Instruction: Generate impression based on medical findings.

Input: Clinical question: Malignant neoplasm of brain, unspecified site. Signs and symptoms: History of GBM status post TMZ/RT, surveillance scan. Signs and symptoms: Headache. Pre- and post enhanced brain MRI:No evidence of restricted diffusion.Examination demonstrates a large necrotic rim-enhancing mass in the right posterior temporal-parietal region with evidence of interval increased size since prior study. On axial postenhanced series isMass measures maximum of 40 x 28 mm in transaxial compared to prior study measurement of 33 x 26. There is a thick focus of rim enhancement along the superior/anterior aspect of necrotic tumor measuring 13 mm in thickness and 21 mm along the necrotic cavity wall. There is also subtle interval overall increased thickness of rim enhancing tumor since prior exam. Findings are suggestive of interval progression of disease. There is extensive surrounding vasogenic edema interval increased extent since prior exam.Previously noted small thin rim enhancing lesion at the site of prior surgical resection in the right frontal lobe demonstrate decreased size and decreased surrounding vasogenic edema. No definitive evidence of tumor.Ventricular system remains within normal heads with maintained midline and without change.

Output: 1.Interval increased size of a necrotic rim-enhancing tumor in the right hemisphere. There is generalized as well as focal interval thickening of rim enhancement of tumor and surrounding edema consistent with progression of disease as detailed/measured above.2.Interval decreased size and reduced surrounding edema at the site of right anterior frontal lobe resection cavity since prior exam.


Instruction: Generate impression based on medical findings.

Input: 51 years, Female, possible demyelinating disease. Fatigue, paresthesias. Evaluate for progression. Brain: Again seen are scattered T2/FLAIR hyperintense lesions in the subcortical as well as the periventricular white matter which are not significantly changed since 12/29/2015 although current study is of higher resolution limiting comparison of small lesions. In particular, small lesions are noted along the margins of the right temporal horn as well as along the callososeptal interface. Signal abnormality adjacent to the right temporal horn appears more prominent but this may be related to technique. No significant burden of T1 hypointense lesions. Brain parenchymal volume is preserved.No intracranial mass or mass effect. Ventricles and sulci are within normal limits. Major flow-voids are preserved. Calvarium and extra cranial soft tissues are grossly unremarkable. There is abnormal signal involving the left optic nerve compatible with history of prior optic neuritis and was present on prior study.Cervical spine: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. No suspicious osseous lesion. The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: There is mild right neural foraminal narrowing related to uncovertebral hypertrophy. Left neural foramen and spinal canal are patent. Findings are unchanged.C4-5: There is a disc osteophyte complex including uncovertebral hypertrophy on the right with moderate right-sided neural foraminal stenosis. Mild effacement of the ventral thecal sac without significant spinal canal stenosis overall. Left neural foramen is patent. Findings are unchanged.C5-6: There is a disc osteophyte complex with partial effacement of the ventral thecal sac. No significant spinal canal stenosis overall. There is mild left neural foraminal narrowing. Right neural foramen is patent. Findings are unchanged.C6-7: Disc osteophyte complex including a left foraminal disc protrusion and uncovertebral hypertrophy. Partial effacement of the ventral thecal sac without significant spinal canal stenosis overall. There is moderate to severe left and mild right neural foraminal stenosis. Mild right neural foraminal narrowing. Findings are not significantly changed.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Allowing for slight differences in technique with current study of higher resolution, there is no significant change in mild burden of T2/FLAIR hyperintense lesions in the supratentorial white matter compared to 12/29/2015. The distribution and morphology of these lesions is overall nonspecific although few lesions such as along the right temporal horn are suggestive of demyelinating or prior inflammatory process. 2. No signal abnormality in the cervical cord to suggest demyelinating disease.3. Degenerative changes in the cervical spine without significant spinal canal stenosis at any level. There is up to moderate to severe left C6-C7 neural foraminal stenosis and milder neural foraminal stenoses at additional levels as detailed above. These findings are not significantly changed since 2/3/2015.4. Abnormal signal in the left optic nerve compatible with prior optic neuritis.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Altered mental status. Altered mental statusClinical question: R/O brain metastasisSigns and Symptoms: delirium, new weakness The CSF spaces are appropriate for the patient's stated age with no midline shift. There is thickening of the left tentorial leaf along its medial aspectNo abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There is mild and subtle nonspecific thickening of the left tentorial leaf along its medial aspect. Differential considerations may include the idiopathic thickening of the tentorial leaf though it could also be related to granulomatous or lymphomatous disorder. Metastasis would be unusual but can occasionally present as a dural based lesion as well. Please correlate with patient's clinical history. If clinically appropriate, a follow-up exam would be helpful.


Instruction: Generate impression based on medical findings.

Input: ESRD on HD presenting with MRSA bacteremia and low back pain. The vertebral bone marrow signal is unremarkable. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. There are mild degenerative changes involving the lower lumbar spine facet joints, but no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. There is extensive mediastinal lymphadenopathy and atrophic and cystic kidneys.

Output: 1. No evidence of discitis-osteomyelitis in the thoracic and lumbar spine, although assessment is somewhat limited without intravenous contrast.2. Extensive mediastinal lymphadenopathy and atrophic and cystic kidneys. Please refer to the prior body CT report for additional details.


Instruction: Generate impression based on medical findings.

Input: History of DCIS, status post lumpectomy, MRI from 8/2015 showed BI-RADS 3 with recommendation for six-month follow-up. Patient presents for 6 month follow-up today. There is extreme amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally. Post lumpectomy changes noted in the left breast.No abnormal enhancement is seen in either breast. Stable focus of enhancement identified in the right breast 11:00 position anteriorly. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on medical findings.

Input: Reason: adrenal insufficiency History: short gut, TPN dependence, poor growth, normal GLT stim test and centreal adrenal insufficiency MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images, predominantly on the left side.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI pituitary:The pituitary gland is appropriate in overall height and morphology. The infundibulum of the pituitary gland is midline. No suprasellar or intrasellar mass is identified. The cavernous sinuses are intact bilaterally.

Output: 1.No abnormal lesion is identified in the pituitary gland. The pituitary is normal in overall size and morphologic appearance.2.Punctate periventricular white matter lesions of a mild degree are present which are nonspecific. Given the patient's PMH, they are most likely are perinatal in origin.


Instruction: Generate impression based on medical findings.

Input: Wedge-shaped abnormalities on CT scan. HCV Cirrhosis. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology with left and caudate lobe hypertrophy and mild diffuse fibrotic changes. Fibrosis and atrophy of the anterior segment of the right hepatic lobe without a focal lesion or biliary ductal dilatation.No suspicious liver lesion, biliary ductal dilatation or vascular abnormality. Normally distended gallbladder. The vessels are patent.SPLEEN: Splenomegaly measuring 19.7 cm in craniocaudal dimension with numerous Gamna-Gandy bodies.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted. Extrarenal pelvis bilaterally.RETROPERITONEUM, LYMPH NODES: Upper abdominal collateral vessel formation.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Cirrhotic liver with fibrotic changes of the anterior segment of the right hepatic lobe without a suspicious lesion.


Instruction: Generate impression based on medical findings.

Input: Disorientation, unspecified [R41.0] / Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits [Z86.73], Reason for Study: ^Reason: AMS, h/o ?recent CVA History: AMS Redemonstration of prior craniotomy with metastatic colon cancer resection on the left frontal lobe superior frontal gyrus and adjacent encephalomalacia, no change since prior scan.Localized encephalomalacia of the left occipital lobe, no change since prior scan.Underlying brain shows extensive patchy high signal intensity lesions on bihemispheric periventricular white matter, likely related to prior treatment, no change since prior scan.Multifocal various sized bihemispheric susceptibility lesions on gradient echo images indicating possible prior radiation therapy related are again seen, no change since prior scan.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: 1. No evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement.2. No change of multifocal encephalomalacia, non specific white matter lesions and susceptibility lesions since prior scan.


Instruction: Generate impression based on medical findings.

Input: History of ALL with nasopharyngeal tumor, radiation to brain and spine: baseline surveillance exam. Brain: There is a right transfrontal Ommaya catheter that appears to terminate in the suprasellar cistern, with mild high T2 hyperintensity in the parenchyma surrounding the catheter that may represent gliosis or edema. The ventricles are otherwise normal in size and configuration. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement.There is no midline shift or herniation. The major cerebral flow voids are intact. Face: The nasopharyngeal mucosa to be appears intact, without discernible mass lesions.The orbits and salivary glands are grossly unremarkable. There is mild heterogeneity of the sphenoid with predominantly fatty marrow and paucity of the sphenoid sinuses. LIkewise, the right maxillary and bilateral frontal sinuses appear to be non-pneumatized and the left maxillary sinus is hypoplastic.

