Instruction: Generate impression based on medical findings.

Input: Clinical question: evaluate for extension of CVA signs and symptoms: Dysphagia Nonenhanced CT of brain: Bilateral cerebellar strokes with no evidence of hemorrhagic conversion.Multiple supratentorial subcortical and periventricular white matter low attenuation consistent with patient's known prior strokes remains similar. There is a small left parietal nonhemorrhagic cortical stroke since prior exam. This may represent extension of the previously noted stroke or a new cortical stroke. Review of prior MRI examination demonstrated a small cortical stroke at this site on 8 -- 10 -- 2010.No evidence of intracranial hemorrhage, mass effect, midline shift or hydrocephalus.

Output: 1.No definitive evidence of any new stroke.2.No evidence of hemorrhagic transformation.3.Better delineation of areas of stroke secondary to further evolution of multiple strokes.


Instruction: Generate impression based on medical findings.

Input: Planning for deep brain stimulator placement. Enhanced head CT:80 cc of Omnipaque 350 is administered for this exam.Stealth Enhanced head CT for surgical planning protocol is utilized.Minimal periventricular low attenuation of white matter is nonspecific and unchanged since prior head CT.There is evidence of a deep brain stimulator on the left side entering the calvarium from left paramedian frontal bone, traversing the left frontal lobe, entering the left lateral ventricle and with the tip of the stimulator at the level left cerebral peduncle. The appropriateness of this positioning should be decided by referring clinical physician.There is mild I. location of cortical sulci and ventricular system for patient's stated age of 34 similar to prior study. There is no evidence of any abnormal enhancement.A very small thin isodense subdural measuring approximately 2 mm in the frontal -- parietal region is again noted. Compared to prior MRI exam from 9 -- 8 -- 2011 there is interval decrease in the size of the subdural.

Output: 1.No evidence of acute intracranial findings.2.No evidence of abnormal enhancement.3.Left-sided deep brain stimulator with no change in position since prior study.4.A smaller residual left-sided frontal -- parietal subdural since prior MRI exam.


Instruction: Generate impression based on medical findings.

Input: 49-year-old female with right knee pain. Evaluate for right knee meniscus tear. MENISCI: There is horizontally oriented intermediate signal abnormality within the anterior horn of the lateral meniscus which extends to the body of the meniscus as well as the femoral and tibial articular surfaces, appearing similar to the prior study. There are also subcentimeter foci of fluid signal intensity along the anterior aspect of the anterior horn consistent with parameniscal cyst formation, appearing decreased in size when compared to the prior study. These findings may represent a combination of postsurgical change related to the patient's history of prior partial meniscectomy and prior tearing. There is no gadolinium filled defect to suggest a re-tear. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is a near full-thickness articular cartilage fissure along the medial facet of the patella. The remainder of the articular cartilage of the patellofemoral compartment appears intact. The articular cartilage of the medial and lateral tibiofemoral compartments appears intact without evidence of near full-thickness or full-thickness articular cartilage defects. The bone marrow signal intensity is normal.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Postsurgical changes of prior partial meniscectomy and prior tearing of the lateral meniscus without definite evidence to suggest a re-tear of the meniscus.


Instruction: Generate impression based on medical findings.

Input: History of cerebellopontine angle meningioma status post resection. There are postoperative findings related to right-sided suboccipital craniotomy, with flattening of the right cerebellar hemisphere. There is mild dural enhancement along the posterior aspect of the right petrous apex and minimal patchy enhancement in the right cerebellar hemisphere, but no discernible mass lesion. There is a left parietal lobe developmental venous anomaly. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation.

Output: Expected postoperative findings without discernible evidence of residual right cerebellopontine angle meningioma. Please refer to the brain MRI report from 1/8/14 for additional details.


Instruction: Generate impression based on medical findings.

Input: 69 years, Male, memory loss, evaluate for structural lesions. History of prostate cancer. Examination is slightly limited due to motion degradation. 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 disease. Relatively more prominent T2/FLAIR hyperintensity is evident involving the left frontal corona radiata. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. Incidentally seen is a 3 x 7 mm pineal cyst. No suspicious masses or evidence of intracranial mass effect. Partially empty sella is incidentally noted, which can be normal variant. There is mild to moderate global parenchymal volume loss. There is questionable mild disproportionate enlargement of the ventricular system for the degree of volume loss. No definite evidence of hydrocephalus however. No disproportional volume loss involving the hippocampi is appreciated. No abnormal parenchymal or meningeal enhancement to suggest metastatic disease.There is evidence of prior endoscopic sinus surgery including bilateral uncinectomies and ethmoidectomies. There is moderate opacification of the bilateral frontal sinuses and left greater than right ethmoid sinuses. There is also mild mucosal thickening involving the maxillary sinuses, left greater than right. No destructive lesions involving the calvarium.

Output: 1. Mild chronic small vessel ischemic disease.2. Mild to moderate global parenchymal volume loss.3. No suspicious intracranial masses or evidence of intracranial mass effect. No evidence of intracranial metastatic disease.4. Ventriculomegaly is at least predominantly related to the volume loss. There is questionable mild disproportionate enlargement of the ventricular system for the degree of volume loss, which can be correlated for clinical signs of communicating hydrocephalus/NPH.5. Paranasal sinus disease as described above.


Instruction: Generate impression based on medical findings.

Input: Reason: stroke History: acute aphasia MRI brain:There are numerous supratentorial and infratentorial bilateral foci of diffusion restriction with large regions of restricted diffusion in the right frontal and left occipital lobes. Right frontal and right parietal foci areas of diffusion restriction correspond to findings on recent CT. Hyperdensity within the right frontal lesion demonstrates susceptibility, likely reflecting petechial hemorrhage. A few of these lesions have increased FLAIR signal, although many do not. Numerous punctate foci of susceptibility are present bilaterally, many of which are not associated with areas of diffusion restriction. No frank hematoma is evident. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the bilateral maxillary sinuses. Opacification of the mastoid air cells bilaterally is likely related to intubation.MRA brain:The intracranial internal carotid arteries are normal in course and caliber. There is a hypoplastic A1 segment. The middle and anterior cerebral arteries are otherwise unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.MRA neck:There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. The common carotid arteries and cervical internal carotid arteries are normal in course and caliber. Both vertebral artery origins are patent. There is no evidence of flow-limiting stenosis or occlusion.

Output: 1.Numerous bilateral foci of diffusion restriction in the anterior and posterior distributions compatible with acute infarcts and favoring embolic etiology.2.Multiple foci of susceptibility effect within the infarcts are compatible with petechial hemorrhages. No frank hematoma formation is evident. Numerous additional bilateral foci of punctate susceptibility not associated with areas of diffusion restriction likely represent chronic microhemorrhages, which may be related to thrombotic microangiopathy or anticoagulation among other causes. No significant mass effect, midline shift, or herniation.3.No significant stenosis in the intracranial vasculature. No significant stenosis in the neck vasculature.


Instruction: Generate impression based on medical findings.

Input: Status post fall. Questionable loss of consciousness. Please evaluate. Positive headache. There is no evidence of intracranial hemorrhage, mass effect, edema or midline shift. Areas of hypodensity in the left superior frontal gyrus are unlikely related to the patient's trauma and may represent volume averaging. The cerebellar tonsils are low lying and appear at the level of the foramen magnum. Further imaging, such as with an MRI, is recommended.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal without evidence of fracture. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No intracranial hemorrhage or calvarial fracture. There is an area of hypodensity in the left superior frontal gyrus and the cerebellar tonsils are low-lying. MRI imaging is recommended as clinically indicated.These findings were discussed with Dr. Paik at the time of interpretation.


Instruction: Generate impression based on medical findings.

Input: 39 year old female. Pain. Evaluate for meniscal tear. MENISCI: The body of the lateral meniscus is markedly attenuated and deformed compatible with extensive tearing assuming no prior meniscectomy. There is also less severe deformity and attenuation of the posterior horn of the lateral meniscus with intrasubstance signal in the posterior and anterior horns contacting the tibial articular surface suggesting additional tearing. The medial meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is near full thickness degeneration of the articular cartilage of the lateral tibial plateau beneath the posterior horn of the lateral meniscus. There is moderate thinning of the articular cartilage of the lateral femoral condyle above the posterior horn of the lateral meniscus. Additional focal degeneration along the far posterior cartilage of the lateral femoral condyle is noted.LIGAMENTS: The collateral and cruciate ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Lateral meniscal tear, lateral compartment chondral degeneration, and ossified loose body, as described above.


Instruction: Generate impression based on medical findings.

Input: Seizure and altered mental status. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is normal degree of myelination. The hippocampi are intact. There is no evidence of heterotopia. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is diffuse mild paranasal sinus mucosal thickening.

Output: No evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on medical findings.

