Instruction: Generate impression based on medical findings.

Input: 28 year old man with atrial fibrillation, referred for cardiac MRI to evaluate for other underlying structural heart disease, fibrosis. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 60%, the LV end diastolic volume index is 100 ml/m2 (normal range: 74+/-15), the LVEDV is 200 ml (normal range 142+/-34), the LV end systolic volume index is 40 ml/m2 (normal range 25+/-9), the LVESV is 80 ml (normal range 47+/-19), the LV mass index is 39 g/m2 (normal range 85+/-15), and the LV mass is 77 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.No intracardiac thrombus.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 53%, the RV end diastolic volume index is 102 ml/m2 (normal range 82+/-16), the RVEDV is 202 ml (normal range 142+/-31), the RV end systolic volume index is 48 ml/m2 (normal range 31+/-9), and the RVESV is 95 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace 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. The right superior and inferior pulmonary veins demonstrate immediate branches anatomy. 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 pericardial effusion.

Output: 1. The left ventricle is normal in size and systolic function. The overall LV ejection fraction is 60%.2. The right ventricle is normal in size and systolic function. The overall RV ejection fraction is 53%3. All four pulmonary veins drain normally into the left atrium. The right superior and inferior pulmonary veins demonstrate immediate branching anatomy, within 1 cm of the ostia. 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: 69-year-old male with hypertension, diabetes, and esophageal carcinoma, transhiatal esophagectomy Pulmonary Artery: Technically good study. No pulmonary embolism noted to the subsegmental level.MEDIASTINUM AND HILA: There has been interval subxiphoid pericardial drain placement. The drain traverses the distal transverse colon and enters the pericardial sac from a trans-diaphragmatic location (image 32/99). There is a moderately sized pericardial effusion of water density at this time. The right atrium is dilated, a mid LAD stent is present.Again noted are findings compatible with a gastric pull-up containing fluid, air and debris. There is no enteric contrast leak into the mediastinum. Calcified right hilar and mediastinal lymph nodes consistent with prior granulomatous infection.LUNGS AND PLEURA: There is a loculated left pleural effusion with peripheral pleural enhancement and associated internal adhesions suggestive of inflammation. Small associated loculated component within the major fissure on the left. Associated left lower lobe atelectasis. Trace right pleural effusion.Stable biapical pleural scarring with calcification. A reference right-sided, pleural-based nodule has decreased in size measuring 5 x 5 millimeters (22/111). A pulmonary micronodule in the left apical posterior segment is stable.CHEST WALL: No suspicious osseous lesions.UPPER ABDOMEN: An ill-defined area of hypodensity within segment two of the liver (91/111) is present. This is not a dedicated evaluation of the hepatic parenchyma. A metastasis cannot be excluded. Therefore, either a triphasic CT or dedicated hepatic MRI recommended. Multiple bilateral renal cysts.

Output: 1. Interval placement of subxiphoid pericardial drain that traverses the distal transverse colon and anterior diaphragm. Findings have been verbally relayed, images have been reviewed with the clinical service at the time of dictation. Moderate pericardial effusion, water density at this time.2. Low-density lesion of segment two hepatic parenchyma raising question of metastasis. Further investigation with either triphasic CT or dedicated hepatic MRI is advised.3. Near complete resolution right pleural effusion. Loculated left pleural effusion with peripheral enhancement and possible internal adhesions.


Instruction: Generate impression based on medical findings.

Input: 2 years Male (DOB:5/2/2014)Reason: assess for structural causes of acute ataxia History: progressive ataxia following febrile illnessPROVIDER/ATTENDING NAME: JAMES H TONSGARD JAMES H TONSGARD The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: MRI of the brain is within normal limits. No intracranial lesions are appreciated which can explain the patient's ataxia on the basis of this exam alone.


Instruction: Generate impression based on medical findings.

Input: 25-year-old male with history of ulcerative colitis, elevated LFTs. Evaluate for PSC. ABDOMEN:LIVER, BILIARY TRACT: No suspicious hepatic lesions. No intra or extra hepatic biliary ductal dilation.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic duct is not well-visualized.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No imaging features of primary sclerosing cholangitis or any other findings to account for the patient's elevated LFTs.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: Left knee pain A large mass with aggressive features is seen arising from the medial femoral condyle and distal tibial metaphysis which extends into the adjacent soft tissues. It measures approximately 8.0 x 6.7 x 10 cm in the greatest transaxial and craniocaudal dimensions. The mass is iso- to hypointense to skeletal muscle on T1WI and slightly hyperintense to skeletal muscle on fat saturated T2 sequences and scattered areas of signal heterogeneity. There is extension of the mass to the weightbearing surface of the medial femoral condyle with irregularity of the subchondral bone plate, possibly representing a pathologic fracture.There is soft tissue edema of the thigh, including the VMO. There is a large joint effusion with both discrete and ill-defined foci of low signal intensity scattered throughout, likely representing a combination of blood products, cartilaginous fragments, and synovitis; however, cannot exclude the possibility of intra-articular seeding of tumor. There is a small Baker's cyst with fluid extending along the popliteal tendon. There is slight displacement of the VMO by the mass; the mass does not appear to extend into the popliteal vessels. A few slightly prominent lymph nodes are noted within the popliteal fossa which are all less than 1 cm.Note that evaluation of the articular cartilage and menisci is degraded by motion artifact and the large field of view provided to completely image the mass. Within these limitations, full-thickness cartilage defects are noted along the medial patellar facet with delamination of the articular cartilage of the femoral trochlea.The ACL, PCL, and LCL are intact. The MCL courses proximally along the medial aspect of the mass but is not seen at its proximal attachment. The extensor mechanism is unremarkable.

Output: Large soft tissue mass with aggressive features arising from the distal femur highly suspicious for primary malignancy such as osteosarcoma. Correlation with conventional radiographs and referral to orthopedic oncology is recommended.Note that at the time of the study, the patient was currently admitted at Jackson Park Hospital (773-947-7500) and transferred for the purposes of routine knee MRI at University of Chicago Medical Center. These findings were discussed with Dr. B. Najeeb (resident for Dr. Syed Ali, the primary attending caring for the patient at Jackson Park Hospital) via telephone at 4:25 pm on the date of the exam. Also note that the order for MRI was initially placed by ancillary services prior to the patient's admission by Dr. Edward Pillar (708-924-8000) who was also made aware of the findings.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old, with obesity, left lower extremity weakness, and incontinence of bowel and urine, also with radicular low back pain. Assess for cord compression. No significant spinal canal stenosis or cord compression is seen in the cervical region.In the thoracic spine, there is prominence of the dorsal epidural fat most notably from T3-4 through T8-9 which results in moderate to severe spinal canal narrowing and perhaps some mass effect on the spinal cord. In addition, there is significant facet arthropathy and ligamentum flavum thickening at T4-5, T5-6 and T6-7. At T4-5, there is questionable abnormal cord signal intensity.Beginning with T5, the endplates of the thoracic vertebral bodies are irregular and most levels show a slight anterior wedging which could reflect Scheuermann's disease.In the lumbar spine, disc degeneration and endplate signal abnormality are seen at L5-S1. In addition, there is a large inferiorly directed L5-S1 disc extrusion which narrows the spinal canal at the S1 level, potentially impinging on transiting nerve roots. Elsewhere, no significant stenosis seen within the lumbar spine.Spinal alignment is relatively anatomic allowing for straightening of the cervical lordosis. Except as discussed in the thoracic region, vertebral body heights are preserved. Scattered degenerative marrow signal change is noted.

Output: 1.Prominence of the dorsal epidural fat is seen in the thoracic spine, most notably from T3-4 through T9. This, along with facet hypertrophy and ligamentum flavum thickening at T4-5, T5-6 and T6-7, contributes to a moderate to severe generalized narrowing of the thoracic spinal canal with perhaps some mass effect on the cord. There is questionable cord signal abnormality at T4-5. Findings could be better assessed with dedicated thoracic spine imaging.2.Disc degeneration is seen at L5-S1, and in particular, there is a large inferiorly directed disc extrusion which significantly narrows the spinal canal at the S1 level potentially impinging on traversing nerve roots. Findings could be better assessed with dedicated lumbar spine imaging.


Instruction: Generate impression based on medical findings.

Input: Pituitary adenoma status post surgery. There are postoperative findings related to left frontal craniotomy for debulking of a sellar and suprasellar mass, which appears to have slightly increased in size in the bilateral cavernous sinuses, with encasement of the bilateral internal carotid arteries. There is persistent mass effect upon the adjacent brain and brainstem and inferior extension into the sphenoid sinuses. There are areas of susceptibility effect within the tumor and along the surgical approach related to prior hemorrhage. There is also confluent high T2 signal in the brain parenchyma surrounding the surgical approach. There is associated ex vacuo dilatation of the left lateral ventricle and mild dilatation of the right lateral ventricle. There is no evidence of acute infarct. There is no residual subgaleal collection.

