Instruction: Generate impression based on medical findings.

Input: 34 year old male with a history of D-transposition of the great vessels s/p Mustard procedure at 18 months, sinus node dysfunction, recurrent SVT, s/p CTI for atrial flutter who was admitted for persistent junctional rhythm and atypical chest pain. He was referred for cardiac MRI for further evaluation. Overall AnatomyD-TGA. There is a Mustard baffle that connects the SVC and IVC to the sub-pulmonic ventricle (i.e. morphologic left ventricle) via the mitral valve. The morphologic left ventricle communicates with main pulmonary artery. The pulmonary venous flow returns to the systemic ventricle (i.e. morphologic right ventricle) via the common atrium that surrounds the baffle via the tricuspid valve. The morphologic right ventricle communicates with the aorta.Systemic Venous ReturnThere is a baffle that connects the SVC and IVC to the sub-pulmonic ventricle (i.e. morphologic left ventricle) via the mitral valve. There is significant tubular narrowing within the the SVC and IVC baffle limbs. The SVC limb is ~8 mm at its narrowest transverse dimension. The IVC limb is ~10 mm at its narrowest transverse dimension. The common portion of the baffle limb is ~6 mm at its narrowest dimension. There is no evidence of flow acceleration within the baffle. The IVC is dilated. The SVC is normal in size. There is no obvious baffle leak noted. Systemic Ventricle (i.e. Morphologic Right Ventricle)The right ventricle is significantly dilated and hypertrophied with moderate to severely reduced systolic function. The overall RV ejection fraction is 30%, the RV end diastolic volume index is 113 ml/m2 (normal range 82+/-16), the RVEDV is 206 ml (normal range 142+/-31), the RV end systolic volume index is 79 ml/m2 (normal range 31+/-9), and the RVESV is 62 ml (normal range 54+/-17). There is late gadolinium enhancement noted at the anterior and inferior insertion points of the right ventricle. Pulmonary Venous ReturnThere are four pulmonary veins which drain into the common atrium and then through the tricuspid valve. There are no obvious obstructions of the pulmonary veins.Sub-Pulmonary Ventricle (i.e. Morphologic Left Ventricle)The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 63%, the LV end diastolic volume index is 58 ml/m2 (normal range: 74+/-15), the LVEDV is 106 ml (normal range 142+/-34), the LV end systolic volume index is 22 ml/m2 (normal range 25+/-9), the LVESV is 40 ml (normal range 47+/-19). The interventricular septum bows into the sub-pulmonic left ventricle causing systolic anterior motion of the mitral valve leaflets and flow acceleration in the outflow tract below the pulmonary valve. Common AtriumThe interatrial septum has been resected resulting in a common atrium. The common atrium is significantly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation. There is systolic anterior motion of the mitral leaflets causing sub-pulmonic outflow obstruction as described above. Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is moderate tricuspid regurgitation.Great VesselsThe aorta is located anterior and to the right of the pulmonary trunk. There is a left sided aortic arch with a normal brachiocephalic branching pattern. There is no thoracic aortic aneurysm or thoracic aortic dissection. 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. D-Transposition of the Great Vessels status post Mustard atrial switch procedure. 2. There is significant narrowing within the SVC and IVC baffle. No obvious baffle leaks were detected.3. Significantly dilated and hypertrophied systemic right ventricle. RV systolic function is moderate to severely reduced (RVEF 30%).4. The subpulmonic ventricle (left ventricle) is normal in size with normal systolic function (LVEF 63%). 5. The interventricular septum bows into the sub-pulmonic left ventricle causing systolic anterior motion of the mitral valve leaflets and flow acceleration in the outflow tract below the pulmonary valve.6. Moderate tricuspid regurgitation associated with significant atrial dilation. 7. IVC is dilated. When compared to the prior study, the systemic ventricle has a slightly lower ejection fraction.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: 37-year-old female with headaches and a history of meningiomas. The patient is status post resection of a right frontal meningioma in 3/17/2015. Compared to previous Brain MRI dated 1/23/2016 there has been no significant change in the FLAIR hyperintensity/gliosis with mild enhancement surrounding the right frontal resection cavity. Mild postsurgical dural thickening is also unchanged at the craniotomy site.An enhancing meningioma along the left anterior falx abutting the crista galli measures 0.9 x 0.9 x 1.3 cm (axial series 1001, image 14 and sagittal series 12-3, image 84) and is unchanged compared to the previous exam. There been no interval change in the minimal adjacent edema.There is stable plaque-like dural thickening and enhancement filling the left Meckel's cave and the right cavernous sinus. A stable small enhancing meningioma along the superior aspect of the right tentorium is unchanged and measures 0.6 x 0.6 cm (series 1001, image 12)There are prominent calcifications of the cord plexus with mild surrounding enhancement which are unchanged. There is grossly symmetric enhancement of the facial nerves, slightly more prominent in the left geniculate ganglion region which is nonspecific.There is no evidence of intracranial hemorrhage, mass effect, midline shift or herniation. The ventricles and basal cisterns are normal in size and configuration. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.Stable postsurgical changes in the right frontal region status post resection of a meningioma on 3/17/2015. No findings to suggest residual or recurrent meningioma in this region.2.Stable small meningiomas along the left inferior frontal falx and along the right tentorium. Stable mild edema associated with the left inferior frontal meningioma.3.Stable enhancement involving right cavernous sinus and left Meckel's cave which may be related to meningiomas or perhaps schwannomas.4.Stable appearance of the calcified right larger than left choroid plexus with mild surrounding enhancement. Findings nonspecific, but meningiomas in these regions not excluded.


Instruction: Generate impression based on medical findings.

Input: Reason: ?rotator cuff tear, supraspinatus - unable to raise arm, recent h/o injury lifting heavy weight History: left shoulder weakness Several sequences are limited by patient motion artifact.ROTATOR CUFF: There are massive tears of the rotator cuff, with complete tears of the supraspinatus and infraspinatus tendons with retraction to the level of the glenohumeral joint. There is mild to moderate atrophy of the supraspinatus and infraspinatus muscles. There is a full-thickness near-complete tear of the subscapularis tendon with only the most inferior fibers extending to the lesser tuberosity; the majority of the subscapularis tendon fibers are retracted to the level of the glenoid. Moderate to severe fatty atrophy of the subscapularis muscle. Teres minor tendon and muscle are intact. SUPRASPINATUS OUTLET: Moderate osteoarthritis of the acromioclavicular joint. There is a small amount of fluid in the subacromial/subdeltoid bursa containing intermediate signal intensity, likely reflecting bursitis. This fluid extends into and through the acromioclavicular joint resulting in a small fluid collection dorsal to the joint. Humeral head is high riding with the acromiohumeral interval measuring 1 to 2 mm.GLENOHUMERAL JOINT AND GLENOID LABRUM: Small to moderate glenohumeral joint effusion containing small foci of intermediate signal intensity, likely debris. Mild osteoarthritis of the glenohumeral joint. Bone marrow signal is normal.There is increased signal in the anterior and superior labrum, which may reflect degeneration/degenerative tearing.BICEPS TENDON: There is full-thickness rupture of the biceps tendon within the rotator interval. The tendon is not visualized within the bicipital groove.

Output: Massive rotator cuff tear and other findings as above.


Instruction: Generate impression based on medical findings.

Input: Reason: pain History: pain ROTATOR CUFF: There is minimal heterogeneity of the supraspinatus tendon suggesting mild tendinosis, but we see no discrete tear. The supraspinatus muscle appears intact. The infraspinatus muscle and tendon appear intact. The teres minor muscle and tendon appear intact. There is increased signal intensity along the deep fibers of the subscapularis tendon likely representing a combination of tendinosis and undersurface tearing, but we see no full-thickness subscapularis tear. There is perhaps mild fatty atrophy of the superior fibers of the subscapularis muscle. There are foci of signal abnormality within the lesser tuberosity which are likely degenerative in etiology.SUPRASPINATUS OUTLET: Mild to moderate osteoarthritis affects the acromioclavicular joint. There is no fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. Mild osteoarthritis affects the glenohumeral joint. There is a small amount of fluid within the glenohumeral joint extending into the subscapular recess. There is poorly defined intermediate signal intensity within the joint, anteriorly, which may represent a synovitis. There is mild degeneration of the anterior superior labrum, but otherwise the labrum appears normal for age.BICEPS TENDON: The tendon of long head of the biceps appears perched on the lesser tuberosity, suggesting pulley dysfunction and its margins are irregular within the proximal bicipital groove indicating partial thickness tearing.ADDITIONAL

Output: 1. Undersurface degeneration and tearing of the subscapularis tendon. There is also partial thickness tearing of the long head of the biceps tendon which appears perched on the lesser tuberosity, suggesting pulley dysfunction.2. Osteoarthritis of the acromioclavicular and glenohumeral joints. Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Ms Greco is a 37 year old female with history of right triple negative breast cancer and metastatic right axillary lymphadenopathy, status post neoadjuvant chemotherapy. Patient is on I-SPY 2 research protocol, with most recent breast MRI (10/10/2016) demonstrating reduction in size of the index mass, satellite lesions and metastatic right axillary lymph node. Patient also has history of benign right 9:00 biopsy (fibrocystic change, ductal ectasia) and benign left retroareolar biopsy. Family history is positive for premenopausal breast cancer in a maternal aunt. This is I-Spy MRI #4. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No suspicious enhancement is seen in either breast. There is a 3 mm enhancing focus located several centimeters medial to the site of the previously enhancing right breast index malignancy. This focus has central high T2 signal and thin peripheral enhancement. The high T2 signal at this site is even more apparent on the most recent prior study. The appearance is compatible with either a small inflamed cyst or an oil cyst/fat necrosis (consensus opinion of 3 breast radiologists). The two Hydromark clips in the right breast and one on the left are well seen. The index malignancy clip is not well seen on MRI today. The anterior left breast proven benign mass does not significantly enhance today. The biopsied right axillary lymph node contains Hydromark clip artifact and measures up to 8 mm, previously 1.3 cm on the October MRI. The additional axillary clip is seen outside of this node, in fat anterolateral to the node. No abnormal axillary lymph nodes are identified in the left axillary region.

