Instruction: Generate impression based on medical findings.

Input: Dilated pancreatic duct on endoscopic ultrasound. Lack of intravenous contrast limits evaluation for solid organ, bowel and vascular pathology.ABDOMEN:LIVER, BILIARY TRACT: Hypotense liver parenchyma suggestive of iron deposition. The liver is normal in morphology. No intra or extrahepatic biliary ductal dilatation. Probable right hepatic lobe cyst, unchanged. No focal suspicious lesion. Normally distended gallbladder.SPLEEN: Probable iron deposition. The spleen measures 13 cm in length with a lobulated multicystic/multiseptated 2.7 cm lesion, likely benign hemangioma or lymphangioma.PANCREAS: The main pancreatic duct at the level of the body is dilated up to 7 mm without mural nodularity evident with mild narrowing and irregularity at the head, without a discrete lesion. Lack of contrast limits evaluation for enhancing components. The pancreatic parenchyma is not significantly atrophic. No focal pancreatic parenchymal lesion is apparent on this limited nonenhanced study.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The kidneys are mildly atrophic with the parenchyma replaced with innumerable T2 weighted hyperintense foci some of which are not simple appearing cysts, progressed from prior. No hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Main pancreatic ductal dilatation up to 7 mm without mural nodularity with irregular narrowing at the pancreatic head without a discrete lesion. Otherwise limited nonenhanced study. Correlate with the endoscopic ultrasound findings.2.Findings of acquired cystic kidney disease of dialysis with multiple cysts and several indeterminate lesions which are not completely characterized by noncontrast MRI.3.Hemosiderosis.


Instruction: Generate impression based on medical findings.

Input: Left neck mass. There is a skin marked overlying the left cheek. There is a fat signal intensity mass within the anterior superficial left parotid gland that measures up to 3 cm. The other salivary glands and upper aerodigestive tract are unremarkable. There is no evidence of significant lymphadenopathy in the images portions of the neck. There is a retropharyngeal right carotid artery flow void. The orbits are grossly unremarkable. There appears to be a nodule within the isthmus of the thyroid gland. There is diffuse cerebral volume loss and chronic left cerebellar and right caudate infarcts superimposed upon a background of diffuse cerebral white matter chronic ischemic disease.

Output: 1. Left parotid lipoma measuring up to 3 cm.2. Apparent nodule within the isthmus of the thyroid gland, which is otherwise incompletely characterized. A thyroid ultrasound may be useful for further evaluation.3. Diffuse cerebral volume loss and chronic left cerebellar and right caudate infarcts.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Altered mental status, unspecified Cerebellar stroke syndromeClinical question: r/o acute infarcts or enhancementSigns and Symptoms: altered mental status MRI of the brainNo diffusion weighted abnormalities are appreciated.There is encephalomalacia involving the posterior aspect of the right cerebellar hemisphere which was in the subacute phase and 2013. There is associated asymmetric dilation of the fourth ventricle. A smaller focus of encephalomalacia is present in the left temporal lobe anteriorly. Another small focus of encephalomalacia is present along the left cerebellar hemisphere.Redemonstration of a T2 and FLAIR hyperintense focus centered in the left thalamus.Periventricular and subcortical white matter T2 and FLAIR hyperintense punctate foci of a mild degree are present. The lateral ventricles are fairly large but unchanged compared to a recent head CT.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.The pituitary gland measures 10 mm in height but is unchanged since prior exam 9/20/2013.MRA brain:Exam is somewhat degraded due to patient motion which would obscure more subtle abnormalities.Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. The A2 segment is azygos.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.

Output: 1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.No evidence for acute cerebral infarction.4.There is redemonstration of moderate-sized focus of encephalomalacia involving the right cerebellar hemisphere and smaller foci of encephalomalacia in the left cerebellar hemisphere and anterior portion of the left temporal lobe which were present on the recent CT head exam from 11/30/15 and have not changed. These are likely vascular related.5.There is redemonstration of an old lacunar infarct in left thalamus.6.The lateral ventricles appear large. Although this could be a result of brain atrophy possibility of normal pressure hydrocephalus cannot be excluded. Please correlate with patient's clinical symptoms.7.Enlargement of the pituitary gland is relatively stable compared to prior exams. Possibility of a pituitary abnormality cannot be excluded. Please correlate with patient's clinical history, signs and laboratory tests8.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on medical findings.

Input: 48 year old male with a family history of arrhythmogenic right ventricular cardiomyopathy who is referrer for further evaluation. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 62 ml/m2 (normal range: 74+/-15), the LVEDV is 152 ml (normal range 142+/-34), the LV end systolic volume index is 27 ml/m2 (normal range 25+/-9), the LVESV is 66 ml (normal range 47+/-19), the LV mass index is 35 g/m2 (normal range 85+/-15), and the LV mass is 86 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pre-contrast native myocardial T1 relaxation time is normal (910 ms). Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 72 ml/m2 (normal range 82+/-16), the RVEDV is 175 ml (normal range 142+/-31), the RV end systolic volume index is 33 ml/m2 (normal range 31+/-9), and the RVESV is 81 ml (normal range 54+/-17). There are no focal aneurysms noted of the right ventricle. Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function (LVEF 56%).2. The right ventricle is normal in size with normal systolic function. (RVEF 54%). 3. Findings not suggestive of arrhythmogenic right ventricular cardiomyopathy.


Instruction: Generate impression based on medical findings.

Input: Right lateral knee pain MENISCI: There is horizontal tearing of the posterior horn of the lateral meniscus with extension into the body. Linear and globular degeneration of the anterior horn of the lateral meniscus is also noted near its root. The medial meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is full-thickness cartilage degeneration along the lateral tibial plateau posteriorly with additional degeneration of the articular cartilage along the weightbearing portion of the lateral femoral condyle. There are degenerative subchondral cysts in the underlying bone. The articular cartilage of the medial compartment is intact.There is moderate thinning of the articular cartilage of the patella inferiorly with underlying subchondral cysts. Subjectively, the femoral trochlea appears slightly shallow which may reflect mild dysplasia. LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Degeneration of the articular cartilage of the lateral and patellofemoral compartments with horizontal tearing of the lateral meniscus.


Instruction: Generate impression based on medical findings.

Input: 63-year-old male with history of right knee pain, status post 3 arthroscopies. MENISCI: A tear of the posterior horn of the medial meniscus extends to the tibia. There is a tear in the posterior horn of the lateral meniscus that extends to the tibia. The roots of the menisci are intact.ARTICULAR CARTILAGE AND BONE: Chondral degeneration of the posterior aspect of the lateral femoral condyle. There is focal, near full thickness chondral defect overlying the medial meniscus. There is severe full-thickness chondral loss in the patellofemoral compartment, with associated subchondral marrow edema of the patella.LIGAMENTS: The MCL and LCL complex are intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1.Tears of the posterior horns of the medial and lateral menisci, extending to the tibia.2.Chondromalacia patella.


Instruction: Generate impression based on medical findings.

Input: Right lower extremity hyperreflexia and acute weakness. Evaluate for stenosis (cord or nerve impingement). Alignment of the cervical spine is anatomic. Bone marrow signal is benign with T1 hyperintense foci such as at the T2 vertebral body compatible with hemangioma or focal fat. No suspicious osseous lesions are seen.The spinal canal shows mild to moderate narrowing at the C3-C4 and C5-C6 levels as described below. Examination is motion degraded however no definite cord signal abnormality is appreciated.Multilevel degenerative changes, as described below:C2-C3: Small central/right paracentral disc-osteophyte complex indents the anterior aspect of the thecal sac and touches the spinal cord. The neural foramina are open.C3-C4: Left more than right facet and uncovertebral proliferative change results in mild bilateral foraminal narrowing. There is also ligamenta flava thickening contributing to mild to moderate spinal canal narrowing. Prominent left-sided facet arthropathy.C4-C5: Disc-osteophyte complex and uncovertebral hypertrophy causes mild canal narrowing and mild to moderate left foraminal stenosis. Left-sided facet arthropathy is evident.C5-C6: There is a disc extrusion that mild to moderately narrows the spinal canal. There is left more than right uncovertebral proliferative change which contribute to narrowing of the left neural foramen.C6-C7 and C7-T1: There is no significant spinal canal or foraminal narrowing.

