Instruction: Generate impression based on medical findings.

Input: 60 year-old male who presents with ataxia. Rule out CVA. There is mild generalized prominence of the ventricles and sulci, consistent with volume loss, which is slightly advanced for the patient's age. There is no evidence of acute intracranial hemorrhage, mass or edema. There is no evidence of extra-axial fluid collection. There is a focal area of hypoattenuation of the left lentiform nucleus in keeping with a chronic infarct (probably small vessel ischemic). Multiple age indeterminate scattered hypodensities are noted within the periventricular and deep white matter bilaterally, better seen on prior MRIs. These findings are nonspecific but most commonly represent mild small vessel ischemic disease. No CT evidence of acute territorial ischemia.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are clear. Moderate intracranial vascular calcifications are noted.

Output: 1. No acute intracranial hemorrhage, CT identifiable acute territorial ischemia or focal mass.2. Old lacunar infarct in the left lentiform nucleus.3. Multiple age indeterminate scattered hypodensities are noted within the periventricular and deep white matter bilaterally. These findings are nonspecific but most commonly represent chronic small vessel ischemic disease. We note an MRI of the brain has been subsequently performed for this patient.


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.The 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, 10 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. Subsequently, 1 cc of Kenalog (40 mm) was injected intra-articularly. The needle was then 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: 24 seconds.

Output: Successful fluoroscopically guided injection of gadolinium into the left hip for MRI arthrogram as well as intra-articular injection of Kenalog.


Instruction: Generate impression based on medical findings.

Input: 64-year-old male experiencing groin pain, history of L3 compression fracture as well as lipomyelomeningocele. Redemonstrated is a severe compression fracture involving the L3 vertebral body with near complete height loss involving the anterior mid aspect of the vertebral body similar to prior, without residual marrow edema. As before, there is evidence of cement augmentation at the L3 vertebral body is again seen. Enhancement within the disc spaces above and below this compression deformity is felt to be reactive as there is no disc fluid. There is no pathologic enhancement elsewhere.Remainder of the vertebral body heights are normal. Alignment is grossly maintained in the lumbar spine. There are diminished posterior osseous elements from L3-L4 to the sacrum reflecting combination of prior laminectomies and dysplasia, stable in appearance.Abnormal T2 signal likely reflecting myelomalacia in the spinal cord at the L2-L3 level again seen, which is unchanged. The spinal cord remains low-lying with the distal neural tissue/conus extending to the L5 level. Septations/adhesions are again again noted in the thecal sac from the L5 to S1 levels similar to prior. Lipoma within the thecal sac at the right lateral S1 level is again seen as well as along the distal aspect of the filum in the midline at the S2 level. These findings are stable in appearance.Degenerative changes are specified by the intervertebral level as follows and unchanged since 3/31/2016:T12-L1: No spinal canal or neural foraminal stenosis, unchanged.L1-L2: There is bilateral facet hypertrophy and ligamentum flavum thickening. There is minimal disc bulge. There is unchanged mild central canal stenosis and bilateral mild to moderate neural foraminal stenosis. These findings are unchanged, and are best visualized on sagittal T2 technique.L2-L3: There is bilateral facet hypertrophy and ligamentum flavum thickening. There is diffuse disc bulge with central protrusion component resulting in moderate to severe spinal canal stenosis and moderate bilateral foraminal stenosis. These findings are unchanged.L3-L4: There is bilateral facet hypertrophy and ligamentum flavum thickening. There is also mild disc bulge with unchanged mild to moderate spinal canal stenosis and mild to moderate bilateral foraminal stenosis. These findings are unchanged.L4-L5: There is bilateral facet hypertrophy. There is central disc protrusion. No significant spinal canal stenosis. There is unchanged mild bilateral foraminal narrowing, relatively worse on the left. These findings are unchanged.L5-S1: There is bilateral facet hypertrophy without neuroforaminal narrowing or spinal stenosis, unchanged.Bridging marginal osteophytes as well as joint space fusion is noted involving the sacroiliac joints (right greater left), unchanged in appearance.Fatty atrophy involving the paraspinous musculature again seen, which is predominantly on the right. Left renal cysts again seen.

Output: 1.No significant change in moderate to severe spinal canal stenosis at the L2-L3 level. Unchanged T2 hyperintensity within the cord and volume loss at the this level consistent with myelomalacia.2.Severe chronic compression fracture of the L3 vertebral body with evidence of cement augmentation is unchanged in appearance. Enhancement within the disc spaces above and below this compression deformity is felt to be reactive as there is no disc fluid.3.Unchanged appearance of the low-lying conus which extends to the L5 level with adhesions within the distal thecal sac as well as residual lipoma involving the right lateral aspect of the thecal sac at the S1 level and to a minimal degree along the distal filum terminale at the S2 level. Re-tethering can be considered in the appropriate clinical setting. 4.Degenerative changes at additional levels as detailed above which are unchanged.


Instruction: Generate impression based on medical findings.

Input: Reason: T3N2b right BOT HPV+ SCC on OPTIMA trial, finished induction chemotherapy with carboplatin/abraxane on 8/26/16. Evaluate for response. Need measurements Again seen is infiltrative enhancing lesion centered on the right base of tongue and extending into the oral tongue and floor of mouth anteriorly and posteriorly involving the glossotonsillar sulcus and right tonsillar fossa. Enhancing lesion measures 41 x 19 mm (axial postgad series 1601 image 39) previously 44 x 22 mm measured in a similar plane. A right level 2A lymph node measures 9 x 13 mm, axial T1 series 1201 image 38, which was previously 12 x 15 mm. There are additional scattered small cervical lymph nodes which are not significant by size criteria. There is motion degradation on multiple sequences however no new masses or new cervical lymphadenopathy is appreciated. Airway remains patent. There is suggestion of increased T2 hyperintensity in the right hemitongue which may represent early denervation changes.Visualized intracranial structures are unremarkable. No MRI evidence of perineural tumor spread. Visualized brain and orbits are gross the unremarkable. Paranasal sinuses are also clear aside from small bilateral maxillary mucus retention cyst.

Output: Compared to MRI dated 6/25/2016 there is mild decrease in size of the right base of tongue mass as well as decrease in size of a right level 2 cervical lymph node.


Instruction: Generate impression based on medical findings.

Input: Female 29 years old Reason: r/o CA History: sz \T\ brain tumor CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: There is an enlarged superior mediastinal, right paratracheal lymph node measuring 1.7 x 1.2 cm (series 3, image 10)CHEST WALL: Small axillary lymph nodes all measure less than 1 cm in short axis dimension. Nodular enhancing focus in the right breast (series 6, image 64) is nonspecific and would be better evaluated with mammography/ultrasound.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: 3.2 x 2.6 cm right adrenal mass (series 15, image 27) which does not meet criteria for lipid rich adenoma. There is a 1.5 x 1.2 cm left adrenal nodule (series 15, image 29) which does not meet criteria for lipid rich adenoma. KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Multiple nonenlarged retroperitoneal lymph nodes. A reference aortocaval node measures 1.6 x 1.0 cm (series 6, image 110).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. PELVIS:UTERUS, ADNEXA: Fetus within the uterus. The study was not optimized for evaluation of fetal anatomy. BLADDER: No significant abnormality noted.LYMPH NODES: Pelvic lymphadenopathy. A reference right external iliac node measures 2.2 x 1.3 cm (series 11, image 52).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Mediastinal, retroperitoneal and pelvic lymphadenopathy as well as bilateral adrenal lesions. Findings are suspicious for metastatic disease with no primary malignancy identified although breast or melanoma would be differential considerations. The right adrenal lesion would be amenable to percutaneous biopsy under CT/MRI guidance.


Instruction: Generate impression based on medical findings.

Input: History of hilar/intrahepatic stricture status post stenting and ERCP with brushings showing reactive changes. Now with abdominal pain. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology size and signal intensity.Right hepatic lobe cyst. No new suspicious liver lesion.Demonstrated again is left greater than right intrahepatic biliary ductal dilatation to the level of Klatskin's point, slightly improved from the prior study. The previously described adjacent region of poorly defined enhancement on delayed imaging (series 18/54) is less conspicuous on today's study. The main common bile duct is normal in caliber with mild circumferential thickening.Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: Redemonstrated cystic lesion at the pancreatic head/neck junction measuring 4.5 x 2.9 cm (series 5 image 18), compared to 2.7 x 2.6 cm previously. The lesion appears to communicate with the main pancreatic duct. The main pancreatic duct is normal in caliber. Small additional cystic foci in the pancreatic head and body are noted.No evidence of acute pancreatic inflammation. Several prominent peripancreatic lymph nodes, the largest measuring 2.3 x 1.5 cm (series 10/20) disease, unchanged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Punctate renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Persistent intrahepatic biliary ductal dilatation to Klatskin's point, slightly improved. The previously described adjacent region of poorly defined enhancement on delayed imaging (series 18/54) is less conspicuous on today's study.2.Mild interval increase in size of the cystic lesion at the pancreatic head neck junction which communicates with the main pancreatic duct, a pancreatic pseudocyst or a cystic neoplasm (such as a mucinous cystic neoplasm fistulized to the duct) remain diagnostic possibilities. No suspicious post-contrast enhancement of this lesion.