Input: 68 years Male (DOB:10/5/1947)Reason: Hx of lymphoma, new ataxia, rule out CNS involvement History: see abovePROVIDER/ATTENDING NAME: CARA ANN ROSENBAUM CARA ANN ROSENBAUM There are subdural effusions present in the posterior fossa and supratentorial brain which were also present on the prior exam and have not changed substantially.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Since the prior exam there've been a couple new periventricular white matter lesions. Specifically one in the left centrum semiovale is new. T2 hyperintense punctate lesion is also present in the subcortical white matter of the cerebellum at the level of the upper vermis. This was also present on the prior exam and is also unchanged.There are a few punctate T2 and FLAIR hyperintense foci present in the brainstem which were also present on the prior exam and do not appear to have changed significantly.There is a focus of encephalomalacia and susceptibility artifact which is redemonstrated along the medial aspect of the right occipital lobe. There is redemonstration of multiple punctate foci of signal loss and susceptibility imaging in the subcortical white matter of the supratentorial brain which were also present on the prior exam and have not changed significantly in number.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mucosal thickening in the left maxillary sinus and an asymmetrically smaller left maxillary sinus relative to the right maxillary sinus. The visualized portions of the mastoid air cells demonstrate opacities in the left mastoid air cells.. The visualized portions of the orbits are intact.

Output: 1.Since the prior exam periventricular and subcortical white matter lesions have mildly increased in number.2.There are multiple microhemorrhages present in the subcortical white matter which are stable compared to prior exam. These are nonspecific. One possibility is that they're related to amyloid angiopathy.3.A focus of encephalomalacia and associated old blood products is redemonstrated in the right occipital lobe. This has not changed.4.Subdural effusions are likely related to atrophy.5.There is no evidence for a new enhancing lesion within the brain parenchyma to suggest CNS lymphoma.


Instruction: Generate impression based on medical findings.

Input: Redemonstrated is mild levorotoscoliosis with its apex centered at approximately L3. There are no fractures or subluxations. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. Other than a right simple renal cyst, the visualized intra-abdominal and paraspinal contents are unremarkable.Disc desiccation is present throughout from L2 through S1. Disc height loss is noted at is: significant at L2/3, mild at 3/4, moderate at L/5, and mild at L5/S1. Mild edematous discogenic reactive endplate changes (Modic type I) are evident at L2/3 and L4/5.Redemonstrated is posterior scalloping of the T11 and T12 vertebral bodies with CSF signal intensity extending into the left neural foramen at the T11-T12 foramen and extending along the leftward epidural space. These findings are unchanged in appearance and are thus felt to represent benign change, given the 7 year stability.At the L1-L2 level, bilateral neural foramen are patent without evidence of central canal stenosis, unchanged. At the L2-L3 level there is new asymmetric bulge to the right, slight ligamentum flavum thickening, and mild bilateral facet hypertrophy with mild right neural foraminal stenosis.At the L3-L4 level there is new mild disc bulge, however the bilateral neural foramen and central canal remain patent without evidence of stenosis. At the L4-L5 level there are new changes as follows: Large right foraminal/lateral disc extrusion with associated free fragment posterolaterally effacing the adjacent nerve roots, central disc protrusion, mild disc bulge, ligamentum flavum thickening, and mild to moderate bilateral facet hypertrophy. There is mild central, mild bilateral lateral recess, and severe right lateral neural foraminal stenosis.At the L5-S1 level, bilateral neural foramen are patent without evidence of central canal stenosis. Facet osteoarthritis seen in the left greater than right at this level. In the left lateral aspect of the disc there is high signal compatible with an annular tear. These findings are unchanged.

Output: 1.At the L2-L3 level there is new asymmetric bulge to the right with mild right neural foraminal stenosis.2.At the L4-L5 level there are new changes as follows: Large right foraminal/lateral disc extrusion with associated free fragment posterolaterally effacing the adjacent nerve roots, central disc protrusion, mild disc bulge, ligamentum flavum thickening, and mild to moderate bilateral facet hypertrophy. There is mild central, mild bilateral lateral recess, and severe right lateral neural foraminal stenosis.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Evaluate left lumbar radiculopathy. Findings and symptoms: Back pain extending to left lower extremity, anesthesias. Nonenhanced lumbar MRI:The signal intensity of the vertebral column is unremarkable and the alignment remains anatomic.T12-L1 is unremarkable.L1-L2 is unremarkable.L2-L3 is unremarkable.L3-L4 demonstrate mild ligamentum flavum hypertrophy and unremarkable otherwise.L4-L5 demonstrate mild bilateral ligamentum flavum hypertrophy and unremarkable otherwise.L5-S1 demonstrate moderate disc disease and loss of T2 signal intensity and height and mild bilateral ligamentum flavum hypertrophy. There is a central and left para median shallow broad-based disc protrusion which is best appreciated on axial T2 series 6 image 37, axial T2 series 8 image 22 and 23. There is no spinal stenosis or neural foraminal compromise. Disc protrusion and mild hypertrophic changes of the left articulating facet and ligamentum flavum results in compromise of the left lateral recess and mass effect on the left S1 nerve root which is best appreciated on axial T2 series 8 on images 23 and 24.Unremarkable paraspinal soft tissues.

Output: 1.L5-S1 demonstrate a left lateral shallow broad-based disc protrusion which in combination with mild left facet and ligamentum flavum hypertrophy results in compromise of the left lateral recess and mass effect on the left S1 nerve root as detailed above.2.Essentially unremarkable nonenhanced lumbar MRI study otherwise.


Instruction: Generate impression based on medical findings.

Input: Right upper extremity paresthesia and pain. Cervical Spine: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate height. There is straightening of the cervical spine curvature with minimal anterolisthesis of C4 on C5. Bone marrow signal is within normal limits. 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: No significant compromise to the spinal canal or neural foramina.C4-5: Mild disk bulge. No significant compromise to the spinal canal or neural foramina.C5-6: There is left paracentral disk extrusion with effacement of the left ventral thecal sac and minimal impression on the left ventral cord. Dorsal thecal sac is patent. No significant compromise to the neural foramina.C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: There is moderate narrowing of the right neural foramen related to combination of uncovertebral hypertrophy and disk material. There is mild narrowing of the left neural foramina. No significant spinal canal stenosis.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.Brachial Plexus:Subtle increased T2 hyperintensity is noted involving the C8 nerve root which is favored to be related to the stenosis more proximally in the right C7-T1 neural foramen. Otherwise, remainder of the brachial plexus nerve roots and more distal trunks, divisions, and cords are symmetric in signal and caliber with no abnormal T2 signal or enhancement. No neck masses to suggest compression.

Output: 1. Degenerative changes in the cervical spine as detailed above with moderate right neural foraminal stenosis at C7-T1 related to combination of disc material and uncovertebral hypertrophy. There is suspected impingement of the right C8 nerve root. Additional level findings as above.2. No high-grade spinal canal stenosis, cord compression, or cord signal abnormality.3. Subtle T2 hyperintensity/edema involving the proximal right C8 nerve root likely related to stenosis proximally in the neural foramen. Otherwise remainder of the brachial plexus is unremarkable.


Instruction: Generate impression based on medical findings.

Input: Please refer to the subsequent MRI report for further information.Exposure time: 44 seconds

Output: Successful fluoroscopically guided right wrist arthrogram for MRI.


Instruction: Generate impression based on medical findings.

Input: NF3: visual field defect, diplopia, and numbness and weakness bilaterally of arms and hands. Orbits: There is slight interval increase in size of the tumor along the right optic nerve sheath that encases and compresses the optic nerve. The tumor now measures 22 mm width and 16 mm in height, previously 20 mm and 14 mm, respectively. The tumor compresses the right medial rectus muscle and results in proptosis. The right globe is otherwise intact. The left orbit is unremarkable. The left parotid and left cheek subcutaneous tumors have not significantly changed. Brain: There are postoperative findings related to right retrosigmoid craniotomy, with encephalomalacia in the right lateral cerebellum. The remaining portion of the right vestibular schwannoma in the right cerebellopontine angle cistern is perhaps minimally larger, measuring up to 9 mm, previously 8 mm. Likewise, the residual tumor within the skeletonized right internal auditory canal appears to be slightly more prominent. There is a 2 mm wide enhancing nodule within the left internal auditory canal, which is more conspicuous. The right geniculate fossa tumor is not significantly changed, measuring 9 x 7 mm in axial cross-section. Likewise, a tumor centered in the right Meckel's cave and along the bilateral oculomotor cisternal segments have not significantly changed. There are multiple supratentorial and infratentorial dural-based enhancing tumors, which do not appear to have changed significantly. For example, the largest tumor along the right frontal convexity measures 18 mm in height and 22 mm in width, previously also 18 mm and 22 mm, perspectively. There are several unchanged punctate foci of T2 hyperintensity in the cerebral white matter. There is no midline shift or herniation. There is no evidence of acute infarction. The ventricles are unchanged in size and configuration. There is a subcentimeter right ethmoid retention cyst.Cervical Spine: There is an enhancing extramedullary mass within the left aspect of the spinal canal at C4-5 with marked compression of the spinal cord. The tumor extends through the left C4-5 neural foramen and along the brachial plexus. The tumor measures up to 15 mm in width and 45 mm in length and displaced and perhaps narrows the left vertebral artery flow void. There minimal T2 hyperintensity within the spinal cord at the C4-5 level. There is also an enhancing lesion within the right C5-6 neural foramen. In addition, there is a 3 mm wide enhancing nodule within the left spinal canal at the C2-3 level. There are dural-based enhancing lesions along the posterior spinal canal at the C2 level that measure up to 3 and 5 mm in thickness and indent the spinal cord. There also appears to be a punctate posterior dural -based lesion at the C5 level, with minimal mass-effect upon the spinal cord. The cervical spine alignment is straightened in the sagittal plane, but there is no spondylolisthesis. The vertebral body hei8ghts are preserved.