Output: Multilevel cervical spondylosis associated with mild to moderate spinal canal stenosis at C3-C4 and C5-C6. Examination is motion degraded however demonstrates no convincing cord signal abnormality. Foraminal narrowing is also suboptimally evaluated due to motion but is evident at multiple levels as detailed above.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Metastatic base of tongue squamous cell carcinoma, treated with pembrolizumab, palliative RT to left orbit, and started palliative carbo/paclitaxel/cetuximab. The left cerebellar tonsil lesion is now intrinsically hyperintense with associated susceptibility effect and measures up to 5 mm in diameter. There is no evidence of other infratentorial or supratentorial lesions. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is interval decrease in size of the enhancing left posterior globe lesion, measuring up to 3 mm in thickness, previously 7 mm. The left lateral retinal detachment has resolved. There is mild diffuse conjunctival and lacrimal gland enhancement, likely related to radiation therapy effects. The skull and scalp soft tissues are grossly unremarkable. There is a small left maxillary sinus retention cyst. There are left mastoid air cell effusions.

Output: 1. Interval evolution of the appearance of the subcentimeter left cerebellar tonsil metastasis, likely due to treatment effects. 2. Interval decrease in size of the left ocular metastasis with improvement of the associated retinal detachment.


Instruction: Generate impression based on medical findings.

Input: Cavernous malformation surveillance. There is an unchanged lesion centered in the right cerebral peduncle that measures up to approximately 15 mm. There is circumferential susceptibility effect and central loculated area of intrinsic T1 hyperintensity, as well as patchy enhancement in the lesion. There also appears to be at least one developmental venous anomaly associated with the lesion, but there is no surrounding vasogenic edema. There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: A lesion centered in the right cerebral peduncle is unchanged and likely represents a cavernous malformation associated with at least one developmental venous anomaly.


Instruction: Generate impression based on medical findings.

Input: Lumbar spinal stenosis. Bilateral thigh pain and change in bowel and bladder habits. Assess for change in stenosis. There are 5 lumbar-type, ribless vertebrae. The last well-formed disc is at L5-S1. Sagittal alignment is anatomic accounting for straightening. The vertebral bodies are preserved in height and their marrow signal. The lumbar discs show preserved heights and only minimal L4-L5 and L5-S1 desiccation. There are chronic soft tissue and bone changes related to previous L4-5 discectomy and partial laminectomies.The lumbar spinal canal is diffusely, congenitally narrowed. The conus medullaris tip lies at the lower L2 level, which is unchanged. Otherwise, the conus medullaris and caudal part of the spinal cord show normal signal and shape.T12-L1 and L1-L2: There is no disc herniation and only mild facet arthropathy. There is no spinal canal or foraminal stenosis.L2-L3 and L3-L4: There is mild-to-moderate facet arthropathy and ligamenta flava thickening but no disc herniation. There is mild foraminal stenosis and the mild congenital spinal canal stenosis.L4-L5: There are extensive postoperative changes from previous discectomy and partial laminectomies with thickened posterior and lateral epidural fat, which largely contrast enhances with the exception of a small area in the medial left neural foramen, which probably relates to facet osteophyte rather than disc fragment. Additionally, the thecal sac is more open than on the previous examination, which is probably related to evolution of the postoperative changes into scarring. There is marked left and moderate right facet proliferative change along with joint effusion and contrast enhancement. These are increased since the previous examination and result in moderate left and mild right neural foraminal stenosis. L5-S1: There is moderate facet arthropathy but no disc herniation. There is no spinal canal or foraminal stenosis.

Output: 1.Postoperative findings from previous L4-L5 discectomy and partial laminectomy have evolved with improved decompression of the thecal sac. However, severe left and moderate right facet arthropathy appears slightly worse and is associated with moderate left foraminal stenosis. Please correlate with left L4 radiculopathy.2.Otherwise, there is diffuse, congenital lumbar spinal canal stenosis and low lumbar facet arthropathy as described above.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: 67-year-old female with history of IPMN. ABDOMEN:LIVER, BILIARY TRACT: Stable subcentimeter cyst of hepatic segment 4A (coronal series 3 image 23). No intra or extra hepatic biliary ductal dilatation. Normal gallbladder.SPLEEN: No significant abnormality noted.PANCREAS: The small cystic lesion of the pancreatic tail at the level of the splenic hilum measuring 1.2 x 1 cm (axial series 4 image 16) is stable in size when measuring from the same slice level on the prior exam. Additional subcentimeter areas of T2 hyperintensities are again seen of the pancreatic body and neck. These foci are suggestive of sidebranch IPMNs.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multiple subcentimeter sidebranch IPMNs. The small cystic lesion of the pancreatic tail measuring 1.2 x 1 cm (axial series 4 image 16) is stable in size when measuring from the same slice level on the prior exam.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old. Pain and neuropathy ROTATOR CUFF: There is a full-thickness tear of the anterior fibers of the distal supraspinatus tendon at its insertion. The tear measures approximately 9 mm in AP diameter. Torn fibers are retracted approximately 1 cm. The infraspinatus, teres minor, and subscapularis tendons are intact. The rotator cuff musculature shows no significant fatty atrophy.SUPRASPINATUS OUTLET: There is mild acromioclavicular joint osteoarthritis.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is increased signal within the posterior labrum, likely degenerative. There is no focal articular cartilage defect noted. Bone marrow signal is normal.BICEPS TENDON: The tendon of the long head of the biceps is normal in morphology and position. ADDITIONAL

Output: 1.Full-thickness tear of the supraspinatus tendon as described above.2.Thickening of the coracohumeral ligament and loss of the subcoracoid fat pad, raising the possibility of adhesive capsulitis.3.Increased signal within the posterior labrum, likely degenerative.


Instruction: Generate impression based on medical findings.

Input: Evaluate ventricle size. Hydrocephalus. There is a large infratentorial cystic mass posterior and superior to the cerebellar hemispheres causing mass effect on the cerebellum and the frontal lobes. The fourth ventricle is enlarged with altered configuration. The lateral and third ventricles appear normal in size. An MRI is recommended for further evaluation.There is no evidence of intracranial hemorrhage. There are questionable foci of hypodensity in the left cerebellar hemisphere of unclear clinical significance.A shunt catheter traverses the right parietal bone and with its tip located in the large cystic infratentorial mass.The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Large cystic mass posterior and superior to the cerebellar hemispheres causing mass effect with enlargement of the fourth ventricle. Shunt catheter tip is within the cystic mass. An MRI is recommended for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Short stature. Pituitary: There is an ectopic posterior pituitary bright spot located in the region of the tuber cinereum. The anterior pituitary is otherwise unremarkable. There is no evidence of pituitary region mass lesions. The cavernous sinuses and optic apparatus are intact. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable, with an expected degree of myelination. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Ectopic posterior pituitary.


Instruction: Generate impression based on medical findings.

Input: There are postoperative findings related to right frontal craniotomy with no significant change in the area of confluent T2 hyperintensity within the right superior frontal gyrus surrounding the surgical cavity. However, there is no evidence of associated abnormal intraparenchymal enhancement. The ventricles and sulci are stable. There is no midline shift or mass effect. There is no evidence of acute infarct. The skull and extracranial soft tissues appear to be unchanged.

Output: Post-treatment findings involving the right frontal lobe without evidence of interval tumor progression.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old, with progressive gait deterioration. Grade 1 anterolisthesis of C4 relative to C5 is seen, progressed from the prior examination. A mild reversal of the normal cervical lordosis has developed as well.Progressive disc degeneration is seen between C4 and C7 with further loss of disc height and endplate integrity and degenerative loss of vertebral body height. No significant marrow edema is detected. Ventral epidural thickening from C4 through C7 has also progressed, likely secondary to degeneration of the adjacent discs.Sequelae of prior laminectomy are again seen from C3-C7. The spinal canal remains decompressed in this region similar to prior. The spinal cord is thinned in the area of laminectomy and there is superimposed focal signal abnormality at the C5 level compatible with myelomalacia. Elsewhere, the cord is unremarkable.C2-3: Right facet arthropathy. Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild right foraminal narrowing. No interval changes. C3-4: Facet arthropathy. Mild posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Moderate to severe bilateral foraminal narrowing. No interval changes. C4-5: Bilateral facet arthropathy. Posterior disc-osteophyte complex formation asymmetric to the right paracentral and foraminal zones. No spinal canal stenosis. Severe bilateral foraminal narrowing. No interval changes. C5-6: Facet arthropathy. Progressive disc and endplate degeneration with disc osteophyte formation. No significant spinal canal stenosis. Severe bilateral foraminal narrowing, likely progressed. C6-7: Facet arthropathy. Progressive disc and endplate degeneration with disc osteophyte formation. No significant spinal canal stenosis. Severe left foraminal narrowing, unchanged. C7-T1: Progressive disc and endplate degeneration with disc osteophyte formation. Moderate generalized spinal canal narrowing which has slightly progressed. Severe bilateral foraminal narrowing, similar to prior.

