Instruction: Generate impression based on medical findings.

Input: MRI better demonstrates mild diffuse volume loss with a somewhat more predominant frontal, and less so adjacent parietal, atrophy pattern. The temporal lobes by MRI do not appear disproportionately atrophied.Patchy subcortical and periventricular white matter T2 hyperintensity correlates with previous CT hypodensity, compatible with chronic small vessel ischemic disease.The ventricles and sulci are unchanged in size or shape. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. Redemonstrated is an enlarged, empty sella. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Mucosal thickening is present within the right frontal sinus, right ethmoid air cells, and bilateral inferior maxillary sinuses. The remaining paranasal sinuses and the mastoid air cells are clear.

Output: 1.MRI better demonstrates mild diffuse volume loss with a somewhat more predominant frontal, and less so adjacent parietal, atrophy pattern. The temporal lobes by MRI do not appear disproportionately atrophied.2.Chronic small vessel ischemic disease.


Instruction: Generate impression based on medical findings.

Input: Clinical question: CVA. Signs and symptoms: CVA. Nonenhanced head CT:Patchy periventricular and subcortical foci of low-attenuation likely result of small vessel disease of indeterminate age are noted.There is no evidence of residual subdural hematoma as was noted on prior exam.There is no evidence of intracranial hemorrhage, mass effect, midline shift or hydrocephalus. No evidence of acute cortical stroke. Recommend follow-up with an MRI if concern for acute stroke persists. Bilateral frontal burr holes are again noted in calvarium is otherwise unremarkablelimited view of paranasal sinuses and mastoid air cells are unremarkable.

Output: 1.No evidence of acute intracranial hemorrhage or cortical stroke.2.Small vessel disease of indeterminate age.3.No evidence of residual subdural as was noted on prior exam.


Instruction: Generate impression based on medical findings.

Input: 13 day old male born at 36 weeks with perinatal depression and whole body cooling protocol. Exam is limited secondary to motion artifact. No restricted diffusion. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Major flow-voids are preserved. Myelination is appropriate for age.Midline structures are within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: Motion limited exam but grossly unremarkable.


Instruction: Generate impression based on medical findings.

Input: 20 years Male (DOB:2/2/1996)Reason: history of rhabdomyosarcoma s/p radiation therapy History: new onset memory loss; history of rhabdomyosarcoma s/p radiation therapyPROVIDER/ATTENDING NAME: ELISE OBERMAN TARA O HENDERSON 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 demonstrate small mucous retention cysts. The visualized portions of the right mastoid air cells are clear. The patient is status post left mastoidectomy .The left parotid gland is absent. The visualized portions of the orbits are intact.

Output: There is no evidence for brain metastases.


Instruction: Generate impression based on medical findings.

Input: Reason: rule out worsening spinal stenosis History: bowel incontinence, weakness, pain There are 4 nonrib bearing lumbar vertebrae with sacralization of L5. For the purposes of this dictation, consistent with prior reports, the lowest visualized intervertebral disc space is labeled L4-S1.Vertebral body heights are within normal limits. Minimal anterolisthesis of L2 relative to L3. Minimal retrolisthesis of L3 relative to L4. Multilevel disc desiccation with disc space loss at L4-S1. Mildly increase STIR signal at L4-S1 is similar to the prior exam and likely degenerative. Mild prominence of the epidural fat is unchanged. No abnormal signal within the cord or conus which ends at L1.T12-L1: No significant disc disease. No spinal canal or neural foraminal stenosis.L1-L2: No significant disc disease. Mild ligamentum flavum hypertrophy and facet arthropathy. No spinal canal or neural foraminal stenosis.L2-L3: Diffuse disc bulge with uncovering of the disc and superimposed central extrusion extending 8 mm superiorly which is decreased and posterior extent from the prior exam. Moderate ligamentum flavum thickening and facet arthropathy, left greater than right. Moderate spinal canal stenosis is improved from the prior exam. Mild bilateral neural foraminal stenosis is unchanged.L3-L4: Diffuse disc bulge with uncovering is unchanged. Moderate ligamentum flavum thickening and facet arthropathy is unchanged. Mild spinal canal stenosis is unchanged. Moderate left and mild right neural foraminal stenosis is unchanged.L4-S1: Diffuse disc bulge, asymmetric to the right, is unchanged. Mild facet arthropathy and ligamentum flavum thickening is unchanged. No significant spinal canal stenosis. Narrowing of the right lateral recess with impingement of the descending right S1 nerve root is unchanged. Moderate bilateral neural foraminal stenosis is unchanged.Paraspinous soft tissues are within normal limits. Small left renal cyst.

Output: 1. Transitional lumbosacral anatomy as detailed above. If surgery is to be contemplated, correlation with imaging of the entire spine is recommended.2. Multilevel degenerative changes with significant improvement in spinal canal stenosis at L2-L3. Additional degenerative disc disease and neural foraminal narrowing is unchanged.


Instruction: Generate impression based on medical findings.

Input: Cavernoma, please compare to outside images. There is no significant interval change in the right pons multilocular and peripherally enhancing lesion with peripheral hemosiderin that measures up to approximately 15 mm, with mild surrounding vasogenic edema. There is no evidence of acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No significant interval change in the right pons cavernous malformation with associated mild vasogenic edema.


Instruction: Generate impression based on medical findings.

Input: 69 year old female referred for cardiac MRI to evaluate aortic valve insufficiency. Left VentricleThe left ventricle is severely dilated with mildly reduced systolic function. The overall LV ejection fraction is 46%, the LV end diastolic volume index is 132 ml/m2 (normal range: 65+/-11), the LVEDV is 258 ml (normal range 109+/-23), the LV end systolic volume index is 72 ml/m2 (normal range 18+/-5), the LVESV is 140 ml (normal range 31+/-10), the LV mass index is 61 g/m2 (normal range 67+/-11), and the LV mass is 118 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.No intracardiac thrombus.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size with normal sysolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 80 ml/m2 (normal range 69+/-14), the RVEDV is 156 ml (normal range 110+/-24), the RV end systolic volume index is 40 ml/m2 (normal range 22+/-8), and the RVESV is 78 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveTrileaflet aortic valve with thickened leaflets and moderate calcification. Leaflet motion is mildly restricted. Dedicated through-plane imaging demonstrated moderate aortic regurgitation from the central coaptation site with regurgitant fraction 32%. Forward flow is 119 mL, regurgitant volume is 38 mL. Effective orifice area is normal, at 2.8 cm2. Mitral ValveThe mitral valve opens widely and there is mitral regurgitation, visually estimated to be mild. Mitral valve leaflets appear mildly thickened. Dedicated through-plane imaging was not performed. 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 mildly dilated. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no pericardial effusion.Extracardiac FindingsLeft subscapluar intramuscular lipoma.

Output: 1. Thickened and calcified trileaflet aortic valve with moderate aortic regurgitation, quantified as 32%)2. Severely dilated left ventricle with mildly reduced systolic function (LVEF 46%)3. Normal right ventricular size and systolic function.4. Severe left atrial dilation.5. Mitral regurgitation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Patient with spinal metastases, neck pain. Signs and symptoms: Neck pain Nonenhanced CT of the cervical spine:Previously described on prior MRI of the cervical spine with the study the lesion to the vertebral body of C5 is not identified on this study. There is subtle low attenuation of C7 vertebral body consistent with patient's known metastatic lesion. There is no evidence of fracture of this vertebrae and the alignment of vertebral column is unremarkable.Nonenhanced CT of thoracic spine:The alignment the vertebral column is within normal limits. Examination identifies previously detected metastatic lesion to T1 with mild compression deformity and minimal bulge of vertebrae into the spinal canal. There is no involvement of the pedicle of T1. The alignment remains intact. Mild compression deformity of vertebral body of T5 along its superior aspect and the internal lytic changes. There is no definitive involvement of the pedicles of T5. No definitive evidence of any additional lytic changes of vertebral column is detected.No definitive metastatic lesion to the facets of the pedicles of vertebral column.Nonenhanced CT of the lumber spine:The alignment of vertebral column is unremarkable. No definitive for the study kidneys to the lumber spine is detected.No evidence of central spinal stenosis or neural foramina compromise.There is very subtle low-attenuation involving S2 vertebral body however been no distinct destruction of the cortex or any perispinal soft tissue abnormality. Possibility of metastatic disease cannot be entirely ruled out.

Output: 1.Multiple metastatic disease to the thoracic spine and a suspected metastatic lesion to as to as detailed.2.There is mild compression fracture of T1 and T5 and mid no involvement of the pedicles of T1 or T5.The alignment of the vertebral column throughout the spine remains normal.


Instruction: Generate impression based on medical findings.