Output: 1. Stigmata of neurofibromatosis type 2 with multiple intracranial meningiomas that appear to not have significantly changed, cervical spine meningiomas, a right optic nerve sheath meningioma that has slightly increased in size, multiple intracranial schwannomas, including slight increase in size of the residual right vestibular schwannoma and a punctate left vestibular schwannoma, and a large schwannoma at C4-5 that compresses the spinal cord and extends beyond the left neural foramen. The posterior spinal canal meningiomas at the C2 level also indent the spinal cord.2. Unchanged nonspecific cerebral white matter lesions, but no evidence of acute infarct.


Instruction: Generate impression based on medical findings.

Input: There is transitional lumbosacral anatomy with 6 lumbar vertebral bodies. For the purposes of this exam the last fully formed disc is L6-S1.The conus medullaris ends at the level of lower L2. The cord is of normal caliber and signal. Normal alignment of the vertebral bodies. There is no abnormal enhancement.There is a tiny dorsally projecting synovial cyst in the right L4-L5 facet. There are mild facet degenerative changes in the lower lumbar spine.In the visualized right lower lobe, there is a 4 mm nodule along the posterior pleural surface. Recommend follow-up.

Output: 1. Transitional lumbosacral anatomy with 6 lumbar vertebral bodies. For the purpose of this exam the last fully formed disc is at least L6-S1. If surgery is to be contemplated, please correlate with imaging of the entire spine.2. No evidence of intrathecal metastases.3. Nonspecific subcentimeter nodule is seen in the right lower lobe along the posterior pleural surface. Recommend follow-up CT chest for a complete evaluation.


Instruction: Generate impression based on medical findings.

Input: Obstructive hydrocephalus. Status post neurocytoma resection 3 months ago. There has been evolution of the postoperative changes since the previous examination. Foci of diffusion restriction in the surgical bed and along the right transparietal surgical tract are improved and probably reflect residual blood products and other postoperative change. Right frontal infarct and edema have evolved, with less extensive white-matter T2-hyperintensity with associated overlying cortical laminar necrosis. There is a linear surgical tract in the left frontal lobe from previous biopsy.The right transparietal ventriculostomy catheter has been removed and the tract is larger than before which probably reflects evolution of the ischemic changes along the tract. There is also T2-hyperintensity along the right parietal surgical tract, probably gliosis given previous postoperative findings. There is new significant focal expansion of the posterior parts of the right lateral ventricle and its temporal horn, which is probably caused by adhesions in the posterior body. The anterior right lateral ventricle is unchanged. The third and left lateral ventricle are mildly more expanded than previously but are not particularly dilated. Small amount of residual heterogeneous tumor along the roof of the right lateral ventricle is probably present as described before. It was compressed previously by blood and other postoperative change, and has now emerged as an oval area of abnormality. Foci of susceptibility effect in the ventricles, along the tentorium and in the surgical cavities are reflective of blood products. There is mild contrast enhancing dural thickening underlying the craniotomy flaps, within expected. There is minimal, somewhat linear contrast enhancement in the right transparietal surgical tract, which is probably postoperative in nature relating to granulation tissue. The major cerebral flow voids are intact. Severe mucosal thickening completely opacifies the right maxillary sinus. There is also mucosal thickening involving the right anterior ethmoid sinuses and the hypoplastic right frontal sinus.

Output: 1.Expected evolution of the postoperative findings in the right frontal and parietal lobes.2.Following removal of the right transparietal ventriculostomy catheter, there has been interval focal dilatation of the right lateral ventricle posterior to presumed adhesions in the posterior body.3.An area of oval residual tumor has now emerged along the roof of the right lateral ventricle.


Instruction: Generate impression based on medical findings.

Input: 76-year-old female with left neck pain and left arm radiculopathy Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is reversal of normal cervical lordosis with mild kyphotic angulation at the C5-C6 level. No abnormal cord signal is appreciated.Moderate degenerative changes are seen throughout the cervical spine as detailed below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: There is disc osteophyte complex and ligamentum flavum thickening with mild spinal canal stenosis. There is minimal right neural foraminal narrowing. No significant left neural foraminal narrowing.C4-5: There is disc osteophyte complex, uncovertebral hypertrophy, and ligamentum flavum thickening. There is mild to moderate spinal canal stenosis. There is mild right worse in left neural foraminal stenosis.C5-6: There is small disc osteophyte complex and kyphotic angulation at this level. There is mild to moderate spinal canal stenosis. Mild bilateral neural foraminal narrowing.C6-7: There is disc osteophyte complex and ligamentum flavum thickening with moderate spinal canal stenosis. There is moderate left and mild to moderate right neural foraminal stenosis.C7-T1: There is disc osteophyte complex, uncovertebral hypertrophy, and ligamentum flavum thickening. There is moderate spinal canal stenosis. There is moderate to severe left neural foraminal stenosis and moderate right neural foraminal stenosis.There is prominent facet arthropathy at the left C4-C5 level. The vertebral artery flow voids appear to be intact. Small bilateral thyroid nodules noted.

Output: 1. Degenerative changes throughout the cervical spine with up to moderate degree of spinal canal stenosis at multiple levels from C3-C4 to the C7-T1 levels. 2. There is multilevel neural foraminal stenosis, as detailed above, relatively worse at the left C6-C7 and C7-T1 levels which may be impinging on the left C7 and C8 nerve roots. No cord signal abnormality.3. Prominent facet arthropathy at the left C4-C5 level which may be contributing to patient's neck pain.


Instruction: Generate impression based on medical findings.

Input: There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There is susceptibility effect within the right superior frontal sulcus compatible with chronic subarachnoid hemorrhage. There are mild scattered punctate foci of T2 hyperintensity within the supratentorial white matter. 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, although, there is an apparent medially directed 2-mm outpouching involving the flow void of the right cavernous internal carotid artery. The skull and scalp soft tissues are unremarkable. There is minimal fluid and mucosal thickening within the sphenoid sinuses. There are partially imaged degenerative changes of the cervical spine resulting in at least mild spinal canal stenosis at C4-C5.

Output: 1.No evidence of acute infarct. 2.Mild chronic small vessel ischemic disease.3.Chronic right frontal subarachnoid hemorrhage. 4.Probable approximately 2mm aneurysm of the medial right cavernous carotid artery into the cavernous sinus is not well evaluated on this exam. Dedicated vascular imaging may be obtained for further evaluation.5.Fluid in sphenoid sinuses. Please correlate clinically.


Instruction: Generate impression based on medical findings.

Input: 78 years Male (DOB:1/4/1938)Reason: Evaluate for lower extremity numbness and spasticity History: Lower extremity numbness and spasticityPROVIDER/ATTENDING NAME: THOMAS J KELLY THOMAS J KELLY 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. No abnormal lesions are identified in the thoracic spine. There is multilevel disc desiccation present and minor degenerative change in the thoracic spine.

Output: No abnormal thoracic spinal cord lesions are appreciated to explain the patient's spasticity. There is no compromise of thoracic spinal canal or exiting nerve roots.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Localized swelling, mass and lump, neckClinical question: right supraclavicular mass , low grade vascular neoplasmSigns and Symptoms: eval extent of mass to vessels MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. MRI neck:There is a 48 x 28 mm heterogeneous mass centered in the right supraclavicular area which is surrounded by adjacent vasculature including the subclavian artery and vein as well as thyrocervical trunk. Along its superior medial aspect there is a 12 x 9 mm axial dimension fluid collection present there is infiltration of the surrounding fat planes. There are punctate foci of signal loss within this lesion with slight susceptibility effect. The skin surface superficial to the lesion is irregular and somewhat disrupted. Some blood products are present within the adjacent subcutaneous tissues.Within the suprahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated. Within the infrahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated.Within the visceral space the thyroid gland appears intact.The airway appears patent.The visualized intracranial structures which include the posterior fossa are intact. The visualized portions of the orbits and paranasal sinuses are intact. The paranasal sinuses and mastoid air cells are clear.The parotid and the submandibular glands appear intact.The carotid and vertebral vasculature visualized on this exam appears intact.The cervical vertebral bodies in general are intact with no evidence for canal stenosis.

Output: 1.There is a right supraclavicular mass associated with surrounding inflammatory changes and findings suggesting recent surgery. No arterial blood supply is appreciated. A biopsy of this lesion indicates that this represents a hemangioma. Given this biopsy information, certainly the findings are consistent with a recent biopsy of a hemangioma. A follow-up cross-sectional exam after the inflammatory changes regress may help further evaluate this.


Instruction: Generate impression based on medical findings.

Input: Memory difficulty No intracranial mass or mass-effect. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. There is mild global parenchymal volume loss which appears slightly prominent for age. No hydrocephalus.Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, including a relatively more prominent focus in the left frontal corona radiata and nonspecific. Brain parenchyma is otherwise unremarkable. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. There is expansile, abnormal T1 hypointensity and enhancement involving the left skull base including the jugular tubercle extending into the upper left occipital condyle. There is a subcentimeter left parotid nodule, which is nonspecific, possibly small lymph node. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. No intracranial mass or mass-effect. 2. Mild global parenchymal volume loss which appears prominent for age.3. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, including a relatively more prominent focus in the left frontal corona radiata. These are nonspecific but compatible with mild chronic small vessel ischemic changes, sequela of prior inflammation/infection, or less likely demyelination.4. Expansile, abnormal T1 hypointensity and enhancement involving the left skull base including the jugular tubercle extending into the upper left occipital condyle. Finding may represent a benign osseous lesions such as fibrous dysplasia, but recommend CT for further assessment to better exclude other processes including metastasis.


