Instruction: Generate impression based on medical findings.

Input: Clinical question: Evaluate for metastases, history of prostate cancer. Signs and symptoms: Bilateral lower extremity weakness. Pre- and post enhanced cervical MRI:Examination demonstrates a large focus of marrow signal replacement with enhancement involving vertebral body of C6 and with involvement of left pedicle and left articulating facet with enhancement. Finding is consistent with a metastatic lesion. There is no detectable extraosseous spread of tumor into the spinal canal. There is no convincing evidence of any additional osseous metastatic lesions of the cervical spine and no detectable metastatic lesion to the cord or the leptomeninges.Degenerative changes at C4-C5 and to a lesser degree at C3-C4 and C5-C6 results in central spinal stenosis. Significant bilateral neural foraminal compromise at C4-C5, C5-C6 secondary to degenerative changes are noted. Mild neural foraminal compromise at other levels.Pre and post enhanced thoracic MRI:Examination demonstrates extensive osseous metastatic lesions involving T2, T3, T4, T5, T6, T7, T8, T10, T11 and T12 vertebral bodies and some with involvement of posterior elements. No evidence of fracture or malalignment.There is evidence of tumor also in the epidural space posteriorly at T3, T4 and to a lesser degree T5 levels with resultant mass effect and flattening deformity of the cord and central spinal stenosis at C3 and C4 level. Although difficult to assess due to flattening deformity there is no convincing evidence of cord edema on this study, however this possibility cannot be entirely excluded. There is no evidence of central spinal stenosis or appreciable mass effect on the cord at any other level.There is normal signal intensity and caliber of thoracic cord otherwise and without detectable enhancement of the cord or the meninges.Pre and post enhanced lumbar MRI:Examination demonstrates diffuse osseous metastatic lesions of the vertebral column however without evidence of malalignment. Fracture of L4 vertebral body is again noted as well as seen on prior CT of the abdomen from 4-7-15.There is no detectable extraosseous spread of tumor into the spinal canal.There is normal signal intensity of the lower most visualized thoracic cord, conus and cauda equina without abnormal enhancement.Degenerative changes at L4-L5 and including a small central disc protrusion results in significant central spinal stenosis and moderate bilateral neural foraminal compromise. Degenerative changes at L3-L4 also result in moderate central spinal stenosis and moderate right neural foraminal compromise. Degenerative changes at L2-L3 results in mild central spinal stenosis and without neural foraminal compromise.

Output: 1.Pre and post enhanced MRI of cervical spine demonstrate metastatic lesion involving the vertebral body of C6, left pedicle and articulating facets with enhancement. No detectable extraosseous spread of tumor. Moderate central spinal stenosis at C4-C5 and to a lesser degree at C3-C4 and C5-C6 levels and significant bilateral neural foraminal compromise C4-C5 and C5-C6 levels secondary to degenerative changes are noted. No detectable but the meningeal enhancement.2.Pre and post enhanced MRI of thoracic spine demonstrate diffuse osseous metastatic lesions involving vertebral bodies and to a lesser degree of the posterior elements. There is also evidence of metastatic lesion in the dorsal epidural space at T3-T5 levels and with evidence of mass effect, flattening deformity and central spinal stenosis which is most noticeable at T3 and T4 levels. No fracture or malalignment and normal signal intensity of the cord without enhancement.3.Pre- and post enhanced lumbar MRI demonstrates diffuse intraosseous metastatic lesions. Fracture of metastatic L4 vertebral body without significant change since prior CT of abdomen. No evidence of leptomeningeal metastatic lesions. Significant central spinal stenosis secondary to degenerative disease at L4-L5 and moderate central spinal stenosis at L3-L4 as detailed above. Multilevel neural foraminal compromise as mentioned in the body of report.


Instruction: Generate impression based on medical findings.

Input: 38-year-old female with right breast cancer. MRI for further evaluation. There is extreme amount of fibroglandular tissue in both breasts. Marked parenchymal enhancement is noted bilaterally, a limitation to this study.There is non-mass enhancement within the left medial breast, extending 4.0 x 2.1 x 2.9 cm, including anteriorly to the retroareolar region. This projects to within 7 mm of the nipple. There is associated susceptibility artifact within the posterior aspect of the enhancement, compatible with clip from outside hospital biopsy. There is no evidence of chest wall invasion. There is no abnormal enhancement within the left breast.A single lymph node within the right axilla has equivocal cortical thickening, measuring 3mm. Lymph nodes in each axilla are otherwise normal.

Output: 1.Biopsy proven right medial breast non-mass enhancement, consistent with known cancer, spans 4 cm AP and projects to within 7 mm of the nipple. Given that the enhancement on this exam and extent of calcifications on mammography are similar, and if further tissue diagnosis for extent is needed, stereotactic biopsy could be performed. 2.Equivocal cortical thickening of a right axillary lymph node. 3.No MR evidence of malignancy within the left breast.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: Assess aneurysm for stability: nasopharyngeal cancer, microhemorrhage versus mets. MRI: There are numerous unchanged subcentimeter non-enhancing lesions with associated susceptibility effect. There is no associated edema with the lesions. There is no evidence of 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. There is a small amount of fluid in the right mastoid air cells. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is no evidence of tumor in the nasopharyngeal region, although the imaging is not optimized for assessment of that region.MRA: There is an unchanged 3 mm diameter posteromedially directed right aneurysm arising from the anterior genu of the internal carotid artery. There is no evidence of significant steno-occlusive lesions.

Output: 1. Numerous unchanged subcentimeter non-enhancing lesions with associated susceptibility effect likely represent cavernous malformations or chronic microhemorrhages.2. Unchanged 3 mm diameter posteromedially directed right aneurysm arising from the anterior genu of the internal carotid artery.


Instruction: Generate impression based on medical findings.

Input: 40 years Female (DOB:10/5/1975)Reason: interval change History: Lhermitte'sPROVIDER/ATTENDING NAME: ANTHONY T REDER ANTHONY T REDER MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of patchy T2 and FLAIR hyperintense lesions located in the periventricular white matter as well as the T2 and FLAIR hyperintense foci in the left cerebral peduncle, the left superior cerebellar peduncle and along the anterior medial medulla. There are a few punctate lesions present in the right cerebellar hemisphere which were also present on the prior exam. The lesion along the medulla appears to have increased in extent and now extends down into the cervical spinal cord. The other lesions appear to be relatively stable.Findings raise the question of possible lesion in the left optic nerve at the canalicular segment. It is not clear whether this was present on 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. There are patchy ill-defined lesions located within the cervical spinal cord at the C1 level, the C3 to level, the C3-C4, C5, C6, C7 and the visualized upper thoracic levels. These lesions appear to be predominantly along the near midline aspects of the cervical spinal cord.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge at this level.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge at this level.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge at this level.There is a disc bulge at T1-T2.The vertebral artery flow voids appear to be intact.

Output: 1.Since the prior exam the lesion located in the medulla has extended inferiorly into the upper cervical spinal cord.2.There are multiple lesions scattered in the supratentorial and infratentorial brain as well as the cervical spinal cord as detailed above which are concerning for demyelinating process.


Instruction: Generate impression based on medical findings.

Input: 17 year-old female status post fall with double vision and headache, loss of consciousness and blood from left ear canal. There is no evidence of intracranial mass or edema. A small focus of high density presumably represents an extra-axial fluid collection adjacent to the frontoparietal cortex, (images 12 and 13). Focus of soft tissue density overlying the left parietal occiput likely represents a hematoma without underlying fracture.These focal findings suspicious for a small subdural hematoma would be better evaluated with an MRI.Low-density focal widening of the right lateral sylvian fissure may represent an arachnoid cyst (image 7).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: 1. Small focus of hyperdensity, as described above, may represent a subdural hematoma which would be better evaluated with MRI.2. Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: 67-year-old male with history of multiple sclerosis experiencing left-sided weakness. Brain MRI:Restricted diffusion with ADC hypointensity within the left cerebellar hemisphere correlates with previously identified increased hypoattenuation within the left cerebellar hemisphere. To a lesser extent, there are a few small foci of restricted diffusion with ADC hypointensity within the right cerebellar hemisphere and vermis. This is associated with some folio effacement on the left, T2 hyperintensity,T1 hypointensity, and a minimal degree of enhancement. This constellation of findings is consistent with subacute infarction. Previously identified supratentorial restricted diffusion in 2012 has resolved.Redemonstrated is T2 hyperintensity within the white matter, confluent in many locations, without associated mass effect correlating with previous hypodense abnormality on CT. There is no associated enhancement. Encephalomalacia in the right parietal lobe and right frontal lobe from prior remote infarct is noted. Prominence of the right sylvian fissure is again noted as identified on the recent head CT, correlating with evolution of the restricted diffusion identified on the 2012 MRI.Mucosal thickening is again noted within the left maxillary sinus. Expected vascular flow-voids are demonstrated, including the distal bilateral vertebral arteries and basilar artery.Cervical spine MRI:Numerous foci of T2 hyperintensity are noted within the cervical cord, most prominently identified at the following levels: C2, C3, C4, C5/6, C7, and T1.There are no fractures. The marrow signal is benign. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: Mild posterior osteophyte disc complex, ligamentum flavum thickening, left uncinate hypertrophy, and left facet hypertrophy. There is moderate left neural foraminal stenosis.C3/4: Trace retrolisthesis C3 on C4, posterior osteophyte disc complex, uncinate hypertrophy, ligamentum flavum thickening, and left facet hypertrophy. There is mild central and severe bilateral neural foraminal stenosis.C4/5: Trace retrolisthesis C4 on C5, posterior osteophyte disc complex, uncinate hypertrophy, ligamentum flavum thickening, and minimal left facet hypertrophy. There is minimal central and severe bilateral neural foraminal stenosis.C5/6: Posterior osteophyte disc complex, ligamentum flavum thickening, and bilateral uncinate hypertrophy. There is severe bilateral neural foraminal stenosis.C6/7: Posterior osteophyte disc complex, left uncinate hypertrophy, and ligamentum flavum thickening. There is moderate left neural foraminal stenosis.C7/T1: Posterior osteophyte disc complex without significant stenosis.

