Instruction: Generate impression based on medical findings.

Input: Female 78 years old Reason: eval for wrist pathology/tendinitis History: recurrent left wrist swelling/pain LIGAMENTS: The scapholunate ligament is well visualized and intact.TRIANGULAR FIBROCARTILAGE COMPLEX: There is disruption of the triangular fibrocartilage complex with extension of joint fluid between the radiocarpal and distal radial ulnar joints.TENDONS: The tendons appear intact with no findings to suggest tenosynovitis. BONES: There is narrowing and osteophyte formation at the basilar joint with subchondral cyst formation in the base of the first metacarpal and trapezium.

Output: 1.Severe osteoarthritis of the basilar joint.2.Disruption of the triangular fibrocartilage complex.3.Radiocarpal and distal radioulnar joint effusions.4.No findings to suggesting tenosynovitis.


Instruction: Generate impression based on medical findings.

Input: 19 years Male (DOB:2/10/1997)Reason: Hx of choroid plexus papilloma History: as abovePROVIDER/ATTENDING NAME: KATARINA VESKOVIC KATARINA VESKOVIC The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient is status post posterior fossa craniotomy as well as left frontal craniotomy. The left lateral ventricle remains asymmetrically larger than the right lateral ventricle. There is redemonstration of a defect along the body of the corpus callosum.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: The patient status post left frontal craniotomy and posterior fossa surgery. A portion of the body of the corpus callosum has been removed. These findings are stable compared to previous exams. Since the prior exam there is no evidence for recurrence


Instruction: Generate impression based on medical findings.

Input: The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. 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. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain. Incidental note is made of bilateral staphyloma.

Output: Negative MRI of the brain including gadolinium enhancement. Specifically, there are no MRI findings to explain the patient's headaches.


Instruction: Generate impression based on medical findings.

Input: Recurrent right upper extremity and shoulder pain Again seen are postoperative changes of anterior cervical discectomy and fusion at C6-C7. Hardware is better assessed on recent CT.Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Individual levels as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: Mild narrowing of the neural foramina related to uncovertebral hypertrophy. No significant spinal canal stenosis.C5-6: There is mild to moderate right-sided and mild left neural foraminal stenosis related to uncovertebral hypertrophy. No spinal canal stenosis.C6-7: Postoperative changes of anterior fusion. No evidence of recurrent disc herniation. Neural foramina are patent. No significant spinal canal stenosis.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Postoperative changes of ACDF at C6-C7 without evidence of recurrent disc herniation at this level. 2. Mild degenerative changes including mild to moderate narrowing of the right C5-C6 neural foramen and mild narrowing of the bilateral C4-C5 and left C5-C6 neural foramina related to uncovertebral hypertrophy.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old, with history of surgery on the optic nerve in 1986, presenting with visual field alteration. Periventricular T2 hyperintensity, particularly at the level of the atria, is stable to at most minimally progressed when compared to the prior examination. Encephalomalacia of the left gyrus rectus is unchanged. T2 signal abnormality seen on the prior examination within the left anterior temporal lobe has resolved.No evidence of restricted diffusion, mass effect or significant parenchymal edema is seen. No acute intracranial hemorrhage or any new abnormal extra-axial fluid collection is observed. Postcontrast images show no pathologic parenchymal or extra-axial enhancement.Please note this examination was not tailored for the assessment of the orbits. Within this limitation, enophthalmos of the left globe is a stable finding. The left optic nerve is not visualized, nor is the left superior rectus, findings which also appear unchanged from prior.

Output: 1.Periventricular T2 hyperintensity is stable to minimally progressed. This is a nonspecific finding which may reflect chronic microvascular ischemic disease.2.Stable encephalomalacia of the left gyrus rectus. Signal abnormality seen on the prior examination within the left anterior temporal lobe has resolved.3.No new areas of parenchymal signal abnormality or pathologic enhancement are seen.4.Although not protocoled as a dedicated orbital examination, enophthalmos of the left globe, along with inability to visualize the left optic nerve and left superior rectus muscle, are stable findings.


Instruction: Generate impression based on medical findings.

Input: Status post craniotomy for sphenoid/cavernous sinus meningioma in July 2012. There are changes of previous resection of the right frontal and paraclinoid meningioma resection. There is a surgical tract in the right frontal lobe at the depth of which there is punctate diffusion restriction, most likely reflecting blood products. Otherwise, there is no acute infarct. The lobulated T1/T2-hypointense signal along the inferior half of the craniotomy flap remains unchanged, representing bone cement. Cavernous sinuses enhance symmetrically. The ventricles and sulci are unchanged. There is mild ethmoid mucosal thickening.

Output: Postoperative findings without evidence of tumor recurrence.


Instruction: Generate impression based on medical findings.

Input: Autism and global developmental delay: assess myelination. The third and lateral ventricles are mildly prominent due to apparent mild deficiency of white matter bulk diffusely. However there is complete myelination of supratentorial and infratentorial white matter. There is a 10 mm wide arachnoid cyst overlying the anteromedial aspect of the left temporal pole. Otherwise, there is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, mastoid air cells, and scalp soft tissues are grossly unremarkable. There is mild diffuse paranasal sinus mucosal thickening.

Output: 1. The third and lateral ventricles are mildly prominent due to apparent mild deficiency of white matter bulk diffusely. However there is complete myelination of supratentorial and infratentorial white matter. 2. Small arachnoid cyst overlying the anteromedial aspect of the left temporal pole.


Instruction: Generate impression based on medical findings.

Input: Suspicion for left ACL tear. MENISCI: Bucket handle-type tear of the posterior horn of the medial meniscus, with the meniscal fragment displaced anteromedially. No significant abnormality noted in the lateral meniscus.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted. No bone contusions are evident.LIGAMENTS: There is a complete tear of the ACL. No significant abnormality noted in the PCL. The MCL and LCL complex are normal.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Complete tear of the ACL.2. Bucket handle tear of the posterior horn of the medial meniscus.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old, with right base of tongue mass, tongue deviated to the right, throat and tongue pain. Brain:No evidence of parenchymal mass effect or edema is seen. No pathologic parenchymal or extra-axial enhancement is detected. There are a number of scattered small foci of FLAIR hyperintensity including within the anterior temporal lobes and the right superior frontal gyrus which are unchanged and nonspecific. Innumerable foci of susceptibility are redemonstrated with particular involvement of the bilateral frontal lobes, the inferior parietal lobes and the temporal lobes, similar to that seen on the prior examination. No evidence of acute intracranial hemorrhage is seen. No abnormal extra-axial collections are detected. Ventricular size morphology are within normal limits.Neck:Image quality is limited by motion artifact. An enhancing mass is redemonstrated centered on the right tongue base with invasion of the intrinsic tongue musculature and floor of mouth. The lesion does extend across midline to involve the left tongue base to some degree. Compared to the prior examination, it appears that the lesion has increased in size, now measuring up to 38 mm in maximal axial length, previously approximately 28 mm when measured similarly. As before, tumor partially effaces the vallecula.The remainder of the aerodigestive mucosa is within normal limits. No pathologic adenopathy is detected by size criteria. The salivary glands and the thyroid appear to be free of focal lesions. Multilevel cervical spondylosis is demonstrated superimposed on a congenitally slender canal.

Output: 1.Probable increase in size of the right tongue base/floor of mouth tumor.2.No pathologic adenopathy is detected in the neck.3.No evidence of intracranial metastases is seen.4.Numerous scattered foci of brain parenchymal susceptibility are redemonstrated. These lesions are compatible with chronic microhemorrhage, perhaps related to amyloid angiopathy.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Compression of brain. Variants of migraine, not elsewhere classified, without mention of intractable migraine without mention of status migrainosusClinical question: Please evaluate for meningeal enhancement. Known Chiari.Signs and Symptoms: Right arm numbness and positional headaches. MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. The cerebellar tonsils are low lying. No abnormal enhancing lesions are appreciated intracraniallyNo abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a minor disc bulge at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.No intracranial mass lesions are appreciated.2.There are only minor degenerative changes present in the cervical spine.


Instruction: Generate impression based on medical findings.

Input: MRI BRAIN: The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are mild bilateral punctate T2/FLAIR hyperintense foci within the periventricular and subcortical white matter as well as the pons most compatible with chronic small vessel ischemic disease. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. There are moderate secretions within the maxillary sinuses with air-fluid levels, right greater than left. The mastoid air cells are clear.MRI ORBITS: There is ectasia of the optic nerves and optic nerve root sheaths. The optic chiasm and optic tracts appear normal. There is flattening of the optic discs. The extraocular muscles are normal and symmetric. The globes appear normal. No retinal detachment or vitreous clouding. The lacrimal glands are symmetric and within normal limits for size. No orbital mass lesion. Note is made of a partially empty sella with CSF signal within the pituitary fossa.