Input: Chiari malformation decompression/VP shunt: headaches, neck pain, and back pain. Brain: There are postoperative findings related to Chiari decompression. There is deformity of the inferior cerebellum, which appears to contact the overlying dura. There appears to be deficiency of flow across the neo-foramen magnum, although this may be in part be artifactual. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable, aside from minimal scattered foci of nonspecific T2 hyperintensity. There is a right transfrontal ventricular catheter that terminates in the region of the left foramen of Monro. The ventricular system is not dilated. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable.Spine: There are postoperative findings in the posterior lower cervical spine. There is straightening of the cervical spine alignment in the sagittal plane. The rest of the vertebral column alignment is within normal limits. There is mild degenerative spondylosis at multiple levels of the cervical spine, lower thoracic spine, and at L5-S1, with up to slight spinal canal stenosis. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable, aside from degenerative endplate signal alterations in the lower thoracic spine. The spinal cord displays normal signal and morphology and the conus medullaris is appropriately situated at the L1 level. The paravertebral soft tissues are unremarkable.

Output: 1. Postoperative findings related to Chiari decompression with evidence of adhesions involving the inferior cerebellum with what appears to be associated diminished cerebrospinal fluid flow in this region.2. No evidence of syringohydromyelia or hydrocephalus.


Instruction: Generate impression based on medical findings.

Input: Right cervical radiculopathy: pain in neck and right arm. There is multilevel degenerative spondylosis with considerable bilateral neural foraminal stenosis at C5-6 and C6-7, as well as mild spinal canal stenosis at these levels. There is mild bilateral neural foraminal narrowing at C4-5 and C7-T1, but no significant spinal canal narrowing. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: Multilevel degenerative spondylosis with considerable bilateral neural foraminal stenosis at C5-6 and C6-7, as well as mild spinal canal stenosis at these levels.


Instruction: Generate impression based on medical findings.

Input: Symptoms of vague numbness and burning pain involving the arms in recent months. The spinal cord displays normal signal and morphology. The tip of the conus medullaris is located at the L1 level and shifts appropriately between the prone and supine positions. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. There are no gross dysraphic defects. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable. The cerebellar tonsils are mildly low-lying on the limited localizer images that include the cervical spine.

Output: No evidence of syringohydromyelia in the imaged portions of the spinal cord. The conus medullaris is not low-lying and shifts appropriately between the prone and supine positions.


Instruction: Generate impression based on medical findings.

Input: History of hepatic and pancreatic cysts. Evaluate for progression. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in size and morphology. There are multiple simple cysts throughout the liver. The largest lesion is a complex cystic lesion demonstrating internal debris and signal suggestive of prior hemorrhage, measuring approximately 12.5 x 11.5 cm (series 7/41), compared to 15.3 x 15.1 cm previously. On postcontrast subtraction images it demonstrates no internal enhancement. Again this may represent a complex cyst or biliary hamartoma. It causes mild local mass effect on the adjacent duodenum and common bile duct without evidence of obstruction.No biliary ductal dilatation. Contracted gallbladder. No suspicious liver lesion.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic tail multiloculated cystic lesion measures 5.9 x 3.6 cm (series 7/31), compared to 6.0 x 3.1 cm previously. There is suggestion that it communicates with the main pancreatic duct which is normal in caliber. Otherwise the pancreatic parenchyma is unremarkable.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small umbilical fat-containing hernia and diastases of the rectus abdominis musculature.OTHER: No significant abnormality noted.

Output: 1.Multiple benign-appearing liver cysts are unchanged. Complex cyst versus giant biliary hamartoma demonstrates interval decrease in size.2.No significant change in the pancreatic tail cystic lesion likely communicating with a normal caliber main pancreatic duct and representing a side-branch IPMN versus less likely a serous cystadenoma. No suspicious post-contrast enhancement.


Instruction: Generate impression based on medical findings.

Input: 48-year-old with history of left mastectomy for IDC in 2007. She is status post left implant reconstruction in 2008, as well as a right breast lift in 2008. No current breast complaints. There is heterogeneous amount of fibroglandular tissue in the right breast.Minimal parenchymal enhancement is noted in the right breast.No abnormal enhancement is seen in right breast. Status post left mastectomy and implant placement.The retropectoral implant on the left side appears intact.No abnormal enhancement is seen in the left mastectomy bed.No abnormal lymph nodes are identified in either axillary region.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on medical findings.

Input: Known right breast cancer, presents for I-SPY 2 MRI #5. There is heterogeneous fibroglandular tissue and moderate background parenchymal enhancement noted bilaterally. Multiple simple and septated cysts are again identified in both breasts.The index mass at the 10:00 position of the right breast, posterior depth, measures 2.0 x 2.1 x 2.2 cm (AP x LR x CC, previously 2.0 x 2.1 x 2.2 cm). The right breast mass at the 12:00 position measures 0.6 x 0.7 x 0.8 cm (previously 0.6 x 0.7 x 0.7 cm). A third mass, anterior to the index mass, which does not contain a clip measures 0.9 x 1.0 x 0.8 cm (previously 0.9 x 1.1 x 0.7 cm). Other scattered enhancing foci and non-mass enhancement remain in the right breast, with total disease extent measuring 6.5 x 3.2 x 5.8 cm (previously 7.0 x 3.2 x 5.7 cm), which is without significant overall change. No abnormal enhancement is seen in the left breast. No abnormal lymph nodes are identified in either axillary region.

Output: No significant interval change in size of known, multifocal right breast cancer.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: Male 20 years old Reason: Evaluate the Small Bowel History: Crohn's Disease ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No suspicious hepatic lesions. Hepatic and portal veins are patent. Biliary tree is normal in caliber.SPLEEN: Spleen is top normal in size.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small bowel is normal in caliber and course. Postsurgical changes are present near the terminal ileum. No evident inflammatory change. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Postsurgical changes without evident inflammation.


Instruction: Generate impression based on medical findings.

Input: Directed second look ultrasound of the right breast in patient with newly diagnosed right breast ILC at the 10 o'clock position. Staging MRI demonstrated two satellite lesions anterior to the index mass as well as a mildly atypical appearing subpectoral lymph node in the right axilla and an indeterminate focus of enhancement in the central aspect of the right breast. A targeted ultrasound of the right breast and right axilla was performed for the areas identified on the MRI. A 2.9-cm along right axillary lymph node is noted in the central inferior right axilla. The margins are slightly lobulated. The cortex measures 3 mm in thickness. There is hilar flow. This does not have morphologic features that are suspicious enough change the standard surgical approach to staging the axilla. The suspicious subpectoral lymph node seen on MRI could not be identified. The index mass is again identified at the 10 o'clock position approximate 7 cm from the nipple. Immediately adjacent to the lateral edge of the mass is a 4 x 2 mm hypoechoic nodule. This is either a focal protrusion from the index mass or an adjacent satellite. This is labeled number one.A satellite lesion is identified approximately the 5 mm anterior to the index mass corresponding to one of the two satellite lesions seen on MRI. This is labeled number two. This measures approximately 8 x 3 x 3 mm. There is apical blood flow on color Doppler imaging.A second satellite lesion measuring 8 x 3 x 8 mm and demonstrating apical blood flow is identified just anterior to lesion labeled number two. This is labeled number 3. The two satellite lesions together measure approximately 2 cm and therefore the more anterior lesion is approximately two half centimeters away from the index mass.No sonographic correlate was identified in the expected location of the additional MRI detected focus in the central medial right breast.

Output: 1. The two satellite lesions anterior to the mass that were suspected on MRI are seen on ultrasound. Measurements as documented above. A third satellite or focal projection was identified immediately adjacent to the lateral edge of the mass.2. The indeterminate subpectoral lymph node in the right axilla could not be identified. There were no lymph nodes with sonographic features that would alter the standard surgical approach to staging the axilla.3. No sonographic correlate corresponding to the additional central medial enhancing focus could be identified. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Rule out bleed, hydrocephalus or mass effect. Clinical question: Progressive dizziness, gait disturbance, urinary symptoms. Non-enhanced CT of brain:There is no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus. The cortical sulci and ventricular system appear slightly prominent however this may be still within normal range for patient's stated age of 87. Prior MRI examination indicates a small vessel disease however on this exam no definitive small vessel disease is detected.

Output: Essentially unremarkable non-enhanced CT of brain.


Instruction: Generate impression based on medical findings.