Instruction: Generate impression based on medical findings.

Input: A patient submitted outside study for review. Submitted for review are images from MRI guided biopsy of the right breast with specimen radiograph and post procedural right mammographic images (4/1/15) performed at Northwestern Memorial Hospital. For comparison, breast MRI (3/18/15) are available. MRI guided biopsy for the enhancing lesion at the right posterior upper outer quadrant, and another enhancing lesion at the right anterior lower inner quadrant was performed. Targeting appears good for each lesion. Specimen radiograph for each lesion shows multiple solid cores without calcifications. Post procedural right mammographic images show two marker clips; M shaped clip at anterior lower inner quadrant and rectangular shaped clip at posterior upper outer quadrant. Per outside radiology report, results for both biopsies are benign, and concordant.

Output: Status post benign MRI guided biopsy of right breast.BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on medical findings.

Input: 22 years, Female, bilateral blurry vision, right face droop. Evaluate for MS worsening versus PML.. Again seen are multiple T2/FLAIR hyperintense lesions in the periventricular and subcortical white matter with morphology and distribution consistent with known demyelinating disease. Compared to 4/1/2016, there has been interval development of multiple, at least 5, new T2/FLAIR hyperintense lesions involving the bilateral frontal and parietal lobes. There is associated peripheral enhancement including some with incomplete rim of peripheral enhancement, characteristic of demyelinating lesions. Restricted diffusion is also evident, particularly of a left frontal lesion. No intracranial mass effect. No midline shift or herniation. Ventricles are normal in size. Brain parenchymal volume is preserved. Calvarium and extracranial soft tissue structures are unremarkable.

Output: Evidence of progression of demyelinating disease since prior MRI. There are multiple new lesions with enhancement which are compatible with active demyelination.


Instruction: Generate impression based on medical findings.

Input: Left knee pain MENISCI: The lateral meniscus is intact. There is branching signal abnormality within the posterior horn and body of the medial meniscus with extension to the tibial articular surface indicating a complex tear. The anterior horn is intact.ARTICULAR CARTILAGE AND BONE: The full-thickness articular cartilage defect along the weightbearing portion of the medial femoral condyle is no longer seen, perhaps secondary to interval microfracture surgery. There is mild thickening and heterogeneity of the articular cartilage in this location with a focus of abnormal subchondral signal intensity that could represent a degenerative cyst or the sequela of prior microfracture. There is also a focal bony protuberance extending into the articular cartilage at this location which is new from the prior exam, perhaps due to prior microfracture. A second bony protuberance is noted along the femoral trochlea centrally, perhaps representing an additional site of microfracture. There is a small near full-thickness to full-thickness cleft just above this bony protuberance. There is mild degeneration of the articular cartilage of the patella, particularly of the medial facet, with a small focus of underlying degenerative subchondral signal abnormality.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Due to technologist error, the right knee was incorrectly imaged. The patient will not be charged for the exam and will be recalled for appropriate imaging of the left knee.2. Medial meniscal tear with findings suggestive of prior microfracture surgery as described above.


Instruction: Generate impression based on medical findings.

Input: Clinical question: History of brain metastases. Compared with prior exam. Signs and symptoms: None. Pre-and post-enhanced brain MRI:A previously measured 5.8-mm left occipital lobe medullary hemorrhagic metastatic lesion demonstrate interval decreased size and measuring at 2.7-mm. No surrounding edema however minimal or mass effect.A right posterior temporal subcortical metastatic lesion which measured 5-mm on prior exam demonstrates interval decrease size and measuring at 1.9-mm. No surrounding edema or mass effect.A right posterior temporal metastatic lesion is remeasured at 9.2-mm on prior exam demonstrate interval decreased size and measuring at 8.3-mm on current study. The minimal internal hemorrhagic changes and surrounding edema however demonstrate no significant change.The largest metastatic lesion is at the level of the trigone of left lateral ventricle and inseparable from the ventricle wall. It measures at 8-mm and post-enhanced images compared to prior study measurement of 9.8-mm areaa punctate focus of enhancement pain in right posterior parietal lobe which measured at 2.4-mm demonstrate subtle interval decrease size and measuring at 1.7-mm. Post operative changes of high convexity right lateral frontal craniotomy with expected dural thickening and enhancement demonstrates no change. Focus of encephalomalacia at the site without abnormal enhancement is also again noted without change.Stable normal size of ventricular system and maintained midline.No detectable calvarial or orbital abnormal enhancement.

Output: Redemonstration of multiple previously known brain metastatic lesion with further interval decreased size as detailed/measured above.


Instruction: Generate impression based on medical findings.

Input: T2 N2B M0 tonsil squamous cell carcinoma on OPTIMA protocol. There is marked interval decrease in size of the right palatine tonsil tumor, without measurable disease. There is also decrease in size of the right cervical lymphadenopathy. For example, a right level 2A lymph node measures 8 x 16 mm, initially 18 x 24 mm. The thyroid and major salivary glands are unremarkable. The osseous structures are intact. The imaged intracranial structures and orbits are unremarkable.

Output: 1. Marked decrease in size of the right palatine tonsil tumor, without measurable disease. 2. Decrease in size of the right cervical lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: Female, 16 years old, history of mediastinal lymphoma and extradural soft tissue mass at T5-6, 6 months off therapy. Cervical:The spinal cord is morphologically normal. No pathologic intrathecal or epidural enhancement is seen. Alignment of the cervical spine is straightened, similar to prior and likely secondary to positioning. Vertebral body morphology and marrow signal characteristics are normal.Thoracic:The spinal cord is morphologically normal. No evidence of any residual pathologic epidural or foraminal enhancement is seen. No pathologic intrathecal enhancement is detected. Alignment is anatomic. Vertebral body morphology and marrow signal characteristics are normal. Lumbar:The conus and cauda equina are normal. No pathologic intrathecal or epidural enhancement is detected. Alignment is anatomic. Vertebral body morphology and marrow signal characteristics are normal.

Output: No evidence of residual or recurrent tumor in the spine.


Instruction: Generate impression based on medical findings.

Input: Left-sided numbness. Altered status. BRAIN MRI:The moderate frontoparietal periventricular white-matter hypoattenuation on the CT scan correlates with T2/FLAIR hyperintensity without diffusion restriction. This is most compatible with chronic microvascular ischemia. There is no abnormal brain diffusion restriction or susceptibility effect to suggest acute infarct or hemorrhage, respectively. The brain volume loss is more pronounced in the frontotemporal lobes. There is no mass-effect or midline shift. There is no destructive skull lesion. There is no gross orbital abnormality, accounting for findings of previous bilateral cataract surgery. Left occipital fat intensity lesion is compatible with a lipoma and measures in the axial plane 2.0 cm x 0.6 cm.CRANIAL MRA:There is no significant, flow-limiting stenosis of the major intracranial arteries. Of note, the left vertebral artery is smaller than the right which is probably developmental/congenital. The right posterior cerebral artery is almost fetal-type, which is a normal variation.NECK MRA:There is mild focal narrowing in the distal left common carotid artery, just upstream from its bifurcation which involves the origin of the left external carotid artery without hemodynamically significant stenosis. Otherwise, the cervical carotid arteries show preserved caliber, contrast opacification and flow-related signal.The left vertebral artery is smaller than the right, throughout its length and without ostial narrowing. This is probably congenital/developmental.

Output: 1.There is no acute brain ischemia or acute intracranial hemorrhage.2.Moderate cerebral chronic microvascular ischemia is also associated with volume loss that is more pronounced in the frontal and temporal lobes.3.Cranial MR angiography shows no significant stenosis or aneurysm.4.Neck MR angiography shows mild distal left common carotid artery narrowing but no significant, flow-limiting stenosis otherwise. The small size of the left vertebral artery is felt to be congenital/developmental.


Instruction: Generate impression based on medical findings.

