect of the olecranon process and the posterior aspect of the medial humeral condyle with small osteophytes, suggesting a degenerative etiology, which may be associated with overlying focal cartilage loss.No loose bodies in the joint. No joint effusion.Low signal intensity within the posterolateral aspect of the radiocapitellar articulation may represent a prominent radiohumeral plica, which can be associated with "synovial fringe syndrome" in the correct clinical context (posterolateral pain and/or mechanical symptoms).Remainder of the soft tissue structures are normal.

Output: 1.Postoperative changes of distal humeral trochlear osteochondral defect bone grafting, appearing similar to prior.2.New small foci of signal abnormality within the trochlear groove of the olecranon and along the medial aspect of the ulnohumeral articulation, which could be degenerative in etiology.3.Findings suggestive of a prominent radiohumeral plica, which can be associated with "synovial fringe syndrome" in the correct clinical context (posterolateral pain and/or mechanical symptoms).


Instruction: Generate impression based on medical findings.

Input: Reason: eval for osteomyelitis or any other underlying infectious etiology History: left, lateral lower extremity wound x 3 weeks with surrounding cellulitis Bandage material overlies the lateral aspect of the lower leg. There is thickening and enhancement of the underlying skin with small fluid collections along the skin surface, which may represent superficial blister formation. There is diffuse subcutaneous edema with minimal enhancement following gadolinium administration. Additionally, there is edema of the anterior compartment and deep posterior musculature with little if any enhancement, and no discrete fluid collection. No bone marrow signal abnormality is present to indicate osteomyelitis. Osteoarthritis affects the knee. There is a small joint effusion as well as a small Baker's cyst.On the large field-of-view coronal images, there is also diffuse subcutaneous edema and metallic susceptibility artifact related to a right total knee arthroplasty.

Output: Left leg cellulitis without evidence of osteomyelitis.


Instruction: Generate impression based on medical findings.

Input: Reason: Eval autoimmune vs neoplastic lesion. History: abnml brain MRI.. There is a heterogeneous left frontal lesion which exhibits high T2 signal and scattered areas of susceptibility. A small cyst within the lesion is unchanged. T2 abnormality extends across the genu of the corpus callosum and into the left temporal lobe, similar in extent to prior exams. There may be some very mild patchy nonmass-like enhancement within the lesion along with intrinsic T1 hyperintensity, all unchanged. Perfusion imaging shows areas of both elevated and diminished perfusion within the affected parenchyma. A left frontal burr hole is unchanged. 4 mm of left to right shift is unchanged. Mass effect with effacement of the left frontal horn appears similar to the prior exam. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. Bilateral mucous retention cysts/polyps.

Output: Heterogeneous, chronically injured parenchyma in the left frontal lobe is not significantly changed from prior exams.


Instruction: Generate impression based on medical findings.

Input: Reason: Hx of right breast cancer in 2008 (ER+, node+). Left breast cancer that was HER2+, node+ left breast cancer, s/p neoadjuvant therapy and lumpectomy/SLNBx \T\ XRT. Currently on exemestane History: new rib pain, now with vertebral body sclerosis at C4 concerning for metastasis Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is 5 mm anterolisthesis C7 on T1. There is some loss of normal lordosis with mild reversal involving the upper cervical spine. No destructive osseous lesions or abnormal enhancement involving the vertebral bodies to suggest metastatic disease is appreciated. No suspicious enhancement within the spinal canal is definitively appreciated. The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below, advanced at the C7-T1 level:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Disc osteophyte complex and bilateral uncovertebral hypertrophy. There is no significant spinal canal stenosis. There is moderate right worse than left neural foraminal stenosis. C4-5: Bilateral uncovertebral hypertrophy with moderate right and mild left neural foraminal stenosis. No significant spinal canal stenosis.C5-6: Bilateral uncovertebral hypertrophy with mild to moderate bilateral neural foraminal stenosis. No significant spinal canal stenosis.C6-7: Bilateral uncovertebral hypertrophy and small disc osteophyte complex. There is moderate to severe left and mild right neural foraminal stenosis. There is mild to moderate spinal canal stenosis.C7-T1: Advanced degenerative changes with anterolisthesis with disc uncovering and extrusion. There is moderate spinal canal stenosis at this level including mild impression on the cord without cord signal abnormality. Advanced facet arthropathy is noted bilaterally. There is abnormal enhancement surrounding the facet joints, extending into the neural foramen bilaterally, as well as the epidural space, all favored to be on a degenerative basis. There is minimal right and moderate left neural foraminal stenosis.