Output: 1.Multilevel disc degeneration has progressed between C4 and C7. Although most of these levels have been surgically decompressed, a moderate canal narrowing is evident at C7-T1.2.The spinal cord remains thinned between C4 and C7 with focal chronic myelomalacia at the C5 level. No other cord abnormalities are identified.3.Evidence of prior laminectomy for spinal canal decompression is seen between C3 and C7.


Instruction: Generate impression based on medical findings.

Input: 59 years Male (DOB:10/1/1956)Reason: staging for newly diagnosed lung cancer History: lung cancerPROVIDER/ATTENDING NAME: EVERETT E. VOKES EVERETT E. VOKES 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.Periventricular punctateNormal 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.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 2.No evidence for brain metastases


Instruction: Generate impression based on medical findings.

Input: Clinical question: Rule out underlying structural lesion. Signs and symptoms: Headache awakening from sleep. Pre and post enhanced brain MRI:No acute intracranial process and negative diffusion weighted images.There is normal anatomical morphology and development of brain parenchymal. There is normal signal intensity of brain parenchyma on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.No detectable abnormal parenchymal or leptomeningeal enhancement.Unremarkable images through the calvarium and orbits without abnormal enhancement.All paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal patterns.

Output: Unremarkable pre and post enhanced brain MRI as detailed above.


Instruction: Generate impression based on medical findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.he patient was placed supine on the fluoroscopy table. The right hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 12 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 37 seconds

Output: Successful right hip arthrogram injection. Please refer to the subsequent MRI report for further information.


Instruction: Generate impression based on medical findings.

Input: Sacral chordoma, restaging Again seen is a lobulated hyperintense lesion centered at the S3 level representing the known sacral chordoma. It now measures approximately 6.3 x 3.1 x 5.2 cm in the greatest transverse, AP and craniocaudal dimensions as compared to 6 x 2.5 x 4.5 cm previously. Again seen is extension of the mass into the anterior presacral soft tissues. An additional small nodule is again seen posterior to the left sacroiliac joint that now measures approximately 3.1 x 2 as compared to 1.9 x 1 cm previously. A third satellite lobular mass posterior to the right paraspinal musculature also appears increased from the prior exam now measuring 3.9 x 3.1 cm as compared to 3.3 x 3 cm previously. Additionally, there is new abnormal marrow signal within the right sacroiliac joint particularly within the ileum posteriorly in the sacrum anteriorly. New abnormal marrow signal also affects the left sacrum. Following contrast administration, there is some peripheral enhancement of the aforementioned lesions with new enhancement of the right sacroiliac joint particularly sacrum. Additional small foci of enhancement are noted in the left gluteal musculature (image 28/52 of series 11)Edema and fluid extending along the posterior inferior right sacrum appears similar to the prior study, which may be postoperative in etiology.There is mild diffuse heterogeneity of the bone marrow which appears similar to the prior study. There is fatty atrophy of the gluteal musculature, right greater than left, appearing similar to the prior study.

Output: Overall progression of sacral chordoma with increasing size of S3 lesion as well as increasing size of satellite lesions within the right paraspinal soft tissues. There is also new abnormal marrow signal and enhancement within the sacrum concerning for progression of disease.


Instruction: Generate impression based on medical findings.

Input: Recent new headache associated with unilateral neurologic changes and confusional state. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a left maxillary sinus retention cyst.

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


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Secondary malignant neoplasm of brain and spinal cord Malignant neoplasm of thyroid glandClinical question: history of papillary thyroid carcinoma previously treated with radiosurgery; please evaluate response (particular attention to enlarging L superior parietal region)Signs and Symptoms: brain metastases. The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient is status post left-sided craniotomy. There is adjacent dural thickening present and blood products. A previously noted mass in the left inferior parietal lobule is not readily identified on the current exam. Instead there is a small amount of enhancement associated with the susceptibility effect indicative of postsurgical change.There is a 6 mm ring-enhancing lesion present along the left superior parietal lobule just behind the left postcentral gyrus. This measured 8 mm on 5/29/2015 and 6 mm on the 6/23/2015 exam.There is redemonstration of a 3 mm enhancing longitudinal along the lateral aspect of the right orbital gyrus. This area is obscured on susceptibility weighted imaging.A 2 mm minimal nodule is redemonstrated at the frontal horn of the right lateral ventricle. It is barely visible on the current exam and was more conspicuous on the prior exam. It is associated with the susceptibility effect and is more conspicuous on the susceptibility weighted images on the current exam.A 2 mm nodule is present along the right inferior frontal gyrus. It is associated with the susceptibility effect.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 scattered opacities. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.The patient has undergone surgical removal of a left inferior parietal lobule mass.2.There are multiple small nodules scattered in the right frontal lobe, left parietal lobe and left frontal lobe. There appear to be blood products associated with these lesions which make the somewhat more conspicuous on susceptibility weighted imaging in areas where there is less artifact from the skull base. In general these lesions appear stable compared to the 6/23 exam but slightly smaller compared to the 5/29 exam.


Instruction: Generate impression based on medical findings.

Input: 56-year-old male with right lower extremity swelling and muscular mass visualized on right lower extremity vascular Doppler examination. There is a large mass in the posterior compartment of the calf which is predominantly situated between the gastrocnemius and soleus muscles. There is an additional component extending anteriorly between the tibia and fibula along the lateral aspect of the posterior tibialis muscle. The maximum transverse dimensions measure 8.5 x 9.0 cm and 13.5 cm in the craniocaudal dimension. The mass displaces the popliteal neurovascular bundle and its branches anteriorly. The signal intensity is predominantly fat signal intensity on all pulse sequences. There are thin minimally enhancing septa and/or vessels within the mass. We see no additional masses. There is nonenhancing reticulation of the subcutaneous fat of the lower leg suggestive of edema. Moderate osteoarthritis affects the knee. Slight focal nonenhancing heterogeneity of the bone marrow of the proximal tibial diaphysis may represent an island of residual red marrow.

Output: Large calf lipoma, as described above.


Instruction: Generate impression based on medical findings.

Input: Reason: Eval for demyelinating disease History: paresthesias MRI brain:There is redemonstration of punctate signal hyperintensities located in the pons which are stable compared to the prior exam.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is right-sided facet hypertrophy present. This is unchanged compared to the prior examAt C3-4 there is no significant compromise to the spinal canal or neural foramina. There are small uncovertebral osteophytes present at this level associated with some disk materialAt C4-5 there are endplate and uncovertebral osteophytes present associated with a diffuse disk bulge and posterior ligamentous hypertrophy. There is associated effacement of spinal fluid ventral and posterior to the spinal cord. There are bilateral uncovertebral osteophytes present at this level associated disk material and narrowing the neural foramina bilaterally. Compared to the prior exam these findings at the this level have progressed. There are endplate reactive change is present at this level which may be subacute with some bright signal on T2 and dark signal on T1.At C5-6 there is loss of disk space height and disk desiccation, endplate and uncovertebral osteophytes with effacement of spinal fluid ventral and posterior to the left hemicord and encroachment of the exiting nerve roots left more than right. Overall this appears relatively stable compared to the prior exam.At C6-7 there is a loss of disk space height, disk desiccation and diffuse disk bulge associated with endplate and uncovertebral osteophytes and partial effacement of spinal fluid ventral and posterior to the spinal cord and encroachment of the left-sided exiting nerve roots within the neural foramen.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.Pontine lesions are stable when compared to the prior exam in general the are suggestive of vascular related lesions, however, they are nonspecific and could relate to other cause such as vasculitis or demyelination.2.Since the prior exam degenerative changes at the C4-5 have progressed and now there is a moderate degree of spinal stenosis present at this level associated encroachment of the exiting nerve roots bilaterally.3.Since the prior exam degenerative changes at C5-6 and C6-7, where there is encroachment of left-sided exiting nerve roots and encroachment of the left hemicord at C5-6 and a mild to moderate degree of spinal stenosis C5-6, have remained relatively stable.


Instruction: Generate impression based on medical findings.