Output: 1. No significant residual enhancement at the sites of proven right breast malignancy. 2. Interval decrease in size of biopsied right axillary lymph node.3. Enhancing focus in the right medial breast is benign in appearance, compatible with an inflamed cyst or oil cyst/fat necrosis. Once treatment is completed, an annual MRI follow up should be considered based on her breast density and young age at cancer diagnosis.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on medical findings.

Input: Prostate cancer PELVIS:PROSTATE:Prostate Size: 3.2 x 4.9 x 3.5 cm (AP x TR x CC; series 801, image 15).Peripheral Zone: Nodular focus of T2 hypointensity involving the left peripheral zone at the apex with associated low ADC signal and is suspicious for carcinoma (series 801, image 13). Additional scattered foci of T2 signal abnormality are present.Central Gland: Benign prostatic hyperplasia.Seminal Vesicles: No significant abnormality noted. Extracapsular Extension: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Nodular focus of T2 signal abnormality involving the left peripheral zone at the apex is suspicious for carcinoma.2.No evidence of extracapsular extension, seminal vesicle invasion, or lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Likely soft tissue lipoma; lesion in the midline; evaluate depth/size, spinal abnormality. Signs and symptoms: Soft tissue mass. Nonenhanced thoracic spine MRI:There is normal anatomical alignment and signal intensity of vertebral column. There is no detectable significant degenerative disease at any level. There is no evidence of the spinal canal or neural foraminal compromise at any level. There is normal signal intensity and caliber of thoracic cord.There is a small well demarcated subcutaneous mid line lipoma in the subcutaneous soft tissues of the spine posteriorly at T9 and T10 measuring 40-mm in cranial cephalad access and 8mm in AP axis and 31-mm in transverse axis. The lipoma is directly over the musculature without extension into the musculature.The paraspinal soft tissues are otherwise entirely within normal.

Output: 1.Well-demarcated posterior subcutaneous midline lipoma at T9 and T10 measuring at 8 mm in AP x 40 mm in cc and 31mm in transverse axis as detailed above.2.Negative nonenhanced thoracic spine MRI otherwise.


Instruction: Generate impression based on medical findings.

Input: The lumbar lordosis is preserved. Minimal anterolisthesis of L3 over L4 and L4 on L5 appear similar to prior examination. The vertebral body heights are maintained. The non-contrast bone marrow signal characteristics are within normal limits. Lumbar spinal cord signal intensity and morphology are normal throughout. The conus terminates at L1 level showing normal morphology and signal characteristics. There is congenital narrowing of the lumbar spinal canal secondary to short bilateral pedicles and posterior epidural lipomatosis. There is redundancy and thickening of the cauda equina nerve roots. There is slight loss of disk height and disk desiccation at L3-4, L4-5 and L5-S1 with vacuum disc phenomena now at L4-5 and L5-1. Additional level specific findings are as follows.T10-T11: Unremarkable. T11-T12: Unremarkable. T12-L1: Unremarkable. L1-2: Unremarkable. L2-3: There is mild central spinal stenosis on the basis of developmental spinal canal narrowing without neuroforaminal stenosis. Bilateral facet and ligamentous hypertrophic degenerative changes are seen. L3-4: There is a diffuse disc bulge with facet and ligamentous hypertrophic degenerative changes with bilateral degenerative facet joint effusions resulting in mild to moderate right and moderate left neuroforaminal stenosis. A small dorsal left facet joint synovial cyst is visualized. L4-5: There is minimal uncovering of the disc with superimposed mild disc bulge is rightward predominant. There is significant bilateral facet arthropathy and ligamentum flavum thickening, greater on the left side. This results in moderate-severe left foraminal narrowing. There is moderate central spinal canal stenosis. L5-S1: There is a diffuse disc bulge eccentric to the left with a a superimposed left paracentral disc extrusion migrating cranially indenting the left thecal sac and impinging upon the descending left S1 nerve root. There are severe left and moderate right facet/ligamentous degenerative changes resulting in moderate-severe right and moderate left neuroforaminal stenosis.

Output: 1. Developmental narrowing of the mid to distal lumbar spinal canal. 2. Multilevel degenerative changes of the lumbar spine as described above, most pronounced at L5-S1 level where there is moderate severe right and severe left foraminal narrowing, as well as at L4-L5 where there is high-grade left foraminal narrowing.


Instruction: Generate impression based on medical findings.

Input: Left leg pain and weakness and anosmia with history of stroke. Brain: There is cavitary encephalomalacia centered in the straight gyri bilaterally, right larger than left, as well as volume loss of the bilateral olfactory bulbs and tracks. There is also susceptibility effect along the margins of the encephalomalacic cavities, which likely represents chronic hemosiderin deposition. Furthermore, there is dural thickening and enhancement of the overlying dura in this region, which may be reactive in nature. There are subcentimeter foci of encephalomalacia in the pons and left thalamus and basal ganglia. There is unchanged extensive diffuse patchy and punctate T2 hyperintensity and scattered punctate foci of susceptibility effect in the cerebral and brainstem white matter. There is a background of mild diffuse cerebral volume loss. There is no evidence of acute infarction. There is no midline shift or herniation. The major cerebral flow voids are grossly intact. The skull and scalp soft tissues are grossly unremarkable. There is scattered paranasal sinus mucosal thickening and secretions. There are also subcentimeter adenoid retention cysts.Orbits: There is a defect in the defect in the left lamina papyracea, with protrusion of orbital fat and deformity of the left medial rectus muscle. The bilateral globes and ocular adnexa otherwise appear to be intact. There is no evidence of intraorbital mass lesions or abnormal enhancement.

Output: 1. Encephalomalacia and hemosiderin deposition involving in the bilateral straight gyri, as well as the olfactory bulbs and tracks, right larger than left, which may represent the sequela of prior hemorrhagic contusions. 2. Extensive chronic small vessel ischemic disease and chronic lacunar infarcts, but no evidence of acute infarction. 3. A defect in the left lamina papyracea may represent a chronic fracture. The bilateral orbits otherwise appear unremarkable.


Instruction: Generate impression based on medical findings.

Input: 68-year-old female with history of carcinoid of the ileum ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter, 1 to 2 mm T2 hyperintense lesions in the right lobe of the liver.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter renal cysts. No hydronephrosis. 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.PELVIS:UTERUS, ADNEXA: Multiple uterine fibroids. Small amount of fluid in the endometrial canal. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes in the right lower quadrant from bowel resection. BONES, SOFT TISSUES: Perineural cyst versus Tarlov cyst in the sacrum. OTHER: No significant abnormality noted.

Output: 1.No suspicious lesions are evident to suggest metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Images are motion degraded. Given this caveat:There is slight reversal of normal 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. The visualized paraspinal contents are unremarkable.C2/3: UnremarkableC3/4: UnremarkableC4/5: UnremarkableC5/6: Posterior osteophyte disc complex asymmetric to the right combined with right uncinate hypertrophy causes slight anterior right hemicord flattening without intrinsic cord signal abnormality. There is mild right neural foraminal stenosis.C6/7: Posterior osteophyte disc complex and bilateral uncinate hypertrophy. There is moderate to severe left neural foraminal and minimal right neural foraminal stenosis.C7/T1: UnremarkableT1/2: Endplate spurring towards the left causes mild encroachment of the left neural foramen.

Output: 1.C5/6: Posterior osteophyte disc complex asymmetric to the right combined with right uncinate hypertrophy causes slight anterior right hemicord flattening without intrinsic cord signal abnormality. There is mild right neural foraminal stenosis.2.C6/7: Posterior osteophyte disc complex and bilateral uncinate hypertrophy. There is moderate to severe left neural foraminal and minimal right neural foraminal stenosis.3.T1/2: Endplate spurring towards the left causes mild encroachment of the left neural foramen.


Instruction: Generate impression based on medical findings.

