Instruction: Generate impression based on medical findings.

Input: 46 years Female (DOB:3/7/1970)Reason: possible osteoporosis, radiculopathy, facet joint inflammation History: pain in multiple sitesPROVIDER/ATTENDING NAME: ANDREA H. SHASHOUA ANDREA H. SHASHOUA Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. There is some subtle T2 signal hyperintensity present along the cervical spinal cord which is suspected to be artifactual.. The patient status post anterior fusion using anterior plate and screws at C6-7.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.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is left-sided facet hypertrophy at this level associated with mild narrowing of the left neural foramen.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There are small uncovertebral osteophytes at this level associated with a disc bulge.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.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 a mild levocurvature to the upper thoracic spine.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. There are 4 nonrib-bearing lumbar-type vertebrae and a sacralized lumbar vertebra present. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is loss of disc space height, disc desiccation and broad-based central disc protrusion associated with some partial effacement of the fat at the lateral recesses bilaterally. There is mild encroachment of the nerve roots at the lateral recesses at this level which is worse on the right when compared to the left side.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is some disc desiccation and a mild disc bulge at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.Please note that L5 is sacralized with articulation with the sacral ala.2.There are multilevel degenerative changes present in the lumbar spine. There is some mild to moderate encroachment of nerve roots of the right lateral recess at L4-5 due to degenerative changes.3.Patient status post cervical spine surgery. There is no significant compromise to the cervical spinal canal or exiting nerve roots.4.No compression fractures are identified in the spine.


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. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain. Images of the internal auditory canals demonstrate the seventh and eighth nerves to be normal in size and symmetric bilaterally without masses or enhancing lesions along the course of these nerves or in the cerebellopontine angle cisterns bilaterally. The inner ear structures are normal in appearance and symmetric bilaterally without congenital inner ear anomalies identified on either side. There are no vascular anomalies.

Output: Negative MRI of the brain and internal auditory canals including gadolinium enhancement. Specifically, the seventh/eighth nerve complexes are intact within bilaterally.


Instruction: Generate impression based on medical findings.

Input: Female, 38 years old, 24 weeks gestational age, with fetal ventriculomegaly as seen on ultrasound. The atria of the lateral ventricles are enlarged, each side measuring up to 13 mm in the axial plane. The frontal horns are within normal limits. The fourth ventricle is also normal in size. The cerebral aqueduct is not reliably visualized due to fetal motion and as such, patency of the aqueduct cannot be assessed.The cavum septum pellucidum is not confidently visualized. However, the corpus callosum is present. The brainstem and posterior fossa are within normal limits. Cerebral morphology and the degree of sulcation are appropriate for gestational age. No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collections are detected.

Output: 1.Mild bilateral ventriculomegaly is seen. Although no clear etiology for this is identified, the cerebral aqueduct is not adequately visualized to assess for patency.2.The cavum septum pellucidum is not reliably visualized. However, the corpus callosum is present and appears to be normally formed.3.The remainder of the examination is within normal limits.


Instruction: Generate impression based on medical findings.

Input: Abnormal findings on diagnostic imaging of skull and head, not elsewhere classified [R93.0] / Migraine with aura, not intractable, without status migrainosus [G43.109], Reason for Study: ^Reason: please compare to prior, please do Dr. Javed MS protocol, c Motion artifacts degraded exam quality.There are multifocal bihemispheric scattered high signa intensity white matter lesions on FLAIR images including bilateral frontal lobe, parietal lobe and corpus callosum, overall no change since prior scan in terms of size, number and signal intensity level.There is no evidence of abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Multifocal scattered bihemispheric and corpus callosum high FLAIR high signal intensity lesions indicating demyelinating disease, no change in terms of size, number of lesions and MR signal characteristics since prior scan.No evidence of abnormal enhancement.


Instruction: Generate impression based on medical findings.

Input: Unspecified abnormalities of gait and mobility [R26.9] / Unspecified fall, subsequent encounter [W19.XXXD], Reason for Study: ^Reason: r/o structural lesion or stroke History: gait imbalance, falls No evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.About 5 mm downward displacement of cerebellar tonsil.

Output: 1. 5mm downward displacement of cerebellar tonsils are seen.2. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on medical findings.

Input: This exam is mildly degraded by motion artifact. There are unchanged postoperative findings related to resection of a right vestibular schwannoma. There is an unchanged subcentimeter patchy focus of enhancement within the superior aspect of the right internal auditory canal as well as unchanged thin linear enhancement along the posterior aspect of the right internal auditory canal. There is clumping of the right cranial nerve 7 and 8 complex. The left internal auditory canal is unremarkable. The bilateral inner ear structures are unremarkable.

Output: Unchanged nonspecific enhancing tissue within the right internal auditory canal amidst postoperative findings. 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: Right chronic parotidis. There is an ovoid low T1 and T2 structure within parotid duct along the anterior aspect of the right parotid gland that measures 4 mm in width and 10 mm in length, which is compatible with a calculus. There is an additional low T1 and T2 structure within parotid duct compatible with a calculus overlying the anterior masseter muscle, measuring 3 mm in length and 2 mm in width. There is dilatation of the parotid duct up to 6 mm over a length of 25 mm between the two calculi. However, the duct is relatively narrow focally just anterior to the larger calculus. There is also mild diffuse intraparotid ductal dilatation, as well as considerable thickening and enhancement of the walls of the right parotid duct. There is also extensive enhancement of the right parotid gland and overlying subcutaneous tissues, but no evidence of abscess or discrete tumor. There are mild prominent right parotid lymph nodes, which are likely reactive. The left parotid gland appears to be unremarkable. There is fluid and mild mucosal thickening within the right maxillary sinus. There is a partially-characterized left supraclinoid internal carotid artery aneurysm that measures up to approximately 15 mm.

Output: 1. Acute upon chronic right parotitis and overlying cellulitis associated with parotid sialodocholithiasis and ductal dilatation.2. Findings compatible with acute rhinosinusitis.3. Partially-characterized left supraclinoid internal carotid artery aneurysm that measures up to approximately 15 mm.


Instruction: Generate impression based on medical findings.

Input: 64 years Male (DOB:8/5/1951)Reason: Evaluate for ischemia History: Transient RUE weakness x 2 episodesPROVIDER/ATTENDING NAME: JAMES J WALTER HELENE G RUBEIZ MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mild mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion. The left A1 segment is larger than the right A1 segment. The LVA is smaller than the RVA.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The vertebral arteries are similar in size.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.

Output: 1.There is no evidence for intracranial hemorrhage or intracranial mass to explain the patient's right upper extremity weakness.2.No evidence for intracranial cerebrovascular occlusive disease.3.No evidence for extracranial cerebrovascular occlusive disease.


Instruction: Generate impression based on medical findings.

Input: Sacral decubitus ulcer. Evaluate for osteomyelitis There is diffuse subcutaneous gas seen in the soft tissue overlying the proximal right femur, with partial loss of the greater trochanter and lucencies within the proximal femur, consistent with osteomyelitis, unchanged from the MRI of the same day. No evidence of acute fracture or malalignment.

Output: Osteomyelitis of the right femur, with diffuse subcutaneous gas, better seen on the MRI from the same day.


Instruction: Generate impression based on medical findings.

Input: Back pain and leg weakness Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is loss of normal lumbar lordosis. Alignment is otherwise maintained. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis.L5-S1: There is disk bulge with component of central disk protrusion which effaces the lateral recesses and contacts the bilateral traversing S1 nerve roots. No significant central canal stenosis. There is mild bilateral neural foramina stenosis.Paraspinous soft tissues are within normal limits.

Output: Mild degenerative changes in the lumbar spine with disk protrusion at the L5-S1 level. There is contact of the traversing S1 nerve roots in the lateral recesses as well as mild narrowing of the L5-S1 neural foramina involving the exiting L5 nerve roots.


Instruction: Generate impression based on medical findings.

Input: There are postsurgical changes of suboccipital decompression including resection of the posterior arch of C1. There is much improvement in CSF spaces at the foramen magnum with robust biphasic flow now present ventrally and slightly diminished, but interval improved, flow dorsally. There is small fluid collection at the level of the suboccipital craniectomy measuring approximately 9 mm in thickness compatible with a pseudomeningocele. There is prominent enhancement involving the paraspinous soft tissues likely related to granulation tissue, although infection is not excluded and can be considered in the appropriate setting. Enhancement is also noted along the pial surface of the cerebellar tonsils.There is interval decrease in size of previously seen syrinx. Prior exam demonstrated a syrinx extending from the lower medulla into the cervical and thoracic cord with inferior limit at the T11-T12 level based on prior sagittal lumbar MRI images. Note a dedicated prior thoracic spine MRI is not available for comparison. Current study demonstrates significant decrease in extent and caliber of the syrinx which now extends to the mid T11 level. Residual signal abnormality involving the medulla is again evident best seen on the 3-D T2 sequence. There is marked decrease in the caliber of the syrinx; for example at the C6-C7 level, syrinx previously measuring 6.7 mm now measures 2.4 mm in the AP dimension. Previously seen associated cord expansion has now resolved with thinning/volume loss of the cord parenchyma much more apparent.There is mild reversal of normal cervical lordosis. There is also mild thoracic dextroscoliosis. Vertebral body heights are maintained. Disc desiccation at multiple levels are also seen with minimal bulge. Upper cervical spinal canal appears small on a congenital basis. There is also mild C3-C4 and C4-C5 neural foraminal narrowing. Otherwise no high-grade spinal canal or neural foraminal stenosis. There is calvarial thickening including the partially imaged clivus and also evident on outside brain MRI. Finding nonspecific and may be related to dysplasia or endocrinologic abnormality, for example. Dysplastic appearance of the thoracic ribs are also noted which appear slightly widened.