Instruction: Generate impression based on medical findings.

Input: MRI brain: There is inferior descent of the cerebellar tonsils up to 11 mm below the foramen magnum compatible with Chiari I malformation. There is diminished CSF space at the level of foramen magnum, worse posteriorly.CSF flow sequence is technically limited and direction of the flow cannot be evaluated. Magnitude images demonstrate mildly diminished CSF flow ventrally and more severe diminished flow dorsally.There is no diffusion abnormality. There are no areas of abnormal signal. The ventricles and sulci are within normal limits. There is no hydrocephalus. The basal cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. There is minimal opacification of the paranasal sinuses. MRI spine: There is a large cervical syrinx which begins at the upper C4 level and more inferiorly occupies nearly the entire diameter of the cervical cord, measuring approximately 11 x 9 mm in the axial plane at the C6 level. There is further extension of the syrinx down to the thoracic cord at the lower T12 level.Conus terminates normally at the upper L2 level. There is no evidence of filar lipoma or other lesions within the lumbar spinal canal. On prone sagittal imaging, there appears to be minimal ventral motion of the conus, approximately 1 mm; however, there is greater ventral motion of the cauda equina about 4 mm at the L3 level. The apparent reduced ventral motion of the conus is of questionable significance given the normal position of the conus, appropriate ventral motion of the cauda equina nerve roots, and absence of additional lesions in the lumbar spinal canal.The spine is in normal alignment. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. There is no significant spinal canal or foraminal stenosis within the spine at any levels. The paraspinal soft tissue structures are unremarkable.

Output: 1. Inferior descent of the cerebellar tonsils of up to 11 mm below the foramen magnum consistent with Chiari I malformation. 2. Extensive syringohydromyelia involving the cervical and thoracic spinal cord extending from upper C4 to the lower T12 vertebral levels.3. No convincing imaging evidence of tethered cord. Please see comment above.


Instruction: Generate impression based on medical findings.

Input: 82-year-old female with metastatic cancer. Rule out brain metastases prior to anticoagulation. There is no evidence of intracranial hemorrhage, edema, or midline shift. Patchy areas of subcortical and periventricular white matter hypodensity likely represent extensive small vessel ischemic disease, age indeterminate by CT. Calcifications are noted in the basal ganglia bilaterally. Two foci of dystrophic calcification are noted in the right cerebellar hemisphere with a surrounding area of focal low attenuation. Though this could represent microangiopathic changes with dystrophic calcification, a neoplastic lesion cannot be ruled out an MRI with intravenous contrast is recommended for further evaluation.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.These findings were communicated to the clinical service at the time of interpretation.

Output: Extensive small vessel ischemic disease, age indeterminate. An area of low attenuation with foci of calcification in the right cerebellar hemisphere may represent microangiopathic changes, but a neoplastic lesion cannot be ruled out. MRI with intravenous contrast is recommended for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Intermittent pain and instability. Evaluate for MCL tear. MENISCI: Horizontal tear of the anterior horn of the lateral meniscus, extending from the apex towards the body and to the inferior surface.ARTICULAR CARTILAGE AND BONE: Mild overall loss of cartilage in the lateral compartment, with focal areas of near full thickness loss at the lateral femoral condyle and lateral tibial plateau, with mild associated bone marrow reactive changes. LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Tear of the anterior horn of the lateral meniscus, as above.2. Mild cartilage degeneration, worst in the lateral compartment.


Instruction: Generate impression based on medical findings.

Input: 69 years Male (DOB:6/5/1947)Reason: evaluate for brain metastatic disease History: renal cell CAPROVIDER/ATTENDING NAME: JAMES X TAO JAMES X TAO The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The cerebellar tonsils are low lying.

Output: There is no evidence for brain metastases. Please note that contrast-enhanced exams or more sensitive for the detection of metastatic disease compared to noncontrast exams.


Instruction: Generate impression based on medical findings.

Input: 87 years Male (DOB: 5/21/1929)Reason: dizziness and falls History: fallsPROVIDER NAME: CHRISTOPHER L KRAMER MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is generalized brain atrophy present.There is an 11 mm lesion in the right frontal lobe which on all pulse sequences has a peripheral area of low signal in the popcorn-like appearance centrally on T2 and T1 imaging. It is predominantly bright centrally on T1 and T2.On susceptibility imaging there are several punctate foci of signal loss in the cerebellar hemispheres. Additional punctate foci of signal loss on susceptibility imaging are present in the right periventricular white matter as well as the right half of the corpus callosum at the level of the splenium.There is a subgaleal hematoma present adjacent the right parietal bone measuring 11 mm in thickness. There is no evidence for coup or contrecoup injury.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.MRI cervical spine:The cervical vertebral bodies are appropriate in overall height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal lesions are identified in the cervical spine. There is straightening of the normal cervical curvature present.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is bilateral facet hypertrophy present at this levelAt C3-4 there is no significant compromise to the spinal canal or neural foramina. There is bilateral facet hypertrophy present at this level. There is mild anterior subluxation of C3 on C4.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is bilateral facet hypertrophy present at this level associated with uncovertebral osteophytes and mild anterior subluxation of C4 and C5At C5-6 there are endplate uncovertebral osteophytes present associated loss of disc space height and some encroachment of the left-sided exiting nerve roots within the neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina. Endplate osteophytes are present at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.Right frontal lobe cerebral cavernous malformation.2.Multilevel degenerative changes are present cervical spine associated with neural foramen encroachment of exiting nerve roots bilaterally at C3-4 and on the left-sided C5-6. There is mild anterior subluxation of C4 on C5 and C3 on C4


Instruction: Generate impression based on medical findings.

Input: Provided history of uterine fibroids. PELVIS:UTERUS, ADNEXA: Markedly enlarged uterus replaced with heterogeneous well-defined masses compatible with numerous large fibroids. The uterus measures 10.8 x 21.2 cm in the sagittal plane.A representative intramural fibroid in the posterior uterine body measures 6.7 x 6.0 cm (series 1 104/162) in axial dimension. In the anterior fundus the largest discrete fibroid measures 9.4 x 7.5 cm (series 1 104/310).The fibroids demonstrate moderate to marked arterial enhancement.The endometrium is markedly distorted by marked mass effect but is not thickened.Fluid-filled tubular structure in the left adnexa likely represents a hydrosalpinx. No significant surrounding inflammatory changes.In the region of the right adnexa physiologic cyst formation is suggested, less likely insinuating small bowel.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Markedly enlarged lobular fibromatous uterus. The fibroids demonstrate moderate to marked arterial enhancement.2. Left sided hydrosalpinx without significant inflammatory changes.


Instruction: Generate impression based on medical findings.

Input: Cervical: There is evidence of osseous metastatic disease in the cervical spine with more diffuse marrow infiltration noted involving the C4 vertebral body extending into the posterior elements on the right. This lesion is new since prior MRI cervical spine from 2/20/2014. No evidence of epidural tumor in the cervical spine. No compression fractures in the cervical spine. Vertebral body heights and alignment are maintained. No cord signal abnormality. There are mild degenerative changes in the cervical spine including multilevel facet arthropathy. No significant spinal canal or neural foraminal stenosis is appreciated although motion degradation slightly limits evaluation. Thoracic: There is evidence of multifocal osseous metastatic disease. There is a small osseous lesion involving the the anterior inferior T1 vertebral body. There is a larger lesion involving the dorsal aspect of the T2 vertebral body. Small scattered lesions are seen throughout the thoracic spine more inferiorly as well with larger lesions involving the T8 and T9 vertebral bodies. Posterior element involvement is noted at multiple levels as well. No new compression fractures are demonstrated. Minimal irregularity/compression deformity involving the superior T3 endplate and mild wedging of the T6 and T7 vertebral bodies are unchanged.Compared to 2/20/2014, T8 and T9 lesions appear similar. Small T1 lesion is new/larger. There are multiple small new lesions involving the T2 T3, T4, T5, and T6 levels with posterior element involvement at multiple levels. There is extensive enhancing epidural tumor which extends from the C7-T1 level to the T3-T4 level with significant narrowing of the spinal canal from T1-T2 through the T2-T3 level and deformity of the cord. No cord signal abnormality is appreciated. These findings are new since 2/20/2014.Prominence of the epidural fat in the thoracic spine is again noted narrows the thoracic spinal canal more diffusely. No high-grade stenosis in the thoracic spine at additional levels however is demonstrated. There is narrowing of the left T2-3 neural foramen as well as the right T2-T3 and T9-T10 neural foramina. Otherwise no significant foraminal stenosis is appreciated. Prominent right posterior medial 9th and 10th rib involvement is again noted. Right lower lobe consolidation and small right pleural effusion noted. Please refer to prior chest CT.

Output: 1. Compared to prior cervical and thoracic spine MRI from 2/20/2014, there is progression of metastatic disease with new C4 lesion as well as multiple new upper thoracic lesions.2. There is interval development of extensive epidural tumor which extends from the C7-T1 level to the T3-T4 level with significant narrowing of the spinal canal from T1-T2 through the T2-T3 level with deformity of the cord. No cord signal abnormality is appreciated. 3. Subtle irregularity involving the superior endplate of the T3 vertebral body and mild wedging of the T6 and T7 vertebral bodies are similar to prior. No new pathologic compression fractures.