Output: Postoperative findings related to left frontal craniotomy for debulking of a sellar and suprasellar pituitary adenoma, which appears to have slightly increased in size in the bilateral cavernous sinuses.


Instruction: Generate impression based on medical findings.

Input: The vertebral column alignment is within normal limits without sagittal spondylolisthesis. There is new mild anterior wedging and superior endplate deformity involving the L2 vertebral body. Within the L2 superior endplate, there is a linear band of decreased T1 signal, increased STIR signal compatible with bone marrow edema, and shows Gad enhancement. Constellation of these findings are most compatible with an acute compression fracture. There is no associated retropulsion into the spinal canal. Vertebral body heights are otherwise preserved. A few scattered small Schmorl's nodes and additional mild degenerative endplate changes are present. There are several foci of increased T1 and T2 signal within the lumbar vertebrae, sacral vertebrae, and iliac bones which are favored to represent hemangiomas or focal fat deposition. There is mild loss of disc height at L4-L5. The disks are diffusely desiccated. The spinal cord displays normal signal and morphology. The conus terminates at L1-L2. The paravertebral soft tissues are unremarkable.T12-L1: No significant central canal or foraminal stenosis.L1-L2: Mild disc bulge and facet hypertrophy without significant central canal or foramina stenosis.L2-L3: Mild disc bulge and facet/ligamentum flavum hypertrophy. Mild central canal stenosis. Right greater than left moderate foraminal stenosis.L3-L4: Mild disc bulge and facet/ligamentum hypertrophy. Mild central canal stenosis. Mild left foraminal stenosis.L4-L5: Mild disc bulge and facet/ligamentum flavum hypertrophy. Mild central canal and moderate bilateral foraminal stenosis.L5-S1: Mild disc bulge and facet/ligamentum flavum hypertrophy. No significant central canal or foraminal stenosis.

Output: 1.Findings most compatible with mild acute compression fracture of the L2 vertebral body without retropulsion. No definite source of infection is identified in the lumbar spine. Given history of fevers, recommend evaluation for alternate source of infection. Recommend consultation with the interventional neuroradiology for L2 kyphoplasty for the purpose of back pain reduction. Discussed by Dr. Lee with VERMA, ANSHU at 10:00 a.m. on 9/4/2015. 2.Multilevel degenerative changes as described above including mild central canal stenosis at L2-L3, L3-L4, L4-5 as well as scattered foraminal stenosis.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Slurred speechClinical question: vascular stenosisSigns and Symptoms: slurred speech, r side weakness MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a 9 mm hypointense lesion on T2-weighted imaging with surrounding T2 and FLAIR signal hyperintensity and susceptibility effect which is centered in the left cerebellar hemisphere.There are multiple punctate foci of signal loss on susceptibility weighted imaging present in addition to the above described lesion. The lesion present in the hippocampi. There are multiple punctate foci of signal loss on susceptibility imaging located in the thalami bilaterally peduncle and in the basal ganglia bilaterally. There is a slitlike focus of susceptibility effect involving right basal ganglia. There are punctate foci of signal loss and susceptibility weighted imaging in the subcortical white matter as well involving the temporal lobes and left cingulate gyrus.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 mucosal thickening in the left maxillary sinus associated with a smaller left maxillary sinus compared to the right maxillary sinus. Involution of the maxillary sinus could be related related to silent sinus syndrome. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits demonstrate medial deviation of the left lamina papyracea. This suggests an old medial orbital blowoutMRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is not readily. The left A1 segment is larger than the right A1 segment. There is fetal origin of the posterior cerebral arteries bilaterally. The right vertebral artery is small and effectively ends in the right posterior inferior cerebellar artery. There is extracranial origin of the left posterior inferior cerebellar artery. The vertebral arteries are similar in size.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. The left common carotid artery originates from the innominate artery.

Output: 1.There is a hemorrhagic lesion present in the left cerebellar hemisphere. Underlying etiology is unclear. If clinically appropriate follow-up exam which may include postcontrast imaging may be of benefit to further evaluate this.2.There are multiple microhemorrhages present as detailed above. The pattern is suggestive - but not confirmatory - of microhemorrhages related to hypertension. 3.Findings suggest an old hemorrhage involving the right basal ganglia which is now in the chronic stage.4.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 5.Old left medial blowout fracture and findings suggestive of left silent sinus syndrome.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old, with acute lymphoblastic leukemia, presenting with a right visual field change involving the left eye. Assess for leptomeningeal disease as well as for hemorrhage. Brain:Amorphous abnormal signal is evident within the left globe, primarily situated along the central and temporal margins of the posterior globe with some additional strands which extend anteriorly to the lens. This material demonstrates strong susceptibility artifact highly suggestive of hemorrhage. This blood product may be both subretinal and within the vitreous. As such, detachment of the retina should be suspected. There is mild enhancement of the underlying choroidal layer.No evidence of any significant brain parenchymal signal abnormality is seen. No mass effect or edema is detected. No pathologic parenchymal or leptomeningeal enhancement is seen. The ventricles are normal in size and morphology. No abnormal extra-axial fluid collections are observed.Spine:Spinal cord morphology and signal characteristics are within normal limits. No pathologic intramedullary or leptomeningeal enhancement is seen. Likewise, the nerve roots of cauda equina are of normal caliber and free of pathologic enhancement. No epidural pathology is suspected.Spinal alignment is anatomic. Vertebral body heights are preserved. Bone marrow signal characteristics demonstrate diffuse and mild low signal on the T1-weighted images which likely indicates marrow reconversion related to anemia or chronic disease. No evidence of marrow edema or suspicious marrow replacement is seen.At C5-6, there is mild disc osteophyte formation with a very mild spinal canal stenosis but no significant foraminal narrowing. Small disc protrusions are seen at T2-3 and T12-L1 without significant spinal canal or foraminal stenosis.At L5-S1, there is a small central disc protrusion, without significant spinal canal or neuroforaminal stenosis.

Output: 1.Left intraocular hemorrhage is seen, along the posterior and left temporal margin of the globe, which may be both subretinal and within the vitreous. The choroidal layer underlying the area of hemorrhage is mildly enhancing. The possibility of retinal detachment should be considered. In addition, given the clinical history, the possibility of intraocular leukemic involvement should be considered.2.Otherwise, unremarkable evaluation of the brain. In particular there is no evidence of intracranial leptomeningeal disease.3.Likewise, evaluation of the spine shows no evidence of leptomeningeal disease. Mild degenerative findings are noted as above.


Instruction: Generate impression based on medical findings.

Input: 49 years Female (DOB:7/23/1967)Reason: stenosis? History: L4-L5 spondylolisthesis proximal to L5-S1 PSFPROVIDER/ATTENDING NAME: JAMES M MOK JAMES M MOK Five lumbar type vertebral bodies are presumed to be present. The patient is status post posterior lumbar fusion with pedicle screws and interconnecting rods at L5-S1 1. This creates a significant amount of artifact which obscures visualization of the lumbar spine from L3 down to S1. Within the left half of the L1 vertebral body there is a 21 x 16 mm sagittal dimension well-circumscribed lesion which is high signal on T1 and T2 which most likely represents a vertebral body hemangioma.There are cystic lesions present within the kidneys bilaterallyAt L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: Examination is compromised due to metal artifact. The patient status post lower lumbar spine fusion. There is no spinal stenosis or compromise to the exiting nerve roots at the L2-3 or L1-2 levels.


Instruction: Generate impression based on medical findings.

Input: Mr. Kemph is a 56 yr old male with PSA 4.2 to 5.7 ng/ml with recent 20 core and lesion-guided biopsy without evidence of cancer. PELVIS:PROSTATE:Prostate Size: 4.6 x 5.7 x 3.9 cm.Peripheral Zone: Within the central left aspect of the mid gland (series 601, image 23), there is a focus of decreased T2 and ADC signal measuring 4 x 8 mm which is suspicious for neoplasm.Central Gland: The central zone is hypertrophic with numerous hyperplastic nodules compatible with BPH. Within the central zone, there are 2 discrete well-circumscribed nodules (series 601, images 19 and 17) which demonstrates low T2 and ADC signal which most likely represent benign nodules.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small fat-containing bilateral inguinal hernias are noted.

Output: Central left mid peripheral zone focus of signal abnormality suspicious for neoplasm measuring 4 x 8 mm.


Instruction: Generate impression based on medical findings.