Input: CT head 9/10/2015 and 9/10/2013. MRA BRAIN: There is a saccular aneurysm arising from the anterior communicating artery that is inferiorly-directed and measures 9 mm in length, 7 mm in width, and a neck that measures approximately 5 mm in width. There appears to be mild mass-effect upon the prechiasmatic optic nerves. There is no evidence of significant steno-occlusive lesions. The left vertebral artery terminates are the PICA, which is an anatomic variant.MRI BRAIN: There is no evidence of intracranial hemorrhage or acute infarct. There are scattered subcortical and confluent periventricular hyperintensities, which may be nonspecific most likely related to chronic small vessel ischemic changes. The ventricles are unchanged. There is no midline shift or herniation. There are left orbital floor fracture and lamina papyracea blow out fractures associated with enophthalmos. The left maxillary sinus contains mucosal thickening and is smaller in size compared to the right. There is torus palatinus. There is a large lipoma overlying the right occipital scalp, grossly unchanged from previous.

Output: 1. A saccular aneurysm arising from the anterior communicating artery measures up to 9 mm.2. No evidence of acute intracranial hemorrhage or acute infarct.3. Moderate periventricular white matter hyperintensities likely related to chronic small vessel ischemic disease.4. Chronic eft orbital floor fracture and lamina papyracea blow out fractures associated with enophthalmos.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: 56-year-old male with knee pain, rule out meniscus or chondral injury. MENISCI: There is complex tear of the body of the lateral meniscus, extending to the tibial surface. There is also extensive tearing of the body and posterior horn of the medial meniscus, with a small fragment flipped into the intracondylar notch posteriorly.ARTICULAR CARTILAGE AND BONE: Full-thickness cartilage loss is seen in the central weight-bearing portion of the medial femoral condyle. Patellar chondral softening is also noted. Subchondral sclerosis and cyst formation particularly affects the medial tibial plateau.LIGAMENTS: There is subacute to chronic tearing of the anterior cruciate ligament. The posterior cruciate ligament is intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1.Medial and lateral meniscal tears, as above.2.Subacute to chronic ACL tear.


Instruction: Generate impression based on medical findings.

Input: 50 year-old female status post craniotomy for meningioma. Postoperative changes status post bifrontal craniotomy, with pneumocephalus, surgical hardware, and skin staples evident. Previously described partially calcified lesions along the anterior interhemispheric fissure just right of midline and along the high left frontal convexity are unchanged. There is marked low attenuation within the frontal lobes, right greater than left, corresponding to edema seen on MRI. The previously described area of focal low attenuation in the medial left frontal lobe appears increased compared with the prior study, concerning for ischemia. Punctate high attenuation in the medial left frontal lobe may represent a calcification or hemorrhage, though thrombus within the anterior cerebral artery may have this appearance.A small curvilinear focus of high attenuation is seen in the medial right frontal lobe inferior to the partially calcified lesion, which may represent a small focus of hemorrhage, unchanged from the prior study. The degree of leftward midline shift and ventricular volumes are unchanged. The remainder of the cerebral and cerebellar hemispheres and brainstem demonstrate normal morphology and attenuation. Postoperative changes affect the frontal bones, with the remainder of the calvarium and osseous structures appearing intact. There is partial opacification of the left anterior ethmoid air cells, with the remainder the visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Continued evolution of focal low attenuation in the medial left frontal lobe, suspicious for anterior cerebral artery territory or venous infarction.2. Extensive postoperative changes with residual tumor and mass effect unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old, with known pituitary mass, assess for progression, annual screening. A heterogeneous enhancing mass centered on the sella is redemonstrated which measures up to 18 mm in the craniocaudal dimension and which shows no significant interval change in size or morphology. The lesion extends into the suprasellar cistern with mass effect upon the optic chiasm, similar to prior. The lesion fills the sella from side to side and may extend minimally into the right cavernous sinus, but without significant mass effect upon the ICA. The pituitary infundibulum deviates towards the left similar to that seen on the prior examination.

Output: No interval change in the size or morphology of the pituitary mass.


Instruction: Generate impression based on medical findings.

Input: 38 years Female (DOB:4/8/1977)38 year old female with new onset electrical sensation in head occurring multiple times a dayPROVIDER/ATTENDING NAME: SERVICES ANCILLARY SERVICES ANCILLARY The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: MRI of the brain is within normal limits


Instruction: Generate impression based on medical findings.

Input: Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. There are degenerative bone marrow endplate changes at the C6-C7 level. There is disc desiccation with mild to moderate loss of intervertebral disc height at the C3-C4 and C6-C7 levels. There is a well-defined focus of increased STIR signal in the left aspect of the spinal cord at the C3-C4 level. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C1/2: No significant abnormality.C2/3: Mild disc osteophyte complex. No significant spinal canal or neural foraminal stenosis.C3/4: Mild disc bulge and small disc osteophyte complex causes moderate spinal canal stenosis, moderate right and mild left neural foraminal stenoses.C4/5: Mild disc bulge and small disc osteophyte complex causes mild spinal canal stenosis and minimal narrowing of the neural foramen bilaterally.C5/6: Mild disc bulge, disc osteophyte complex and bilateral facet arthropathy causes moderate to severe bilateral neural foraminal stenoses. There is mild narrowing of the spinal canal, predominantly on a developmental basis. There is very mild edema associated with the bilateral facet arthropathy.C6/7: Mild disc bulge and prominent uncovertebral osteophyte formation causes mild to moderate spinal canal stenosis, severe left and moderate to severe right neural foraminal stenoses.C7/T1: Mild disc bulge and bilateral facet arthropathy causes mild to moderate left and mild right neural foraminal stenoses. No significant spinal canal stenosis.Ovoid cystic lesion in the midline posterior subcutaneous tissues at the C4-C5 level may represent a sebaceous cyst but is nonspecific and can be correlated with examination.

Output: 1. Multilevel degenerative changes of the cervical spine, including moderate spinal canal stenosis at the C3-C4 level and to a lesser degree at the C4-C5 and C6-C7 levels.2. Focal T2 signal abnormality in the left aspect of the spinal cord at the C3-C4 level is favored to represent myelomalacia.


Instruction: Generate impression based on medical findings.

Input: Focal seizure with secondary generalization. Abnormal EEG because of an active T8 spike focus. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. The hippocampi appear to be grossly intact and there is no evidence of heterotopia. 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: No discernible seizure foci.


Instruction: Generate impression based on medical findings.

Input: History of primary sclerosing cholangitis. Evaluate for concerning lesion. ABDOMEN:LIVER, BILIARY TRACT: There is mild left liver lobe atrophy. There is multifocal bilobar left greater than right irregular stricturing and dilatation of the intrahepatic bile ducts and the common bile duct consistent with primary sclerosing cholangitis. This most prominently involves the lateral segment of the left hepatic lobe, but this is improved from the prior study, for example, duct measuring up to 5 mm today, compared to 7 mm previously. No underlying lesion is evident on today's study. No new dominant stricture or discrete mass lesion is evident. Segment 5 subcentimeter simple hepatic cyst. Normally distended gallbladder. The vessels are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post left nephrectomy with susceptibility artifact in the nephrectomy bed. No evidence of residual recurrent tumor in the nephrectomy bed.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: Redemonstrated multifocal areas of severe dilatation and stricturing of the intra and extrahepatic biliary tree most pronounced in the left lobe laterally appearing slightly improved from the prior study without a discrete masslesion evident. An underlying masslesion cannot be entirely excluded but the interval mild decrease in bile duct dilatation favors a benign PSC stricture.


Instruction: Generate impression based on medical findings.

Input: 74-year-old female history of CAD and S/P CABG presents with acute SOB evaluate for stroke On image 19, a small focal hypoattenuation adjacent to the right Sylvian fissure most likely due to technique difference from prior. If acute ischemic infarction is concerned, MRI exam is recommended.The images re-demonstrate chronic ischemic infarction in the right basal ganglia and the left thalamus as well as periventricular white matter small vessel disease. There is no evidence of intra-or extra axial fluid collection/hemorrhage, mass or edema.The ventricles and basal cisterns are normal in size and configuration for the patient's stated age.The calvaria and skull base are radiographically normal. Visualized paranasal sinuses and mastoid air cells are normally pneumatized. Calcified atherosclerotic disease of the vertebrobasilar system and internal carotid arteries is noticed.

Output: Small vessel ischemic disease and chronic ischemic infarction with no evidence of acute intracranial hemorrhage/ischemic change.


Instruction: Generate impression based on medical findings.

Input: 53 years Female (DOB:10/2/1962)Reason: hx Lumbar schwannoma. eval for change in size History: back pain., left leg painPROVIDER/ATTENDING NAME: EDWIN RAMOS EDWIN RAMOS Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a mild disc bulge at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is a left lateral disc protrusion at this level which narrows the left neural foramen and displaces the left-sided exiting nerve roots after they exit the neural foramen.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is a left far lateral disc protrusion at this level which abuts the left-sided exiting nerve root as it exits the neural foramen. There are some mild enhancement present within this disc protrusion at the left far lateral zone and adjacent the left neural foramenAt L2-3 there is no significant compromise to spinal canal or neural foramina. There is a left far lateral disc protrusion at this level which encroaches on the left-sided exiting nerve root after it exits the neural foramen. There is effacement of fat planes adjacent to this left far lateral disc protrusion expected location of the nerve roots. There is associated enhancement along the left-sided exiting nerve root after it exits the neural foramen.At L1-2 there is no significant compromise to spinal canal or neural foramina. There is a broad-based left lateral recess disc protrusion present at this level without compromise to spinal canal or exiting nerve roots.