Output: 1. Right transfrontal Ommaya catheter in position with mild surrounding gliosis or edema, but no evidence of acute intracranial hemorrhage, mass, or acute cerebral infarction.2. No evidence of nasopharyngeal mucosal mass lesions.3. Diffusely hypoplastic paranasal sinuses. A sinus CT may be useful for further assessment, if clinically warranted.


Instruction: Generate impression based on medical findings.

Input: Facial asymmetry since childhood and hyperreflexia here for evaluation of possible multiple sclerosis. There are a few scattered punctate foci of T2 hyperintensity in the cerebral white matter, particularly the frontal lobes. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is minimal fluid signal in the left mastoid air cells. There is anterior nasal deviation to the left.

Output: 1. A few scattered punctate foci of T2 hyperintensity in the cerebral white matter, particularly the frontal lobes, are nonspecific, but perhaps related to chronic small vessel ischemic disease, but no compelling findings for intracranial demyelinating lesions otherwise.2. Anterior nasal deviation to the left.


Instruction: Generate impression based on medical findings.

Input: 63 years, Female, metastatic ovarian cancer status post resection and radiation therapy. Compared to 6/24/2015, there is evidence of treatment response with decrease in size of multiple enhancing lesions. For example left frontal lesion previously 10 x 10 mm now measures 6 x 6 mm. Right parietal 11 x 7 mm lesion measures 7 x 5 mm. 4 mm right cerebellar lesion now measures less than 2 mm. There is interval decrease in FLAIR hyperintensity associated with the left frontal and right parietal lesions. Additional areas of FLAIR hyperintensity in the periventricular and subcortical white matter are not significantly changed. Unchanged appearance of the right frontal resection cavity with surrounding FLAIR hyperintensity which may represent gliosis. Unchanged restricted diffusion involving the posterior aspect of the right frontal resection cavity likely related to chronic blood products. No new enhancing lesion or new mass effect is appreciated. Unchanged ventricular size and periventricular FLAIR abnormality. No midline shift or herniation. Major flow-voids are preserved. Paranasal sinuses and mastoid air cells are clear. No suspicious osseous lesions.

Output: Compared to 6/24/2015 there is evidence of treatment response with decrease in size of multiple previously seen enhancing lesions. No new lesions.


Instruction: Generate impression based on medical findings.

Input: Midline low back pain without sciatica MRI thoracic spine:At T8-T9 there is a T1 and T2 hypointense lesion present within the left anterior aspect of the spinal canal measuring 11 x 7 mm axial dimensions and 18 x 9 mm sagittal dimensions. It tracks behind the adjacent vertebral bodies. It extends towards the left T8-9 neural foramen and abuts the left pedicle of T9. This lesion mildly displaces the spinal cord towards the right.The T8-T9 disc is mildly desiccated and there is mild loss of disc space height at T8-T9. There is some loss of disc space height at T6-T7.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. Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a broad-based central disc protrusion present at L5-S1 which impresses on the ventral aspect of the thecal sac. It does extend into the inferior aspects of the neural foramina. It abuts the nerve roots at the right lateral recess but does not compress them. It extends across the midline and minimally abuts the nerve roots at the left lateral recess. The disc protrusion itself this contains some high signal material.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There is a lesion present along the left lateral recess at T8-T9 which appears represent a partially calcified mass. It is most likely discogenic in origin. A CT of the thoracic spine may help further evaluate it if information on calcification is needed.2.There is a small central disc protrusion eccentric to the right present at L5-S1 without significant compromise spinal canal or neural foramina. It abuts the nerve roots at the right lateral recess.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old, with headache and tremors, known small cell lung cancer, evaluate for metastases. Motion artifact degrades image quality on several sequences. No evidence of mass effect or pathologic parenchymal or extra-axial enhancement is seen. No restricted diffusion is evident. Encephalomalacia of the right inferior frontal lobe is likely related to prior infarction. Scattered periventricular T2 hyperintensities are also noted, most likely representing chronic microvascular ischemic disease. On postcontrast images, the pituitary gland appears to be inhomogeneously enhancing with an area of relative hypoenhancement posteriorly.No acute intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. The ventricles are within normal limits for size and morphology.

Output: 1.No evidence of intracranial metastatic disease within the limitations of a motion degraded examination.2.No definite acute intracranial abnormalities. Sequelae of chronic right inferior frontal infarction are noted along with findings likely related to chronic microvascular ischemic disease.3.Incidental note is made of asymmetric hypoenhancement of the posterior aspect of the pituitary. This is probably an incidental finding and unrelated to the patient's presenting symptoms. If clinical concern warrants, dedicated pituitary imaging can be considered.


Instruction: Generate impression based on medical findings.

Input: 68-year-old male with bilateral lower extremity weakness after a fall. Evaluate for etiology of the weakness. The vertebral column alignment is within normal limits. The vertebral body heights are preserved without evidence of fracture. There is multilevel disc desiccation involving the lower lumbar spine as well as severe disc height loss at the L3-4 and L5-S1 levels. At these levels there are endplate degenerative changes. 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. Degenerative changes are seen in the cervical spine as described below:T12-L1: There is no significant compromise to spinal canal or neural foramina.L1-L2: Right greater than left disc bulge with mild right-sided neural foraminal stenosis. No left foraminal or spinal canal stenosis.L2-L3: Diffuse disc bulge with a small left paracentral disc protrusion which effaces the ventral thecal sac on the left and causes mild narrowing of the left lateral recess. There is also mild spinal canal stenosis and mild bilateral neural foraminal stenosis.L3-L4: Severe disc disease and disc bulge as well as facet hypertrophy which causes moderate bilateral neural foraminal and spinal canal stenosis. L4-5: Diffuse disc bulge with a left lateral annular fissure as well as facet arthropathy. There is no significant spinal canal or neural foraminal stenosis.L5-S1: Severe disc disease with lobular fatty material in the epidural space of the right anterior spinal canal at the L5-S1 level. The lesion abuts the disc and adjacent facet joint but does not clearly arise from either. Signal characteristics are entirely different from disc and there is no evidence of enhancement. This displaces the S1 nerve root posteriorly along with the other transiting sacral nerves. There are additional degenerative changes, a bulging disc with osteophyte formation and facet arthropathy which contributes to mild bilateral neural foraminal stenosis.

Output: 1.Lobular fatty material in the epidural space of the right anterior spinal canal at the L5-S1 level. The lesion abuts the disc and adjacent facet joint but does not clearly arise from either. Signal characteristics are entirely different from disc and there is no evidence of enhancement. This, along with additional degenerative changes, contributes to S1 nerve root displacement posteriorly along with the other sacral nerves. The differential includes a lipoma, dermoid cyst, or fatty degeneration of some other benign lesion.2.Severe disc disease and disc bulge at the L3-4 level as well as facet hypertrophy which causes moderate bilateral neural foraminal and spinal canal stenosis. 3.Diffuse disc bulge at the L2-3 level with a small left paracentral disc protrusion which effaces the ventral thecal sac on the left and causes mild narrowing of the left lateral recess. There is also mild spinal canal stenosis and mild bilateral neural foraminal stenosis at this level.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Status post biopsy. Signs and symptoms: Status post biopsy. Pre and post enhanced brain Stealth MRI:Examination demonstrates a thin rim enhancing lesion in the anterior and mid temporal lobe lateral to the trigone of left lateral ventricle. It measures approximately 25 mm in AP axis and 8mm in transverse. No significant change since prior exam.Extensive surrounding FLAIR and T2 hyperintensity without enhancement is again also noted suspected of nonenhancing component of tumor. There are thin serpiginous low T2 signal intensity consistent with previously seen cortical calcification on prior CT is again noted without change. Beyond this region vasogenic edema anterior and posterior to the mass similar to prior exam is again noted. Findings resulting regional mass effect as well as trace the radiation of midline to the right without significant change since prior exam. A small linear and loculated internal focus of T2 hyperintensity suggestive of track of prior biopsy approach.Stable normal size of ventricular system.No detectable new foci of signal abnormality or abnormal parenchymal/leptomeningeal enhancement.There is however new thin uniform dural thickening and enhancement in the left temporal and frontal region likely as result of recent surgical intervention.

Output: 1.Revisualization of partially enhancing mass in the left anterior and mid temporal lobe without significant change since prebiopsy study. Stable regional mass effect and trace deviation of midline to the right.2.Expected post biopsy changes and including mild uniform dural thickening and enhancement in the left frontal and temporal region.


Instruction: Generate impression based on medical findings.