Input: C5 -- C6, C6 -- C7 radiculopathy. History of C7 -- T1 herniated disk there Nonenhanced CT of the cervical spine:Routine nonenhanced CT of cervical spine the sagittal and coronal 2-D reformatted images were obtained.This is not an appropriate exam for detection of herniated disk. The CT examination of cervical spine cannot precisely evaluate the soft tissues of the cervical spine (disk material or hypertrophic changes of the ligamentum flavum).To evaluate for a herniated disk an MRI examination of cervical spine is the study of choice.Very advanced degenerative disease throughout the cervical spine is noted. There is exaggerated lordosis of cervical spine. The alignment the vertebral column is otherwise unremarkable.Foramen magnum.Examination at this level is unremarkable.C2 -- C3.Degenerative disk disease and hypertrophic changes of posterior elements. No bony central spinal stenosis or neural foramina compromise.C3 -- C4.Advanced degenerative disk disease with loss of intervertebral disk height. Moderate hypertrophic changes of posterior elements. Compromise of bilateral neural foramina secondary to bony hypertrophic changes (left greater than right). No central spinal stenosis.C4 -- C5.Moderate degenerative disk disease and extensive hypertrophic changes of posterior elements (left greater than right). Compromise of bilateral neural foramina secondary to a both changes. No central spinal stenosis.C5 -- C6.Moderate degenerative disk disease and exaggerated hypertrophic changes of posterior elements with resultant bilateral neural frontal compromise. No central spinal stenosis.C6 -- C7.Advanced degenerative disk disease and also disk height. Moderate hypertrophic changes of posterior elements. Mild to moderate compromise of the left neural foramina. Questionable minimal compromise the right neural foramina. No central spinal stenosis.C7 -- T1.Advanced degenerative disk disease and minimal hypertrophic changes of posterior elements. No central spinal stenosis. No definitive neural foramina compromise.Limited view of upper thoracic spine demonstrate no central spinal stenosis and no significant degenerative changes.

Output: 1.Extensive degenerative disk disease and hypertrophic changes of posterior element throughout the cervical spine as detailed.2.No central spinal stenosis at any level however multi-level bilateral neural foramina compromise secondary to degenerative changes is present as detailed per level above.3.This examination cannot assess for herniated disk as mentioned above. If concern for acute herniated disk exist a dedicated MRI of the cervical spine is recommended.


Instruction: Generate impression based on medical findings.

Input: 81-year-old female with a history of a lung mass presents with back pain, concern for bony metastases; evaluate for spinal cord compression. This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities or dural based metastases. There is diffuse patchy marrow replacement throughout the visualized spine.There are T2 hyperintense lesions corresponding to lytic lesions on recent chest CT and lumbar spine CT present. One is located on the right aspect of T5 and extends into the posterior elements of T5. There is soft tissue extension outside of the bony elements into the epidural space and into the adjacent T4-5 and T5-6 neural foramina. There is encroachment of exiting nerve roots at T4-5 and T5-6. There is no associated cord compression.There is a mild compression fracture present at T12 associated with a lytic lesion at T12 also visualized on the recent CT of the lumbar spine. There is no associated cord compression.There is a lytic lesion present along the anterior aspect of L2 which is hyperintense on T2 imaging and also identified on the recent CT of the lumbar spine. There is no associated cauda equina compressionThere are degenerative changes present in the cervical spine without evidence of associated spinal canal stenosis. This appears to be worse at C4-5, C5-6 and C6-7 where there are uncovertebral osteophytes and disc material narrowing neural foramina.There are degenerative changes present in the lumbar spine which appear worse at L5-S1 where there is a disc bulge present and loss of disc space heightA left lung mass lateral to the aorta and left-sided pleural thickening is partially imaged and better appreciated on the prior CT.

Output: 1.No evidence of spinal cord compression. Please note that this is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities, nerve root involvement or dural based metastases. 2.There is a lytic lesion present at T5 which extends into the surrounding tissues including the right neural foramina of T4-5 and T5-6 and the epidural space. There is encroachment of the right-sided exiting nerve roots at T5-6 as a result. There is no spinal cord compression appreciated.3.There is a lytic lesion present at T12 associated with a mild compression fracture which is been also identified in the recent lumbar spine CT. There is no associated cord compression.4.There is a lytic lesion present within the L2 vertebral body which was also identified on the recent lumbar spine CT.5.There is a left-sided long the mass present which is associated pleural-based lesion. Please refer to the recent chest CT for further comments.6.There are degenerative changes present in the cervical spine and lumbar spine without evidence of spinal cord compression or cauda equina compression.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old, with left upper extremity contractures. Evaluate for etiology. The cervical lordosis is straightened, but sagittal alignment is otherwise unremarkable. Vertebral body morphology is unremarkable allowing for mild degenerative loss of height of C5, C6 and C7. No evidence of concerning marrow replacement or marrow edema is seen.Spinal cord morphology is altered by multilevel disc osteophytes as discussed below. No convincing evidence of cord signal abnormality is seen. No epidural abnormality is suspected.C2-3: Left greater than right facet hypertrophy. Mild posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild left foraminal narrowing. C3-4: Left greater than right facet hypertrophy. Posterior disc-osteophyte complex formation with a large superimposed central disc extrusion impinges on the ventral spinal cord and causes a moderately severe canal stenosis. Moderate bilateral foraminal narrowing. C4-5: Left facet hypertrophy. Posterior disc-osteophyte complex formation asymmetric to the right. Effacement of the ventral thecal sac with a moderate spinal canal stenosis and minimal if any cord deformation. Moderate bilateral foraminal narrowing. C5-6: Posterior disc-osteophyte complex formation with a small central component which mildly impinges on the cord and causes a mild to moderate spinal canal stenosis. Severe left and moderate right foraminal narrowing. C6-7: Posterior disc-osteophyte complex formation with a small central component which minimally impinges on the cord and causes a mild spinal canal stenosis. Mild bilateral foraminal narrowing. C7-T1: Facet hypertrophy. Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild to moderate bilateral foraminal narrowing.

Output: Multilevel degenerative disc findings are seen. This is most severe at the C3-4 level where disc osteophyte formation and a superimposed central extrusion causing spinal cord impingement and a moderately severe stenosis of the spinal canal.Less severe cord impingement and spinal canal stenosis is seen at C4-5, C5-6 and C6-7. Scattered mild to moderate foraminal narrowing is also demonstrated as detailed above.


Instruction: Generate impression based on medical findings.

Input: 72 year old female patient with severe hip pain, fungemia, elevated CRP/ESR, eosinophilia. Evaluate for PVNS. Please note patient could not tolerate the examination and only T1 weighted coronal and axial fat-suppressed T2-weighted images were obtained, both of which are markedly limited by motion artifact. Given this limitation, the following observations are made:There are erosions of the femoral head and acetabulum as seen on a recent CT scan. There is edema type signal within the femoral neck which may be secondary to the aforementioned erosions. Due to the aforementioned limitations, we cannot tell if there has been progression of erosions compared to the prior CT study. We see no frank fluid within the hip joint. Low signal intensity along the right femoral neck may represent pigmented villonodular synovitis, but could also be seen with amyloid deposition. There is edema within the adductor musculature within the hip, the musculature anterior to the right proximal femur, the right gluteus minimus muscle, and along the right iliopsoas muscle. Edema is noted within the subcutaneous fat. Mild osteoarthritis affects the left hip.

Output: Markedly limited study as described above showing erosive arthropathy of the right hip without frank fluid in the joint, which could represent pigmented villonodular synovitis, amyloidosis, or sequela of chronic inflammatory (including chronic fungal) arthritis. A repeat study following proper patient sedation can be considered.


Instruction: Generate impression based on medical findings.

Input: Right shoulder pain Radiographs dated 9/2/2016ROTATOR CUFF: There is full-thickness tearing of the supraspinatus tendon with retraction to the level of the glenoid. Tearing extends posteriorly to involve the anterior of the infraspinatus tendon which also appears to demonstrate a full-thickness tear. Heterogeneous signal near the insertion of the tendons likely represents at least some scar. The teres minor tendon is intact. There is tendinopathy of the superior fibers of the subscapularis however there is no evidence of full-thickness tear.There is mild fatty atrophy of the supraspinatus, infraspinatus, and superior portion of the subscapularis.SUPRASPINATUS OUTLET: There is mild acromioclavicular arthrosis. A small amount of fluid is noted within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Evaluation of the glenoid labrum is limited by motion artifact. Within these limits, there is no evidence of full-thickness tear. The glenohumeral joint alignment is normal. There is no evidence of fracture. Degenerative marrow signal is noted at the greater tuberosity.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Full-thickness tears of the supraspinatus and infraspinatus tendon with retraction to the level of the glenoid. There is mild associated fatty atrophy of the rotator cuff musculature.


Instruction: Generate impression based on medical findings.