Output: 1.Findings consistent with subacute infarction involving the cerebellar hemispheres (left greater than right) and vermis.2.Redemonstrated is extensive T2 abnormality within the supratentorial white matter, none of which enhances. Some of this correlates with previously identified foci of ischemia. However, the findings most likely represent a confluence of the patient's known multiple sclerosis and superimposed vascular disease.3.Numerous foci of T2 hyperintensity are noted within the cervical cord, most prominently identified at the following levels: C2, C3, C4, C5/6, C7, and T1.4.C2/3: Moderate left neural foraminal stenosis.5.C3/4: Mild central and severe bilateral neural foraminal stenosis.6.C4/5: Minimal central and severe bilateral neural foraminal stenosis.7.C5/6: Severe bilateral neural foraminal stenosis.8.C6/7: Moderate left neural foraminal stenosis.


Instruction: Generate impression based on medical findings.

Input: 86-year-old female with altered mental status and history of transient ischemic attack x 2. Rule out ischemia. There is no evidence of intracranial hemorrhage, mass or edema. Small lacunae in the right basal ganglia. Few diffuse hypodensities consistent with minimal small vessel disease, age indeterminate, essentially within normal limits for the patient's age. If there is clinical concern for acute ischemia an MRI may be considered.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: Minimal 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: A patient submitted outside study for review. Submitted for review are breast MRI (3/16/2015) performed at silver cross. For comparison, prior MRIs dated 5/6/2014 and 10/9/2013 are available. MRI was performed as per outside protocol.Per outside report, the patient is status post bilateral mastectomies. The tissue seen is therefore all compatible with bilateral reconstructions. Multiple signal voids from surgical clips are seen bilaterally. There are bilateral areas of fat density with thin peripheral enhancement compatible with fat necrosis. The largest area is in the right upper breast measuring 6.4 x 7.9 x 6.8 cm. The largest left breast area is located medially and inferiorly, and measures 3.6 x 1.7 x 2.1 cm. A 5 mm focus of enhancement in the right lateral reconstruction near 9:00 is stable compared to priors and likely represents a small intramammary lymph node. No abnormal lymph nodes are identified in either axillary region.

Output: Benign MRI appearance is compatible with bilateral areas of fat necrosis in this patient who is status post bilateral mastectomies and reconstructions.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: 21-year-old male with pain and swelling of fifth metatarsal The bone marrow signal is within normal limits. The fifth metatarsal specifically appears unremarkable. There is no evidence of fracture or malalignment. Extensor and flexor tendons are intact with normal signal intensity.

Output: No fracture or other specific finding to account for the patient's pain.


Instruction: Generate impression based on medical findings.

Input: Patient with adenocarcinoma of the lung and multiple known bony metastases and 3 possible brain metastases shown on outside MRI, but only visible on once axial slice each. Need MRI with thin cuts to evaluate for brain metastases. No focal neurologic deficits. High functioning. There are multiple, at least 15, supratentorial and infratentorial subcentimeter lesions. For example, the largest supratentorial lesion is located in the right precentral gyrus and lateral to the right posterior cingulate gyrus and measure 4 mm in diameter, while the largest infratentorial lesion is located in the left cerebellar hemisphere and measures 6 mm in diameter. There are also multiple enhancing lesions in the skull, including within the clivus, as well as within the mandible. There is no evidence of intracranial hemorrhage 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, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Multiple, at least 15, supratentorial and infratentorial subcentimeter lesions are compatible with metastases.2. Multiple bone lesions are also compatible with metastases.


Instruction: Generate impression based on medical findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.he patient was placed supine on the fluoroscopy table. The left hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 12 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 55 seconds

Output: Successful fluoroscopic-guided left hip arthrogram injection.


Instruction: Generate impression based on medical findings.

Input: Left arm numbness, right leg numbness, left face numbness, rule out transient ischemic attacks. There is no evidence of acute infarct, intracranial hemorrhage, mass. There is a punctate focus of T2 hyperintensity within the right frontal lobe, unchanged. Otherwise, the brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are unchanged. There is no midline shift or herniation. The major cerebral flow voids are intact. There are retention cysts in the maxillary sinuses. The orbits are grossly unremarkable. There is a 2 mm thick frontal outer table osteoma.

Output: 1. No evidence of acute infarct or intracranial hemorrhage.2. Unchanged nonspecific punctate focus of T2 hyperintensity in the right frontal lobe white matter.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: There is a large right-sided chest wall mass just anterior to the manubrium and sternum which is incompletely imaged, and seen on prior PET/CT to represent metastasis. Additionally, there is partial visualization of a larger right lateral chest wall mass.There is moderate to severe motion artifact which significantly limits evaluation. While there are are multiple enlarged lymph nodes in the right subpectoral region and axilla, with the largest lymph node in the right infraclavicular fossa measuring 16 x 10 mm. There is no significant mass-effect or compression of the brachial plexus/neurovascular bundle suspected however the branches of the right brachial plexus appear to course into the large lateral right chest wall mass.There is mild cervical spondylosis.

Output: 1.Moderate to severe motion artifact limited examination with no evidence for right brachial plexus compression. However the right brachial plexus branches appear to course into the area of the large right lateral chest wall mass.2.Large right-sided chest wall masses partly imaged, consistent with metastases. Also lytic left manubrial metastasis.


Instruction: Generate impression based on medical findings.

Input: hypothyroidism. Evaluate for thyroid gland abnormality.EXAMINATION: Sonogram thyroid RIGHT LOBE MEASUREMENTS: 1 x 2 x 0.8 cmLEFT LOBE MEASUREMENTS: 0.8 x 2 x 0.8 cmISTHMUS MEASUREMENTS: 2 mmRIGHT LOBE: Normal in echogenicity and vascularity with no focal lesion.LEFT LOBE: Normal in echogenicity and vascularity with no focal lesion.ISTHMUS: Normal in echogenicity and vascularity with no focal lesion.PARATHYROID GLANDS: Not visualized. LYMPH NODES: Normal size and appearance of cervical lymph nodes.OTHER: No significant abnormality noted.

Output: Normal examination.


Instruction: Generate impression based on medical findings.

Input: 55-year-old female with history of HCV cirrhosis and HCC status post resection ABDOMEN:LIVER, BILIARY TRACT: Redemonstrated cirrhotic morphology with residual prominence and hypertrophy of the left lobe.Postsurgical changes of a segment 5 hepatectomy with heterogenous T2 signal in the surgical bed is again noted measuring 3.1 x 2.3 cm, previously 3.7 x 2.5 cm. There is a small amount of subcapsular fluid overlying the resection cavity, also decreased. Decreased extent of diffusion restriction, now with peripheral curvilinear focus at the anterior aspect of the cavity. No abnormal enhancement is evident. SPLEEN: Top normal splenic size.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Marked stenosis/occlusion of the proximal celiac trunk with collateralization is again noted. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Susceptibility artifact from surgical material in the anterior abdominal wall. OTHER: No significant abnormality noted.

Output: 1.Postsurgical changes of a segment 5 resection with decrease in size of the resection cavity. No evidence of local recurrence.


Instruction: Generate impression based on medical findings.

Input: Evaluate for left breast implant rupture There is scattered fibroglandular tissuein the right breast.Mild parenchymal enhancement is noted in the right breast. Left silicone implant is intact. No evidence of rupture. No abnormal enhancement is seen in right breast and left reconstructed breast. 5 mm enhancing focus in the central right breast with a dark internal septations most likely represents a benign fibroadenoma. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on medical findings.