Output: 1. Compared to outside MRI, interval postsurgical changes of suboccipital decompression for Chiari I malformation are seen with much improvement in CSF spaces and biphasic flow at the foramen magnum. There is also marked improvement in size and extent of syrinx which extends from the medulla to the lower thoracic cord, as detailed above. There is associated resolution of previously seen cord expansion with volume loss/parenchymal thinning in the cord now more evident.2. Small suboccipital fluid collection likely represents a pseudomeningocele. There is also T2 hyperintensity involving the cerebellar tonsils as well as enhancement along the surface of the cerebellar tonsils which may represent expected postsurgical change. There is also prominent enhancement involving the suboccipital soft tissues which while may also represent postsurgical change/granulation tissue, but raises possibility of infection in the appropriate clinical setting. 3. Thickening of the clivus/partially imaged calvarium as well as mildly dysplastic appearance of the thoracic ribs which are broadened. These findings are nonspecific and may be related to dysplasia or endocrinologic abnormalities for example.


Instruction: Generate impression based on medical findings.

Input: Follow-up for multiple sclerosis. There are multiple T2 hyperintense lesions cerebral white matter and perhaps in the right superior cerebellar peduncle. There has been interval increase in size of a lesion in the right superior frontal gyrus and in the left temporal horn periventricular white matter. The other lesions have not significantly changed. Many of the lesions demonstrate T1 hypointensity. 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: Interval increase in size of demyelinating lesions in the right superior frontal gyrus and in the left temporal horn periventricular white matter. The other lesions have not significantly changed. 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: ORBITS: There is questionable minimal T2 hypertensity within the intraorbital segment of the left optic nerve only seen on the axial STIR sequence as well as minimal expansion within it's intracranial segment extending to involve the left aspect of the chiasm which shows asymmetric expansion. There is no associated enhancement. The right optic nerve and right side chiasm are unremarkable. The extraocular muscles are unremarkable. There is a 12 x 12 mm nonenhancing hypothalamic mass located just posterior to, and intimately associated with, the optic chiasm. There is mild splaying of the optic tracts by this lesion that extends posteriorly into the interpeduncular cistern. The infundibulum and pituitary gland are not involved.BRAIN: There are scattered patchy foci of T2 hyperintensity within the basal ganglia, thalami, cerebral peduncles, brainstem, and bilateral cerebellar white matter as well as within the left insula where there is also mild expansion without enhancement. There is a 3 mm focus of enhancement within the right precentral gyrus with subtle corresponding T2 signal abnormality. There is no evidence of acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: 1.Hypothalamic glioma likely extends toward the optic chiasm especially toward left side with resultant mass effect.2.Stigmata of NF1 including intracranial left optic nerve / chiasm enlargement most compatible with glioma and numerous supratentorial and infratentorial foci of signal abnormality compatible with "UBOs". The left hippocampal "UBO" demonstrates mild expansion and mass effect suggestive of low grade glioma. Follow-up imaging is recommended. 3.Small focus of enhancement within the right precentral gyrus with subtle associated T2 hyperintensity is nonspecific and may represent a vascular lesion such as a capillary telangiectasia, a neoplasm, or less likely artifact. Follow-up imaging is recommended.


Instruction: Generate impression based on medical findings.

Input: 63 years Female (DOB:1/26/1953)Reason: right arm pain History: right arm painPROVIDER/ATTENDING NAME: BEN-ZION ROITBERG BEN-ZION ROITBERG The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is multilevel disc desiccation present.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal. There are right-sided uncovertebral osteophytes present at this level and some ligamentum flavum hypertrophy. There is encroachment of the exiting nerve roots within the right neural foramen at this level as a result of osteophyte formationAt C5-6 there is no significant compromise to the spinal canal. There is loss of disc space height, disc desiccation as well as endplate and uncovertebral osteophytes at this level with narrowing of the neural foramina bilaterally but worse on the right side where there is encroachment of the right-sided exiting nerve roots within the neural foramen.At C6-7 there is no significant compromise to the spinal canal. There is loss of disc space height, disc desiccation as well as endplate and uncovertebral osteophytes at this level with some narrowing of the neural foramina bilaterally.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. The right vertebral artery appears very small and has very little intracranial contribution..

Output: There are multilevel degenerative changes present in the cervical spine with encroachment of exiting nerve roots predominantly in the right side at C4-5 and C5-6 as a result of a degenerative changes.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old, with headaches and history of sarcoidosis. Mild enhancement of the optic chiasm, pre-chiasmatic optic nerves, and the optic tracts is not significantly changed.Scattered patchy areas of previously seen leptomeningeal enhancement along the sulci of the cerebral hemispheres and cerebellum have completely or nearly completely resolved.Focal widening along the right central sulcus is unchanged and may represent the presence of a small arachnoid cyst.Minimal patchy T2 hyperintensity within the pons is unchanged and nonspecific. No significant parenchymal edema or mass effect is detected. No restricted diffusion is seen.No evidence of significant intracranial hemorrhage is seen. The ventricles are stable in size and morphology. Mild coaption of the right frontal horn is unchanged.Large mucus tension cyst remained within the maxillary sinuses, and there is patchy mucosal thickening through the ethmoid air cells.

Output: 1.Stable enhancement of the visualized portions of the optic apparatus.2.Interval complete or near complete resolution of previously seen patchy leptomeningeal enhancement.3.No new intracranial lesions.


Instruction: Generate impression based on medical findings.

Input: 67-year-old male with elevated PSA. PELVIS:PROSTATE:Prostate Size: 4 x 5.3 x 4.3 cm.Peripheral Zone: 6 mm focus of low T2 signal with restricted diffusion at the right apex posteriorly, suspicious for prostate cancer (series 801/12). 7 mm focus of low T2 signal with restricted diffusion at the right base posteriorly, suspicious for prostate cancer (series 801/20). Mild diffuse thinning of the left peripheral zone with patchy low T2 signal, suggestive of prior inflammation.Central Gland: Heterogeneous.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Penile implant, partially visualized, with intrapelvic reservoir.

Output: Findings suspicious for multifocal right-sided prostate cancer without evidence of extracapsular extension.


Instruction: Generate impression based on medical findings.

Input: 69-year-old female with a history of right basal ganglia stroke now with lethargy and confusion. Evaluate for hemorrhagic conversion. There is no evidence of intracranial hemorrhage, extra-axial fluid collection or mass. There is no mass effect or midline shift. There is a focal area of hypoattenuation in the right MCA perforator distribution in the right basal ganglia and right anterior limb of the internal capsule which appears more well defined and correlates to a subacute infarction previously demonstrated on MRI. There is no significant associated vasogenic edema.Redemonstration of nonspecific moderate periventricular and deep white matter hypoattenuation. These findings are most consistent with age indeterminate small vessel ischemic disease.The ventricles and basal cisterns are normal in size and configuration. The calvaria and skull base are radiographically normal. The visualized mastoid air cells are within normal limits. Again seen is a moderate mucosal thickening of the maxillary sinuses which appears unchanged when compared to the previous study.

Output: 1. Focal area of hypoattenuation in the right MCA perforator distribution in the right basal ganglia and right anterior limb of the internal capsule which correlates to a subacute infarction previously demonstrated on MRI. There is no evidence of hemorrhagic conversion.2. Nonspecific moderate periventricular and deep white matter hypoattenuation. These findings are most consistent with age indeterminate small vessel ischemic disease.3. Mild mucosal thickening of the maxillary sinuses bilaterally, unchanged.


Instruction: Generate impression based on medical findings.

Input: Left breast IDC and DCIS status post lumpectomy and complete axillary lymph node dissection in 2010. Patient received radiation, chemotherapy and hormonal therapy. Patient presents for consultation for possible bilateral mastectomy. Personal history of ovarian cancer. History of breast cancer in paternal aunt and cousin. There is heterogeneous amount of fibroglandular tissue in the right breast and scattered fibroglandular tissue in the left breast. Minimal parenchymal enhancement is noted bilaterally.Left breast: Expected postsurgical changes from a lumpectomy and axillary dissection are present. No suspicious enhancing masses, non-mass enhancement or foci are present.Right breast: Susceptibility artifact from a biopsy clip is present at the 8 o'clock position, mid depth. An exophytic skin lesion is present at the 6 o'clock position of the right breast for which clinical correlation is recommended. No suspicious enhancing masses, non-mass enhancement or suspicious foci are present. No abnormal axillary lymph nodes are identified in either axillary region.