Instruction: Generate impression based on medical findings.

Input: Evaluate for residual flair signal change and for hemorrhage History: s/p right side craniotomy for resection of temporal lesion Postsurgical changes of anterior right temporal craniotomy and resection of the mesial temporal lesion. There is small amount of diffusion restriction along the posterior margin of the resection cavity compatible with cytotoxic edema and blood products. At least most of the previously seen masslike FLAIR hyperintensity has been resected. In comparison with preoperative images, however, there is a focus of FLAIR signal abnormality (series 801 image 15) involving the right medial temporal lobe adjacent to the temporal horn, which is suspicious for minimal residual lesion. The right anterior temporal resection cavity is filled with postoperative fluid/blood products which extend along the right cerebral convexity. There is parenchymal intrinsic T1 hyperintensity related to the right anterior temporal blood products without definite residual enhancement previously seen with the lesion. No midline shift or herniation. No hydrocephalus. There is edema of the overlying scalp extending to the periorbital region. There is diffuse nonspecific opacification of the bilateral mastoid air cells and paranasal sinuses.

Output: Postsurgical changes involving the right anterior temporal lobe. There appears to be near total resection of the right temporal lesion with small focus of residual FLAIR signal abnormality involving the right medial temporal lobe adjacent to temporal horn, which may represent minimal residual tumor.


Instruction: Generate impression based on medical findings.

Input: Male 57 years old Reason: hx of portal vein thrombosis, cirrhosis, and HCC History: eval for portal vein thrombosis LIMITED ABDOMENLIVER: Heterogeneous liver. Coarse echotexture of the liver. There is partial main portal vein thrombus. Right portal vein is not well visualized. Ill-defined masses in the right and left lobe of the liver that were seen on CT are not well seen on ultrasound. These lesions were suspicious for hepatocellular carcinoma. Further evaluation of the liver with MRI is recommended.BILIARY TRACT: No evidence of intra or extrahepatic biliary dilatation. Status post cholecystectomy.PANCREAS: No significant abnormalities noted.SPLEEN: Spleen is enlarged measuring 16 cm. RIGHT KIDNEY: No significant abnormalities noted.OTHER: No significant abnormalities noted.

Output: Cirrhotic liver. Infiltrative, ill-defined bilateral lobar liver masses detected on the previous CT were not well seen on today's study. These lesions were suspicious for hepatocellular carcinoma. Further evaluation with liver MRI is recommended.Partial thrombosis of the main portal vein.Splenomegaly.


Instruction: Generate impression based on medical findings.

Input: 25 years, Female, history of cranial radiation, baseline exam. History of leukemia. There are multiple foci of T2/FLAIR hyperintensity in the bilateral subcortical and periventricular white matter which are nonspecific but compatible with posttreatment change. No intracranial mass or mass effect. No evidence of infarct or hemorrhage. Ventricles are within limits. No extra-axial collections. No abnormal parenchymal or meningeal enhancement. There is heterogeneous low T1 marrow signal including the clivus and visualized upper cervical spine which are nonspecific but compatible with history of leukemia. There is near complete opacification of the left sphenoid sinus extending into the left posterior ethmoid sinus. Paranasal sinuses are otherwise clear. Remainder of the visualized extracranial soft tissues are unremarkable.

Output: Several T2/FLAIR hyperintense foci scattered in the periventricular and subcortical white matter which while nonspecific are compatible with posttreatment change. No intracranial mass or abnormal enhancement to suggest neoplasm.


Instruction: Generate impression based on medical findings.

Input: Female, 4 years old, with stable urinary incontinence. Evaluate for tethered cord. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. There is a normal complement of lumbar vertebral bodies. No pathologic marrow replacement or marrow edema is seen.The distal spinal cord, conus and cauda equina are all within normal limits. The conus tip terminates at the L1 level which is normal. No evidence of a fatty filum terminale or other intraspinal fatty lesion is seen. On prone imaging, there is clear evidence of anterior displacement of the conus and cauda equina.The intervertebral discs are preserved. No significant compromise of the spinal canal or neural foramina is noted.

Output: Unremarkable evaluation with no evidence of tethered cord.


Instruction: Generate impression based on medical findings.

Input: Patient with worsening confusion and headaches. History of metastatic renal cell cancer with brain metastases. Undergoing whole brain radiation. Rule out bleed, edema, increased intracranial pressure. Nonenhanced CT of brain:Examination demonstrate a slightly high density mass in the basal cistern measuring 13 mm x 16.6-mm in transaxial dimension. There is evidence of edema in the hypothalamic and bilateral basal ganglia. Considering patient's provided clinical history of malignancy this finding could represent a metastatic focus. Further follow-up with an MRI is recommended to exclude other lesions in this location.Shunted lateral ventricles with complete collapse of right lateral ventricle and normal appearing third ventricle and left lateral ventricle.Foci of encephalomalacia in the right frontal lobe under a right frontal craniectomy may represent site of prior surgical intervention for removal of tumor. There is no evidence of hemorrhage or midline shift.Calvarium demonstrates right high convexity frontal craniotomy and is otherwise negative.Limited view of paranasal sinuses and mastoid air cells are unremarkable. Limited view of orbits are negative.

Output: 1.High density mass in the basal cistern/hypothalamic region with surrounding edema highly concerning for metastatic lesion considering provided history of renal cell cancer.2.No evidence of any additional metastatic foci and no evidence of midline shift or hydrocephalus.3.High convexity right posterior frontal encephalomalacia under a right frontal craniectomy.4.Calvarium, paranasal sinuses and mastoid air cells are intact.


Instruction: Generate impression based on medical findings.

Input: Male, 40 years old, with five days of unremitting migraine headache and one episode of vomiting. An ill-defined, bubbly multicystic lesion is demonstrated centered on the cerebellar vermis. Several of the small cysts suppress on FLAIR while others do not. The intervening vermian parenchyma is somewhat deformed, but no additional lesional tissue is suspected. No pathologic lesional enhancement is seen. However, there is one ill-defined focus of susceptibility within the lesion which could reflect blood product or mineralization. No large or abnormal vascular structures are suspected on either the postcontrast or susceptibility weighted images. The vermis may be very slightly expanded, but overall, no significant mass effect is seen. The contour of the fourth ventricle remains within normal limits.No additional lesions are seen. Morphology and signal characteristics of the supratentorial brain are within normal limits. No pathologic intracranial enhancement is seen. No abnormal extra-axial fluid collections are detected. There are no findings to suggest acute intracranial hemorrhage. The ventricular system is within normal limits.

Output: A bubbly appearing lesion is seen centered quite specifically in the cerebellar vermis which appears to be composed of numerous cysts and the deformed intervening vermian parenchyma. No pathologic enhancement is seen. No enlarged or abnormal vessels are detected. The lesion exerts little if any mass effect. There is one focus of associated susceptibility which could reflect blood product or mineralization.The differential diagnosis for this lesion is broad and would include a congenital dysplasia, sequelae of prior inflammation or infection, low-grade potentially involuted tumor, or an atypical presentation of Lhermitte-Duclos. A vascular malformation is considered unlikely.


Instruction: Generate impression based on medical findings.

Input: Female 66 years old Reason: cuff tear History: pain ROTATOR CUFF: There is complete full thickness tearing of the supraspinatus muscle. There is also full thickness tearing of the infraspinatus muscle. There may be some intact anterior fibers. There is fraying and irregularity of the torn tendon fibers which demonstrate background tendinosis. There is retraction of approximately 3.6 cm. There is complete full thickness tearing of the subscapularis tendon. The teres minor muscle and tendon are unremarkable. There is marked edema within and atrophy of the supraspinatus, infraspinatus and subscapularis muscles.SUPRASPINATUS OUTLET: There are severe degenerative changes of the acromioclavicular joint with marked synovial hypertrophy. Note is made of an os acromiale.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a high riding humeral head. There is diffuse fragmentation of the labrum and loss of the normal articular cartilage.BICEPS TENDON: There is complete full thickness tearing of the long head of biceps tendon with the retracted tendon identified at the level of the humeral neck.ADDITIONAL

Output: 1. Complete full thickness rotator cuff tear as described above with retraction of approximately 3.6 cm.2. Complete full thickness tearing of the long head of biceps tendon with retraction.2. Diffuse fragmentation of the the glenoid labrum with associated loss of the normal articular cartilage.3. Other findings as above.


Instruction: Generate impression based on medical findings.

Input: Seizures. Evaluate for abscess status post cavernous malformation resection. There are postoperative changes of a left posterior temporal craniotomy for cavernous malformation resection. There is high T1 signal surrounding resection cavity and susceptibility effect indicating postoperative edema and blood blood products. There is minimal rim of peripheral enhancement along the edge of the resection cavity as well as enhancement of the adjacent dura which is nonspecific and likely related to the postsurgical changes. Peripheral restricted diffusion along the resection cavity could be from the sequela of cytotoxic edema or blood products themselves. No central restricted diffusion to suggest purulent material within the cavity. The size of the surgical cavity and edema are grossly similar to minimally larger from prior CT allowing for differences in technique. There are no abnormalities elsewhere in the brain. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. Mild scalp soft tissue thickening and minimal extra-axial fluid in the left parietal region is also related to postoperative changes. The major cerebral flow voids are intact. A mucous retention cyst or polyp is present in the right maxillary sinus. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: Evolving postoperative changes related to resection of left posterior temporal cavernous malformation. There is no specific evidence of intracranial infection, with blood products along the resection cavity, mild surrounding edema, and enhancement which may represent evolving postsurgical changes. If there is high suspicion of intracranial infection, follow-up imaging may be obtained.