Input: Migraine headaches. History of congenital cavernous malformation. Redemonstration of a very small focus of susceptibility artifact within the mesial right precentral gyrus seen primarily on the gradient echo images compatible with a small congenital cavernous malformation. There is perhaps subtle associated T2 signal abnormality associated with lesion, but no significant perilesional vasogenic edema. There is no associated enhancement. No additional lesions are identified.The T2, FLAIR and diffusion weighted images are otherwise normal.There is no evidence of intracranial hemorrhage, mass or edemaThe ventricles and basal cisterns are normal in size and configuration.The expected intracranial vascular flow voids are present.The paranasal sinuses are clear. The visualized mastoid air cells are clear. The orbits are unremarkable.

Output: Stable findings compatible with a small suspected cavernous malformation in the mesial aspect of the right precentral gyrus. No additional lesions are identified.


Instruction: Generate impression based on medical findings.

Input: Dizziness. Neck pain. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.Trace amount of low attenuation are present in the periventricular and subcortical white matter. Gray-white differentiation is preserved. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No acute intracranial abnormality.


Instruction: Generate impression based on medical findings.

Input: Evaluate for episodes of L-sided weakness and numbness. Also has new episodes of confusion. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are small bilateral maxillary sinus retention cysts.

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


Instruction: Generate impression based on medical findings.

Input: Male 6 years old Reason: orbital cellulitis, concern for intracranial involvement. ENT requesting orbital views History: Orbital cellulitis. There is diffusion restriction in the right maxillary sinus and scattered areas of restriction in the right posterior ethmoid air cells likely relating to pus. There is also near complete opacification of the right maxillary sinus, right anterior ethmoid air cells, and right frontal sinus. There is adjacent abnormal T2 hyperintensity and enhancement involving the medial extraconal fat of the right orbit. There is extraconal confluently enhancing tissue measuring approximately 5 x 16 mm (series 1201, image 9), without focal collection to suggest subperiosteal abscess. There is mild peripheral enhancement along the right medial rectus muscle, which is somewhat ill-defined but does not appear enlarged or asymmetrically enhancing. The majority of the inflammatory changes are seen anteriorly and the orbital apex is relatively clear. No evidence of intracranial extension of abnormal signal or enhancement to suggest intracranial extension of the infection.There is also partial opacification and mucosal thickening of the left maxillary sinus. The major cerebral flow voids are intact. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma 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.

Output: 1.Right post septal orbital cellulitis with a small probable phlegmon in the the medial extraconal fat and mild inflammatory changes of the medial rectus muscle. No evidence of intracranial extension of infection.2.Findings compatible with right anterior acute sinusitis.


Instruction: Generate impression based on medical findings.

Input: Reason: prostate cancer; please evaluate for high risk features on MRI History: prostate canerBiopsy 6/23/2014: right apex Gleason 7 adenocarcinoma PELVIS:PROSTATE:Prostate Size: 5.0 x 3.2 x 4.0 cmPeripheral Zone: Right apical lesion which is T2/ADC dark measures 1.3 x 0.9 cm (703/264), suspicious for prostate adenocarcinoma.Central Gland: Few small BPH nodulesSeminal Vesicles: No evidence of seminal vascular invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Diverticulosis without evidence

Output: 1.Lesion at the right apex peripheral zone is suspicious for prostatic adenocarcinoma.2.No pelvic adenopathy or evidence of extracapsular extension.


Instruction: Generate impression based on medical findings.

Input: 69-year-old female status post burn to the left index finger, please evaluate for osteomyelitis. There is acroosteolysis of the distal phalanx of the index finger of the left hand. There is diffusely abnormal marrow signal within the distal phalanx with abnormal contrast enhancement of the bone marrow. Further, there is a soft tissue defect at the tip of the index finger with a T2 hyperintense sinus tract that appears to communicate between the cutaneous surface and the underlying distal phalanx.The middle phalanx demonstrates mild edema, likely representing reactive osteitis without evidence of osteomyelitis. There is no significant joint effusion. Otherwise, the extensor and flexor tendon complexes of the index finger appear intact. Findings compatible rheumatoid arthritis about the carpus in multiple MCPs with superimposed osteoarthritis.

Output: Soft tissue swelling and osteolysis indicative of osteomyelitis secondary to history of burn injury of the distal phalanx of the index finger. Further, a sinus tract extends from the cutaneous surface to the underlying bone. Reactive osteitis is visualized within the middle phalanx, without definite findings of osteomyelitis.


Instruction: Generate impression based on medical findings.

Input: Unspecified cerebral artery occlusion with cerebral infarction [434.91], Reason for Study: ^Reason: assess for new stroke, h/o numerous strokes in posterior circulation History: assess for new stroke, h/o numerous strokes in posterior circulation. Brain MRI:Multifocal scattered diffusion restriction lesions on the left basal ganglia, left external capsule, left cerebellar hemisphere and left inferior thalamus indicating acute ischemic infarction without evidence of hemorrhagic transformation.There are multifocal tissue defects indicating prior ischemic infarctions including right external capsule, left upper pons, and left cerebellar hemisphere.Underlying brain shows multiple patchy high signal intensities on FLAIR images on bilateral periventricular white matter indicate non specific small vessel ischemic disease.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. 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.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate multifocal intracranial arterial luminal stenosis. Especially the left MCA distal M1 segment shows more than 70% of luminal stenosis. The right MCA M1 segment shows luminal irregularities but without significant (more than 70%) stenosis. The vertebrobasilar system shows luminal irregularity of the basilar artery and bilateral PCAs without significant luminal narrowing. The distal left vertebral artery lumen is narrowed and irregular. In addition, the C1 and C2 portions of the left vertebral artery are smaller than that of the right side indicating possible hypoplastic nature or could be atherosclerotic stenosis. Neck MRA: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 left vertebral artery origin shows about less than 50% luminal stenosis, however, this could be an artifactual finding. There is focal luminal stenosis at the level of C1-skull base junction which could represent atherosclerotic stenosis.There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

Output: 1. Multifocal acute ischemic strokes on the left basal ganglia, external capsule and left cerebellar hemisphere without evidence of hemorrhagic transformation.2. Multifocal various degree intracranial arterial luminal stenosis indicating atherosclerotic changes of intracranial arterial system. Especially the left MCA distal M1 segment stenosis appears to be significant (more than 70% stenosis).3. No evidence of significant (more than 50%) luminal stenosis of extracranial arterial system except the left vertebral artery ostium.


Instruction: Generate impression based on medical findings.

Input: Secondary malignant neoplasm of brain [C79.31], Reason for Study: ^Reason: RCC to brain; history of RT to brain; now with new brain met; MRI for RT planning History: RT planning Motion artifact degraded image quality.Previously demonstrated enhancing nodule with the surrounding edema located at the right inferior parietal lobule close to the distal portion of intraparietal sulcus, is unchanged since prior scan (measured about 8mm on 3D SPGR sequence). There are also susceptibility artifacts on the right inferior parietal lobule which again unchanged since prior scan.There is no other abnormal enhancing lesion seen on the scan.There is evidence of right parietotemporal craniotomy.The ventricles, sulci and cisterns are unremarkable. The gray-white matter differentiation is normal. The mastoid air cells are clear. Left maxillary sinus retention cyst is seen, unchanged since prior scan.

Output: 1. Preoperative localization scan was performed.2. Unchanged the size of the right inferior parietal lobule nodular enhancing lesion and the extent of the surrounding edema since prior scan.3. Unchanged hemorrhagic lesion at the right parietal lobe since prior scan.


Instruction: Generate impression based on medical findings.

Input: Compared to 2/11/2013 there is unchanged appearance of the minimal enhancing tissue within the medial right cavernous sinus. Enhancing tissue along the floor of the sella on the left, which is in continuity with the left pituitary stalk and likely representing residual pituitary gland, also shows no appreciable change. Left cavernous sinus is unremarkable.As demonstrated previously, there is retraction of the optic chiasm inferiorly related to postsurgical change, however this is unchanged. Left cavernous sinus is unremarkable. Limited visualization of the remainder of the brain demonstrates no intracranial mass or mass effect.

Output: Examination of the sella including minimal enhancing tissue within the medial right cavernous sinus remains unchanged since 2/11/2013. No new or enlarging lesions.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: 54-year-old female with segmentally distributed pleomorphic calcifications in the left breast, biopsy of which proved ADH worrisome for DCIS. The patient presents for technical repeat MRI study. There is scattered fibroglandular tissue in both breasts.Marked parenchymal enhancement is noted bilaterally.There is segmental non-mass enhancement at 6:00 - 8:00 position in the left breast, measuring 100 x 41 x 19 mm (AP x ML x CC).Because of the marked parenchymal enhancement, this non-mass enhancement is only seen on ultrafast imaging. A marker clip is identified at posterior lateral and inferior aspect of the lesion.No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in either axillary region.