Output: Stable postsurgical changes of the left breast. Exophytic skin lesion at the 6 o'clock position of the right breast. Clinical correlation is recommended. No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on medical findings.

Input: Male, 21 years old. Reason: MRI History: same ACETABULAR LABRUM: The anterior superior labrum is somewhat blunted, with a small tear at the underside of the labrum at this location. The labrum appears otherwise intact.ARTICULAR CARTILAGE AND BONE: Normal bone marrow signal for age. Articular cartilage appears normal, without significant narrowing or focal defect.SOFT TISSUES: The visualized muscles appear normal. ADDITIONAL

Output: Anterior superior labral tear as described above.


Instruction: Generate impression based on medical findings.

Input: 43-year-old man with history of paraplegia. Evaluate for osteomyelitis Again seen is heterogeneous signal intensity and enhancement within the subcutaneous fat posterior to the sacrum, favored to represent a combination of edema, scar tissue and heterotopic ossification. There is irregularity of the overlying skin, presumably reflecting ulceration. The signal intensity of the underlying sacrum appears normal and we see no findings to suggest osteomyelitis of the sacrum.Again seen is a deep ulcer along the left gluteal fold extending to the left ischium, which was present on the prior MRI as well as a CT scan from 2014. There is mild decreased signal intensity of the left ischial tuberosity on T1-weighted images, as well as mild increase in signal intensity on the fat suppressed T2-weighted images. This appearance is consistent with chronic osteomyelitis. Increased signal intensity within the ischial tuberosity on the fat suppressed T2-weighted sequence appears slightly more prominent on the current study when compared to the prior study, but it is uncertain whether this represents a slight increase in bone marrow edema, or if this simply represents differences between the two MRI scanners. We are not convinced that there has been any further bone destruction when compared to the March 2016 study. Heterogeneous signal intensity adjacent to the left ischium presumably represents edema, scar tissue and heterotopic ossification, similar to the prior study.An additional sinus tract is again seen extending from the right gluteal fold to the right ischium, but we see no signal abnormalities to suggest osteomyelitis in this region.Postsurgical changes of a right Girdlestone procedure are again seen. We see no abnormal signal intensity in the proximal right femur to suggest osteomyelitis.Again seen is deformity of the left proximal femur with adjacent heterotopic ossification, which appears unchanged from the prior MRI. Osteoarthritis of the left hip appears similar to prior. Heterogeneous signal intensity in the soft tissues surrounding the left hip likely represents scar tissue and additional heterotopic ossification, and appears similar to prior.There is ankylosis of the sacroiliac joints, particularly on the right. There is diffuse muscle atrophy. Again noted is mild edema and enhancement of the gluteal musculature, but we see no findings to suggest an abscess. Increased T2 signal intensity within the adductor musculature may represent atrophy or mild edema, and appears similar to prior. There is a Foley catheter within the bladder.

Output: 1. Pelvic soft tissue ulcers as describe above, with findings suggesting chronic osteomyelitis of the left ischium. Although the degree of edema within the ischium appears to have increased slightly when compared to the prior study, this may simply reflect differences between the two MRI scanners. We see no findings to confirm progression destruction of the ischium.2. Other findings as detailed above, appearing similar to the prior study.


Instruction: Generate impression based on medical findings.

Input: Left sided PTA. Neck CT:There is soft tissue thickening and enlargement of the left palatine tonsil, with soft tissue thickening and edema extending to the rest of the oropharynx and hypopharynx resulting in effacement of the left piriform sinus. The edematous soft tissue abnormality extends into the left submandibular and sublingual space. Cervical lymphadenopathy is seen in the neck bilaterally, greater on the left.No discrete fluid collection is seen to suggest abscess.There is mild diffuse sclerosis of the cervical spine bony structures, but no focal lesion is seen.There is a cystic lesion in the right middle cranial fossa, and may represent an arachnoid cyst. It is incompletely visualized, and can be further evaluated with MRI brain.

Output: 1. Extensive soft tissue abnormality involving the left palatine tonsils, oro- and hypopharynx, with edematous soft tissue thickening extending into the left submandibular and sublingual space. Findings suggest most likely infectious / inflammatory process. Please also correlate clinically.2. Cerivcal adenopathy greater on the left, probably reactive.3. Mild diffuse sclerosis of cervical spine may be seen in patients with metabolic and endocrine disease. Please correlate with clinical parameters.4. Right middle cranial fossa arachnoid cyst. Further imaging can be obtained with MRI brain.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Mass? Intracranial hemorrhage? Signs and symptoms: Central vertigo x 1 month history of metastatic melanoma to brain and with status post RT Non-enhanced head CT:A there is no evidence of intracranial hemorrhage, edema, mass-effect or midline shift or hydrocephalus.The cortical sulci, ventricular system, CSF cisterns are essentially minimal for patient's stated age of 74.Diffuse patchy areas of subcortical and periventricular low-attenuation are nonspecific however they are suspected for small vessel ischemic disease of indeterminate age. Similar findings were present on prior MRI examination from 12 -- 13 -- 2010.Calvarium is intact. Limited view of paranasal sinuses and mastoid air cells as well as middle ear cavities are unremarkable.Limited images through the orbit demonstrate ptosis bulbi of the right globe as was noted on multiple prior studies.

Output: 1.No evidence of any acute new findings in particular no evidence of hemorrhage or acute cortical stroke.2.Findings of small vessel ischemic disease of indeterminate age.3.Ptosis bulbi of right globe.4.Unremarkable calvarium, paranasal sinuses and mastoid air cells.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Radiculopathy, lumbar regionClinical question: eval for lumbar disk herniationSigns and Symptoms: lumbar radiculopathy, h/o herniation s/p surgery in 2001 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 disc desiccation at this level as well as a mild disc bulge. There is effacement of the fat at the lateral recess bilaterally at this level but worse on the right than the left side. There is encroachment of the nerve roots at the lateral recess bilaterally.At L4-5 there is loss of disc space height and a broad-based central disc protrusion associated with some mild triangulation of the thecal sac and partial effacement of fat at the lateral recess bilaterally but worse on the right side. The encroachment of the nerve roots is worse at the right lateral recess versus the left. There is mild ligamentum flavum hypertrophy at this level. Overall there is a mild to moderate degree of spinal stenosis at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There is encroachment of the nerve roots at the lateral recess bilaterally at L5-S1 and on the right at L4-5 due to disk disease as detailed above.


Instruction: Generate impression based on medical findings.

Input: 49-year-old male with AML and neutropenic fever. Status post SCT. Now with recent seizure and fevers Suboptimal exam secondary to extensive motion artifact.No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus is detected. Further follow-up with an MRI recommended.The paranasal sinuses are unremarkable and no pneumatized.Mastoid air cells demonstrates opacification bilaterally which was present on the prior exam.

Output: Poor quality exam and no definitive evidence of an acute findings.


Instruction: Generate impression based on medical findings.

Input: 72 years Female (DOB:10/23/1943)Reason: progression of WM lesions? History: gait decline history of multiple sclerosisPROVIDER/ATTENDING NAME: JAMES R. BRORSON JAMES R. BRORSON There is a moderate to marked degree of periventricular and subcortical T2 and FLAIR signal intensity lesions which were also present on the prior exam from 2012. Comparing the 2 exams a not changed substantially.There are punctate foci of T2 and FLAIR signal hyperintensity in the basal ganglia, thalami and brainstem which were also present on the prior exam and do not appear to have progressed significantly when compared.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There are multiple lesions in the brainstem and basal ganglia and thalami which are stable. Given the patient's clinical history of multiple sclerosis these could very well represent prior demyelinating plaques. Please note that the lacunar infarcts may have a similar appearance.2.There is a moderate to marked degree of periventricular and subcortical white matter lesions which were also present on the prior exam and have not changed significantly. Given patient's clinical history much of this may represent demyelination, however, vascular related lesions can have a similar appearance.3.There is no evidence for acute cerebral ischemic infarction.4.Examination is mildly degraded due to motion artifact which may obscure more subtle abnormalities.


Instruction: Generate impression based on medical findings.

Input: Signs and symptoms: History of meningioma. Syncopal episode today, balance problem for one week. Clinical question: Change of meningioma. Non-infused CT of brain:Small partially calcific meningioma along the right petroclinoid ligament is identified. Non-infused study is significantly less sensitive for detection of true measurements of meningioma. On this non-infused study meningioma measures approximately 13.7 mm in AP access and 10.6-mm in transverse axis (axial image 8). Considering the significant difference between the two studies of CT of brain today an MRI from 8 -- 28 -- 2009 no significant interval change can be appreciated. This mass is in contact with the right aspect of the pons with minimal flattening. This was noted on prior study as well. There is no evidence of edema of brain parenchyma adjacent to the meningioma. This non-infused CT examination of brain also demonstrates findings consistent with small vessel disease of indeterminate age. No intracranial hemorrhage is detected.