Input: 49 years Male (DOB: 12/20/1966)Reason: please compare to prior History: progressionPROVIDER NAME: JACQUELINE T BERNARD MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of multiple periventricular and subcortical white matter lesions many of which are perpendicularly oriented to the lateral ventricles. Additional lesions are present in the internal capsules bilaterally which are also unchanged.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.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. . No abnormal enhancing lesions are identified in the cervical spine.There is a high signal focus present within the cervical spinal cord at the C3 vertebral body level measuring 6 x 12 mm sagittal dimensions which is eccentric to the right hemicord. There is a 34 mm in length T2 hyperintense lesion within the cervical spinal cord extending from the C4 level to the C6 level which is eccentric to the left hemicord. There is a T2 hyperintense lesion within the cervical spinal cord at the C2 vertebral body level involving the right hemicord. Overall the cervical spinal cord is small. These lesions were also present on the prior exam from 5/22/2012At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is disc desiccation at this level.At C3-4 there is no significant compromise to the spinal canal. There is disc desiccation present at this level. There is a left lateral recess disc protrusion present at this level which is associated with uncovertebral osteophytes and encroachment of the left-sided exiting nerve roots. This has not significantly progressed since the prior exam.At C4-5 there is no significant compromise to the spinal canal. There is disc desiccation at this level associated with diffuse disc bulge and endplate and uncovertebral osteophytes with narrowing of the neural foramina bilaterally and encroachment of the left-sided exiting nerve roots. This has not significantly progressed since the prior exam.At C5-6 there is loss of disc space height, disc desiccation, diffuse disc bulge and endplate uncovertebral osteophytes associated with ligamentum flavum hypertrophy. There is effacement of spinal fluid ventral and posterior the spinal cord and encroachment of the exiting nerve roots within the right neural foramen at this level. Overall there is mild to moderate spinal stenosis at this level. This has not significantly progressed since the prior exam.At C6-7 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with endplate and uncovertebral osteophytes. There is some narrowing of the neural foramina but no significant optimized to the exiting nerve roots. There is partial effacement of spinal fluid ventral and posterior the spinal cord. Overall there is a mild degree of spinal stenosis at this level. This has not significantly progressed since the prior exam.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There are multiple lesions within the cervical spinal cord which are compatible with demyelinating disorder. These were also present on the prior exam from 5/22/2012 and have not changed significantly.2.There are multilevel degenerative changes present in the cervical spine which appear to be worse at C5-6 where there is mild to moderate spinal stenosis and encroachment of right-sided exiting nerve roots. There is some encroachment of exiting nerve roots at other levels as well. These findings are stable compared to the prior exam.3.There are multiple white matter lesions scattered within the brain parenchyma which are stable compared to prior exam 5/22/2012 which support the patient's clinical diagnosis of multiple sclerosis.


Instruction: Generate impression based on medical findings.

Input: Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: R MCA History: Left sided weakness. Brain MRIRestricted diffusion on the right insular, right frontal lobe, right temporal lobe anterior aspect, right globus pallidus, right internal capsule posterior limb, and right cerebral peduncle indicating acute ischemic stroke. There are surrounding edema with mass effects with effacement of the right lateral ventricle. There is no evidence of midline shift.Posterior aspect of the ischemic stroke lesion shows curvilinear susceptibility artifacts on Gradient echo images which likely represent cortical veins which were displaced due to local mass effects instead of hemorrhagic conversion. There is no evidence of hemorrhagic conversion. There are multifocal encephalomalacia at the right temporo-occipital lobe and left centrum semiovale indicating chronic stroke. The cranial-cervical junction are normal. Mucosal thickenings on the right maxillary sinus and ethmoid sinus.Opacifications on the right mastoid air cells.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate near total occlusion of the right MCA proximal M1 segment with minimal forward flow through a very tiny vascular structure which most likely represent anterior temporal branch. There are multifocal luminal narrowings on bilateral PCA P1 segments and left MCA M2 segment indicating atherosclerosis.There is no evidence of intracranial arterial aneurysm.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate luminal irregularities especially on the right extracranial ICA without evidence of luminal stenosis indicating possible fibromuscular dysplasia. Bilateral vertebral artery ostia appear to show mild to moderate (less than 50%) luminal stenosis. However, there is no evidence of significant (more than 50%) luminal narrowing on bilateral CCAs, and left extracranial ICA. Bilateral cervical vertebral arteries appear to be within normal limits. Bilateral subclavian arteries appear to be normal.

Output: 1. Right MCA territorial acute ischemic infarction involving right frontal lobe, right frontal operculum, right anterior temporal lobe, right insular, right basal ganglia, and right cerebral peduncle without evidence of hemorrhagic conversion.2. Near total occlusion of the right MCA at the proximal M1 segment with evidence of intracranial atherosclerosis.3. Multifocal chronic encephalomalacia at the right temporo-occipital lobe and left centrum semiovale.4. Irregular right extracranial ICA lumen indicating possible fibromuscular dysplasia.


Instruction: Generate impression based on medical findings.

Input: 16 year-old female with knee pain, evaluate for tear of the medial patellofemoral retinaculum MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: There is signal abnormality and surface fraying of the articular cartilage along the lateral patella facet. The patellofemoral and tibiofemoral articular cartilage are otherwise normal. No osteochondral defect.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: There is slight increased T2 signal abnormality within the lateral patellofemoral retinaculum at its attachment on the patella. No full thickness disruption of the patellofemoral retinaculum. Patellar alignment is within normal limits. The patella and quadriceps tendons are intact. ADDITIONAL

Output: 1. Signal abnormality within the lateral patellofemoral retinaculum at its attachment on the patella suggesting injury without full thickness disruption. Patella alignment is normal.2. Chondromalacia of the lateral patella facet without full thickness defect or OCD.3. Mild edema within the lateral aspect of the infra-patella fat pad may represent fat pad impingement.4. Intact menisci, cruciate and collateral ligaments.


Instruction: Generate impression based on medical findings.

Input: The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain. There is a 6 mm maximal dimension focus of relative hypoenhancement within the superior border of the left paramedian anterior pituitary gland, which is heterogeneous on both T1 and T2 noncontrast sequences. The pituitary stalk is slightly deviated leftward to this region. There is no involvement of the optic apparatus or the cavernous sinuses.

Output: There is a 6 mm maximal dimension focus of relative hypoenhancement within the superior border of the left paramedian anterior pituitary gland, which is heterogeneous on both T1 and T2 noncontrast sequences suggestive of pituitary adenoma.


Instruction: Generate impression based on medical findings.

Input: Craniotomy on 5/27 for resection of recently hemorrhagic left middle cerebellar cavernous malformation with associated DVA. There has been interval left suboccipital craniotomy for resection of the lesion centered in the left middle cerebellar peduncle with residual surrounding hemosiderin staining. There is no residual surrounding vasogenic edema or effacement of the fourth ventricle. There is no evidence of acute infarct. There is no midline shift or herniation. The orbits are grossly unremarkable. There is a retention cyst in the left maxillary sinus.

Output: Interval resection of the left middle cerebellar peduncle cavernous malformation with residual peripheral hemosiderin staining and associated developmental venous anomaly.


Instruction: Generate impression based on medical findings.

Input: Known bilateral breast cancers (multifocal left breast invasive ductal carcinoma and right breast DCIS), evaluate response to therapy. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.The known anterior malignancy in the left outer breast is only minimally enhancing on the late phases of the dynamic sequence compared to background. This measures 1.1 x 0.9 x 0.9 cm. This measured 2.1 x 2.0 x 2.2 cm on November 26, 2014. Along the medial margin of the previous location of the posterior mass there is a 1.0 cm area of non mass enhancement. The posterior mass is not otherwise enhancing above the level of background. It previously measured 2.9 x 2.0 x 2.5 cm.The right medial breast non-mass enhancement is faintly seen on the post contrast images, measuring 0.5 cm, previously 2.9 cm.  No abnormal lymph nodes are identified in either axillary region.A port-a-cath is present in the right superior chest wall.

Output: Significant response to therapy in both breasts with residual tumor measurements given above. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter..


Instruction: Generate impression based on medical findings.

Input: Ataxia, stroke, diabetes type II. 44-year-old female The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a hyperdense focus along the lower aspect of the right postcentral gyrus representing a focus of infarction identified and a recent MRI of the brain it measures approximately 3.5 cm by 9 mm in axial dimensions. There is also a small hypodense focus along the left cingulate gyrus extending towards the left paracentral lobule and another smaller one along the left inferior parietal lobule. These are also identified on a recent MRI of the brain . Atherosclerotic calcifications are present along the distal internal carotid arteries.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. The visualized portions of the paranasal sinuses demonstrate partial opacification of right and middle ethmoid air cells.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits demonstrate a hyperdense left eyeball probably postoperative. It is unchanged since prior exam.

Output: 1.The patient has a focus of infarction in the right postcentral gyrus. 2.There are small foci of encephalomalacia along the left cingulate gyrus extending towards the left paracentral lobule and along the left inferior parietal lobule. 3.No evidence for acute intracranial hemorrhage.


Instruction: Generate impression based on medical findings.

Input: Female, 35 years old, with headache and hydrocephalus. A midline cystic lesion is evident centered on the midbrain and measuring up to 29 mm AP, 19 mm CC, and 17 mm TV. Inferiorly, the lesion contains multiple septations or cystic loculations, and this portion of the lesion appears to be intraparenchymal within the midbrain tegmentum. Superiorly, the dominant portion of the cyst projects into the posterior aspect of the third ventricle, elevating and stretching the midbrain tectum, and likely obstructing outflow through the cerebral aqueduct. No clear evidence of any solid or enhancing tissue is seen within the lesion.The lateral and third ventricles are enlarged with evidence of mild transependymal CSF flow. The fourth ventricle is within normal limits. Incidental note is made of descent of the cerebellar tonsils approximately 10 mm below the level of the foramen magnum.