Input: Female; 49 years old. Reason: uterine anomaly seen on ultrasound. Need MRI to determine exact anatomy and if also has renal anomaly. 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: Ventral abdominal wall hernia containing mesenteric fat. Pelvis:UTERUS, ADNEXA: The uterus demonstrates two horns; morphology is borderline between septate and bicornuate uterus but favor bicornuate uterus. No suspicious adnexal lesions. Numerous subcentimeter T2 hyperintense lesions throughout the uterine wall likely represent adenomyosis. Heterogeneous lesion adjacent to the right uterine wall with larger T2 hyperintense cystic areas is suggestive of a focal adenomyoma, but could also represent a degenerated fibroid (series 19, image 11). There is a mildly T2 hyperintense mass located within the endometrial cavity and right uterine horn that demonstrates gray signal on T1 weighted sequences and measures 3.8 x 2.7 cm, best seen on series 19, image 12. This lesion extends to the level of the lower uterine segment and may also extend into the left uterine horn, but does not transgress the myometrium to the serosal surface. BLADDER: No significant abnormality noted.LYMPH NODES: No significant pelvic lymphadenopathy. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.BIcornuate uterus containing soft tissue mass of intermediate signal intensity as described above, which does not appear to extend into the myometrium. Findings are suspicious for endometrial carcinoma.2.Uterine adenomyosis with focal adenomyoma vs degenerated fibroid. 3.No structural renal anomalies identified as clinically questioned.


Instruction: Generate impression based on medical findings.

Input: Female, 8 years old, with history of arachnoid cyst status post cyst fenestration in June 2015. Evaluate for changes. The fenestrated arachnoid cyst located at midline just above the cerebellar vermis shows no significant interval change when compared to the prior examination. There is no mass effect upon the tectum or the vermis, and the cerebral aqueduct remains well visualized and patent.No evidence of significant parenchymal signal abnormality is seen. There are no areas of edema or mass effect. No pathologic parenchymal or extra-axial enhancement is seen. Sequelae of prior suboccipital craniectomy are redemonstrated without significant interval change. The ventricles are normal in size and morphology.

Output: Stable size of the fenestrated arachnoid cyst.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Displacement of lumbar intervertebral disc without myelopathy. Thoracic or lumbosacral neuritis or radiculitis, unspecifiedClinical question: hx lumbar disc herniation. Eval for new abnormality or reherniationSigns and Symptoms: back pain, Left leg pain, left big toe numbness Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is a high T1 signal lesion present within the L4 vertebral body which is a on the right half of the vertebral body and measures 13 x 12 mm sagittal dimensions and most likely represents a vertebral body hemangioma.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is a left lateral disc protrusion present which extends into the left neural foramen and encroaches on the left-sided exiting nerve root. Additionally there is a sequestered fragment present at the left lateral recess behind the L4 vertebral body. This sequestered fragment was not present on the prior exam. The lateral disc protrusion was present on the prior exam and has mildly progressed. There is redemonstration of loss of disc space height and disc desiccation at this level. High signal foci on T2 imaging are present within the disc protrusion.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There are small Schmorl's nodes present at T12-L1 and T11-T12 along the corresponding superior endplates.

Output: Since the prior exam in addition to the left lateral disc protrusion encroaching the exiting nerve roots on the left-side at L4-5 which has progressed, the patient has developed a disc fragment which is at the left lateral recess behind the L4 vertebral body affecting the nerve roots at the left lateral recess.


Instruction: Generate impression based on medical findings.

Input: Paresthesias, urinary frequency, and diplopia. There is linear branching enhancement with associated susceptibility effect and mild T2 hyperintensity in the right pons. There are also punctate foci of patchy enhancement and associated susceptibility effect within the right inferior frontal lobe. The brain parenchyma otherwise appears unremarkable. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild scattered paranasal sinus mucosal thickening.

Output: 1. Linear branching enhancement with associated susceptibility effect and mild T2 hyperintensity in the right pons is compatible with a developmental venous anomaly.2. Punctate foci of patchy enhancement within the right inferior frontal lobe may also represent developmental venous anomalies or telangiectasias.3. No evidence of intracranial demyelinating lesions.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old, with thoracic abscess status post surgical decompression and removal. Evidence of instrumented posterior fusion is again seen at T7-T12. Decompressive laminectomy also has been performed from T8 through T10.Artifact from the fixation instruments does impede the assessment of structures from T7 through T12. Visualization is, however, better than on prior examinations. Again seen is extensive endplate destruction and loss of vertebral body height centered at T9-10. Vertebral body and disc material protrudes into the anterior paraspinal space at this level, particularly on the right. Within the limitations of the artifact, it does appear that spinal canal narrowing and cord compression seen previously at T9-T10 secondary to ventral epidural encroachment has been relieved. Assessment of cord morphology and cord signal through this region is not reliable.Above and below the operative field, no significant vertebral body or spinal canal abnormalities are detected, and the spinal cord is within normal limits. Incidental note is made of numerous renal cystic lesions.

Output: Postoperative findings are seen compatible with instrumented posterior fusion from T7 through T12 as well as decompressive surgery from T8 through T10.Extensive disc space and vertebral body destruction is again seen centered at T9-10 compatible with the history osteomyelitis discitis. Disc and osseous material continues to protrude into the anterior paraspinal space at this level. Within the limitations of artifact, it does appear that the ventral epidural encroachment at T9-10 which previously caused a significant canal stenosis and cord compression has been relieved.


Instruction: Generate impression based on medical findings.

Input: 52 year old female with pain, evaluate rotator cuff ROTATOR CUFF: There is increased signal intensity within the distal supraspinatus tendon at its insertion on the greater tuberosity, consistent with a mild insertional tendinosis. We see no discrete tear. Minimal edema within the myotendinous junction of the supraspinatus centrally may represent a mild strain, but the muscle otherwise appears normal. A small cyst is present within the humeral head with possible mild undersurface fraying of the overlying infraspinatus tendon. The infraspinatus tendon and muscle otherwise appear normal. The teres minor muscle and tendon are within normal limits. The subscapularis tendon and muscle are intact. SUPRASPINATUS OUTLET: There is minimal if any acromioclavicular joint osteoarthritis. Trace fluid is noted within the subacromial-subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. Mild irregularity of the margin of the superior labrum likely represents mild fraying. The anterior labrum is poorly defined at 2 o'clock, which is of uncertain clinical significance and may represent a normal variant. The inferior labrum appears normal. Trace fluid is in the joint without significant effusion.BICEPS TENDON: There is mild increased intrasubstance signal within the tendon of the long head of the biceps at its transition from the rotator interval to the intertubercular groove suggesting mild tendinosis. The tendon is otherwise normal. Fluid within the biceps tendon sheath more likely represents extension of fluid from the joint rather than tenosynovitis.

Output: Mild rotator cuff tendinosis and possible mild supraspinatus muscle strain, but no discrete rotator cuff tear. Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Ms. Dieckow is a 58 year old female with a personal history of right breast lumpectomy in 2006 for breast cancer, treated with radiation and chemotherapy. No current breast complaints. Family history of breast carcinoma in a paternal aunt, paternal great aunt, and paternal great-grandmother. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Stable postsurgical changes are identified in the right breast, compatible with stated history of right breast lumpectomy. Multiple scattered foci of enhancement are seen throughout the left breast, appearing similar when compared to multiple prior examinations. No one focus appears more suspicious than the rest.There is no new abnormal enhancement seen in either breast. No abnormal lymph nodes are identified in either axillary or internal mammary region.

Output: Stable postsurgical changes of the right breast. No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on medical findings.

Input: Evaluate bilateral angiomyolipomas RIGHT KIDNEY: The right kidney measures 8.7 cm in length. There is no evidence of hydronephrosis. There is a echogenic upper pole nodule measuring 1.2 cm in diameter. This is compatible with an angiomyolipoma. The previously described questionable lower pole angiomyolipoma identified on MRI is probably still present but difficult to characterize on ultrasound given body habitus.LEFT KIDNEY: The left kidney measures 9.6 cm in length. Numerous echogenic nodules are noted which are nonspecific but compatible with angiomyolipomas. The largest is exophytic at the lower pole measuring 3.2 x 3.1 x 2.5 cm.BLADDER:: No significant abnormalities noted. Bladder is well-distended and grossly normal in contour

Output: Multiple bilateral echogenic renal nodules which are nonspecific but compatible with angiomyolipomas. These are amenable to embolization if desired clinically.


Instruction: Generate impression based on medical findings.

Input: Thigh mass, endometrial cancer Within the anteromedial soft tissues of the right thigh is an irregular lesion measuring 4.7 x 2.7 x 2 cm in the greatest transaxial and craniocaudal dimension. This lesion demonstrates predominantly low signal on both T1 and fat-suppressed T2 sequences with some areas appearing slightly more cystic in nature. Following contrast administration, there is no significant enhancement. No additional lesions or abnormal enhancement is identified within the right thigh. The marrow signal of the femur is normal. There is mild atrophy of the posterior compartment musculature.

Output: Irregular lesion within the anteromedial soft tissues of the right thigh is nonspecific but given the low signal intensity on both T1 and T2 sequences and the lack of discrete enhancement, the findings may reflect fibrosis or scarring in an area of prior hematoma (per clinical history). However given the patient's history, continued follow-up is recommended.


Instruction: Generate impression based on medical findings.