Output: 1.Small vessel disease of indeterminate age.2.Stable right petroclinoid meningioma and B. no appreciable change since prior MRI study. Please see above comments.3.No acute intracranial findings.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Sciatica, right sideClinical question: pain with right sided sciatica 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 mild facet hypertrophy present at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is a moderate degree of bilateral facet hypertrophy present at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is mild ligamentum flavum hypertrophy present at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: There is no compromise to lumbar spinal canal or neural foramina. There are mild degenerative changes present in the lumbar spine.


Instruction: Generate impression based on medical findings.

Input: Abdominal pain. Elevated amylase. Previous alcohol use. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted. No focal hepatic lesions. No biliary ductal dilation. No cholelithiasis or choledocholithiasis.SPLEEN: No significant abnormality noted.PANCREAS: Normal anatomy, enhancement, and inherent signal of the pancreas. No pancreatic ductal dilation. No pancreatic mass identified. No peripancreatic fluid collections.ADRENAL GLANDS: The left adrenal gland is not well seen due to the below-described mass. Normal appearance of the right adrenal gland.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: There is a 4.3 x 4.1 x 4.9 cm well-defined lobulated soft tissue mass anteromedial to the left kidney with nonspecific intermediate T1 and T2 signal and mild enhancement.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 4.9 cm lobulated left retroperitoneal soft tissue mass likely representing lymphoma or metastatic lymphadenopathy, though a primary tumor otherwise is not identified.


Instruction: Generate impression based on medical findings.

Input: Parkinson's disease: preoperative planning for DBS. The images are degraded by patient motion. Nevertheless, there is no evidence of acute intracranial hemorrhage or tumor. However, there is a left middle cranial fossa arachnoid cyst that measures up to 25 mm with mass effect upon the anterior temporal lobe. There is also scattered cerebral white matter T2 hyperintensity. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are bilateral lens implants.

Output: Left middle cranial fossa arachnoid cyst and probable small vessel ischemic disease of the white matter. Otherwise, unremarkable treatment-planning MRI.


Instruction: Generate impression based on medical findings.

Input: Fall. History of agenesis of the corpus callosum and subdural hemorrhage. There is motion artifact at the convexities, however within this limitation there is stability in size (12 mm coronally) of the evolving left subdural hematoma which was first documented on the MRI performed 8/20/2013. There has been partial resolution of the previously described right parasagittal subdural hematoma. There are stable bilateral prominent CSF attenuating fluid collections. There are no new extra axial fluid collections identified.Previously described findings representing complete agenesis of the corpus callosum are stable. No new intracranial masses, mass effect including midline shift or CT evidence of acute hydrocephalus. Ethmoid air cells are aerated and maxillary sinuses are partially aerated. Sphenoid are opacified, as is appropriate for the patient's age. Mastoid air cells are unremarkable. There are no visualized bony abnormalities.

Output: 1.Stable evolving left subdural hematoma.2.Interval partial resolution of a right parasagittal subdural hematoma.3.Stable findings representing complete agenesis of the corpus callosum.4.Stable CSF attenuating extra-axial fluid collections bilaterally.


Instruction: Generate impression based on medical findings.

Input: 57-year-old male with a history of hemangioblastoma presents for surveillance. Redemonstrated are post-operative changes of a right suboccipital craniotomy with resolution of the right cerebellar enhancing lesion and associated right cerebellar hemorrhage/edema. There is no longer effacement of the fourth ventricle. There is residual susceptibility abnormality indicating prior blood product and some small residual encephalomalacia. There is no restricted diffusion or abnormal enhancement. The enlarged perivascular space in the right midbrain is again seen and appears unchanged. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild maxillary sinus and frontal sinus mucosal thickening bilaterally.

Output: Status post removal of a posterior fossa mass without evidence for local recurrence.


Instruction: Generate impression based on medical findings.

Input: Ms. Warren is a 43 year old female with a strong family history of breast cancer in sister (diagnosed at the age of 36) and maternal aunt (diagnosed at the age of 40) and ovarian cancer in maternal grandmother (diagnosed in her 40s). She has no current breast related complaints. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.In the left central to medial breast, there are several new enhancing masses with interspersed non-mass enhancement identified. The total span of abnormal enhancement measures 5.2 x 3.7 x 4.4 cm (AP x ML x SI). The two largest enhancing masses are located in the left medial and left central breast, measuring approximately 2.1 x 0.9 and 1.2 x 0.5 cm respectively.No abnormal enhancement is seen in the right breast. No abnormal lymph nodes are identified in either axillary or internal mammary region.Bilateral small pleural effusions are identified.

Output: (1) New enhancing masses/nonmass enhancement identified in the left central to medial breast, the two largest lesions of which are located in the left medial and left central breast, respectively. An MR directed ultrasound with possible biopsy is recommended for further evaluation.(2) No MRI evidence of malignancy in the right breast. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required.


Instruction: Generate impression based on medical findings.

Input: 43-year-old female with myalgia and intermittent weakness, evaluate for myopathy affecting the quadriceps. BONES: Multisequence MRI images of the right femur demonstrate mild heterogeneity of the bone marrow compatible with normal red marrow reconversion. No fractures are identified. Large field-of-view images also demonstrate grossly normal bone marrow signal within the left femur.SOFT TISSUES: ]The visualized musculature is within normal limits without abnormal signal to suggest myositis. The visualized neurovascular structures are also intact.High T2 signal tubular structures (series 9, image 1) seen on a single image in the expected location of the uterine cervix are incompletely visualized and evaluated.

Output: 1.[No evidence of myositis.2.Fluid intensity tubular structures within the expected location of the uterine cervix are incompletely imaged. If there is concern for gynecologic pathology, could be further evaluated with ultrasound.


Instruction: Generate impression based on medical findings.

Input: Status post craniotomy for tumor resection. Assess extent of resection. History of rectal carcinoid cancer in 2011 and breast cancer in 2009. No relevant preoperative imaging studies are available for comparison.There is a 3 cm in diameter resection cavity in the left frontal lobe (middle frontal gyrus) with expected blood products in the cavity and along the resection margin. There are small foci of diffusion restriction along the medial and inferior lateral surgical margins which may reflect postoperative change. There is minimal contrast enhancement along the surgical margin, especially superiorly, which may reflect postoperative change as well. There is minimal T2-hyperintensity surrounding the surgical cavity and no significant mass-effect. There is no midline shift. The ventricles are normal in size. There is minimal extra-axial fluid and dural thickening underlying the left frontal craniotomy flap.While there is no other contrast-enhancing brain lesion, there are tiny foci of diffusion restriction involving the right cerebellar hemisphere correlating with T1 hypointense, T2-hyperintense signal reflecting small acute/subacute infarcts. There is nonspecific ethmoid mucosal thickening and maxillary small retention cyst. The eye globes are elongated anteroposteriorly, which can be associated with severe myopia.

Output: 1.The patient is status post recent left middle frontal gyrus surgery for removal of the lesion. No preoperative exams to compare with. There are postoperative changes within the surgical cavity and adjacent to it include intracranial air and scalp soft tissue swelling suggesting this is recent surgery. Please correlate with the surgical findings.2.Small foci of diffusion restriction in the right cerebellar hemisphere represent acute/subacute microinfarcts3.No other contrast-enhancing brain lesion.


Instruction: Generate impression based on medical findings.

Input: 52 year old female with left sided weakness. Evaluate for CVA. White matter changes present with area of low attenuation found in the right internal capsule and subinsular white matter. An additional area of white matter change is located periventricularly on the left. Age of the lesions is indeterminate. This may represent microangiopathic disease, however cannot rule out other white matter disease. Further evaluation with MRI is recommended.

Output: White matter changes in the right internal capsule, subinsular region, and the left periventricular region. Further evaluation with MRI is recommended.


Instruction: Generate impression based on medical findings.

Input: Metastatic renal cell carcinoma follow up after treatment. There is no significant change in size of the enhancing lesion in the left precuneus, which measures up to 5 mm, previously also 5 mm. Likewise, the associated mild confluent surrounding T2 hyperintensity is not significantly changed. The enhancing right inferior temporal gyrus lesion has also decreased in size, which measures up to 3 mm, previously also 3 mm. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a small amount of fluid in the mastoid air cells and retention cyst formation in the maxillary sinuses.

Output: No significant interval change in size of the left parietal and right temporal lobe metastases.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old, history of renal cell carcinoma with solitary metastasis to the brain, status post surgery and postoperative SRS. Although dedicated pituitary sequences were not acquired on this exam, there has been a clear interval decrease in the size of enhancing sellar and suprasellar mass. The lesion demonstrates progressive T2 hypointensity which may represent hemosiderin staining or mineralization. Sequelae of prior and spinal sellar surgery are noted.Elsewhere intracranially, no pathologic enhancement is seen. No areas of edema or mass effect are detected. No acute intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricles are normal in size and morphology.