Output: A cystic lesion is evident centered on the midbrain which projects into the third ventricle and likely effaces the cerebral aqueduct. Consequently, hydrocephalus involving the lateral and third ventricles is seen. The lesion appears to be at least partly intraparenchymal within the midbrain tegmentum, and this portion of the lesion demonstrates multiple septations or loculations. The differential diagnosis would include a neuroglial cyst, with arachnoid cyst a somewhat less likely consideration given location and imaging features. A cystic neoplasm is felt to be unlikely due to lack of solid or enhancing tissue.Inferior herniation of the cerebellar tonsils is seen which technically meets criteria for a Chiari I malformation. However, this finding should be assessed after correction of hydrocephalus as the appearance may change.


Instruction: Generate impression based on medical findings.

Input: Reason: history of ibd, evaluate small bowel History: nausea, vomiting, abdominal pain, diarrhea ABDOMEN:LIVER, BILIARY TRACT: Common bile duct dilatation measuring up to 8 mm, unchanged. No focal narrowing identified. No focal hepatic lesion.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No bowel wall thickening. No abnormal enhancement. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No abnormal fluid collection. PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No bowel wall thickening. No abnormal enhancement. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No abnormal fluid collection.

Output: 1.No evidence of active inflammatory bowel disease.2.Stable mild extrahepatic biliary ductal dilatation. No new or suspicious focal hepatic lesions.


Instruction: Generate impression based on medical findings.

Input: 39-year-old female with history of knee pain and persistent "Bakers cyst". MENISCI: Globular signal within the body and posterior horn of the medial meniscus indicates intrasubstance degeneration. This signal extends to the femoral articular surface compatible with a degenerative tear. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is moderate degeneration of the articular cartilage of the femoral trochlea particularly along the medial facet with underlying cyst formation. There is also subjective thinning of the articular cartilage of the patella particularly along the lateral facet. We see no fluid-filled defects within the articular cartilage of the medial and lateral tibiofemoral compartments.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.No evidence of a Baker's cyst.2.Degeneration and degenerative tearing of the medial meniscus.3.Cartilage degeneration affecting the patellofemoral joint and other findings as above.


Instruction: Generate impression based on medical findings.

Input: 63-year-old male with history of hepatic cirrhosis. Evaluate for liver lesions and vessel patency. ABDOMEN: Small left pleural effusionLIVER, BILIARY TRACT: Severe hepatic cirrhosis with sequela of portal hypertension. There are scattered T2 hyperintense foci in the liver compatible with cysts. There is a nonspecific segment 6/7 subcentimeter arterially enhancing focus (series 1601, image 452) without evidence of washout.SPLEEN: Splenomegaly with the spleen measuring 17 cm in length.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Large-volume ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cirrhosis with sequela of portal hypertension. No definite arterially enhancing and washing out lesion.2.Nonspecific segment 6/7 arterially enhancing subcentimeter lesion. Attention on follow-up is recommended.


Instruction: Generate impression based on medical findings.

Input: Female, 27 days old, currently 35 weeks corrected gestational age, not showing feeding cues, concerning for TORCH infection. No evidence of restricted diffusion, edema or mass effect is seen. No findings to suggest intracranial hemorrhage or any abnormal extra-axial fluid collections are detected. Ventricular size and morphology are within normal limits. The degree of sulcation is relatively delayed for a corrected gestational age of 35 weeks, appearing more similar to that which is seen at 32 weeks gestation. However, the pattern of myelination is appropriate or even somewhat advanced for gestational age.The region of the pituitary gland is unremarkable. The corpus callosum is present and fully formed. The brainstem, cerebellar vermis and cerebellar hemispheres are all within normal limits.

Output: 1.No definite acute or focal abnormalities are seen.2.The degree of cerebral sulcation appears to be mildly delayed, correlating more closely to a 32 week gestation than a 35 week gestation. However, the pattern of myelination is appropriate or even somewhat advanced for age. The relevance of these findings is uncertain. A follow-up examination is suggested, preferably in no less than 3-6 month's time, to assess for subsequent development.


Instruction: Generate impression based on medical findings.

Input: 29-year-old male with long history of sickle cell disease with crisis and known hip avascular necrosis now with increasing right hip pain and radiculopathy RIGHT HIP:ACETABULAR LABRUM: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: Patchy T2 signal within the superior aspect of the femoral head. Focal serpiginous low signal with osteochondral fragmentation along the superior aspect of the femoral head compatible with avascular necrosis. No cortical collapse is evident. SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: 1.Avascular necrosis with fragmentation involving the right femoral head as described above.2.Edema within the left femoral head likely represent early avascular necrosis.


Instruction: Generate impression based on medical findings.

Input: History of a liver lesion status post TACE RFA. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. Post radiofrequency ablation halos in the right hepatic dome involving segments 7/8. The more anterior older ablation defect measures 1.7 x 1.4 cm (series 10/120), compared to 2.0 x 1.5 cm previously.The more posterior lateral ablation defect measures 3.4 x 2.3 cm (series 10/122).There is persistent arterial enhancement adjacent to the anterior aspect of the new larger ablation cavity (series 10 image 17) measuring 1.4 x 1.2 cm.There are additional arterial enhancing foci throughout the liver which are not significant changed in size and demonstrate no definite washout.SPLEEN: Stable splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Subcentimeter right adrenal nodule is stable.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: New ablation defect in the dome of the liver. There is a persistent 1.4 cm enhancing focus with subtle washout adjacent to the anterior aspect of the new ablation defect, suspicious for residual hepatocellular carcinoma.


Instruction: Generate impression based on medical findings.

Input: Reason: assess for recurrence of cervical spinal stenosis History: progressive gait impairment, myelopathy CERVICAL SPINE:Findings of C3-C6 laminectomy with interval evolution of postsurgical changes including resolution of the previously seen fluid collection in surgical bed. The cranial-cervical junction is normal. There is mild kyphotic angulation of the lower cervical spine, grossly similar to the prior exam. The vertebral body heights are preserved accounting for endplate degeneration. There is near complete loss of intervertebral disc space at C6-7, which appears similar to prior. There has been interval increase in the degree of edematous signal change at C6-7. There is no definite cord signal abnormality.Degenerative changes are specified by the intervertebral level as follows: C2-3: Facet hypertrophy. Ligamentum flavum thickening. Mild posterior disk osteophyte formation. Mild to moderate spinal canal stenosis. No significant foraminal narrowing. No interval changes. C3-4: Posterior spinal canal decompression. Facet hypertrophy. Severe left and mild right foraminal narrowing, unchanged.C4-5: Posterior spinal canal decompression. Very mild posterior disk osteophyte formation. No spinal canal stenosis. Mild to moderate right and mild left neuroforaminal stenosis.C5-6: Posterior spinal canal compression. Mild posterior disk osteophyte. No spinal cord impingement. Facet hypertrophy. Moderate to severe left and mild to moderate right neuroforaminal narrowing, unchanged. C6-7: Moderate posterior disk osteophyte formation which contributes to a moderate spinal canal stenosis with mild deformation of the spinal cord but without significant cord signal abnormality. Moderate bilateral, left greater than right , foraminal narrowing. Findings are unchanged. C7-T1: No significant spinal canal or neuroforaminal stenosis. LUMBAR SPINE:Five lumbar type vertebral bodies are presumed to be present. The vertebral body heights are well-maintained. There is moderate to severe loss of the intervertebral disc space at L4-L5, which appears increased from the prior exam. There is disc desiccation at L5-S1, which was present previously. No focal marrow signal abnormality is appreciated. The conus medullaris on sagittal imaging is grossly intact. A simple cyst is noted in the right kidney, unchanged.T12-L1: There is no significant compromise to spinal canal or neural foramina.L1-L2: There is no significant compromise to spinal canal or neural foramina.L2-L3: Mild disc bulge and ligamentum flavum hypertrophy. Minimal neuroforaminal stenosis bilaterally. There is no significant compromise to the spinal canal.L3-L4: Ligamentum flavum hypertrophy and mild facet arthropathy. Mild neuroforaminal stenosis bilaterally. There is no significant compromise to spinal canal.L4-5: Ligamentum flavum hypertrophy and severe facet arthropathy. There is grade 2 anterolisthesis of L4 on L5 with uncovering of the intervertebral disc at this level, which appears slightly increased from the previous exam. There is severe neuroforaminal stenosis, which likely results in impingement of the L4 nerve roots. Mild to moderate narrowing of the central spinal canal. There is also partial effacement of the lateral recesses, which is worse on the right.L5-S1: Ligamentum flavum hypertrophy and mild facet arthropathy. There is no significant compromise to spinal canal or neural foramina.

Output: 1. Grade 2 anterolisthesis of L4 on L5 with severe neuroforaminal stenosis and likely impingement of the L4 nerve roots. This can be further assessed with dynamic radiographs. There is mild to moderate spinal canal stenosis at this level which is slightly worse.2. Expected evolution of postsurgical findings of C3-C6 laminectomy. There is mild progression of cervical degenerative changes although the mild to moderate spinal canal stenosis at C2-C3 and up to moderate spinal canal stenosis at the C6-C7 level are not significantly changed. No new cord signal abnormality.


Instruction: Generate impression based on medical findings.