Input: Clinical question: Status post tumor resection. Signs and symptoms: Status post tumor resection. Pre and post enhanced brain MRI:Examination demonstrates postoperative changes of left posterior temporal craniotomy for removal of tumor. Extensive residual peritumoral vasogenic edema and its associated mass effect with resultant effacement of left occipital horn and trace deviation of midline to the right is again noted.A surgical cavity containing a small amount of hemorrhage and procedural air is noted. Surgical cavity measures approximately 26 x 28 mm in transaxial dimensions. Post enhanced images there is a thick irregular wall enhancement of surgical cavity primarily along its inferior medial aspect which is highly suggestive of residual tumor. This component of tumor is abutting the occipital horn of left lateral ventricle and measures at least at 26 mm in length and 13 mm in transverse axis. On sagittal post enhanced series 14 image 24 residual mass appears larger and measures at 30 x 33 mm in size.There is a visualization of a stable enhancing mass in the posterior lateral aspect of right cerebellum since prior study measuring at approximately 18 x 12 mm in size.

Output: 1.Expected postoperative changes of left posterior temporal-parietal craniotomy as detailed.2.There is residual enhancing tumor abutting and encasing the left occipital horn of lateral ventricle measuring at 30 x 33 millimeters on sagittal post enhanced images.3.Stable diffuse peritumoral edema and associated mass effect with trace deviation of midline to the right.4.Stable enhancing right cerebellar tumor since prior exam as detailed/measured above.


Instruction: Generate impression based on medical findings.

Input: Headache; likely migraine, but rule out other structural reason. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain, cerebellum, brainstem, and pituitary gland appear unremarkable. There is an incidental left occipital lobe developmental venous anomaly. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral artery flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: No evidence of intracranial structural abnormalities other than an incidental left occipital lobe developmental venous anomaly.


Instruction: Generate impression based on medical findings.

Input: Other general symptoms(780.99) [780.99], Reason for Study: ^Reason: etiology for altered mental status History: AAO x2 There is no evidence of acute ischemic or hemorrhagic lesion on the scan.On FLAIR images, there are multifocal bihemispheric scattered white matter lesions indicating nonspecific small vessel disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion.Minimal scattered nonspecific small vessel ischemic disease.


Instruction: Generate impression based on medical findings.

Input: Status post prostatectomy. Evaluate for recurrence. History of her buttock-assisted laparoscopic radical prostatectomy and bilateral pelvic lymph node dissection 10/07/2015. No recent PSA in the system. PELVIS:PROSTATE: Status post radical prostatectomy. There is mild asymmetric hyperemia of the right anterior vesicourethral anastomosis (series 1901/40 and 1801/37) which may be physiologic/post-surgical without discrete nodular enhancement. BLADDER: No significant abnormality noted.LYMPH NODES: Small external iliac and inguinal lymph nodes are not pathologically enlarged.BONES, SOFT TISSUES: Partially imaged infrarenal abdominal aortic aneurysm; see prior CT for further characterization.OTHER: Duplicated left collecting system is partially imaged.

Output: Mild asymmetric hyperemia of the right anterior vesicourethral anastomosis (series 1901/40 and 1801/37) which is favored to be physiologic/post-surgical, no discrete nodular enhancement.


Instruction: Generate impression based on medical findings.

Input: There are postsurgical findings consistent with midline suboccipital craniotomy relating to resection of pontine cavernous malformation. Susceptibility related to hemosiderin deposition is demonstrated in the posterior pons with small foci of nonspecific T1 and T2 signal. The exophytic portion of the pontine lesion has been resected. The lesion now measures 8 x 6 mm, previously 12 x 15 mm. A prominent adjacent DVA in the left cerebellum is again demonstrated. The ventricles and sulci are within normal limits. Slightly prominent perivascular spaces are incidentally noted along the ventricular atria within the periventricular white matter. The cisterns remain patent. There is no midline shift or mass effect. There are no additional areas of abnormal signal or pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.

Output: There are interval postoperative findings related to resection of dorsal pontine cavernous malformation with a residual rounded dorsal pontine signal abnormality suspected to represent a small residual component of the lesion. The exophytic component has been entirely resected. A prominent left cerebellar DVA is again demonstrated.


Instruction: Generate impression based on medical findings.

Input: 57-year-old female with known CCM disease including bleeding in July 2015, and prior history of resection in 2007. There are innumerable areas of low signal intensity on susceptibility-weighted sequences of varying sizes within the bilateral cerebral hemispheres as well as brainstem and cerebellum consistent with cavernous malformations. There is a large lesion within the left posterior frontal lobe abutting the frontal horn of the left lateral ventricle measuring 3.2 cm x 3.1 cm (series 701, image 19) which demonstrates internal T1 hyperintensity which may be related to recent hemorrhage. An additional lesion within the medial right temporal lobe measures 2.3 cm x 2.0 cm (series 701, image 11) demonstrates similar signal intensity pattern. There is no surrounding edema associated with these lesions. There is also hemosiderin staining involving the left pre- and postcentral gyri likely related to prior rupture of a cavernous malformation. There is evidence of prior resection within the right parietal lobe. There is no evidence of infarct. No midline shift or herniation. No hydrocephalus.Partial opacification of the right maxillary sinus, anterior ethmoid air cells and sphenoid sinuses. The orbits are unremarkable.

Output: 1. Numerous cavernous malformations throughout the brain. The largest lesions involving the left posterior frontal periventricular region and the right medial temporal lobe demonstrate T1 hyperintensity which may be related to more recent hemorrhage. There is also hemosiderin staining involving the left pre and postcentral gyri likely related to prior ruptured cavernous malformation. No edema is associated with the lesions. No prior studies are available for comparison, and if made available, an addendum can be issued.2. Postsurgical changes in the right parietal lobe presumably related to prior cavernous malformation resection.


Instruction: Generate impression based on medical findings.

Input: 41-year-old female BRCA 1 positive. Family history of breast cancer diagnosed in maternal cousin, ovarian cancer diagnosed in mother, and cervical cancer in maternal grandmother. There is scattered fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on medical findings.

Input: 74-year-old female with altered mental status. Evaluate for stroke. Large focal left hypodensity within the extra-axial space with septations and mass effect. This finding could represent a chronic subdural hematoma. Further imaging evaluation with MRI may be considered, if clinically warranted. Mild microangiopathic changes of indeterminate age.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: Large focal hypodensity may be due to chronic subdural hematoma but would be better evaluated with MRI, if clinically warranted.


Instruction: Generate impression based on medical findings.

Input: 52-year-old female with pain and weakness. Evaluate post rotator cuff repair one year ago. Evaluation of the greater tuberosity and adjacent soft tissue is limited due to metallic susceptibility artifact from orthopedic hardware.ROTATOR CUFF: At the 12:00 position, a thin supraspinatus tendon can be followed from the myotendinous junction to the greater tuberosity at the vicinity of aforementioned orthopedic hardware. This intact portion of the tendon measures approximately 1.5 to 2 cm in AP dimension. We suspect that there is delamination of the undersurface fibers of the supraspinatus with retraction to the level of the glenohumeral joint, but this may represent pre-existing undersurface tearing rather than postoperative tearing. There is a fluid-filled gap along the anterior margin of the remaining supraspinatus tendon insertion compatible with a full-thickness tear of the anterior fibers of the supraspinatus, but again we are uncertain if this represents a pre-existing tear or tear which occurred following surgery. There is mild atrophy of the supraspinatus muscle. The infraspinatus muscle and tendon appear intact, although there is perhaps mild fatty infiltration along the myotendinous junction. The teres minor muscle and tendon appear intact. Subscapularis muscle and tendon appear intact.SUPRASPINATUS OUTLET: There is mild widening of the acromioclavicular joint indicating prior surgery. There is a small amount of fluid within the subacromial bursa. There is anterior spurring of the acromion process.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is within normal limits. We see no evidence of joint effusion. Branching intermediate signal intensity within the superior labrum as well as attenuation of the posterior labrum may reflect degenerative tearing.BICEPS TENDON: The biceps tendon is noted anterior to the proximal humeral diaphysis but this disappears within the bicipital groove, presumably representing prior tenotomy.

Output: 1. Fibers of the thinned supraspinatus tendon can be traced to their insertion on the greater tuberosity. There appears to be delamination of the undersurface fibers of the supraspinatus tendon, with retraction proximally, as well as full-thickness tearing of the anterior most fibers of the tendon. However, we cannot state with certainty if this represents pre-existing tearing or tearing that is occurred since surgery.2. Postoperative changes of the greater tuberosity, acromioclavicular joint, and biceps tendon as described above.3. Degeneration of the glenoid labrum.


Instruction: Generate impression based on medical findings.

Input: Left shoulder pain ROTATOR CUFF: There is marked tendinopathy of the supraspinatus and infraspinatus tendons at the insertion upon the greater tuberosity. There is a small focus of full-thickness tearing involving the distalmost fibers of the supraspinatus tendon. The supraspinatus and infraspinatus muscles are preserved. The teres minor tendon and muscle and tendon are intact. There is mild insertional tendinosis of subscapularis tendon. The subscapularis muscle is intact.SUPRASPINATUS OUTLET: There is severe arthrosis of the acromioclavicular joint. A trace amount of fluid is present in the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The humeral head is slightly high riding. Mild osteoarthritis affects the glenohumeral joint. There is marked irregularity and abnormal morphology of the anterior labrum likely the result of chronic degenerative tearing. There is no joint effusion.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1. Rotator cuff tears involving the supraspinatus and infraspinatus tendons as described above.2. Severe osteoarthritis of the acromioclavicular joint.