Output: 1.Interval decrease in size of the sellar/suprasellar tumor. 2.No additional intracranial lesions are seen.


Instruction: Generate impression based on medical findings.

Input: The exam is limited secondary to susceptibility artifact from surgical hardware. Again seen are postoperative changes of partial corpectomy of T6 and T7 with expandable cage placement and paraspinous rods and transpedicular screws extending from T4 inferiorly to T11 for fusion. Laminectomies are seen from T6 to T8 with decompression of the spinal canal at these levels.There is extensive marrow infiltration involving the thoracic vertebral bodies which has progressed since prior MRI from 9/15/2015. Most notably there is interval increased infiltration involving the T1, T2, T3, and T4 vertebral bodies extending into the posterior elements, left worse in right.There is mild deformity involving the T1 and T2 vertebral bodies with minimal loss of height which is new since 9/15/2015. There is minimal osseous retropulsion of the T2 vertebral body with mild spinal canal stenosis at this level. Osseous retropulsion involving the T7 vertebral body is again noted, with the spinal canal surgically decompressed at this level. Lack of postcontrast sequence limits evaluation for epidural tumor. There is ill-defined low T1 and low T2 signal involving the upper thoracic spinal canal which appears worse and suspected to represent worsening epidural tumor and can be confirmed with postcontrast sequence. No obvious cord signal abnormality.Limited view of the cervical spine on the sagittal counting sequence demonstrates moderate to severe spinal canal stenosis at the C2-C3 level which is not well assessed but appears worse since prior MRI from 9/15/2015.Mediastinal lymphadenopathy again seen.

Output: 1. Compared to MRI from 9/15/2015 there is evidence of progression of metastatic disease with increased marrow infiltration particularly of the T1 to T4 vertebral bodies extending into the posterior elements. There appears to be increased epidural tumor at these levels which can be better assessed/confirmed with postcontrast sequence. No new cord signal abnormality within the limitations of susceptibility artifact from the hardware.2. Postsurgical changes related to partial corpectomy of T6 and T7 with cage placement, posterior fusion from T4 to T11, and laminectomies from T6 to T8.3. Mild deformity/compression fractures involving the T1 and T2 vertebral bodies with mild osseous retropulsion involving the T2 vertebral body which is new since prior MRI. There is mild spinal canal stenosis at this level.4. Limited view of the cervical spine on the sagittal counting sequence demonstrates moderate to severe spinal canal stenosis at the C2-C3 level which is not well assessed but appears worse since prior MRI from 9/15/2015. Consider dedicated cervical spine MRI for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Evaluate left facial mass concerning for left sinonasal malignancy. There is a heterogeneous and infiltrative mass centered in the left sinonasal region, completely obliterating the left maxillary sinus and much of the left nasal cavity and ethmoid sinuses, with extension into the inferior and medial extraconal orbit, abutting the left inferior rectus muscle, and into the overlying left facial subcutaneous tissues with surrounding fat stranding and into the retromaxillary space. There is also compression of the left nasolacrimal duct, with dilatation of the lacrimal sac. Overall, the mass measures up to approximately 7 cm. There are secretions and mucosal thickening in the left frontal sinus and right ethmoid sinuses. The right orbit and paranasal sinuses are unremarkable. There is no significant cervical lymphadenopathy. The salivary glands appear to be grossly intact. There is no evidence of gross intracranial tumor. There is no evidence of acute cerebral infarction, hemorrhage, or ventriculomegaly. There is minimal nonspecific periventricular T2 hyperintensity.

Output: An aggressive mass centered in the left sinonasal region with extension into the extraconal orbit, the overlying left facial subcutaneous tissues, and the retromaxillary space is compatible with a malignant neoplasm.


Instruction: Generate impression based on medical findings.

Input: 39 years Female (DOB:1/5/1977)Reason: residual tumor posterior fossa History: headachePROVIDER/ATTENDING NAME: BAKHTIAR YAMINI SERVICES ANCILLARY The patient status post cerebellar surgery. There are enhancing lesions present in the left cerebellar hemisphere which were also identified on the recent MRI and have not changed significantlyNormal 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: This a limited MR for the purpose of stereotactic guidance during surgery. To extent of visualization there is no interval change in the appearance of the patient's left cerebellar mass relative to the prior exam from 11/2/2016.


Instruction: Generate impression based on medical findings.

Input: Elevated PSA. Previous negative biopsy. PELVIS:PROSTATE:Prostate Size: 2.8 x 4.4 x 4.5 cmPeripheral Zone: No suspicious focus of T2 weighted hypointensity or restricted diffusion.Central Gland: Centered within the anterior mid gland transitional zone and extending into the anterior fibromuscular stroma and left anterior peripheral zone is a poorly defined 2.2 x 1.3 cm (series 801/16) lesion demonstrating T2 weighted hypointensity, restricted diffusion and early arterial enhancement. The lesion abuts and bulges the anterior capsule. Indeterminate right lateral base T2 weighted hypointense focus measuring 6 x 6 mm (series 1/20) without restricted diffusion.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: The anterior mid gland lesion abuts and bulges the anterior capsule.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Suspicious 2.2 cm anterior mid gland lesion bulging the anterior capsule.2. Indeterminate 6 x 6 right lateral base focus.


Instruction: Generate impression based on medical findings.

Input: 72-year-old male with Gleason 6 prostate cancer on active surveillance, left lateral mid prostate PELVIS:PROSTATE:Prostate Size: 6.0 x 5.7 x 4.8 cm.Peripheral Zone: There is a 9 x 7 mm T2 hypointense focus corresponding restricted diffusion in the mid gland (frozen (series 1201, image 15).Central Gland: Severe degree benign prostatic hypertrophy.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: There is mild discontinuity of the low T2 signal capsule adjacent to the left mid gland peripheral zone lesion raising suspicion of extracapsular extension (series 401, image 66).BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.T2 hypointense focus in the left mid gland peripheral zone with findings suspicious for micro-extracapsular extension.


Instruction: Generate impression based on medical findings.

Input: 65 years Female (DOB:6/17/1950)Reason: 65 yof with h/o renal transplant with persistent headaches, on prograf - r/o PRES History: headachePROVIDER/ATTENDING NAME: SHANNON K MARTIN SHANNON K MARTIN 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. Additional T2 and FLAIR hyperintense punctate foci are present in the brainstem. This is minimally/mildly progressed since the prior exam.On susceptibility weighted imaging there are multiple punctate foci of signal loss in the periventricular and subcortical white matter. These were also present on the prior exam and have not changed substantially.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mild mucosal thickening The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Periventricular and subcortical white matter lesions as well as lesions in the brainstem of a mild degree are nonspecific. At this age they are most likely vascular related. This has only mildly progressed since the prior exam2.There is redemonstration of multiple microhemorrhages scattered throughout the periventricular and subcortical white matter. This is somewhat nonspecific given its distribution. One possibility is related to hypertensive episodes. The pattern may be representative of other cause of microhemorrhages including amyloid angiopathy.


Instruction: Generate impression based on medical findings.

Input: Lupus cerebritis and altered mental status. There is a subcentimeter mildly T2 hyperintense lesion with restricted diffusion in the posterior left cerebellar hemisphere. Punctate foci of high T21 signal without restricted diffusion in the right thalamus and left basal ganglia and thalami. There is also trace bilateral periventricular white matter T2 hyperintensity. There is no evidence of intracranial hemorrhage or mass. There is no abnormal intracranial enhancement. There is perhaps mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, mastoid air cells, and scalp soft tissues are grossly unremarkable. There is a small amount of secretions in the posterior right ethmoid sinus.

Output: 1. Acute infarct in the posterior left cerebellar hemisphere, which may be related to lupus vasculitis. 2. Punctate foci of high T21 signal without restricted diffusion in the right thalamus and left basal ganglia and thalami may represent prior lacunar infarcts related to lupus vasculitis.


Instruction: Generate impression based on medical findings.

Input: Hemangioma of intracranial structures [D18.02], Reason for Study: ^Reason: CCM History: CCM Yearly Surveillance Redemonstration of multifocal cavernous malformations involving supra and infratentorial regions.The number, approximate maximum diameter on T2 weighted images and the degree of susceptibility artifacts do not show any significant interval change since prior scan.There is no evidence of surrounding edema of each cavernous malformation.The right middle frontal gyrus lesion appears to be associated with a DVA, unchanged. The right cerebellar hemispheric encephalomalacia with susceptibility lesion on the left middle cerebellar peduncle is again demonstrated, unchanged.The right middle frontal, left parietal and left posterior aspect of the superior temporal gyrus lesions (series1404, image65; image 66, image 59) show subtle peripheral enhancement, unchanged.Right suboccipital craniotomy is again seen, unchanged.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Unchanged multifocal cavernous malformations, right cerebellar hemispheric encephalomalacia and postoperative changes since prior scan.No evidence of new ischemic or hemorrhagic lesion.