Output: 1.There is a left far lateral disc protrusion present at L2-3 which displaces the left-sided exiting nerve root as it exits the neural foramen. This is associated with some infiltration adjacent to it. This infiltration could represent inflammation or an alternative type of infiltrating lesion. Please correlate with clinical symptoms.2.There are infiltrative changes are also associated with left lateral disc protrusion at L3-4 and the left far lateral zone which are less prominent than at L2-3. Involve the adjacent exiting nerve root as it exits the neural foramen. This could also represent inflammation or an alternative type of infiltrating lesion.


Instruction: Generate impression based on medical findings.

Input: Clinical question: subarachnoid hemorrhage. Signs and symptoms :subarachnoid hemorrhage. Nonenhanced head CT:Residual blood within the fourth ventricle with interval decrease since prior study.Interval decrease in the supratentorial subarachnoid hemorrhage. Extensive residual hemorrhage is still present.Hematoma in the interhemispheric fissure measuring 28.7-mm in transverse axis not significantly changed since prior study. There is effacement of all cortical sulci. There are one suspected areas of cortical low attenuation in the left frontal and parietal region concerning for air the onset of ischemic stroke. Follow-up with an MRI is recommended.Shunted lateral ventricles remain stable in size since prior study and no evidence of hydrocephalus. Residual blood within the lateral ventricles demonstrate no definitive interval change.

Output: 1.No evidence of new hemorrhage since prior study.2.Slight interval decrease in the amount of subarachnoid hemorrhage and blood within the fourth ventricle.3.Stable size of ventricular system and intraventricular hemorrhage in the lateral and third ventricle.4.Suspected areas of low attenuation of the cortex in the left hemisphere concerning for possible early onset of ischemic strokes. For further evaluation an MRI exam is recommended.


Instruction: Generate impression based on medical findings.

Input: Chronic myelomonocytic leukemia not having achieved remission [C93.10] / Nontraumatic subarachnoid hemorrhage, unspecified [I60.9] / Transplanted organ and tissue status, unspecified [Z94.9] / Toxoplasmosis, unspecified [B58.9], Reason for Study There is evidence of encephalomalacia on the right parietal lobe superior parietal lobule and right superior and middle frontal gyri indicating chronic ischemic infarct. These lesions are new comparing to prior scan.There is no abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses are clear.Fluid collections on the right mastoid air cells.

Output: 1. Interval development of right superior and middle frontal gyri as well as right parietal lobe superior lobe middle indicating chronic ischemic infarct.2. No abnormal enhancement.


Instruction: Generate impression based on medical findings.

Input: 42-year-old female with locally recurrent cervical cancer undergoing external beam radiation with brachytherapy. Routine monitoring during treatment with MRI. PELVIS:UTERUS, ADNEXA: Large nearly circumferential cervical mass is redemonstrated, extending to the mid to low uterine body. It measures approximately 6.5 x 5.3 x 7.0 cm (AP by ML by CC dimensions), previously 6.7 x 5.0 x 8.5 cm. Invasion into the vagina, parametrium and posterior bladder is again seen, with large fistulous communication between the bladder and vagina/uterine cavity redemonstrated (series 901, image 28). Total tumor volume appears to have slightly decreased in size, as evidenced by aforementioned measurements and extent of tumor into the uterine body. Tumor is again noted abutting the rectum posteriorly without definite evidence of invasion.BLADDER: Invasion of the posterior bladder by cervical mass, as described above. Bilateral nephroureteral stents are again noted.LYMPH NODES: Multiple pathologically enlarged bilateral inguinal pelvic lymph nodes are redemonstrated. A right pelvic lymph node measures 1.8 x 0.9 cm (series 1301, image 223), previously 2.8 x 1.9 cm. Other pelvic and inguinal lymph nodes are also stable to mildly decreased in size.BOWEL, MESENTERY: New rectal wall thickening likely represents radiation-related effects.BONES, SOFT TISSUES: The partially imaged anterior L5 vertebral body lesion demonstrating hypointense T1 and T2 signal and rim peripheral enhancement on postcontrast images is suspicious for osseous metastasis and is more prominent than seen on prior imaging.OTHER: No significant abnormality noted.

Output: 1.Large cervical mass has slightly decreased in size. Invasion and fistulization with the posterior bladder is redemonstrated.2.Lymphadenopathy is stable to slightly decreased, as above.3.Increased size of a peripherally enhancing L5 anterior vertebral body lesion, suspicious for metastasis though may also represent radiation-related effects.


Instruction: Generate impression based on medical findings.

Input: Female, 39 years old. Reason: assess bleed R ICH-- going straight to OR History: altered mental status There is an acute right temporal lobe hematoma measuring 4.6 x 3.5 cm with surrounding vasogenic edema and associated 10 mm of leftward midline shift. Small amount of subarachnoid hemorrhage is also present. There is no evidence of hydrocephalus.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Acute right temporal lobe hematoma with associated vasogenic edema and midline shift.


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. There is mild asymmetry to the lateral ventricles with the right being larger than left and a slight medial outpouching of the right lateral ventricle results in mild mass effect on the right fornix. The hippocampi are symmetric and normal in appearance. There is no evidence of structural abnormality. The midline structures and craniocervical junction are within normal limits. There is no midline shift or herniation. The major cerebral flow voids are intact.

Output: Mild asymmetry to the lateral ventricles with the right being larger than left and a slight medial outpouching of the right lateral ventricle resulting in mild mass effect on the right fornix. This finding is of uncertain clinical significance and may simply reflect altered CSF flow dynamics. The exam is otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Nonspecific biliary dilation of the common bile duct noted on ultrasound. History of hepatitis C. ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter liver cysts. A subcentimeter arterially enhancing T2 hyperintense lesion in the inferior left hepatic lobe (series 11, image 52) likely represents an hemangioma. A nonenhancing T2 hyperintense lesion in the right hepatic lobe (series 11, image 62) is indeterminant though likely of benign etiology. The common bile duct is prominent up to the level of the ampulla. No definite ampullary mass is identified. No intrahepatic biliary ductal dilation is present.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic duct is prominent up to the level of the ampulla. The pancreas is of normal signal and enhancement, without pancreatic mass identified.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts, some of which are hemorrhagic. Otherwise no abnormality noted.RETROPERITONEUM, LYMPH NODES: A peripancreatic retroperitoneal lobulated nodule measures 2.5 x 2.3 cm (series 4, image 20), likely representing an enlarged lymph node. An additional enlarged portocaval lymph node is identified (series 4, image 21).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Prominent common bile duct and pancreatic duct up to the level of the ampulla. Enlarged retroperitoneal lymph nodes. Although a definite ampullary mass is not identified on MR, ERCP is may be helpful for further evaluation given these findings.


Instruction: Generate impression based on medical findings.

Input: 52 year old female with right pain, evaluate for labral tear, FAI. ACETABULAR LABRUM: There is extravasated contrast within the anterior soft tissues which is iatrogenic related to the injection. There is contour irregularity of the acetabular labrum suggestive of degenerative tearing.ARTICULAR CARTILAGE AND BONE: There is irregularity of articular cartilage of the femoral head and acetabulum with subchondral sclerosis in the femoral head and subchondral cyst formation in the acetabulum. No evidence of femoral head collapse. Bone marrow signal is otherwise normal. There are no findings suggest femoral acetabular impingement with a normal alpha angle measurement.SOFT TISSUES: As mentioned above there is extravasated contrast within the anterior soft tissues which is iatrogenic related to injection.ADDITIONAL

Output: Posterior arthritic changes of the right hip as discussed above. No evidence of femoral acetabular impingement.


Instruction: Generate impression based on medical findings.

Input: Unspecified fracture of second lumbar vertebra, sequela [S32.029S], Reason for Study: ^Reason: history of L2 pathologic fracture History: history of L2 pathologic fracture There is complete loss of normal fatty marrow of L2 vertebral body with compression fracture of about 30% of height loss. There is central to left retropulsion of fractured fragment with soft tissue mass results thecal sac indentation. Enhancing nature of the soft tissue mass indicate metastatic lesion. Bilateral neural foramina appear to be preserved.There are additional vertebral body compression fractures at L1 (about 25%) and L5 (about 10%) especially superior endplate area with bone marrow edema. Though those fracture areas show some enhancement of vertebral bodies, these lesions are not associated with soft tissue masses, thus unlikely to be metastatic lesion. There is normal thoracic kyphosis. The thoracic spine alignment is anatomic. The bone marrow and end plates of thoracic spine demonstrate a normal MR appearance. The signal of the visualized cord is normal. There is no evidence of spinal canal/neural foraminal narrowing, cord compression, or myelopathy. The conus medullaris terminates at the L1 level.