Instruction: Generate impression based on medical findings.

Input: 83 year old man with history of bradycardia with dual chamber pacemaker, PVC s/p recent ablation, referred for cardiac MR to evaluate scar. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 48%, the LV end diastolic volume index is 76 ml/m2 (normal range: 74+/-15), the LVEDV is 167 ml (normal range 142+/-34), the LV end systolic volume index is 39 ml/m2 (normal range 25+/-9), the LVESV is 86 ml (normal range 47+/-19), the LV mass index is 72 g/m2 (normal range 85+/-15), and the LV mass is 159 g (normal range 164+/-36). There is abnormal septal motion and apical hypokinesis. There is a small, focus of subendocardial late gadolinium enhancement in the basal lateral wall which is not transmural but extends to 2/3 of the wall thickness. Although the late gadolinium enhancement involves the endocardium, it is associated with normal wall thickness and is not likely to be secondary to a small focal myocardial infarction. It suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process.There is [no]myocardial iron overload. There is no LV thrombus. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 48%, the RV end diastolic volume index is 90 ml/m2 (normal range 82+/-16), the RVEDV is 197 ml (normal range 142+/-31), the RV end systolic volume index is 47 ml/m2 (normal range 31+/-9), and the RVESV is 103 ml (normal range 54+/-17). A pacemaker lead terminates in the right ventricular apex. Right AtriumThe right atrium is normal in size. A pacemaker lead terminates within the right atrial appendage. Aortic ValveThe aortic valve opens widely. Qualitatively there is mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is mildly dilated (44 mm at the sinus of Valsalva; 39 x 39mm ascending aorta.)Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated (34mm). Venous AnatomyThe SVC and IVC drain normally into the right atrium. Pacemaker leads traverse the innominate and SVC into the right heart.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsA pacemaker is present in the right upper chest wall. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal LV size with mildly reduced systolic function (EF 48%). There is a small focus of late gadolinium enhancement as described above which suggests the presence of a fibrosing, infiltrative, or inflammatory process. 2. Normal RV size with mildly reduced systolic function (EF 48%).3. Pacemaker leads within the SVC and right heart.4. Mild aortic regurgitation. 5. Mildly dilated aortic root. 6. Mildly dilated main pulmonary artery. 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: Melanoma with new brain metastases on CT scan. There is a medial left cerebellar enhancing lesion that measures up to 18 mm, a left lateral cerebellar enhancing lesions that measures up to 10 mm, a left middle frontal gyrus enhancing lesion that measures up to 9 mm, a left superior frontal gyrus lesion that measures up to 6 mm, a left hippocampal tail enhancing lesion that measures up to 4 mm, and a right medial cerebellum enhancing lesion that measures up to 4 mm. There is confluent T2 hyperintensity surrounding the lesions. There is no evidence of intracranial hemorrhage or acute infarct. There is partial effacement of the fourth ventricle. The third and lateral ventricles are not particularly enlarged. There is no midline shift or herniation. There is mild scattered subcortical and confluent periventricular white matter T2 hyperintensity without associated enhancement. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is a subcentimeter exophytic cystic lesion in the skin along the left lateral eyelid region, which may represent a hidrocystoma. There is an apical scalp lipoma that measures 7 mm in thickness. There are small bilateral maxillary sinus retention cysts.

Output: Multiple supratentorial and infratentorial metastases with vasogenic edema, but no midline shift or herniation.


Instruction: Generate impression based on medical findings.

Input: 66 year old woman with history of LV dysfunction and eosinophilia, with previous cardiac biopsy suggestive of eosinophilic myocarditis. She was referred for cardiac MRI to evaluate for scar and active inflammation. Left VentricleThe left ventricle is mild to moderately dilated with mildly reduced systolic function. The overall LV ejection fraction is 46%, the LV end diastolic volume index is 97 ml/m2 (normal range: 65+/-11), the LVEDV is 165 ml (normal range 109+/-23), the LV end systolic volume index is 52 ml/m2 (normal range 18+/-5), the LVESV is 89 ml (normal range 31+/-10), the LV mass index is 40 g/m2 (normal range 67+/-11), and the LV mass is 68 g (normal range 114+/-24). There is global hypokinesis. The native T1 myocardial relaxation time is borderline elevated (between 1040-1080ms). There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.No LV thrombus. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 78 ml/m2 (normal range 69+/-14), the RVEDV is 131 ml (normal range 110+/-24), the RV end systolic volume index is 39 ml/m2 (normal range 22+/-8), and the RVESV is 66 ml (normal range 35+/-13). No RV thrombus. Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is trivial mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The ascending aorta measures 40mm (mildly dilated). The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is a small pericardial effusion. 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. Mild to moderately dilated left ventricle with mildly reduced systolic function (LV EF 46%).2. No late gadolinium enhancement to suggest an infiltrative, inflammatory or fibrotic process. Native myocardial T1 relaxation times are at the upper limits of normal. 3. Normal size right ventricle with normal systolic function (EF 50%).4. Mild aortic regurgitation. 5. Mild tricuspid regurgitation. 6. There is a small pericardial effusion. 7. Mild aortic root dilation. 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: Seizure disorder and likely mitochondrial disorder with new focal neuro deficits. Focal right posterior parietal/occipital lobe seizures. There are scattered gyriform areas of T2 hyperintensity in the right parietal and occipital lobes. There has been interval cavitation of the expanded bilateral medullary olives with associated peripheral enhancement. There are T2 hyperintense lesions in the bilateral thalami, right larger than left. The caudate nuclei appear to be slightly T2 hyperintense diffusely. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a right superior frontal gyrus developmental venous anomaly. 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: Scattered gyriform areas of T2 hyperintensity in the right parietal and occipital lobes, persistent abnormalities in the bilateral thalami and basal ganglia, and interval cavitation of the medullary olives. Overall, the findings may represent stigmata of a mitochondrial disease, particularly Leigh and Leigh-like syndromes, with associated seizure activity and hypertrophic olivary degeneration.


Instruction: Generate impression based on medical findings.

Input: 55-year-old male with history of colorectal cancer. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Multiple perirectal lymph nodes measuring less than 5 mm noted within the perirectal fat. The closest is located on the left approximately 6 mm from the mesorectal fascia.BOWEL, MESENTERY: Near-circumferential mildly enhancing fungating mass of the upper rectum/sigmoid junction measuring 16 mm in maximal axial thickness and approximately 5 cm craniocaudally. The adjacent serosal surface is slightly indistinct as well as fat stranding suggesting tumor involvement. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Colonic mass in the upper rectum (near rectosigmoid colon) with invasion to level of serosa and adjacent mild infiltration of adjacent fat noted. Multiple small perirectal lymph nodes. The mesorectal fascia is uninvolved.


Instruction: Generate impression based on medical findings.

Input: Known CCM near brainstem, seen on outside imaging. There is a subcentimeter focus of susceptibility effect in the left periaqueductal region of the midbrain. There is no evidence of acute intracranial hemorrhage, 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: A subcentimeter focus of susceptibility effect in the left periaqueductal region of the midbrain may represent a cavernous malformation.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Dizziness and giddinessClinical question: 1 week of vertigo, concern for stroke The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. The right vertebral artery is very small on this exam and may be hypoplastic. This finding is unchanged when compared to the prior examThe visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is no evidence for acute ischemic cerebral infarction.2.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old, with headache. A 5 mm lesion is redemonstrated within the right occipital lobe showing internal T2 hyperintensity and a rim of surrounding susceptibility effect. The lesion has not changed in size. The surrounding parenchyma is free of edema. Adjacent curvilinear enhancement most likely represents a developmental venous anomaly.Several scattered small foci of nonspecific FLAIR hyperintensity are redemonstrated within the cerebral hemispheres showing no significant interval change. No edema or mass effect is detected. No abnormal extra-axial fluid collections are seen and there is no evidence to suggest acute intracranial hemorrhage. Ventricular size and morphology are within normal limits. No additional pathologic enhancement is identified intracranially.

Output: 1.Stable presumed right occipital cavernous malformation with an associated developmental venous anomaly.2.Stable scattered foci of nonspecific signal abnormality.3.No new or additional findings are seen to account for the patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: 22-year-old male with CML status post stem cell transplant with acute mental status changes. Diffuse low density seen throughout the subcortical and periventricular white matter, indicating significant white matter disease, grossly unchanged from MRI performed 5/1/2008. Diffuse intracerebral edema resulting in effacement of sulci and narrowing of the lateral ventricles is unchanged to slightly progressed compared to the prior MRI, though significantly increased from prior CT. There is no evidence of intra-cranial hemorrhage or abnormal extra-axial fluid collections. The ventricles are midline, with no evidence of midline shift.The visualized calvarium and other osseous structures are within normal limits. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Significant diffuse white matter abnormality and cerebral edema, slightly progressed from MRI performed 5/1/2008. Differential considerations include drug reaction or auto-immune reaction to stem cell transplant, less likely infection. Contrast-enhanced MRI may be considered to further evaluate this abnormality.Results were discussed with the clinical service at the time of interpretation.