Output: 1.Limited exam as only precontrast images were obtained due to patient intolerance.2.Partially empty sella with ectasia of the optic nerves and optic nerve root sheaths as well as flattening of the optic disks. This constellation of findings can be seen in idiopathic intracranial hypertension (aka pseudotumor cerebri) in the appropriate clinical setting.3.Chronic small vessel ischemic disease. 4.Bilateral maxillary sinus opacification with air-fluid levels, right greater than left, similar to recent CT.


Instruction: Generate impression based on medical findings.

Input: Brain MRI:The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. 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 left maxillary sinus and right sphenoid sinus, otherwise the remaining paranasal sinuses and mastoid air cells are clear. Cervical spine:Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable. There are no MRI findings of ligamentous injury.C2/3: UnremarkableC3/4: UnremarkableC4/5: Left uncinate hypertrophy causes mild left neural foraminal stenosis.C5/6: Minimal osteophyte disc complex without resulting stenosisC6/7: UnremarkableC7/T1: Unremarkable

Output: 1.Mucosal thickening is present within the left maxillary sinus and right sphenoid sinus, otherwise negative noncontrast brain MRI.2.C4/5: Mild left neural foraminal stenosis.


Instruction: Generate impression based on medical findings.

Input: Chest pain, unspecified [R07.9] / Persistent atrial fibrillation [I48.1] / Paresthesia of skin [R20.2], Reason for Study: ^Reason: Hx of afib, concern for Tia symptoms, looking for stroke History: left sided paresthesias Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion.There is abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. Mucosal thickenings on the left posterior ethmoid sinuses.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate bilateral retropharyngeal course of cervical ICAs. However, there is normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries. Neck MRIMotion artifacts degraded exam quality.PHARYNX/LARYNX: The nasopharynx, oropharynx, and hypopharynx are unremarkable. The larynx is unremarkable. The upper trachea and esophagus are unremarkable. There is no abnormal soft tissue mass or pathological enhancement.GLANDS: The contrast-enhanced appearance of the submandibular, sublingual, and parotid glands bilaterally is unremarkable. The thyroid gland is unremarkable. ORAL CAVITY: The oral tongue and the floor of mouth are unremarkable.CERVICAL SOFT TISSUES: Scattered small cervical lymph nodes are identified.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement.2. Normal Neck MRA3. Normal Neck MRI


Instruction: Generate impression based on medical findings.

Input: Neoplasm of unspecified behavior of endocrine glands and other parts of nervous system [D49.7], Reason for Study: ^Reason: 3 T SCANNER WITH CSF FLOW PLEASE History: PINEAL TUMORAdditional history from EMR: pineal parenchymal tumor of intermediate differentiation Images are limited by patient motion. There is regeneration of postoperative changes from previous partial resection of a infiltrative appearing enhancing lobulated pineal tumor, with right paramedian occipital approach. There is underlying right occipital pole encephalomalacia. Compared to the recent exam from 11/4/2016, there has been no significant interval change in the overall morphology and size of this heterogeneously enhancing mass, again measuring up to 37 mm transverse. On T2-weighted images, there is again an infiltrative appearance involving the thalami bilaterally, with more cranial extension on the right side and associated mass effect upon the posterior aspect of the third ventricle. The tectum is not discretely delineated, engulfed by the mass. The cerebral aqueduct is not well visualized.A right frontal approach ventriculostomy catheter is again seen, with tip near the septum pellucidum at the level the body of the lateral ventricles. Although third ventricular dilatation appears similar in degree, lateral ventricles are increasingly dilated and rounded in morphology especially along the atria, with the right atrium now measuring 22 mm transverse compared to previous 18 mm. There appears to be stable thickness of periventricular abnormal T2 hyperintensity. Additional patchy areas of T2 hyperintensity are seen elsewhere throughout the cerebral white matter.CSF flow imaging appears technically limited. Biphasic flow is identified only along the ventral brainstem and upper cervical cord, as well as the dorsal upper cervical spinal canal. Biphasic flow is not identified through the aqueduct ventricle.A prominent oval area of mild T2 hyperintensity seen along the left occipital scalp is nonspecific, although previous imaging demonstrated avid enhancement. This measures approximately 17 x 18 mm in greatest axial dimensions. It does appear to involve the skin surface.

Output: 1. Stable appearance of lobulated heterogeneously enhancing pineal mass with infiltrative involvement of the thalami bilaterally, greater on the right side.2. Slight interval increased dilatation of the lateral ventricles with stable right frontal approach ventriculostomy catheter. CSF flow imaging is somewhat technically limited, although appears to demonstrate lack of flow through the cerebral aqueduct and fourth ventricle, with minimal flow detected along the ventral brainstem and ventral as well as dorsal upper cervical spinal canal.3. Redemonstration of oval mildly T2 hyperintense 18 mm lesion in the left occipital scalp with heterogeneous enhancement, extending to the skin surface. Please correlate with direct inspection, although the finding has been present since baseline exam of May 2014, potentially representing a sebaceous cyst with associated infectious or inflammatory changes..


Instruction: Generate impression based on medical findings.

Input: Clinical question: Evaluate for hemorrhage. Signs and symptoms: Status-post grids in for seizure focus resection. Non-infused CT of brain:There is evidence of a large right temporal and frontal -- parietal craniotomy. Expected extra axial (epidural) air and fluid collection under the craniotomy flap is noted. There is overall increase mass effect in the right hemisphere with effacement of sulci and approximately 1 to 2-mm midline shift. There is evidence of a placement of epidural electrodes extending from the level of the floor of the right middle cranial fossa superiorly to above the level of lateral ventricles. Electrodes cover part of the right temporal lobe and extends superiorly into the parietal lobe. There is medial extension of electrodes which is best appreciated on axial image 11. The cortical sulci are not well visualized due to technique however I believe this component of electrodes are within the right sylvian fissure. There is no evidence of any parenchymal edema or hemorrhage. There is no evidence of ventriculomegaly. There is a focal area of CSF density within the expected level of right sylvian fissure noted on axial image 13. This corresponds with focal area widening of the sylvian fissure that was present on prior MRI examination. This is believed to represent a focal area of encephalomalacia of the operculum of right temporal lobe deep within the sylvian fissure. This is best appreciated on coronal T2 weighted images 15 through 17. No evidence of hemorrhage, edema, hydrocephalus is noted.

Output: 1.Expected postoperative changes of right craniotomy for placement of epidural electrodes over the right temporal and frontal lobes.2.Focal area of encephalomalacia believed to be within the operculum of right temporal lobe deep within the right sylvian fissure.


Instruction: Generate impression based on medical findings.

Input: Malignant neoplasm of connective and soft tissue of thorax [C49.3], Reason for Study: ^Reason: History of soft tissue sarcoma,e valuate for local recurrence History: surveillance Redemonstration of postoperative changes of thoracic right paraspinal soft tissue lesion, unchanged since prior scan.There is no evidence of abnormal signal intensity.No evidence of abnormal enhancement.There is normal thoracic kyphosis The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow demonstrate a normal MR appearance. The signal of the visualized cord is normal. T1 and T2 hyperintensity in the left third and seventh ribs compatible with small hemangiomas, unchanged since prior scan. Degenerative changes including mild spinal stenosis at the level of T11-12 and neuroforaminal narrowings bilaterally at the level of T9-10 and T10-11 are again seen, unchanged.

Output: 1. No evidence of recurrent disease.2. Unchanged postoperative findings and multi-level degenerative changes as described above.


Instruction: Generate impression based on medical findings.

Input: 17 year old male with schwannomas in leg and groin area. Beading of the left femoral nerve and sciatic nerve is similar in appearance to the prior exam. The schwannoma/neurofibroma of the proximal tibial nerve is similar in appearance and has a maximum diameter of 1.2 cm, 1.2 cm previously. Subtle beading is again noted in the distal tibial nerve. No new lesions are identified.

Output: No significant change in neurofibromas/schwannomas since prior exam.


Instruction: Generate impression based on medical findings.

Input: Lesion of uncertain significance. There is no significant interval change in size of the patchy T2 hyperintense lesion that measures up to approximately 14 mm, involving the inferomedial left basal ganglia, with apparent compression of the adjacent optic pathway. There is also an unchanged punctate focus of enhancement in the central portion of the lesion. However, there appears to be an additional punctate focus of enhancement more inferiorly within the lesion. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is scattered paranasal sinus mucosal thickening and retention cyst formation.

Output: No significant interval change in size of the patchy T2 hyperintense lesion with a punctate focus of enhancement involving the inferomedial left basal ganglia, although there appears to be an additional punctate focus of enhancement. A neoplastic remains a salient possibility for this lesion.


Instruction: Generate impression based on medical findings.