Input: Reason: R sacral mass--abscess vs leukemic infiltrate History: low back pain, CML in blast crisis, mass on CT Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the sacral lesion.

Output: Sacral bone biopsy of a right sided sacral lesion under CT guidance. A total of 9 samples were delivered for analysis as detailed above.


Instruction: Generate impression based on medical findings.

Input: Dementia, unspecified, without behavioral disturbance. Other speech disturbance MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a cystic lesion present crossing the left foramen ovale which is unchanged since the prior exam. It has not changed since the prior examNo intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses 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.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are small. The vertebral arteries are mildly asymmetric - left larger than right.

Output: 1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.A cystic lesion coursing through the left foramen ovale is unchanged compared to the prior exam. It is contiguous with the left temporal lobe and most likely represents an encephalocele.4.No evidence for acute ischemic cerebral infarction.5.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on medical findings.

Input: History of HIV/AIDS. Left-sided weakness and altered mental status. A punctate focus of restricted diffusion with associated FLAIR hyperintensity is visualized along the right paracentral lobule indicating a very small region of acute infarct. There is no mass effect in this area or evidence of edema. There is no evidence of intracranial hemorrhage.A couple of scattered punctate nonspecific foci of signal susceptibility abnormality are noted. There is an unchanged old lacunar stroke in the right thalamus, encephalomalacia in the left peritrigonal region, and diffuse patchy periventricular and subcortical white matter T2/FLAIR signal abnormality which are stable compared to prior exams. 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.Again seen is a deformity of the anterior and lateral walls of the left maxillary sinus which was also present on prior studies and better described on the previous CT.

Output: 1.Punctate focus of restricted diffusion in the right paracentral lobule indicating a very small acute infarct. There is no significant edema, abnormal enhancement or mass effect in this region.2.Other underlying white matter changes are stable compared to prior exams.


Instruction: Generate impression based on medical findings.

Input: Reason: L hip FAI and labral tear History: L hip pain Note that given the patient's inability to tolerate the exam, only a coronal T2 fat sat sequence obtained in the prone position and axial T1 sequence obtained in the decubitus position was obtained. The sequences are also limited by motion artifact.There is abnormal T2 and T1 marrow signal within the left femoral head and neck. Further characterization of this abnormal signal intensity is limited.Gadolinium is noted within the left hip joint. Evaluation of small labral tears is markedly limited however within the limits of exam, there is no obvious labral detachment.

Output: Abnormal marrow signal within the left femoral head and neck which is nonspecific and cannot be further characterize given the limitations of the exam. Repeat examination of the left hip or alternatively CT may be beneficial to further characterize these findings. Evaluation of the labrum is essentially nondiagnostic.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Rule out CVA. Signs and symptoms: Right upper and lower extremity weakness. Nonenhanced head CT:Large vessel intracranial calcification of bilateral vertebral and cavernous carotids are noted. Images through posterior fossa are unremarkable.On axial images 11 and 12 there is a focus of low attenuation in the pons on the left extending across the midline. This is believed to represent artifact. Please correlate with neurological examination findings and if concern persists recommend and MRI.Images through the supratentorial space demonstrate no detectable hemorrhage, edema, mass effect, midline shift or hydrocephalus. There is a slight prominence of cortical sulci and ventricular system which may represent mild underlying parenchymal volume loss.

Output: 1.No definitive acute intracranial findings.2.Foci of low-attenuation in the pons on the left which also extend across the midline to the right and is believed to represent an artifact. Please correlate with neurological findings and if there is concern for stroke in this region recommend follow-up with CT or an MRI.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Rule out intracranial hemorrhage, abscess, mass. Signs and symptoms going altered mental status, short-term memory loss. Non-infused head CT:The examination again demonstrates extensive subcortical and periventricular diffuse areas of low-attenuation with no appreciable interval change since prior MRI examination of 3 -- 29 -- 11. Findings likely represent post therapy changes. A shunted right lateral ventricle with no change in the size of ventricular system since prior study. Prominence of cortical sulci for patient's stated age concerning for underlying parenchymal volume loss.No evidence of hemorrhage, edema, mass effect or midline shift. No hydrocephalus.

Output: 1.Shunt in the right lateral ventricle and stable ventricular system since prior exam.2.Post therapy changes of bihemispheric white matter.3.No detectable acute intracranial findings.4.Extensive opacification of paranasal sinuses with fluid levels within bilateral maxillary sinuses.


Instruction: Generate impression based on medical findings.

Input: Left-sided neck paresthesias. Right fourth/fifth finger paresthesia for 3 months. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained aside from minimal retrolisthesis of C3 on C4. There is a subcentimeter focus of T1 hypointensity and STIR hyperintensity involving the anterior base of the dens which is nonspecific. Bone marrow signal is otherwise unremarkable. No discrete destructive or infiltrative osseous lesions are evident. The cervical spinal cord has normal signal characteristics and overall morphology.Mild multilevel degenerative changes are seen including mild generalized facet arthropathy, relatively worse at the right C7-T1 level. Individual levels as below: C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Small disc osteophyte complex including uncovertebral hypertrophy. There is mild right and moderate left neural foraminal stenosis. No significant compromise to the spinal canal.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: Minimal disc osteophyte complex and ligamentum flavum thickening. No significant spinal canal stenosis. There is minimal left neural foraminal stenosis related to uncovertebral hypertrophy and mild facet arthropathy.C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina. Mild bilateral facet arthropathy, right greater than left.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Mild multilevel degenerative changes in the cervical spine as described above. There is no significant spinal canal stenosis at any level or cord signal abnormality. Neural foraminal stenosis is relatively worse at the left C3-C4 level where there is moderate stenosis.2. Subcentimeter T1 hypointense, T2/STIR hyperintense vertebral lesion at C2 which may represent an atypical hemangioma, but is nonspecific.


Instruction: Generate impression based on medical findings.

Input: Glioblastoma status post resection and chemoradiation. There are postoperative findings related to right frontotemporal craniotomy. There is no significant change in the irregular peripherally-enhancing mass in the right temporal, with apparent elevated perfusion in the enhancing component, although, the extent of adjacent ependymal enhancement has increased. There is no significant interval change in the irregular peripherally-enhancing mass in the right frontal lobe, but the more lateral adjacent solidly-enhancing tumor has decreased in size. The presence of susceptibility effect in this region limits assessment of the perfusion characteristics. However, there is increased surrounding confluent white matter T2 hyperintensity with associated slight increase the right uncal herniation and effacement of the right lateral and third ventricles since December 2015. There is 6 mm of midline shift to the left. There is no evidence of acute intracranial hemorrhage or infarction. There is unchanged nonspecific patchy cerebral white matter hypoattenuation in the left cerebral hemisphere. The orbits, paranasal sinuses, and scalp soft tissues are grossly unchanged.

Output: 1. No significant change in the irregular peripherally-enhancing mass in the right temporal, with apparent elevated perfusion in the enhancing component, although, the extent of adjacent ependymal enhancement has increased2. No significant interval change in the irregular peripherally-enhancing mass in the right frontal lobe, but the more lateral adjacent solidly-enhancing tumor has decreased in size. 3. Confluent white matter abnormality surrounding the tumor foci has increased since December 2015, which may represent tumor infiltration and/or edema related to treatment.


Instruction: Generate impression based on medical findings.

Input: 38 years, Male, multiple sclerosis, follow-up for progression. Paresthesias. Again seen are multiple scattered punctate and linear foci of T2/FLAIR hyperintensity within the periventricular and juxtacortical white matter, some of which are oriented perpendicular to the long axis of the lateral ventricles. These are consistent with demyelinating lesions. Some of the lesions appear more conspicuous on prior study performed at 3 Tesla. No new lesions are seen. No definite posterior fossa lesions are identified. There is mild burden of T1 hypointense lesions. Brain parenchymal volume appears preserved.The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified. Incidental note is again made of a partially empty sella. There is mild to moderate mucosal thickening in the maxillary sinuses as well as mild ethmoid opacification.

Output: No new lesions to suggest progression of demyelinating disease.


Instruction: Generate impression based on medical findings.

Input: Dizziness and giddinessClinical question: evaluate cause for dizzinessSigns and Symptoms: "dizziness for 2 months, had head trauma due go GLF about 2 months ago" The CSF spaces are appropriate for the patient's stated age with no midline shift. No foci of diffusion restriction are appreciated within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.

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


Instruction: Generate impression based on medical findings.

