Instruction: Generate impression based on medical findings.

Input: 43-year-old male with chronic pancreatitis and new onset right lower quadrant pain ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: Numerous calcifications are scattered throughout the pancreas, compatible with chronic pancreatitis.A 14 x 9 cm cystic lesion is seen at the junction of the body/tail of the pancreas (series 3, image 41) with possible associated calcifications, unchanged from recent MRI.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The appendix is not definitively visualized. No right lower quadrant inflammatory changes are visualized.A tubular, blind ending structure (series 3, image 114) arises off the distal ileum, compatible with a Meckel's diverticulum. No adjacent inflammatory changes are visualized.Mild diffuse haziness of the mesentery is seen, not significantly changed.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Trace free fluid in the pelvis, unchanged.

Output: Meckel's diverticulum without adjacent inflammatory changes. Nonvisualized appendix without inflammatory changes in the ileocecal region to suggest appendicitis.Cystic lesion in the pancreas, unchanged from MRI from 7/15/09. In retrospect, this is compatible with a side branch IMPN. Follow-up MRI may beneficial.


Instruction: Generate impression based on medical findings.

Input: 69 years Female (DOB:10/2/1946)Reason: Stroke work up in setting of new onset seizure History: Shaking of L side and unrespnosive, L gaze deviationPROVIDER/ATTENDING NAME: TAO W XIE TAO W XIE MRI of the brainNo diffusion weighted abnormalities are appreciated.There is encephalomalacia present along the right superior frontal gyrus and right cingulate gyrus. There is some diffusion restriction is present along portions of the right cingulate gyrus and right superior frontal gyrus.In general the brainstem and cerebellum are relatively small. There are some patchy T2 and FLAIR signal hyperintensities within the pons.There are submillimeter punctate foci of T2 and FLAIR signal hyperintensity in the thalami. On susceptibility weighted imaging there are punctate foci of signal hypointensity within the thalami bilaterally which correspond to the T2 and FLAIR signal abnormalities.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.The calcifications present along the falx.MRA brain:The MRA exam is mildly degraded due to motion artifact.Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. The right A1 segment is larger than the left A1 segment. The right anterior cerebral artery becomes attenuated at the level of the A2 segment and does not opacify along the A4 and A5 segments.There is no evidence for intracranial aneurysm .The anterior communicating artery is identified and is medium sized. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.

Output: 1.There is encephalomalacia present along the medial aspect of the right frontal lobe involving right superior frontal gyrus and right cingulate gyrus which is associated with some foci of diffusion restriction suggesting a superimposed subacute or acute infarct.2.There is attenuation of the right anterior cerebral artery along the right A2 and A3 segments with suspected occlusion more distally.3.Periventricular and subcortical white matter lesions of a mild degree as well as patchy lesions in the pons are nonspecific. At this age they are most likely vascular related. 4.There is atrophy of the pons and cerebellum.5.A couple microhemorrhages in the thalami are present in isolation these are somewhat nonspecific. They could be hypertensive in origin based on location.6.The MR angiogram is somewhat degraded due to some mild motion artifact which may obscure some subtle or small abnormalities .


Instruction: Generate impression based on medical findings.

Input: Weakness [R53.1] / Malignant neoplasm of unspecified part of unspecified bronchus or lung [C34.90], Reason for Study: ^Reason: nerve root compression, bone metastasis. History: History of lung cancer presenting with left leg weakness, urinary retention Cervical Spine MRI:There is normal cervical lordosis. The cranial-cervical junction is normal. Spinal cord signal intensity is normal.Multilevel disc degenerations with disc desiccation on cervical spine including central disc protrusion at the level of C34 C4-5 and diffuse disc bulging C6-7 minimal to mild right side neural foraminal narrowing at the level of C6-7. However, there is no definitive evidence of spinal canal stenosis.There is about 24.8 mm x 29 mm sized soft tissue lesion likely representing lymph node on the right side of thyroid gland.Thoracic Spine MRI:There is about 23mm sized intramedullary lesion with diffuse enhancement at the level of T7-T8 level. There are evidence of spinal cord edema above and below the lesion with cord expansion.There is no evidence of associated syrinx.There is no evidence of hemorrhagic foci within or peripheral aspect of the lesion.Constellation of these findings suggest possible intramedullary spinal metastasis. Differential diagnosis include primary spinal cord lesion such as ependymoma. There is normal thoracic kyphosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. Lumbar Spine MRI:There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved but there are focal bone marrow edema especially anterior aspect of vertebral body at the level of the L2 and L3 which may suggest focal compression fracture without height reduction.At the level of :45 there is disc dessication, decreased disc height and central focal extrusion of disc which compresses thecal sac. In addition, associated, bilateral ligamentum flavum thickening at the level results moderate to severe spinal canal stenosis.The cord signal is normal. The conus medullaris terminates at the level of T12-L1. Again the bladder distention is shown.There is no evidence of abnormal enhancement except focal enhancement surrounding the extruded disc. No evidence of cord compression or mass.