Input: New breast cancer in the right breast. Status post two outside hospital biopsies of the right breast (10:00 pathology is mucinous IDC, 12:00 pathology is benign). MRI for extent of disease and for surgery planning. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.There is biopsy clip artifact in the right lateral breast at mid depth. This corresponds to the site of the recent right breast 10:00 malignant biopsy. There is a faint enhancement around the clip, though the degree of enhancement near the clip is very similar to the rest of the background breast enhancement. A definite artifact from the 12:00 benign biopsy clip cannot be seen. There is a faintly enhancing 8 mm mass at the 12:00 position that may be a correlate to the biopsied mass. This finding is benign in appearance. No abnormal enhancement is seen in the left breast. Typical benign edge parenchymal enhancement pattern is noted along the anterior/superior aspect of her breast tissue on the left.No abnormal lymph nodes are identified in either axillary region.

Output: Right outer breast biopsy clip artifact represents the site of the recent 10:00 malignant biopsy. Only mild enhancement is seen around the clip.Faintly enhancing right breast 12:00 mass is typically benign in appearance and may correspond to the finding shown at this location on ultrasound.  BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: Headache [R51] / Fever, unspecified [R50.9], Reason for Study: ^Reason: Rule out meningitis/infection, intracranial bleed, CVA History: headaches, fevers, immune suppression No evidence of acute ischemic or hemorrhagic lesion on the scan.There is evidence of chronic ischemic infarct with encephalomalacia on the left MCA territory including left frontal lobe with subtle ex vacuo changes. There are multi focal lacunar infarcts on the left thalamus and bilateral caudate nuclei.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Chronic ischemic infarction on the left frontal lobe with multiple lacunar infarcts as described above.No evidence of acute ischemic or hemorrhagic lesion on this scan.No abnormal enhancement.


Instruction: Generate impression based on medical findings.

Input: Male, 81 years old, with altered mental status. No restricted diffusion is seen. Numerous scattered foci of periventricular and cortical T2 hyperintensity are seen, becoming somewhat confluent in the periatrial regions. The quantity and distribution of these lesions appear similar to the prior MRI exam. No evidence of mass effect or edema is seen. No intracranial hemorrhage or abnormal extra-axial fluid collection is detected. No pathologic parenchymal or extra-axial enhancement is seen. The ventricles and sulci are prominent compatible with underlying volume loss, similar to prior.

Output: 1.No acute intracranial abnormality.2.Findings compatible with chronic microvascular ischemic disease without significant interval change.


Instruction: Generate impression based on medical findings.

Input: Pain with weightbearing TENDONS: There is a minimal amount of fluid in the peroneus longus tendon sheath as it courses along the anterior calcaneus and cuboid but this is within normal limits. The remaining tendons are unremarkable.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: There are no findings to suggest a cuboid fracture. A small rounded focus of mildly increased signal intensity is seen on fluid sensitive sequences within the proximal medial cuboid beneath the anterior process of the calcaneus. This may represent an early degenerative cyst but is of questionable clinical significance. The bone marrow signal of the ankle and hindfoot is otherwise unremarkable. ADDITIONAL

Output: Tiny focus of signal abnormality within the proximal medial cuboid proximal to the anterior calcaneus may represent an early degenerative cyst but there is no evidence of cuboid fracture. Other findings are described above.


Instruction: Generate impression based on medical findings.

Input: 61-year-old female with hip pain ACETABULAR LABRUM: There is degenerative tearing of the anterior and superior labrum. The transverse ligament is thickened as is the ligamentum teres at its attachment on the transverse ligament.ARTICULAR CARTILAGE AND BONE: There are foci of full-thickness cartilage loss involving the superior acetabulum. There are osteoarthritic changes involving the superior acetabulum in the area of underlying labral tear. Bone marrow signal intensity is within normal limits. No evidence of fracture or malalignment.SOFT TISSUES: No muscle atrophy or edema is noted. The tendinous origins of the iliopsoas, hamstring and gluteal muscles are intact.ADDITIONAL

Output: Tear of the anterosuperior labrum with underlying osteoarthritic changes.


Instruction: Generate impression based on medical findings.

Input: Neck mass. 37-year-old male. CT of the soft tissues of the neck with infusion:Images through the skull base, cavernous sinuses, paranasal sinuses and mastoid air cells are unremarkable.Images through the neck demonstrates a low-density mass with extensive internal vascular enhancement in left neck immediately posterior to the left carotid bifurcation. There is anterior displacement of distal left common carotid, proximal left internal and external carotid arteries. The mass measures 72 mm in cranial cephalad access and 42-mm x 38 0.7-mm in its axial dimension. On axial images a tapered cephalad extension of this mass reaches the anterior aspect of body of C1 vertebrae. Prior MRI examination demonstrated intense enhancement of this tumor however the enhancement on the CT examination is very patchy and not solid as it was noted on MRI. This mass demonstrates a very well demarcated margin and with no evidence of any edematous changes of adjacent fascia planes. There is significant mass-effect and lateral displacement of the left internal internal jugular which at the level of maximum compression is almost nondetectable. There is no evidence of encasement of the left carotid by this mass. Left internal jugular home for her superior and inferior to this tumor remains open.The differential for this tumor remains and is a chemodectoma, a schwannoma or a metastatic lymph node.A small right submandibular lymph node measuring 12 mm times 15-mm in transaxial dimension is present. This shows no enhancement or necrosis. Multiple smaller scattered nonenhancing and not a pathologic nodes are also noted.There is symmetrical prominence collecting tonsils with no enhancement or necrosis. Limited images of the apices of the lungs are negative for pathology.Limited images of the mediastinum are also negative. 70 cc of Omnipaque 350 was utilized for the above study.

Output: 1. Large well-demarcated low-density mass with patchy internal vascular enhancement in the left neck. Finding is believed to represent a schwannoma, additional possibility of chemodectoma, metastatic lesion cannot be entirely ruled out.2.Small additional nonenhancing and nonpathologic lymph nodes as detailed.3.Prominent adenoids and collecting tonsils with no abnormal enhancement.


Instruction: Generate impression based on medical findings.

Input: 44-year-old female with a subcentimeter echogenic right renal mass on recent ultrasound examination. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is a focus of fluid signal intensity corresponding to the previously described hyperechoic focus in the superior pole of the right kidney, which likely represents a simple cyst. Multiple fluid signal intensity foci are identified within the kidneys bilaterally, consistent with simple cysts. No solid or enhancing mass lesions are identified.RETROPERITONEUM, LYMPH NODES: No evidence of lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Bilateral renal cysts without evidence of a solid or enhancing renal mass.


Instruction: Generate impression based on medical findings.

Input: MRI Brain:There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild periventricular and subcortical white matter T2/FLAIR hyperintensity, which is nonspecific but likely related to mild chronic small vessel ischemic disease. These changes are slightly progressed since prior study from 2007. 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. There is mild scattered paranasal sinus opacification.MRA Brain: The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. No evidence of aneurysms or vascular malformations. MRA Neck: There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. The common carotid arteries and cervical internal carotid arteries are normal in course and caliber. Both vertebral artery origins are patent. There is no evidence of stenosis or occlusion.

Output: 1.No evidence of acute infarct, edema or mass effect.2.No significant stenosis involving the intracranial arteries or arteries of the neck.3.Mild chronic small vessel ischemic changes, which have progressed since prior MRI from 2007.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: 88 year old female with pain. Evaluate for type II dens fracture. Again seen is a type II dens fracture better evaluated on recent CT and MRI study. There is mild widening of the fracture fragment on the extension view. The fracture fragment abuts the inferior aspect of the clivus. No prevertebral soft tissue swelling. Multilevel severe degenerative changes of the cervical spine most pronounced at C5-C6. There is grade 1 anterolisthesis of C4 on C5.

Output: Type II dens fracture better evaluated on recent CT and MRI study. The fracture fragment abuts the inferior aspect of the clivus and there is mild widening of the fracture fragment on the extension view.


Instruction: Generate impression based on medical findings.

Input: Multiple sclerosis [G35], Reason for Study: ^Reason: headache h/o MS History: headache h/o MS Brain MRIMultifocal FLAIR/T2 high signal intensity lesions on bihemispheric white matter consistent with demyelinating disease.No evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. 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 MRV3D MRV brain post-gadolinium with maximum intensity projections of the superficial/deep intracranial venous drainage demonstrate normal flow enhancement in the superior sagittal sinus, transverse sinuses, sigmoid sinuses, internal cerebral veins, vein of Galen and straight sinus.

Output: 1. Multifocal bihemispheric white matter lesions consistent with demyelinating disease.2. Normal brain MRV.


Instruction: Generate impression based on medical findings.