Output: 1. No convincing evidence of metastatic disease in the cervical spine. No suspicious lesion is seen corresponding to the C4 sclerosis seen on recent cervical radiographs and was most likely on a degenerative basis.2. Advanced degenerative changes at the C7-T1 level with grade 1 to grade 2 anterolisthesis and advanced bilateral facet arthropathy. There is abnormal paraspinous soft tissue enhancement at this level extending into the epidural space which is likely on a degenerative basis. There is moderate spinal canal stenosis at this level with mild impression on the cord, without cord signal abnormality. Additional levels as above.


Instruction: Generate impression based on medical findings.

Input: A 78 year old female with hypertension, atrial fibrillation and suspected hypertrophic cardiomyopathy. Referred to cardiac MRI for further evaluation. 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 58 ml/m2 (normal range: 65+/-11), the LVEDV is 96 ml (normal range 109+/-23), the LV end systolic volume index is 26 ml/m2 (normal range 18+/-5), the LVESV is 43 ml (normal range 31+/-10), the LV mass index is 45 g/m2 (normal range 67+/-11), and the LV mass is 74 g (normal range 114+/-24). There is focal hypertrophy of the basal antero-septum (dimension 13mm) and the remainder of the myocardium has normal wall thickness (~9mm). Based on myocardial tagging, the basal septum has somewhat reduced myocardial deformation. The deformation is normal in the remainder of the myocardium. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.No intracavitary thrombus was seen.No myocardial iron overload was seen.Left AtriumThe left atrium is severely dilated. The LA volume is 220 ml.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 56 ml/m2 (normal range 69+/-14), the RVEDV is 92 ml (normal range 110+/-24), the RV end systolic volume index is 26 ml/m2 (normal range 22+/-8), and the RVESV is 42 ml (normal range 35+/-13). Right AtriumThe 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 at least moderate to severe mitral regurgitation. The anterior mitral leaflet is thickened and somewhat calcified. No systolic anterior motion of the mitral leaflets is noted. Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least moderate to severe 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 mildly dilated (31 x 32mm). 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. Normal left ventricular size and systolic function (LVEF 55%). The basal septum is mildly hypertrophied and has a mild reduction in intramyocardial deformation. The remainder of the myocardium has normal wall thickness and normal deformation. There is no evidence of underlying myocardial fibrosis, inflammation, or infiltration. Strictly speaking, the diagnostic criteria for hypertrophic cardiomyopathy are not met on this study suggesting that the hypertrophy involving the basal septum may be secondary to a sigmoid septum rather than hypertrophic cardiomyopathy. Repeat imaging to assess for change in septal wall thickness may be helpful to differentiate hypertrophic cardiomyopathy from a sigmoid septum. If the diagnosis of hypertrophic cardiomyopathy has been confirmed by other means, then from a cardiac MRI perspective, the absence of late gadolinium enhancement is considered a low risk marker for significant arrhythmia.2. Normal RV size and systolic function (RVEF 54%). 3. Severe biatrial dilation.4. At least moderate to severe mitral and tricuspid valve regurgitation .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: Pineal cyst. There is a cystic pineal gland that measures up to 11 mm. There is no evidence of intracranial hemorrhage or acute infarct. The brain parenchyma appears unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: The cystic pineal gland that measures up to 11 mm.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old, with angiosarcoma of the scalp. A defect of the cutaneous and subcutaneous tissues is seen at the midline forehead compatible with prior surgery. The underlying frontal bone, mainly to the left of midline, demonstrates abnormal marrow replacement which could reflect prior surgery or prior tumor invasion.Beginning at the left edge of the surgical defect, the cutaneous and subcutaneous tissues of the scalp are thickened and edematous. Cutaneous thickening continues posteriorly to the parietal region. Within the parietal scalp, there is a dominant cutaneous nodule measuring 33 x 31 x 12 mm which appears to extend in depth to the level of the galea. Numerous additional small scattered nodules are seen within the subcutaneous tissues between this dominant nodule and the anterior surgical resection bed. All of these lesions demonstrate mild diffusion restriction. Subgaleal fluid or edema is demonstrated along the left frontal scalp, possibly reactive. Apart from findings in the left frontal bone as above, no clear osseous involvement is seen.The cutaneous layer of the right scalp is also thickened but to a lesser degree than that of the left. Within the posterior right frontal scalp, at least two subcentimeter subcutaneous nodules are demonstrated (see image 32 series 501) which also demonstrate mild diffusion restriction.Intracranially, no evidence of parenchymal edema or mass effect is seen. A few scattered small foci of FLAIR hyperintensity are demonstrated within the cerebral hemispheres which are nonspecific as is mild periventricular hyperintensity. No acute intracranial hemorrhage or any abnormal extra axial fluid collection is suspected. The ventricles are normal in size and morphology.