Output: 1. Intramedullary enhancing mass at the level of T7-T8, likely represents intramedullary metastatic lesion with the differential diagnosis include spinal cord ependymoma. 2. Central disc extrusion at the level of L45 with thecal sac compression.3. No evidence of spinal cord compression.4. Multilevel various degree degenerative disc diseases as described above including cervical spine and lumbar spine level.


Instruction: Generate impression based on medical findings.

Input: Female 12 years old with neck swelling unable to palpate edges of thyroid gland. Please assess for nodules or masses and thyroid size. RIGHT LOBE MEASUREMENTS: 1.3 x 1.2 x 4.0 cm transverse by AP by craniocaudalLEFT LOBE MEASUREMENTS: 1.3 x 1.0 x 3.6 cm transverse by AP by craniocaudalISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Mildly heterogeneous but no nodules are present.LEFT LOBE: Mildly heterogeneous but no nodules are present.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: A few prominent left level 3 and 4 lymph nodes with normal morphology and fatty hila are identified. The largest level 3 lymph node on the left measures 1.6 x 0.6 x 2.0 cm.OTHER: No significant abnormality noted.

Output: No evidence of thyroid nodules.


Instruction: Generate impression based on medical findings.

Input: ACL rupture, check lateral collateral ligament. MENISCI: Horizontal linear signal is observed in the posterior horn of the medial meniscus without definite clear extension to the inferior articular surface. The remaining menisci are otherwise intact and well positioned, specifically the posterior aspects are well anchored bilaterally.ARTICULAR CARTILAGE AND BONE: Marrow signal within osseous structures are intact and well aligned. Specifically no evidence of contusion or acute abnormality. Cartilage is well visualized throughoutLIGAMENTS: Minimal signal is observed along the medial retinaculum and medial collateral ligament with adjacent soft tissue changes suggesting mild to moderate sprain. Fibers appear intact in both these ligaments. Additionally the ACL, PCL and remaining ligaments are also otherwise intact. Specifically ACL is well visualized.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: MCL and medial retinaculum appear moderately sprained, along with an intrasubstance linear signal within the medial posterior meniscal horn, as described.


Instruction: Generate impression based on medical findings.

Input: 71-year-old man with history of biopsy in 2014 with one core of atypical small acinar proliferation, PSA of 5.85 Jan 2016 and 4.64 Sept 2016. PELVIS:PROSTATE:Prostate Size: 50 x 38 mmPeripheral Zone: Within the left mid prostate (401/71) there is an approximately 11 mm area of decreased T2 signal with mild ADC abnormality. The remainder of the peripheral zone appears normal.Central Gland: Markedly enlarged and impressing upon the bladder.Seminal Vesicles: Unremarkable.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: Nonspecific inguinal lymph nodes are likely reactive.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Signal abnormality in the left lateral mid prostate peripheral zone which is indeterminate for tumor but is a candidate for biopsy.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old, with headache. Assess for intracranial mass. Numerous patchy foci of white matter T2 hyperintensity are seen within the cerebral hemispheres without associated restricted diffusion or mass effect. No parenchymal edema is seen. No evidence of significant intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. The ventricular system is patent and normal in size.

Output: 1. Numerous scattered foci of white matter T2 hyperintensity are seen, a nonspecific finding which can reflect chronic sequelae of microvascular ischemic disease, demyelination, migraine headache, vasculitis or other inflammatory conditions.2. No evidence of any intracranial mass or other definite acute intracranial findings.


Instruction: Generate impression based on medical findings.