Input: Female 74 years old with epigastric pain radiating to back 1 month ago, abnormal liver tests, and cholelithiasis on abdominal ultrasound. Liver tests are now normal but she has intermittent epigastric pain. Assess for choledocholithiasis, pancreatitis. ABDOMEN:LIVER, BILIARY TRACT: No focal liver lesion, biliary ductal dilation, or ascites. Cholelithiasis. A subcentimeter T2 hypointense focus within the distal common duct (series 7, image 33) consistent with a nonobstructing stone (no upstream extrahepatic or intrahepatic biliary duct dilatation seen), focus is identical in appearance and signal to stones seen in gallbladder. There is no evidence of acute cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: There is mildly decreased intrinsic T1 signal of the pancreas, nonspecific but may represent sequela of prior pancreatitis.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Inverted duodenal sweep better depicted on prior small bowel follow-through.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Nonobstructing distal common bile duct stone seen.2.Cholelithiasis, without evidence of acute cholecystitis.


Instruction: Generate impression based on medical findings.

Input: 23 years Male (DOB:5/23/1993)Reason: Seizure foci History: SEIZURE DOPROVIDER/ATTENDING NAME: NAOUM ISSA DAVID G. BEISER The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There are a couple left sided periventricular punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.A couple left-sided periventricular white matter lesions are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific. 2.No intracranial mass lesion is identified


Instruction: Generate impression based on medical findings.

Input: 79 year-old female with fever, evaluate for osteomyelitis Ankle: There is slight increased T2 signal, likely representing edema within the posterior aspect of the calcaneus without T1 marrow changes to indicate osteomyelitis. Mild overlying soft tissue irregularity is noted. The lateral and medial collateral ligaments are intact. The Achilles tendon is intact.Foot: Bone marrow signal is within normal limits. There is increased T2 signal likely represent edema within the soft tissues posterior to the metatarsals. The soft tissue structures are otherwise unremarkable.

Output: Mild edema along the posterior calcaneus which is likely reactive without evidence of osteomyelitis.


Instruction: Generate impression based on medical findings.

Input: Low back pain for months with left sided pain and weakness. There is slight disc dessication at L4-5 and a small disc protrusion eccentric to the left with impingent upon the adjacent left lateral recess nerve roots and mild neural foraminal stenosis. The other lumbar spine levels are unremarkable and there is no significant spinal canal stenosis. The vertebral body heights are preserved. The vertebral column alignment is within normal limits. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: Degenerative spondylosis at L4-5 with a small disc protrusion eccentric to the left that impinges upon the adjacent left lateral recess nerve roots and causes mild neural foraminal stenosis.


Instruction: Generate impression based on medical findings.

Input: There are areas of T2 hyperintensity and restricted diffusion involving both grey and white matter structures, including the right basal ganglia, the right insular cortex, the right lateral periventricular white matter, the right posterior temporal lobe, right inferior frontal gyrus, and the right lateral occipital lobe. There is no midline shift or hemorrhagic transformation. There is a subcentimeter hypointense extra-axial lesion along the right frontal convexity, which may represent a meningioma. There is diffuse cerebral volume loss. Mild scattered foci of T2 hyperintensity in the cerebral white matter without restricted diffusion may represent chronic small vessel ischemic disease. There are a few punctate foci of susceptibility effect scattered in the brain parenchyma, which may represent chronic microhemorrhages. There is mild scattered fluid signal in the bilateral mastoid air cells.

Output: Scattered areas of acute infarction in the right middle cerebral artery territory without hemorrhagic transformation or midline shift.


Instruction: Generate impression based on medical findings.

Input: Left clavicle fibromyxoid sarcoma: 3 month post op follow up. There are postoperative findings related to left clavicle sarcoma resection. There is diffuse edema and enhancement in the soft tissues surrounding the reconstructed left clavicle, with ill-defined soft tissue partially surrounding the underlying neurovascular bundle. Assessment of the bone marrow of the reconstructed left clavicle is limited due to the presence of metal hardware artifact. The regional lymph nodes do not appear to be particularly enlarged. There is a cystic right thyroid nodule that measures up to 12 mm.

Output: Extensive post-treatment findings in the left brachial plexus region, including what may represent granulation and scar tissue, although a small amount of residual tumor cannot be entirely excluded. Follow up with PET may be useful.


Instruction: Generate impression based on medical findings.

Input: Acute cervical pain with right radiculopathy; paresthesia and weakness. There is reversal of the usual cervical lordosis. The vertebral body heights are preserved. There is multilevel degenerative spondylosis. At C2-C3, there is a small disc-osteophyte complex that slightly indents the ventral aspect of the thecal sac, but there is no significant neural foraminal stenosis. At C3-C4, there is a disc-osteophyte that indents the ventral aspect of thecal sac without spinal cord signal abnormality. Uncovertebral arthropathy results in moderate left and mild right foraminal stenoses. At C4-C5, a disc-osteophyte complex indents the spinal cord without associated signal abnormality. Uncovertebral arthropathy results in mild bilateral neural foraminal stenoses. At C5-C6, a disc-osteophyte complex indents the ventral aspect of thecal sac. Left more than right uncovertebral arthropathy results in moderate left and mild right neural foraminal stenoses. At C6-C7, a disc-osteophyte results in no significant spinal canal stenosis, but uncovertebral and facet arthropathy result in severe left and mild right neural foraminal stenoses. At C7-T1 a disc-osteophyte complex eccentric to the right result in no significant spinal canal stenosis, but there is severe right and moderate left neural foraminal stenoses. At T1-T2, facet arthropathy results in mild bilateral neural foraminal stenoses. The vertebral body heights are preserved. The paraspinal soft tissues are unremarkable. There is patchy T2 hyperintensity in the pons, which may represent chronic small vessel ischemic disease.

Output: Multilevel degenerative cervical spondylosis, including mild C3-C4, C4-C5, and C5-C6 spinal canal stenosis and neural foraminal stenoses that are most pronounced on the right at C7-T1, and on the left at C3-C4, C5-C6, C6-C7, and C7-T1.


Instruction: Generate impression based on medical findings.

Input: 48-year-old male with bilateral L5 radiculopathy. Five lumbar type vertebral bodies are presumed to be present. Since prior MR, posterior fusion has been extended to include the L4-S1 levels with iliac screws. Details are better appreciated on most recent CT on 12/13/2016. Interbody fusion device at the L5-S1 level and laminectomy at the L5 level are again noted. There are endplate changes involving the L5-S1 level, likely related to postoperative and degenerative changes. Vertebral body heights are otherwise well-maintained. There is 10 mm of anterior spondylolisthesis of L5 on S1, without significant interval change. Alignment is otherwise within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.There are fluid collections in the superficial and deep posterior soft tissues. In the deep posterior soft tissues, an irregular fluid collection extends from the L3-L4 level to the L5-S1 level and measures up to 6 cm in the craniocaudal dimension and 2.5 cm in thickness with enhancement of the surrounding soft tissues. More superficially, there is a larger fluid collection measuring up to 12 cm in the craniocaudal dimension and 2.5 cm in thickness. No epidural collection is identified.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: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: Again seen is a mild disc bulge with small central protrusion. Mild neural foraminal stenosis, without significant interval change. No significant spinal canal stenosis. L5-S1: Grade 2 anterolisthesis of L5 on S1, without significant interval change. There are endplate changes, likely related to surgery and degeneration. Again seen is diffuse disc bulge and mild facet arthropathy causing mild spinal canal stenosis. Neural foraminal stenosis is suspected bilaterally but not well seen due to surrounding artifact.

Output: 1. Evidence of interval extension of posterior fusion, which now extends from the L4-S1 level and iliac bones.2. New fluid collections in the superficial and deep posterior operative soft tissues, which may be within normal limits given patient's recent surgery. Correlation with clinical and laboratory parameters is advised to assess for possibility of infection.3. Disc degeneration and facet arthropathy of the L5-S1 level causing mild spinal canal stenosis, similar to prior. Neural foraminal stenoses is suspected but not well seen due to artifact.


Instruction: Generate impression based on medical findings.

Input: Reason: hx ACDF- eval for abnormality or resolution History: continued spasticity The cervical vertebral bodies are appropriate in overall alignment and height. There is multilevel disk desiccation present The patient is status post anterior fusion at C3-4. There is a signal hyperintensity within the spinal cord at the C3-4 level associated with volume loss suggesting cord myelomalacia.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal. There is a disk bulge present at this level with mild narrowing of the neural foramina. There is posterior ligamentous hypertrophy at this level.At C6-7 there is no significant compromise to the spinal canal. There is a endplate osteophyte formation present at this level associated with uncovertebral osteophytes and encroachment of the left sided exiting nerve roots it does has been previously present and is unchanged. There is posterior ligamentous hypertrophy at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. The left vertebral artery is large raise the right vertebral artery is small and hypoplastic distally.

Output: 1.There is cord myelomalacia present at the C3-4 level.2.Status post recent anterior fusion at C3-4.


Instruction: Generate impression based on medical findings.