Output: Sequelae of prior tumor resection are demonstrated at the midline forehead. The frontal bone underlying this surgical defect demonstrates marrow replacement which could be postoperative in nature but may also reflect prior or current tumor invasion.Beginning at the surgical defect margin, the left scalp cutaneous layer is diffusely thickened extending posteriorly to the parietal region which may reflect prior treatment change but could also indicate diffuse tumor spread. Within the parietal region, there is a dominant subcutaneous soft tissue nodule which correlates with the hypermetabolic lesion on PET compatible with tumor.Between the resection bed and this dominant parietal nodule, there are numerous scattered smaller subcutaneous nodules which are also suspicious for tumor spread. Within the right posterior frontal scalp, at least two small similar-appearing nodules are demonstrated which are nonspecific, but given the overall imaging context, are suspicious for sites of tumor spread as well.


Instruction: Generate impression based on medical findings.

Input: [17-year-old male patient with open radius fracture treated with ORIF at outside hospital. Pain in distal ulna consistent with infection.] [Evaluation of the distal radius and surrounding soft tissues is limited due to metallic susceptibility artifact from orthopedic fixation of the distal radius.The distal 5 to 6 cm of the ulna is replaced with abnormal signal intensity which is isointense to skeletal muscle on T1-weighted images and hyperintense on T2-weighted images compatible with osteomyelitis, and likely intra-osseous abscess formation. There is heterogeneous enhancement of the distal ulna and surrounding soft tissues following contrast administration with a small rim-enhancing fluid collection anterior to the distal end of the ulna representing a small abscess. Additional mild edema is noted within the distal ulnar diaphysis. Portions of the cortex of the distal ulna appear completely destroyed. The soft tissue inflammatory component along the distal end of the ulna measures approximately 3 cm in greatest transverse dimension. The inflammatory process extends to the sigmoid notch of the distal radius and there is underlying edema within the marrow of the distal radial metaphysis which could represent reactive osteitis or osteomyelitis. There is mild edema within the pronator quadratus, but we see no discrete abscess within the musculature of the forearm and visualized proximal hand. We see no findings to suggest osteomyelitis of the proximal carpal row.

Output: [Osteomyelitis of the distal ulna with surrounding soft tissue inflammatory changes as described above which abuts the sigmoid notch of the distal radius. Edema within the distal radial metaphysis may reflect reactive osteitis or osteomyelitis. On the basis of accompanying outside hospital radiographs, the diagnosis of osteomyelitis of the distal radius is favored.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Rule out cord compression/cauda equina. Signs and symptoms: Bowel incontinence and metastatic breast cancer. Nonenhanced complete spine MRI:Examination demonstrate diffuse patchy foci of marrow signal changes consistent with previously known diffuse osseous metastases disease.There is also evidence of mild compression deformity of T6, T7, T8, T11 and L1 vertebral bodies. There is mild expansion of compressed vertebrae at the one into the spinal canal with resultant complete effacement of the subarachnoid space and flattening and posterior displacement of the cord and central spinal stenosis. There is no evidence of cord signal abnormality.Compared to prior CT examination from February 3rd of 2015 there is no convincing evidence of internal progression of this finding. Very minimal bulge of compressed T6 vertebrae into the spinal canal with mild compromise of the spinal canal is also present. There is also a shallow ventral epidural soft tissue density at the level of compressed T8 vertebrae which is suggestive of small epidural spread of tumor. There is no evidence of any significant spinal canal compromise at these levels. The signal intensity of the cord also remains normal.There is significant exaggeration of thoracic kyphosis secondary to multilevel compression deformity without change since prior chest CT.There is evidence of bilateral pleural effusion which are only partially visualized and measure maximum of 16 mm in thickness on the right.MRI of thoracic spine:Axial T2 weighted images of thoracic and spine were also acquired which demonstrate the small focus of epidural spread of tumor on the left at T5 level without spinal stenosis and shallow ventral epidural spread of tumor at T8 as detailed above.MRI of lumbar spine:Additional axial T2-weighted images of the lumbar spine were also acquired for her assessment of one compression fracture. These images confirm mass effect on the cord and complete effacement of subarachnoid space and spinal stenosis. Compromise of bilateral neural foramina at this level is also detected.