Input: Transient cerebral ischemic attack, unspecified [G45.9] / Muscle weakness (generalized) [M62.81], Reason for Study: ^Reason: r/o acute stroke History: alterations and weakness There is no evidence of acute ischemic or hemorrhagic lesion on this scan.Patchy FLAIR/T2 high signal intensities on periventricular white matter and centrum semiovale are again seen, unchanged since prior scan.Focal tissue losses indicating multifocal lacunar infarctions are seen on the right cerebellar hemisphere, bilateral basal ganglia and bilateral external capsules.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Non visualization of bilateral lenses indicating postoperative status.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Non specific chronic ischemic disease, unchanged since prior scan.


Instruction: Generate impression based on medical findings.

Input: 47-year-old female with left hip pain. 3 views of the left hip demonstrate moderate osteoarthritic changes, slightly progressed since the prior study from 5/19/2014. Single AP view of the pelvis again demonstrates moderate osteoarthritis of the left hip as well as mild osteoarthritis involving the right hip. Mild sclerosis along the left SI joint is likely degenerative in etiology. Mild degenerative changes are also noted in the lower lumbar spine.

Output: Osteoarthritis as described above.


Instruction: Generate impression based on medical findings.

Input: 60 years Female (DOB:1/4/1956)Reason: r/ostroke History: right face tinglingPROVIDER/ATTENDING NAME: GREGG M HELLAND JACQUELINE T. BERNARD MRI of the brainThere is diffusion restriction present along the left posterior limb of internal capsule extending to the centrum semiovale measuring 24 x 12 mm axial dimensions. There is associated FLAIR and T2 signal abnormality.There is a punctate focus of FLAIR signal hyperintensity in the right basal ganglia.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.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 small. The posterior communicating arteries are very small.. The vertebral arteries are similar in size. There is extracranial origin of the right posterior inferior cerebellar artery. The left A1 segment is larger than the right A1 segment.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.

Output: 1.Acute infarction involving left posterior limb of internal capsule and adjacent centrum semiovale. 2.No evidence for intracranial cerebrovascular occlusive disease.3.No evidence for intracranial aneurysm.4.No evidence for extracranial cerebrovascular occlusive disease.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Encephalopathy? Patient altered status post extubation history of multiple myeloma. This extrahepatic; upward going Babinski; areflexia. Nonenhanced brain MRI:No acute intracranial process and negative diffusion weighted series.Examination demonstrate scattered tiny foci of FLAIR and T2 hyperintensity in the subcortical and periventricular white matter which are nonhemorrhagic and nonspecific. This appearance however in this age group is often result of microvascular ischemic changes. Minimal similar signal changes in the basal ganglia is also noted.The cerebral cortex and cortical sulci as well as ventricular system and CSF spaces are within normal restaging age and maintained midline.The signal void of major intracranial branches are identified. Unremarkable images through the orbits.Bilateral mastoid air cells demonstrate extensive opacification however without detectable opacification of middle ear cavities.Paranasal sinuses remain well pneumatized and only a small retention cyst in the left chamber of the sphenoid sinus is noted.

Output: 1.No acute intracranial process.2.Mild chronic small vessel ischemic strokes as detailed and unremarkable exam otherwise.3.Opacification of bilateral mastoid air cells.


Instruction: Generate impression based on medical findings.

Input: 65 year old male with SVT sp ablation with 22 % PVCs and new LV dysfunction (LVEF 41%) Left VentricleThe left ventricle is severely dilated with moderately reduced systolic function. The overall LV ejection fraction is 39%. The LVEDV is 323 ml (normal range 142+/-34), the LV end diastolic volume index is 127 ml/m2 (normal range: 74+/-15), the LVESV is 197 ml (normal range 47+/-19) and the LV end systolic volume index is 78 ml/m2 (normal range 25+/-9). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.The native T1 myocardial relaxation time is <1050 ms in the septum and lateral wall suggestive of absence of underlying diffuse fibrosis or infiltration.There is no myocardial iron overload. There is no LV thrombus. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 56%. The RVEDV is 228 ml (normal range 142+/-31), RV end diastolic volume index is 90 ml/m2 (normal range 82+/-16), the RVESV is 101 ml (normal range 54+/-17), and the RV end systolic volume index is 40 ml/m2 (normal range 31+/-9).There is no abnormal wall motion or evidence of pseudoaneurysms in the right ventricular wall. Right AtriumThe right atrium is normal in size.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 no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1.The left ventricle is severely dilated with moderately reduced systolic function. LVEF 39%.2.The right ventricle is mildly dilated with normal systolic function. RVEF 56%. No imaging findings to suggest ARVC.3.Moderate left atrial dilation.4.No areas of late gadolinium enhancement to suggest a fibrotic, infiltrative or inflammatory process.