Input: History of subdural hematoma, now 2 week history of intermittent right lower extremity and right upper extremity weakness/numbness. Evaluate for subacute stroke. Again seen are subdural collections along the bilateral cerebral convexities, measuring up to 25 mm on the right, previously 15 mm in a similar plane from CT dated 4/24/2015, and up to 9 mm on the left previously 9 mm as well. There is susceptibility consistent with blood products within the right-sided collection with mild loculations. There is increased mass effect on the right frontoparietal sulci, effacement of the right lateral ventricle, and increase in leftward midline shift from 3 mm to 8 mm at the level of the septum pellucidum. No uncal herniation. Minimal subdural blood products also suspected in the posterior fossa bilaterally. Small fluid collection in the right parietal scalp is again noted measuring up to 9 mm x 3.9 cm in the transverse and AP dimensions which communicates with the subdural collection via the prior posterior burr hole. Mild enlargement of the left lateral ventricle is noted which may be getting entrapped.No restricted diffusion to suggest acute ischemia. Again seen are multiple foci of T2/FLAIR hyperintensity in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with moderate chronic small vessel ischemic changes and similar to prior. Major flow-voids are preserved. Parenchymal volume loss is noted particularly on the left.Partially empty sella incidentally noted. Minimal mucosal thickening in the paranasal sinuses. Bone marrow signal and extracranial soft tissues are within normal limits. Two right-sided burr holes again noted.

Output: 1. Compared to CT 4/24/2015, there is interval increase in size of right frontoparietal convexity subdural hematoma measuring up to 25 mm, previously 13 mm. There is significant increase in mass effect with leftward midline shift measuring 8 mm, previously 3 mm. Mild enlargement of the left lateral ventricle is also noted which may be getting entrapped. 2. No significant change in small left-sided subdural collection with signal features mostly compatible with a hygroma. No significant mass effect. 3 Small right parietal scalp fluid collection again noted which communicates with the subdural collection via previously placed burr hole.4. Moderate chronic small vessel ischemic disease. No evidence of recent infarct.Dr. Ali discussed findings with Dr. Cotts at 1050 on 5/15/2015. Patient was transported to the ED for further evaluation.


Instruction: Generate impression based on medical findings.

Input: 51 year old woman with history of systolic heart failure, palpitations, and fatigue who presents for cardiac MRI to evaluate for etiology of LV dysfunction and symptoms. Left VentricleThe left ventricle is mildly dilated with mild to moderately reduced systolic function. The overall LV ejection fraction is 40%, the LV end diastolic volume index is 89 ml/m2 (normal range: 65+/-11), the LVEDV is 153 ml (normal range 109+/-23), the LV end systolic volume index is 53 ml/m2 (normal range 18+/-5), the LVESV is 91 ml (normal range 31+/-10), the LV mass index is 29 g/m2 (normal range 67+/-11), and the LV mass is 49 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is epicardial late gadolinium enhancement involving the basal to mid inferior wall which suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pattern is atypical for prior myocardial infarction. No evidence of myocardial iron overload. No evidence of cardiac amyloid.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 102 ml/m2 (normal range 69+/-14), the RVEDV is 174 ml (normal range 110+/-24), the RV end systolic volume index is 50 ml/m2 (normal range 22+/-8), and the RVESV is 86 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is mildly dilated with mild to moderately reduced systolic function [LVEF 40%]2. There is epicardial late gadolinium enhancement involving the basal to mid inferior wall. The pattern is atypical for prior myocardial infarction and suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pattern is most consistent with fibrosis due to old myocarditis, but can also be seen with other types of cardiomyopathy. The overall burden of late gadolinium enhancement is small.3. Mild RV dilation with normal systolic function (RVEF 50%). 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: Seizures and syncope. Malignant neoplasm of breast. There are postoperative findings related to right anterior temporal lobectomy with high T2 signal diffusely along the surgical margins. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Postoperative findings related to right anterior temporal lobectomy with mild gliosis along the surgical margins. 2. No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on medical findings.

Input: Increased seizure activity, rule out acute pathology. Neck pain. Brain: There are postsurgical changes of right-sided craniotomy including resection of the right anterior temporal lobe. There is T2/FLAIR hyperintensity surrounding the resection cavity consistent with gliosis. There is ex vacuo dilatation of the right temporal horn. There is an additional area of FLAIR hyperintensity and volume loss compatible with encephalomalacia in the right frontal lobe including primarily the right middle frontal gyrus and extending to the right frontal periventricular white matter.Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Several punctate foci of FLAIR hyperintensity are noted in the right superior frontal gyrus which may also represent chronic infarcts. There is severely diminished flow-void involving the visualized right upper cervical, petrous and cavernous internal carotid arteries with improved flow-void of the right supraclinoid ICA and its branches, which may be related to collateral flow.No restricted diffusion to suggest acute ischemia. Punctate focus of diffusion hyperintensity seen in the right anterior frontal lobe without corresponding ADC abnormality. No intracranial mass or mass-effect. No hydrocephalus. Mild mucosal thickening is noted throughout the paranasal sinuses. Bone marrow signal within normal limits.Cervical spine: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate height. There is mild reversal of cervical lordosis. Alignment is otherwise maintained. Bone marrow signal is benign. The cervical spinal cord has normal signal characteristics and overall morphology.The cervical spinal canal appears mildly narrow on a congenital basis with superimposed minimal degenerative changes as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal. Minimal bilateral neural foraminal narrowing relatively worse on the left related to uncovertebral hypertrophy and mild facet arthropathy.C4-5: No significant compromise to the spinal canal. Minimal left foraminal stenosis related to uncovertebral hypertrophy and facet arthropathy.C5-6: No significant compromise to the spinal canal or neural foramina.C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: Minimal disc bulge. No significant compromise to the spinal canal or neural foramina.Right vertebral artery flow-void is diminutive which may be related to hypoplasia and/or proximal stenosis. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Postsurgical changes involving the right anterior temporal lobe, presumably related to epilepsy surgery. There is gliosis surrounding the right anterior temporal resection cavity.2. Encephalomalacia in the right frontal lobe suspected to be related to chronic infarct. No evidence of acute infarct. Punctate focus of mild diffusion hyperintensity seen in the right anterior frontal lobe (image 250) with corresponding FLAIR hyperintensity and without corresponding ADC abnormality; finding may represent a punctate subacute infarct.3. Severely diminished flow-void is seen involving the right upper cervical, petrous and cavernous segments of the internal carotid artery which may be related to occlusion or high-grade proximal stenosis. Consider dedicated MRA or CTA evaluation to better assess the vasculature. 4. No intracranial mass or mass effect.5. Mild congenital narrowing of the cervical spinal canal with superimposed mild degenerative changes as detailed above. No high-grade spinal canal or neural foraminal stenosis at any level is appreciated. No cord signal abnormality.


Instruction: Generate impression based on medical findings.

Input: CTLA4 deficiency autoimmune disease, inflammatory arthritis, AIHA status post splenectomy on Rapamune, pulmonary nodules, now presenting with new onset severe headache and nausea/vomiting. There are multiple infiltrative cortical and white matter enhancing lesions with high T2 signal within the right frontal lobe, bilateral parietal lobes, occipital lobes, left insula, and right cerebellum, which are generally more prominent. In addition, there is a newly apparent subcortical enhancing lesion in the left middle frontal lobe. The lesions display minimal mass effect and there is no midline shift. There are no associated susceptibility or restricted diffusion. There is an unchanged linear T2 hyperintense lesion in the superior right frontal white matter without associated enhancement. The ventricles and basal cisterns are normal in size and configuration. There is diffuse paranasal sinus mucosal thickening and fluid levels in the maxillary sinuses. There are partially-imaged prominent cervical lymph nodes, particularly on the left side. The orbits are unremarkable.

Output: 1. Slightly increased prominence of multiple supratentorial and infratentorial lesions may represent lymphocytic infiltration associated with CTLA4 deficiency versus lymphoma. 2. Partially-imaged prominent cervical lymph nodes, particularly on the left side may also be related to the autoimmune disorder or lymphoma.3. Findings suggestive of acute sinusitis.


Instruction: Generate impression based on medical findings.

Input: Evaluate C5/C6 central disc bulge and C6/C7 left foraminal stenosis: pain in the left arm -- radiculopathy. There is a 4 mm thick posterior disc-osteophyte complex at the C5-6 level, which slightly indents the left aspect of the spinal cord and mildly narrows the left neural foramen at this level. There is no abnormal spinal cord signal, however. There is also an eccentric left disc-osteophyte complex that moderately narrows the left neural foramen at this level. There is no significant spinal canal or neural foramen stenosis at the other cervical spine levels. There is straightening of the vertebral column in the sagittal plane. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: 1. A disc-osteophyte complex at the C5-6 level slightly indents the left aspect of the spinal cord and mildly narrows the left neural foramen at this level. 2. An eccentric left disc-osteophyte complex moderately narrows the left neural foramen at this level.