Input: Ms. Kim is 38-year-old BRCA2 positive woman with personal history of left breast invasive carcinoma status post mastectomy and right breast lumpectomy for DCIS. She developed liver metastasis in 2013. She submitted outside studies for review which include mammograms (2/22/2016; 2/24/2026) and MRI (2/23/2016) performed at M.D. Anderson Cancer Center. There are no comparisons study available. MAMMOGRAM 2/22/16: The patient is status post left mastectomy and therefore right mammograms are submitted. Three standard and spot magnification views of the right breast were obtained. The breast parenchyma is heterogeneously dense, which limits the sensitivity of the mammogram . There are postsurgical/posttreatment changes in the upper outer quadrant. Calcifications are noted in upper outer quadrant. These persist on the spot magnification views and appear amorphous and a loosely grouped to segmental distribution. No suspicious masses identified in the right breastMRI 2/23/16:Axial T1, and fat saturated axial and sagittal postcontrast as well as diffusion weighted sequences were submitted. There is moderate heterogeneous fibroglandular elements in the right breast. Minimal background enhancement is present. There is no suspicious mass or non mass enhancement. Specifically, there are no abnormal findings and distribution of the calcifications seen on mammogram in the upper outer quadrant.There are postsurgical changes of left mastectomy and reconstruction. There is no suspicious enhancement in the mastectomy bed or chest wall.No gross axillary lymphadenopathy.MAMMOGRAM 2/24/2016:Static images from right breast stereotactic biopsy targeting the calcifications in the upper-outer quadrant were submitted. Targeted and is appropriate. Biopsy marking clip was applied. Postbiopsy mammograms demonstrate the clip to be in good position in the upper outer quadrant of the right breast, along with postbiopsy changes, about 1 cm displaced from some residual calcifications. Specimen radiograph showed calcifications.Pathology report is not available at this time.

Output: Status post stereotactic biopsy of low suspicion right breast calcifications. Correlation with biopsy pathology is recommended. A benign result could be considered concordant based on the low level of suspicion and negative MRI. Status post previous left mastectomy with reconstruction and previous right lumpectomy. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on medical findings.

Input: Female, 28 years old, with headache. A 5 mm focus of T2 hyperintensity seen within the subcortical white matter of the right anterior temporal lobe (see image 20 series 6). There is no evidence of edema, mass effect or pathologic enhancement associated with this lesion.No other focal signal abnormally is seen. Brain morphology is within normal limits. No pathologic intracranial enhancement is observed. A small developmental venous anomaly is present in the left parietal lobe. No edema, mass effect or restricted diffusion is seen. There are no findings to suggest intracranial hemorrhage or any abnormal extra-axial fluid collections. Ventricular size and morphology are within normal limits.

Output: A 5 mm focus of signal abnormality is present in the subcortical white matter of the right anterior temporal lobe. There is no associated edema, mass effect or abnormal enhancement. This finding is nonspecific and probably incidental. The remainder of the brain is within normal limits.


Instruction: Generate impression based on medical findings.

Input: 60-year-old male with right arm intention tremor and question raised in outside MRI 3/2016 of low grade neoplasm in the pons. There has been evolution of the prior infarct involving the right thalamus extending into the midbrain on outside brain MRI from 10/17/2016. There is T2/Flair hyperintense signal involving the right midbrain cerebral peduncle with associated volume loss indicating chronic infarct and/or associated Wallerian degeneration. There is additional T2/FLAIR signal abnormality involving the right greater than left pons which is not significantly changed compared to the prior exams from 3/3/2016. There is no discrete evidence of pontine expansion or enhancement. Separately more dorsally in the pons is additional T2/FLAIR signal, again indicating an appearance most consistent with small vessel ischemic disease. There is additional scattered periventricular and subcortical white matter T2/FLAIR hyperintensity, which is nonspecific but likely related to underlying chronic small vessel ischemic disease. Chronic lacunar infarcts are evident in the right frontoparietal corona radiata similar to prior.The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.Compared to 10/17/2015, there has been evolution of the previously seen infarct involving the right thalamus extending into the right midbrain.2.T2/FLAIR signal abnormality involving the bilateral pons is not significantly changed since 3/3/2016 and favored to represent sequela of chronic small vessel ischemic disease or perhaps prior osmotic demyelination or other inflammation. Pontine glioma, as questioned, seems much less likely given absence of expansion or enhancement and evidence of prior infarcts. Additional follow-up can be considered as clinically warranted.3.Additional evidence of mild chronic small vessel ischemic disease including lacunar infarcts along the right frontoparietal corona radiata.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Female 54 years old Reason: pancreatitis, hypertriglyceridemia, gastric outlet obstruction secondary to duodenal stenosis, s/p gastrojejunostomy History: abdominal pain, nausea, vomiting ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No suspicious hepatic lesions. Hepatic and portal veins are patent. Status post cholecystectomy. Common bile duct measures 10 mm. There is narrowing of the common bile but within the head of the pancreas for a 2 cm length.SPLEEN: Spleen is enlarged. There are multiple large varices in the splenic hilum and the back wall of the stomach.PANCREAS: Creating inflammation has resolved. The pseudocyst in the pancreatic head has resolved. The cystic area in the pancreatic tail measures 2.9 x 2.5 cm. And is unchanged from prior CT. Pancreatic duct is normal in caliber although it is slightly irregular through the body suggesting early stricture formation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small right renal cyst. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Small upper abdominal retroperitoneal lymph nodes.BOWEL, MESENTERY: There is a stent between the stomach and the proximal jejunum. Stomach is not distended. The duodenum is normal in caliber.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No ascites.INDEX LESION MEASUREMENTS (Current exam date/time: 11/29/2016 10:00:00)PANCREATIC TAIL LESION: 2.9 x 2.5 cm (Image 24, Series 601); 2.8 x 3.1 cm on prior (10/10/2016) (Image 41, Series 201).

Output: 1.Resolution of the pseudocyst in the head of the pancreas. Persistent narrowing of the common bile duct in the head of the pancreas with mild biliary duct dilatation.2.No significant size change in the pancreatic tail cystic lesion representing a pseudocyst.


Instruction: Generate impression based on medical findings.

Input: 88-year-old male with spiculated left upper lobe opacity on chest x-ray. LUNGS AND PLEURA: Emphysema. Adjacent to the aortic arch and right perihilar region is a spiculated mass with areas of cavitation measuring 2.7 x 4.7 cm call (image 32, series 5), consistent with a primary lung neoplasm. Adjacent region of right upper lobe septal thickening may present local lymphangitic spread, (image 43, series 5).Probable intrapulmonary lymph node coma (image 50, series 5).Hilar calcifications compatible with prior granulomatous disease.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Enhancing right adrenal mass measures 2.2 x 1.6 mm (image 12, series 3) is nonspecific but suspicious for metastatic disease. Further follow-up may be considered with PET/CT, dedicated adrenal CT or MRI as clinically indicated.Well-defined hypodense lesion within the midpole of the right kidney is incompletely evaluated but most likely represents a simple cyst.

Output: 1. Right parahilar mass consistent with primary neoplasm.2. Enhancing right adrenal mass suspicious for metastatic disease.Further follow-up may be considered with PET/CT, dedicated adrenal CT or MRI as clinically indicated.


Instruction: Generate impression based on medical findings.

Input: 42 years Female (DOB:12/8/1973)Reason: Chiari decompression, Lp shunt, with new symptoms, evaluate for changes History: new headaches, neck pain, dizziness.PROVIDER/ATTENDING NAME: DAVID M. FRIM DAVID M. FRIM MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. Incidental note is made of partial empty sella.The cerebellar tonsils extend approximately 3 mm below the level of foramen magnum. CSF flow at the level of the foramen magnum is within normal limits.There several periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. This is stable compared to prior examNo 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 alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is multilevel disc desiccation present.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There are small uncovertebral osteophytes at this level mildly narrowing the neural foramina.At C5-6 there is loss of disc space height, disc desiccation and a disc bulge associated with small uncovertebral osteophytes and mild narrowing of the neural foramina bilaterally. There is encroachment of the right-sided exiting nerve roots and to a lesser degree left-sided exiting nerve roots due to uncovertebral osteophytes. There is partial effacement of spinal fluid ventral and posterior the spinal cord. Overall there is mild spinal stenosis at this level. This is stable compared to the prior exam.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There are mild degenerative changes present in the cervical spine without significant compromise to the spinal canal. There is mild encroachment of exiting nerve roots at C5-6 due to uncovertebral osteophytes which appear worse on the right compared to the left side. This is stable compared to the prior exam.2.The cerebellar tonsils are low lying which is borderline for Chiari I malformation. There is no evidence for ventriculomegaly or syrinx and no CSF flow obstruction at the level of the foramen magnum. This is stable compared to the prior exam.3.Several periventricular and subcortical white matter are present which are nonspecific and not unusual in this number at this age. They are therefore of little clinical significance. This is stable compared to the prior exam.


Instruction: Generate impression based on medical findings.

Input: Left breast ADH underwent a recent MRI that showed areas of non-Mass enhancement in the left upper, outer quadrant, corresponding to the calcification seen on mammogram. Enhancing, lobulated mass right breast 12 o'clock position measuring 15 mm is noted for which second look ultrasound is recommended. Dr. Chhablani recommends a left breast second look ultrasound to evaluate any suspicious area that can be targeted by an ultrasound-guided biopsy. A targeted bilateral breast ultrasound was performed. Right breast 12 o'clock position does not demonstrate a correlate to the enhancing mass on MRI. Clip is identified in the left upper, outer quadrant from prior stereotactic biopsy. Hypoechoic area with calcifications are seen adjacent to the clip approximately, measuring 1.6 x 0.7 by 2.1 cm with increased blood flow.