Instruction: Generate impression based on medical findings.

Input: BRAIN: There are multiple patchy foci of T2 hyperintensity within the supratentorial subcortical white matter bilaterally. There is involvement of the right greater than left anterior temporal lobe, with smaller foci more posteriorly in the left temporal lobe. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are unremarkable. There is a right maxillary sinus retention cyst.CERVICAL SPINE: The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The imaged spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1.Multiple prominent patchy areas of bilateral signal abnormality within the subcortical white matter are nonspecific with the differential including gliosis, demyelinating disease, infectious/inflammatory etiologies such as encephalitis or vasculitis, CADASIL, or less likely metabolic disease, among other etiologies and follow-up imaging is suggested, possibly with contrast. MR spectroscopy could also be considered.2.Normal cervical spine MRI.


Instruction: Generate impression based on medical findings.

Input: 81-year-old male with history of bilateral adrenal hemorrhage and histoplasmosis diagnosed at outside hospital ABDOMEN:LIVER, BILIARY TRACT: T2 hyperintense subcentimeter foci in the liver.SPLEEN: Spleen is top normal measuring 14.8 cm.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Enlarged bilateral adrenal gland masses. Intrinsic T1 hyperintensity with central T1 hypointensity within the bilateral adrenal gland masses. The right adrenal gland measures 3.8 x 2.5 cm (series 11, image 167). Left adrenal gland measures 3.7 x 3.2 cm (series 11, image 168). There is no convincing enhancement of these lesions.KIDNEYS, URETERS: There is T2 hyperintense cystic lesions in bilateral kidneys. No hydronephrosis or perinephric inflammation.RETROPERITONEUM, LYMPH NODES: Gastric diverticulum is present.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Status post left hip arthroplasty.OTHER: No significant abnormality noted.

Output: Bilateral T1 hyperintense adrenal gland masses are compatible with provided history of adrenal hemorrhages. Measurements are provided above and an addendum can be issued when comparisons are made available. If no comparisons are available, follow-up is recommended to ensure resolution.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old. Left hip pain, evidence of pathologic fracture A lesion within the left femoral neck measures approximately 2 cm x 2 cm x 5 cm, has decreased signal on T1 and increased signal on T2 weighted images. Increased signal within the lesion on T1 fat sat precontrast images is likely artifactual, but precludes evaluation for lesion enhancement. There is a small amount of surrounding edema outside the lesion. An associated nondisplaced pathologic fracture is more readily evaluated on recent CT imaging.Partially imaged pelvic masses may reflect uterine fibroids. The imaged soft tissues are otherwise unremarkable.

Output: Lesion within the left femoral neck as detailed above. Given the imaging appearance and the patient's age, this likely represents a solitary plasmacytoma or metastasis of unknown origin- statistically most likely lung or renal primary.


Instruction: Generate impression based on medical findings.

Input: 42-year-old female with headaches and vision change. History of CVA. No evidence of hemorrhage, mass-effect, midline shift or hydrocephalus. No evidence of any acute or chronic stroke is detected on this exam. Cortical sulci, ventricular system and all CSF cisterns remain within normal limits. Widening of the level from in magnum with bony remodeling is highly suspected ectopic cerebellar tonsils. Further evaluation with an MRI is recommended.

Output: 1.No evidence of acute findings.2.Suspected ectopic cerebellar tonsils with bony remodeling at the level of foramen magnum.


Instruction: Generate impression based on medical findings.

Input: Left knee locking MENISCI: There is globular signal abnormality within the posterior horn of the medial meniscus suggesting intrasubstance degeneration although there is no discrete signal abnormality extending to either articular surface to suggest focal tear. The lateral meniscus also appears intact.ARTICULAR CARTILAGE AND BONE: There is heterogeneity and thinning of the articular cartilage of the medial compartment, particularly of the femoral condyle anteriorly. There is no discrete full-thickness defect. Similar changes are noted in the lateral compartment although to a lesser degree. There is severe articular cartilage loss of the patellofemoral compartment particularly of the lateral patellar facet. There is associated underlying degenerative marrow signal abnormality and these changes have progressed from the prior exam.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1.Mild intrasubstance degeneration of the posterior horn of the medial meniscus with no evidence of discrete medial or lateral meniscal tear.2.Worsening articular cartilage loss of the patellofemoral compartment.3.Small foci of low T1/T2 signal are identified in the posterior joint space which may represent small calcified bodies however these are similar in size and location to the prior exam and may be fixed in nature.


Instruction: Generate impression based on medical findings.

Input: Pseudotumor evaluation The evaluation of the pelvis/hips is limited by the presence of bilateral hip arthroplasties.Within the limits of the exam, there is no abnormal mass or signal surrounding the hip arthroplasties to suggest the presence of pseudotumor. There is a mild amount of signal along the right greater trochanter which may reflect mild bursitis or may be clinically insignificant. Otherwise there is no abnormal fluid collection surrounding the the hip arthroplasties. The bone marrow and muscle signal within the femoral neck and proximal femur is normal.

Output: Bilateral total hip arthroplasties without evidence of surrounding abnormal signal, mass, or fluid collection.


Instruction: Generate impression based on medical findings.

Input: Pain and swelling Osseous structures: There are destructive and erosive changes of the midfoot, tibiotalar joint, and talocalcaneal joint reflective of Charcot arthropathy. There is no definite marrow abnormality to confirm osteomyelitis. Metallic susceptibility artifact is noted in the medial aspect of the calcaneus which may reflect prior surgical intervention. There is a small anterior joint effusion which contains a probable loose body.Soft tissues: There is diffuse subcutaneous edema although no discrete fluid collection is identified. There is increased signal throughout the muscles of the foot, but particularly within the plantar muscles.

Output: 1. No definite evidence of osteomyelitis or focal abscess.2. Destructive changes of the foot described above likely relate to Charcot arthropathy given the patient's history.3. Increased signal throughout the muscles of the foot may reflect diabetic myopathy.


Instruction: Generate impression based on medical findings.

Input: Ms. Greer is a 39 year old female with known left breast cancer currently on neoadjuvant chemotherapy. She presents today for I-SPY2 protocol MRI #3. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.In the left retroareolar region, the known malignancy now measures approximately 5.1 x 4.4 x 5.4 cm, previously 4.6 x 4.4 x 5.2 cm (AP x ML x SI), and originally measuring 4.1 x 4.5 x 4.5 cm. The malignancy continues to extend towards and involve the anterior skin and nipple. The biopsy marker clip is seen peripherally at the anterior aspect of the malignancy. The interval increase in measurement is partially due to enlargement of the lateral nodular component of the mass. There is additionally a 1.3 cm area of enhancement along the posterior lateral aspect of the mass that is more nodular and suspicious in appearance on this exam. No abnormal enhancement is seen in the right breast. At least two enlarged left axillary lymph nodes continue to be seen, the previously measured node again measures 3.0 x 1.7 cm. A biopsy marker clip is seen within this lymph node. However, an additional deeper lymph node is enlarged compared to the prior studies, now measuring up to 2.0 cm. No abnormal lymph nodes are identified in the right axillary or internal mammary region.

Output: 1. Interval increase in enhancement in the left breast, with the index mass enlarged to 5.4 cm in greatest dimension. 2. Interval increase in size of one axillary lymph node, now measuring up to 2.0 cm. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: Distal esophagus/gastroesophageal junction adenocarcinoma. Now with metastatic; was originally diagnosed in 1/2013 (s/p chemoRT, Ivor Lewis esophagectomy; cT2N1 -stage IIB in 5/2013). Study is at least mildly limited by patient motion. There is mild brain volume loss manifested by expansion of the ventricles and the other CSF-containing spaces. There are punctate T2 hyperintensities without diffusion restriction or mass effect in the frontoparietal white-matter, which are nonspecific but most likely from chronic microvascular ischemia. There is no space-occupying brain lesion. There is no midline shift or herniation. The major intracranial vascular flow voids are preserved, reflecting gross patency. There is no intracranial hemorrhage or abnormal diffusion restriction.There is no gross orbital abnormality. Minimal anterior ethmoid and maxillary sinus mucosal thickening is very nonspecific.

Output: 1.The study is mildly limited by patient motion and inability to complete the examination.2.No evidence of intracranial metastatic disease.3.Mild brain volume loss and trace frontal parietal chronic microvascular ischemia.


Instruction: Generate impression based on medical findings.

Input: Male 28 years old Reason: Pancreatic Neuroendocrine followup, hx of angiomyolipoma of kidneys, s/p distal pancreatectomy splenectomy, left nephrectomy, history tuberous sclerosis. Evaluate for interval change or development of met disease History: PNET and angiolipoma of kidneys ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. There are scattered well marginated T1 hyperintense lesions that suppress on fat suppressed imaging and are compatible with small fat containing lesions. The largest is in the left hepatic lobe measuring 1.3 x 1.3 cm.SPLEEN: Status post splenectomy. Small enhancing nodule in the splenic bed likely represent small residual splenic tissue.PANCREAS: Status post distal pancreatectomy. No fluid collections or focal mass identified in the surgical resection margin.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There are multiple right renal lesions with fat intensity compatible with angiomyolipomas. Solid lesions such as the lesion in the upper pole of the right kidney as seen on image 53 of series 19 has only a few foci of fat and are likely lipid poor angiomyolipoma.Dominant fatty right kidney mass measures 4.8 x 3.7 cm with nodular enhancement. Postsurgical changes in the lower pole of the left kidney. There are multiple fat-containing lesions in the left kidney.Subcentimeter T2 hyperintense foci in the kidneys likely represent small cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: A fatty mass near the apex of the heart is present. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Multiple liver lesions which are fat-containing.2.Multiple renal lesions most of which have fat compatible with angiomyolipomata. Dominant lesion is in the right kidney. 3.Status post distal pancreatectomy and splenectomy without definite recurrent disease.