Input: The procedure, indications, benefits, risks/complications and alternatives were described to the patient and informed consent was obtained. The patient was placed in the prone position and the inferior back was prepped with Betadine, draped and anesthetized with 1% lidocaine subcutaneously into the deeper soft tissues. Using fluoroscopic guidance, a 22 gauge x 3-1/2 inch spinal needle was localized into the thecal sac at the L4-5 vertebral level. Care was taken to avoid the nearby catheter from the pain pump which was visualized the entire time by fluoroscopy by undergoing a right paramedian approach inferior to the catheter. Approximately 15 cc of clear CSF was obtained and separated into 3 vials. The sample was given to the primary team for further analysis. The patient tolerated the procedure well with no immediate complications.TOTAL FLUOROSCOPY TIME: 0 minutes and 30 seconds

Output: Successful fluoroscopic guide lumbar puncture.


Instruction: Generate impression based on medical findings.

Input: Decreased visual acuity of the left eye: blurry vision. Brain: Many of the images are degraded by motion artifact. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are grossly unremarkable. There is mild scattered paranasal sinus mucosal thickening.Orbits: Many of the images are degraded by motion artifact. The bilateral globes and ocular adnexa are unremarkable. There is no evidence of abnormal intraorbital enhancement or mass lesions.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct, although many of the images are degraded by motion artifact.2. No evidence of orbital lesions, although many of the images are degraded by motion artifact.


Instruction: Generate impression based on medical findings.

Input: 18 year-old female with paresthesias and multiple sclerosis. Redemonstrated are numerous T2 hyperintense lesions within the subcortical and periventricular white matter as well as corpus callosum. One definite new lesion is present within medial left frontal subcortical white matter. The majority of lesions are stable, although a view with increased/decreased in size. Previously demonstrated pontine abnormality is less apparent, however axial FLAIR imaging includes phase artifact through this region, and no conventional T2 sequence was acquired. There is questionable involvement of the right superior cerebellar peduncle.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, or intra- or extra-axial fluid collection. The midline structures and cranial-cervical junction are normal.

Output: MRI evidence for multiple sclerosis which appears primarily stable, although one definite new lesion is present within the medial left frontal subcortical white matter.


Instruction: Generate impression based on medical findings.

Input: Back pain, frequent muscle cramps. For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing. The conus medullaris terminates at the T12-L1 level. The paraspinal soft tissues are unremarkable.Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: no neuroforaminal narrowing or spinal stenosis. There is about 3 mm sized well-circumscribed cystic lesion on posterior aspect of left facet joint. This may represent exophytic left facet synovial cyst or benign intramuscular cyst.L4-L5: no neuroforaminal narrowing or spinal stenosis. Mild disc desiccation with diffuse disc bulging. In particular, there is a broad-based disc bulging toward left side lateral recess, however, no blood compression is not evident.L5-S1: no neuroforaminal narrowing or spinal stenosis.

Output: Disc desiccation with a diffuse disc bulging associated with focal bulging towards left lateral recess without evidence of nerve root compression at the level of L4-5 as described above.Otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: 43 year old male with paroxsymal atrial fibrillation, refractory to medical therapy and plan for atrial fibrillation ablation. Pre procedure MRI. Left VentricleThe left ventricle is normal in size with globally decreased function. The overall LV ejection fraction is 37%. The LVEDV is 220 ml (normal range 142+/-34), the LV end diastolic volume index is 97 ml/m2 (normal range: 74+/-15), the LVESV is 82 ml (normal range 47+/-19) and the LV end systolic volume index is 61 ml/m2 (normal range 25+/-9). The LV mass is 203 g (normal range 164+/-36) and the LV mass index is 30 g/m2 (normal range 85+/-15). 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.Left AtriumThe left atrium is dilated. The left atrial appendage appears free of clot. Right VentricleThe right ventricle is normal in size with reduced function. The overall RV ejection fraction is 34%. The RVEDV is 264 ml (normal range 142+/-31), RV end diastolic volume index is 117 ml/m2 (normal range 82+/-16), the RVESV is 175 ml (normal range 54+/-17), and the RV end systolic volume index is 78 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve is trileaflet, 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.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSmall scattered pulmonary micronodules. Probable left renal cyst. Enhancing left thyroid lobe nodule measuring at least 2.9 cm. 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: 2.9 cm enhancing left thyroid lobe nodule. Correlation with thyroid ultrasound and possible tissue sampling depending on the ultrasound appearance of this lesion is suggested.Left ventricle is normal in size with globally decreased function. The overall LV ejection fraction is 37%. Right ventricle is normal in size with reduced function, RVEF is 34%There are 4 pulmonary veins draining into the left atrium. Left atrial appendage free of clot. 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: 35 year-old female with new diagnosis of malignancy of unknown origin presenting with dyspnea and tachycardia. Abdominal mass on palpation. Evaluate for PE and neoplasm. PULMONARY ARTERIES: Technically adequate pulmonary embolus examination without evidence of filling defect to indicate pulmonary embolus.LUNGS AND PLEURA: Left-sided pleural effusion with adjacent compressive atelectasis. Scattered bilateral micronodules too numerous to count.MEDIASTINUM AND HILA: Left upper lobe round soft tissue density mass measures 2.1 x 2.1 cm (image 59/159) series 9, within the left perihilar region region demonstrates mass effect on the left mainstem bronchus and left segmental pulmonary artery.CHEST WALL: Scattered, nonspecific axillary lymph nodes. Destructive lesions of third and fifth anterior ribs. Destructive lesions involve the scapula bilaterally. Multiple lytic lesions throughout the thoraco- lumbar spine consistent with metastatic disease. Expansile lytic lesion within the vertebral body T7 demonstrates posterior expansion into the central canal and may be further evaluated with MRI as clinically warranted.UPPER ABDOMEN: Ill-defined hypodense lesion within the left lobe of the liver with correlated with abdomen and pelvis CT performed same day consistent with metastatic lesion. Multiple retroperitoneal lymph nodes.For further evaluation of the abdomen and pelvis please see dedicated abdomen and pelvis CT report performed same day.

Output: 1. No evidence of pulmonary embolus as clinically questioned.2. Left-sided large pleural effusion.3. Multiple scattered micronodules likely represent lymphangitic spread.4. Left parahilar mass causes mild adjacent compression of the left segmental pulmonary artery and left bronchus.5. Multiple bony and hepatic metastases as described above.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old, with history of lung cancer. A T2 hyperintense, partially FLAIR suppressing and presumably cystic lesion is identified within the right occipital lobe measuring 14 x 14 mm. There may be a small internal nodular component along the inferior aspect of the cyst versus a layer of debris. This lesion induces very mild edema in the adjacent parenchyma, but no significant mass effect.Numerous focal and patchy T2 hyperintense lesions are identified in the peri-ventricular and subcortical white matter of the cerebral hemispheres, a non specific findings which may reflect chronic microvascular ischemic disease or demyelinating disease among other possibilities. No restricted diffusion or other areas of edema are suspected.No acute intracranial hemorrhage is seen. The ventricular system is normal in size and morphology.An 18-mm region of T1/T2 hypointense marrow replacement is seen within the right parietal bone. Elsewhere, marrow signal characteristics are unremarkable.

Output: 1.A cystic or perhaps cystic and solid lesion is evident in the right occipital lobe. Given the stated history, this is concerning for metastatic disease.2.No definite additional metastases are suspected. However, postcontrast imaging is recommended, both to better assess the above lesion and to provide a more sensitive evaluation for additional small lesions.3.An area of marrow replacement within the right parietal bone is nonspecific and may simply represent sclerosis. This lesion would benefit from assessment with postcontrast imaging or CT imaging.


Instruction: Generate impression based on medical findings.