Input: Progressive lower extremity weakness. Multiple intracranial metastases. Evaluate for cord compression. There is no evidence of cord compression. Vertebral body heights in the cervical, thoracic, and lumbar spine are normal. No large infiltrating or destructive osseous lesion is evident. There is a 9 mm nonspecific osseous lesion involving the L4 vertebral body. There is reversal of cervical lordosis with mild degenerative changes including small disc osteophyte complexes from C3-C4 to C6-C7. There is fairly mild associated spinal canal narrowing. No significant spinal canal or neural foraminal stenosis in the thoracic or lumbar spine is appreciable. No obvious cord signal abnormality.

Output: 1. No evidence of compression of the spinal cord or cauda equina.2. This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine.3. Nonspecific 9 mm osseous lesion involving the L4 vertebral body.


Instruction: Generate impression based on medical findings.

Input: Presents with right upper quadrant pain. History of liver transplant and biliary stricture. ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes from a liver transplant. The gallbladder is absent.Subcentimeter segment II and V very hyperintense T2-weighted foci compatible with cysts.No suspicious liver lesion. Mild intra and extrahepatic biliary ductal dilatation with the common duct measuring 9 mm at the porta hepatis, increased from the prior study. There is a focal T2-band near the anastomotic site suspicious for a focal stricture, best seen on series 501, image 18. Distally the duct tapers smoothly to the level ampulla. No filling defect to suggest a mass.The hepatic artery, portal vein and hepatic veins are patent.SPLEEN: No significant abnormality noted.PANCREAS: 8 x 8 mm cystic lesion in the head/uncinate process of the pancreas with lobular margins but no septations, or mural enhancing nodules, unchanged and likely a sidebranch IPMN. Additional relatively stable subcentimeter cystic foci in the pancreatic, body and numerous foci in the pancreatic tail are relatively stable in size and number.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable subcentimeter cyst in the superior pole of the left kidney. No hydroureteronephrosis or suspicious focal lesion.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild bilateral gynecomastia.OTHER: No significant abnormality noted.

Output: 1.Interval increase in intra and extra-hepatic biliary ductal dilatation with a focal T2-band near the level of the anastomosis suspicious for a focal stricture. 2.No significant interval change in the multiple subcentimeter pancreatic cystic foci most consistent with sidebranch IPMNs.


Instruction: Generate impression based on medical findings.

Input: Ms. Lyons is a 47 year old female presenting for MR-directed ultrasound based on outside hospital MRI findings. Targeted left breast ultrasound was performed for the outside hospital MRI findings, including 8.4 cm of diffuse nonmass enhancement in the left outer breast. No sonographic correlate was identified for the MRI findings.Targeted left axillary ultrasound was performed for the outside hospital MRI findings. In the left axilla, there is an abnormal morphology lymph node identified measuring 2.5 x 1.1 x 2.1 cm.

Output: (1) No sonographic correlate identified for the 8.4 cm diffuse nonmass enhancement in the left outer breast. Therefore, a two-site MR guided biopsy is recommended for further evaluation.(2) Abnormal morphology lymph node in the left axilla. An ultrasound-guided biopsy with clip placement is recommended for further evaluation.All results and recommendations were discussed with the patient.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 21 years old, blurry vision for 6 months with Chiari I malformation on MRI, CSF flow study recommended. The cerebellar tonsils descend below the level of the foramen magnum, approximately 5 mm on the left and 7 mm on the right. The tonsils do, however, maintain their round morphology, and there is preservation of the CSF space posterior to the tonsils and anterior to the brainstem. CSF flow imaging is suboptimal despite an attempt to correct this by adjusting the technical parameters of the sequence. Given this limitation, there does seem to be robust flow anterior to the brainstem through the foramen magnum. There may be some degree of flow posterior to the spinal cord and along the cerebellar tonsils but this is difficult to assess with certainty.The remainder of the examination is unremarkable. Parenchymal morphology and attenuation are within normal limits. No areas of signal abnormality are suspected. No intracranial hemorrhage or abnormal extra-axial fluid is seen. The ventricles are normal in size.

Output: Descent of the cerebellar tonsils as described above is compatible with Chiari I malformation. However, the cerebellar tonsils maintain a round morphology, and there is little if any actual crowding at the foramen magnum with preservation of CSF space both anterior to the brainstem and around the cerebellar tonsils. Therefore, the relevance of the Chiari malformation to the patient's presenting symptoms is unclear. CSF flow imaging is compromised by technical difficulties which could not be corrected at the time of scanning. The sequence, therefore, contributes little diagnostic information. If this information is felt to be necessary for clinical management, the patient may return to repeat the flow sequence only at no additional charge.


Instruction: Generate impression based on medical findings.

Input: 42-year-old male with mental status change There is no evidence of intracranial hemorrhage, mass or edema. 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: Normal brain CT.


Instruction: Generate impression based on medical findings.

Input: Intractable headache (occipital). There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is patchy and scattered cerebral white matter T2 hyperintensity, which is most pronounced in the bilateral posterior periventricular regions. There is no abnormal intracranial enhancement. There are bilateral small lateral ventricular choroid plexus glomus xanthogranulomas. The ventricles and basal cisterns are otherwise 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. There is an apparent small right parotid lesion that is only depicted on the coronal T2-weighted sequence. There is a subcentimeter incisive duct cyst.

Output: 1. Probable chronic small vessel ischemia, but no evidence of intracranial hemorrhage, mass, or acute infarct. 2. Incompletely imaged apparent small right parotid lesion. An ultrasound of this region may be useful for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Enlarging liver cysts and shoulder pain. ABDOMEN:LIVER, BILIARY TRACT: Hepatomegaly measuring 25 cm in craniocaudal dimension secondary to innumerable small cystic foci and large hepatic dome cystic lesions. The largest is a septated lesion in the mid liver measuring 14.1 x 10.3 x 16.7 cm. An adjacent predominantly right hepatic lobe lesion measures 10.5 x 7.2 cm. An adjacent left hepatic lobe lesion measures 8.5 x 7.6 cm and contains complex fluid. In the periphery of segment 3 there is a 4.2 x 4.0 cm cystic lesion. The remaining cystic lesions measure less than 2 cm. There is no internal or mural nodular postcontrast enhancement of these lesions.No intrahepatic biliary ductal dilatation.SPLEEN: Normal splenic size without a focal lesion.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Hepatomegaly with regional mass effect secondary to several very large cystic lesions without suspicious internal or mural enhancement, likely giant hepatic cysts. Given their size cystadenoma cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: Seizure like activity, developmental delay. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of potential seizure foci or gross structural abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 41 years old. Lateral right knee pain after injury MENISCI: There is a large complete radial tear through the junction of the anterior horn and body of the lateral meniscus. The posterior horn of the lateral meniscus is intact. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: We see no fluid-filled articular cartilage defects.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Full-thickness radial tear of the lateral meniscus and other findings as above.


Instruction: Generate impression based on medical findings.

Input: NSVT Left VentricleThe left ventricle has moderately reduced EF. The overall LV ejection fraction is 43%, the LVEDV is 221 ml (normal range 109+/-23), the LVESV is 125 ml (normal range 31+/-10) There are no regional wall motion abnormalities present. . There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.The native T1 myocardial relaxation time is grossly normal. There is [ no]LV thrombus. Left AtriumThe left atrium is mildly dilated.Right VentricleThe right ventricle is normal. The overall RV ejection fraction is 62%, the RVEDV is 129 ml (normal range 110+/-24), and the RVESV is 48 ml (normal range 35+/-13). Right AtriumThe right atrium is normal. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac Findings . 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. Moderate LV systolic dysfunction with no evidence for delayed enhancement.2. Normal RV systolic function.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: Epistaxis. MRI: There is evidence of blood products in the right nasal cavity and nasopharynx as well as right nasal packing material, but no discernible evidence of a tumor. There is mild diffuse mucosal thickening of the pneumatized paranasal sinuses. There is diffuse prominence of the adenoids, which is an expected findings in infants. The salivary glands are unremarkable. There is non-specific high T2 signal within the mastoid air cells bilaterally. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is mild prominence of the anterior cerebral convexity extra-axial cerebrospinal fluid spaces, which can be encountered in infants. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable.MRA: There is no evidence of significant steno-occlusive lesions or anomalous arteries in the sinonasal region.

Output: Stigmata of right nasal cavity epistaxis with packing material and hemorrhage, but no discernible sinonasal tumor and no evidence of maxillofacial vascular malformations within the limits of detection made possible by the modality.


Instruction: Generate impression based on medical findings.

Input: 62 year-old female with left cerebellar peduncle hemorrhage, follow-up.IMAGE ACQUISITION: Nonenhanced CT of the head Again identified is a hyperattenuating focus in the left posterior pons, which appears to not have significantly changed in size. However, there is subtle increased associated vasogenic edema, as evidenced per recent MRI.No hydrocephalus or midline shift.Postsurgical changes with left temporal occipital encephalomalacia, unchanged. Mild hypoattenuation in periventricular and subcortical white matter, most consistent with small vessel ischemic disease.Visualized paranasal sinuses and mastoid air cells are clear.