Instruction: Generate impression based on medical findings.

Input: Assess for worsening spinal pathology s/p fall: bilateral radiculopathy, lumbago. There is a persistent eccentric disc extrusion at L5-S1 with marked loss of disc space height and degenerative bone marrow signal alterations and irregular contours of the adjacent endplates. There is associated severe left lateral recess and otherwise moderate central spinal canal narrowing at this level, with compression of left-sided nerve roots. There is also a left lateral disc protrusion at L4-5, which impinges upon the left-sided exiting nerve roots and moderate left neural foraminal narrowing. There is no significant spinal canal or neural foraminal narrowing at T12 through L4. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unchanged, with diffuse T1 and T2 hypointensity. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable, aside from dependent edema in the posterior subcutaneous tissues.

Output: 1. Persistent eccentric disc extrusion at L5-S1 associated severe left lateral recess and otherwise moderate central spinal canal narrowing at this level, with compression of left-sided nerve roots. 2. Persistent left lateral disc protrusion at L4-5, which impinges upon the left-sided exiting nerve roots. 3. The vertebral bone marrow signal is unchanged, with nonspecific diffuse T1 and T2 hypointensity.


Instruction: Generate impression based on medical findings.

Input: Systemic sclerosis. New onset bilateral lower extremity pain. The patient is also immunosuppressed. Thoracic Spine:There is exaggeration of the upper thoracic kyphosis though without significant anterior compression at any single level. Alignment is otherwise anatomic. There is no suspicious marrow focality. There is mild multilevel disc height and T2 signal loss. The discs at T2-T3, T3-T4, and T7-T8 cause shallow ventral thecal sac indentations as well as minimal indentation of the spinal cord. Less significant ventral thecal sac indentations are caused by the T8-T9 and T10-T11 discs without morphologic spinal cord abnormality. T10-T11 disc is associated with small interbody herniations but no edema. There is facet arthropathy multiple levels but without significant foraminal stenosis.The spinal cord shows normal signal. Following contrast administration, there is no abnormal spinal cord or leptomeningeal contrast enhancement.C7-T1 and T1-T2: There is no signal spinal canal or foraminal stenosis.T2-T3: There is a central component to the disc which minimally indents the spinal cord. There is no foraminal stenosis.T3-T4: There is a focal right paracentral component to the disc-osteophyte complex which minimally indents the spinal cord. There is no significant foraminal stenosis.T4-T5, T5-T6, and T6-T7: There is no significant spinal canal or foraminal stenosis.T7-T8: The disc-osteophyte complex is slightly more pronounced on the left causing minimal left paracentral indentation on the thecal sac. There is no significant foraminal stenosis.T8-T9: The disc-osteophyte complex has a very small central component minimally indenting the thecal sac. There is no central or foraminal stenosis.T9-T10, T10-T11, T11-T12 and T12-L1: There is no spinal canal or foraminal stenosis.Dependent lung opacities may represent atelectasis. The esophagus is more thick-walled and more open than expected which may reflect involvement by systemic sclerosis.Lumbar Spine:Alignment is notable for straightening which may reflect patient positioning. The vertebral bodies are preserved in height. Marrow signal is also without suspicious focality. The intervertebral discs are notable for mild T2 signal loss at L4-L5 and moderate height and T2 signal loss at L5-S1. Tip of the conus medullaris is at the L1-L2 level. The conus medullaris shows normal morphology and signal characteristics. The cauda equina nerve roots are normally distributed in the thecal sac. There are small anterior indentations of the thecal sac at L4-5 and L5-S1 due to discs as described below. Following contrast injection, there is no abnormal contrast enhancement along the conus or cauda equina roots.T12-L1, L1-L2 and L2-L3: There is no significant disc herniation. There is no spinal canal or foraminal stenosis. There is mild facet arthropathy.L3-L4: Disc bulge flattens the anterior aspect of thecal sac. There is also mild facet arthropathy. There is no significant spinal canal or foraminal stenosis.L4-5: Disc bulge is slightly eccentric to the left narrowing the left subarticular recess and abutting the traversing left L5 nerve root. There is left more than right facet arthropathy causing mild foraminal stenoses.L5-S1: There is a central disc extrusion which causes moderate left worse than right subarticular recess stenosis abutting traversing S1 nerve roots. There is also mild central spinal canal stenosis. This is associated with mild left worse than right foraminal stenoses. The disc extrusion is associated with contrast enhancement which is probably reactive.

Output: 1.Mild multilevel degenerative disease of the thoracic spine is present as described above. There is no significant spinal canal or foraminal stenosis.2.Lower lumbar degenerative spondylosis is most pronounced at L5-S1, where disc extrusion is abutting the S1 nerve roots. Please correlate with S1 radiculopathy, especially on the left. Milder degenerative disease is present at L4-5 as described above. Please correlate with left L5 radiculopathy.3.There is no abnormal spinal cord signal to suggest myelitis.


Instruction: Generate impression based on medical findings.

Input: Other headache syndrome [G44.89], Reason for Study: ^Reason: evaluation for worsening frontal headache x 9 months History: constant frontal headache No evidence of acute ischemic or hemorrhagic lesionThere are nonspecific T2/FLAIR high signal intensity lesions on white matter, one on the left frontal lobe superior frontal gyrus and another on the right inferior lobule of parietal lobe. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion.Nonspecific T2/flair high signal intensity lesions as described above.


Instruction: Generate impression based on medical findings.

Input: A 72 year old female with hypertension, hyperlipidemia, breast cancer, s/p chemotherapy and now on herceptin, family history of premature coronary artery disease. The electrocardiogram showed anterior ST-T abnormalities and the echocardiography (6/30/2015) showed LVEF of 30% with normal LV function. Referred to cardiac MRI for further evaluation MEDICATIONS: vitamin D3, clonazepam, metoprolol, zolpidem. First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 65%, the LV end diastolic volume index is 66 ml/m2 (normal range: 65+/-11), the LVEDV is 119 ml (normal range 109+/-23), the LV end systolic volume index is 23 ml/m2 (normal range 18+/-5), the LVESV is 42 ml (normal range 31+/-10), the LV mass index is 47 g/m2, and the LV mass is 85 g. There are no regional wall motion abnormalities present. No intracardiac thrombus. Left AtriumThe left atrium is normal size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 59%, the RV end diastolic volume index is 76 ml/m2 (normal range 69+/-14), the RVEDV is 137 ml (normal range 110+/-24), the RV end systolic volume index is 31 ml/m2 (normal range 22+/-8), and the RVESV is 56 ml (normal range 35+/-13). Right AtriumThe right atrium is normal size. Aortic ValveThe aortic valve is trileaflet and opens widely. There is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern. The ascending aorta is non aneurysmal, measuring 3.6 x 3.7 cm (non orthogonal measurement).Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no pericardial effusion.Extracardiac FindingsThere is an incidental lipoma of the right subscapularis musculature.A 2.6 x 3.2cm T2 high signal lesion occupies the left breast with surrounding striations, favoring appearance of post operative seroma that is unchanged from recent ultrasound.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 65%).4. Normal RV size and systolic function (RVEF 59%).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: Reason: Patient with history of chronic knee pain, swelling noted on exam, with pain on valgus stress, concern for MCL tear vs sprain MENISCI: There is predominantly horizontal tear of the lateral meniscus extending from the anterior root to the body. The lateral meniscus is extruded. Medial meniscus is normal in signal characteristics and morphology.ARTICULAR CARTILAGE AND BONE: Bone marrow signal is within normal limits. Osseous alignment is anatomic. There is thinning of the patellar cartilage, particularly at the lateral facet. There is also thinning of the cartilage at lateral femoral condyle and lateral tibial plateau overlying the meniscal tear.LIGAMENTS: Cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: Quadriceps tendon and patellar tendon are intact.ADDITIONAL

Output: Horizontal tear of the lateral meniscus from the anterior root to the body. There is cartilage thinning of the lateral femoral condyle overlying this region. There is also thinning of the patellar cartilage particularly at the lateral facet. Other findings as above.


Instruction: Generate impression based on medical findings.

Input: Diffusion images are negative for acute stroke. Again as in the previous study there is demonstration of numerous varying sized foci of increased signal intensity on FLAIR and T2-weighted images in the periventricular and subcortical white matter of the bilateral cerebral hemisphere. High signal is again seen in the bilateral caudate nuclei and basal ganglia.Since the previous study the foci that were seen in the pons are progressed and more conspicuous and currently seen in the right more than the left.The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There is no diffusion abnormality. No extra-axial fluid collection is identified.Empty sella is seen; however, there no other associated MR signs of pseudotumor cerebri.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is partial opacification of the left ethmoid and the maxillary sinuses bilaterally, left more than the right.