Input: Evaluate for aneurysm and potential coilings. LICA and RICA aneurysms. This patient is an 87 years old woman with acute diffuse subarachnoid hemorrhage. She has multiple aneurysms based on CTA. It is not clear based on the CTA which aneurysm ruptured. Angiography would help further assess this and decision to coil should be made following angiography.OPERATORS: Greg ChristoforidisFLUOROSCOPY TIME: 102.8 minutesFrontal: 2611.72 mGyLateral: 2996.65 mGyPROCEDURES: 1) cerebral angiogram 2) Intracranial right PCOMA cerebral aneurysm coil embolization with balloon assistance. 3) Intracranial left PCOMA cerebral aneurysm coil embolization with balloon assistance. 4) 3-D reconstructions of intracranial right internal carotid artery 5) 3-D reconstructions of intracranial left internal carotid artery AORTA with iliac runoffs: No contraindication to closure device deployment.Right common carotid artery: No stenosis at the carotid bifurcation on the basis of NASCET criteria. There is no evidence for carotid dissection.Right internal carotid artery: There is opacification of the right anterior, middle and posterior cerebral arteries. Venous and parenchymal phases were within normal limits. The right A1 segment is small. There is a 50% irregular stenosis at the posterior bend of the cavernous RICA. There is a 4mm wide neck right PCOMA aneurysm with a pointed tip on it which is directed posteriorly. The right PCOMA originates at the base of the aneurysm. There is a 2mm right MCA aneurysm present at the distal m1 segment at the bifurcation which is directed inferiorly.There is fetal origin of the right PCA with minor contribution from p1segment. A meningeal branch arises from the opthalmic artery.Left common carotid artery: No evidence for carotid stenosis on the basis of NASCET criteria. There is no evidence for carotid dissection.Left internal carotid artery: There is opacification of the left anterior, middle and posterior cerebral arteries. Venous and parenchymal phases were within normal limits. There is a left PCOMA aneurysm present which has a relatively small neck. The left PCOMA originates from the base of the aneurysm. The left A1 segment is dominant and supplies the left ACA and partly the right ACA. There is opacification of the left PCA which has a fetal origin with inflow of unopacified blood from the left p1 segment.There is a prominent anterior falx artery present.Left subclavian artery: No evidence for arteriovenous fistula. No evidence for vertebral dissection.Left vertebral artery: No evidence for aneurysm AVM or arteriovenous fistula. There is opacification of the cerebellar vasculature. The PCAs fill transiently the right p1 segment is very small. The left p1 segment does provide some supply to the left p2 segment and beyond.Right subclavian artery: No evidence for arteriovenous fistula. No evidence for vertebral dissection.Right vertebral artery: No evidence for aneurysm AVM or arteriovenous fistula. There is opacification of the cerebellar vasculature. The PCAs fill transiently the right p1 segment is very small. The left p1 segment does provide some supply to the left p2 segment and beyond.Intraprocedural angiograms:Serial arteriograms performed during aneurysm coiling demonstrate serial occlusion of the aneurysms using balloon remodeling. The balloon remained across the neck of the aneurysm throughout the procedure.Final RICA arteriogram :At the end of the procedure there is no opacification of the majority of the aneurysm with preservation of the PCOMA and anterior choroidal artery. There is opacification of the base of the aneurysm. There is occlusion of a branch of the parietoccipital artery with collateralization from the posterior parietal artery.Final LICA arteriogram :At the end of the procedure there is no opacification of the aneurysm with preservation of the PCOMA and anterior choroidal artery and no thromboembolic events.Repeat RICA arteriogram :At the end of the procedure there is no opacification of the majority of the aneurysm with preservation of the PCOMA and anterior choroidal artery. There is opacification of the base of the aneurysm. There is improved opacification of the right parietoccipital artery with partial reperfusion.Right common iliac artery: No contraindications to closure device.

Output: 1.6mm left PCOMA aneurysm2.4mm right PCOMA aneurysm3.2mm right MCA aneurysm4.50% stenosis of the right cavernous ICA5.Embolization of right PCOMA aneurysm with MRI compatible embolic occlusion coils and balloon assistance technique. There is a residual opacification of the base of the aneurysm6.Embolization of left PCOMA aneurysm with MRI compatible embolic occlusion coils and balloon assistance technique. 7.Small thromboembolic event of a branch of the right parietoccipital artery of the PCA was treated with mild anticoagulation. More aggressive treatment was not pursued based on risk/benefit assessment.8.Findings were discussed with Dr Awad and Dr Cueva at the end of the procedure.


Instruction: Generate impression based on medical findings.

Input: 50 year-old female with history of multiple sclerosis presenting with paresthesias. Brain:Again seen are multiple white matter T2 hyperintensities in a primarily subcortical distribution in the supratentorial brain and pons. Patient motion on both today's scan and the prior examination mildly limits comparison, but within this limitation no definite new lesions are identified and the existing lesions are not significantly changed. Only the largest lesion which is located in the left occipital lobe is associated with decreased T1 signal. No significant cerebral volume loss.In the skull base there appears to be anomalous vessel arising from the mildly ectatic junction of the cavernous and petrous right internal carotid connecting to the basilar artery, traversing the dorsum sellae. This is just above the level of the trigeminal nerve. The slightly focally ectatic cavernous carotid mildly remodels the dorsum sella on the right side. There is no evidence of intracranial hemorrhage or mass. The ventricles and basal cisterns are normal in size and configuration. The expected intracranial vascular flow voids are present. The paranasal sinuses are clear. The visualized mastoid air cells are clear. The orbits are unremarkable.Cervical spine:The cervical spinal cord is normal in caliber and contour throughout. No evidence of myelomalacia. No evidence of demyelinating disease. The vertebral body and intervertebral disc heights are maintained. There is minimal multilevel decreased intervertebral disc signal compatible with early desiccation. There is straightening of the lower cervical lordosis which may be positional or degenerative in etiology. No bone marrow signal abnormalities.There are very minimal disc osteophyte complexes at C3-4, C5-6, and C6-7 without significant neural foraminal or spinal canal stenosis. Thoracic spine:Again seen are patchy poorly defined areas of increased T2 signal within the proximal thoracic spinal cord. This is most notable in the ventral cord at the lower T1 level as well as in the right lateral cord at the T3 and T4 levels. A more focally defined plaque of increased T2 signal within the central to posterior spinal cord at the T9-10 level measures 3 x 3 x 12 mm, previously 3 x 3 x 11 mm. There is mild volume loss associated with the T9-10 lesion. These findings are not significantly changed from prior and no new lesions are identified.The vertebral body and intravertebral disc heights are maintained. The alignment is anatomic. No bone marrow signal abnormalities. There are small right paracentral disc protrusions at T5-6 and T6-7. There is mild spinal canal stenosis with flattening of the anterolateral cord T6-7. No significant neural foraminal stenosis.

Output: 1. Stable findings of multiple sclerosis in the brain with multiple demyelinating lesions in the supratentorial brain and pons. Accounting for differences in techniques, these lesions are not significantly changed and no new lesions are identified. Overall, trace T1 and mild T2 burden of disease, including infratentorial lesions.2. Stable findings of demyelinating disease with patchy areas of abnormal T2 signal in the proximal thoracic cord as well as a more defined focal plaque at T9-10. No new lesions are identified.3. Anomalous vessel in the skull base likely representing a persistent trigeminal artery with associated ectasia of the right cavernous carotid artery, and associated remodeling of the dorsum sella which is a common finding. This can be further evaluated with MR angiography.4. No evidence of demyelinating disease in the cervical spine.


Instruction: Generate impression based on medical findings.

Input: Pain. Evaluate for osteoarthritis. Note is made of increased bone marrow signal abnormality about the second tarsometatarsal joints indicating degenerative change. There is a well-circumscribed lesion within the mid diaphysis of the third metatarsal which demonstrates decreased signal abnormality on T1-weighted images and increased signal abnormality on fluid sensitive sequences with peripheral low signal intensity likely representing sclerosis. This has benign imaging characteristics and may represent an enchondroma, although this could be better characterized with radiographs, if available. There is no cortical destruction or soft tissue extension. The flexor and extensor tendons appear intact. The peroneal tendons appear intact. The Achilles tendon is normal in appearance. There is nonspecific subcutaneous edema about the dorsal aspect of the second and third tarsometatarsal joints. The ligaments of the ankle appear intact. There is nonspecific edema within Kager's fat pad.

Output: Osteoarthritis of the foot and other findings as described above


Instruction: Generate impression based on medical findings.

Input: Known DCIS now status post lumpectomy in the right inner breast. The patient also had a benign right outer breast biopsy. There is heterogeneous amount of fibroglandular tissue in both breasts. Multiple scattered high T2 cysts are present. Moderate parenchymal enhancement is noted bilaterally, somewhat limiting the study.No new or suspicious enhancement is seen in either breast. In the posterior depth of the right inner breast, there is a seroma cavity compatible with recent surgery. No suspicious nodular enhancement is seen around the cavity. In the left medial breast, an oval enhancing mass has high T2 signal and is stable compared to the recent prior MRI, measuring about 6 mm. Note is made that this had a typically benign appearance on an outside ultrasound dated 8/20/15 as well. No abnormal lymph nodes are identified in either axillary region.

Output: Expected post-surgical changes of the right inner breast. No new finding that requires additional work up is seen.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o mass History: vertigo, dizziness, giddiness. The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Periventricular and subcortical white matter changes of a mild degree are nonspecific. They are most likely vascular related.


Instruction: Generate impression based on medical findings.

Input: 28 year-old female with new onset worst headache in life. The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Unremarkable contrast enhanced CT head.


Instruction: Generate impression based on medical findings.

Input: Female 44 years old Reason: Rotator cuff tear after shoulder dislocation vs labral tear History: pain ROTATOR CUFF: There is a partial articular surface tear of the supraspinatus at the insertion. No full-thickness tear is identified.SUPRASPINATUS OUTLET: Osteophyte formation is noted at the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: Anterior labrum is internal increased signal and is most likely torn.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1.Partial articular surface tear of the supraspinatus. No full-thickness tear.2.Likely torn anterior labrum. If clinically indicated, further evaluation may be obtained with MR arthrogram.