Output: 1.Examination demonstrate diffuse osseous metastatic lesions involving the entire visualized lower cervical, thoracic and lumbosacral spine as detailed.2.Significant compression fracture of L1 with extension into the spinal canal results in mass-effect and posterior displacement of the cord and central spinal stenosis as detailed. The fracture demonstrates no significant change since prior studies.3.There is no detectable signal abnormality of the cord or the conus. 4.Multi-additional levels of mild compression fractures of the thoracic spine without significant compromise of canal or mass effect on the cord. There is however result in significant kyphotic deformity of the thoracic spine.5.Bilateral pleural effusions are detected.


Instruction: Generate impression based on medical findings.

Input: 78-year-old woman with history of cancer of unknown primary and multiple hepatic and splenic lesions. ABDOMEN:LIVER, BILIARY TRACT: A well-defined area of T2 hyperintensity is seen in the left lobe of the liver (series 4, image 20) represents a cyst. A hypoattenuating focus seen in segment 7 of the liver on the prior CT is not well seen on the current examination. A peripheral focus of arterial enhancement in the right lobe of the liver (series 14, image 22) is likely perfusional.The gallbladder is unremarkable.SPLEEN: Innumerable T2 hyperintense lesions are seen in the spleen, the largest of which near the splenic hilum (series 4, image 15) demonstrates progressive nodular enhancement with centripetal filling is and is most likely a hemangioma. The spleen is normal in size.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: A septated cystic lesion in the right mid/upper pole is seen without definite enhancement and measures 27 x 22 mm (series 4, image 22). Multiple, additional subcentimeter cysts are seen in the right kidney. The left kidney appears normal.RETROPERITONEUM, LYMPH NODES: The enhancing paracaval focus seen on the prior CT is unchanged in size and measures 10 x 7 mm (series 4, image 29).BOWEL, MESENTERY: The visualized small bowel and colon appear normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Innumerable splenic lesions, not compatible with sarcoidosis by imaging, largest focus demonstrates characteristics consistent with that of a hemangioma, smaller additional lesions more difficult to characterize due to size but may be followed up with imaging as clinically warranted.2.Bosniak 2F equivalent right renal cyst which may be followed up as clinically warranted.


Instruction: Generate impression based on medical findings.

Input: Low grade astrocytoma of the medulla oblongata status post biopsy and chemotherapy. Brain: There is no significant interval change in size of the infiltrative, non-enhancing T2 hyperintense mass within the medulla, which now measures up to 24 mm, . There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. The ventricles are stable in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unchanged. Cervical spine: There is no signal abnormality in the spinal cord. There is no evidence of tumor within the cervical spine. There is unchanged straightening of the vertebral column in the sagittal plane. The vertebral body heights are preserved. The vertebral bone marrow signa is unremarkable. There is no spinal canal narrowing. The paraspinal soft tissues are unremarkable.

Output: No significant change in size of the low grade astrocytoma involving the the medulla oblongata.


Instruction: Generate impression based on medical findings.

Input: T1N0 acinic cell carcinoma of the left posterior alveolus status post WLE on 4/29/2015 with primary closure. There is no evidence of measurable mass lesions or significant cervical lymphadenopathy, including a left level 2A lymph node that measures up to 10 mm in short axis. There is unchanged mild diffuse prominence of the palatine tonsils, which is nonspecific. The tongue and rest of the upper aerodigestive tract appear to be intact. The thyroid and major salivary glands are unremarkable. The major cervical vessels flow voids are intact. The osseous structures are unchanged. The airways are patent. The imaged intracranial structures are unremarkable. There is residual thymic tissue in the anterior superior mediastinum.

Output: No evidence of measurable mass lesions or significant cervical lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: Left asymmetrical sensorineural hearing loss. The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable. There are secretions in the left sphenoid sinus. There are bilateral lens implants.

Output: No evidence of retrocochlear or inner ear lesions.


Instruction: Generate impression based on medical findings.