Output: No correlates identified to the enhancing mass seen on MRI in the right breast 12 o'clock position, MR guided biopsy is recommended.Suspicious hypoechoic area's with calcifications identified on ultrasound adjacent to the clip, ultrasound guided core biopsy is recommended.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.


Instruction: Generate impression based on medical findings.

Input: 61 year old female with history of ischemic cardiomyopathy, hypertension, COPD, diabetes, chronic kidney disease, peripheral arterial disease, Hodgkin's lymphoma s/p chemotherapy here for evaluation for advanced options. Left VentricleThe left ventricle is normal in size with mild to moderately reduced systolic function. There is a basal septal hypertrophy. The overall LV ejection fraction is 42% The left ventricular systolic function is global with regional variation. Specifically, the apical inferior, lateral and anterior wall, mid inferolateral and anteroseptal walls, the LV end diastolic volume index is 87 ml/m2 (normal range: 65+/-11), the LVEDV is 168 ml (normal range 109+/-23), the LV end systolic volume index is 51 ml/m2 (normal range 18+/-5), the LVESV is 98 ml (normal range 31+/-10), the LV mass index is 52 g/m2 (normal range 67+/-11), and the LV mass is 100 g (normal range 114+/-24). There is late gadolinium enhancement (LGE) in the pattern of coronary artery disease with multiple infarctions. In the apex, there is a full thickness transmural infarct. In the junction of the basal 1/3 and mid 1/3 of the there is a punctate area of LGE that is less than 50% in thickness. The anterior apical wall has a 60% subendocardial infarct present and the infero-lateral and inferior walls have a greater than 50% thickness infarct from the mid to apical portions. These areas of LGE are likely not viable. and there is no left ventricular thrombus present. Left AtriumThe left atrium is mild-moderately enlarged. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 60 ml/m2 (normal range 69+/-14), the RVEDV is 116 ml (normal range 110+/-24), the RV end systolic volume index is 51 ml/m2 (normal range 22+/-8), and the RVESV is 98 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least trace mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is tricuspid regurgitation.AortaThere is a left sided aortic arch with a common origin of the innominate and left common carotid artery. The aorta is normal in size. There atherosclerosis in the descending aorta. Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no pericardial effusion.Extracardiac FindingsThere is a T2 hyperintense lesion in the liver that may represent a cyst; however, this is not completely characterized. There is T2 hyperintensity in several mid thoracic vertebrae which may represent hemangiomas which not completely characterized on the current exam. Sternotomy wires are present consistent with coronary artery bypass surgery.

Output: 1. The left ventricle is normal in size with mild-moderately reduced systolic function (LVEF 42%)2. The right ventricle is normal in size and systolic function (RVEF 52%)3. The left ventricular systolic function is global with regional variation as described above, there are significant areas of late gadolinium enhancement which are likely not viable (described above).


Instruction: Generate impression based on medical findings.

Input: Clinical question: Spinal stenosis. Signs and symptoms: Left lower back pain with radiating pain to left leg. Nonenhanced lumbar MRI:The lower most visualized thoracic spine demonstrate moderate disc disease and loss of disc height at T10-T11 through T12-L1 levels. There are multiple Schmorl nodes at these levels. There is no spinal stenosis however mild angulation of the spinal column at T11-T12 is noted. This appearance is not greatly different than the study from 9-30-15. The marrow signal intensity of the vertebral column is unremarkable.L1-L2 demonstrate mild degenerative changes. There is a left lateral ventral epidural defect which extend into the left neural foraminal (axial T2 series 601 images 30 through 32 and sagittal T1 series 301 images 6 through 8). Finding demonstrate T1 hyperintense and T2/T2 STIR hyperintense signal pattern. The finding is believed to represent an extruded disc fragment which is often mass effect on the thecal sac and significant compromise of the left neural foramina. Less likely possibility of a mass cannot be entirely excluded. Follow-up with enhanced imaging is recommended. Note however should be made that this finding is not associated with any adjacent marrow signal changes of bone. There is no spinal stenosis and the right neural foramina remains widely patent. This finding retrospectively is identified on prior nondedicated lumbar MRI study (cord compression protocol exam) and without definitive change.L2-L3 demonstrate mild degenerative changes of the disc and the posterior elements without central spinal stenosis or neural foraminal compromise.L3-L4 demonstrate mild degenerative disc disease, mild to moderate bilateral ligamentum flavum hypertrophy and mild facet disease. Constellation of changes results in mild central spinal stenosis and mild bilateral neural foraminal compromise.L4-L5 demonstrate moderate disc disease and loss of disc height, mild grade 1 anterolisthesis, extensive bilateral (L>R) facet hypertrophic changes and mild bilateral ligamentum flavum hypertrophy. Degenerative changes of facet on the left includes a loculated synovial cyst arising from the superior aspect of the left articulating facet (sagittal T2 series 501 image 3). Changes at this level results in moderate central spinal stenosis and with significant right and moderate to significant left neural foraminal compromise.L5-S1 demonstrate mild disc disease and loss of disc height however with extensive left and moderate right facet hypertrophic changes and mild to moderate bilateral ligamentum flavum hypertrophy. There is no spinal stenosis however moderate right neural foraminal compromise is present.

Output: 1.L1-L2 demonstrate a ventral left lateral soft tissue density suspected of an extruded disc which occupies the left neural foramina and with mild mass effect on the thecal sac without central spinal stenosis. This finding is not associated with any adjacent bone marrow signal changes. Possibility of a mass although is considered less likely, however follow-up with postcontrast imaging is recommended for further assessment.2.Mild degenerative changes at other levels however with disproportionate extensive degenerative/hypertrophic changes of the articulating facets in particular at L4-5 and L5-S1 levels as detailed above.3.There is mild central spinal stenosis at L3-L4 and moderate central spinal stenosis at L4-L5.4.Multilevel neural foraminal compromise as detailed per level above.


Instruction: Generate impression based on medical findings.

Input: Acute midbrain hemorrhage. New vertical gaze palsy. Many of the images are at least mildly limited by patient motion.MRI: The left midbrain hemorrhage that extends into the posterior medial aspect of the left thalamus has not significantly changed in size since the previous examination. The associated vasogenic edema along T2 hyperintense signal has slightly increased compared to the CT scan, accounting for differences in techniques. There is trace hemorrhage within the occipital horns of the lateral ventricles. There is encephalomalacia in the right basal ganglia and corona radiata, as well as the left corona radiata. In addition, moderate to extensive periventricular confluent T2 hyperintensity, as well as small patches of subcortical T2 hyperintensity are compatible with chronic microvascular ischemia. There is no contrast-enhancing brain lesion. There is no evidence of acute territorial infarct. The pituitary gland appears unremarkable. The ventricles and sulci are enlarged diffusely, reflecting a combination of ex vacuo dilatation from previous infarcts and global cerebral volume loss, but there is no evidence of hydrocephalus otherwise. There is no midline shift or herniation. A left nasal cavity polypoid lesion, a retention cyst in the left maxillary sinus, and secretions in the right posterior ethmoid sinuses are unchanged. The orbits, skull, and scalp soft tissues are grossly unremarkable.MRA: The included upper cervical, petrous, cavernous and supraclinoid internal cleft arteries show preserved flow-related signal and caliber with no flow-limiting lesion or aneurysm. The paired anterior and middle cerebral arteries are also unremarkable. An anterior communicating artery is present. The left vertebral artery is small (both its intracranial and included upper extracranial segments). This is associated with small osseous foramina, which is probably developmental/congenital. The basilar artery is predominantly supplied by the right vertebral artery. The right P1 segment is either absent or very small. The right posterior cerebral artery is supplied through an enlarged right posterior communicating artery (fetal origin; normal variation). The left posterior cerebral artery is conventional in anatomy. Both posterior cerebral arteries are otherwise unremarkable.

Output: 1. Left midbrain and thalamic hemorrhage has not significantly changed since the previous CT scan, although the associated vasogenic edema has slightly increased, accounting for differences in technique. Minimal intraventricular extension of the hemorrhage is present as well.2. Extensive chronic small vessel disease and chronic infarcts are unchanged.3. No hemodynamically significant cerebrovascular lesions.


Instruction: Generate impression based on medical findings.

Input: Reason: pain History: pain ACETABULAR LABRUM: There is no evidence of labral tear. ARTICULAR CARTILAGE AND BONE: Bone marrow signal intensity is within normal limits throughout. Articular cartilage is normal in appearance.SOFT TISSUES: The imaged soft tissues are unremarkable. ADDITIONAL

Output: No acute abnormalities of the left hip are identified on this MRI.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o anatomic abnormality, space occupying lesion History: HA/AMS There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull and scalp soft tissues are grossly unremarkable. The paranasal sinuses are unremarkable.