Instruction: Generate impression based on medical findings.

Input: 49-year-old female. Status post liver transplant, hyperbilirubinemia. EPIC history: liver transplant 3/10, 3/11 for subcapsular hematoma, 3/23 for abdominal washout and liver biopsy for work-up of cholestasis. ABDOMEN:LIVER, BILIARY TRACT: Post surgical findings of a liver transplant. Surgical drain terminates over the anterior right hepatic dome and a new drain has been placed adjacent to the left hepatic lobe. Perihepatic packing material appears to have been removed with residual peripheral T1 hyperintensity at the lateral aspect of the liver that likely represents residual hematoma. Heterogeneous signal in segment 7 of the liver is concerning for an infarct. Very mild scattered intrahepatic biliary ductal dilatation.Limited evaluation of the hepatic vasculature on this noncontrast exam. Normal vascular flow-voids of the portal vein and hepatic veins are present on T2 sequences. The common hepatic artery signal flow void is seen 1 cm from its take off from the celiac axis; the rest of the artery is not visualized. SPLEEN: Splenomegaly measuring 17.1 cm. Peripheral heterogeneous signal in the spleen is concerning for splenic infarcts.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Infrarenal IVC filter.BOWEL, MESENTERY: Proximal small bowel dilatation up to 4.3 cm with a partially collapsed distal terminal ileum, concerning for a partial small bowel obstruction. Nonspecific small bowel wall thickening. Enteric tube terminates in the proximal jejunum.BONES, SOFT TISSUES: Anasarca. Midline skin staples.OTHER: Small amount of abdominopelvic ascites.

Output: 1.Very mild scattered intrahepatic biliary ductal dilatation. Hepatic veins and portal vein are patent with normal vascular flow voids. Common hepatic artery flow void is seen 1 cm from its take-off from the celiac axis, rest of the artery is not well-visualized. 2. Findings concerning for a segment 7 hepatic infarct and multiple splenic infarcts.3. Dilated small bowel likely due to a partial small bowel obstruction.4. Small amount of ascites.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o acute stroke History: r sided sensory deficits MRI of the brainThere is a punctate focus of diffusion restriction present along the right thalamus.There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional FLAIR and T2 hyperintense punctate lesions are present along the basal ganglia and brainstem.There are numerous punctate foci of susceptibility along the posterior fossa structures and basal gangila with much lesser involvement of the subcortical white matter.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate air fluid level in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Incidental note is made of partial empty sella.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. The posterior communicating arteries are intact. 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. The LCCA originates from the innominate artery.The vertebral artery origins are tortuous. There is 40% narrowing at the origin of th right vertebral artery. There is no significant stenosis along the course of the vertebral arteries.

Output: 1.There is a punctate focus of acute infarction along the left superior thalamus.2.Innumerable microhemorrhages are present in a pattern suggestive of hypertension.3.Older lacunar infarcts are present in the basal ganglia, brainstem and thalamus.4.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. 5.No evidence for intracranial cerebrovascular arterial stenosis6.No evidence for significant extracranial cerebrovascular occlusive disease. There is 40% narrowing at the origin of the right vertebral artery.


Instruction: Generate impression based on medical findings.

Input: Diffuse large B-cell lymphoma and PET with possible FDG avid lesion in the right cerebellum. There are small areas of encephalomalacia in the central pons, left periventricular cerebellar hemisphere, and left thalamus. In addition, there are scattered areas of high T2 signal in the bilateral cerebral white matter. However, there is no abnormal intracranial enhancement or mass. There is no evidence of intracranial hemorrhage or acute infarct. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. There are mucosal retention cysts within the maxillary and sphenoid sinuses bilaterally. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: 1. No evidence of intracranial mass or abnormal enhancement. 2. Chronic lacunar infarcts in the central pons, left periventricular cerebellar hemisphere, and left thalamus, superimposed upon a background of probable chronic small vessel ischemic disease.


Instruction: Generate impression based on medical findings.

Input: 11 years Female (DOB:9/2/2005)Reason: AVM, history intracranial hemorrhage, resection and radiation, yearly follow up History: yearly surveillance.PROVIDER/ATTENDING NAME: DAVID M. FRIM DAVID M. FRIM MRI of the brainNo diffusion weighted abnormalities are appreciated.There are numerous flow voids present in the left parietal lobe. An area of encephalomalacia and gliosis is present in the left parietal lobe adjacent to the AVM. Patient status post left-sided craniotomy. The left middle, anterior and posterior cerebral artery vasculature appears larger than the right middle, anterior and posterior cerebral artery vasculature.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. The left middle cerebral artery vasculature appears larger than the right middle cerebral artery vasculature. The left posterior cerebral artery vasculature appears larger than the right posterior cerebral artery vasculature. The left anterior cerebral artery vasculature appears larger than the right anterior cerebral artery vasculature. Venous drainage appears to be superficially draining.The prior exam was limited, however, based on the cerebral artery caliber and appearance, the AVM has not changed significantly.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.

Output: 1.Status post left parietal lobe surgery for arteriovenous malformation. There is persistence of arteriovenous malformation in the left parietal lobe. The prior exam was limited, however, based on the cerebral artery caliber and appearance, the AVM has not changed significantly. Follow-up surveillance exams inclusive of the entire head and possible with time resolved MRA would help further assess. 2.Status post left parietal surgery for AVM removal.3.Encephalomalacia adjacent to the AVM.


Instruction: Generate impression based on medical findings.

Input: There is no intracranial mass or mass-effect. There are no areas of abnormal signal or pathological enhancement. The ventricles and sulci are within normal limits. There is no midline shift or mass effect. There is no evidence of ischemia or hemorrhage. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is interval improvement in previously seen opacification of the paranasal sinus, which are now grossly clear.

Output: No evidence of metastatic disease to the brain or calvarium.


Instruction: Generate impression based on medical findings.

Input: 62-year-old male with elevated PSA, enlarged prostate. Questioning abnormal PSA. PELVIS:PROSTATE:Prostate Size: The prostate measures 5.4 cm in transverse, 4 cm in AP, and 4.8 cm in craniocaudal length.Peripheral Zone: In the mid gland left peripheral zone, there is a 17 x 12 mm ADC and T2 hypointense focus suspicious for a dominant lesion (series 301 image 42, series 403 image 224), and indistinctness of the hypointense capsule is concerning for extracapsular extension (series 301 image 42). Central Gland: Nodular changes of BPH.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: As above.BLADDER: Asymmetric thickening at the level of the left UVJ (series 601 image 64)LYMPH NODES: Nonspecific left external iliac lymph node measuring 1.3 x 0.4 cm (series 601 image 60).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Dominant lesion in the left peripheral zone mid gland measuring 17 x 12 mm with suspected extracapsular extension (PI-RADS 5).2. Asymmetric thickening at the level of the left UVJ within the bladder, possibly mass, would be better characterized with direct visualization. No prior studies are available for comparison.PI-RADS™ v2 Assessment Categories:PIRADS 1 – Very low (clinically significant cancer is highly unlikely to be present) PIRADS 2 – Low (clinically significant cancer is unlikely to be present)PIRADS 3 – Intermediate (the presence of clinically significant cancer is equivocal)PIRADS 4 – High (clinically significant cancer is likely to be present) PIRADS 5 – Very high (clinically significant cancer is highly likely to be present)https://www.acr.org/~/media/ACR/Documents/PDF/QualitySafety/Resources/PIRADS/PIRADS%20V2.pdf


Instruction: Generate impression based on medical findings.

Input: Images are somewhat limited by patient motion. There is a background of severely heterogeneous marrow signal, scattered superimposed mildly expansile discrete metastatic osseous lesions which demonstrate STIR hyperintensity and T1 hypointensity, including posterior element involvement. There has been further progression of the now moderate-severe compression deformity involving T4. The most conspicuous lesions are again noted at the T9, T11, and T12 levels. There has been interval mild-moderate compression deformity involving T12. Dorsal epidural fat encroachment by tumor is suggested at T3, T9, T12, and possibly L1 levels. However, there is no evidence of acute cord compression. There is no significant retropulsion of fracture fragments any level, with mild to moderate scattered predominantly lumbar and to a lesser degree cervical spondylotic changes. There is likely most mild-moderate central spinal canal stenosis along the lumbar spine.In addition, metastatic lesions are seen at the C5-C7 levels within the cervical spine, as well as involving all the lumbar vertebrae. There is interval pathologic compression deformity of mild-moderate degree along the superior endplate of L5 where there is focal concavity compared to prior MRI, although this likely was present on the most recent CT chest.Scattered multilevel disc narrowing is present. The spine is in normal alignment. The spinal cord is grossly of normal caliber and signal.Due to the compression deformity of the T4, there appears to be mild-moderate bilateral foraminal narrowing at at T4-T5. There is moderate bilateral foraminal narrowing at L3-4 on the left as well as moderate right foraminal narrowing at L4-L5. At L5-S1, there is suggestion of mild bilateral foraminal narrowing.There is partial visualization of diffuse or hyperintensity throughout the pons, which is nonspecific.