Instruction: Generate impression based on medical findings.

Input: Craniotomy for laser ablation for astrocytoma. There are postoperative findings related to laser ablation with interval decrease in size and enhancement of a tectal plate mass that now measuring approximately 12 x 18 mm in cross-section, previously 16 x 19 mm. There is no evidence of acute intracranial hemorrhage or acute infarct. The right cerebral convexity fluid collection has resolved. There is a right transfrontal Ommaya catheter that terminates adjacent to the right caudate nucleus. There are also postoperative findings related to endoscopic third ventriculostomy, with an apparent jet of cerebrospinal fluid into the third ventricle. Nevertheless, the third and lateral ventricles remain enlarged. There is no midline shift or herniation. There is a left cerebellar hemisphere developmental venous anomaly. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues appear unchanged. There is diffuse paranasal sinus mucosal thickening.

Output: 1. Postoperative findings related to laser ablation with interval decrease in size of a tectal pilocytic astrocytoma.2. Postoperative findings related to endoscopic third ventriculostomy, with an apparent jet of cerebrospinal fluid into the third ventricle. Nevertheless, the third and lateral ventricles remain enlarged. 3. The right transfrontal Ommaya catheter terminates adjacent to the right caudate nucleus.


Instruction: Generate impression based on medical findings.

Input: Left lower extremity weakness and right eye vision loss. The right superior fissure and optic canal regions are unremarkable. There is no evidence of mass lesions. The bilateral orbital contents are intact. The optic nerves and chiasm are unremarkable. There is diffuse high T2 signal in the left mandible and right maxillary alveolus. There are prominent arachnoid granulations in the floor of the right middle cranial fossa. There is patchy scattered cerebral white matter T2 hyperintensity. There is mucosal thickening in the right ethmoid sinuses. There is mild mucosal thickening in the bilateral mastoid air cells.

Output: 1. The right optic nerve is unremarkable.2. Inflammatory changes in the bone marrow in the left mandible and right maxillary alveolus at the site of periodontal disease previously demonstrated on CT.3. Patchy scattered cerebral white matter T2 hyperintensity may represent chronic small vessel ischemic disease.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Left unilateral hearing loss. Signs and symptoms: Hearing loss, incontinence, tinnitus. Pre and post enhanced MRI of IACs:Examination demonstrates normal signal intensity and morphology of pons, bilateral cerebellopontine angle cisterns, bilateral neurovascular bundles, bilateral internal auditory canals, bilateral mastoid air cells and middle ear cavities and grossly unremarkable signal intensity and morphology of the inner ear structures. There is no detectable abnormality at the level of the skull base. There is no detectable abnormal enhancement of the pons, bilateral neurovascular bundles, internal auditory canals or within the petrous bones. No detectable abnormal enhancement of skull base. There is no detectable abnormality of cranial nerves and no detectable abnormal enhancement.

Output: Negative pre and post enhanced MRI of the IACs.


Instruction: Generate impression based on medical findings.

Input: Reason: HCV cirrhosis, HCC s/p TACE/RFA 7/2016: follow up imaging for treatment effect. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology including left hepatic lobe and caudate lobe hypertrophy as well as fissural prominence.In hepatic segment 5 at the site of the previously seen focal lesion compatible with HCC, there is a new ablation cavity which measures 1.7 x 3.7 cm and demonstrates some intrinsic T1 hyperintensity compatible with blood products. There is no definite associated marginal or nodular arterial enhancement with washout to suggest residual disease or recurrence. There is a new area of arterial enhancement in segment 5/6 (series 9, image 31) which measures 0.9 x 1.3 cm and lacks washout on more delayed images. This is nonspecific but may reflect a transient hepatic intensity difference. Status post cholecystectomy with prominence of the common bile duct up to 11 mm, not significantly changed. No evidence of choledocholithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cirrhotic liver morphology. 2.Interval ablation of segment 5 lesion without specific evidence of marginal residual disease or recurrence.3.New small area of arterial enhancement in segment 5/6 without washout which is favored to represent a transient hepatic intensity difference but should be followed on subsequent examinations.


Instruction: Generate impression based on medical findings.

Input: 50 year-old man with Hodgkin's lymphoma status post chemotherapy now with altered mental status, focal neurologic deficits. Rule out CVA and increased intracranial pressure. There is no evidence of intracranial hemorrhage, mass or edema. There are no CT findings of stroke. If stroke remains a clinical concern, MRI is more accurate for detection of acute ischemia.The ventricles are normal in size and configuration. The suprasellar, basilar, and quadrigeminal cisterns are normal appearance.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: Male, 52 years old, history of thyroid cancer with metastases, compare to prior. Numbering is performed as per prior reports.Thoracic MRI: An enhancing lesion in the left anterior aspect of the T5 vertebral body measures is unchanged from the prior exam. The lesion is associated with mild superior endplate concavity, also unchanged.Lesions within the left transverse process and pars interarticularis of T5 and T6 also show no significant interval change.Instrumented fusion of T10 through T12 is again seen, and the T11 vertebral body remains compressed demonstrating diffusely abnormal signal characteristics compatible with metastatic involvement. Findings are stable.No new lesions are seen. No epidural disease extension is identified. As before, the spinal canal is not significantly narrowed. Mild kyphotic angulation centered at T11 is stable.T1 shortening in the thoracic and lumbar likely related to prior radiation. Increased signal within the T9 and L1 vertebral bodies on fat-suppressed T1 post contrast images is at least in part artifactual and due to metal related failure of fat suppression.Lumbar MRI:A lesion within the right L2 vertebral body is unchanged.A lesion within the left L3 vertebral body is unchanged.A small nonspecific lesion along the left inferior endplate of L4 is unchanged.A lesion in the left L5 vertebral body measures is unchanged.No new lesions are significant epidural disease extension is identified. No spinal canal encroachment or significant foraminal narrowing is detected.Mild degenerative changes are again seen without significant spinal canal or foraminal stenosis, stable in appearance.

Output: 1.No significant change in multiple osseous lesions in the thoracic and lumbar spine without significant interval change in size or morphology. 2.No new lesions are detected. 3.No significant epidural disease or spinal canal/foraminal narrowing.


Instruction: Generate impression based on medical findings.

Input: Gowing right parotid mass, please evaluate. There is a relatively well-defined, enhancing mass in the deep left parotid gland that measures up to 15 mm. There is no gross evidence of perineural tumor extension. There is no evidence of cervical lymphadenopathy. The right parotid and bilateral submandibular glands, thyroid gland, and upper aerodigestive tract appear to be unremarkable. There is multilevel degenerative cervical spondylosis. There are multiple T2 hyperintense lesions in the cervical spinal cord, brainstem, and cerebellum.

Output: 1. A mass in the deep left parotid gland that measures up to 15 mm may represent a salivary neoplasm, such as a pleomorphic adenoma.2. Demyelinating lesions in the cervical spinal cord, brainstem, and cerebellum are better delineated on the recent brain and cervical spine MRI.


Instruction: Generate impression based on medical findings.

Input: Vestibular schwannoma: vison changes and history of Familial Mediterranean fever. Internal Auditory Canals: There is an ovoid enhancing lesion in the left internal auditory canal, which measures up to 10 mm in length and 5 mm in width. There is mildly diminished fluid signal in the left inner ear structures, which are otherwise intact. The right cranial nerve 7 and 8 complexes are intact, without evidence of associated mass lesions. The right inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear grossly unremarkable.Brain: There is no evidence of intracranial hemorrhage or acute infarct. There is mild scattered cerebral white matter T2 hyperintensity bilaterally, mainly in a periventricular distribution. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and paranasal sinuses are grossly unremarkable. There is a 10 mm thick apical scalp lipoma.

Output: 1. A left internal auditory canal vestibular schwannoma measures up to 10 mm.2. Mild scattered cerebral white matter T2 hyperintensity bilaterally may represent a demyelinating disease, perhaps related to Familial Mediterranean fever, but are nonspecific.


Instruction: Generate impression based on medical findings.