Output: 1. Compression fracture with soft tissue mass on the L2 vertebral body with central to left retropulsion as described above.2. Additional compression fractures at the level of L1 and L5 without evidence of associated soft tissue mass indicating possible non-malignant compression fractures.3. Spinal cord signal intensity appears to be normal.


Instruction: Generate impression based on medical findings.

Input: Right knee pain MENISCI: There is increased horizontal signal within the posterior horn of the medial meniscus, reflecting tear. There is mild extrusion of the meniscus into the medial gutter although the root appears intact. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is full-thickness cartilage loss of the medial compartment of both the femoral condyle and tibial plateau there is associated degenerative marrow signal within the underlying bone. The articular cartilage of the lateral compartment is relatively preserved. There is thinning of the articular cartilage of the femoral trochlea without full-thickness defect of the patellar cartilage.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Horizontal tear of the posterior horn of the medial meniscus with mild extrusion.2. Full-thickness cartilage loss of the medial compartment with milder thinning of the patellofemoral and lateral compartments.3. Small joint effusion and mild synovitis.


Instruction: Generate impression based on medical findings.

Input: 37 year old with history of heart transplant in may 2015, hypertension, hyperglycemia presenting with pericardial effusion s/p drainage. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 67 ml/m2 (normal range: 74+/-15), the LVEDV is 151 ml (normal range 142+/-34), the LV end systolic volume index is 30 ml/m2 (normal range 25+/-9), the LVESV is 68 ml (normal range 47+/-19), the LV mass index is 56 g/m2 (normal range 85+/-15), and the LV mass is 126 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 myocardial fibrosing, infiltrative, or inflammatory process. Native T1 times are moderately elevated at 1160 ms in the mid interventricular septum. Left AtriumThe left atrium is consistent with transplant morphology. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 59%, the RV end diastolic volume index is 79 ml/m2 (normal range 82+/-16), the RVEDV is 178 ml (normal range 142+/-31), the RV end systolic volume index is 32 ml/m2 (normal range 31+/-9), and the RVESV is 73 ml (normal range 54+/-17).Right AtriumThe right atrium is consistent with transplant morphology.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 is normal in size. There is IVC continuation of the azygous vein, which is enlarged and empties in the SVC normally. PericardiumThe pericardium is moderately thickened with evidence of increased T2-signal and late gadolinium enhancement of the visceral and parietal pericardium. Based on myocardial tagging, the pericardium is tethered to the myocardium. On real time cine imaging, there is no obvious interventricular discordance during respiration noted. There is a small, loculated complex appearing pericardial effusion located posteriorly. Extracardiac FindingsThere are small bilateral pleural effusions, left greater than right. Sternotomy wires are present. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The pericardium is moderately thickened with evidence of increased T2-signal and late gadolinium enhancement of the visceral and parietal pericardium. Based on myocardial tagging, the pericardium is tethered to the myocardium. On real time cine imaging, there is no obvious interventricular discordance during respiration noted. There is a small, loculated complex appearing pericardial effusion located posteriorly. These findings suggest that the pericardium is significantly inflamed. 2. Normal left ventricular size and systolic function (LVEF 55%) without evidence of underlying myocardial late gadolinium enhancement suggesting the absence of replacement fibrosis or overt inflammation; however, the native myocardial T1 time is moderately elevated which could be seen in the setting of subclinical edema or mild diffuse interstitial fibrosis. 3. Normal right ventricular size and systolic function (RVEF 59%). 4. Small bilateral pleural effusions 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: word finding deficit, history of NSCLC. Multiple restricted diffusion lesions on bilateral hemispheres, right thalamus and right cerebellar hemisphere indicating acute ischemic infarctions. No evidence of hemorrhagic conversion.The left side of clivus shows relatively well marginated, subtle enhancing lesion (22mm x 17mm) about mainly low signal intensity on T1 and low signal intensity on T2 weighted images. Considering the patient's history of NSCLC and prior PET scan, this lesion is likely represent metastatic bony lesion. The ventricles, sulci and cisterns are symmetric and unremarkable.There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage,or abnormal contrast enhancement. The midline structures are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal flow enhancement in bilateral ICAs, bilateral MCAs and ACAs. Acom artery is patent and right Pcom artery is patent but the left Pcom is not seen. There is no intracranial aneurysm. There is no intracranial large vessel occlusion.3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries. 3D MRV brain post-gadolinium with maximum intensity projections of the superficial/deep intracranial venous drainage demonstrate normal flow enhancement in the superior sagittal sinus, transverse sinuses, sigmoid sinuses, internal cerebral veins, vein of Galen and straight sinus.

Output: 1. Multifocal acute ischemic infarctions on bilateral hemispheres, right thalamus and right cerebellar hemisphere without evidence of hemorrhagic conversion.2. 22mm x 17mm sized lesion on the left side of clivus likely represent metastatic lesion.3. No evidence of intracranial arterial aneurysm. No intracranial arterial stenosis.4. Normal extracranial craniocervical arterial system.5. Normal intracranial superficial and deep venous system on MRV.


Instruction: Generate impression based on medical findings.

Input: 75 years Male (DOB:5/1/1940)Reason: assess for herniated disk, spinal stenosis History: groin pain and weakness. EMG with S1 pathologyPROVIDER/ATTENDING NAME: WILLIAM R. HARPER WILLIAM R. HARPER Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height and disc desiccation and a mild disc bulge at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is asymmetric loss of disc space height with more loss of disc space height on the right side compared to the left side of the disc space. There is partial effacement of the fat at the lateral recess bilaterally at this level which has mildly progressed compared to the previous exam. There are endplate reactive changes present at this level with some T2 signal hyperintensity suggestive of some acute or subacute endplate reactive change along the right half of the disc space.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is mild loss of disc space height, disc desiccation and diffuse disc bulge at this level which was also present on the prior exam.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation present at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina.Since the prior exam an abdominal aortic aneurysm has decreased significantly in size.There is redemonstration of a renal cyst along the right kidney which currently measures 33 x 24 mm axial dimensions and previously measured 24 x 19 mm axial dimensions.

Output: 1.There are degenerative changes present in the lumbar spine which appear to be worse at L4-5 where there is some subacute endplate reactive changes and mild encroachment of the nerve roots at the lateral recess is. Overall the findings at L4-5 have slightly progressed.2.Since prior exam a cyst along the right kidney has mildly enlarged3.The prior exam the patient is undergone abdominal aortic aneurysm repair


Instruction: Generate impression based on medical findings.

Input: Status post L1 -- L3 spinal fusion and tumor resection. There is mild thickening at the posterior aspect of the trachea at the T3 level. At T10 - T11 right neural foramen, there is prominent soft tissue density of uncertain etiology. This may represent prominent nerve root sleeve or perineural cyst and can be better assessed with MRI study.Postsurgical changes of tumor resection at L2 vertebral level, and spinal fusion from L1 to L3 are again noted. Hardware is intact without evidence of acute fracture. Fusion cage at L2 level is again seen positioned posteriorly laterally, and is causing effacement of the left neural foramina at L2 -- L3, with possible nerve impingement. Multi-level degenerative disease of the lumbar spine is again noted with spinal canal and neuroforaminal narrowing as described previously. No significant interval change is noted.

Output: 1. Postsurgical changes and degenerative disease of the lumbar spine as described above. No evidence of interval change.2. Mild thickening at the posterior aspect of the trachea at the T3 level of uncertain significance. This can represent secretion. Please correlate or follow-up as clinically indicated.3. At T10 - T11 right neural foramen, there is prominent soft tissue density of uncertain etiology. This may represent prominent nerve root sleeve or perineural cyst and can be better assessed with MRI study.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old, with history of brain metastases status post laser ablation to the right frontal lesion and stereotactic radiosurgery to a left occipital lesion. A partially solid and partially cystic lesion is redemonstrated within the right superior frontal gyrus. As on prior examinations, the solid component is intrinsically T1 hyperintense but does also enhance homogeneously. Although it is difficult to appreciate significant changes in this lesion when compared to the immediate prior exam, the solid nodular component of the lesion has more clearly increased in size when compared to older studies. For example, the solid component measures up to 17 mm in the axial plane on today's examination, and measured approximately 10 mm on 01/18/16. There is a mild degree of surrounding parenchymal FLAIR hyperintensity which has also slowly increased over the prior several exams.An intrinsically T1 hyperintense, enhancing nodule within the cuneus of the right occipital lobe has also increased slightly in size over prior examinations. Mild associated FLAIR hyperintensity has also become more conspicuous.A previously seen enhancing nodule within the cuneus of the left occipital lobe has clearly decreased in size. Associated FLAIR hyperintensity has also diminished.No new pathologic enhancement is observed. A small developmental venous anomaly is redemonstrated along the right postcentral gyrus. A small pineal region cyst is unchanged and likely benign. No evidence of generalized mass effect is seen. Multiple foci of nonspecific parenchymal FLAIR hyperintensity are redemonstrated without significant interval change. Ventricular size and morphology are within normal limits.