Input: The last well formed disk space is referred to as L5-S1. Marrow signal is benign. There is no spondylolisthesis. There is loss of T2 signal in the L5-S1 disk. The conus terminates at L2 and shows normal caliber and signal. There are tiny hepatic T2 hyperintensity foci likely representing cysts.T11-12: No spinal stenosis.T12-L1: Mild disk bulge with no spinal stenosis.L1-2: No disk herniation or spinal stenosis.L2-3: No disk herniation or spinal stenosis. Mild ligamenta flava thickening and facet arthropathy.L3-4: Mild disk bulge, ligamenta flava thickening and facet arthropathy with no spinal stenosis.L4-5: Mild disk bulge, ligamenta flava thickening and facet arthropathy with no spinal canal stenosis and minimal left neural foraminal stenosis.L5-S1: Mild disk bulge, moderate ligament flava thickening and facet arthropathy causing no significant spinal canal stenosis and mild bilateral neural foraminal stenosis. Mild edema in the bilateral L5-S1 pedicles and facets with a small right L5-S1 facet effusion.

Output: Bilateral L5-S1 facet arthrosis with small right facet effusion, and reactive mild edema in the bilateral L5, and S1 pedicles and facets. Mild bilateral L5-S1 neural foraminal stenosis.


Instruction: Generate impression based on medical findings.

Input: Small effusion. Laxity on Lachman. Evaluate ACL. MENISCI: The medial meniscus appears intact. There is mucoid degeneration of the root of the anterior horn of the lateral meniscus that is new when compared with the prior study additional increased signal intensity within the peripheral fibers of the anterior horn of the lateral meniscus extending to the femoral articular surface appears more extensive on the current study on the prior study, and may represent a partial-thickness longitudinal tear in the red zone. There is also undersurface shallow undersurface fraying/tearing of the posterior horn of the lateral meniscus. The body of the body of the lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is edema within the anterior aspect of the lateral femoral condyle and the inferomedial aspect of patella likely representing a recent transient lateral patellar dislocation. There is partial thickness degeneration of the articular cartilage of the patella, particularly along the median eminence, that appears to have progressed when compared with the prior study. The articular cartilage of the femoral trochlea appears relatively intact, but the trochlear groove itself appears shallow suggesting femoral trochlear dysplasia. There is a full-thickness cleft of the articular cartilage of the weightbearing surface of the lateral tibial plateau that appears similar to that seen on the prior study accounting for technical differences. The underlying marrow edema seen on the prior study has resolved. There is additional degeneration of the articular cartilage of the lateral tibial plateau beneath the posterior horn of the lateral meniscus. The articular cartilage of the medial compartment appears relatively intact.LIGAMENTS: The anterior cruciate ligament is intact. The posterior cruciate ligament is intact. The medial collateral ligament is intact, as is the lateral collateral ligament complex. There is edema along the medial retinacular structures including the medial patellofemoral ligament, the femoral attachment of which is poorly defined suggesting a tear. The patellar attachment of the medial retinacular structures is also poorly defined which may reflect additional tearing. The lateral retinacular structures appear normal. EXTENSOR MECHANISM: The quadriceps and patellar tendons appear normal. The tibial tuberosity to trochlear groove distances within normal limits. Insall-Salvati ratio is within normal limits.ADDITIONAL

Output: 1.Normal-appearing anterior cruciate ligament.2.Small to moderate-sized joint effusion.3.Imaging findings of recent transient patellar dislocation with injury to the medial supporting structures of the patella as described above.4.Progression of cartilage abnormalities as described above.5.Lateral meniscal degeneration/tearing as described above.


Instruction: Generate impression based on medical findings.

Input: Previously seen patchy areas of abnormal T2/STIR hyperintensity throughout the cervical cord are similar except for interval left lateral involvement at the C2-C3 level. Previously, areas of abnormal signal were often associated with mild cord expansion. This is resolved, with minimal if any areas of slight decreased cord volume. Additional patchy abnormal signal extends into the medulla, where previous discrete oval lesions were identified.The cervical spine is in normal alignment, with mild reversal of the normal cervical lordosis centered at C4-C5. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated.At C4-C5 and C5-C6, there are very shallow left paracentral disc protrusions without stenosis, which appear new since the prior exam.THORACIC SPINE

Output: 1. Patchy abnormal signal throughout the cervical and thoracic cord consistent with known demyelinating disease. Overall, previously expanded areas of cord abnormality and decreased, with scattered mild areas of volume loss suggested. Mild expansion of the cord at the T8 level which may indicate more recent plaque. Left lateral involvement at C2-C3 appears to be new since the prior exam.2. Mild spondylotic changes as detailed above without high-grade stenosis at any level.