Instruction: Generate impression based on medical findings.

Input: Clinical question to be answered: Rule-out intracranial process. Signs and symptoms: Seizure. Prominence of cortical sulci and ventricular system for patient's stated age is again identified and the great normal change.A nonspecific small new area of low-attenuation in the subcortical white matter of left frontal lobe is noted. The finding may represent edema. There is however no detectable mass effect with this finding. The exact etiology of finding is not clear. Further evaluation with an infused MRI is recommended. This examination is otherwise unremarkable. Calvarium, paranasal sinuses and mastoid vessels are also unremarkable.

Output: 1.Prominence of cortical sulci and ventricular system for patient's stated age as was noted on prior examination from 2007.2.Nonspecific focal area of low-attenuation in the subcortical white matter of left frontal lobe which needs further evaluation with an infused MRI examination.3.Unremarkable calvarium, paranasal sinuses and mastoid air cells.


Instruction: Generate impression based on medical findings.

Input: Dizziness and giddiness [R42], Reason for Study: ^Reason: hx of Cowden syndrome, presenting with vertigo History: vertigo There is no evidence of acute ischemic or hemorrhagic lesion.There is no evidence of abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1.No evidence of acute ischemic or hemorrhagic lesion.2.No evidence of abnormal enhancement.


Instruction: Generate impression based on medical findings.

Input: Pain in right hip [M25.551], Reason for Study: ^Reason: sciatica type pain - pt previously on long term steroids History: see above For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The conus medullaris terminates at the T12-L1 level. There is no evidence of abnormal enhancement, cord compression or mass. Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: Diffuse bulging of disc with ligamentum flavum thickening, resulting minimal spinal canal stenosis. No neuroforaminal narrowing. L3-L4: no neuroforaminal narrowing or spinal stenosis. L4-L5: Disc desiccation. There is focal disc bulging toward left side lateral recess which narrows left side neural foramen. L5-S1: no neuroforaminal narrowing or spinal stenosis.

Output: 1. Broad-based focal disc bulging toward left side neural foramen of L4-5.2. Minimal spinal canal stenosis at the level of L23.


Instruction: Generate impression based on medical findings.

Input: Grade 2 astrocytoma, follow-up evaluation Postoperative changes are again seen from previous left frontal approach biopsy, with T2 hyperintensity and blood products along the biopsy tract. Previously biopsied left thalamic lesion overall measures 2.1 x 3.7 cm cm in greatest axial dimensions, not appreciably changed since prior exam with motion degradation on the FLAIR sequence slightly limiting current examination. There is minimal mass effect upon the third ventricle, unchanged. There is slight persistent T2/FLAIR signal abnormality in the anteromedial temporal lobe which is also not significantly changed. FLAIR hyperintensity involving the left posterior frontal corona radiata and centrum semiovale is not significantly changed since 1/13/2016 but increased since 10/16/2015, and favored to represent post treatment effect. Intrinsic T1 shortening involving the left thalamus is again noted. No suspicious enhancement is evident.The ventricles and cortical sulci are mildly prominent, unchanged. There are a few scattered and confluent cerebral white matter T2 hyperintense foci are nonspecific and similar to prior. The major cerebral flow voids are intact. There is minimal mucosal thickening in the maxillary sinuses.

Output: No findings to suggest progression of left thalamic and left anteromedial temporal lobe astrocytoma.


Instruction: Generate impression based on medical findings.

Input: Altered mental status, left hemispheric intracerebral hemorrhage. There is a 32 mm x 20 mm sized left frontal intra-axial lesion. The lesions show high signal intensity on T1 as well as T2 weighted image with relatively thin rim of signal voids indicating chronic intra-axial hematoma with hemosiderin ring.There is a another lesion on the left parietal lobe precuneus sized about 4 mm x 19 mm with the surrounding edema. The lesion shows high signal intensity on T1 and low signal intensity on T2-weighted images indicating subacute hematoma.On gradient echo images, there are multifocal gyriform susceptibility lesions on bilateral frontal parietal lobes indicating chronic subarachnoid hemorrhage. In addition, there are small scattered nodular signal voids lesions on bilateral cerebral hemisphere as well as bilateral cerebellar hemisphere indicating chronic petechial hemorrhagic lesions.On gadolinium enhancement, there is no evidence of abnormal enhancing lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.3D MRV brain post-gadolinium with maximum intensity projections of the superficial/deep intracranial venous drainage demonstrate normal flow enhancement in the superior sagittal sinus, left transverse sinuses, left sigmoid sinuses, internal cerebral veins, vein of Galen and straight sinus. Right transverse and sigmoid sinus appear to be hypoplastic. There is no evidence of major dural sinus occlusion.

Output: 1. Multifocal multi-age intracerebral as well as subarachnoid hemorrhages as described above. In particular, there is a 32 mm x 20 mm sized organize hematoma on the left frontal lobe and 4 mm x 19 mm sized subacute hematoma on the left precuneus.2. No evidence of abnormal enhancement.3. Hypoplastic right transverse and sigmoid sinus as well as right jugular bulb which most likely represent congenital normal variation, otherwise unremarkable MR venogram of the brain.


Instruction: Generate impression based on medical findings.

Input: 52 year old with multicentric ILC at 2 sites, OSH MRI was inadequate. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.Right breast:Spiculated heterogenously enhancing mass with clip artifact is noted within the superior and posterior breast (lower axillary region) corresponding to biopsy proven cancer. It measures 20 x 16 x 13 mm (AP X ML X CC) with post biopsy changes tracking towards the skin surface. Clip artifact noted within the second biopsy proven cancer in the right breast 11 to 12:00 position that measures 32 x 33 x 30 mm (AP X ML X CC). It is irregular in shape with heterogenous enhancement difficult to locate the margins accurately. Located immediately lateral and posterior to this lesion is another irregular mass which measures 28 x 22 x 18 mm (AP X ML X CC) located in right breast 11:00 position. Extensive non mass enhancement is noted anterior to the anteriormost biopsy proven mass reaching within 9 mm from the nipple. Total extent of the masses and non mass enhancement (excluding the spiculated mass in the lower axillary region) within the right breast measures 110 x 62 x 60 mm (AP X ML X CC).No abnormal axillary lymph nodes are identified in right axillary region.Left Breast:Irregular heterogenously enhancing masses are seen in the central posterior left breast measuring 25 x 12 x 13 mm (AP X ML X CC) and at 11:00 position mid depth measuring 9 x 8 x 10 mm (AP X ML X CC). Extensive non mass enhancement adjacent to these masses is seen predominantly from 10 to 2:00 position in mid to anterior depth reaching 12 mm from the nipple. Total extent of masses with non mass enhancement is 63 x 50 x 46 mm (AP X ML X CC).No abnormal axillary lymph nodes are identified in left axillary region.

Output: 1. Two biopsy proven ILC sites in right breast with additional masses and extensive non mass enhancement measuring more than mammogram.2. Two suspicious masses in the left breast central posterior and 11:00 mid depth with adjacent non mass enhancement. MR directed ultrasound and spot compression views of focal asymmetries in the upper inner and central breast are recommended. If no correlate is found, MRI guided biopsy is recommended. 3. No abnormal axillary lymph nodes are seen bilaterally. BIRADS: 6 - Known cancer.RECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required.


Instruction: Generate impression based on medical findings.

Input: 76-year-old female experiencing bilateral upper extremity numbness, tingling, and pain, left hand symptoms are worse. Posterior fossa findings from previous extra-axial mass resection are better demonstrated on previous brain MRI dated 11/11/2014. Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position.There is lack of flow void within the right vertebral artery as previously described for the brain MRI dated 8/29/2013, and unchanged dating back to the cervical spine MRI comparison dated 8/21/2013.C2/3 redemonstrates a left paramedian disk protrusion which results in flattening of the anterior left hemicord. The signal intensity of the cord remains within normal limits and bilateral neural foramina remain patent. These findings are unchanged.C3/4 demonstrates minimal degenerative changes and is unremarkable otherwise, unchanged.C4/5 demonstrates mild degenerative changes, mild left neural foraminal compromise and is unremarkable otherwise. These findings are unchanged.C5/6 demonstrates mild degenerative changes with resultant mild left neural foraminal compromise and is unremarkable otherwise. These findings are unchanged.C6/7 demonstrates minimal degenerative changes but is otherwise unremarkable, unchanged.C7/T1 is unremarkable and unchanged.