Input: 69-year-old male with knee pain. Assess for lateral meniscus tear. Some sequences are limited by patient motion artifact.MENISCI: There is mild increased signal abnormality within the lateral meniscus indicating intrasubstance degeneration, but we see no discrete tear. There is also increased signal abnormality within the medial meniscus indicating intrasubstance degeneration of the medial meniscus. This signal extends in a linear fashion to the free edge of the posterior horn and may represent a degenerative horizontal tear but this is equivocal. We see no fluid signal intensity within the meniscus to confirm an unstable tear.ARTICULAR CARTILAGE AND BONE: There is severe degeneration of the articular cartilage of the patellofemoral joint with large portions of the medial facet of the patella and femoral trochlea devoid of articular cartilage with associated underlying degenerative subchondral signal abnormality. There is also near full-thickness to full-thickness degeneration of the articular cartilage along the inferior aspect of the femoral trochlea, centrally, with underlying subchondral cyst formation. There is also moderate articular cartilage degeneration affecting the medial tibiofemoral compartment with near full-thickness to full-thickness cartilage loss along the medial femoral condyle, particularly along its medial aspect, with underlying subchondral cyst formation. Beneath the posterior horn of the lateral meniscus there is near full-thickness to full-thickness cartilage degeneration. There is tricompartmental osteophyte formation.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. No evidence of lateral meniscus tear. Equivocal medial meniscal horizontal tear.2. Tricompartmental articular cartilage degeneration.3. Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: History of breast cancer now with shoulder pain, evaluate for metastasis. ROTATOR CUFF: There is mild thickening of as well as intermediate signal within the supraspinatus tendon compatible with mild tendinosis. No discrete tears are identified. The remaining tendons and muscles of the rotator cuff are within normal limits.SUPRASPINATUS OUTLET: Mild-moderate osteoarthritis affects the acromioclavicular joint. No significant fluid is present within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Bone marrow signal within the visualized osseous structures is within normal limits without evidence of metastatic disease. A small subchondral cyst is present within the humeral head. The articular cartilage of the glenohumeral joint is grossly intact. The labrum is grossly intact.BICEPS TENDON: The tendon of the long head of the biceps is intact. ADDITIONAL

Output: 1.No evidence of metastatic disease.2.Mild supraspinatus tendinosis.3.Additional findings as described above.


Instruction: Generate impression based on medical findings.

Input: Relapsed neuroblastoma with headache. The lobulated heterogeneous mass along the floor of the left middle cranial fossa and infratemporal fossa with perineural extension into the left cavernous sinus through foramen ovale and rotundum has slightly increased in size, measuring up to approximately 4.5 cm, previously 4.0 cm. In addition, tumor along the left lateral extraconal space appears to have slightly increase in size, measuring up to 11 mm in thickness, previously 7 mm, with mass effect upon the left lateral rectus muscle and compression of the left optic nerve in the orbital apex. An extradural nodule adjacent to the lateral inferior left frontal lobe now measures up to 7 mm, previously 5 mm, and displays central non-enhancement. There is also interval increase in size of the tumors along the bilateral mandibular condyles, measuring up to 22 mm in overall width on the right, previously 15 m, and 13 mm in overall width on the left, previously 11 mm. There is no evidence of intracranial hemorrhage or acute infarct. There is mild mega cisterna magna. Otherwise, the ventricles and basal cisterns are normal in size and configuration. There is no midline shift. There is scattered paranasal sinus mucosal thickening and secretions. There is obstructed fluid within the left mastoid air cells.

Output: 1. Interval increase in size of tumor along the left lateral wall of the orbit with associated compression of the left optic nerve at the orbital apex.2. Slight interval increase in size of the mass along the floor of the left middle cranial fossa and infratemporal fossa with apparent perineural extension into the left cavernous sinus through foramen ovale and rotundum, as well as associated left Eustachian tube obstruction.3. A subcentimeter extradural lesion adjacent to the inferior left frontal lobe laterally has slightly increased in size and now appears to be partly necrotic.4. Interval increase in size of the tumors along the bilateral mandibular condyles.


Instruction: Generate impression based on medical findings.

Input: Ms. Nagle is a 51-year-old female with a family history of breast cancer in her maternal grandmother diagnosed in her 40s. Personal history of benign left breast biopsy. No current breast related complaints. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.High T2 signal hepatic lesion seen on prior studies is partially visualized, likely a benign cyst or hemangioma.

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


Instruction: Generate impression based on medical findings.

Input: Reason: pre op please call neurosurgery on call to place fiducles 6876 History: pre op for craniotomy today The patient is status post right frontal craniotomy for right frontal lobe surgery. At the tumor resection site there is nodular enhancement present along the medial aspect of the right frontal lobe and medial aspect of the adjacent right cingulate gyrus. This was present on the 3/16/15 exam but is new since exams. There is cystic encephalomalacia present along the anterior aspect of the right frontal lobe with some surrounding T2 signal hyperintensity at the surgical site which remains relatively stable compared to the prior prior exam from march but has progressed over the past year. Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Limited exam for surgical guidance.2.Compared to the prior exam from March there is no significant interval change in the appearance of the right frontal lobe and cingulate gyrus nodular lesions. This is suspicious for local recurrence.3.Status post right frontal lobe surgery.


Instruction: Generate impression based on medical findings.

Input: 38 year ols with history of left skin/nipple sparing mastectomy in 05/2013 for ER/PR positive breast cancer. There is extreme amount of fibroglandular tissue in the right breast.Marked parenchymal enhancement is noted in the right breast.Status post left mastectomy.Bilateral retropectoral silicone implants appear intact.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on medical findings.

Input: 49 year-old female with low back pain. Additional history per chart, prior L3-L4 discectomy. 5 lumbar type vertebral bodies are presumed. Vertebral body heights are maintained. There is minimal retrolisthesis of L5 on S1 as well as straightening of the lumbar curvature similar to prior. Again seen is fatty infiltration involving the filum terminale with more focal lipoma along the filum measuring 4 mm at the L2 level, inferior to the conus which terminates normally at the L1-L2 level.Slightly prominent epidural fat in the distal sacral spinal canal is felt to represent an anatomic variant. Marrow signal is benign. Multilevel degenerative changes as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Previously seen left paracentral disc extrusion has resolved. There remains a mild disc bulge without significant spinal canal or neural foraminal stenosis.L3-L4: Asymmetric disk bulge to the right with loss of disk height. There is mild bilateral, right greater than left, neural foraminal stenosis and also contact of the right extraforaminal L3 nerve root. This finding is stable to minimally worse since 7/15/2013. Again seen is atrophy of the right paraspinous musculature likely reflective of prior surgery for discectomy. No significant central spinal canal stenosis.L4-L5: Disc bulge with an eccentric portion involving the left extraforaminal segment and mild bilateral facet arthropathy. Disc height loss appears minimally worse. Mild to moderate left and mild right neural foraminal stenosis, minimally worse in the interval. No significant central spinal canal stenosis.L5-S1: Disc bulge and mild bilateral facet arthropathy. There is partial effacement of the lateral recesses without significant central spinal canal stenosis. There is mild to moderate right and mild left neural foraminal stenosis stable to minimally worse (on the right) since prior. There is contact and mild lateral displacement of the extraforaminal right L5 nerve root. Conjoined right S1 and S2 nerve roots incidentally noted.

Output: 1. Mild to moderate multilevel degenerative changes in the lumbar spine have overall minimally changed from MRI from 7/15/2013. No significant central spinal canal stenosis at any level. Please see additional details above. 2. Lipomatous infiltration of the filum terminale again seen, measuring up to 4 mm in thickness at L2. Conus is in normal position at the L1-L2 level but would suggest correlation with clinical signs of cord tethering.


Instruction: Generate impression based on medical findings.

Input: 30 years Female (DOB:8/6/1985)Reason: evaluate for intracranial abnormality given CT findings History: concern for PRESSPROVIDER/ATTENDING NAME: TIEN S DONG TIEN S DONG The CSF spaces are appropriate for the patient's stated age with no midline shift. A focus of encephalomalacia is present in the left parietal lobe. It is associated with some adjacent dilation of the left lateral ventricle.There is a small T2 and FLAIR hyperintense focus present along the gyri adjacent to the posterior aspect of the left superior frontal sulcus measuring 15 mm suggestive of a small focus of encephalomalacia.There is patchy T2 and FLAIR signal hyperintensity within the brainstem associated with volume loss in the brainstem. The cerebellum is relatively small.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There is generalized brain atrophy present.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The left eyeball lens is thin.

Output: 1.There is generalized brain atrophy present which is unusual for age 30.2.There is encephalomalacia involving the left parietal lobe. A possible this is related to prior vascular type injury.3.A small focus of encephalomalacia is present in the left frontal lobe.4.There is cerebellar atrophy present. This is in excess of the patient's stated age.5.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. It is possible they're vascular related, however, they're nonspecific it could also be related to other entities. They are unusually high in number for this age.6.Lesions within the brainstem are suspected to be vascular related.


Instruction: Generate impression based on medical findings.

Input: 49 years, Female, metastatic lung cancer, status post SRS, assess for recurrent/progressive disease. Again seen are postsurgical changes of frontal craniotomy for resection of right superior frontal gyrus mass. There is a small focus of enhancement along the medial surface of the right frontal gyrus abutting the falx measuring approximately 6 x 7 x 7 mm and appears more nodular in the interval (best appreciated on coronal series 1201 image 136). There has been further collapse of the underlying resection cavity. There are chronic blood products in this region. Mild T2/ FLAIR hyperintensity in the right superior frontal gyrus is also not significant changed and may represent residual edema and/or gliosis.Remainder of the brain parenchyma is unremarkable for age. No new metastatic foci. Major flow-voids are preserved. Sella and orbits are grossly within normal limits. There is interval development of moderate mucosal thickening involving the bilateral maxillary sinuses with small fluid levels, which may reflect acute sinusitis. There is also mild ethmoid and sphenoid sinus opacification.There is diffuse low T1 marrow signal which is nonspecific without discrete destructive osseous lesions.