Output: 1. Suspicious segmental non-mass enhancement in the left breast at 6:00 - 8:00 position. Stereotactic biopsy for calcifications located at 6:00 position (anteromedial from the marker clip) is recommended for tissue diagnosis. Before stereotactic biopsy, ultrasound for left breast can be performed to look for possible target for biopsy.2. No MRI evidence for malignancy in the right breast3. No abnormal lymph nodes in either axillary regionBIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on medical findings.

Input: 51-year-old female with pain, stiffness and swelling. MENISCI: There is globular increased signal abnormality within the anterior horn of the lateral meniscus consistent with intrasubstance degeneration. Some of this signal extends to the tibial articular surface consistent with degenerative tearing/fraying. There is focal fluid signal intensity within the body of the lateral meniscus consistent with meniscal cyst, indicating a tear. The posterior horn appears intact. There is globular increased signal abnormality within the posterior horn of the medial meniscus consistent with intrasubstance degeneration. Some signal extends to the tibial and femoral articular surfaces consistent with degenerative fraying. There is a full-thickness radial tear affecting the posterior horn of the medial meniscus (coronal series 8; image 20).ARTICULAR CARTILAGE AND BONE: No bone marrow signal abnormalities identified. No full-thickness or near full-thickness articular cartilage defects are identified.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Tearing of the medial and lateral meniscus, including a radial tear of the posterior horn of the medial meniscus as described above.2. Small joint effusion. Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Left sided asymmetric sensorineural hearing loss. There is an enlarged left vestibular aqueduct. There also appears to be deficient bone overlying the superior semicircular canal. There is a somewhat prominent venous flow void in the cerebellopontine angle cistern, but the cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The mastoid air cells and middle ears also appear unremarkable.Right: The 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 mastoid air cells and middle ears also appear unremarkable.

Output: Enlarged left vestibular aqueduct and apparent deficient bone overlying the superior semicircular canal, which may represent dehiscence, but no evidence of retrocochlear or inner ear lesions. A temporal bone CT may be useful for further evaluation.


Instruction: Generate impression based on medical findings.

Input: 51-year-old woman with history of cystic pancreatic lesion. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology. Parenchymal loss of signal on the opposed phase images indicates steatosis. No focal lesion identified.The gallbladder is normal. There is no intra or extrahepatic biliary ductal dilatation.SPLEEN: The spleen is normal.PANCREAS: A 7 x 5 mm T2 hyperintense, nonenhancing focus in the pancreatic body (series 601, image 20) is again seen communicating with the main pancreatic duct and is unchanged.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: There is a subcentimeter hemorrhagic cyst in the inferior pole of the right kidney, otherwise the kidneys are normal and enhance symmetrically.RETROPERITONEUM, LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: Small bowel and colon appear normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Unchanged pancreatic body sidebranch IPMN.


Instruction: Generate impression based on medical findings.

Input: Bilateral leg weakness, evaluate for disc disease 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 at the lower limits of normal in position at the lower L2 level.There is fairly mild generalized facet arthropathy. Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: Mild disc desiccation and minimal bulge. No spinal canal or neural foraminal stenosis.L4-L5: Disc desiccation and minimal bulge. Minimal effacement of the left lateral recess. Otherwise no significant spinal canal or neural foraminal stenosis.L5-S1: Dorsal annular fissure with small central and right paracentral paracentral disc protrusion. There is contact of the right S1 nerve root in the lateral recess without evidence of impingement. Spinal canal is otherwise patent. There is mild right neural foraminal stenosis. Left neural foramen is patent. Paraspinous soft tissues are within normal limits. There are multiple cysts involving the right kidney.

Output: 1. Very mild multilevel degenerative changes in the lumbar spine. There is minimal effacement of the lateral recesses at L4-L5 and L5-S1 as described above and mild right L5-S1 neural foraminal narrowing. Otherwise no significant spinal canal or neural foraminal stenosis at any level.2. Conus is at the inferior L2 level which is at the lower limits of normal.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: HeadacheClinical question: cause of headaches , leptomeningeal disease vs stokeSigns and Symptoms: headaches The CSF spaces are appropriate for the patient's stated age with no midline shift. No foci of diffusion restriction are appreciated.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There is generalized brain atrophy present.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.There is heterogeneous marrow signal present within the visualized upper cervical spine

Output: 1.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 2.There is no evidence for acute ischemic cerebral infarction.3.There is no evidence for leptomeningeal disease.4.There is heterogeneous marrow signal in the visualized upper cervical spine. This is a nonspecific finding . Please correlate with patient's clinical history for chronic disease or myeloproliferative disorder or lymphoproliferative disorder.


Instruction: Generate impression based on medical findings.

Input: Cervical radiculopathy, neck pain and radiation. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is mild reversal of cervical lordosis which appears to be positional. Alignment is otherwise maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: Small central disc protrusion. Left-sided facet arthropathy with minimal left neural foraminal stenosis. Otherwise no significant compromise to the spinal canal or neural foramina. C3-4: Mild disc bulge. No significant compromise to the spinal canal or neural foramina. Mild facet arthropathy, worse on the left.C4-5: Mild disc bulge. No significant compromise to the spinal canal or neural foramina.C5-6: Disc osteophyte complex including central disc protrusion with indentation of the ventral cord. There is mild to moderate spinal canal stenosis at this level. Neural foramina are patent. C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.There are multiple nodules involving the thyroid gland, which are better assessed on prior ultrasound.

Output: Mild multilevel degenerative changes in the cervical spine as described above, not significantly changed since 5/6/2015. There is mild to moderate spinal canal stenosis at the C5-C6 level related to disc protrusion which indents the ventral aspect of the cord. There are also additional disc bulges more superiorly. No cord signal abnormality. No significant stenosis involving the neural foramina.


Instruction: Generate impression based on medical findings.

Input: Bilateral lower extremity weakness and numbness. Evaluate for cause. Status post debridement and wound closure on 6/2. Examination is motion degraded slightly limiting evaluation. 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 heterogeneous with low T1 hypointensity without discrete destructive osseous lesions demonstrated. The conus medullaris is normal in position.Mild degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis.L5-S1: There is disc desiccation and mild diffuse disc bulge. No significant spinal canal stenosis. Minimal bilateral neural foraminal narrowing. Mild facet arthrosis in the lumbar spine. Minimal fluid is noted in the subcutaneous soft tissues at the level of the sacrum which extends below the field-of-view. Lack of contrast slightly limits evaluation however no discrete fluid collection or abscess involving the spinal canal or paraspinous soft tissues is demonstrated.

Output: 1. No findings to explain patient's symptoms. There is minimal fluid which is seen involving the superficial subcutaneous soft tissues overlying the visualized portion of the sacrum. No findings to suggest discitis-osteomyelitis in the lumbar spine. No epidural collections or abscess in the lumbar spine. No obvious paraspinous fluid collections.2. Mild degenerative changes, particularly at L5-S1, without significant spinal canal or neural foraminal stenosis at any level.3. Diffuse low T1 marrow signal which is nonspecific and can be seen in entities such as chronic anemia, for example.


Instruction: Generate impression based on medical findings.

Input: knee pain which is getting worse with possible subluxation and instability. Evaluate for MCL sprain. MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: Bone marrow signal is within normal limits. The articular cartilage within all three compartments is intact.LIGAMENTS: The anterior and posterior cruciate ligament are intact. The medial and lateral collateral ligaments are intact. The popliteus muscle and tendon are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: No specific findings to account for the patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Ischemic stroke workup. Left lower extremity weakness with acute on chronic worsening of RUE and RLE weakness. Signs and symptoms: As above. Nonenhanced brain MRI:Diffusion weighted images demonstrate an acute nonhemorrhagic ischemic stroke in the distribution of the left lenticulostriate artery measuring approximately up to 5.5 x 13.5-mm.Additionally flair and T2-weighted images demonstrate moderate chronic small vessel ischemic strokes of bilateral subcortical and periventricular white matter as well as left bilateral basal ganglia, the thalamus and extensively of the pons. No evidence cerebral cortical chronic ischemic stroke is detected. Punctate foci of T2 hyperintensity in the right cerebellum is suspicious for a tiny chronic cerebellar stroke. Slight prominence of cortical sulci for age.The signal void of major intracranial arterial branches are identified.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells.

Output: 1.Acute nonhemorrhagic ischemic stroke in the distribution of left lenticulostriate artery measuring at 5.5 x 13.5-mm.2.Moderate chronic minimally small vessel ischemic strokes as detailed.


Instruction: Generate impression based on medical findings.