Instruction: Generate impression based on medical findings.

Input: Low thoracic pain, rule out disk herniation or nerve compression Thoracic vertebral body heights are maintained. There is mild thoracic dextrocurvature. Alignment is otherwise maintained. No significant spinal canal or neural foraminal stenosis is seen. Thoracic cord is normal in signal and contour. Bone marrow signal is benign with no suspicious lesions. Small perineural cysts are incidentally noted at the T1-2 level.Mild degenerative changes are seen. Minimal disk bulges are seen at T2-T3, T3-T4, and T5-T6 without significant spinal canal or neural foraminal stenosis. No significant disk disease in the lower thoracic spine is appreciated. There is facet arthropathy at the T11-T12 and T12-L1 levels. Disk osteophyte complex at the C6-C7 level is noted without significant spinal canal stenosis.

Output: 1. Mild degenerative changes in the thoracic spine without significant spinal canal or neural foraminal stenosis at any level.2. Facet arthropathy in the lower thoracic spine at the T11-T12 and T12-L1 levels which may be contributing to patient's lower thoracic pain.


Instruction: Generate impression based on medical findings.

Input: 52-year-old female s/p OLT now with altered mental status status There is patchy restricted diffusion in the pons with questionable mildly restricted diffusion involving the caudate nuclei and bilateral thalami. Corresponding T2 hyperintensity is seen involving the caudate and putamina bilaterally and possibly the medial temporal lobes and hypothalami. The ventricles are not frankly enlarged though they do appear to be 2 to 3 mm larger in caliber when compared to previous CT. There is a thin rim of ependymal T2 hyperintensity along the lateral ventricular margins.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified.

Output: Restricted diffusion is evident in the pons, thalami and questionably the basal ganglia. Abnormal T2 signal intensity is seen in these areas, and also in the hypothalami and medial temporal lobes. Although the ventricles are not frankly dilated, they have increased in caliber by 2 to 3 mm and there is a thin rim of ependymal signal abnormality along the lateral ventricular margins. Some of the above findings could be accounted for by a metabolic derangement, perhaps osmotic demyelination related to osmotic stress, although other metabolic abnormalities are not excluded. On the basis of this examination, a nonspecific encephalitis (infectious, autoimmune or drug related) could also be considered. Findings are not typical for either an ischemic process or classic hepatic encephalopathy. Imaging follow-up with contrast enhanced MRI should be considered if symptoms fail to improve.


Instruction: Generate impression based on medical findings.

Input: MRI Brain:There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is a tiny incidental right frontal developmental venous anomaly. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. 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.

Output: Unremarkable MRI Brain/MRA head.


Instruction: Generate impression based on medical findings.

Input: Enureses, numbness, and weakness of the bilateral lower extremities. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The conus medullaris is positioned at the L1-2 level. There appear to be punctate right L3-4 and L4-5 posterior facet joint synovial cysts. The paravertebral soft tissues are unremarkable.

Output: No evidence of low-lying conus medullaris, spinal canal stenosis or tumors in the lumbar spine.


Instruction: Generate impression based on medical findings.

Input: 68-year-old male status post laparoscopic cholecystectomy found to have a mesenteric/small bowel mass ABDOMEN:LIVER, BILIARY TRACT: Scattered T2 hyperintense foci in the liver, likely benign. The hepatic vasculature is patent. Status post cholecystectomy. No biliary ductal dilation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Focal chronic dissection of the infrarenal abdominal aorta. Duplicated IVC.BOWEL, MESENTERY: Encapsulated, nonenhancing and predominantly fatty mesenteric mass measures 15.2 x 6.1 cm (series 12, image 74). Multiple mesenteric vessels course through this mass including the SMA and SMV. No significant nodularity or lymphadenopathy.Cystic structure contiguous with the duodenum suggestive of a duodenal diverticulum (series 9, image 19).BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Large fat-containing mesenteric mass most consistent with mesenteric panniculitis.