Output: MRI of the brain is within normal limits


Instruction: Generate impression based on medical findings.

Input: Pituitary mass. Ptosis and ophthalmoplegia. The sella turcica is expanded by a heterogeneous lesion with thin peripheral enhancement. Overall, the lesion measures 3.2 cm x 2.1 cm in the coronal plane and 1.7 cm in the anteroposterior dimension and there is associated suprasellar extension with mild mass effect upon the optic apparatus, particularly on the left side. In addition, the lesion also extends laterally into the bilateral cavernous sinuses and the left cavernous sinus appears to be mildly prominent and heterogeneous. The pituitary infundibulum is slightly thickened and displaced to the right. There is mucosal thickening in the sphenoid and posterior ethmoid sinuses which is associated with T1-hyperintense fluid on the left side. There appears to be mild enhancement of the sphenoid body. There is diffuse dural thickening and enhancement.

Output: 1.The sellar lesion that measures up to 3.2 cm produces mass effect upon the optic apparatus may represent a pituitary adenoma with apoplexy versus an abscess that could be associated with adjacent sinusitis and possible early central skull base osteomyelitis. 2.The slightly heterogeneous appearance and thickening of the cavernous sinuses, particularly on the left may represent cavernous sinus thrombosis versus compressive effects by the adjacent lesion. Follow up via dedicated CT venography may be useful.3.Diffuse pachymeningeal thickening may be related to a recent lumbar puncture.


Instruction: Generate impression based on medical findings.

Input: 91 years Male (DOB:3/17/1925)Reason: stroke History: left facial and arm hypoesthesiaPROVIDER/ATTENDING NAME: CHRISTINE A BABCOCK KOUROSH ANNA REZANIA MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a subcentimeter T2 and FLAIR hyperintense lesion present in the right thalamus.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.Incidental note is made of C2-3 congenital fusion.Exam is somewhat degraded by motion artifact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. There is fetal origin of the left posterior cerebral artery with a medium sized left P1 segment. The right posterior communicating artery is small. The anterior communicating artery is small. The vertebral arteries are similar in size.The right vertebral artery is smaller than the left vertebral artery.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. There is mild narrowing at the origin of the right vertebral artery

Output: 1.No evidence for acute ischemic cerebral infarction.2.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 3.An old lacunar infarct is present in the right thalamus4.There is no evidence for intracranial or extracranial cerebrovascular occlusive disease.5.Examination is somewhat degraded by motion artifact which may obscure more subtle abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate for etiology of chronic neck and right parascapular pain History: pain in posterior shoulder, neck and right parascapular region Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is mild retrolisthesis of C5 on C6. Alignment is otherwise maintained. 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. Bilateral facet arthropathy.C3-4: Minimal disc bulge and ligamentum flavum thickening. Minimal spinal canal narrowing. No significant neural foraminal stenosis. Mild facet arthropathy.C4-5: No significant compromise to the spinal canal or neural foramina. Mild facet arthropathy.C5-6: Disc osteophyte complex, ligamentum flavum thickening, and uncovertebral hypertrophy. There is mild to moderate spinal canal stenosis. There is mild right sided neural foraminal stenosis. No significant left neural foraminal narrowing.C6-7: Disc osteophyte complex, ligamentum flavum thickening, and uncovertebral hypertrophy. There is mild to moderate spinal canal stenosis. There is mild right sided neural foraminal stenosis. No significant left neural foraminal narrowing.C7-T1: No significant compromise to the spinal canal or neural foramina. Facet arthropathy, particularly on the left.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Mild multilevel degenerative changes in the cervical spine as detailed above. There is mild to moderate spinal canal stenosis at C5-C6 and C6-C7. There is mild right C5-C6 and C6-C7 neural foraminal stenosis. No high-grade neural foraminal narrowing at any level. There is also facet arthropathy at multiple levels which may be contributing to patient's neck pain.


Instruction: Generate impression based on medical findings.

Input: Post craniotomy with aneurysm clipping. New symptoms and worsening headaches Non-infused head CT:Minimal area of low attenuation in the inferior aspect of right frontal lobe near the surgical site of clipped aneurysm may represent edema or encephalomalacia. This finding remains stable since prior exam. Expected postoperative changes of right-sided frontal craniotomy with interval improvement since prior study. Patchy nonspecific foci of subcortical low attenuation could represent small was ischemic disease. This appears a slightly more pronounced on the current exam than prior study. Recommend follow-up with an MRI. There is no evidence of cortical low attenuation to suggest ischemic cortical stroke.Widened subarachnoid space along the inner table of the skull in the right posterior frontal and parietal is highly suspected only small subdural collection. This is also a new finding since prior exam. There is very subtle effacement of cortical sulci secondary to finding.

Output: 1.Findings I do suspect that of small vessel disease of indeterminate age with interval worsening since prior study. Recommend follow-up with an MRI to exclude new subcortical ischemic strokes.2.A small CSF density subdural in the right posterior frontal -- parietal with minimal effacement of adjacent cortical sulci is a new finding since prior exam3.there is no evidence of any acute cortical stroke, hemorrhage, hydrocephalus or midline shift.


Instruction: Generate impression based on medical findings.

Input: 56-year-old female presents with right knee pain, swelling, and a "knee pop"; evaluate for ligament tear. MENISCI: There is full-thickness avulsion of the posterior horn of the medial meniscus from its root associated with mild medial extrusion of the body of the medial meniscus. Intrasubstance increased signal within the posterior horn and body of the medial meniscus suggests mucoid degeneration. Within the body of the medial meniscus, this signal extends to the tibial articular surface perhaps representing degenerative fraying/tearing. The lateral meniscus appears normal for age.ARTICULAR CARTILAGE AND BONE: There is moderate degeneration of the articular cartilage of the patellofemoral joint, particularly along the lateral facet of the patella. There is perhaps a small focus of partial thickness degeneration of the articular cartilage along the weightbearing surface of the medial femoral condyle. The articular cartilage of the lateral compartment appears intact.LIGAMENTS: The cruciate and lateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. Avulsion of the root of the posterior horn of the medial meniscus.2. Moderate-sized joint effusion and a Baker's cyst with edema along the medial head of the gastrocnemius which may reflect leakage or rupture of the Baker's cyst.3. Cartilage degeneration, most pronounced at the patellofemoral joint.


Instruction: Generate impression based on medical findings.

Input: There has been interval evolution of postoperative findings related to left frontal lobe surgery for resection of recurrent left frontal lobe mass. The cavity now contains multiple septations and susceptibility effect. There is persistent confluent T2 hyperintensity surrounding the posterolateral aspect of the resection cavity and extending into the anterolateral aspect of the left lateral ventricle and the corpus callosum. There is also linear enhancement along the margins of the resection cavity, which is more extensive than previously. However, there is no associated grossly elevated perfusion in this region. There is dural enhancement anterior to the resection cavity, which crosses the midline to the right anteromedial dura. There are nonspecific punctate foci of susceptibility effect in the right parietal region. The ventricles and the basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is no evidence of acute infarct.

Output: Interval evolution of postoperative findings related recurrent glioblastoma from the left frontal lobe, in which the resection cavity contains blood products in apparently septated compartments and nonspecific enhancement surrounding the resection cavity. Otherwise, no evidence of glioblastoma progression.


Instruction: Generate impression based on medical findings.

Input: H/o stroke. There is redemonstration of the bilateral ACA, MCA and PCA territory and right cerebellar with vermis strokes. In comparison with prior brain MRI, there appears more mass effect, causing effacement of the fourth, third and left lateral ventricles and prepontine cistern. There are also enlargement of the right lateral ventricle and more midline shift to the right. Postoperative change of a frontal craniotomy and residual suprasellar and sellar mass are re-identified. The right subdural fluid collection is not visualized. No new hemorrhage is detected.

Output: 1. Bilateral ACA, MCA and PCA territory and right cerebellar with vermis strokes with increased mass effect. 2. Interval development of hydrocephalus of the right lateral ventricle. 3. Stable postoperative change of a frontal craniotomy.


Instruction: Generate impression based on medical findings.