Output: 1. There is mild progression of subtle T2 and FLAIR hyperintensity in the right greater than left pons, likely representing chronic small vessel ischemic changes.2. Numerous stable variably sized foci of abnormal signal in the periventricular and subcortical white matter of the bilateral cerebral hemisphere without any abnormality in the posterior fossa. Findings again, may represent chronic small vessel disease or the sequela of SLE.


Instruction: Generate impression based on medical findings.

Input: Known right breast cancer, MRI #3 on protocol. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.The index lesion in the right breast 3:00 position posteriorly is no longer visible on post-contrast images. The biopsied satellite lesion is not enhancing, either. Other satellite lesions are not seen above the level of background enhancement. The axillary biopsy clip is present. All right axillary nodes are normal in morphology. No abnormal enhancement is seen in the left breast. No abnormal lymph nodes are identified in left axillary region.

Output: Complete imaging resolution of known right breast cancer.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on medical findings.

Input: Non-small cell lung cancer with brain metastasis. Presurgery (biopsy) planning. Limited exam, for stereotactic guidance. The numerous areas of poorly defined T1 shortening predominantly, previously proved to be partly hemorrhagic and partly contrast enhancing, involving the cortex but also the deep brain structures have not significantly changed since the previous examination, accounting for technique differences. Some areas of associated heterogeneous T2 signal are seen with the parenchymal lesions, consistent with blood products. Scattered subtle contrast enhancement on the surface of the cerebellum in the interfolial spaces represents leptomeningeal metastatic involvement and is again unchanged. They are not associated with mass effect, midline shift or herniation. There has been no other significant changes since the previous examination on this limited.

Output: This study was obtained for surgical planning and shows no significant change when compared to the recent August 21, 2015 examination regarding the numerous parenchymal and leptomeningeal metastatic lesions.


Instruction: Generate impression based on medical findings.

Input: Ms. Coleman is a 45-year-old female with a history of left modified radical mastectomy for IDC/DCIS in 2007 treated with radiation and chemotherapy. Personal history of right breast reduction and left breast reconstruction in 2014. Family history of breast cancer in her maternal aunt. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Postsurgical changes consistent with recent breast reduction surgery are identified in the right breast. There is no abnormal enhancement seen in the right breast.Postsurgical changes consistent with modified radical mastectomy are identified in the left breast. There is no abnormal enhancement seen in the left chest wall. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on medical findings.

Input: Lower extremity weakness, breast cancer. There is a T1 hypointense lesion in the right aspect of the T2 vertebra with apparent slight narrowing of the adjacent neural foramen, but no evidence of spinal cord compression. There is congenital fusion of the C3 and C4 vertebrae. There are posterior disc-osteophyte complexes at C4-5 and C5-6, which abut the anterior aspect of the spinal cord. The vertebral body heights and alignment are preserved. There are numerous liver, spleen, and bilateral lung lesions. There is also mediastinal and right lower neck lymphadenopathy.

Output: 1. A metastasis in the right aspect of the T2 vertebra with apparent slight narrowing of the adjacent neural foramen, but no evidence of spinal cord compression. Characterization is otherwise limited due to the abridged nature of the study.2. Multiple liver, spleen, bilateral lung, and lymph node metastases.3. Posterior disc-osteophyte complexes at C4-5 and C5-6 abut the anterior aspect of the spinal cord.


Instruction: Generate impression based on medical findings.

Input: Check for sacroiliitis. Pain in left hip. Ulcerative pancreatitis Osseous structures and specifically the SI articulations appear normal. No MR findings to support inflammation. SI joints are well visualized. No abnormal enhancementVisualized portions of the neural canal in the nerve roots are unremarkable.Vascular and the intrapelvic contents are normal. No abnormal fluid or discrete segments of bowel in this limited evaluation.External muscular compartments and soft tissues are also unremarkable.

Output: Normal exam


Instruction: Generate impression based on medical findings.

Input: Point tenderness. There is no evidence of cervical spine bone marrow edema of gross ligamentous disruption. The vertebral body heights are preserved. There is multilevel degenerative spondylosis with associated spinal canal and neural foraminal narrowing, particularly at C4-5, C5-6, C6-7 and C7-T1. The spinal cord signal is preserved. There is lack of the usual cervical lordosis, but no spondylolisthesis. There is a left thyroid nodule.

Output: 1. No evidence of cervical spine bone marrow edema of gross ligamentous disruption.2. Multilevel degenerative spondylosis with associated spinal canal and neural foraminal narrowing, particularly at C4-5, C5-6, C6-7 and C7-T1. 3. Left thyroid nodule.


Instruction: Generate impression based on medical findings.

Input: Male 31 years old Reason: eval for colloid cyst resection History: eval for colloid cyst resection Motion artifact mildly degrades image quality and interpretation.Redemonstration of a right frontal ventriculostomy catheter with tip projecting midline in the anterior lateral ventricles. There is artifact from a prior left frontal surgical approach.There is persistent ventriculomegaly involving the lateral ventricles which is slightly decreased when compared to the preoperative MR, and there is slight interval decrease in periventricular T2 signal indicating a decrease in transependymal fluid shift. Foci of air within the anterior lateral ventricles seen on prior CT have decreased. Layering T2 hypointensity within the occipital horns has minimal susceptibility artifact compatible with postoperative blood products. Other scattered foci susceptibility are seen along the ventricular margins consistent with blood products.Redemonstration of a round mass in the third ventricle level of the foramen of Monro with low T1 and low T2 signal and only peripheral enhancement on the postcontrast images compatible with a colloid cyst. This measures 13 x 11 mm in the axial plane previously 17 x 16 mm on preoperative MRI.No pathologic extra-axial fluid collection.There is grossly stable cerebellar tonsils positioning, extending 5 mm below the level the foramen magnum, with associated pointing of the tonsils. Partially visualized syringohydromyelia in the cervical spinal cord at the level of C2 measures 9 x 8 mm in greatest axial dimensions and extends 2.5 cm in the craniocaudal dimension. There is crowding of structures at the level of the foramen magnum.The expected intracranial vascular flow voids are present.

Output: 1. Persistent residual colloid cyst at the foramen of Monro which measures 13 x 11 mm, decreased from the preoperative MR.2. Persistent dilatation of the lateral ventricles which is perhaps slightly decreased compared to the preoperative MR. The degree of transependymal CSF flow is also slightly decreased.3. Borderline cerebellar tonsillar ectopia with pointed configuration. Focal syringohydromyelia in the high cervical spinal cord is partially visualized. In retrospect this was present on the prior study but was largely obscured by motion artifact. Findings likely represent sequela of acquired Chiari I malformation. Additional spine imaging can be considered as clinically warranted.


Instruction: Generate impression based on medical findings.

Input: Ms. Kaparos is a 44-year-old female presenting for high-risk screening MRI evaluation. Family history of breast cancer in mother, sister, and ovarian cancer in maternal grandmother. Patient has a CHEK 2 mutation. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old, with increased falls and decreased sensation in the legs, bowel and bladder incontinence, symptoms over a one to two month period per patient and family. History of prostate cancer, unclear staging. Unclear history prior back surgery. Spinal alignment is anatomic. Vertebral body height and morphology are normal. Marrow signal characteristics and pattern of enhancement are unremarkable. No evidence of metastatic disease is seen.The spinal cord shows normal signal intensity and morphology. No pathologic intramedullary or leptomeningeal enhancement is seen. No intraspinal masses are detected.A very small disk protrusion is seen at T1-2. Mild facet hypertrophy and ligamenta flava thickening is demonstrated at T7-8 and T11-12. No significant spinal canal or neuroforaminal stenosis is detected.Small renal lesions are seen on the left. Note is made of numerous prominent mediastinal and perihilar lymph nodes of uncertain significance.

Output: 1. No findings in the thoracic spine to account for the patient's symptoms.2. Note is made of mediastinal and perihilar adenopathy. This adenopathy may have been present as far back as 2010 based on chest x-ray and is therefore of uncertain significance.


Instruction: Generate impression based on medical findings.

Input: History of left-sided testicular cancer. Evaluate for metastatic disease. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Punctate subcentimeter left peri-aortic lymph nodes are not pathologically enlarged by size criteria and are unchanged from priors.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No retroperitoneal lymphadenopathy or evidence of metastatic disease in the abdomen or pelvis.


Instruction: Generate impression based on medical findings.