Instruction: Generate impression based on medical findings.

Input: Female, 24 years old, with history of cT4 N1 Mx left tongue squamous cell carcinoma status post treatment. Anatomic distortion of the left hemitongue is again seen with perhaps some degree of volume loss when compared to prior exams. The previously extensive tongue mass with involvement of the floor of mouth, tongue base, left tonsil and soft palate continues to decrease in size and conspicuity. Accurate measurements are difficult, but for reference purposes, ill-defined left tongue enhancement now measures 29 x 22 mm x 27 mm (see image 16 series 13, and image 22 series 12), previously 55 x 40 x 40 mm.A reference left level IIa lymph node now measures 10 x 7 mm (image 24 series 5), previously 17 x 13 mm. No new or growing pathologic adenopathy is seen in the neck. Progressive treatment related findings are noted including reticulation of the subcutaneous fat and pharyngeal and supraglottic mucosal edema. The glandular tissues are unremarkable. Bone marrow signal characteristics are within normal limits.

Output: Since the prior examination, the previously seen extensive tongue, tonsil and soft palate tumor continues to decrease in size. A reference left level IIa lymph node has also diminished in size. No new or progressive lesions are seen in a background of treatment related findings.


Instruction: Generate impression based on medical findings.

Input: 53-year-old female status post sacral muscle flap reconstruction now presents with sacral pain. Evaluate for sacral osteomyelitis or abscess. Postsurgical changes and scar tissue are noted in the posterior pelvic soft tissues and anterior pelvic wall. Interspersed metallic fragments likely represent surgical clips. While these areas of scarring demonstrate peripheral enhancement on post-contrast images, there is no evidence of edema or abnormal enhancement within the bone marrow. Bone marrow signal is within normal limits on T1-weighted images. No focal fluid collection to suggest abscess formation.

Output: Postsurgical changes and scarring as described above without evidence of sacral osteomyelitis or abscess.


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old, new headaches and history of breast and lung cancer. No restricted diffusion is seen. A few scattered nonspecific small foci of T2 hyperintensity are evident in the cerebral white matter. No edema or mass effect is detected. No pathologic parenchymal or extra-axial enhancement is seen. No acute intracranial hemorrhage or any abnormal extra-axial fluid collections are detected. The ventricles are normal in size and morphology.

Output: 1.No acute intracranial abnormality.2.No evidence of intracranial metastatic disease.


Instruction: Generate impression based on medical findings.

Input: 23-year-old female with recent injury/fall. Assess for ACL tear. MENISCI: The medial and lateral menisci appear intact.ARTICULAR CARTILAGE AND BONE: Numerous intramedullary cortically-based lesions are noted, as seen on prior imaging studies, previously described as nonossifying fibromas. There has been interval decrease in fluid signal intensity and increase in fat signal intensity suggesting some interval healing of these lesions. There are bone contusions identified along the posterior aspect of the lateral tibial plateau and lateral femoral condyle above the anterior horn of the lateral meniscus. An additional contusion is identified along the posterior aspect of the medial tibial plateau. We see no fluid-filled articular cartilage defects.LIGAMENTS: The is a complete rupture of the ACL through its mid to proximal fibers. The PCL appears intact. The lateral collateral ligament and medial collateral ligament appear intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: ACL tear and other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Ms. Pistorio is a 31-year-old female with a personal history of left triple negative breast cancer, with left axillary metastatic lymph nodes, status post neoadjuvant chemotherapy. She presents today for MRI evaluation to assess for treatment response. I-Spy trial MRI #4. There is extreme amount of fibroglandular tissuein both breasts. Moderate background parenchymal enhancement is noted bilaterally, which limits the sensitivity of this examination.LEFT BREAST: The known index malignancy in the left axillary tail no longer enhances on this examination. However, there are several enhancing foci/masses seen extending inferiorly, the largest one of which measures approximately 0.9 x 0.7 x 1.0 cm, previously measuring 0.9 x 0.5 x 0.9 cm. Susceptibility artifact from a hydromark biopsy clip is again noted lateral to this lesion. The total span of abnormal enhancement (of the residual enhancing foci/masses) measures approximately 4.9 cm in the AP oblique dimension, previously measuring 5.1 cm. However, the total span of enhancement including the biopsy marker clip from index malignancy and residual enhancing foci/masses measures approximately 6.9 cm. This corresponds to the mammographically-identified distance between the index malignancy biopsy marker clip and satellite lesion biopsy marker clip of 7.2 cm.In the left axilla, the biopsy proven lymph node now measures 0.9 cm, compared to 0.9 cm. RIGHT BREAST: Several benign enhancing foci/masses are again seen in the right breast, and stable when compared to prior MRI examinations. There is no new abnormal enhancement within the right breast. No abnormal right axillary lymph nodes are identified.