Output: 1. Continued evolution of posttreatment changes of radiation and prior resection of right superior frontal gyrus mass. There is interval increase in nodular enhancement along the medial surface of the right superior frontal gyrus which may represent posttreatment change. Recurrent metastasis seems less likely but would recommend a close follow-up exam to better exclude this possibility. 2. No new foci of metastasis elsewhere in the brain.


Instruction: Generate impression based on medical findings.

Input: 62-year-old female with pain and stiffness, progressive ring and small finger flexion contracture, possible mechanically locked trigger finger versus other pathology. LIGAMENTS: The ligaments are intact.TENDONS: There is abnormal volar displacement of the flexor tendon of the fourth digit with associated increased STIR signal interposed between the proximal phalanx and the tendon. In addition, at the level of the proximal phalanx there is indistinctness of the flexor tendon with intermediate signal intensity on T1-weighted sequences suggesting at least a partial thickness tear. Further distally however the flexor digitorum superficialis and profundus tendons are visualized and demonstrate normal signal intensity. At the level of the metacarpal there is fluid signal within the tendon sheath of the flexor tendons suggesting tenosynovitis. The remaining flexor tendons of the other digits are intact and appear normal. The extensor tendons are intact and appear normal. BONES: Bone marrow signal intensity is normal. The visualized erosions described on the subsequent radiograph are not well-defined on the current study.ADDITIONAL

Output: Findings are suggestive of at least a partial thickness tear of the flexor tendon of the fourth digit with possible tenosynovitis.


Instruction: Generate impression based on medical findings.

Input: Concern for brain and spine abscess. Exam is limited by motion artifact.MRI brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild scattered white matter T2 hyperintensity. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRI of the cervical spine: There is extensive abnormal signal and enhancement involving the C3 and C4 vertebral bodies and disc space with extension into the anterior epidural space, with narrowing of the spinal canal. There is extensive inflammatory changes and enhancement of prevertebral soft tissue and paraspinal musculature. There is loss of the usual cervical lordosis, but no subluxation. The vertebral body heights are maintained. There are secretions within the trachea. MRI of the thoracic spine: The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. There is right pleural fluid.

Output: No evidence of intracranial abscess.Findings compatible with discitis-osteomyelitis involving C3 and C4 with extension of inflammatory changes in to the anterior epidural space and prevertebral space, but no abscess. 3. Secretions within the trachea may be a risk factor for aspiration pneumonia. Findings discussed with Dr. Sarah Tarplin at 11 AM on 2/20/2016.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: 48-year-old man with right hip pain ACETABULAR LABRUM: There is abnormal signal of the posterior labrum compatible with a tear and/or changes related to prior repair. An additional small defect is seen within the anterior superior labrum.ARTICULAR CARTILAGE AND BONE: Bone marrow signal intensity is within normal limits. Mild lateral acetabular osteophytes are noted. The articular cartilage is normal.SOFT TISSUES: No significant abnormality noted. Iliopsoas, abductor, gluteal and hamstring morphology is normal. There is no muscular fatty atrophy.ADDITIONAL

Output: Postoperative and degenerative changes of the labrum as detailed above.


Instruction: Generate impression based on medical findings.

Input: Right upper quadrant abdominal pain with elevated lipase ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis without wall thickening. Non-cirrhotic liver. No focal hepatic lesion. No intrahepatic or extrahepatic ductal dilatation. Hepatic vessels patent.SPLEEN: Absent or atrophicPANCREAS: No significant abnormality noted. Specifically, no evidence for pancreatic ductal dilatation. No significant peripancreatic inflammatory changes. No significant pancreatic necrosis.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Trace ascitesBONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No evidence for significant complication from patient's known pancreatitis. Specifically, no evidence for pancreatic ductal dilatation, significant necrosis, or significant peripancreatic loculated fluid collection.2.Cholelithiasis without acute inflammation or ductal dilatation.3.Trace ascites.


Instruction: Generate impression based on medical findings.

Input: 37 years, Male, Reason: Eval grade II astrocytoma. Pt has NOT had RT. Please compare to most recent scan as well as back to postop scan. History: grade 2 astrocytoma.. Again seen are postsurgical changes of left frontal craniotomy for tumor resection. Compared to examinations from 9/10/2014 and 5/24/2013, there is gradually progressive increase in T2 hyperintensity surrounding the left superior frontal gyrus resection cavity extending to the left frontal horn. There is also a new nodular focus of enhancement measuring approximately 6 x 6 x 11 mm along the lateral aspect of the resection cavity, not present on prior study from 9/10/2014.No significant intracranial mass effect. Remainder of the brain parenchyma is unremarkable. No new sites of tumor. There is unchanged ex vacuo dilatation of the left frontal horn. Ventricles are otherwise normal in size. No evidence of acute ischemia or hemorrhage. Calvarium and extracranial soft tissues are also unremarkable.

Output: Compared to prior examinations from 9/10/2014 and 5/24/2013 there is evidence of gradual increase in T2 hyperintensity surrounding the left superior frontal gyrus resection cavity and extending to the left frontal horn. There is also interval development of a new 6 x 6 x 11 mm enhancing nodule along the lateral aspect of the resection cavity. These findings are concerning for gradual tumor progression, especially in the absence of radiation therapy.


Instruction: Generate impression based on medical findings.

Input: Secondary malignant neoplasm of brain [C79.31], Reason for Study: ^Reason: brain mets (breast primary) History: radiation planning Numerous various sized intra axial enhancing lesions on bilateral cerebral and cerebellar hemispheres as well as basal ganglia and deep white matter indicating multiple metastatic nodules. The largest one is on the left temporal lobe which is measured about 7mm indicating interval increase in size. Again the left thalamic developmental venous anomaly is seen, no change since prior scan.No evidence of acute hemorrhagic lesion on the scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Multiple various sized metastatic nodules found on supra and infratentorially.2. Interval increase in size of enhancing lesions especially lesions at the left temporal lobe and the right basal ganglia since prior scan.


Instruction: Generate impression based on medical findings.

Input: Female, 14 years old. Lateral subluxation of patella. Knee instability. MENISCI: The menisci appear normal.ARTICULAR CARTILAGE AND BONE: There are rounded foci of heterogeneous subchondral signal intensity within the lateral femoral condyle, likely representing the site of microfracture of the osteochondral lesion seen on the prior outside study. There is mild edema and cyst formation in the adjacent marrow. The signal intensity of the overlying articular cartilage is heterogeneous, but we see no frank fluid-filled defect. The remaining articular cartilage appears normal. Subjectively the femoral trochlea is shallow superiorly with asymmetry of the facets (lateral > medial) suggesting mild trochlear dysplasia. Currently, patellofemoral alignment is normal.LIGAMENTS: The cruciate and collateral ligaments are intact. A thin irregular low signal intensity structure can be followed from the vicinity of the abductor tubercle to the superomedial patella which may represent the medial patellofemoral ligament; however, given its irregular appearance, we cannot exclude scar tissue in the vicinity of the of the ligament from old injury. EXTENSOR MECHANISM: The quadriceps and patellar tendons are intact. Portions of the lateral retinaculum are not well seen, likely due to prior release. The tibial tubercle-trochlear groove distance is approximately 18 mm which is borderline abnormal. The Insall-Salvati ratio is 1.2 which is within normal limits.ADDITIONAL

Output: 1.Findings of mild femoral trochlear dysplasia and borderline elevated tibial tubercle-trochlear groove distance as well as irregularity of the medial patellofemoral ligament; these findings may be associated with patellofemoral instability.2.Surgical changes of lateral femoral condyle microfracture.


Instruction: Generate impression based on medical findings.

Input: 81-year-old female with HCC status post TheraSphere treatment ABDOMEN: The study is limited due to lack of intravenous contrast.LIVER, BILIARY TRACT: Cirrhotic liver morphology with ablation cavity in segment 4A is redemonstrated. There is been no significant change in the reference segment for ablation cavity when using similar measurement techniques. The ablation cavity extends towards the hepatic dome and extends inferiorly into segment 4A. These findings are not significantly changed when compared to the prior exam. There is intrinsic T1 hyperintensity within the segment 4A ablation cavity representing hemorrhage. There are no significant changes compared to the prior exam.Previously seen posterior right hepatic lobe focus is unchanged and incompletely characterized due to lack of IV contrast.Cholelithiasis with cholecystostomy tube is again noted..SPLEEN: Splenomegaly measuring 15.5 cm. Perisplenic ascites is present.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts are unchanged.RETROPERITONEUM, LYMPH NODES: Scattered subcentimeter retroperitoneal lymph nodes without pathologic enlargement.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Limited exam due to the lack of intravenous contrast. No significant change in appearance of treatment cavity.2.Unchanged indeterminate segment 6 focus.