Instruction: Generate impression based on medical findings.

Input: History of hydrocephalus, neurogenic bladder, neurogenic dysphagia, vocal tremor, cerebral cyst, Chiari malformation with decompression, syrinx, ataxia, headache, falls, complicated UTI, hypothyroidism, and VA shunts. Brain: There are postoperative findings related to complex Chiari decompression surgery with extensive encephalomalacia and punctate foci of susceptibility effect in the medial portions of the cerebellum and left middle cerebellar peduncle. There is interval involution of the cystic cavity in the left cerebellomedullary angle cistern, while the cystic compartment in the right cerebellomedullary angle cistern persists, measuring 9 x 12 mm in axial cross-section. There is interval decreased T2 hyperintensity and swelling of the bilateral medullary olives. There is no evidence of acute infarct. There is a left transparietal ventricular shunt catheter that terminates in the right frontal horn. The third and lateral ventricles are nearly collapsed. There is linear encephalomalacia that traverses the body of the corpus callosum into the bilateral centrum semiovale. There is also a prior left transfrontal catheter track. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are unremarkable.Spine: There are postoperative findings related to complex Chiari decompression surgery with a persistent transverse low signal band that kinks the anterior aspect of the upper spinal cord at the level of the dens. There is persistent extensive central T2 hyperintensity throughout the cervical and upper thoracic spine. There is persistent lack of the usual cervical lordosis. The rest of the vertebral column alignment is otherwise anatomic. There is prominence of the epidural venous plexus in the anterior craniocervical junction region. There are scattered extramedullary intrathecal foci of low signal intensity throughout the spinal canal, particularly posteriorly. There also appears to be clumping of the lower cauda equina nerve roots. There is a small posterior disc-osteophyte complex at the C6-7 level, but no significant degenerative spondylosis in the thoracic and lumbar spine. The vertebral body heights are preserved.

Output: 1. Postoperative findings related to complex Chiari decompression surgery with persistent encephalomalacia and punctate foci of chronic hemorrhage in the medial portions of the cerebellum and left middle cerebellar peduncle and a cystic compartment in the right cerebellomedullary angle cistern, but interval involution of the cystic cavity in the left cerebellomedullary angle cistern. 2. Persistent extensive central T2 hyperintensity throughout the cervical and upper thoracic spine, which may represent a combination of edema and myelomalacia, perhaps aggravated by a persistent apparent fibrotic band that kinks the upper spinal cord at the level of the dens.3. Scattered extramedullary intrathecal foci of low signal intensity throughout the spinal canal and apparent clumping of the lower cauda equina nerve roots, which may be related to arachnoiditis incited be chronic hemorrhage. 4. The shunted third and lateral ventricles are nearly collapsed. 5. Interval evolution of hypertrophic olivary degeneration, which is now less conspicuous.


Instruction: Generate impression based on medical findings.

Input: ALTE in the setting of genetic disease NOS. Dysmorphic features (iris colobomas, somewhat low left ear, smooth philtrum), an undescended testicle. There is an apparent punctate focus of restricted diffusion in the left anterior corpus callosum. There is no evidence of intracranial hemorrhage or mass. There appears to be paucity of myelination, particularly in the peri-rolandic region. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The vein of Galen appears prominent and displays high T1 signal. The major cerebral flow voids are otherwise intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is deformity of the right lens and posterior globe at the optic nerve head.

Output: 1. Apparent acute punctate infarct in the left anterior corpus callosum.2. The vein of Galen appears prominent and displays high T1 signal, which may be an artifact of slow flow, although thrombosis cannot be entirely excluded. A Doppler ultrasound may be useful for further evaluation. 3. Suggestion of delayed myelination.4. Deformity of the right lens and posterior globe are likely related to coloboma.


Instruction: Generate impression based on medical findings.

Input: 85 year-old female with facial asymmetry and left hand weakness. There is redemonstration of a left temporal craniotomy with underlying extensive encephalomalacia in the left frontotemporal and ex vacuo dilatation of the left lateral ventricle, unchanged when compared to the previous study. There is no new parenchymal lesion or CT evidence of acute territorial ischemia. MRI would be more sensitive for small or acute infarctions.There is no acute intracranial hemorrhage or extraaxial collection. The ventricles and sulci are stable with ex vacuo dilation of the left lateral ventricle as noted earlier. No midline shift or basal cistern effacement.The visualized mastoid air cells and paranasal sinuses are within normal limits. Orbits unremarkable. Redemonstration of debris within the extra auditory canals bilaterally.

Output: 1. No evidence of acute intracranial hemorrhage or CT evidence of acute territorial ischemia. MRI is offered as a more sensitive test should there be a high degree of suspicion for acute infarction.2. Stable left temporal lobe encephalomalacia underlying prior craniotomy site consistent with prior left MCA infarct.


Instruction: Generate impression based on medical findings.

Input: Shoulder pain Single scout image of the left shoulder was obtained in preparation for MRI arthrogram. The patient declined intra-articular contrast injection.

Output: Single scout image of the left shoulder obtained in preparation for MRI arthrogram


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old, status post resection of a large acoustic neuroma in April, 2015, 6 months status post SRS for residual tumor at Swedish Covenant in September, 2015. IACs:Redemonstrated are findings related to prior translabyrinthine resection of a left IAC and CP angle schwannoma. Residual enhancing tumor remains evident within the left cerebellar pontine angle cistern and skeletonized IAC. The lesion measures 26 mm TV, 14 mm AP and 17 mm CC (previously 32 x 15 x 20 mm). The tumor itself is more heterogeneously enhancing than previously. Mass effect upon the adjacent pons and middle cerebellar peduncle with mild parenchymal T2 hyperintensity has not significantly changed.Brain:No other specific intracranial lesions are seen. Brain parenchymal morphology and signal characteristics are otherwise unremarkable. No other pathologic intracranial enhancement is detected. No intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. The ventricular system is normal in size and morphology.

Output: 1.Slight interval decrease in the size of the residual left IAC/CP angle schwannoma. Progressive heterogeneity of tumor enhancement may also reflect a treatment related effect.2.Otherwise unremarkable evaluation of the brain.


Instruction: Generate impression based on medical findings.

Input: Smoldering multiple myeloma. Restaging. Sagittal alignment is anatomic. The vertebral bodies are preserved in height. Marrow is slightly heterogeneous though without suspicious focal lesion. T1/T2-hypointense lesion subjacent to the superior endplate of T11 has not changed since the previous examination and represent focal sclerosis, as evident on the CT part of the PET/CT scan dated March 29, 2016. There is desiccation and mild height loss involving L3-L4 and L4-L5 discs. There is focal contrast enhancement and T2-hyperintensity involving the right lateral aspect of the L3-L4 disc, probably representing annular fissure. The spinal canal is preserved. The conus medullaris tip is at upper L2 level. The conus medullaris has normal shape and signal. L4-L5 and L5-S1 facet arthropathy is moderate on the right at L4-L5 facet and mild elsewhere. There is mild right L4-L5 neural foraminal stenosis. The other neural foramina are fairly preserved. There is mild osteoarthritic change involving the sacroiliac joints, slightly more pronounced on the right.

Output: 1.The marrow is mildly heterogeneous but there is no destructive or definite marrow replacing lesion.2.Focal T2-hyperintensity and contrast enhancement in the L3-L4 disc annulus on the right probably represents annular fissuring.3.Degenerative disease in the lower lower lumbar spine otherwise.


Instruction: Generate impression based on medical findings.

Input: Measures are somewhat limited by patient motion. The ventricles and sulci are somewhat prominent, consistent with mild global mild volume loss greater than expected for patient's stated age. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement. Please note that 3-D T1 post contrast images are degraded by artifact. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. Again noted is a small T2 hyperintense lesion within the with paramedian posterior aspect of the anterior pituitary gland. The remainder of the midline structures and craniocervical junction are within normal limits. A small left sphenoid mucosal retention cyst.CERVICAL SPINE

Output: 1.Redemonstration of benign appearing tiny T2 hyperintense lesion within the left paramedian pituitary gland which is nonspecific and likely incidental. Otherwise, unremarkable contrast enhanced MRI of the brain.2.No significant cervical spine abnormality. Minimal mid to lower cervical spondylotic changes without significant stenosis at any level.


Instruction: Generate impression based on medical findings.