Input: 73 year man with coronary artery disease, ischemic cardiomyopathy, paroxysmal atrial fibrillation, DM, CK, pulmonary sarcoidosis, and ventricular tachycardia. Resting SPECT perfusion defects noted in the mid to apical inferior wall, the apical septum and anterior walls, and in the apical cap. LVEF (visual) on TTE was 35%. Referred for cardiac MRI to delineate scar tissue for possible ablation. Left VentricleThe left ventricle is moderately dilated with severely reduced systolic function. The overall LV ejection fraction is 27%. Evaluation of systolic function is slightly limited by imaging artifact from the AICD. The LVEDV is 285 ml (normal range 142+/-34), the LV end diastolic volume index is 142 ml/m2 (normal range: 74+/-15), the LVESV is 77 ml (normal range 47+/-19) and the LV end systolic volume index is 104 ml/m2 (normal range 25+/-9). The LV mass is 132 g (normal range 164+/-36) and the LV mass index is 65 g/m2 (normal range 85+/-15). There is akinesis and severe thinning of the apical cap and apical septum extending into the apical anterior and inferior walls. There is hypokinesis and moderate thinning of the mid septum as well as basal lateral LV wall. There is question mild septal dyskinesis suggestive of intra-ventricular conduction delay. There are multiple areas of full thickness and near full-thickness (75%) late gadolinium enhancement in the mid and apical septum, in the apical anterior and inferior walls and apical cap. There is also full thickness late gadolinium enhancement in the entire basal septum.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 38%. The RVEDV is 149 ml (normal range 142+/-31), RV end diastolic volume index is 74 ml/m2 (normal range 82+/-16), the RVESV is 92 ml (normal range 54+/-17), and the RV end systolic volume index is 46 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is trivial mitral regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trivial tricuspid regurgitation which may be related to ICD lead. ICD lead is noted in the right ventricle.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsMutiple enlarged lymph nodes in the mediastinum and bilateral hila compatible with patient's history of sarcoidosis. Right upper lung irregular opacity likely scarring, but incompletely evaluated on this study.This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1.The left ventricle is moderately dilated with severely reduced systolic function. LVEF 27%. Evaluation of systolic function is slightly limited by imaging artifact from the AICD.2.The right ventricle is normal in size with moderately reduced systolic function. RVEF 38%.3.Three vessel coronary artery disease with nonviable myocardium involving predominantly the mid and apical septum and basal lateral wall as detailed above.4.Stigmata of sarcoidosis with likely bandlike scarring in the right upper lobe.


Instruction: Generate impression based on medical findings.

Input: cT2N0M0 left oral tongue squamous cell carcinoma, p16 negative, status post glossectomy with free flap reconstruction. There are postoperative findings related to glossectomy and free flap reconstruction, without evidence of measurable tumor. There is no evidence of significant upper cervical lymphadenopathy. The remaining salivary glands and thyroid appear unremarkable. There are cystic defects in the anterior mandible, which may be related to prior dental disease. The orbits and imaged intracranial structures are grossly unremarkable.

Output: 1. Postoperative findings related to glossectomy and free flap reconstruction, without evidence of measurable tumor. 2. No evidence of significant upper cervical lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: History of cervical schwannoma. Annual follow-up. The examination is significantly limited by patient motion.The contrast-enhancing soft tissue mass expanding the left C2-C3 neural foramen has not significantly changed since the prior examinations, measuring transaxially 15 mm x 10 mm. Postoperative findings involving the left C2 lamina and the overlying soft tissues remain unchanged. The mild deformity including rotation of the upper cervical spinal cord at the C1-C2 level which is unchanged, and may be related to the adhesion. The cervical spinal cord shows normal signal. Multilevel degenerative changes, most pronounced at C4-C5, C5-C6 and C6-C7 related to small disc osteophyte complexes and uncovertebral hypertrophy remain unchanged since the prior examination, resulting mild spinal canal stenosis. Mild right C3-C4, left more than right C4-C5, moderate left and mild right C5-C6, and moderate left C6-C7 neural foraminal stenoses are present.

Output: 1.The contrast-enhancing, expansile soft tissue in the left C2-C3 neural foramen, compatible with the known schwannoma, remains unchanged compared to prior examinations from June 2015 and June 2014.2.Mild cord deformity and rotation at C1-C2 level is unchanged and may relate to adhesions.3.Multilevel degenerative disease resulting in variable mild-to-moderate spinal canal and neural foraminal stenoses, also remains not significantly changed.


Instruction: Generate impression based on medical findings.

Input: 70 years Female (DOB:4/21/1946)Reason: s/p srs surgery History: surveillancePROVIDER/ATTENDING NAME: PETER C. WARNKE PETER C. WARNKE There is redemonstration of right frontal craniotomy and encephalomalacia in the right frontal lobe. There is associated T2 and FLAIR signal hyperintensity within the right superior frontal gyrus and part of the right middle frontal gyrus as well as a small portion of the right precentral gyrus and paracentral lobule. There is some associated ex vacuo effect on the right lateral ventricle. The enhancing lesion continues to decrease in size.There is redemonstration of T2 and FLAIR signal hyperintensity within the subcortical white matter extending to the periventricular white matter of the left occipital lobe which was also present on the prior exam and has not changed. There is associated heterogeneous lesion centrally within this as well as susceptibility artifact. Small amount of contrast enhancement is present within the area of susceptibility artifact.There is redemonstration of punctate foci of signal loss on susceptibility imaging within the cerebellar vermis, right cerebellar hemisphere, left cerebellar hemisphere. These are unchanged.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: Findings are compatible with previously treated lesions in the right frontal lobe and left occipital lobe. The left occipital lobe lesion continues to decrease in size.


Instruction: Generate impression based on medical findings.

Input: History of testicular cancer. ABDOMEN:LIVER, BILIARY TRACT: Mild hepatic steatosis without focal lesion, biliary ductal dilatation or vascular abnormality.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts and probable too small to characterize cysts are present. No hydronephrosisRETROPERITONEUM, LYMPH NODES: No measurably enlarged retroperitoneal lymph nodes are evident.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No abnormally enlarged lymph nodes. Prominent inguinal nodes bilaterally are less than 1cm in short axis.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality.

Output: No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Multiple sclerosis. There are numerous, greater than ten, T2 hyperintense lesions involving the cerebral white matter. A lesion in the right frontal centrum semiovale has increased in size, while the other lesions do not appear to have significantly changed. The brain parenchyma and pituitary gland appear unremarkable. The presumed subcentimeter cystic pineal gland appears unchanged. 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: Numerous cerebral white matter lesions are compatible with multiple sclerosis. A lesion in the right frontal centrum semiovale has increased in size, while the other lesions do not appear to have significantly changed.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Lumbar spinal stenosis. Signs and symptoms: Pain. Nonenhanced lumbar MRI:Lowermost visualized thoracic spine and thoracic cord is unremarkable.T12 -- L1 demonstrate mild degenerative changes and unremarkable otherwise.L1 -- L2 demonstrate mild degenerative changes and unremarkable otherwise. L2 -- L3 demonstrate moderate disk disease and loss of disk height, shadow diffuse bulging disk, mild bilateral ligamentum flavum hypertrophy and mild facet disease. There is no evidence of spinal stenosis however moderate left neural foraminal compromise is present.L3 -- L4 demonstrate mild to moderate disk disease and loss of disk height, moderate left and mild right ligamentum flavum hypertrophy and minimal facet disease. There is a tiny left lateral disk protrusion at this level which projects into the inferior aspect of the left neural foramina. Degenerative changes on the left results in mild neural foraminal compromise and patent right and central spinal stenosis.L4 -- L5 demonstrate mild disk disease and loss of disk height, moderate bilateral ligamentum flavum hypertrophy and mild facet disease. No spinal stenosis. Moderate right neuroforaminal compromise is sagittal images.L5 -- S1 demonstrate moderate disk disease with loss of disk height, moderate right and mild left ligamentum flavum hypertrophy, moderate bilateral (right greater than left) facet hypertrophic changes are noted. Constellation of the above findings results in mild grade 1 anterolisthesis however no convincing evidence of central spinal stenosis. There is moderate left lateral recess and left neural foraminal compromise . There is a suspected small synovial cyst on the right projecting anterior to the right ligamentum flavum.

Output: 1.No convincing evidence of a spinal stenosis at any level.2.Extensive degenerative changes at L5 -- S1 level with resultant mild grade 1 anterolisthesis and moderate left neural foraminal and lateral recess compromise.3.Mild to moderate degenerative changes at other levels however without central spinal stenosis.4.Neural foraminal compromise as detailed level above.


Instruction: Generate impression based on medical findings.