Output: 1.Compared to prior available spine imaging, interval development of multiple discrete cervical and predominantly lumbar lymphomatous lesions, with redemonstration of several stable scattered thoracic lesions from lymphomatous involvement. Diffuse background of heterogeneous abnormal signal throughout the marrow.2.No acute cord compression. At most mild/moderate central spinal canal stenosis at several levels along the lumbar spine, with scattered dorsal epidural tumor as detailed above.3.Interval further collapse of the T4 vertebral body which is now moderate-severe in degree. Stable mild to moderate chronic compression deformity of T12 and more recent compression deformity of L5. No significant retropulsion of fracture fragments at any level.


Instruction: Generate impression based on medical findings.

Input: Cirrhosis. Cyst found on recent ultrasound. Evaluate for lesion. ABDOMEN:LIVER, BILIARY TRACT: Mild left hepatic lobe hypertrophy and fissural prominence.Punctate cysts are noted.No focal suspicious liver lesion. No biliary ductal dilatation. The vessels are patent.Normally distended gallbladder.SPLEEN: The spleen is normal in size.PANCREAS: Pancreas divisum (series 5, image 21). Several punctate cystic foci in the pancreatic body and tail without definite communication with the main pancreatic duct which is normal in caliber. The largest is a bilobed/septated cystic lesion in the body measuring 1.1 cm. No suspicious post-contrast enhancement. No parenchymal atrophy or suspicious lesion.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral simple appearing cysts. No hydronephrosis or suspicious lesion.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small fat-containing umbilical hernia.OTHER: No significant abnormality noted.

Output: 1. 1.1 cm bilobed/septated cystic lesion in the pancreatic body without definite communication with the main pancreatic duct which is normal in caliber. No suspicious postcontrast enhancement. Additional punctate pancreatic cystic foci are noted pancreatic tail. This may be followed with serial imaging to document stability. 2. No suspicious liver lesion.3. Pancreas divisum without specific stigmata of acute or chronic pancreatitis.


Instruction: Generate impression based on medical findings.

Input: Ms. Cyrus is a 40-year-old female with a family history of breast cancer in sister (diagnosed at the age of 40) and a maternal aunt. Personal history of benign left breast MRI guided biopsy in 2014 for fibroadenomatoid change. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild background parenchymal enhancement is noted bilaterally.Scattered T2 intense nonenhancing cysts are identified bilaterally. Scattered foci of enhancement are seen in both breasts, including at site of benign left breast biopsy, all of which are stable compared to prior examinations. No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.Stable T2 hyperintense hepatic lesion.

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


Instruction: Generate impression based on medical findings.

Input: Female, 87 years old. Reason: eval for osteomyelitis History: left ankle with open wound, purulence, exposed tendon, and CRP 240 There is extensive soft tissue edema about the ankle with associated obliteration of the normal pre-Achilles fat posterior to the ankle joint. Mild heterogeneous soft tissue enhancement diffusely suggests an ongoing inflammatory process. On postcontrast images, an area of low signal in the superficial soft tissues anterior to the distal tibia with peripheral enhancement may reflect a fluid collection within the soft tissues. A small amount of fluid is noted within the retrocalcaneal bursa. Increased T2 signal within the sinus tarsus may reflect additional inflammation.The underlying osseous structures are intact, with and normal cortical thickness and bone marrow signal. The visualized tendons of the ankle are intact. The anterior talofibular ligament is not well visualized. A small ankle joint effusion is noted.

Output: 1.Diffuse soft tissue inflammation/edema, without evidence of osteomyelitis.2.Possible small fluid collection in the superficial soft tissues anterior to the distal tibia.


Instruction: Generate impression based on medical findings.

Input: 77 year-old female, evaluate for tendon injury, infection, or foreign body A marker was placed along the volar aspect of the distal thenar region/palm and the field of view was enlarged to include this region. Nonspecific edema-type signal is present along the flexor pollicis longus tendon as it courses volar to the first MCP joint. There is also mild nonspecific inflammation of the subcutaneous fat of the thumb and surrounding the proximal phalanx. Other than a small amount of fluid in the flexor pollicis longus tendon sheath, the tendon itself appears intact. The bone marrow signal intensity appears normal. There is no artifact to suggest foreign body. No fluid collection/abscess is evident. Mild edema of the subcutaneous fat along the radial aspect of the second metacarpophalangeal joint is noted. The thenar musculature appears intact. Trace fluid within the flexor tendon sheaths of the fingers is likely of no current clinical significance. Although not protocoled for detailed evaluation of the collateral ligaments of the thumb, these appear grossly intact. Note is made of osteoarthritis of the wrist and hand, as well as a possible TFCC tear, although this is not well imaged on this exam.

Output: Mild nonspecific inflammatory changes along the flexor pollicis longus tendon and proximal phalanx of the thumb as well as osteoarthritis of the wrist. We see no tendon injury, foreign body or fracture.


Instruction: Generate impression based on medical findings.

Input: Female, 8 years old. Left thigh soft tissue defect. Pain w/ activity. 2-3mo duration, not improving Focal linear areas of increased signal on fluid sensitive sequences in the subcutaneous tissues of the left anterolateral thigh with overlying skin thickening. Abnormal signal extends to the underlying fascial plane but does not involve the muscle. There is no significant abnormal enhancement in this region. No discrete fluid collection or mass lesion is identified.The deep soft tissues, osseous structures, and imaged right thigh and intrapelvic structures are normal.

Output: A small area of scattered subcutaneous fluid signal in the left anterolateral thigh is nonspecific. No discrete fluid collection or mass lesion.


Instruction: Generate impression based on medical findings.

Input: Ms. Kasprzak is a 36-year-old female with personal history of left breast lumpectomy in July 2012 for DCIS and microinvasion treated with radiation and tamoxifen therapy. Personal history of benign right breast biopsy in 2012 for intraductal papilloma. Family history of breast cancer in maternal grandmother (diagnosed at the age of 37) and maternal aunt (diagnosed at the age of 42). There is heterogeneous amount of fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.Stable postsurgical changes are identified in the left upper breast. Mildly enhancing focus anterior to the biopsy clip in the right inferior breast is stable, compatible with prior history of benign breast biopsy. No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on medical findings.

Input: 69-year-old female with a history of glioblastoma multiforme presents with generalized weakness. There is redemonstration of a large right frontotemporal lobe mass involving the insula consistent with patient's biopsy proven glioblastoma multiforme. There is hypodensity surrounding this mass consistent with a combination of tumor infiltration and vasogenic edema. Periventricular white matter hypoattenuation also noted. These findings appear similar to the prior studies though MRI would be more accurate for evaluation of tumor progression.There is no evidence of a new intracranial mass or focal lesion. There is no evidence of acute territorial ischemia. There is no acute intracranial hemorrhage or extra-axial fluid collection. While there remains 4mm of right to left midline shift, the sulci and ventricles appear slightly more prominent than in November 2011, probably on the basis of treatment related change (e.g. steroids). There is no basal cistern effacement or herniation.Right frontal bone burr hole. The remainder of the calvaria and skull base are radiographically normal. The visualized mastoid air cells are clear. Partial opacification of the ethmoid sinuses bilaterally. Bilateral lens prosthesis.

Output: 1. No acute intracranial abnormality.2. Right frontotemporal mass with surrounding edema, similar to the previous examination when allowing for differences in modalities. No significant interval change in associated leftward midline shift. MRI examination would be more sensitive for evaluation of tumor progression.


Instruction: Generate impression based on medical findings.

Input: Right parotid mass follow up. There is a fairly well defined, but heterogeneous mass in the superficial right parotid gland that measures up to 35 mm. There is suggestion of what may represent a hilum within the mass. The mass appears to have increased in size since 2013, accounting for differences in technique. The other salivary glands are unremarkable. There is no significant upper cervical lymphadenopathy based on size criteria otherwise. There is a small left vallecular retention cyst versus secretions. There is diffuse paranasal sinus mucosal thickening. There is a left inferior orbital wall blow out fracture, as well as a defect in the right lamina papyracea. There is probable plaque at the bilateral carotid bifurcations. There appears to be patchy high T2 signal in the pons and cerebral white matter, which likely represent chronic small vessel ischemia. There is multilevel degenerative cervical spondylosis.