Input: 54-year-old male with cutaneous T-cell lymphoma. Presents with right eye swelling and purulent drainage. Please evaluate for orbital cellulitis, sinusitis or abscess. Images of the retroseptal space of both orbits remain within normal limits. There is no evidence of any edematous changes of retro-orbital fat. The morphology and density of the globe remains within normal limits bilaterally in both their anterior and posterior chambers. The lens are in normal location.The extraocular musculature and optic nerves remain normal bilaterally.Extensive periorbital preseptal soft tissue thickening anterior to the right orbit is identified. No definitive evidence of any cavity formation or a sinus tract can be identified. The paranasal sinuses are well pneumatized and demonstrate no evidence of acute or chronic sinus disease.Limited images through the brain parenchyma demonstrates large area of low density in the left frontal lobe with no definitive evidence of enhancement. There are no prior CT examination or MRI examination of the brain on this patient's radiology file. This above finding may represent an area of old stroke and encephalomalacia however this should be further evaluated with dedicated CT of brain or an MRI for better evaluation.

Output: 1.Extensive right-sided preseptal periorbital cellulitis. No evidence of abscess formation or a sinus tract2.No evidence of any retroseptal abnormality.3.No evidence of acute or chronic sinusitis..


Instruction: Generate impression based on medical findings.

Input: Left shoulder pain ROTATOR CUFF: No significant abnormality noted.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: Mild age-related degeneration of the superior labrum noted. Otherwise there is no significant abnormality.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: No significant abnormality. Specifically no evidence of full-thickness rotator cuff tear, biceps tendon tear, or greater tuberosity fracture.


Instruction: Generate impression based on medical findings.

Input: 50-year-old female with strong family history of breast cancer presents for MRI breast for screening. There is scattered fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.No significant interval change of the enhancing focus within the right nipple, which was characterized as a papilloma on the prior ultrasound.No additional abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: 1. No MRI evidence for malignancy. 2. Stable enhancing focus in the right nipple likely represents a benign papilloma.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on medical findings.

Input: Reason: History of ischemic stroke. There is a small, focal area of signal abnormality centered within the posterior aspect of the left putamen extending into the adjacent left frontal deep white matter which demonstrates increased T2 signal, mixed T1 signal, increased signal on diffusion-weighted images, and isointense signal on ADC images compatible with a subacute infarction. This area corresponds to the hypodensity described on recent CT. The remaining brain parenchyma appears within normal limits for age. The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is mild mucosal thickening within the maxillary sinuses. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: Subacute infarct involving the left putamen and adjacent deep white matter which was also present on recent CT from 7/20/2016.


Instruction: Generate impression based on medical findings.

Input: 55-year-old male with history of necrotic tumor of transverse colon causing duodenal outlet obstruction. Evaluate for possible left renal vein thrombosis/invasion. ABDOMEN:LIVER, BILIARY TRACT: Status post right hepatectomy. No suspicious hepatic lesions. No hepatic steatosis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable moderate left-sided hydronephrosis. The known large peripherally enhancing centrally necrotic tumor arising from the transverse colon is again seen to invade the left lower renal pole parenchyma. Nonenhancing intraluminal thrombus expanding the left renal vein (axial series 9 image 34) is in direct continuity with the colonic mass and is felt to represent tumor invasion.RETROPERITONEUM, LYMPH NODES: Stable size of mildly enlarged left retroperitoneal lymph node (axial series 9 image 21).BOWEL, MESENTERY: Large peripherally enhancing and centrally necrotic tumor arising from the transverse colon is better evaluated on the prior CT exam. No significant interval change. Interval decompression of the stomach, however there is persistent dilatation of the first and second portion duodenum.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Thrombus expanding the left renal vein is in direct continuity with the known colonic mass is favored to represent tumor invasion.2.Stable findings of a large necrotic tumor arising from the transverse colon again invading the left renal parenchyma and causing proximal dilatation of the duodenum. Stable mildly enlarged left retroperitoneal lymph node.


Instruction: Generate impression based on medical findings.

Input: There is evidence of intracranial metastatic disease. Contrast enhancing lesion in the left medial occipital lobe measuring 1.0 x 0.7-cm (post contrast image 76) with associated vasogenic edema is compatible with intracranial metastasis. There is a second contrast enhancing lesion in the left cerebellum measuring 1.2 cm x 1.0 cm (post contrast image 38) with associated vasogenic edema. There is also area of FLAIR hyperintensity centered at the left anterior temporal lobe without definite underlying lesion likely related to treatment change. There is however a punctate focus of enhancement in the left anterior temporal lobe which may be related to prior treatment versus tiny metastatic lesion. No evidence of midline shift or mass effect. Additional subcentimeter areas of abnormal enhancement and edema in the bilateral superior/middle cerebellar peduncles may represent additional smaller lesions versus a separate perhaps toxic-metabolic process. There is a 5 mm lesion more laterally in the left superior cerebellum and a punctate lesion in the superior cerebellar vermis (axial image 74/175 series 1301) . Additional symmetric areas of T2 hyperintensity of the periventricular and subcortical white matter are compatible with chronic small vessel ischemic disease or treatment changes. Evidence of prior left frontal and temporal craniotomies. No destructive calvarial lesions. No evidence of acute hemorrhage or infarction. Flow voids are present within the major vessels indicating patency. There is fluid in the mastoid air cells. Orbits are unremarkable.

Output: 1.Dominant metastatic lesions in the left medial occipital lobe and left cerebellum. Additional subcentimeter areas of abnormal enhancement and edema in the bilateral superior/middle cerebellar peduncles may represent additional smaller metastases versus a separate perhaps toxic-metabolic/treatment-related process. There is a 5 mm lesion more laterally in the left superior cerebellum and another punctate lesion in the superior cerebellar vermis. No significant mass effect, midline shift, or herniation. Comparison with prior MRI would be helpful if available.2.FLAIR hyperintensity in the left anterior temporal lobe likely represent gliosis related to prior treated lesion.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old, pain and paresthesias in the arms. Alignment is anatomic. Vertebral body height and morphology are normal. Marrow signal characteristics are within normal limits. There is mild edema within the left C3-4 facet complex and in the right C4-5 facet complex.C2-3: Unremarkable. C3-4: Left facet hypertrophy. Left paracentral disk osteophyte complex with effacement of the left ventral thecal sac and slight flattening of the left aspect of the cord. No convincing cord signal abnormality is seen. Moderate right and severe left foraminal narrowing. C4-5: Mild facet hypertrophy. Mild broad disk osteophyte complex. Minimal narrowing of the spinal canal. Moderate bilateral foraminal narrowing. C5-6: Unremarkable. C6-7: Minimal disk osteophyte complex formation. No spinal canal or foraminal stenosis. C7-T1: Unremarkable.

Output: 1. A left paracentral disk osteophyte complex at C3-4 causes effacement of the left ventral thecal sac and slight impingement on the left aspect of the cord.2. At C3-4, there is severe left and moderate right foraminal narrowing. At C4-5, there is moderate bilateral foraminal narrowing.3. Mild edematous facet arthropathy is seen on the left at C3-4 and on the right at C4-5.


Instruction: Generate impression based on medical findings.

Input: Male, 5 years old. History of neuroblastoma now with bruising around left eye. The new lobular, T1 hypointense, T2 heterogeneous mass within the left masticator space and infratemporal fossa measuring approximately 4.0 cm has diffuse heterogeneous enhancement and diffusion restriction. There is a small enhancing lobule extending cranially into the posterior aspect of the left lateral extraconal space with mild mass effect on the lateral rectus muscle (series 801, image 8). There is focal narrowing of the proximal optic canal with decreased visualized fluid within the optic nerve sheath at this level, but the nerve does not appear invaded by tumor.There is a cordlike area of enhancement along the left V2 nerve through the foramen rotundum. There is loss of the lateral wall cortex of the vidian canal with nodular enhancement superomedially. There is diminished caliber of the left pterygomaxillary fissure and pterygopalatine fossa without frank enhancement within the structures. There is extension of the tumor through the widened left foramen ovale into the extradural space in the middle cranial fossa inferior to the temporal lobe (series 701, image 5). There is an extradural enhancing nodule measuring 7 x 6 cm adjacent to the inferior left frontal lobe laterally (series 801, image 3), compatible with tumor extension, with subtle FLAIR abnormality in the adjacent brain parenchyma seen on prior noncontrast MRI. There is a an additional small enhancing lobulation anterior to the left temporal lobe (series 801, image 9).Additionally, there is new/increased masslike enhancing soft tissue surrounding the mandibular rami, right greater than left (series 701, image 4) which is favored to represent additional tumor, although there may be a component of adjacent local lymphadenopathy as well. These areas of soft tissue demonstrate diffusion restriction. The vestibular rami marrow signal is now STIR hyperintense, further suggesting osseous involvement. Additional small cervical lymph nodes are partially imaged. There is scattered mild paranasal sinus mucosal thickening.There is no evidence of intracranial hemorrhage or acute infarct. There is mild mega cisterna magna. Otherwise, the ventricles and basal cisterns are normal in size and configuration. There is no midline shift. The midline structures and craniocervical junction are within normal limits. Normal flow-voids are demonstrated in the major intracranial vascular structures. There is scattered mild paranasal sinus mucosal thickening as well as scattered mastoid air cell opacification bilaterally.