Output: 1.Slow interval growth of a lesion in the right superior frontal gyrus is noted, most evident when comparison is made over multiple prior studies.2.Similarly, slow interval growth of a lesion in the right superior occipital lobe is demonstrated.3.Interval decrease in size of a lesion in the superior left occipital lobe.4.No new lesions are detected.


Instruction: Generate impression based on medical findings.

Input: 40 year old female with a solid mass in the left breast detected by recent ultrasound study (1/30/15) presents for research MRI. Known multiple cysts in both breast. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There are multiple cysts in both breasts.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on medical findings.

Input: Right trigeminal neuralgia evaluate for demyelination or vascular compression. A venous structure appears to impress upon the inferior aspect of the root entry zone of the right trigeminal nerve, while the posterior cerebral artery abuts the superior aspect of the root entry zone of the right trigeminal nerve. 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 orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. A venous structure appears to impress upon the inferior aspect of the root entry zone of the right trigeminal nerve, while the posterior cerebral artery abuts the superior aspect of the root entry zone of the right trigeminal nerve, which may represent a vascular loop syndrome. 2. No evidence of demyelinating or mass lesions.


Instruction: Generate impression based on medical findings.

Input: 56-year-old male with history of renal cell carcinoma. Evaluate for recurrence or metastases. ABDOMEN:LIVER, BILIARY TRACT: Scattered subcentimeter benign cysts.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Postoperative changes of left upper pole partial nephrectomy.Left mid pole T2 hypointense lesion with mild enhancement measuring 1.8 x 1.4 cm (image 34 series 3). Two additional T2 hypoattenuating lesions with mild contrast enhancement are seen in the left lower pole measuring 11 and 8 mm and are indeterminant.Right upper pole T2 hypoattenuating lesion has increased in size measuring 7 mm, previously 3 mm (image 22 of series 3). Right midpole complex cyst with enhancing septations measures 1.9 x 1.3 cm, previously 1.9 x 1.6 cm (image 21 of series 13).Additional benign-appearing cysts are present bilaterally.RETROPERITONEUM, LYMPH NODES: Nonspecific right paraaortic soft tissue thickening is stable to slightly smaller when compared to prior and is nonspecific.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Left mid pole solid lesion concerning for papillary RCC, not significantly changed from prior. Additional smaller lesions in the left lower pole are indeterminant, but stable in size. 2. Interval increase in size of small right upper pole lesion which is too small to accurately characterize.3. Right sided complex cyst is stable in size and appearance.4. Stable to slight decrease in size of right paraaortic nonspecific soft tissue thickening.


Instruction: Generate impression based on medical findings.

Input: 21-year-old male with history of AML and severe avascular necrosis, now with significant R knee pain.VIEWS: Right knee AP, oblique, and lateral (3 views) 5/7/2015 at 12:55 There is patchy sclerosis of the distal femur and proximal tibia as well as focal areas of demineralization. The medial femoral condyle is flattened and contains a large subarticular crescentic lucency, this is new from to the prior study.

Output: Avascular necrosis of the distal femur and proximal tibia with subchondral collapse of the medial femoral condyle.


Instruction: Generate impression based on medical findings.

Input: Male, 25 years old, history of lymphoma, complaining of nighttime and morning pressure headaches and pins-and-needles tingling down the right arm. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. No abnormal parenchymal or extra-axial enhancement is detected. The ventricular system is normal in caliber and morphology. Bone marrow signal characteristics are unremarkable. A mucous retention cyst is evident in the right maxillary sinus.

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


Instruction: Generate impression based on medical findings.

Input: 56 show male with osteoarthritis of the knee MENISCI: There is increased signal within the anterior horn of the lateral meniscus near its root with fraying of the free edge, which may represent intrasubstance degeneration or degenerative tearing. There is a complex tear of the posterior horn extending into the body of the medial meniscus with mild medial extrusion of the body of the medial meniscus. A 4 mm parameniscal cyst is present adjacent to the medial meniscal posterior horn.ARTICULAR CARTILAGE AND BONE: There is edema along the far medial tibial plateau and anterior lateral femoral condyle which is likely reactive. There is mild thinning of the articular cartilage in the medial and lateral there is focal full-thickness cartilage loss along the lateral aspect of the trochlea with underlying reactive marrow signal changes. The patellar cartilage is intact without full-thickness cartilage loss. Small tricompartmental osteophytes are present.LIGAMENTS: The ACL and PCL are intact. There is mild fluid surrounding the MCL which may indicate a mild sprain. The lateral collateral ligament complex is intact.EXTENSOR MECHANISM: The quadriceps tendon as intact. There is mild thickening of the patellar tendon without clear internal signal.ADDITIONAL

Output: 1.Large complex medial meniscal tear.2.Increased signal within the lateral meniscus with fraying of the free edge may represent intrasubstance degeneration or degenerative tearing.3.Mild MCL sprain.4.Mild osteoarthritis.


Instruction: Generate impression based on medical findings.

Input: There are postoperative changes related to left frontal craniotomy for resection of a left frontal lobe mass. There is marginal susceptibility along the resection cavity as well as along the residual anterior left frontal lobe parenchyma, consistent with chronic hemosiderin deposition likely from the prior surgery. There is also diffuse smooth dural enhancement in the left frontal region with mild thickening, also likely postoperative in etiology. There has been interval near-resolution of enhancement along the margins of the resection cavity otherwise. There is no significant interval change in the extent of the mildly expansile T2 hyperintense infiltrative mass in the left frontal lobe surrounding the resection cavity with extension across the corpus callosum into the right frontal lobe. However, there is also increased patchy T2 hyperintensity in the white matter of the bilateral cerebral hemispheres, which may be treatment related. There is mild mucosal thickening in the right frontal sinus and left ethmoid air cells. The orbits are unremarkable.

Output: Evolution of postoperative findings related to left frontal mass resection without convincing evidence of tumor progression.


Instruction: Generate impression based on medical findings.

Input: Giant adrenal mass. Preoperative evaluation. ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in signal and morphology. There is a 1.9 cm simple cyst in the left lobe. No intrahepatic or extrahepatic biliary ductal dilatation. No suspicious enhancing lesion.SPLEEN: The spleen is displaced anteromedially into the midline. No focal suspicious lesion.PANCREAS: The pancreas is displaced medially. No focal lesion. No pancreatic duct dilatation.ADRENAL GLANDS: The left adrenal gland is compressed and displaced by the large retroperitoneal mass. There appears to be a fat plane between the adrenal gland and the mass. No adrenal mass is evident. The right adrenal gland is unremarkable.KIDNEYS, URETERS: The left kidney is displaced by the retroperitoneal mass. Multiple bilateral simple renal cysts. One cyst in the inferior pole of the left kidney has a rim of decreased signal and intermediate intrinsic T1 signal compatible with a hemorrhagic cyst.RETROPERITONEUM, LYMPH NODES: Within the left perirenal space posterior to the kidney there is a large mass which measures 24.1 x 13.0 x 19.3 cm. This mass is predominantly mildly increased T2 signal with with heterogeneous low signal internal components. There is prominent postcontrast enhancement of the peripheral components of the mass with areas of central hypoenhancement likely reflecting necrosis.Immediately adjacent to the main mass there are 2 additional nodules (series 2/2/2001 image 163 and image 147). It is unclear if these represent extensions of the main mass or small satellite lesions.The mass appears based within the retroperitoneal soft tissues and is not contiguous with or invading the adjacent organs.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Large retroperitoneal mass based in the left perirenal space is most compatible with a liposarcoma. There are 2 adjacent nodules which may reflect extension of the main mass or local metastases. No evidence of distant metastatic disease. There is extensive mass effect on the adjacent solid organs, but no evidence of direct invasion.


Instruction: Generate impression based on medical findings.

Input: Male, 42 years old, with history of right anterior skull base encephalocele, preoperative imaging. Correlating with findings on the same day CT, a lobular lesion is present centered on the left paramedian clivus with extension into the sphenoid sinus and minimally into the prepontine cistern. The lesion is T1 hypointense and markedly T2 hyperintense with some signal heterogeneity. The lesion does not enhance on postcontrast images.Although osseous structures are better assessed on prior CT, again no definite defect in the anterior skull base is seen. There are no areas of suspected meningeal or parenchymal herniation. Scattered mucosal thickening and/or secretions are redemonstrated in the paranasal sinuses.The signal characteristics and morphology of the brain are otherwise unremarkable. No evidence of restricted diffusion, edema or focal signal abnormality is seen. There are no findings to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collections. No pathologic intracranial enhancement is observed. A small right frontal developmental venous anomaly is noted incidentally. The ventricles are normal in size and morphology. A right suboccipital subcutaneous lipoma is redemonstrated.