Output: Stable size of left posterior pontine hemorrhagic lesion.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: CervicalgiaClinical question: h/o MCV, evaluate for ligamentous injury to cervical spine The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a small central disc protrusion present at this level.At C4-5 there is loss of disc space height, disc desiccation, endplate osteophytes and uncovertebral osteophytes associated with mild posterior ligamentous hypertrophy. There is effacement of the spinal fluid ventral and posterior the spinal cord at this level. There is a right paramedian disc protrusion present at this level which encroaches on the right hemicord and right-sided exiting nerve root at this level. Overall there is a mild to moderate degree of spinal stenosis at this level.At C5-6 there is loss of disc space height, disc desiccation, endplate and uncovertebral osteophytes and a disc bulge associated with some effacement of spinal fluid ventral and posterior the spinal cord and encroachment of the exiting nerve roots within the neural foramina bilaterally due to osteophytes and disc material.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There are multilevel degenerative changes present in the cervical spine with mild to moderate spinal stenosis at C4-5 and C5-6 and encroachment of the right-sided exiting nerve roots at C4-5 and bilaterally at C5-6.


Instruction: Generate impression based on medical findings.

Input: Right hip pain. Breast cancer, stage IIIC, new pain over right hip. Question of osseous metastasis. Bone marrow signal is within normal limits. Two foci of increased signal within the left femoral head likely represent synovial herniation pits. No fracture is identified. No abnormal osseous enhancement is seen on post-contrast imaging. There is minimal increased T2 signal and enhancement within the insertional fibers of the right gluteus medius and minimus tendons which may reflect mild inflammation. Otherwise, the remaining musculature and soft tissues are normal.

Output: 1. No evidence of an osseous metastatic lesion in the right hip.2. Minimal signal abnormality within the right gluteus medius and minimus tendons may represent mild inflammation/tendinopathy.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: WeaknessClinical question: evaluate for myelopathy, L hemisensory / hemi-motor symptomsSigns and Symptoms: evaluate for myelopathy, L hemisensory / hemi-motor symptoms MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. There is multilevel disc desiccation present.There is a disc bulge present at T3-4. There is a mild disc bulge present at T5-6, T6-7, T7-8, T9-T10 and T10-11. A Schmorl's node is present at the superior endplate of T8 associated with some reactive change.. Some endplate reactive changes are identified at T6-7 with high signal on T2 and low signal on T1.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a minor disc bulge present at this level. At L4-5 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge present at this level associated with bilateral ligamentum flavum hypertrophy. The fat at the lateral recesses sees is not effaced.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is a right far lateral disc protrusion at this level which mildly encroaches on the right-sided exiting nerve roots as they exit the neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There are cystic lesions present in the kidneys. One in the left kidney measures approximately 6 8-mm in diameter

Output: 1.There are multilevel degenerative changes present in the thoracic spine without significant compromise to the spinal canal or exiting nerve roots. Similar degenerative changes appear to be in the subacute stage in the midthoracic spine at the T7-8.2.There are degenerative changes present in the lumbar spine without significant compromise to the spinal canal or neural foramina as detailed above. There is a right far lateral disc protrusion at L3-4 which encroaches on the right exiting nerve root.3.There is a tiny lesion in the left kidney which is suspected to represent a cyst but is not adequately imaged.


Instruction: Generate impression based on medical findings.

Input: 72-year-old man with possible pancreatic tail lesion on CT. ABDOMEN:LIVER, BILIARY TRACT: The liver and gallbladder appear normal. There is no intra or extra hepatic ductal dilatation.SPLEEN: The spleen is normal.PANCREAS: There is a subcentimeter focus of T2 hyperintensity which appears to communicate with the main pancreatic duct in the pancreatic body (series 12, image 16). The pancreas is otherwise normal without focal lesion identified. Specifically, there is no lesion in the pancreatic tail.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: Multiple renal cysts are noted bilaterally, otherwise the kidneys are normal and enhance symmetrically.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: Partially visualized small bowel and colon are normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No focal lesion in the pancreatic tail. Subcentimeter sidebranch IPMN in the pancreatic body.


Instruction: Generate impression based on medical findings.

Input: Male 65 years old Reason: to be done 3/ 2015. Side Branch IPMN r/o growth. Need MRI gad / MRCP secretin History: to be done 3/2015. Side Branch IPMN r/o growth. Need MRI gad / MRCP secretin. ABDOMEN:LIVER, BILIARY TRACT: Signal dropout on in phase images suggestive of iron deposition. SPLEEN: Signal dropout on in phase images suggestive of iron deposition. PANCREAS: Again seen is a nonenhancing cystic lesion in the head of the pancreas which communicates with the main pancreatic duct. This measures 1.1 x 0.9 cm (series 5, image 40), not significantly changed compared to prior study allowing for differences in imaging technique and compatible with a side branch IPMN. A smaller 4 mm cystic lesion superior to this is also unchanged (series 5, image 33). As on prior study, this does not demonstrate definitive communication with the duct. An additional 3 mm nonenhancing cystic lesion (series 5, image 47) arises from the main duct downstream from the dominant cystic lesion and also likely represents a smaller sidebranch IPMN and appears unchanged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter T2 hyperintensities within the kidneys are suggestive of renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Again seen are two cystic lesions within the pancreas likely representing side branch IPMNs as described above. These are unchanged compared to prior study.2.Additional cystic lesion which does not demonstrate definite communication with the pancreatic duct is also unchanged, most likely an additional IPMN.3.Findings suggestive of iron deposition within the liver and spleen.


Instruction: Generate impression based on medical findings.

Input: 52-year-old female presents for screening MRI. She is BRCA1 positive. She Has a family history of prostate and lung cancer in her father, ovarian cancer in her aunt and cousin. Known fibroadenoma in the right breast. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.The 5 mm round focus with a dark septation is again noted in the inferior and anterior aspect of the right breast and remains stable from the prior. This is most compatible with a fibroadenoma, which is benign. No additional abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. Stable 5 mm benign fibroadenoma in the anterior right breast.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on medical findings.

Input: Reason: Scaphoid Fx History: Pain, Tenderness There is edema concentrated within the waist of the scaphoid likely due to a nondisplaced fracture. The fracture line itself is not well defined on this study. Although this study was not protocoled for detailed evaluation of the intrinsic ligaments of the wrist, there is increased signal intensity traversing the membranous portion of the scapholunate ligament likely representing a tear. The lunotriquetral ligament appears intact. There is mild edema at the styloid attachment of the long radiolunate ligament which may represent a sprain or partial tear. The triangular fibrocartilage complex appears intact. The flexor and extensor tendons are normal in appearance.

Output: Nondisplaced fracture of the middle third of the scaphoid and other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Male 14 months old Reason: IVH, born 25 wk gestation, one of triplets. There is a large oval CSF signal intensity structure centered in the right parietal region representing a porencephalic cyst which communicates with the body of the right lateral ventricle. There is associated loss of parenchymal tissue involving a majority of the right parietal lobe, a portion of the posterior right frontal lobe, as well as the right corpus callosum, distal to the anterior body. This cyst measures 5.7 cm in craniocaudal dimension and 5.9 x 2.7 cm in axial dimensions, and results in mild localized mass effect. There are more focal areas of encephalomalacia along the posterior aspect of the cyst as well as susceptibility artifact consistent with hemosiderin staining suggesting prior hemorrhage.There is mild-moderate dilatation of the lateral and third ventricles, as well as anterior subarachnoid spaces. Susceptibility in the occipital horns in noted, consistent with history of intraventricular blood products. The distal right anterior cerebral artery flow void is absent. Otherwise the major cerebral flow voids are intact.With regard to corrected age, the visualized white matter appears somewhat delayed in myelination pattern on T2 imaging. However on T1 imaging the white matter appears more compatible with expected appearance although the arborization is somewhat decreased, likely secondary to diffuse paucity of white matter. The cerebellum is somewhat dysplastic with crossing folia suggesting some degree of rhomboencephalosynapsis. There is also hypoplasia of the inferior aspect of the cerebellum. There are a few scattered punctate foci of susceptibility in the cerebellum suggesting possible prior punctate hemorrhage.

Output: 1.Large right porencephalic cyst with associated parenchymal loss of white matter and cortex of the majority of the right parietal lobe and a portion of the posterior right frontal lobe as detailed above. Evidence of hemosiderin deposition along the severely encephalomalacic right posterior parietal region indicating previous hemorrhage. Mild localized mass effect.2.Dysplastic cerebellum with suggestion of rhomboencephalosynapsis.3.Heart absence of the posterior right corpus callosum.4.Mildly delayed myelination pattern on T2-weighted images with overall significant possibly of white matter volume.5.Prominence of ventricles and anterior subarachnoid spaces which may in part relate to the generalized volume loss as well as superimposed benign enlargement of subarachnoid spaces of infancy which should resolve by 2 years of age.6.Trace hemosiderin in the occipital horns dependently, relating to previous intraventricular blood products.


Instruction: Generate impression based on medical findings.