Input: Reason: Patella Chondromalacia History: Pain MENISCI: There is linear and globular increased signal intensity within the anterior horn of the lateral meniscus that also extends into the body of the meniscus in a horizontal fashion indicating degeneration. This linear signal intensity appears to contact the tibial articular surface suggesting a degenerative horizontal tear. Furthermore, the mucoid material extends to the periphery of the meniscus to form an elongated parameniscal cyst that runs along the anterior, lateral, and possibly posterior aspects of the meniscus. There is slight blunting of the posterior horn of the lateral meniscus which may represent mild fraying. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is severe degeneration of the articular cartilage of the medial facet of the patella and femoral trochlea with much of the facets being devoid of articular cartilage. There is associated degenerative subchondral signal abnormality in the surrounding area. There is relatively mild degeneration of the articular cartilage of the lateral facet of the patella. We see no fluid-filled articular cartilage defects affecting the medial and lateral tibiofemoral compartments. There are tricompartmental osteophytes.LIGAMENTS: The cruciate and collateral ligaments appear intact. There is a lobulated collection of fluid signal intensity along the posterior margin of the PCL which may represent ganglion formation. There is thickening and intermediate signal intensity within the proximal fibers of the LCL proper which may represent prior sprain or degeneration.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Severe osteoarthritis of the patellofemoral joint, predominantly involving the medial facets.2. Degeneration and degenerative tearing of the lateral meniscus with parameniscal cyst formation.3. Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are no areas of abnormal parenchymal signal. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. There is a possibly partially empty sella.

Output: 1.No evidence of intracranial hemorrhage, mass, or acute infarct.2.Questionably small pituitary gland for age. Please correlate with pubertal status and any symptoms of possible pituitary dysfunction.


Instruction: Generate impression based on medical findings.

Input: 70 years Male (DOB:4/15/1946)Reason: eval pineal tumor and flow from 3vc, please include cine flow History: eval pineal tumor and flow from 3vc, please include cine flowPROVIDER/ATTENDING NAME: FERNANDO D. GOLDENBERG There is a heterogeneous enhancing mass centered in the pineal region and quadrigeminal plate which is associated with narrowing of the aqueduct and ventriculomegaly. This was demonstrated on prior exams. There is associated surrounding T2 signal hyperintensity within the thalami and midbrain. There is associated susceptibility effect within the lesion. The mass itself currently measures 42 x 32 mm axial dimensions and on the 11/24 exam measured 39 x 29 mm axial dimensions. It has a central nonenhancing component on the current exam which was smaller on the prior exam. This nonenhancing component is heterogeneous on T2 and predominantly hypointense on T1. It is associated with susceptibility effect and some T1 hyperintensity suggesting products.The patient is status post right occipital craniotomy.There are multiple foci of susceptibility effect within the lateral ventricles with fluid fluid levels.A ventriculostomy tube is present coursing the right frontal lobe into the right lateral ventricle with a tip adjacent to the septum pellucidum within the frontal horn of the right lateral ventricle. A ventriculostomy tract course of the right frontal lobe into the body of the right lateral ventricle. Biventricular diameter on the current exam is proximal 43 mm prior exams is likely 45 mm. the temporal horns of lateral ventricles remain dilated.There is a right-sided subdural effusion present measuring 8 mm in thickness which was smaller on the prior exam measured 2 mm. There is a mild to moderate degree of periventricular and subcortical confluent hyperintense white matter lesions present identified on the FLAIR and T2 images. This has not changed substantially compared the prior examNormal 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.Incidental note is made of a cystic lesion most likely representing a sebaceous cyst along the left occipital scalp tissues. This also present on previous exams and is unchanged. It extends to the skin surface and distorts the skin surface.The exam is somewhat degraded due to motion artifact.CSF flow study demonstrates biphasic flow at the level of foramen of Monro but no flow clearly seen in the aqueduct. A third ventriculostomy is not readily visualized current exam.

Output: 1.Quadrigeminal plate and pineal region mass. Since the prior exam the mass has mildly enlarged and is now associated with the central hemorrhagic component. Surrounding edema has also increased relative to the prior exam.2.Ventriculomegaly. A ventriculostomy tube is in place. There are some blood products present within the lateral ventricles. The lateral ventricles are minimally smaller on the current exam compared to the prior exam. There is no convincing evidence for flow through the aqueduct. A third ventriculostomy is not readily seen on this exam.3.A right-sided subdural collection has enlarged compared to the previous exam. There is minimal shift of the septum pellucidum.4.Periventricular and subcortical white matter lesions of a mild to moderate degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on medical findings.

Input: Low back pain. There is a 15 mm thick disc central extrusion at L4-5 that result in severe spinal canal stenosis with compression of the cauda equina nerve roots, but no significant neural foramen stenosis. There is also a 9 mm thick eccentric right disc extrusion at L3-4 with effacement of the right lateral recess with compression of the adjacent nerve roots, but no significant neural foramen stenosis. There is no significant spinal canal stenosis at the other levels of the lumbar spine. The vertebral column alignment is within normal limits. The vertebral body are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1. A central extrusion at L4-5 results in severe spinal canal stenosis with compression of the cauda equina nerve roots.2. An eccentric right disc extrusion at L3-4 results in effacement of the right lateral recess with compression of the adjacent nerve roots.


Instruction: Generate impression based on medical findings.

Input: 29 year old with history of hypertension and peripartum cardiomyopathy presenting for cardiac evaluation. MEDICATIONS: Amlodipine, aspirin, atorvastatin, furosemide, metoprolol, spironolactone, valsartan First Pass PerfusionDuring hyperemia, no perfusion defects were present. A prominent dark rim artifact is noted.Viability/ Myocardial ScarThere is no late gadolinium enhancement to suggest the presence of underlying myocardial fibrosis, inflammation, or infiltration. The entire myocardium is viable. Left VentricleThe left ventricle is severely enlarged with moderately reduced systolic function. There is mild circumferential left ventricular hypertrophy (IVSd=10mm). The overall LV ejection fraction is 38%, the LV end diastolic volume index is 153 ml/m2 (normal range: 65+/-11), the LVEDV is 287 ml (normal range 109+/-23), the LV end systolic volume index is 95 ml/m2 (normal range 18+/-5), the LVESV is 179 ml (normal range 31+/-10), the LV mass index is 65 g/m2, and the LV mass is 121 g. The left ventricular systolic dysfunction is global. Left AtriumThe left atrium is severely enlarged. Right VentricleThe right ventricle is severely enlarged with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 146 ml/m2 (normal range 69+/-14), the RVEDV is 274 ml (normal range 110+/-24), the RV end systolic volume index is 72 ml/m2 (normal range 22+/-8), and the RVESV is 136 ml (normal range 35+/-13). Right AtriumThe right atrium is moderately enlarged. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a pseudo-bovine brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is a trivial pericardial effusion.Extracardiac FindingsA large left axillary lymph node (15mm) is noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. LV is severely dilated with moderately reduced systolic function (LVEF 38%).4. RV is severely dilated with normal systolic function (RVEF 51%).5. Significant biatrial dilation. 6. Large left axillary lymph node noted.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Disorder of brain, unspecified [G93.9], Reason for Study: ^Reason: increasing weakness RLE History: increasing weakness RLE There is normal thoracic kyphosis and lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The conus medullaris terminates at the T12 level.The paraspinal soft tissues are unremarkable.There is no evidence of abnormal enhancement, cord compression or mass. Incidental finding of the left renal cyst (about 20mm in diameter).Degenerative changes are specified by the intervertebral level as follows: T11-T12: There is broad based disc protrusion toward right side neural foramen which results moderate to severe neural foraminal stenosis.T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: Mild disc desiccation. Diffuse bulging of disc with bilateral ligamentum flavum thickening causing minimal spinal canal stenosis. Broad-based disc bulging toward left side neural foramen causing minimal neural foraminal stenosis on the left side. L4-L5: Disc desiccation. Diffuse bulging of disc with bilateral ligamentum flavum thickening causing mild to moderate spinal stenosis. L5-S1: Disc desiccation. Diffuse bulging of disc causing minimal spinal canal stenosis.

Output: 1. Spinal cord signal intensity is normal.2. Degenerative changes of lumbar discs. In particular, there is a broad-based disc protrusion toward the right side neural foramen at the level of T11-12.3. Degenerative various degree spinal canal stenosis at the level of L34, L45 and L5S1.


Instruction: Generate impression based on medical findings.