Output: 1.A lobular, non-enhancing lesion is evident centered on the left paramedian clivus with extension into the sphenoid sinus and minimally into the prepontine cistern. Given the CT and MRI findings of this lesion, the differential diagnosis would include a notochordal remnant (ecchordosis physaliphora), as well as a neurenteric or developmental cyst. Lack of enhancement and absence of specific symptoms related to this lesion argue against chordoma or some other aggressive lesion, though this possibility is not entirely excluded.2.No evidence of any defect in the anterior skull base is seen. There are no findings to indicate herniation of meninges or brain parenchyma.3.Evaluation the brain is otherwise within normal limits.


Instruction: Generate impression based on medical findings.

Input: Numbness in the legs. History of lumbar fusion. Also history of previous radiation treatment and chemotherapy. Radiculopathy versus neuropathy. The thoracolumbar levoscoliosis centered at L2 level has not appreciably changed since the previous examination: the Cobb angle as measured from the superior endplate of T12 to the inferior endplate of L2 is 42 degrees. The left lateral subluxation of L5 relative to L4 (about 10 mm) is also unchanged. There are several sacral perineural cysts. There is no definite significant spinal canal stenosis. Otherwise, postoperative findings including posterior rods and cerclage wires is associated significant artifact limit assessment of the regional anatomy.

Output: 1.Levoscoliosis of lumber spine centered at the L2 is unchanged.2.No definite evidence of significant central spinal stenosis, although metallic artifact from posterior hardware along the dorsal aspect of vertebral column extending from T11 to S1 limits definitive assessment of the spinal levels.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: 70-year-old female with smoldering myeloma. Evaluate for bone lesions. BONE MARROW: There is a lobulated focus of increased signal abnormality on fluid sensitive sequences within the intertrochanteric region of the left femur with the imaging characteristics most consistent with an enchondroma. No additional bone marrow signal abnormality is identified.SOFT TISSUES: There is nonspecific subcutaneous edema along the posterior aspect of the lumbar spine. The imaged musculature of the pelvis is normal in appearance.JOINTS: There is a small amount of fluid within the hips without evidence of a large effusion.ADDITIONAL

Output: Findings most consistent with a benign enchondroma within the left femur without evidence of a definite myelomatous deposit affecting the pelvis.


Instruction: Generate impression based on medical findings.

Input: headache with papilledema, known AML patient on ATRA. No evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. Right maxillary sinus shows mucosal thickening.3D MRV brain pre and post-gadolinium with maximum intensity projections of the superficial/deep intracranial venous drainage demonstrate normal flow enhancement in the superior sagittal sinus, transverse sinuses, sigmoid sinuses, internal cerebral veins, vein of Galen and straight sinus.

Output: No evidence of acute ischemic or hemorrhagic lesion.Normal brain MRV.


Instruction: Generate impression based on medical findings.

Input: Low back pain for 4 to 6 weeks with arching and in school, plays volleyball, has spina bifida occulta S1. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position. No evidence of filar lipoma or other lesions within the spinal canal. Incomplete posterior arch of S1 is incidentally noted and is a common developmental variant.Individual levels as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis. L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis. There are findings suggestive of mild facet arthropathy at L4-L5 and L5-S1. Paraspinous soft tissues are within normal limits.

Output: 1. No significant disc disease or spinal canal or neural foraminal stenosis at any level.2. No evidence of tethered cord, filar lipoma, or other lesions within the spinal canal.3. If there is specific suspicion for a pars fracture, oblique radiographs or CT would be helpful. There is however no evidence of spondylolisthesis or edema involving the posterior elements.4. There is mild facet arthropathy at L4-L5 and L5-S1.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old, with history of right nasopharyngeal carcinoma status post chemotherapy and radiation. Globular, nonenhancing soft tissue is redemonstrated in the right nasopharynx. Since the prior examination, areas of frank tissue loss have progressed. No masslike lesions are seen to suggest recurrent tumor.Ill-defined edema and hyperenhancement persist within the right parotid gland and masticator space. The salivary glands are otherwise unremarkable. No pathologic adenopathy is observed. The right mastoid air cells are largely opacified with mild partial opacification on the left. Mucous retention cysts are seen in both maxillary sinuses and there is progressive mucosal thickening on the left. Marrow signal abnormality persists within the clivus, anterior C1 arch, and odontoid process. The adjacent ligamentous structures are thickened. Multilevel cervical spondylosis is again seen.

Output: 1.Progressive necrosis and tissue loss along the right nasopharyngeal mucosal space is seen. No findings are evident to suggest recurrent tumor.2.No pathologic adenopathy is detected within the field-of-view of the examination.3.Treatment related findings involving the soft tissues of the right masticator space and parotid gland are unchanged. Likewise, marrow signal abnormality and thickening along the and C1-2 articulation are unchanged and likely treatment related.4.Progressive mucosal thickening is seen in the left maxillary sinus. Opacification of the mastoid air cells suggests Eustachian tube dysfunction.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Newly diagnosed GBM status post biopsy only; please evaluate extent of brain tumor. Signs and symptoms: Difficulty speaking. Pre- and post enhanced brain MRI:Examination demonstrates a large focus of vasogenic edema in the left mid and posterior temporal lobe surrounding a large necrotic enhancing tumor. On postenhanced images the tumor measures approximately 51 x 30 mm in transaxial dimensions. Compared to prior study there is interval increased size of tumor which measure that 30 x 24 mm in transaxial dimensions. This is also noticeable interval increased surrounding mesenteric edema and mass effect. The tumor is inseparable from the temporal horn and the trigone of the left lateral ventricle. On coronal images there is significant bulge of tumor into the left lateral ventricle.There is evidence of a small craniotomy in the left posterior temporal-occipital region with underlying subtle parenchymal edema believed to represent site of previous surgical approach for biopsy. There is expected minimal superficial parenchymal enhancement at the site and with linear enhancement extending to the posterior-lateral aspect of tumor along the surgical path.Mildly prominent lateral ventricles without interval change since prior exam or deviation of the midline. Few nonspecific foci of FLAIR hyperintensity in the subcortical and periventricular white matter of cerebral hemispheres although nonspecific considering patient's stated age of 72 likely representing mild chronic nonhemorrhagic small vessel ischemic strokes.

Output: 1.Interval increased size of a necrotic rim enhancing tumor in the left mid to posterior temporal lobe and its surrounding vasogenic edema since prior exam. The enhancing tumor measures at 51 x 30 mm compared to prior study measurement of 30 x 24.2.Expected postoperative changes of prior tumor biopsy as detailed.3.Unremarkable exam otherwise and evidence of only minimal chronic nonhemorrhagic small vessel ischemic strokes.


Instruction: Generate impression based on medical findings.

Input: 12 month old male with unilateral group D retinoblastoma status post to intra-arterial chemotherapy injections, evaluate disease status Brain: 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, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Orbits: Redemonstrated is minimally enhancing lesion that measures approximately 2 x 7 mm in transaxial imaging along the posterolateral aspect of the right globe with apparent episcleral irregularity. The right optic nerve appears to be intact. These findings are unchanged. The left orbit is unremarkable.

Output: 1.Stable subcentimeter right intraocular retinoblastoma with suggestion of possible episcleral extension. 2.No evidence of left orbital tumor.3.No evidence of intracranial tumor to suggest trilateral retinoblastoma.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old, with brain metastases, on new therapy, surveillance exam. Numerous supratentorial and infratentorial enhancing lesions are redemonstrated. Since the prior exam, most of these lesions have decreased in size by several millimeters. For example, a left insular lesion now measures up to 6 mm, previously 8 mm. The large right parietal-occipital lesion has changed in shape, which may reflect collapse of the necrotic components, and despite appearing more elongated in the axial plane, has probably also decreased in size. The edema surrounding this lesion, and several others, has significantly increased, however. The right ventricular atrium is progressively effaced. There is a mild leftward midline shift, but no brain herniation. No new or growing lesions are seen. Evidence of prior right frontal instrumentation is seen. A small scalp lipoma is unchanged.

Output: Interval decrease in size of most of the numerous brain metastases is seen. A few lesions are unchanged in size, but there are no new or growing lesions. Several lesions, including the dominant right parieto-occipital lesion, show progressive edema which is favored to be a treatment effect.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for rotator cuff tear History: shoulder pain overhead activities for 6 months ROTATOR CUFF: Teres minor and subscapularis are intact. There is diffusely increased T2 signal within the supraspinatus tendon suggesting a tendinopathy with a 1 cm (AP dimension ) near full-thickness tear at the footprint. Rotator cuff muscles are intact.SUPRASPINATUS OUTLET: Type II acromion is present.GLENOHUMERAL JOINT AND GLENOID LABRUM: Reactive marrow edema is present within the greater tuberosity at the insertion of the supraspinatus. Glenoid labrum is intact.BICEPS TENDON: Biceps tendon is intact. ADDITIONAL

Output: Tendinopathy and near full-thickness tearing of the supraspinatus.


Instruction: Generate impression based on medical findings.