Input: Male, 16 years old, with abnormal movements. Evaluate for structural abnormality. Brain:Parenchymal morphology is within normal limits. No structural abnormality or evidence of dysplasia is detected. No focal signal abnormality, restricted diffusion, edema or mass effect is detected. There are no findings to suggest acute or chronic intracranial hemorrhage. No abnormal extra-axial fluid collections are seen and the ventricular system is within normal limits. On postcontrast images, the pattern of intracranial enhancement is unremarkable.Spine:A full complement of normally formed vertebral bodies is evident. Spinal alignment is anatomic with mild straightening of the cervical lordosis likely due to positioning. Vertebral body signal characteristics are within normal limits. No pathologic marrow edema, replacement or enhancement is seen. The visualized spinal cord, conus and nerve roots of the cauda equina are within normal limits. No epidural abnormalities are suspected. No significant compromise of the spinal canal or neural foramina is seen.

Output: Unremarkable evaluation of the brain and spine with no specific findings to account for the patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: SLE/Sjogren's patient with neuropsychiatric disease, assess for progression: memory disorder, difficulty with speech and walking (disorganized thought). Some of the sequences are degraded by patient motion. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is unchanged minimal nonspecific cerebral white matter T2 hyperintensity. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Unchanged minimal nonspecific cerebral white matter signal abnormality. No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on medical findings.

Input: 42 years Female (DOB:10/5/1974)Reason: Grade 2 oligoastrocytoma on TMZ. History: grade 2 oligoastrocytoma.PROVIDER/ATTENDING NAME: RIMAS V. LUKAS RIMAS V. LUKAS The patient is status post right sided frontal craniotomy. As a surgical defect involving the right inferior frontal gyrus and right middle frontal gyrus. There is T2 and FLAIR signal hyperintensity surrounding this defect. The extent of the N T2 signal hyperintensity is similar to the 5/19/2016 exam. There is associated exit vacuo effect on the right lateral ventricle. Some punctate foci of susceptibility are present along the surgical resection site. There is no associated contrast enhancementThere are several punctate foci of signal loss and susceptibility imaging within the subcortical and periventricular white matter.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: Status post right frontal lobe surgery for surgical removal of a primary neoplasm known to represent a grade 2 oligoastrocytoma. The appearance of the surgical bed is stable. There is no current evidence for recurrence.


Instruction: Generate impression based on medical findings.

Input: Extensive metallic artifact is demonstrated throughout the lumbar spine. The visualized portions of the spinal canal are grossly patent. A diffuse disc bulge is visualized at T10-T11 causing mild effacement of the ventral thecal sac. A multilobulated T2 hyperintense structure is visualized extending from the inferior pole of the left kidney, probably a renal cyst.

Output: 1. Severely limited examination secondary to extensive metal artifact. Portions of the visualized spinal canal appear grossly patent.2. A multilobulated T2 hyperintense structure is visualized extending from the inferior pole the left kidney, probably a renal cyst. Further characterization could be obtained with ultrasound, as clinically indicated.


Instruction: Generate impression based on medical findings.

Input: 64 years Female (DOB:9/26/1951)Reason: s/p SRS for metastasis surveillance eval History: s/p SRS for metastasis surveillance evalPROVIDER/ATTENDING NAME: STEVEN J CHMURA STEVEN J CHMURA There is a new enhancing nodule measuring 5 mm in size located along the left postcentral gyrus laterally.Previously noted punctate lesions along the left superior frontal gyrus are not readily identified on the current exam.There is an 11 x 19 mm axial dimension lesion adjacent and anterior aspects of the squamous portion of the left temporal bone which is associated with contrast enhancement and diffusion restriction. This was not present on the priorThere is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Punctate focus of signal loss is present in the left external capsule on susceptibility imagingNormal 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 demonstrate partial opacification of the right mastoid air cells. The visualized portions of the orbits are intact.

Output: 1.A new lesion is present along the left postcentral gyrus which is suspicious for metastatic disease.2.There is a mass adjacent to the outer surface of the left squamous portion of the temporal bone which is new since prior exam. The possibility that this represents metastatic focus cannot be excluded. It is associated with adjacent thickening of the galea.3.Previously noted lesions along the left superior frontal gyrus are no longer appreciated


Instruction: Generate impression based on medical findings.

Input: Reason: r/o CCM History: tremors The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of a small focus of susceptibility effect adjacent to the left medial longitudinal fasciculus which is unchanged compared to the prior exam. There is associated contrast enhancement which is stable compared to the prior exam. There is redemonstration of adjacent draining veins.A stellate focus of susceptibility is present the periventricular white matter adjacent to the frontal horn of the left lateral ventricle which is associated with developmental venous anomaly. It is also stable compared to the previous exam. There is associated enhancement.A small developmental venous anomaly is present along the inferior aspect of the left cerebral hemisphere.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.A small left pontine hemorrhagic lesion is stable compared to the prior exam. One possibility is that this represents capillary telangiectasia.2.Left frontal periventricular white matter lesion most likely represents developmental venous anomaly associated with capillary telangiectasia.


Instruction: Generate impression based on medical findings.

Input: 51-year-old male with pain/avulsion fracture TENDONS: Slight undulation in the Achilles tendon related to retraction. Otherwise the tendon is unremarkable. Mild edema adjacent to the Achilles tendon posteriorly may represent paratenonitis. The remaining tendons are unremarkable.LIGAMENTS: The lateral collateral ligament complex is intact. Distal tibiofibular syndesmotic complex appears intact. Loss of fatty striation in the deltoid ligament with increased signal intensity is compatible with a sprain. Mild edema along the plantar fascia is of questionable clinical significance.ARTICULAR SURFACES AND BONE: As seen on the prior radiograph, there is an avulsion type fracture of the superior aspect of the calcaneus. Edema in the underlying calcaneus presumably represents hemorrhage. Mild osteoarthritis affects the ankle and midfoot.ADDITIONAL

Output: Avulsion-type fracture of the superior aspect of the calcaneus and other findings as described above. The Achilles tendon itself is unremarkable.


Instruction: Generate impression based on medical findings.

Input: The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There is a single nonspecific punctate focus of T2/FLAIR hyperintensity left centrum semiovale There are no areas of pathological enhancement. There is no diffusion abnormality to suggest recent ischemia. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is a moderate-sized air-fluid level in the right maxillary sinus mild circumferential mucosal thickening. The right maxillary sinus contents demonstrates mild diffusion restriction dependently. There is also mild mucosal thickening along the right anterior ethmoid air cells.CERVICAL SPINE

Output: 1.No acute intracranial abnormality. Punctate focus of nonenhancing nonspecific FLAIR hyperintensity in the left centrum semiovale.2.Moderate-sized air-fluid level in the right maxillary sinus with associated diffusion restriction concerning for acute sinusitis. Please correlate clinically for possibility of etiology of headache.3.Minimal mid cervical spondylotic changes as detailed above with no high-grade central spinal canal stenosis. Findings most conspicuous at C4-C5 where there is a small right paracentral disc extrusion abutting the right ventral cord. Mild to moderate right foraminal narrowing at C5-C6 and C6-C7.


Instruction: Generate impression based on medical findings.

Input: Chronic meningoencephalitis, neoplasm, vasculitis. Persistent bilateral lower extremity weakness and encephalopathy of unclear etiology. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are extensive areas of abnormal T2 hyperintensity within the periventricular and subcortical white matter, a few of which are increased in size or new, notably in the left temporal lobe and posterior limbs of the bilateral internal capsules. There are similar signal changes in bilateral basal ganglia and bilateral paramedian pons to a lesser degree. There is no abnormal parenchymal or leptomeningeal enhancement. There is an apparent prior right transfrontal surgical track with linear susceptibility effect. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There is a nonspecific peripherally enhancing 6 mm nodule in the right temporal subcutaneous tissues, which is unchanged from 11/17/2014. There are multiple prominent occipital arachnoid granulations. There is a right posterior frontal burr hole. There is a mucous retention cyst in the right maxillary sinus.

Output: 1. No evidence of acute intracranial hemorrhage, mass, brain abscess, or acute cerebral infarct.2. Extensive areas of abnormal signal in the cerebral white matter are non-specific, but may represent chronic small vessel ischemic disease. 3. A nonspecific subcentimeter nodule in the right temporal subcutaneous tissues is unchanged.


Instruction: Generate impression based on medical findings.

Input: H/o lung cancer. Evaluate for brain metastasis. The previously described left occipital cortical nodule (image# 18-19 of series# 3151) is considered occipital gyrus. The current infused exam shows a 4-mm nodule left adjacent to the posterior sagittal sinus in the left occipital lobe, which corresponds to the lesion identified on the initial MRI dated 12/4/08. The surrounding edema/encephalomalacia is seen. No additional lesion is identified. The small vessel ischemic disease and right parietal encephalomalacia are again identified. No intracranial hemorrhage, mass effect, midline shift or abnormal extraaxial fluid collection is identified. The ventricles are normal in volume. The calvarium is intact.

Output: Essentially stable head CT with a left occipital metastatic lesion. Small vessel ischemic disease of indeterminate age.


Instruction: Generate impression based on medical findings.

Input: Convulsions starting few months ago. There is no evidence of grey matter heterotopia, mesial temporal sclerosis, intracranial hemorrhage, mass, or acute infarct. The brain, brainstem, and cerebellum appear unremarkable. There is no abnormal intracranial enhancement. There is a partially-empty sella and perhaps flattening of the bilateral optic nerve discs. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are grossly unremarkable. There are minimal secretions in a left anterior ethmoid air cell.

Output: 1. No discernible evidence of potential seizure foci.2. A partially-empty sella and perhaps flattening of the optic nerve discs may represent idiopathic intracranial hypertension.