Output: 1. An enhancing 4 cm mass in left masticator space/infratemporal fossa with extension into the left orbit, along the V2 and V3 cranial nerves as detailed above. There is extradural extension into the left middle cranial fossa, with mild mass effect on the adjacent inferior temporal lobe, consistent with neuroblastoma. Dedicated skull base CT imaging can be obtained for further evaluation of skull base osseous involvement.2. Additional enhancing soft tissue surrounding the STIR hyperintense mandibular rami, right greater than left, is consistent with additional tumor, although there may be a component of adjacent local lymphadenopathy as well.


Instruction: Generate impression based on medical findings.

Input: Signs and symptoms: left facial droop and altered mental status. Clinical question: Stroke? Non-enhanced CT brain:There is evidence of a large right temporal craniotomy with diffuse area of encephalomalacia in the right anterior and mid temporal. There is ex vacuo dilatation of right temporal horn and trigone of right lateral ventricle.Encephalomalacia of the right occipital lobe of unknown etiology. This finding could represent an old stroke or cytotoxic views the treated metastatic lesion. Clinical information on MRI of brain head was performed after this CT indicated patient's history of metastatic lung cancer.There is no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.Calvarium demonstrate changes of right frontal temporal craniotomy and is otherwise unremarkable. Visualized mastoid air cells and middle ear cavities and paranasal sinuses are unremarkable.

Output: 1.No evidence of acute intracranial findings.2.Encephalomalacia of in the right temporal lobe under a craniotomy flap are present postoperative change.3.Right occipital encephalomalacia of unknown etiology. Please see above comments.4.Calvarium demonstrate right sided craniotomy and he is otherwise intact.5.Visualized paranasal sinuses, mastoid air cells are unremarkable.


Instruction: Generate impression based on medical findings.

Input: Benign neoplasm of cranial nerves [225.1] / Neurofibromatosis, type 2 (acoustic neurofibromatosis) [237.72] / Neoplasm of unspecified nature of brain [239.6], Reason for Study: ^Reason: please evaluate brainstem tumor vestibular schwannomas Brain MRI:There is no evidence of acute ischemic or hemorrhagic lesion.The Left frontal meningeal enhancing lesion, left frontal scalp enhancing lesion, left cavernous sinus lesions and right tongue lesion do not show any significant interval change since prior exam in terms of size and MR characteristics. Upper cervical enhancing lesion likely represent spinal astrocytoma or ependymoma do not show any interval change since prior scan in terms of size and enhancement pattern.The right upper pontine enhancing lesion, likely represent right oculomotor schwannoma, does not show interval change since prior scan.There are non specific high signal intensities on bilateral subcortical white matter on FLAIR images, no change since prior scan.The ventricles, cerebral sulci and cisterns are symmetric and unremarkable. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. Mucosal thickenings on bilateral maxillary sinuses.IAC MRBilateral IACs' enhancing lesions which represent vestibular schwannoma do not show any significant interval change since prior exam in terms of size and MR characteristics.Subtle enhancement of the right facial nerve tympanic segment, no change since prior scan.Bilateral superior carotid space adjacent to extracranial carotid arteries show fusiform enhancing lesions (left bigger than right) indicating schwannoma, again no change in terms of size and MR characteristics since prior scan.Small enhancing lesion on the left hypoglossal canal extending toward left side superior aspect of the carotid space enhancing lesion likely represent schwannoma, no change since prior scan in terms of size and MR characteristics.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Multi-focal various sized lesions represent schwannomas, meningioma do not show any interval change in terms of size and MR characteristics.3. Bilateral internal auditory canal lesions and skull base lesions, again do not show any interval change since prior exam. 4. Parenchymal lesion on the upper cervical spinal cord do not show any interval change since prior scan.


Instruction: Generate impression based on medical findings.

Input: 69-year-old female with history of basilar tip aneurysm with new headaches. Brain w/wo: There is no evidence of intracranial hemorrhage or acute ischemic infarction. There is a chronic infarction within the left parietal/occipital region appearing similar to prior. There is extensive periventricular and subcortical white matter increased T2/FLAIR signal abnormality which is nonspecific. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The orbits are unremarkable.MRA: Redemonstrated is a 9 x 7 mm wide-necked basilar tip aneurysm. The neck of the aneurysm measures approximately 7 mm. The right PCA and right superior cerebellar artery arise from the aneurysm sac. Overall the aneurysm appears similar to the study from 10/2014. There is anterograde flow within the distal bilateral vertebral arteries, basilar artery, distal bilateral internal carotid arteries and carotid siphons as well as the anterior, middle, and posterior cerebral arteries. There is no evidence of arterial stenosis or occlusions.

Output: 1. Basilar tip aneurysm measuring 9 x 7 mm appearing relatively stable (within 10% of measurement differences) when compared to the MRA from 10/2014. In the setting of new development or changing of the nature of headache, active treatment options should be discussed with the patient. Either Neurosurgical or Neurointerventional clinic consultation is recommended.2. Unchanged nonspecific periventricular and subcortical increased T2/FLAIR signal abnormality which is nonspecific but may be related to XRT and/or chronic small vessel ischemic disease.3. Stable chronic infarction in the left parietal/occipital region.Findings and plan discussed with Brittany Beach by Dr. Masse at 0900 on 3/4/15.


Instruction: Generate impression based on medical findings.

Input: 86-year-old female with mental status change and fall. There is no evidence of intracranial hemorrhage, mass or edema. Diffuse hypodensities in the periventricular and subcortical white matter distribution consistent with small vessel disease age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered. Multiple punctate hypodensities consistent with old lacunar infarcts. Large white matter hypodensity in the distribution of the right posterior cerebral artery consistent with prior stroke.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Small vessel disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered


Instruction: Generate impression based on medical findings.

Input: Reason: Eval for demyelinating disease History: paresthesias MRI brain:There is redemonstration of punctate signal hyperintensities located in the pons which are 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.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is right-sided facet hypertrophy present. This is unchanged compared to the prior examAt C3-4 there is no significant compromise to the spinal canal or neural foramina. There are small uncovertebral osteophytes present at this level associated with some disk materialAt C4-5 there are endplate and uncovertebral osteophytes present associated with a diffuse disk bulge and posterior ligamentous hypertrophy. There is associated effacement of spinal fluid ventral and posterior to the spinal cord. There are bilateral uncovertebral osteophytes present at this level associated disk material and narrowing the neural foramina bilaterally. Compared to the prior exam these findings at the this level have progressed. There are endplate reactive change is present at this level which may be subacute with some bright signal on T2 and dark signal on T1.At C5-6 there is loss of disk space height and disk desiccation, endplate and uncovertebral osteophytes with effacement of spinal fluid ventral and posterior to the left hemicord and encroachment of the exiting nerve roots left more than right. Overall this appears relatively stable compared to the prior exam.At C6-7 there is a loss of disk space height, disk desiccation and diffuse disk bulge associated with endplate and uncovertebral osteophytes and partial effacement of spinal fluid ventral and posterior to the spinal cord and encroachment of the left-sided exiting nerve roots within the neural foramen.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.Pontine lesions are stable when compared to the prior exam in general the are suggestive of vascular related lesions, however, they are nonspecific and could relate to other cause such as vasculitis or demyelination.2.Since the prior exam degenerative changes at the C4-5 have progressed and now there is a moderate degree of spinal stenosis present at this level associated encroachment of the exiting nerve roots bilaterally.3.Since the prior exam degenerative changes at C5-6 and C6-7, where there is encroachment of left-sided exiting nerve roots and encroachment of the left hemicord at C5-6 and a mild to moderate degree of spinal stenosis C5-6, have remained relatively stable.


Instruction: Generate impression based on medical findings.

Input: Sensory level, gait instability. There is a slight disc protrusion at C4-5, which minimally effaces the anterior thecal sac cerebrospinal fluid. There is no significant neural foraminal stenosis or cord compression at any of the cervical spine levels. There is straightening of the vertebral column is the sagittal plane, but no spondylolisthesis. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. There is an incompletely imaged pituitary lesion.

Output: 1. Slight disc protrusion at C4-5, but no significant neural foraminal stenosis or cord compression at any of the cervical spine levels.2. No evidence of demyelinating lesions in the imaged portions of the spinal cord. 2. Incompletely imaged pituitary lesion. Please refer to the recent pituitary MRI report for additional details.


Instruction: Generate impression based on medical findings.