Instruction: Generate impression based on medical findings.

Input: CT head 9/10/2015 and 9/10/2013. MRA BRAIN: There is a saccular aneurysm arising from the anterior communicating artery that is inferiorly-directed and measures 9 mm in length, 7 mm in width, and a neck that measures approximately 5 mm in width. There appears to be mild mass-effect upon the prechiasmatic optic nerves. There is no evidence of significant steno-occlusive lesions. The left vertebral artery terminates are the PICA, which is an anatomic variant.MRI BRAIN: There is no evidence of intracranial hemorrhage or acute infarct. There are scattered subcortical and confluent periventricular hyperintensities, which may be nonspecific most likely related to chronic small vessel ischemic changes. The ventricles are unchanged. There is no midline shift or herniation. There are left orbital floor fracture and lamina papyracea blow out fractures associated with enophthalmos. The left maxillary sinus contains mucosal thickening and is smaller in size compared to the right. There is torus palatinus. There is a large lipoma overlying the right occipital scalp, grossly unchanged from previous.

Output: 1. A saccular aneurysm arising from the anterior communicating artery measures up to 9 mm.2. No evidence of acute intracranial hemorrhage or acute infarct.3. Moderate periventricular white matter hyperintensities likely related to chronic small vessel ischemic disease.4. Chronic left orbital floor fracture and lamina papyracea blow out fractures associated with enophthalmos.


Instruction: Generate impression based on medical findings.

Input: Anesthesia of skin [R20.0] / Paresthesia of skin [R20.2], Reason for Study: ^Reason: assess for stroke History: right arm and leg numbness and tingling Brain MRINo evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.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. Normal brain MRA, normal neck MRA


Instruction: Generate impression based on medical findings.

Input: Metastatic breast cancer. There is an enhancing left parietal bone lesion that measures up to 16 mm. There is also sclerotic areas in the posterior calvarium. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is encephalomalacia in the anterior right temporal lobe. There are also a few scattered punctate foci of nonspecific T2 hyperintensity. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable.

Output: 1. Skull metastases but, no evidence of intracranial metastases. 2. Right anterior temporal lobe encephalomalacia.


Instruction: Generate impression based on medical findings.

Input: Images are somewhat limited by patient motion. The cervical spine is in normal alignment, with a normal cervical lordosis. There is minimal disc narrowing at C5-C6. The vertebral body heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. There is no pathological enhancement.There is abnormal T2 hyperintensity within the cord in an ill-defined manner from C5-C6 and C6-C7, with significant deformity of the cord due to degenerative changes as detailed below.At C2-C3, there is no significant disk pathology or stenosis. There is mild uncovertebral hypertrophy.At C3-C4, there is a mild posterior osteophyte disk complex with minimal left uncovertebral hypertrophy. There is minimal left foraminal narrowing and mild central spinal canal stenosis.At C4-C5, there is a mild posterior osteophyte disk complex. There is mild left facet arthropathy with overall moderate left foraminal narrowing with mild-moderate central spinal canal stenosis.At C5-C6, there is a diffuse posterior osteophyte disk complex with superimposed central/right paracentral disc protrusion which deforms the right ventral cord. There is right greater than left uncovertebral hypertrophy protruding to overall moderate central spinal canal stenosis as well as moderate-severe right and moderate left foraminal narrowing. There is also bilateral ligamentum flavum thickening.At C6-C7, there is a diffuse posterior osteophyte disk complex with significant bilateral facet arthropathy and ligamentum flavum thickening. There is moderate-severe right and moderate left foraminal narrowing with significant deformity of the cord and overall moderate-severe central spinal canal stenosis.At C7-T1, there is no significant disk pathology or stenosis.Sagittal images suggest minimal left paracentral/foraminal disc protrusion at T2-T3 and a small left paracentral protrusion at T3-T4.There is prominent retropharyngeal effusion spanning C1-C2 level down to at least the lower T2 level. This measures up to 10 mm in greatest thickness.

Output: 1.Prominent retropharyngeal effusion of uncertain etiology spanning C1-C2 to at least lower T2, not present on prior comparison CT. Please correlate clinically.2.Moderate cervical spondylotic changes worst at C5-C6 and C6-C7, where there is up to moderate as well as moderate-severe central spinal canal stenosis as well as abnormal cord signal with deformity likely relating to chronic compression and myelomalacia. Also moderate-severe right foraminal narrowing at these levels.