Output: The right parotid mass has increased in size since 2013.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old, with metastatic head and neck cancer and increasing back pain. Cervical:Numerous areas of pathologic marrow replacement are demonstrated throughout the vertebral bodies and posterior elements of the cervical region. No significant compression deformities are suspected. No significant epidural disease extension is seen.Straightening of the cervical lordosis is evident. Spinal alignment is otherwise unremarkable. Vertebral body heights are preserved.Spinal cord signal intensity and morphology are unremarkable except as discussed below.C2-3: Left greater than right facet hypertrophy. Minimal posterior disk osteophyte formation. No significant spinal canal stenosis or neuroforaminal narrowing.C3-4: Left greater than right facet hypertrophy. Posterior disk osteophyte formation. Mild spinal canal narrowing with slight ventral cord flattening but no cord signal abnormality. Mild bilateral foraminal narrowing.C4-5: Mild right facet hypertrophy. Minimal posterior disk osteophyte formation. No significant spinal canal stenosis or neuroforaminal narrowing.C5-6: Marked bilateral facet hypertrophy. Posterior disk osteophyte formation. Moderate generalized spinal canal stenosis with mild mass effect on the cord. The cord tapers at this level and shows patchy bilateral T2 hyperintensity suggesting myelomalacia. Moderate to severe bilateral foraminal narrowing. C6-7: Facet hypertrophy. Mild posterior disk osteophyte formation. No significant spinal canal stenosis. Mild right foraminal narrowing. C7-T1: Facet hypertrophy. Posterior disk osteophyte formation asymmetric towards the right. Mild spinal canal narrowing with very slight ventral cord flattening but no cord signal abnormality. Mild to moderate right foraminal narrowing. Incidental note is made of asymmetry of the floor of mouth and right tongue base along with some supraglottic and mucosal thickening likely reflecting prior therapy.Thoracic:Since the prior examination, marked interval progression of patchy marrow replacement is seen. The vertebral bodies and posterior elements are affected at every visualized level with extensive involvement of the ribs as well.Epidural disease extension is suspected on the right at T6-7 with minimal encroachment upon the thecal sac but fairly significant infiltration of the right T6-7 neural foramen. Epidural disease extension is also suspected bilaterally at T7-8 with mild encroachment upon the thecal sac but infiltration of the neural foramina bilaterally. Infiltrating soft tissue is also evident between the T7 and T8 proximal ribs.The visualized spinal cord demonstrates normal signal intensity and morphology. No areas of significant spinal canal stenosis is seen. Except as discussed above, the neural foramina are unremarkable.Vertebral body heights are preserved. Spinal alignment is within normal limits.A mass is present at the left lung base along with a pleural effusion. Small nodules are also suspected within the visualized right lung.Lumbar:Areas of marrow replacement are seen at every lumbar vertebral level including the vertebral bodies and posterior elements. Scattered lesions are also evident the partially visualized sacrum and iliac bones.Vertebral body heights are grossly maintained and alignment is within acceptable limits.The visualized conus and cauda equina nerve roots are normal. No significant epidural disease extension is suspected.L1-2: Facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. No significant generalized spinal canal stenosis. No significant neuroforaminal narrowing. L2-3: Facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. No significant generalized spinal canal stenosis. Mild bilateral foraminal narrowing. L3-4: Facet hypertrophy and ligamentum flavum thickening. Bulging disk. Mild generalized spinal canal stenosis. Mild to moderate bilateral foraminal narrowing. L4-5: Facet hypertrophy and ligamentum flavum thickening. Bulging disk. No significant generalized spinal canal stenosis. Mild bilateral foraminal narrowing. L5-S1: Facet hypertrophy and ligamentum flavum thickening. Bulging disk with a small superimposed central protrusion. No significant generalized spinal canal stenosis. Mild left foraminal narrowing.

Output: 1.Widespread osseous metastatic disease, with evidence of progression at least when compared to a prior thoracic spine MRI, though more recent chest CTs show evidence of widespread metastatic disease as well.2.Mild epidural disease extension is evident at T6-7 and T7-8. This largely affects the neural foramina without significant compromise of the spinal canal.3.Mild/moderate generative disease is evident as above. There are findings suggestive of myelomalacia at C5-6 which may reflect chronic stenosis and cord impingement at this level.


Instruction: Generate impression based on medical findings.

Input: Reason: Eval cervical radiculopathy History: Shooting arm pain Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits.The cervical spinal cord has normal signal characteristics and overall morphology.Multilevel degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Small disc osteophyte complex and uncovertebral hypertrophy. No significant compromise to the spinal canal. Mild left and minimal right neural foraminal narrowing.C4-5: Small disc osteophyte complex. No significant compromise to the spinal canal. Mild bilateral neural foraminal narrowing.C5-6: Small disc osteophyte complex. No significant compromise to the spinal canal. Mild left and minimal right neural foraminal narrowing.C6-7: Small disc osteophyte complex. No significant compromise to the spinal canal or right neural foramen. Minimal left neural foraminal narrowing.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Mild degenerative changes in the cervical spine with mild multilevel neural foraminal narrowing as described above. No significant spinal canal stenosis or cord signal abnormality.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: Lung cancer with brain metastases. There is an incompletely characterized lesion in the left parietal lobe that measures up to approximately 20 mm. There is no midline shift or herniation. The ventricles are within normal limits in size and configuration.

Output: Aborted examination demonstrates a left parietal lobe lesion, which may represent a metastases, although this is incompletely characterized.


Instruction: Generate impression based on medical findings.

Input: Clinical question:? Cervical myelopathy. Signs and symptoms: LU weakness and UE hyperreflexia. Nonenhanced MRI:Examination is nondiagnostic due to fairly extensive motion artifact. The signal intensity of the cord cannot be assessed secondary to severely degraded images. The alignment of the column appears anatomical. There is moderate degenerative changes of the cervical spine which appears to be more pronounced at C3 -- C4 level. No significant central spinal stenosis is detected. Repeat exam is highly recommended when patient's condition permits.

Output: Nondiagnostic nonenhanced MRI of the cervical spine due to significant motion artifact as detailed


Instruction: Generate impression based on medical findings.

Input: 6-month-old female with tuberous sclerosis and hydronephrosis, evaluate. BLADDER  Wall Thickness: Normal  Contents: Large ureterocele is present within the bladder. Distal Ureter -- SFU Grade**  Right: 0  Left: 3   Ureteral Jets Right: Not observed  Left: ObservedKIDNEYS  Cortical Echogenicity: Normal.   Medullary Echogenicity: Normal   Pelvicaliceal System -- SFU Grade*  Right: 0 Left upper pole: 2  Left lower pole: 2   Length*** Right: 6 cm Left: 6.6 cm   Mean for age: 5.5 cm  Range for age: 4.5 - 7 cmADDITIONAL OBSERVATIONS: None.

Output: Left duplicated ureters with large ectopic ureterocele and partial obstruction of the upper pole moiety.*SFU grading system: Grade 0: No hydronephrosis. Grade 1: The renal pelvis is visualized. Grade 2: A few but not all of the calices are identified in addition to the renal pelvis. Grade 3: Virtually all the calices are seen. Grade 4: Grade 3 and parenchymal thinning. **SFU grading system retrovesical ureter: Grade 0: No ureteral dilatation. Grade 1: Ureter less than 7 mm. Grade 2: Ureter is 7-10 mm. Grade 3: Ureter is over 10 mm. Fernbach SK, Maizels M, Conway JJ. Ultrasound Grading of Hydronephrosis: Introduction to the System used by the Society for Fetal Urology. Pediatric Radiology (1993) 23: 478-480.***Rosenbaum DM, Korngold E, Teele RL. Sonographic Assessment of Renal Length in Normal Children. AJR Am J. Roentgenol (1984) 142:467-469


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Multiple sclerosisClinical question: MS, f/u progressionSigns and Symptoms: paresthesiasComments: 3T CCD, MS protocol. There is redemonstration of multiple subcortical and periventricular white matter lesions which were also present on the prior exam and does not appear to have changed in number or extent.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: Multiple periventricular subcortical white matter lesions are stable compared to the prior exam. These support the clinical diagnosis of multiple sclerosis.


Instruction: Generate impression based on medical findings.

Input: Male, 7 years old. Reason: evaluate proximal fibula radiographic abnormality. May need altered field of view History: knee pain x 6 months. slow onset. no trauma. BONE AND MARROW: The previously identified lesion along the medial aspect of the proximal fibular metaphysis is largely uniformly low signal on T1 sequences, and low signal on T2 sequences. No evidence of enhancement. The lesion arises in the fibular cortex, with discrete cortical sclerotic margins. There is no extension beyond the minimally expanded cortical margin and no adjacent soft tissue component is identified. No periosteal reaction. The bone marrow signal adjacent to the lesion is normal and no additional findings to suggest an associated fracture. Marrow and cartilage signal elsewhere is normal.MENISCI AND LIGAMENTS: No significant abnormality noted.SYNOVIUM: No significant abnormality noted.MUSCULATURE: No significant abnormality noted.ADDITIONAL

Output: Proximal fibular lesion with signal characteristics as described above, which remains most compatible with an uncomplicated benign nonossifying fibroma given the absence of additional abnormality. No findings to account for the patient's pain in the absence of an associated fracture or other abnormalities within the knee.


Instruction: Generate impression based on medical findings.