Input: 81-year-old female with cholestasis and elevated LFTs Examination limited by respiratory artifact.ABDOMEN:LUNG BASES: Small pleural effusions.LIVER, BILIARY TRACT: No focal hepatic lesions. Perihepatic ascites. The portal and hepatic veins are suboptimally evaluated but appear patent. Cholelithiasis without biliary ductal dilation or choledocholithiasis. SPLEEN: No significant abnormality noted.PANCREAS: Nonspecific edema about the pancreatic head.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts, the largest measuring up to 13 cm in the left lower pole.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Cholelithiasis without biliary ductal dilation or choledocholithiasis.2.Small pleural effusions and small amount of ascites.


Instruction: Generate impression based on medical findings.

Input: Straightening of the cervical spine is likely positional. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.The central canal appears congenitally slender from C3/4 through C6/7.C2/3: UnremarkableC3/4: Apart from the congenitally slender canal, unremarkable.C4/5: There is a left paracentral disc extrusion deforming the left hemicord without intrinsic T2 abnormality causing significant proximal neural foraminal obstruction with nerve root compression.C5/6: Apart from the congenitally slender canal, unremarkable.C6/7: Mild disc bulge causing slight anterior cord flattening without intrinsic cord signal abnormality. Apart from the congenitally slender canal, there are no significant stenoses.C7/T1: Unremarkable

Output: 1.The central canal appears congenitally slender from C3/4 through C6/7.2.C4/5: There is a left paracentral disc extrusion deforming the left hemicord without intrinsic T2 abnormality causing significant proximal neural foraminal obstruction with nerve root compression.


Instruction: Generate impression based on medical findings.

Input: 64-year-old male with abdominal pain and ampullary lesion seen on outside CT. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions. Gallbladder surgically absent. No biliary ductal dilation (see below).SPLEEN: No significant abnormality noted.PANCREAS: No focal pancreatic lesions. Previously seen mild dilation of the common bile duct and pancreatic duct appears resolved with the common bile duct measuring up to 5 mm, previously 7 mm, and the pancreatic duct measuring up to 4 mm, previously 8 mm. No ampullary mass is evident. No choledocholithiasis. The findings may be related to benign stricture at the level of the ampulla.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval decreased caliber of the common bile duct and pancreatic duct. No ampullary mass is evident. The findings may be related to benign stricture at the level of the ampulla.


Instruction: Generate impression based on medical findings.

Input: Male, 82 years old. Pain and marked decreased abduction after fall. Evaluate rotator cuff. ROTATOR CUFF: There is increased signal within the supraspinatus tendon indicating tendinosis. There is no full-thickness rotator cuff tear.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is blunting of the posterior inferior glenoid labrum which is most likely degenerative. The remainder of the glenoid labra appear intact. The glenohumeral joint alignment is within normal limits.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1. Coracohumeral ligament is not identified raising the possibility of adhesive capsulitis.2. No full-thickness rotator cuff tear. Tendinosis of the supraspinatus tendon.3. Slight muscle atrophy with a high riding humeral head.


Instruction: Generate impression based on medical findings.

Input: Metastatic melanoma. Neck CT:Again seen is soft tissue mass in the right nasopharynx which measures 24 mm in largest dimension on coronal images (series 80564, image 54) compared to prior measurement of 19 mm on prior study (series 80324, image 46). On axial plane, it measures 19 x 17 mm (series 6, image 34) compared to prior measurement of 17 x 13 mm (series 4, image 18). There is no lymphadenopathy of pathological size.As seen before there is a left sided 6 -mm nodule in the left dorsal subcutaneous fat at level of C3 showing no significant interval change in size or appearance.There are enhancing lesions in the right cerebral hemisphere. These lesions were also present on prior MRI brain of 2/23/2011.There are degenerative changes in the cervical spine. No definite bone metastasis is identified in the cervical spine.

Output: 1. Slight increased size of right nasopharynx soft tissue lesion.2. Brain lesions partially visualized. Please refer to dedicated brain study.


Instruction: Generate impression based on medical findings.

Input: 68 years Female (DOB:8/14/1947)Reason: ro stroke History: ataxiaPROVIDER/ATTENDING NAME: RAYMOND ROOS RAYMOND ROOS MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The AP dimension of the left eye is significantly longer than the right eye measures approximately 30 mm whereas right measures approximately 22 mm AP dimension. The left eye is somewhat irregular in shape.Incidental note is made of partial empty sella. Incidental note is made of hyperostosis frontalis interna.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact and are medium-sized. The left vertebral artery is larger than the right vertebral artery.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. Right thyroid lobe is larger than the left thyroid lobe. The thyroid glands are heterogeneous in signal intensity.

Output: 1.There is no evidence for intracranial cerebrovascular occlusive disease.2.There is no evidence for extracranial cerebrovascular occlusive disease.3.The left eye is deformed. Please correlate with ophthalmoscopic findings4.The thyroid gland is enlarged and heterogeneous suggestive of a multinodular goiter. Please note that MRA is not accurate in evaluation of the thyroid gland and additional investigation is necessary to confirm the of these findings if clinically appropriate. Please correlate with clinical history.


Instruction: Generate impression based on medical findings.

Input: Severe, the pertaining pelvic pain. Rule out cord abnormality or nerve impingement. There are 5 lumbar-type, ribless vertebrae. The last well-formed disc is at L5-S1.Alignment is anatomic accounting for straightening, which may reflect patient positioning. The vertebral bodies are preserved in height. Marrow signal also is normal as well as the disc heights and T2 signal. The spinal canal is preserved. The tip of the conus medullaris lies at the mid L1 level. The conus medullaris shows normal morphology and no abnormal signal. There is no neural foraminal stenosis. There is no edema in the posterior elements or subluxation to indicate the presence of spondylolysis. There is no abnormal contrast enhancement.

Output: Normal lumbar spine MRI.


Instruction: Generate impression based on medical findings.

Input: 36-year-old female with right shoulder pain. History of labral repair. Evaluate for new labral tear. An ABER view was not able to be obtained due to patient discomfort, decreasing sensitivity for labral tears.ROTATOR CUFF: The supraspinatus and infraspinatus muscles and tendons appear intact. There is intermediate signal intensity within the supraspinatus tendon indicating mild tendinosis. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: Mild degenerative changes affect the acromioclavicular joint. There is a trace amount of gadolinium identified within the subacromial subdeltoid bursa which is presumably related to injection as no full-thickness rotator cuff tear is evident.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a linear branching signal abnormality within the superior glenoid labrum, which fills with intra-articular gadolinium, consistent with a re-tear of the glenoid labrum. There is extension of this linear signal abnormality, which fills with intra-articular contrast, into the biceps anchor. There is also heterogeneity and increased signal abnormality within the anterior superior glenoid labrum which may represent postsurgical changes or prior tearing.BICEPS TENDON: The tendon of the long head of the biceps appears intact. ADDITIONAL

Output: Findings consistent with a re-tear of the superior glenoid labrum with extension into the biceps anchor as described above.


Instruction: Generate impression based on medical findings.

Input: Compared to prior MRI lumbar spine dated 1/18/2016, there is worsened diffusely heterogeneous and infiltrative signal abnormality throughout the lumbar spine, partially imaged T11 and T12 levels, and partially imaged pelvis including the bilateral sacrum and iliac bones. There is also associated multifocal STIR hyperintensity and enhancement related to diffuse osseous metastatic disease which has significantly progressed. The degree of enhancement involving the S1 vertebral body has decreased in the interval as has the epidural tumor dorsal to the S1 vertebral body consistent with prior radiation treatment. For example at the L5-S1 level, previously seen epidural tumor measuring up to 5 mm in thickness now measures less than 1 mm. More ill-defined epidural enhancement along the anterior and right lateral aspect of the epidural space from the L5-S1 to S1-S2 levels also appears decreased. T1 hyperintensity involving the pelvis and lower aspect of the L5 vertebral body is consistent with prior radiation. Conjoined right L5, S1, and S2 nerve roots incidentally noted. There is increase in enhancement along the left anterolateral aspect of the L5 vertebral bodies suspicious for paraspinous tumor. There is minimal epidural enhancement along the dorsal aspect of the lumbar vertebral bodies which may represent venous plexus and less likely epidural tumor. There is no definite evidence of new epidural tumor since the prior study or leptomeningeal disease.There is linear T1 and T2 signal involving the S1 vertebral which is new and likely represents a pathologic fracture. Vertebral body heights are grossly preserved although there is progressive endplate deformity involving the inferior L5 and superior S1 endplates. The lumbar spine is in normal alignment, with straightening of the normal lumbar lordosis. There is no significant disc disease or spinal canal or neural foraminal stenosis.

Output: 1. Compared to MRI dated 1/18/2016, there has been marked progression of diffuse osseous metastatic disease throughout the lumbar spine and partially imaged pelvis. Previously seen enhancement associated with the S1 metastasis has decreased, and there is also decrease in epidural tumor at this level. There is however interval development of pathologic fracture involving the S1 vertebral body without significant loss of height.2. There is mild paraspinous tumor extension suspected along the left anterolateral aspect of the L5 vertebral body which is increased. No new epidural tumor is definitively appreciated. 3. There is no significant spinal canal or neural foraminal stenosis.