Input: 39 year old female with a known left IDC grade 3 presents for I-SPY 2 MRI study (pre-treatment). History of recent benign left breast biopsy at 6:00 position. There is scattered fibroglandular tissue in both breasts.Marked parenchymal enhancement is noted bilaterally.A known cancer is identified at retroareolar region in the left breast as a large enhancing mass, measuring 41 x 45 x 45 mm (AP x LR x CC). The lesion extends into anterior skin and the nipple. 13 mm hematoma is present at middle 6:00 position in the left breast, from recent benign biopsy.Patchy area of strong parenchymal enhancement is heterogeneously seen in both breasts. No abnormal enhancement is seen in right breast. In the left axilla, there are at least 2 abnormally enlarged lymph nodes; the largest lymph node with a marker clip measures 30 x 18 mm (CC x LR). The biopsy result of this lymph node was benign.Mildly enlarged lymph nodes are present in the right axilla; however, none of them appears suspicious.

Output: 1. Biopsy proven left breast cancer, extending to the skin and nipple.2. No apparent suspicious lesions in the right breast, although there is strong, heterogeneous parenchymal enhancement. Right breast can be followed in the subsequent MRI studies according to I-SPY protocol. 3. Two enlarged lymph nodes in the left axilla. Recent biopsy of the largest lymph node was benign.4. No abnormal lymph nodes in the right axilla.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on medical findings.

Input: Clinical question:CVA. Signs and symptoms : CVA Nonenhanced head CT :There is no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.Cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation remains within normal.If concern for acute ischemic stroke persist recommend an MRI.

Output: Negative head CT.


Instruction: Generate impression based on medical findings.

Input: There is an enhancing dural-based mass centered on the planum sphenoidale with extension towards the partially empty sella, measuring 15 x 11 x 20 mm. This mass abuts the optic chiasm and is isointense to gray matter on unenhanced T1 and T2 weighted images. Two small additional lesions are again noted over the right frontal convexity, measuring up to 9 mm, which on the prior CT examination displayed calcification. There is mild prominence of the lateral and third ventricles, as well as the sulci due to diffuse cerebral volume loss. There is persistent moderate soft tissue crowding at the foramen magnum with a somewhat pointed morphology of the cerebellar tonsils, which extend up to 7 mm inferior to the foramen magnum. There is unchanged prominence of extra-axial space posterior to the cerebellum. There is minimal nonspecific scattered cerebral white matter T2 hyperintensity. There is no acute infarct or midline shift. There are bilateral lens implants. There is a posterior disc-osteophyte complex at C3-4, which appears to indent the spinal cord.

Output: 1.The planum sphenoidale mass and smaller dural-based extra-axial masses over the right frontal convexity are stable in size, accounting for difference in technique, and likely represent meningiomas.2.Findings consistent with Chiari I malformation.3.No evidence of acute infarction or intracranial hemorrhage. 4.A posterior disc-osteophyte complex at C3-4, which appears to indent the spinal cord. Dedicated cervical spine imaging may be useful for further evaluation.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: History of cystic fibrosis and liver disease. Presenting for HCC screening. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. The portal vein, hepatic artery and hepatic veins appear patent.There is suboptimal timing of the late arterial phase. Given this limitation there is no suspicious liver lesion. No biliary ductal dilatation.Normally distended gallbladder with pericholecystic fluid/wall thickening which is not atypical in the setting of cirrhosis.SPLEEN: Marked splenomegaly measuring 19.1 cm in craniocaudal dimension compatible with portal hypertension. Perisplenic collateral vessels.PANCREAS: Marked fatty atrophy of the pancreas. Prominent peripancreatic and porta hepatic lymph nodes, not uncommon in the setting of cirrhosis.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The right hemicolon wall appears thickened and edematous which may reflect portal hypertensive colopathy.BONES, SOFT TISSUES: Recannulation of the umbilical vein.OTHER: No significant abnormality noted.

Output: 1.Cirrhosis with findings of portal hypertension. Splenomegaly.2.No suspicious liver lesion.3.Right hemicolon wall thickening may reflect portal hypertensive colopathy in the absence of signs and symptoms of colitis.


Instruction: Generate impression based on medical findings.

Input: Female 2 years old Reason: 23 month old girl with history of Diamond Black-fan Anemia and transfusion related iron overload History: iron overload T2*sequences in short axis of the heart was performed to assess iron load. Recovery time was 30 ms on average on the interventricular septum and 27 ms over the free wall.

Output: 1. No evidence of cardiac iron load.


Instruction: Generate impression based on medical findings.

Input: Male, 10 years old, status post craniotomy for tumor resection to 3 month follow-up exam. A small left parietal lobe resection cavity is seen status post resection of a small tumor from this location. Edema surrounding the cavity seen on the prior examination has resolved. Prior gyriform enhancement at the operative site has resolved, and there is now only a small area of curvilinear enhancement extending into the cavity from the dura which is likely postoperative in nature. No definite evidence of residual tumor is seen.Elsewhere brain morphology and signal characteristics are within normal limits. No abnormal extra-axial collections are seen. No parenchymal edema or mass effect is detected. The ventricles are normal in size and morphology.

Output: Expected evolution of postoperative findings status post resection of a small tumor from the left parietal lobe.No definite evidence to suggest residual or recurrent tumor.


Instruction: Generate impression based on medical findings.

Input: Check for ACL tear MENISCI: Mild fraying of the inner age of both menisci without associated additional abnormality. Specifically the meniscal bodies are well-visualized and intact, as well as properly anchored posteriorly.ARTICULAR CARTILAGE AND BONE: Mild cartilaginous thinning more pronounced in the lateral compartment without focal abnormality. Bone marrow and osseous structures are otherwise unremarkable other than minimal degenerative changes.LIGAMENTS: The ACL demonstrates moderate increased signal with intact fibers throughout. A moderate tendinosis and sprain is suspected without definite tearing. The PCL, collateral ligaments, retinaculum and extensor complex are all otherwise intact .EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Moderate ACL signal abnormality with intact fibers representing moderate tendinosis and sprain. Mild degenerative changes otherwise observed, see details above.


Instruction: Generate impression based on medical findings.

Input: Right knee pain, persistent. History of rheumatoid arthritis and sarcoid. Need to evaluate for synovitis from rheumatoid arthritis or other cause. Due to the patient's body habitus, the high-resolution knee coil could not be used. An alternative coil was used instead which results in slightly suboptimal image quality.There is mild intrasubstance degeneration of the menisci, but I see no discrete meniscal tear. Vertically-oriented intermediate signal intensity within the posterior horn of the lateral meniscus likely represents the interface with the meniscofemoral ligament of Wrisberg.There is marked degeneration of the articular cartilage of the patella, with the lateral facet essentially devoid of articular cartilage. There are small subchondral cysts. There is relatively mild degeneration of the articular cartilage of the femoral trochlea. Subjectively, the articular cartilage of the medial tibiofemoral compartment appears diffusely thinned. There is also a full-thickness defect of the articular cartilage of the lateral tibial plateau beneath the posterior horn of the lateral meniscus. I see no bone marrow edema or definite erosions.The cruciate and collateral ligaments are intact. There is a collection of peripherally-enhancing near-fluid signal intensity deep to the tibial collateral ligament suggesting a medial collateral ligament bursitis.The extensor mechanism is intact.There is a small amount of fluid within the joint extending posteromedially into a small Baker's cyst. There is enhancement of mildly thickened synovium indicating a mild synovitis.

Output: 1.Cartilage degeneration most severely affecting the patella.2.Mild synovitis.3.Collection of near-fluid signal intensity deep to the tibial collateral ligament suggesting a bursitis.4.Other findings as above.


Instruction: Generate impression based on medical findings.

Input: 23 year old man with history of heart transplant in 2011, presenting for annual evaluation.MEDICATIONS: Pravastatin, tacrolimus, prednisone, cellcept, tricor, glipizide, metformin, synthroid. First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 63%, the LV end diastolic volume index is 90 ml/m2 (normal range: 74+/-15), the LVEDV is 150 ml (normal range 142+/-34), the LV end systolic volume index is 34 ml/m2 (normal range 25+/-9), the LVESV is 56 ml (normal range 47+/-19), the LV mass index is 43 g/m2, and the LV mass is 71 g. There are no regional wall motion abnormalities present.Left AtriumThe left atrium is consistent with prior transplant.. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 66 ml/m2 (normal range 82+/-16), the RVEDV is 116 ml (normal range 142+/-31), the RV end systolic volume index is 30 ml/m2 (normal range 31+/-9), and the RVESV is 53 ml (normal range 54+/-17).Right AtriumThe right atrium is consistent with prior transplant.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. The main PA is 28 mmVenous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 63%).4. Normal RV size and systolic function (RVEF 55%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Clinical question: MS versus stroke. Signs and symptoms: Inability to walk. Nonenhanced brain MRI:Examination is performed without intravenous contrast due to patient's refusal.Examination of the cervical spine was not performed due to patient's claustrophobia.Negative diffusion weighted images.Examination is degraded due to motion artifact however diagnostic.There is normal anatomical morphology and normal signal intensity of brain parenchymal on all MRI sequences.There is a slight prominence of cortical sulci for patient's stated age. The ventricular system remains within normal and maintained midline.There is normal myelination of brain parenchyma. The CSF spaces remain widely patent and unremarkable.The signal void of major intracranial arterial branches are identified. The signal intensity of intracranial venous sinuses are beginning normal.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells and

Output: Unremarkable nonenhanced brain MRI.