Input: 19 year-old male with right shoulder/acromioclavicular joint pain. ROTATOR CUFF: The rotator cuff is intact and unremarkable.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a cleft in the posterior labrum is consistent with a posterior labral tear. No paralabral cyst is identified.BICEPS TENDON: The biceps tendon is intact and unremarkable. ADDITIONAL

Output: Findings consistent with a posterior labral tear of the right shoulder.


Instruction: Generate impression based on medical findings.

Input: Abdominal pain and recent diagnosis of Crohn's disease ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Bowel wall thickening, enhancement, and associated narrowing involving a 10 cm segment of distal ileum (series 13, image 52, 56, and 60). Additionally, there is a separate 6 cm segment of mid ileum which is similarly affected (series 13, image 58). Angulation of several small bowel loops in the right lower quadrant. No evidence of fistula or abscess.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Acute on chronic changes in the mid and distal ileum as described above compatible with inflammatory bowel disease.


Instruction: Generate impression based on medical findings.

Input: Pain and numbness in bilateral lower extremities. Alignment is anatomic. The vertebral body heights are preserved. Degenerative endplate marrow signal abnormality as well as contour irregularity is present on multiple endplates most notably at L2-3. Severe disc degeneration at L2-3 without increased T2 signal to suggest an acute inflammatory or infectious process. No extra axial masses or fluid collections are identified. No abnormality in the visualized soft tissues. Level by level findings are as follows:L1-L2: No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.L2-L3: Severe disc degeneration with moderate diffuse disc bulge and superimposed focal right paracentral herniation. Moderate facet and ligamentum flavum hypertrophy. Mild left and moderate to severe right neuroforaminal stenosis and mild spinal canal stenosis.L3-L4: Mild diffuse disc bulge, facet hypertrophy, and ligamentum flavum hypertrophy create mild right and minimal left neural foraminal stenosis. Moderate spinal canal stenosis.L4-L5: Moderate to severe facet arthropathy and hypertrophy of the ligamentum flavum. There is mild right neuroforaminal narrowing. No spinal canal stenosis.L5-S1: Moderate to severe facet arthropathy and hypertrophy of the ligamentum flavum creating mild bilateral neural foraminal narrowing. No significant spinal canal stenosis.

Output: 1. Severe degeneration at L2-3 with associated chronic endplate changes and advanced degeneration of the facet joints. This results in moderate to severe right neural foraminal stenosis. Given the advanced disc degeneration at this level compared to the others in the lumbar spine, this raises the possibility of a remote traumatic or inflammatory process at this level.2. Scattered multilevel degenerative changes in the rest of the lumbar spine which create multiple mild neural foraminal narrowings.


Instruction: Generate impression based on medical findings.

Input: Pain radiating down left leg. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is minimal compression deformity involving the right aspect of the superior L1 endplate. There is grade 1 anterolisthesis of L4 on L5, L3 on L4, and to a minimal degree L2 on L3. There is mild multilevel disc desiccation. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: Mild disc bulge, eccentric to the right. There is mild right-sided neural foraminal stenosis. No spinal canal or left neural foraminal stenosis.L2-L3: Mild disc bulge, ligamentum flavum thickening and facet arthropathy. No spinal canal stenosis. Minimal narrowing of the bilateral neural foramina. L3-L4: Mild disc uncovering and bulge, ligamentum flavum thickening and moderate bilateral facet arthropathy. There is no significant spinal canal stenosis. There is mild to moderate right and mild left neural foraminal stenosis.L4-L5: Disc uncovering and disc bulge with small left foraminal disc extrusion. There is also ligamentum flavum thickening and moderate bilateral facet arthropathy. There is moderate left and mild right neural foraminal stenosis. There is no significant spinal stenosis.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits. Multiple left-sided renal cysts.

Output: 1. Multilevel degenerative changes throughout the lumbar spine. There is moderate left-sided neural foraminal stenosis at L4-L5 where there is suspected impingement of the left L4 nerve root.2. Additional details, including multilevel facet arthropathy with grade 1 anterolistheses, as above. No significant spinal canal stenosis at any level.


Instruction: Generate impression based on medical findings.

Input: History of renal cell carcinoma status post partial nephrectomy ABDOMEN:LIVER, BILIARY TRACT: 5 mm T2 hyperintense focus in the inferior right hepatic lobe is nonspecific but likely benign. Cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Probable small right adrenal adenoma.KIDNEYS, URETERS: Postsurgical changes in the lateral aspect of the right kidney. Probable hemorrhagic cyst in the left kidney. Bilateral simple renal cysts. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Postsurgical changes without evidence of tumor recurrence.


Instruction: Generate impression based on medical findings.

Input: Followup of spinal cord injury with re-tethered spinal cord at the site of his gunshot wound, status post surgery. There are postoperative findings related to multilevel lower thoracic posterior element resection, with fluid collections in the paraspinal soft tissues, along the incision plane. There is severe atrophy of the spinal cord at the T10 level. There are also areas of high signal in the spinal cord at the T11 level, where the spinal cord abuts the anterior aspect of the thecal sac. In addition, there is persistent clumping of the cauda equina nerve roots at T11-T12. There are bilateral pars interarticularis defects at L5 without spondylolisthesis. The vertebral column alignment is otherwise within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. There is multilevel degenerative spondylosis, but no significant spinal canal or neural foraminal stenosis. There are small bilateral pleural effusions. There is a probable right renal cyst.

Output: Recent postoperative findings in the lower thoracic spine with stigmata of gunshot wound injury, including severe atrophy of the spinal cord at the T10 level and areas of encephalomalacia in the spinal cord at the T11 level, where the spinal cord abuts the anterior aspect of the thecal sac, which is suggestive of persistent tethering. In addition, persistent clumping of the cauda equina nerve roots at T11-T12 also suggests the presence of adhesions.


Instruction: Generate impression based on medical findings.

Input: Tremor, unspecified [R25.1], Reason for Study: ^Reason: assess for disease of basal ganglia History: new onset tremors. No evidence of acute ischemic or hemorrhagic lesion on the scan.Multifocal high signal intensity lesions on FLAIR/T2 are seen at bilateral frontal lobes, parieto-temporal lobes, periventricular white matter and centrum semiovale indicating non specific small vessel ischemic disease, unchanged in their extent and distribution since prior scan.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. Mucosal thickening on sphenoid sinus and bilateral maxillary sinuses.Right mastoid air cells show opacification.

Output: No change of non specific FLAIR/T2 high signal intensity lesions since prior scan, indicating non specific small vessel ischemic disease.No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on medical findings.

Input: 55 years Female (DOB:5/23/1961)Reason: MS folow up History: nonePROVIDER/ATTENDING NAME: HALINA BRUKNER HALINA BRUKNER 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. These are stable compared to the prior exam from 8/4/2015. Some of the lesions are perpendicularly oriented to the lateral ventricles and extends to the colosso-cingulate junctionNo abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There is redemonstration of multiple periventricular subcortical white matter lesions as well as cerebellar lesions which are stable compared with previous exam. Although these lesions are nonspecific they do support the clinical diagnosis of multiple sclerosis.


Instruction: Generate impression based on medical findings.

Input: Alignment is anatomic. Multilevel heterogeneous marrow signal may be related to chronic renal disease. Additionally, there are multiple large Schmorl nodes. No findings to suggest acute cord compression.Multilevel cervical spondylosis with multilevel mild to moderate central spinal canal stenosis. There is questionable signal changes in the cervical spinal cord at C5/6 level which may be degenerative in etiology versus artifact.Increased STIR signal within L3/L4 disk space may be reactive inflammatory changes and underlying discitis is a concern. There is additionally a compression deformity of the inferior endplate of L3. There is disc bulge with possible annular tear resulting in severe central spinal canal stenosis at L3/4. No pre-vertebral soft tissue or epidural collections. Additional multilevel lumbar spondylosis noted. There is no evidence of traumatic subluxation. The conus is normal in signal and morphology and terminates at an appropriate level. The visualized paraspinal contents are unremarkable.

Output: 1.No findings to suggest acute cord compression.2.Increased STIR signal within L3/L4 disk space may be reactive inflammatory in etiology and underlying diskitis is a concern. Severe central spinal canal stenosis at L3/4, likely from degenerative changes. Dedicated lumbar spine MRI examination is recommended.3.Multilevel cervical spondylosis as above with questionable signal changes within the cervical spine which may be secondary to degenerative changes. Dedicated cervical spine MRI examination is recommended.Findings relayed to Dr. Carter over phone in the Emergency Department at 0940 hours.


Instruction: Generate impression based on medical findings.