Input: View ventricular size and any loculated areas for pre-op planning: prior EVD placement for onset of hydrocephalus after GBS meningitis. Brain: There is persistent, albeit slightly decreased, marked enlargement of the ventricular system, with interval insertion of a right transfrontal ventricular catheter that terminates in the left lateral ventricle, with a small amount of pneumocephalus. There is a defect in part of the septum pellucidum. There are persistent areas of cystic encephalomalacia and/or porencephaly, mainly in the bilateral posterior and inferior portions of the cerebral hemispheres and left frontal lobe. In particular, a cystic component in the right parietal lobe measures up to approximately 25 mm. There is now diffuse prominence of the bilateral supratentorial subdural spaces, particularly overlying the collapsed anterior left temporal lobe, measuring up to approximately 25 mm in width. There is extensive diffuse cerebral and brainstem white matter volume loss, but no evidence of acute infarction. There is susceptibility effect along the choroid plexi and posterior margins of the lateral ventricles related to chronic blood products, but no evidence of acute intracranial hemorrhage. In addition, there are punctate foci of susceptibility effect along the left caudothalamic groove and posterior fourth ventricular margin, also consistent with chronic hemorrhage. There are punctate foci of T1 hyperintensity in the bilateral basal ganglia. There is no midline shift or herniation. There is no evidence of acute infarction or hemorrhage. The orbits are unremarkable.Pituitary: The pituitary gland is normal in size and signal characteristics, including a posterior pituitary bright spot. The infundibulum is intact.

Output: 1. Findings compatible with extensive diffuse chronic cerebral infarction related to neonatal group B streptococcal meningitis with persistent areas of cystic encephalomalacia and/or porencephaly, 2. New subdural fluid collections, likely commensurate to slightly diminished ventriculomegaly, status post interval right transfrontal shunt catheter insertion.2. The pituitary gland appears to be unremarkable.


Instruction: Generate impression based on medical findings.

Input: There is slight reversal of normal upper cervical curvature. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. Heterogeneity, including right-sided T2 hyperintensity, is noted involving the limited visualized aspects of the thyroid gland. Otherwise the visualized paraspinal contents are unremarkable.C2/3: UnremarkableC3/4: UnremarkableC4/5: UnremarkableC5/6: There is a small central disc protrusion which abuts and slightly flattens the anterior cord surface without intrinsic cord signal abnormality and no resulting central stenosis.C6/7: UnremarkableC7/T1: Unremarkable

Output: 1.Heterogeneity, including right-sided T2 hyperintensity, is noted involving the limited visualized aspects of the thyroid gland. 2.C5/6: There is a small central disc protrusion which abuts and slightly flattens the anterior cord surface without intrinsic cord signal abnormality and no resulting central stenosis.


Instruction: Generate impression based on medical findings.

Input: Seizures and pituitary lesion. Per EPIC: supratherapeutic dilantin, hyperammonia from VPA; Possible toxic-metabolic component: pending workup; Paraneoplastic panel negative; LP negative for infection. Pituitary: There is an intrinsically T1 hyperintense lesion in the pituitary gland that measures up to 9 mm. The infundibulum is intact. There is no mass effect upon the optic apparatus or cavernous sinuses.Brain: There is diffuse T2 hyperintensity of the hippocampi. The rest of the brain parenchyma appears unremarkable. There is no evidence of intracranial heterotopia, hemorrhage, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is a small probable retention cyst in the adenoids. There is a small hemangioma in the left parietal calvarium.

Output: 1. An intrinsically T1 hyperintense lesion in the pituitary gland that measures up to 9 mm likely represents a Rathke cleft cyst. 2. Diffuse T2 hyperintensity of the hippocampi likely represents vasogenic edema, which can be a result of a toxic-metabolic process, such as hyperammonemia, for example.


Instruction: Generate impression based on medical findings.

Input: Headaches No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Cortical sulci, ventricular system and all CSF cisterns as well as gray/white matter differentiation remains within normal.Limited real paranasal sinuses, mastoid air cells and middle ear cavities are unremarkable.Calvarium is intact. Small densely calcified lesion along the inner table of the skull in the right pterion with extension inferiorly along the greater wing of sphenoid on the right is noted there is a lucent line separating this lesion from the inner table of the skull which may represent the dura. The finding may not present heavily calcified dural (dural plaque) however possibility of heavily calcified meningioma cannot be ruled out. This lesion can be further evaluated with a dedicated MRI examination of brain with contrast. I detect no soft tissue component with this finding which is best appreciated on bone density images 5 through 12.

Output: 1.Negative CT of brain parenchyma.2.Thin densely calcified extra-axial dural based lesion at the level of right pterion may represent a dural plaque or a heavy calcified meningioma. Please see above comments. Follow-up with a dedicated MRI is recommended.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Evaluate for possible subdural. Signs and symptoms: Poor quality initial CT need to evaluate for subdural. Nonenhanced head CT:There is no evidence of intracranial hemorrhage.There is paucity of cortical sulci, sylvian fissures and a small basal cistern. Findings although may be the normal for patient stated age of 35 possibility of mild diffuse cerebral edema cannot be entirely ruled out. Comment current follow-up with an MRI examination.There is poor differentiation of gray -- white matter however I cannot be certain whether this is due to patient's thicker than normal calvarium and also presence of board under patient's head.

Output: 1.No evidence of parenchymal or subdural hematoma as clinically questioned.2.Paucity of cortical sulci and small size of basal cistern and sylvian fissures and poor differentiation of gray -- white matter as described above. Concern for possible underlying cerebral edema and recommend further follow-up with an MRI exam. Please see above comments.


Instruction: Generate impression based on medical findings.

Input: There is an unchanged lesion centered in the right petrous apex with high T2 and low T1 signal and thinning of the overlying cortex. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are unchanged T2 hyperintense foci compatible with chronic small vessel ischemic disease. There is also left medial temporal lobe encephalomalacia with hemosiderin staining. There is a partially-empty, expanded sella. The ventricles and basal cisterns are symmetric in size and configuration, and unchanged over several examinations. There is no midline shift or herniation. The orbits paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA

Output: 1. Unchanged lesion centered within the right petrous apex for which the differential diagnosis includes an effusion/early mucocele, cephalocele or prominent arachnoid granulation, and less likely neoplasm, such as low grade chordoid matrix tumor.2. Unchanged subcentimeter left MCA bifurcation and right PCOM aneurysms.3. Unchanged probable microangiopathic white matter disease and hypertensive microhemorrhages, as well as left medial temporal lobe encephalomalacia with prior hemorrhage.4. Partially-empty, expanded sella, which can be a manifestation of pseudotumor cerebri. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Evaluate for CVA. Signs and symptoms: Aphagia. Unenhanced head CT:The examination demonstrates very subtle subcortical and periventricular low attenuation which are suspected for mild small vessel ischemic disease of indeterminate age. These findings were noted on prior MRI examination from 6 -- 23 -- 10.There is no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus. High density extra axial lesion measuring approximately 18 times 15 mm in transaxial dimension is noted along the superiorly surface of tentorium on the left is consistent with patient's known meningioma. There is no appreciable interval change since prior exam. There is no evidence of surrounding vasogenic edema.

Output: 1.No detectable acute intracranial findings.2.Minimal small vessel ischemic disease of indeterminate age.3.Stable left sided subtemporal meningioma.


Instruction: Generate impression based on medical findings.

Input: Female 24 years old Reason: PSC, eval for stricture History: PSC, UC ABDOMEN:LIVER, BILIARY TRACT: Mild focal stricture in the mid common bile duct (series 1101/71) appears similar to prior examination. Mild irregularity and stenosis of the distal common bile duct the ampulla is also similar to prior examination. Scattered areas of mild biliary ductal dilatation with scattered areas of narrowing in the right and left hepatic ducts and intrahepatic ducts, not significantly changed.Two round enhancing foci in segment 8 seen only on the arterial phase are most consistent with transient hepatic arterial difference (THAD). No suspicious hepatic lesions.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No evidence of peritoneal carcinomatosis.

Output: No significant interval change in the appearance of the biliary tree with mild focal stricture in the mid common bile duct and additional areas of stenosis and dilatation, consistent with PSC. No new suspicious hepatic lesions.


Instruction: Generate impression based on medical findings.

Input: 73-year-old male status post liver transplant with abnormal CT findings ABDOMEN:LUNG BASES: Trace bilateral pleural effusions. Cardiomegaly.LIVER, BILIARY TRACT: The liver is heterogeneous in signal and enhancement with lobular contours suggestive of periportal fibrosis. There is mild diffuse biliary ductal prominence, similar to the prior CT. No mass is seen in the inferior right hepatic lobe, in the region of suspicion on the prior CT.SPLEEN: Subcentimeter T2 hyperintense foci, likely representing cysts. No significant abnormality noted.PANCREAS: 11 x 9 mm cystic lesion in the pancreatic head (series 6, image 59), which does not appear to communicate with the main pancreatic duct, likely representing a side branch IPMN. The main pancreatic duct is not dilated. No focal lesions are otherwise identified.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: 20 x 11 mm retrocrural lymph node is similar to the prior CT.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Moderate amount of abdominal ascites.

Output: 1.Peri-portal hepatic fibrosis, without mass seen.2.11 x 9 mm cystic lesion in the pancreatic head likely representing a side branch IPMN.