Input: BRAIN: There is a stable 39 x 50 mm right middle cranial fossa arachnoid cyst associated with mild expansion of the right middle cranial fossa. No definite abnormal white matter T2 hyperintense lesions are seen in the cerebral hemispheres, corpus callosum, or the posterior fossa. At most, there may be a very small focus of T2 hyperintensity adjacent to the right temporal horn, but this is equivocal (see image 34 series 501). A 9 x 6 mm extra-axial dural based enhancing nodule is evident along the left postcentral sulcus. This lesion exerts no mass effect on the adjacent parenchyma and is unchanged.The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. CERVICAL: There is mild reversal of the normal cervical lordosis. The osseous marrow signal is benign. There are minimal type I degenerative changes at the C6-7 endplates. No worrisome marrow enhancement is detected.Spinal cord signal is within normal limits. There is no abnormal cord enhancement is seen.C2-3: No disk herniation or spinal stenosis.C3-4: No disk herniation or spinal stenosis.C4-5: Mild facet hypertrophy. No disk herniation or spinal stenosis.C5-6: Disk osteophyte complex effacing the ventral CSF without significant spinal canal stenosis. Bilateral uncovertebral hypertrophy causing no significant neural foraminal stenosis.C6-7. Disk osteophyte complex with ventral CSF effacement without significant spinal stenosis. Mild right neuroforaminal narrowing.C7-T1: No disk herniation or spinal stenosis.The sagittal images show no significant disk herniation or spinal stenosis at T1-2 and T2-3.

Output: 1.Questionable T2 white matter lesion along the right temporal horn suspected. No other discrete white matter lesions are identified in the brain.2.A 9 x 6 mm enhancing dural based nodule is evident adjacent to the left parietal lobe most likely representing an incidental meningioma. This lesion is unchanged.3.Stable arachnoid cyst in the right middle cranial fossa.4.No demyelinating lesions are detected in the cervical spine.5.Mild cervical spondylosis is seen as above.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: 56-year-old male with right hand/arm pain and swelling for one week. Evaluate for infection. No bone marrow signal abnormality is identified. There is no evidence to suggest osteomyelitis. There is extensive diffuse increased signal abnormality in the soft tissues of the right forearm and wrist, most pronounced along the dorsal aspect of the wrist and forearm, consistent with edema/inflammation. There is a moderate amount of fluid within the radiocarpal joint. There are multiple fluid collections about the wrist. There is a 2.2 x 1.4 cm collection about the dorsal aspect of the extensor carpi ulnaris and extensor digiti minimi tendons. There is an additional fluid collection deep to the flexor digitorum tendons measuring approximately 3.1 x 1.3 cm. It should be noted that evaluation for abscess formation is limited due to lack of intravenous contrast.

Output: Multiple focal fluid collections about the wrist, suspicious for abscess formation, with associated extensive soft tissue swelling about the wrist and forearm, as described above.


Instruction: Generate impression based on medical findings.

Input: Sickle cell disease. Right arm numbness/weakness today that is resolving. Evaluate for CVA. Multiple subcortical and periventricular white matter hypodensities in the bilateral frontal and parietal lobes are compatible with small vessel ischemic disease. Most of these areas were present on the prior examination. However, an MRI would be helpful in evaluating for an acute infarct. There is no evidence of intracranial hemorrhage, mass or edema. Prominence of the sulci and ventricles consistent with corticomedullary volume loss. No midline shift.The calvarium is thickened, likely reflecting extramedullary hematopoiesis in a patient with sickle cell disease. This appears similar to the prior examination. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Moderate small vessel ischemic disease, similar in appearance to the prior examination. However, an MRI would be helpful in evaluating for an acute infarct as clinically indicated.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Cerebellar hemorrhage. Signs and symptoms: Cerebellar hemorrhage. Nonenhanced brain MRI:No evidence of restricted diffusion on diffusion weighted studies.Examination demonstrates a focus of susceptibility/hemorrhage in the left cerebellum with subtle surrounding vasogenic edema without into change since the prior CT examination from 4 -- 24 -- 2015. Hematoma measures 9.5 x 8-mm in transaxial dimensions and without interval change or appreciable mass effect. The fourth ventricle remains within normal and in midline.Unremarkable images through posterior fossa otherwise.Images through the supratentorial space demonstrate patchy periventricular and subcortical flair/T2 hyperintensity highly suggestive of small vessel ischemic strokes of mild degree without evidence of hemorrhagic changes.Unremarkable cerebral cortex and cortical sulci as well as ventricular system and CSF spaces otherwise. The signal voids of major intracranial arterial branches are identified.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells. Paranasal sinuses are well pneumatized however a retention cyst in the left maxillary sinus is noted. Bilateral mastoid air cells and there cavities demonstrate normal pneumatization signal patterns.Nonenhanced brain MRA: Patent bilateral intracranial vertebral arteries, bilateral pedicle branches, plaster are free and its distal branches. Mild atherosclerotic disease of right vertebral artery without significant vascular lumen compromise is noted.Patent right internal carotid artery however but it is some mild atherosclerotic disease of the cavernous segment and unremarkable otherwise. Patent right anterior and middle cerebral arteries and their branches. Mild atherosclerotic irregularity of the M1 segment of right middle cerebral artery is noted.Patent left internal carotid artery across the skull base however with mild atherosclerotic irregularity of its cavernous portion. Unremarkable left supraclinoid internal carotid, the left anterior and middle cerebral arteries.

Output: 1.Left cerebellar acute hematoma measuring 9.5 x 8-mm with subtle surrounding vasogenic edema and no appreciable mass-effect. Mild chronic nonhemorrhagic small vessel ischemic strokes only in the subcortical and periventricular white matter of cerebral hemispheres. 2.Mild atherosclerotic disease of the bilateral cavernous carotids and right vertebral artery without significant vascular lumen compromise and unremarkable nonenhanced brain MRI otherwise.


Instruction: Generate impression based on medical findings.

Input: Bilateral lower extremity weakness and dizziness. There is extensive encephalomalacia in the left middle cerebral artery, predominantly involving the inferior left frontal lobe, with associated regional gyriform susceptibility effect and ex vacuo dilatation of the left lateral ventricle. There is no evidence of intracranial hemorrhage, mass, or acute infarct. 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 minimal mucosal thickening int he right ethmoid sinuses.

Output: Chronic left middle cerebral artery territory infarct, but no evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on medical findings.

Input: Other intervertebral disc displacement, thoracic region [M51.24] / Radiculopathy, lumbar region [M54.16], Reason for Study: Thoracic spineThere is normal thoracic kyphosis.The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The cord signal is normal. Minimal bulging of discs at the level of T8-T9, T9-T10, and T10-T11.L Spine:Scoliotic posture of lumbar spine was seen.Spinal cord signal is normal and the conus medullaris terminates at the level of T12-L1Degenerative changes are specified by the intervertebral level as follows: L1-L2: minimal bulging of disc with bilateral ligamentum flavum thickening. No neuroforaminal narrowing or spinal stenosis. L2-L3: disc dessication, diffuse bulging of disc with focal disc bulging toward left side neural foramen associated with left side ligamentum flavum thickening results left side neuroforaminal narrowing. L3-L4: disc dessication, Diffuse bulging of disc with broad based disc bulging toward the left side neural foramen results mild neuroforaminal stenosis. Bilateral ligamentum flavum were thickened. No evidence of spinal stenosis. L4-L5: disc dessication, diffuse bulging of disc, bilateral ligamentum flavum thickening with facet hypertrophy result bilateral mild neuroforaminal narrowing. No spinal stenosis. L5-S1: disc dessication, no neuroforaminal narrowing or spinal stenosis.

Output: 1. Spinal cord signal intensity is normal.2. Mild bulging of disc on multiple thoracic levels without evidence of spinal canal stenosis.3. Degenerative changes of lumbar spine with scoliotic changes.4. Multilevel lumbar level intervertebral disc degeneration with various degree neural foraminal stenosis especially on the left side as described above.


Instruction: Generate impression based on medical findings.

Input: 51 yo female with C2 cavernoma. Surveillance. Cervical Spine: Focus of increased T2 signal abnormality with hemosiderin rim in the ventral left cervical cord at the C2 level measures 5 x 6 x 7 mm (AP x TR x CC), and unchanged allowing for differences in technique. This focus demonstrates associated T1 hyperintensity as well as mild enhancement and unchanged.Cervical spine alignment is anatomic. Signal intensity and morphology of the vertebral bodies are within normal limits. Mild degenerative changes are again seen with central disk protrusion at the C3-C4 level with mild flattening of the ventral cord. No associated cord signal abnormality. There is mild left neural foramina stenosis on the left at C3-C4 related to facet arthropathy and uncovertebral hypertrophy. Mild disc bulge at C6-7 also unchanged without significant spinal canal or neural foraminal stenosis. T1 hyperintense focus at the T2 vertebral body compatible with hemangioma.Brain:No intracranial mass or mass-effect. No lesions to suggest brain cavernous malformation. No intracranial hemorrhage. No restricted diffusion. The ventricles are within normal limits in size and configuration. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Brain parenchyma is otherwise unremarkable for age. There is diffuse mucosal thickening involving the left maxillary sinus.

Output: 1. Compared to 6/29/2012, no significant change in size of left ventral C2 lesion consistent with cavernous malformation. 2. Mild degenerative changes including central disc protrusion at C3-4 with mild spinal canal stenosis and mild left neural foraminal stenosis is also unchanged.3. Brain parenchyma is essentially unremarkable for age. No brain cavernous malformations.