Instruction: Generate impression based on medical findings.

Input: 20 year-old female with edema and pain at multiple regions. Evaluate for Lisfranc injury, fifth metatarsal and lateral ligaments. There is edema within the dorsal subcutaneous fat of the forefoot and midfoot extending into the dorsal/lateral ankle where it appears to become confluent and be associated with high signal on T1 weighted images, indicating ankle hematoma. Although the ankle is not visualized in its entirety, the PTaFL appears intact. The calcaneofibular ligament appears thickened, which may represent sprain. We do not clearly visualize the ATaFL and suspect a tear. The anterior tibiofibular ligament is not well seen, possibly due to the obliquity of the acquired images. Edema within the deep fibers of the deltoid ligament may represent a sprain. There is a small tibiotalar joint effusion.There is a fracture of the base of the fifth metatarsal, extending to the tarsometatarsal joint with fragments in near anatomic alignment. Edema within the plantar aspect of the base of the fourth metatarsal and third metatarsal may represent contusions as we see no discrete fracture lines. A focus of edema within the medial base of the first metatarsal likewise may represent a contusion as we see no distinct fracture line. The Lisfranc ligament itself appears intact. The bone marrow signal of the cuneiforms and navicular is within normal limits. Edema within the anterior cuboid may represent a contusion as we see no fracture line. Edema most concentrated within the medial head of the talus may represent a contusion although we cannot exclude a nondisplaced surface fracture. The bone marrow signal of the distal metatarsals and phalanges is within normal limits. The fourth toe is absent, presumably due to amputation.

Output: 1. Although an ankle MRI exam was ordered, MRI of the forefoot and midfoot was performed, which does not include the ligaments of the ankle in their entirety. We will have the patient return for dedicated ankle MRI exam and will not charge for this forefoot/midfoot examination.2. Nondisplaced fracture of the base of the fifth metatarsal with additional foci of edema within multiple bones which may represent contusions, as described above.3. Hematoma along the lateral ankle with poor visualization of the ATaFL, which could be further evaluated if the patient returns for dedicated ankle MRI.


Instruction: Generate impression based on medical findings.

Input: Reason: Patient with posterior knee pain and swelling. Unstable knee. Please evaluate for meniscal tear, ligament tear. History: Posterior right knee pain. MENISCI: There is increased signal in the posterior horn of the medial meniscus, likely representing degeneration, which may extend to the tibial articular surface.ARTICULAR CARTILAGE AND BONE: There is marked loss of cartilage in the lateral facet of the patella with underlying cyst formation consistent with severe degenerative changes in the patellofemoral compartment.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1.Increased signal in the posterior horn of the medial meniscus likely representing degeneration; it is equivocal whether this extends to the tibial articular surface. 2.Severe degenerative changes affect the patellofemoral compartment.


Instruction: Generate impression based on medical findings.

Input: Female 18 years old Reason: Evaluate the progression of hip AVN History: Chronic Hip Pain Femoral heads are well seated in normal acetabula. Again seen are oblong cystic areas, the largest of which is 5 mm, in the medial left femoral head. Areas of low T2 and T1 signal predominantly in the posterior femoral heads bilaterally do not enhance and are consistent with osteonecrosis. No significant edema in the femoral heads bilaterally. No flattening of the femoral heads. No fracture or joint effusion. The labrum and cartilage are intact.Unchanged abnormal signal in the proximal femoral diaphyses bilaterally consistent with bone infarcts, right worse than left. Abnormal bone marrow signal throughout the femurs and pelvis compatible with red marrow conversion in setting of sickle cell disease. Central vertebral body depression of the lower lumbar spine from sickle cell disease.Subcutaneous edema posterior to the to the lower lumbar spinous processes. Atrophy/increased fat in the paraspinal musculature.

Output: 1.Bilateral avascular necrosis of the femoral head without collapse or fracture. 2.Bone infarcts of the proximal femoral diaphysis.


Instruction: Generate impression based on medical findings.

Input: 67-year-old female with outside CT demonstrating 5-mm groundglass nodule left upper lobe LUNGS AND PLEURA: Mild apical pleural scarring.A 5-mm groundglass nodules identified left upper lobe (image 38 series 4). Previous outside imaging is not available for review at the time of reporting.Mild basilar scarring bilaterally.MEDIASTINUM AND HILA: No evidence of hilar or mediastinal lymphadenopathy.Cardiac size is normal without evidence of pericardial effusion.CHEST WALL: Intraspinal calcification at T10 level on the left appears be extradural in location may represent a calcified small meningioma. There is mild displacement and compression of the spinal cord from left to right. MRI of the thoracic spine is recommended for further evaluation.UPPER ABDOMEN: Cholelithiasis.

Output: 1.Small 5-mm groundglass nodule within the left upper lobe. Follow up examination in one year is advised.2.Intraspinal probable extradural calcification at T10 on the left of uncertain clinical significance. MRI of the thoracic spine is advised for further evaluation.


Instruction: Generate impression based on medical findings.

Input: 58 years Male (DOB:7/26/1957)Reason: Evaluate for steno-occlusive disease, etiology of RUE weakness History: RUE weaknessPROVIDER/ATTENDING NAME: CHRISTOPHER L KRAMER CHRISTOPHER L KRAMER MRI of the brainThere is a focus of diffusion restriction present involving the posterior aspect of the left putamen and extending into the left centrum semiovale measuring approximately 25 x 9 mm in axial dimensions. Another focus of diffusion restriction is present in the left centrum semiovale more anterior measuring approximately 9 x 9 mm axial dimensions. These are also high signal on T2 MRI imaging sequences.The appears to be a small focus of encephalomalacia in the right medial occipital lobe which although has some high signal on diffusion-weighted imaging and is high signal is also present on the ADC maps indicating that it may very well represent T2 shine through rather than diffusion restriction..Punctate T2 signal hyperintense foci are present in the brainstem.Please note that T2 imaging is markedly compromised due to patient motion artifact.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate opacification of the left maxillary sinus and left anterior ethmoid air cells as well as part of the left frontal sinus. This would indicate nonocclusive pattern in the left hiatus semilunaris potentially.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. The left vertebral artery smaller than the right vertebral artery. There is extracranial origin of the left posterior inferior cerebellar artery. The posterior communicating arteries are small. The anterior communicating artery is small.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified.

Output: 1.No evidence for cerebrovascular occlusive disease.2.Findings are compatible with a small foci of infarction in the left centrum semiovale and basal ganglia3.Findings suggest old focus of encephalomalacia in the right occipital lobe possibly related to prior infarction.4.Findings are compatible with the paranasal sinuses obstructive pattern centered in the left hiatus semilunaris.5.Examination is compromised due to patient motion artifact. Additionally, the patient refused to complete the exam due to claustrophobia. This may compromise both interpretation and identification of additional lesions.


Instruction: Generate impression based on medical findings.

Input: There is mild dextrocurvature of the thoracic spine as seen on prior radiographs. Alignment of the thoracic spine is otherwise maintained. Vertebral body heights are normal. Bone marrow signal is benign.Mild degenerative changes are seen including disc desiccation and minimal disc bulges at multiple levels. There is some disc height loss at the T7-T8 level with subtle associated endplate changes. There is mild facet arthropathy in the lower thoracic spine. There is mild left T10-T11 neural foraminal narrowing and to an even lesser degree at the left T11-T12 level. Vacuum phenomena at T11-T12 better seen on same-day CT. There is otherwise no significant spinal canal or neural foraminal stenosis. The spinal cord is of normal caliber and signal. Paraspinous soft tissues are unremarkable. Degenerative changes in the cervical spine are partially imaged on the sagittal counting sequence. No evidence of high-grade cervical spinal canal stenosis.

Output: Mild degenerative changes in the thoracic spine without significant spinal canal stenosis or high grade neural foraminal narrowing at any level. No or cord signal abnormality. Additional details as above.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old. Reason: Rule out cuff tear History: Right shoulder pain ROTATOR CUFF: There is a full-thickness tear of the supraspinatus without muscle retraction. There is thickening and intermediate signal within the infraspinatus tendon likely representing a tendinopathy. There is a small amount of fluid in the subacromial bursa.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenoid labrum is grossly intact.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1. Full-thickness tear of the supraspinatus without retraction. 2. Tendinopathy of the infraspinatus tendon.


Instruction: Generate impression based on medical findings.