Input: History of pituitary microadenoma, now off cabergoline for over one year. Assess for change in size of the pituitary microadenoma. There is slight interval decrease in size of a focus of signal abnormality within the right pituitary lobe measures approximately up to 5 mm. There is no compromise of the optic apparatus or cavernous sinuses. The posterior pituitary bright spot is intact. The infundibulum is not thickened.

Output: No significant interval change in size of the right pituitary microadenoma.


Instruction: Generate impression based on medical findings.

Input: 63 years, Female, right face and arm sensory alterations. Reports a brain hemorrhage in April 20, 2014, unknown etiology. Any sign of vascular malformation.. Compared to prior there is interval development of focus of susceptibility effect in the left thalamus with mild volume loss and consistent with chronic hemorrhage. No adjacent mass, abnormal enhancement, or abnormal flow voids. No additional foci of susceptibility effect are appreciated elsewhere in the brain. There is moderate burden of T2/FLAIR hyperintense lesions involving the bilateral periventricular and subcortical white matter which are nonspecific but compatible with chronic small vessel ischemic disease. Brain parenchyma is otherwise unremarkable for age. No restricted diffusion to suggest acute ischemia. No findings to suggest acute intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. Evidence of chronic hemorrhage involving the left thalamus. No underlying mass, abnormal flow-voids, or abnormal enhancement is appreciated. Finding has developed in the interval when compared to 4/26/2013.2. Moderate chronic small vessel ischemic changes.


Instruction: Generate impression based on medical findings.

Input: Male, 2 years old, status post Chiari decompression with syrinx, one year follow-up from surgery. Postoperative findings are seen compatible with Chiari decompression including suboccipital craniectomy and resection of the posterior arch of C1. The cerebellar tonsils terminate above the level of the neo-foramen magnum, and demonstrate a relatively normal round morphology. The degree of CSF expansion along the posterior aspect of the foramen magnum appears similar to prior. Robust biphasic CSF flow is seen along the ventral neo-foramen magnum. Only a mild blush of flow related signal is seen dorsally through the neo-foramen magnum.A previously seen syrinx in the cervical region has decreased both in craniocaudal extent and in maximal diameter. The syrinx previously began at C4 and extended to the upper thoracic level. It is now only reliably detected at the C6 and C7 levels. The maximum dimension measures 1 mm, previously 2 mm.A larger syrinx cavity seen previously within the thoracic region has also decreased in craniocaudal extent, though the maximum caliber remains similar to prior. The syrinx previously extended from T4-5 down to T9, and currently extends from T5 to T8. The maximum caliber measures 7 x 7 mm, unchanged from prior.The conus tip terminates at L1 which is normal. No intraspinal masses are seen.Spinal alignment and vertebral body morphology are within normal limits. No concerning marrow signal abnormality is detected. The intervertebral discs are normal. No significant spinal canal or neuroforaminal stenosis is detected.

Output: 1.Demonstration of findings compatible with Chiari decompression. The cerebellar tonsils remain above the level of the neo-foramen magnum and show a round morphology.2.Robust CSF flow is seen along the ventral aspect of the neo-foramen magnum, with only a small amount of detectable flow dorsally.3.Interval decrease in caliber and longitudinal extent of a small cervical cord syrinx.4.Interval decrease in longitudinal extent of a large thoracic cord syrinx.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: 60 years, Male, multiple myeloma. Numbness in face, V3 There is smooth thickening and enhancement of the dura along the bilateral cerebral convexities with suggestion of associated small bilateral subdural effusions. No associated intracranial mass effect. Brain parenchyma appears otherwise within normal limits. No abnormal parenchymal or meningeal enhancement to suggest metastatic disease. No evidence of acute infarct or hemorrhage. Ventricles are normal in size without evidence of hydrocephalus. There is mild nonspecific opacification of the bilateral mastoid air cells. Bone marrow signal is heterogeneous which is nonspecific. No destructive calvarial lesions.

Output: 1. No intracranial mass or abnormal enhancement to suggest neoplastic disease. Specifically no lesions along the intracranial course of the trigeminal nerves. No destructive lesions within the calvarium to suggest myeloma. 2. Diffuse dural enhancement with suggestion of small bilateral subdural effusions. No associated mass effect. Finding is nonspecific with a broad differential including prior lumbar puncture, associated with intracranial hypotension, reactive to tiny subdural effusions, or represent a mild inflammatory pachymeningitis for example.


Instruction: Generate impression based on medical findings.

Input: Reason: right C6-7 and left C7-T1 neural foraminal lesions History: weakness Serial CT images obtained during the aspiration procedure demonstrate the needle placement within the right C6-7 neural foraminal lesion. Following needle removal images obtained demonstrate no complications.

Output: Right C6-7 neural foraminal lesion lesion fine needle aspiration under CT guidance.


Instruction: Generate impression based on medical findings.

Input: 67 years Female (DOB:1/19/1949)Reason: dysarthria History: dysarthriaPROVIDER/ATTENDING NAME: ANTON M CHIVU 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. 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.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. The right A1 segment is small. The posterior communicating arteries are very small. The vertebral arteries are similar in size. There is extracranial origin of the left posterior inferior cerebellar artery present.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.

Output: 1.No evidence for intracranial or extracranial cerebrovascular occlusive disease.2.No evidence for acute ischemic cerebral infarction.3.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on medical findings.

Input: weakness There are multiple restricted diffusion lesions on the right right superior and middle frontal gyri indicating acute or subacute ischemic infarctions. Gyriform susceptibility artifacts on GRE within the restricted diffusion area indicate hemorrhagic conversion and corresponding enhancement on post Gad images suggest subacute ischemic infarction related blood brain barrier disruption.High signal intensity lesion on the left precentral gyrus hand motor cortex on DWI is likely to be T2 shine through. The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Acute or subacute ischemic infarction on the right frontal lobe superior and middle frontal gyri with evidence of hemorrhagic transformation as described above.


Instruction: Generate impression based on medical findings.

Input: Male; 73 years old. Reason: 73yo w/ETOH cirrhosis, decompensated with tbili >25. Requesting MRCP for further eval History: jaundice Lack of intravenous contrast limits sensitivity for subtle organ pathology. Moderate motion artifact limits multiple sequences. Pleural effusions and ascites causing dielectric artifact limits multiple sequences. As a result of these artifacts, the examination is overall very limited.ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology with nodular surface contour and widened fissures. Evaluation limited for focal hepatic lesions. Evaluation limited for biliary ductal dilation. Cholelithiasis. Nonspecific gallbladder wall thickening, which may be related to generalized ascites.SPLEEN: Splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral subcentimeter T2 bright renal lesions, most likely due to cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild body wall anasarca. Bilateral gynecomastia.OTHER: Very large right pleural effusion and small left pleural effusion. Large amount of abdominopelvic ascites.

Output: 1. Cirrhotic liver morphology with sequela of portal hypertension including splenomegaly and large amount of abdominopelvic ascites.2. Very large right pleural effusion.3. Very limited examination as detailed above, including for focal hepatic lesions and biliary ductal dilation. For future studies, consider thoracentesis and/or paracentesis before MRI.


Instruction: Generate impression based on medical findings.

Input: Glioblastoma 1mnth post RT/TMZ MRI. There are postoperative findings related to right transfrontal biopsy. There is overall interval increase in size of the multiple lesions within the bilateral cerebral hemispheres. For example, the dominant right frontal lobe mass now measures up to 54 mm, previously 51 mm, and a left occipital lobe lesion measures up to 14 mm, previously 8 mm. The edema associated with many of the lesions is slightly increased or at least persists and there is 8 mm of midline shift to the left. The ventricles are not significantly changed in size. There is no evidence of acute infarction. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged.

Output: Overall interval increase in size of the multifocal glioblastoma.


Instruction: Generate impression based on medical findings.

Input: Hearing loss and right cochlear implant, which was partly removed for the MRI exam. Internal Auditory Canal: There is right retrosigmoid and mastoid air cell fluid related to recent removal of a portion of the right cochlear implant components, with electrodes that remain within the right cochlea. Otherwise, there is no evidence of gross inner ear anomalies bilaterally and the bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The left mastoid air cells and middle ears appear unremarkable.Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain, brainstem, cerebellum, 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 are grossly unremarkable. There are secretions in the right anterior ethmoid sinuses.

Output: Findings related to recent removal of a portion of the right cochlear implant components, but no evidence of cochlear nerve deficiency or gross structural brain anomalies.


Instruction: Generate impression based on medical findings.

Input: Female 44 years old Reason: R sided thyroid enlargement in pt s/p radioactive iodine 20 yrs ago. On replacement hormone w normal TSH History: as above RIGHT LOBE MEASUREMENTS: 3.5 x 1.2 x 1 cmLEFT LOBE MEASUREMENTS: 3.5 x 0.9 x 0.3 cmISTHMUS MEASUREMENTS: 2 mmRIGHT LOBE: 1.3 x 0.7 x 0.6 cm isoechoic solid nodule within the right thyroid lobe.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-appearing bilateral lymph nodes in the neck.OTHER: No significant abnormality noted.

Output: Solitary solid nodule in the right thyroid lobe, amenable to percutaneous biopsy.