Output: (1) Interval decrease in enhancement of left axillary tail index malignancy. Total span of abnormal enhancement (of residual enhancing foci/masses), measures approximately 4.9 cm. Total span of abnormal enhancement (including biopsy marker clip from index malignancy + residual enhancing foci/masses), measures approximately 6.9 cm. Any breast conservation therapy would have to include both biopsy marker clips (index + satellite) which are currently separated by approximately 7 cm (on both MRI and mammogram). (2) Stable size and appearance of metastatic left axillary lymph node.(3) No MRI evidence of malignancy of the right breast. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.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: 57 years Male (DOB:6/9/1958)Reason: MRI treatment planning prior to stereotactic radiosurgery History: nonePROVIDER/ATTENDING NAME: STEVEN J CHMURA STEVEN J CHMURA The CSF spaces are appropriate for the patient's stated age with no midline shift. Since the prior exam a right frontal LASER ablation probe has been removed.There is a heterogeneous and round mass present in the right frontal lobe periventricular white matter which measures approximately 22 x 20 mm axial dimensions. Enhancement predominantly occurs along the periphery. There are foci of susceptibility long the periphery of the lesion. There is redemonstration of a lesion centered in the left posterior pons associated with susceptibility effect measuring approximately 6 x 7 mm axial dimensions which is also associated with a ring enhancement pattern.There are periventricular and subcortical confluent hyperintense white matter lesions present identified on the FLAIR and T2 images. This is not substantially changed relative to prior examsThere are multiple punctate subcortical foci of signal loss identified on susceptibility imaging located in both hemispheres as well as the cerebellum. Some of these are associated with contrast enhancementNormal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mucosal thickening.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is redemonstration of a right periventricular frontal partially hemorrhagic mass. This patient is known to have metastatic disease from RCC. Most likely this represents metastasis.2.There is redemonstration of a left pontine hemorrhagic mass. This patient is known to have metastatic disease from RCC. Most likely this represents metastasis.3.There are multiple microhemorrhages scattered in both hemispheres as well as in the cerebellum. Some of these are associated with contrast enhancement and some are not. It is suspected that these represent metastatic disease.4.There are periventricular confluent white matter signal changes which could be treatment related.


Instruction: Generate impression based on medical findings.

Input: 76 years Female (DOB:7/11/1939)Reason: eval for vascular malformations History: eval for vascular malformationsPROVIDER/ATTENDING NAME: JOSHUA D MOSS JOSHUA D MOSS MRI of the brainThe focus of questionable enhancement along the ependymal and intraventricular focus in the trigone of the left lateral ventricle contains the left lateral atrial vein extending into the vein of Galen as well as a portion of the left choroid plexus.A small amount of blood layers in the occipital horn of the left lateral ventricle.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.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 fenestration of the right A2 segment.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size. There is extracranial origin the left posterior inferior cerebellar artery.

Output: 1.The parenchymal lesion at the anterior aspect of the trigone of the left lateral ventricle appears to represent a confluence of the draining vein and choroid plexus. 2.No evidence for cerebrovascular occlusive disease.3.No evidence for intracranial aneurysm or arteriovenous malformation.4.A small amount of blood layers in the occipital horn of the left lateral ventricle. This was also identified in the recent CT exam.


Instruction: Generate impression based on medical findings.

Input: Left hip pain Moderate to severe osteoarthritis of the left hip has progressed compared with prior radiographs from 2013. Suspected acetabular stress fracture seen on prior MRI is not clearly evident on these radiographs.

Output: Osteoarthritis.


Instruction: Generate impression based on medical findings.