Input: Female; 52 years old. Reason: Evaluation of pancreatic cystic structure seen on ultrasound, also please make sure liver imaging is Cirrhosis protocol History: see above ABDOMEN:LUNG BASES: Cardiomegaly.LIVER, BILIARY TRACT: Ill-defined subcapsular segment two lesion (series 1304/102) and smaller subcapsular lesion in the posterior right hepatic lobe (series 1304/102) best seen on portal venous and delayed phase images are nonspecific. No abnormal arterial enhancement or restricted diffusion. These lesions may be related to perfusional changes.Gallbladder sludge and/or small stones. No biliary ductal dilation.SPLEEN: No significant abnormality noted.PANCREAS: No focal pancreatic lesions. No pancreatic ductal dilation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Prominent left extrarenal pelvis noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Midgut malrotation without evidence of volvulus or obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Moderate abdominal ascites.

Output: 1. Nonspecific hepatic lesions without abnormal arterial enhancement or restricted diffusion may be related to perfusional changes.2. No focal pancreatic lesions.3. Midgut malrotation without evidence of volvulus or obstruction.4. Ascites.


Instruction: Generate impression based on medical findings.

Input: MRI BRAIN: There is a 4 mm diameter enhancing lesion in the inferior medial aspect of the left cerebellar tonsil. There are no additional areas of abnormal signal or pathological enhancement. There is no evidence of intracranial hemorrhage acute infarct. There are probable terminal zones of myelination in the bilateral parietal lobes. The supratentorial brain parenchyma otherwise appears 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 skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is redemonstration of postoperative changes in the right globe, including silicone oil injection and scleral buckling.MRI CERVICAL SPINE: There is an expansile cystic intramedullary lesion in the left ventral aspect of the cervical spinal cord at the level of the C2 vertebral body, which measures up to 18 mm, previously 10 mm. There are two punctate nodular enhancing foci along the anterior aspect of the cyst, which appear unchanged and another punctate focus of enhancement along the posterior aspect of the left spinal cord at approximately the same level, which appears to be larger. In addition, there is mild edema is the spinal cord superior to the cyst. The cervical vertebral bodies are intact and there is no spondylolisthesis. The bone marrow signal is within normal limits. There are no significant degenerative changes are present. The vertebral artery flow voids appear to be intact. The paraspinous soft tissue structures appear within normal limits.

Output: 1. No significant interval change in the inferior medial enhancing cerebellar hemangioblastoma.2. Findings consistent with spinal cord hemangioblastomas at the C2 level with interval increase in size of the cystic component and posterior enhancing lesion, as well as mild edema in the surrounding spinal cord.3. Post-treatment findings in the right globe.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: The thoracic spine is in normal alignment, with a normal thoracic kyphosis. The vertebral body and disk heights are well maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There is no pathological enhancement.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine.LUMBAR SPINE

Output: There is no evidence of cord compression or abnormal signal involving the spinal cord. There is no significant spinal canal or neural foraminal stenosis in the thoracic or lumbar spine.


Instruction: Generate impression based on medical findings.

Input: Chronic back pain with signs of nerve impingement. There is multilevel degenerative spondylosis. At T12-L1, there is loss of disc space height and fatty endplate signal in the T12 vertebral body, but no significant spinal canal or neural foraminal stenosis. At L1 through L4, there is no significant spinal canal or neural foraminal stenosis either. At L4-5, there is a disc bulge, mild facet hypertrophy bilaterally, and ligamentum flavum thickening with mild neural foraminal stenosis, but no significant spinal canal narrowing. At L5-S1, there is a disc bulge, mild facet hypertrophy bilaterally, and ligamentum flavum thickening with mild neural foraminal stenosis, but no significant spinal canal narrowing. The vertebral column alignment is within normal limits. The vertebral body heights are preserved, aside from a Schmorl node in the inferior T11 vertebral body. There is no evidence of tumors. The imaged portions of the spinal cord display normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: Degenerative spondylosis, with mild bilateral neural foraminal narrowing at L4-5 and L5-S1, but no significant spinal canal stenosis.


Instruction: Generate impression based on medical findings.

Input: Reason: new onset left sided rigidity, concern for ischemic event verus MSA versus atypical parkinson's disease: left sided weakness and bradykinesia, looking for hummingbird sign in brainstem. There is punctate susceptibility effect in the right globus pallidus, but the rest of the basal ganglia are unremarkable. The brainstem is intact, without evidence of the hummingbird or Mickey mouse sign. The brain parenchyma and cerebellum also appear unremarkable, aside from minimal nonspecific cerebral white matter T2 hyperintensity. There is no evidence of intracranial mass 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, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Nonspecific punctate susceptibility effect in the right globus pallidus, which may represent incipient mineralization. Otherwise, no specific imaging findings for progressive supranuclear palsy or multiple system atrophy. Perhaps a nuclear medicine scan may be useful for further evaluation.2. No evidence of intracranial mass or acute infarct.


Instruction: Generate impression based on medical findings.

Input: Secondary malignant neoplasm of brain [C79.31] / Secondary malignant neoplasm of other parts of nervous system [C79.49], Reason for Study: ^Reason: please perform STROKE PROTOCOL History: L sided weakness Brain MRINew evidence of susceptibility lesions especially around the right frontal lobe where the tumor resection was performed indicate operation related blood products. There is no evidence of acute ischemic lesion on this scan.Metallic artifacts on the right middle cranial fossa due to surgical clips, unchanged. Left occipital approach catheter with left cerebellar FLAIR high signal lesion are again seen, unchanged.Bihemispheric extra axial fluid collections, subdural most likely, are seen and unchanged in terms of distribution and maximum thickness since prior scan. Right precentral gyrus and left middle frontal gyrus FLAIR high signal intensity lesions are seen, unchanged since prior scan.Scattered and somewhat patchy FLAIR high signal intensity lesions on bilateral periventricular white matter and centrum semiovale indicate non specific small vessel ischemic disease, unchanged since prior scan. The ventricles, sulci and cisterns are unremarkable. 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 non visualization of the right ACA, MCA and distal ICA beyond the level of the right ophthalmic artery most likely due to metallic artifacts.The left ICA, MCA and ACA appear to be normal. Vertebrobasilar system appears to be normal. Left PCA appears to be fetal origin.

Output: 1. Post right frontal tumor resection status, no unusual finding.2. Unchanged extraaxial fluid collections and multifocal FLAIR abnormalities including left cerebellar lesion since prior scan.3. No evidence of acute ischemic or hemorrhagic lesion.4. Brain MRA is unremarkable.


Instruction: Generate impression based on medical findings.

Input: 33 year old man with elevated d-dimer and chest pain presents for cardiac MRI to evaluate for etiology of chest pain and to rule out aortic dissection Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 57%, the LV end diastolic volume index is 77 ml/m2 (normal range: 74+/-15), the LVEDV is 193 ml (normal range 142+/-34), the LV end systolic volume index is 33 ml/m2 (normal range 25+/-9), the LVESV is 84 ml (normal range 47+/-19), the LV mass index is 52 g/m2 (normal range 85+/-15), and the LV mass is 130 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 87 ml/m2 (normal range 82+/-16), the RVEDV is 218 ml (normal range 142+/-31), the RV end systolic volume index is 44 ml/m2 (normal range 31+/-9), and the RVESV is 110 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and without significant aortic regurgitation.Mitral ValveThe mitral valve opens widely without obvious mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely without obvious pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely without obvious tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. There is no evidence of aortic dissection or aneurysm to the infra-renal level of the aorta. There is normal origin of the coronary arteries. Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal LV size and systolic function (LVEF 57%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.2. Normal RV size and systolic function (RVEF 50%).3. No evidence of aortic dissection or aneurysm to the infra-renal aorta level.4. Normal origin of the coronary arteries.


Instruction: Generate impression based on medical findings.

Input: Reason: herniated lumbar disc worsening low back and leg pain History: worsening low back and leg pain Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is a broad-based central disk protrusion which impresses on the ventral aspect of the thecal sac and abuts the nerve roots of the lateral recesses bilaterally effaces the fat at the lateral recess is bilaterally. Compared to the prior exam this has not changed substantially. There is some loss of disk space height at this level.At L4-5 there is some loss of disk space height as well as a left lateral recess broad-based disk protrusion which encroaches on the nerve roots of the left lateral recess and to a lesser degree right lateral recess. The fat of the lateral recesses is effaced and bilaterally left more than right . Compared to the prior exam protrusion appears to have mildly regressed. Overall there is a moderate degree of spinal stenosis at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There is a central disk protrusion present at L5-S1 which encroaches on the nerve roots of the lateral recesses - left more than right- and has not change substantially when compared to the previous exam.2.There is a broad-based left lateral recess disk protrusion at L4-5 which encroaches on the nerve roots of the left lateral recess and to a lesser degree right lateral recess which is subtly partially regressed since the prior exam. Overall there is moderate spinal stenosis at this level.


Instruction: Generate impression based on medical findings.

Input: 23-year-old male with a history of meningitis. Evaluate for structural abnormality. There is no restricted diffusion to indicate acute infarct or susceptibility abnormalities to indicate hemorrhage. There is no mass, mass effect, midline shift, herniation or extra-axial fluid collection. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Normal MRI of the brain.