Output: 1.C2/3 redemonstrates a left paramedian disk protrusion which results in flattening of the anterior left hemicord. The signal intensity of the cord remains within normal limits and bilateral neural foramina remain patent. These findings are unchanged.2.C4/5 demonstrates mild left neural foraminal compromise, unchanged.3.C5/6 demonstrates mild left neural foraminal compromise, unchanged.


Instruction: Generate impression based on medical findings.

Input: History of breast cancer now with headacheIMAGE ACQUISITIONS: Brain CT without and with contrast. 100 cc nonionic Omnipaque 350. There is questionable punctate foci of enhancement which likely represent volume averaging from the vessels in the deep sulci. However, small metastases cannot be excluded. We recommend a brain MRI without and with contrast to further evaluate.Remainder of the cerebrum, cerebellum, and brainstem show normal morphology and attenuation. There are no other areas of abnormal enhancement. No intracranial hemorrhages or abnormal extra-axial fluid collections. Visualized paranasal sinuses and mastoid air cells are pneumatized normally.

Output: Questionable foci of abnormal enhancement. Although these are likely artifactual, we recommend brain MRI without and with contrast given patient's history of breast cancer.


Instruction: Generate impression based on medical findings.

Input: 63-year-old male with elevated PSA. PELVIS:PROSTATE:Prostate Size: 5.7 x 7 x 8.3 cm.Peripheral Zone: No definite focus suspicious for prostate cancer.Central Gland: Heterogeneous.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: Small fat-containing bilateral inguinal hernias.OTHER: No significant abnormality noted.

Output: No definite focus suspicious for prostate cancer.


Instruction: Generate impression based on medical findings.

Input: Reason: Evaluate pancreatic cyst History: cirrhosis with pancreatic cysts ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology. T2 hyperintense subcentimeter lesion likely a small cyst at the dome of the liver. No suspicious hepatic lesions.SPLEEN: Small splenule.PANCREAS: No ductal dilatation. Multiple small cystic foci adjacent to the main pancreatic duct could represent small side branch IPMNs or dilated side branches, grossly unchanged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple subcentimeter T2 hyperintensities are too small to characterize, likely small cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stable examination.


Instruction: Generate impression based on medical findings.

Input: 72 years Male (DOB:9/7/1944)Reason: ro stroke History: vertigoPROVIDER/ATTENDING NAME: NAOUM ISSA MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There are several periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. A couple punctate lesions are also present in the brainstem which are hyperintense on T2 and FLAIR MRI.Punctate focus of loss of signal on susceptibility weighted imaging is present in the right occipital lobe subcortical white matter. In isolation this is nonspecific and likely of little clinical significance..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.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The left A1 segment is hypoplastic The left posterior communicating artery is very small. There is fetal origin of the right posterior cerebral artery. The right P1 segment is small to medium sized. The left vertebral artery is larger than the right vertebral artery.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. The origins of the vertebral arteries appear to be narrowed bilaterally with findings suggestive of stenosis of the left vertebral artery at its origin as well as the right vertebral artery at its origin.

Output: 1.There is no evidence for intracranial cerebrovascular occlusive disease.2.There is no evidence for acute ischemic cerebral infarction.3.Findings suggest stenosis at the origins of the vertebral arteries bilaterally.4.Several periventricular and subcortical white matter lesions as well as a couple lesions in the brainstem are present which are nonspecific nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on medical findings.

Input: 52-year-old with history of T8 with Patchy areas of periventricular hypodensity are present in the subcortical white matter, right side greater than left. Findings are consistent with small vessel ischemic disease These are present on the prior study and do not appear significantly changed.If there is clinical concern for acute ischemic changes MRI with diffusion weighted imaging would allow more sensitive evaluation.

Output: Small vessel ischemic disease without significant change from prior.


Instruction: Generate impression based on medical findings.

Input: Reason: Well-differentiated papillary mesothelioma with invasive foci. Please compare to prior outside exams. ABDOMEN:LIVER, BILIARY TRACT: Normal signal intensity of the liver with homogeneous enhancement. No focal liver lesion is identified. There is no biliary ductal dilatation. The gallbladder is normal in appearance. No gallstones are identified.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small right renal cysts are identified. There is no hydronephrosis.RETROPERITONEUM, LYMPH NODES: No soft tissue density is seen in the left lower quadrant to correlate with findings on outside CT. There is no definite evidence of metastatic or recurrent disease in the abdomen or pelvis.BOWEL, MESENTERY: The bowel is of normal caliber without obstruction. The appendix appears normal.BONES, SOFT TISSUES: Mild degenerative disc disease affects the lower lumbar spine.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: The uterus is normal in appearance. The left ovary is atrophic. The right ovary is not visualized.BLADDER: No significant abnormality noted.LYMPH NODES: Subcentimeter pelvic lymph nodes are present.OTHER: Bilateral breast implants are noted.

Output: 1.No measurable disease is identified in the abdomen or pelvis.2.Subcentimeter pelvic lymph nodes, which are not enlarged by size criteria.


Instruction: Generate impression based on medical findings.

Input: First metatarsal phalangeal pain There is a small amount of edema in the volar aspect of the first metatarsal head . There is also a small amount of fluid in the the metatarsophalangeal joint. These findings represent mild osteo- arthritis

Output: Mild degenerative changes in the first metatarsal pharyngeal joint. Otherwise negative


Instruction: Generate impression based on medical findings.

Input: 40-year-old male with severe knee pain and history of amyloidosis. Evaluate for involvement by amyloid. Evaluation of several sequences is limited by motion artifact.MENISCI: Given the above limitations, there is no evidence of meniscal tear.ARTICULAR CARTILAGE AND BONE: There is linear low signal intensity traversing the articular cartilage of the trochlea centrally. This finding has been found to be associated with cartilage fissuring. The remainder of the articular cartilage appears normal given the aforementioned limitations.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: There is intermediate signal intensity at the insertion of the quadriceps on the patella which may represent focal tendinosis but this is equivocal and of questionable clinical significance. There also appear to be very mild inflammatory changes within the subcutaneous fat along the anterior aspect of the patella, of questionable significance.ADDITIONAL

Output: 1. Limited study due to patient's motion artifact.2. Focal cleft of the articular cartilage of the femoral trochlea.3. Small joint effusion.4. Scarring of Hoffa's fat pad which may represent prior surgery.5. Mild inflammatory changes within the prepatellar subcutaneous fat, of questionable clinical significance.


Instruction: Generate impression based on medical findings.

Input: Reason: PANCREATIC CYSTIC NEOPLASM IN HEAD OF PANCREAS. ANY CHANGE? History: PANCREATIC CYSTIC NEOPLASM IN HEAD OF PANCREAS. ANY CHANGE?. ABDOMEN:LIVER, BILIARY TRACT: Hepatic cysts, unchanged.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic cystic lesions in the uncinate process that appear to communicate with the pancreatic duct are not significantly changed. The largest measures 7 mm, unchanged (series 601 image 69). New punctate uncinate process cystic lesion measuring 2 mm (series 601 image 64). No pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable uncinate process side branch IPMN's. New punctate 2 mm uncinate process cystic lesion, also likely a side branch IPMN.


Instruction: Generate impression based on medical findings.

Input: Reason: concern for rotator cuff tear History: Pain Some sequences are limited by patient motion artifact.ROTATOR CUFF: There is intermediate signal intensity within the supraspinatus and infraspinatus tendons suggesting mild tendinosis, but we see no tear. On the fat suppressed T2-weighted images, there is slight increase in signal intensity of the infraspinatus as well as the proximal belly of the supraspinatus, and to a lesser degree the posterior fibers of the deltoid musculature. We see no frank fatty atrophy on the T1-weighted images. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. There is mild edema type signal within the subdeltoid bursa which may reflect mild inflammation.GLENOHUMERAL JOINT AND GLENOID LABRUM: The anterior inferior labrum is replaced with intermediate signal intensity suggesting degeneration. The anterior superior labrum is detached from the underlying glenoid which may represent a normal variant sublabral foramen. There is no glenohumeral joint effusion. There are small cysts in the humeral head just above the lesser tuberosity.BICEPS TENDON: The tendon of the long head of the biceps appears intact ADDITIONAL

Output: 1. Mild signal abnormality within the supraspinatus, infraspinatus, and posterior deltoid musculature which is nonspecific and could reflect early denervation atrophy. Parsonage-Turner is also included in the differential diagnosis.2. Mild osteoarthritis affects the acromioclavicular joint and there is mild inflammation of the subdeltoid bursa.3. Minimal supraspinatus and infraspinatus tendinosis, but no rotator cuff tear.


Instruction: Generate impression based on medical findings.

Input: CCM yearly surveillance. Artifact related to dental braces obscures portions of the anterior head. Within this limitation, there are multiple unchanged punctate foci of susceptibility effect in the periventricular and subcortical white matter of the bilateral hemispheres. There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation.

Output: Unchanged punctate cavernous malformations in the bilateral cerebral hemispheres.