Instruction: Generate impression based on medical findings.

Input: 64 year old male. Chronic hepatitis C. HCC status post resection. Evaluate for recurrence. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. Cholelithiasis.No suspicious hepatic mass. Previously noted segment 8 arterially enhancing lesion is no longer visualized.Patent hepatic vasculature with a replaced right hepatic artery, representing normal variant anatomy. No biliary ductal dilatation.Small perigastric varices, similar to prior.SPLEEN: Mild splenomegaly measuring 13.8 cm.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Atrophic right kidney.RETROPERITONEUM, LYMPH NODES: Calcific atherosclerotic disease of the abdominal aorta with an ectatic distal aorta that measures 2.3 cm in AP dimension, similar to prior.Mildly enlarged left periaortic lymph nodes and multiple small gastrohepatic ligament lymph nodes, unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multilevel small perineural cysts at neural foramina in the thoracic spine. Mild degenerative changes of the lumbar spine with rightward curve.Post-surgical findings in the anterior abdominal wall.OTHER: No significant abnormality noted.

Output: Cirrhotic liver morphology with no evidence of recurrence or new suspicious lesion.


Instruction: Generate impression based on medical findings.

Input: Right knee pain, meniscal tear versus loose body MENISCI: There is blunting of the free edge of the body of the medial meniscus which is new from the prior exam and likely represents inner edge fraying/tearing. The anterior and posterior horns of the medial meniscus are intact.There is poorly defined increased signal throughout the lateral meniscus representing extensive degeneration and degenerative tearing. Additionally, there appears to be a vertically oriented tear of the posterior horn with blunting of the free edge of the anterior horn that could reflect interval tearing or the sequela of partial meniscectomy. There is further lateral extrusion of the body of the lateral meniscus with deformity of the contour likely representing a combination of degeneration and tearing.ARTICULAR CARTILAGE AND BONE: The full-thickness defect of the articular cartilage of the medial femoral condyle previously seen on the prior exam is no longer evident. This has instead been replaced with an osseous protuberance measuring approximately 15 mm in width and 4 mm in depth and likely represents the site of interval microfracture surgery. The articular cartilage overlying the bony protuberance is thinned and there is a focal full-thickness defect of the articular cartilage immediately medial to this protuberance measuring approximately 5 mm. Additional heterogeneity of the remaining articular cartilage of the medial femoral condyle suggests mild degeneration. There is also focal degeneration of the articular cartilage of the medial tibial plateau immediately posterior to the truncated body of the medial meniscus. There is mild edema type signal within the subchondral bone of the medial femoral condyle as well. There has been progression of cartilage degeneration of the lateral compartment with portions of the weightbearing surface of the lateral tibial plateau essentially devoid of articular cartilage. There has also been progression of subchondral cystic change although the subchondral edema within the tibial plateau is not as prominent. Furthermore, there has been progression of thinning of the articular cartilage of the lateral femoral condyle posteriorly with areas of full-thickness degeneration.There is moderate degeneration of the articular cartilage of the patellofemoral joint which has also progressed from the prior exam with areas of new full-thickness clefts in the femoral trochlea.There is also progression of osteoarthritis of the proximal tibiofibular joint.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Tricompartmental progression of osteoarthritis with meniscal tears and other findings described above. No discrete loose body is identified within the joint.


Instruction: Generate impression based on medical findings.

Input: 77-year-old male with history of lumbosacral pain. There is mild straightening of the lumbar spine in the sagittal plane. The distal spinal cord and conus are within normal limits with the conus terminating at the L1 level. There is mild sacral canal epidural lipomatosis. There is diffuse paraspinal muscle atrophy. There are bilateral probable renal cysts, although incompletely characterized. The vertebral body heights are well-maintained. However, there is disc space loss and vacuum disc phenomenon at multiple levels. There are multilevel degenerative endplate changes with a few Schmorl nodes, with additional degenerative changes as follows:T12-L1: There is a disc bulge, but no significant spinal canal stenosis or neural foramen narrowing.L1-2: There is a disc bulge and facet hypertrophy resulting in mild spinal canal stenosis and mild bilateral neural foramen narrowing. There is a small amount of fluid within the left facet joint.L2-3: There is a disc bulge, ligamentum flavum thickening, and facet hypertrophy resulting in moderate spinal canal stenosis and mild bilateral neural foramen narrowing. There is a small amount of fluid within the right facet joint.L3-4: There is a disc bulge, ligamentum flavum thickening, and facet hypertrophy resulting in severe spinal canal stenosis and mild to moderate bilateral neural foramen narrowing. There is fluid within bilateral facet joints.L4-5: There is a disc bulge, ligamentum flavum thickening, and facet hypertrophy resulting severe spinal canal stenosis and mild to moderate bilateral neural foramen narrowing. L5-S1: There is a disc bulge ligamentum flavum thickening, and facet hypertrophy with mild spinal canal stenosis. There is moderate bilateral neural foramen narrowing.

Output: Extensive multilevel degenerative spondylosis of the lumbar spine, which is most pronounced at L3-4 and L4-5, where there is severe spinal canal stenosis.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: 77-year-old female with metastatic breast cancer and worsening hip pain. There is heterogeneous signal abnormality within the right ischium that corresponds to a treated metastasis seen on prior PET/CT and CT examinations dating back to 2011. The lesion is of heterogeneously high signal intensity on T2-weighted imaging and is predominantly fat signal intensity on T1-weighted imaging with relatively small areas of nonadipose signal on T1-weighted imaging. There is mild enhancement of the lesion following administration of gadolinium. The cortex surrounding the lesion is intact, representing healing when compared to the prior study from 2011. There is very mild poorly-defined edema-type signal abnormality within the head, neck, and intertrochanteric region of the right femur seen on T2-weighted imaging that shows minimal enhancement on postcontrast images. On the T1-weighted images, however, the marrow signal intensity of the femur is of fat signal intensity, more so than that on the contralateral side, suggesting that this is a site of a prior radiation port; therefore, these likely represent postradiation changes.. There is a trace amount of fluid within the right hip joint. There is mild synovial enhancement suggesting a very mild synovitis, but we see no erosions. The remainder of the visualized bone marrow is within normal limits. Degenerative disc disease affects the lower lumbar spine. We see no tendon tearing or gross asymmetry of the musculature of the pelvis. There are small right-sided obturator lymph nodes. Mild degenerative arthritis affects the pubic symphysis. Lobulated fat within the buttocks likely represents injection granulomas.

Output: 1. Findings compatible with the patient's history of a treated ischial metastasis. We see no additional lesions to suggest metastatic disease to bone.2. Minimal right hip synovitis which may reflect prior radiation therapy.3. Degenerative disc disease of the lower lumbar spine and other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Altered mental status, unspecified [R41.82], Reason for Study: ^Reason: Concern for intracranial change compared to prior MRI History: Altered mental status No evidence of acute ischemic or hemorrhagic lesion.Postsurgical changes from prior frontal craniotomy are seen (including bifrontal encephalomalacia, hemosiderin deposition around interhemispheric fissure and frontal small extra-axial fluid collections), unchanged since prior scan.Subtle increased FLAIR high signal intensities on the right middle cerebellar peduncle and right cerebellum are again seen, unchanged.The ventricles, sulci and cisterns are unremarkable. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Postoperative changes related to prior frontal craniotomy for tumor removal are again seen, unchanged since prior scan.


Instruction: Generate impression based on medical findings.