Input: History of MS presenting with paresthesias. Evaluate for progression. Brain:Redemonstration of multiple foci of increased T2 signal in the cerebral white matter in a predominantly periventricular distribution compatible with the history of multiple sclerosis. There is also involvement of the corpus callosum. Overall findings are not significantly changed from prior. The larger lesions are associated with a stable decrease in T1 signal. No new lesions are identified. No evidence of acute ischemia, hemorrhage, or intracranial mass effect.  The ventricles and basal cisterns are normal in size and configuration. The expected intracranial vascular flow voids are present. The paranasal sinuses are clear. The visualized mastoid air cells are clear. Lumbar Spine:Vertebral body heights are preserved. Alignment is anatomic. There is loss of signal in the intervertebral disks at L3-4 compatible with disc desiccation. Increased T2 signal in the vertebral body endplates at L4-5 level which is new from prior and associated with increased signal within the intervertebral disc. No adjacent soft tissue inflammation or epidural collection. The distal cord is grossly normal in signal. The conus medullaris terminates at the mid L1 level.Level by level findings are as follows:T12-L1: No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.L1-L2: No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.L2-L3: No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.L3-L4: Mild disc bulge eccentric to the right which effaces the right lateral recess and extends into the right neural foramen creating mild right neural foraminal stenosis. No central canal or left neural foraminal stenosis.L4-L5: Interval decrease in size of previously noted disc extrusion. There is still effacement of the left lateral recess, however this is significantly improved. Mild left neural foraminal narrowing. No significant central canal or right neural foraminal narrowingL5-S1: Mild disc bulge eccentric to the right partially effacing the right lateral recess and abutting the descending right S1 nerve root. No significant neural foraminal or central canal stenosis.

Output: 1. Stable findings of chronic demyelinating disease in the brain. No new lesions to suggest progression.2. Multilevel degenerative changes of the lumbar spine with interval improvement in previous seen disc extrusion at the left L4-L5 level and improvement in associated effacement of the lateral recess where there was mass effect on the left L5 nerve root. Please see details of additional levels as above.3. Interval increase in T2 signal within the L4-5 vertebral body endplates and intervertebral disc is likely on a progressive degenerative basis. Early discitis-osteomyelitis may appear similar however and can be considered in the appropriate clinical setting.


Instruction: Generate impression based on medical findings.

Input: Ms. Hoyer-Lareau is a 53 year old female with a personal history of right lateral breast excisional biopsy in 7/2015 for intraductal papilloma with FEA/ADH and additional benign biopsy of the right medial breast for intraductal papilloma. Family history of breast cancer in mother, diagnosed at the age of 55. She presents today for MRI evaluation for screening purposes. There is heterogeneous amount of fibroglandular tissuein both breasts. Mild background parenchymal enhancement is noted bilaterally.Stable enhancing mass is seen in the right central breast, unchanged in appearance since MRI from 2007. Scattered benign simple cysts are seen bilaterally. No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on medical findings.

Input: 68 years Female (DOB:9/20/1948)Reason: r/o structural lesion` History: seizurePROVIDER/ATTENDING NAME: MAHESH PADMANABAN MAHESH PADMANABAN The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.Incidental note is made of empty and expanded sella

Output: 1.Examination is degraded due to motion artifact which will obscure more subtle abnormalities.2.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on medical findings.

Input: The last well formed disk space is again referred to as L5-S1. There is grade 1 retrolisthesis at L3-4, unchanged. Patient is status post partial L1 and complete L2 laminectomies and resection of previously identified intradural mass at the level of L2. IIn the operative bed there is diffuse enhancement of the soft tissues extending up to and including, to some degree, the dorsal dura, compatible with scarring. There is no nodular soft tissue or suspicious enhancement within the thecal sac to suggest recurrence. There is no canal stenosis or compression of the thecal sac. Multilevel degenerative changes are not substantially changed since the prior exam. There is desiccation with loss of disk height at L2-3, L3-4 and L5-S1. Disc bulges at L3-4, 4-5, and 5-1 are again identified. Modic type II endplate degenerative changes at L3-4, unchanged.

Output: Expected postoperative changes status post resection of the previously identified L2 intradural mass and laminectomies, as described above, with no evidence of recurrence.


Instruction: Generate impression based on medical findings.

Input: There is redemonstration of right frontoparietal craniotomy. There is significant interval increase in extent of T2/FLAIR hyperintensity in the right cerebral hemisphere related to vasogenic edema compared to 7/30/2015. There is minimal leftward midline shift of 3 mm at the level of the lateral ventricles (401/24) that was not seen in the previous study. There is effacement of the right lateral ventricle Restricted diffusion is seen in the right frontal lobe which is more pronounced and increased in size. There is irregular nodular rim enhancement surrounding the resection site which has increased since the previous study of 7/30/2015. The lesion measures 37 mm in its craniocaudal extent (1701/22) compared to 27 mm in the previous study.Susceptibility images demonstrates blood products within the lesion similar to prior. No uncal herniation. No hydrocephalus.Perfusion images were obtained and processed on a separate workstation but could not be transferred to local PACS. There are areas of elevated CBV associated with the enhancement surrounding the resection cavity raising suspicion for tumor. There is also mild associated restricted diffusion.

Output: 1. In comparison to the previous study there is significant increase in the vasogenic edema of the right frontal and parietal lobes with increased mass effect including minimal leftward midline shift and downward partial effacement of the right lateral ventricle. There is also marked increase in enhancement surrounding the resection cavity with mild restricted diffusion and elevated cerebral blood volumes. Although patient has had recent radiation and posttreatment change is in the differential, early tumor recurrence remains a strong possibility. 2. Minor contrast extravasation as described in the technique section.


Instruction: Generate impression based on medical findings.

Input: 75 years, Male, Reason: history of metastatic basal cell carcinoma with new brain metastases on outside MRI (cerebellum and occipital lobe); please evaluate for radiosurgery planning Limited sequences of the brain for treatment planning protocol including post gadolinium 3-D T1 as well as susceptibility weighted sequences. There is a subtle enhancing lesion in the right occipital lobe measuring approximately 7 mm. There is also a larger enhancing lesion in the left cerebellar hemisphere measuring up to 15 mm in diameter. Please note due to the mild enhancement of the lesions and the limited available sequences, the lesions are difficult to discern. There appears to be mild surrounding edema.No evidence of hemorrhage associated with the lesions. There is a punctate focus of susceptibility in the left parietal lobe without associated enhancement evident and compatible with chronic microhemorrhage. No significant intracranial mass effect, midline shift, or herniation. There are scattered foci T1 hypointensity in the periventricular and subcortical white matter likely reflective of mild chronic small vessel ischemic disease. Vascular structures are patent. Calvarium and extracranial soft tissues are grossly unremarkable.

Output: Prior MRI is not available for comparison, and current examination is limited to sequences per treatment planning protocol. Enhancing lesions are seen in the left cerebellar hemisphere and right occipital lobe with approximate measurements as above. Please note due to the relatively mild enhancement of these lesions, would suggest obtaining prior study to review additional sequences and better assess the size of the lesions.


Instruction: Generate impression based on medical findings.

Input: 84 year-old woman with history of sacral decubitus ulcers, evaluate for osteomyelitis. SOFT TISSUES: There is soft tissue loss posteriorly compatible with the stated history of sacral decubitus ulcer. We see no abscess.There is edema within the subcutaneous fat of the left buttock. Increased signal intensity on T2 sequences within the gluteal muscles and adductor muscles on the left is nonspecific. Increased signal intensity along the left gluteal medius tendon could represent a myotendinous tear but the tendon itself extends to insert on the greater tuberosity.There is edema within the subcutaneous fat of the right flank. Also, there is increased signal intensity on the T2 sequences in the anterior aspect of the gluteus medius, gluteus minimus, and adductor muscles of the hips perhaps representing additional edema. Also, there is mild edema amidst the anterior musculature of the upper right thigh.Increased signal intensity on both T1 and T2 sequences in the paraspinal muscles likely represents atrophy. BONE MARROW: Adjacent to the sacral decubitus ulcer, there is signal abnormality on both T1 and T2 sequences in the lower half of S5 as well as the upper coccyx consistent with osteomyelitis. Additionally, increased signal intensity is noted on the fat saturated T2 sequence in the lower coccyx and the remainder of S5 with relatively normal signal on T1 sequences suggesting reactive edema. The remaining bone marrow signal intensity is within normal limits without evidence of osteomyelitis.JOINTS: Mild degenerative arthritic changes affect the lower lumbar spine.ADDITIONAL

Output: 1.Sacral decubitus ulcer with abnormal signal intensity in the lower sacrum and upper coccyx compatible with osteomyelitis.2.Additional soft tissue inflammation as described above.