Input: Male, 16 years old, status post C2 spinal cord tumor resection, assess resection. Laminectomy has been performed at C1 and C2. A collection is evident in the operative bed containing a mixture of fluid, blood product, and bubbles of air. Air is also evident scattered through the thecal sac.The previously demonstrated intramedullary cystic lesion at C2 has been significantly decompressed. A small area of residual T2 hyperintensity is seen at the site of the cyst measuring 8 mm in length and up to 4 mm in width. Ill-defined cord T2 hyperintensity at and above the level of the lesion is relatively unchanged, perhaps representing edema. A small focus of susceptibility is seen in the ventral cord at the cranial edge of the lesion which may represent blood product or some other post-operative change.On post-contrast images, two small foci of enhancement along the ventral cord at C2 are redemonstrated, appearing minimally more prominent. However, decompression of the cyst may contribute to this apparent change. A focus of enhancement seen previously along the dorsal cord at C2 is no longer appreciated. A focus of enhancement in the left cerebellar tonsil, and faint enhancement along the dorsal cord at T1, are also unchanged. No new enhancing lesions are seen.

Output: Findings are seen compatible with C1-2 laminectomy and decompression of a cystic intramedullary lesion at C2. A small area of T2 hyperintensity at the site of the cyst may represent sequela of resection or minimal residual cyst. Two foci of enhancement associated with the prior cyst along the ventral cord at C2 may be minimally more prominent than on the prior study, although altered cord geometry secondary to decompression of the cyst may contribute to this appearance. An enhancing focus along the dorsal cord at C2 is no longer appreciated. Other small enhancing foci are unchanged as above.


Instruction: Generate impression based on medical findings.

Input: Compression of brain [G93.5] / Low back pain [M54.5], Reason for Study: ^Reason: Chiari malformation with back pain and headaches, follow up with CSF flow study History: Chiari malformation and back pain23 years Female (DOB:11/6/1993)Reason: chiChiarilformation with back pain and headaches, follow up with CSF flow study History: Chiari malformation and back painPROVIDER/ATTENDING NAME: DAVID M. FRIM SERVICES ANCILLARY Complete Spine MRIRedemonstration of Chiari I malformation (downward displacement of cerebellar tonsils) are seen, unchanged since prior scan.There is no evidence of syringomyelia.There is normal cervical lordosis. The cranial-cervical junction is normal. There is normal thoracic kyphosis and lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The cord signal is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal stenosis, cord compression or myelopathy. The conus medullaris terminates at the level of L1-2. The intervertebral discs demonstrate normal T2 intensity and height with no evidence of disc herniation. The paraspinal soft tissues and musculature are unremarkable.2D Phase Contrast MRA for CSF flowBidBidirectionalF flows across the foramen magnum seen both anterior and posterior aspect of upper cervical cord and cervicomedullary junction. In addition, subtle bidbidirectionalF flow is seen through the foramen Magendie.Comparing to prior scan, there is no significant interval change though this exam is not quantitative.

Output: 1. Unchanged Chiari 1 malformation since prior scan.2. No evidence of syringomyelia3. Unchanged bidirectional CSF flow across the foramen magnum both anterior and posterior aspect of upper cervical spine and cervicomedullary junction as well as foramen Magendie.


Instruction: Generate impression based on medical findings.

Input: Reason: assess lines placement History: lines presentVIEW: Chest and abdomen AP (two views) on 5/31/16 time stamped at 10:21. The endotracheal tube tip has been retracted and is now at the level of the carina. There are small lung volumes. The left lung collapse has slightly improved with minimal aeration of the left lung base. There is significant soft tissue edema and abdominal distention. The umbilical venous catheter tip is at the level of the left hepatic vein. The umbilical artery catheter terminates at T8. The NG tube is in the stomach. There is an overall paucity of abdominal gas with peripherally displaced bowel gas, consistent with the abdominal mass identified on the MRI. A catheter seen within the urinary bladder.

Output: The endotracheal tube tip has been retracted and is now at the level of the carina.


Instruction: Generate impression based on medical findings.

Input: Female; 63 years old. Reason: HCC screening History: cirrhosis ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. No focal hepatic lesions suspicious for HCC. Main portal vein and its branches are patent. Cholelithiasis.SPLEEN: Mild splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace perihepatic and perisplenic ascites.

Output: Cirrhotic liver without focal hepatic lesion suspicious for HCC.


Instruction: Generate impression based on medical findings.

Input: 47-year-old female patient with uterine fibroids. Three month follow-up imaging status post uterine fibroid embolization. PELVIS:UTERUS, ADNEXA: The uterus measures 14.8 x 8.5 cm. Multiple uterine fibroids are again identified, the largest of which have decreased in size and no longer enhance. The largest measures approximately 7.4 x 6.1 cm (image 21, series 501), previously 8.9 x 7.3 cm. This fibroid demonstrates decreased T2 signal compared to the prior exam. An additional relatively large fibroid on the left side of the uterus extending to the left adnexa now measures 4.9 x 3.2 cm (image 26, series 501), previously 6.2 x 5.1 image. Multiple other fibroids also no longer demonstrate enhancement. The endometrial stripe is unremarkable. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: A small amount of free fluid is present in the pelvis.

Output: Interval decrease in size and enhancement of multiple uterine fibroids.


Instruction: Generate impression based on medical findings.

Input: Thoracic spine:There is a smooth, physiologic thoracic kyphotic curve. The vertebral body heights and disc spaces are maintained. Marrow signal intensity is benign throughout. The spinal cord has a smooth contour and is without focal atrophy, edema, or myelomalacia. There are no masses.T1/2 demonstrates no significant disc bulge or cord encroachment.T2/3 demonstrates no significant disc bulge or cord encroachment. T3/4 demonstrates no significant disc bulge or cord encroachment. T4/5 demonstrates no significant disc bulge or cord encroachment. T5/6 demonstrates no significant disc bulge or cord encroachment.T6/7 demonstrates no significant disc bulge or cord encroachment. T7/8 demonstrates no significant disc bulge or cord encroachment. T8/9 demonstrates no significant disc bulge or cord encroachment. T9/10 demonstrates no significant disc bulge or cord encroachment.T10/11 demonstrates no significant disc bulge or cord encroachment. T11/12 demonstrates no significant disc bulge or cord encroachment. T12/L1 demonstrates no significant disc bulge or cord encroachment. Lumbar spine:Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. The visualized intra-abdominal and paraspinal contents are unremarkable.L1/2: UnremarkableL2/3: UnremarkableL3/4: UnremarkableL4/5: UnremarkableL5/S1:Unremarkable

Output: Negative noncontrast thoracic and lumbar spine MRI without contrast. Specifically, there are no MRI findings to explain the patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: Brain tumor. Status post biopsy. Since the previous MRI examination, there has been a stereotactic biopsy and aspiration of the cystic hypothalamic/third ventricular lesion. Expected postoperative changes are present along the surgical tract through the left frontal lobe and within the cystic lesion. The lesion show mildly nodular rim of contrast enhancement peripherally and layering debris/blood products centrally. The CT scan from February 23, 2016 shows punctate calcifications in the inferior aspect of the cystic mass. The lesion now measures 2.8 cm x 2.2 cm, compared to 2.8 cm x 2.4 cm previously. The associated mass-effect has improved with improved lateral ventricular dilatation. There is no other contrast enhancing brain lesion. The brain parenchymal T2-hyperintensity surrounding this cystic lesion which also involves the posterior limb of left internal capsule is not significantly changed. There is mild dural enhancement over the left cerebral convexity consistent with postsurgical change. Postoperative changes also include left sided scalp swelling and fluid overlying the burr hole.

Output: 1.Postoperative changes of biopsy and aspiration of cystic suprasellar mass. 2.The cystic component has been partially drained with improved mass-effect and hydrocephalus.


Instruction: Generate impression based on medical findings.

Input: Male 46 years old; Reason: new diagnosis of cirrhosis, evaluate liver morphology, veins, biliary tree and rule out PSC History: new ascites Suboptimal study secondary to artifact related to presence of patient's large ascites.ABDOMEN:LUNGS BASES: Partially imaged gynecomastia. LIVER, BILIARY TRACT: Hepatomegaly, liver measures 21 cm in craniocaudal dimension. Widening of the fissures and surface nodularity seen consistent with underlying cirrhosis. Diffuse signal loss on opposed phase imaging compared to in phase, consistent with hepatic steatosis. No suspicious arterially enhancing hepatic focus seen. Tiny nonenhancing focus at level of liver dome anteriorly on image 202 series 16 favored to be a tiny cyst with corresponding increased T2 signal suggested. Minimal biliary ductal irregularity seen centrally at level of confluence, see key image. No intrahepatic or extrahepatic biliary duct dilatation. Gallbladder contracted containing cholelithiasis. Mild gallbladder wall edema, nonspecific in setting of ascites. Patent portal veins and splenic vein, contrast noted opacifying SMV. Patent hepatic arteries and veins.SPLEEN: Spleen measures up to 13.2 cm.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Prominent upper abdominal including periportal lymph nodes, favored to be reactive in etiology.BOWEL, MESENTERY: Large ascites with associated centralization of bowel.BONES, SOFT TISSUES: Anasarca.OTHER: No significant abnormality noted.

Output: Cirrhotic liver morphology, hepatomegaly, and diffuse hepatic steatosis. Large ascites.Minimal biliary ductal irregularity seen centrally at level of confluence, nonspecific but may be seen in PSC in appropriate clinical setting. No intrahepatic or extrahepatic biliary duct dilatation. Additional findings as above.