Input: Reason: 59yr old male with history of MM; pre-auto sct evaluation History: evaluate SKULL: Multiple small lytic lesions are seen throughout the skull, compatible with a history of multiple myeloma.CERVICAL SPINE: The lower cervical spine is partially obscured. Degenerative changes affect the cervical spine. No discrete myelomatous lesion is evident. THORACIC SPINE: Compression deformity is again seen involving the T5 vertebral body, with approximately 60% loss of vertebral body height and areas of lucency within the vertebral body, compatible with known history of myeloma, appearing similar to that seen on previous MRI. Mild anterior wedge deformity is also seen is T8 vertebral body, and appears chronic. Degenerative disc disease affects the remainder of the thoracic spine.LUMBAR SPINE: Mild degenerative disc disease and facet arthropathy affect the lumbar spine. No discrete myelomatous lesion is evident.RIBS: Subtle lucency along the posterior aspect of the left second rib may represent a myelomatous deposit, but this is equivocal. Mild deformity and sclerosis along the posterolateral aspect of the right ninth rib may represent healing/healed pathologic fracture, possibly related to myelomatous lesion.PELVIS: There is a 5-6 cm lytic lesion with sclerotic margins in the right ilium as seen on previous CT. A healed pathologic fracture is visualized in the left ischium. Degenerative changes affect the bilateral hips. Surgical clips project over the scrotum.UPPER EXTREMITY: Subtle lucencies in the bilateral proximal humeri may represent additional myelomatous deposits, but this is equivocal. Deformity of the mid left clavicle may represent a healed fracture. No myelomatous deposits are seen within the forearms. Degenerative changes affect the bilateral acromioclavicular joints. LOWER EXTREMITY: Poorly defined 1 cm lucency within the distal femoral diaphysis bilaterally, suggestive of myelomatous deposits. Punctate high density foci are seen in the medial subcutaneous fat of the left thigh, of unknown etiology. No discrete myelomatous lesions are seen within the lower legs. An ossicle in the posterior left knee joint may represent a loose body.

Output: Multiple myeloma and other findings as above.


Instruction: Generate impression based on medical findings.

Input: Change in stool caliber bloating and left lower quadrant tenderness. PELVIS:UTERUS, ADNEXA: Retroflexed retroverted uterus. The endometrial thickness is normal. The inner myometrium/junctional zone is normal in thickness. There are small uterine fibroids. The bilateral adnexa are normal in morphology and size without a focal lesion. Small cervical nabothian cysts are noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild degenerative changes of the spine.OTHER: No significant abnormality noted.

Output: No specific findings to account for the patient's left lower quadrant tenderness.


Instruction: Generate impression based on medical findings.

Input: 48 year old woman with sarcoidosis, referred for interval evaluation of cardiac involvement. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function . The overall LV ejection fraction is 49%, the LV end diastolic volume index is 91 ml/m2 (normal range: 65+/-11), the LVEDV is 158 ml (normal range 109+/-23), the LV end systolic volume index is 46 ml/m2 (normal range 18+/-5), the LVESV is 81 ml (normal range 31+/-10). Normal wall motion. There is late gadolinium enhancement in the basal inferolateral wall which suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. Compared to prior MRI on 11/13/13, the extent of LGE has decreased.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 49%, the RV end diastolic volume index is 70 ml/m2 (normal range 69+/-14), the RVEDV is 121 ml (normal range 110+/-24), the RV end systolic volume index is 35 ml/m2 (normal range 22+/-8), and the RVESV is 61 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a "psuedo-bovine" brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSmall bilateral pleural effusions and atelectasis. Thoracic adenopathy. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with mildly reduced systolic function . The overall LV ejection fraction is 49%.2. There is late gadolinium enhancement in the basal inferolateral wall which suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. 3. The right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 49%.4. Compared to prior MRI on 11/13/13, the LV and RV function has decreased and the extent of LGE has decreased.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: History of multiple sclerosis with slurred speech and weakness. Also recent sore throat with fevers. There are numerous, greater than 10, T2 hyperintense lesions involving the cerebral white matter, predominantly in a periventricular distribution. There are also T2 hyperintense lesion in the pons and bilateral middle cerebellar peduncles. Many of the lesions are also T1 hypointense, but there is no discernible associated enhancement. There may also be a T2 hyperintense lesion in the imaged upper cervical spine. There are nonspecific areas of susceptibility effect in the bilateral basal ganglia. However, there is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and sulci are diffusely prominent due to mild cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, mastoid air cells, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is diffuse thickening of the calvarium.There is mild prominence of the adenoids and there is a small amount of secretions in the nasopharynx.

Output: 1. Stigmata of multiple sclerosis, but no evidence of acute intracranial hemorrhage, abscess, or acute infarct. 2. Mild prominence of the adenoids and a small amount of secretions in the nasopharynx may be attributable to an upper respiratory tract infection.


Instruction: Generate impression based on medical findings.

Input: History of uterus fibroids. Evaluation for embolization. PELVIS:UTERUS, ADNEXA: The uterus is markedly enlarged due to multiple fibroids including intramural and subserosal fibroids. It measures 11.4 x 11.2 cm in the sagittal plane.The dominant subserosal fibroid in the left uterine body/fundus measures 8.7 x 7.9 cm, compared to 9.2 x 8.5 cm previously. The right fundal subserosal exophytic fibroid measures 5.5 x 4.8 cm. These demonstrate avid postcontrast enhancement.Demonstrated again is a T1 hyperintense T2 hypointense right adnexal lesion measuring 2.8 x 2.4 cm (series 4/19), compared to 2.8 x 2.2 cm previously, compatible with an endometrioma. Similar lesion in the left adnexa measures approximately 1.8 x 1.0 cm.Normal endometrial thickness. Several punctate T2 cystic foci in the inner myometrium/junctional zone compatible with adenomyosis.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is a T2 hyperintense enhancing lesion in the S1 vertebral body measuring 2.6 x 2.6 cm (series 4/34) suspicious for a metastatic lesion given the history of carcinoid.OTHER: No significant abnormality noted.

Output: 1.2.6 cm enhancing S1 vertebral body lesion suspicious for metastatic disease especially given the history of carcinoid. Further staging imaging is recommended to evaluate for other sites of metastatic disease.2.Enlarged myomatous uterus containing avidly enhancing fibroids. 3.Adenomyosis.


Instruction: Generate impression based on medical findings.

Input: 42-year-old woman with history of pancreatic lesion. ABDOMEN:LIVER, BILIARY TRACT: The liver appears normal in signal and morphology. Cholelithiasis without evidence of cholecystitis. No intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: The tail of the pancreas (6/17) there is a 38 x 34 mm homogenous markedly T2 hyperintense lobulated lesion without enhancement. A few thin internal septations are noted, but there is no nodular component. Along the medial aspect there is a small, tail-like extension towards the pancreatic parenchyma (900/22), but lesion otherwise does not clearly communicate with the pancreatic duct. This lesion measured 34 x 31 mm on the prior exam and has significantly increased in size since exam in 2008 (when measured up to 1.3 cm). The remainder of the pancreas appears normal and there is no pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Simple ovarian cysts noted.

Output: Nonenhancing cystic pancreatic lesion containing thin septations located in the tail of the pancreas, gradually increasing in size over serial exams. Based on imaging appearance, this could represent a oligocystic or macrocystic variant of serous cystadenoma but a purely cystic mucinous cystic neoplasm cannot be entirely excluded (the cystic components of lesion do not demonstrate variable or increased T1 signal). Please correlate with clinical findings and, given continued increasing size (lesion now measures up to 3.8 cm), consider repeat EUS/biopsy.


Instruction: Generate impression based on medical findings.

Input: Hamartoma and gelastic seizures: for use during laser ablation There are interval findings related to repeat laser ablation of the hypothalamic hamartoma with peripheral enhancing along the margins of the ablation zone and perhaps slight increase in size of the hamartoma. There is mass effect upon the optic apparatus, although it demonstrates normal signal. There is a non-enhancing T2 hyperintense focus in the region of the right anterior frontal lobe subcortical white matter that measures up to 12 mm, which has gradually increased in size. There is no evidence of acute cerebral infarction or hemorrhage. The ventricles are unchanged in size. There are findings related to prior frontal craniotomy and transcallosal surgery. There are small retained secretions within the left sphenoid and ethmoid sinuses. There is a small amount of persistent high T2 signal within the right mastoid tip air cells.

Output: 1. Expected findings related to repeat MRI guided laser ablation of a hypothalamic hamartoma. 2. A nonspecific lesion in the region of the right frontal lobe that measures up to 12 mm has gradually increased in size. This may represent a hamartoma of low-grade neoplasm.


Instruction: Generate impression based on medical findings.

Input: Male; 37 years old. Reason: evaluate prostate for potential tumor to target on biopsy History: Elevated PSA history, negative prostate biopsy PELVIS:PROSTATE:Prostate Size: 3 x 4.7 x 4.6 cm.Peripheral Zone: No evidence of prostate cancer.Central Gland: Heterogeneous.Seminal Vesicles: Mild hemorrhage in the left inferior seminal vesicle.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of prostate cancer.