Input: Meningioma treated with SRS. There are postoperative findings related to suboccipital craniotomy with extensive left cerebral and to a lesser extent cerebellar vermian and right cerebellar hemisphere encephalomalacia. There is no significant interval change in the mildly enhancing tumor along the medial left tentorium, which extends and likely invades the confluence of the sinuses. The lesion measures approximately up to 20 mm, previously also 20 SI mm. There are mild scattered nonspecific foci of cerebral white matter T2 hyperintensity, which are likely related to chronic micrangiopathy. There is no evidence of acute infarct. There is diffuse cerebral volume loss, which is perhaps most pronounced in the bilateral medial temporal lobes. The major cerebral artery flow voids are grossly intact. There is a left maxillary sinus retention cyst.

Output: 1. Stable post-operative findings without significant interval change in the residual meningioma along the medial left tentorium that extends and likely invades the confluence of the sinuses and measures up to 20 mm. 2. Diffuse cerebral volume loss, which is perhaps most pronounced in the bilateral medial temporal lobes, may represent Alzheimer disease.


Instruction: Generate impression based on medical findings.

Input: Female 41 years old with right knee pain. Evaluate for meniscal tear. MENISCI: The medial and lateral menisci are intact and unremarkable other than very minimal intrasubstance degeneration of the posterior horn of the medial meniscus, less than on the left.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted, specifically no focal discrete cartilage defects as observed on the left.LIGAMENTS: The cruciate and collateral ligaments are intact. The MCL and LCL complex are intact. EXTENSOR MECHANISM: The extensor mechanism is intactADDITIONAL

Output: No acute or sub acute abnormality.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: This exam is mildly degraded by motion artifact. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few scattered small foci of T2 hyperintensity throughout the supratentorial white matter that are most compatible with mild chronic small vessel ischemic disease. There is mild global volume loss that is slightly more prominent in the parietal lobes. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are unremarkable. There is a left lens implant. There is mucosal thickening throughout the paranasal sinuses.

Output: 1.No evidence of mass or acute ischemia.2.Mild chronic small vessel ischemic disease.3.Mild global volume loss that is slightly more prominent in the parietal lobes.


Instruction: Generate impression based on medical findings.

Input: Myoclonic encephalopathy: worsening myoclonus. Brain MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a small area of encephalomalacia in the left occipital lobe. There is diffuse cerebral white matter T2 hyperintensity bilaterally. There are a few scattered punctate foci of susceptibility effect in the bilateral cerebral hemispheres. There is mild diffuse cerebral and cerebellar volume loss, especially posteriorly. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are grossly unremarkable. There are bilateral lens implants. There are secretions in the left frontoethmoid recess.Brain MRA: There is an unchanged 5 mm diameter saccular aneurysm at the right middle cerebral artery bifurcation with a 3 mm wide neck. There is also an unchanged 6 mm long basilar tip aneurysm with a 3 mm wide neck and a mildly irregular contour. There is no evidence of significant steno-occlusive lesions.Neck MRA: There is an apparent high grade stenosis at the origin of the right vertebral artery. Otherwise, there is no evidence of significant steno-occlusive lesions elsewhere in the major neck arteries. There is a right thyroid nodule that measures up to at least 45 mm.

Output: 1. Small chronic left occipital lobe infarct, but no evidence of acute acute infarct. Nonspecific diffuse cerebral white matter T2 hyperintensity bilaterally may represent chronic small vessel ischemic disease and scattered punctate foci of susceptibility effect in the bilateral cerebral hemispheres may represent chronic microhemorrhages, perhaps related to amyloid angiopathy. 2. Mild diffuse cerebral and cerebellar volume loss, especially posteriorly, may be a manifestation of myoclonic encephalopathy.3. Unchanged subcentimeter right middle cerebral artery and basilar tip aneurysms.4. Apparent high grade stenosis at the origin of the right vertebral artery. Otherwise, no evidence of significant steno-occlusive lesions in the head and neck arteries.5. A nonspecific right thyroid nodule measures up to at least 45 mm. Thyroid ultrasound may be useful for further evaluation.


Instruction: Generate impression based on medical findings.

Input: 77-year-old female with pelvic mass/fluid seen on pelvic ultrasound. PELVIS:UTERUS, ADNEXA: Mild atrophy of the uterus. 13 mm T2 hypointense fibroid is seen within the myometrium at the fundus series (901/33).There has been significant interval decrease in previously seen pelvic free fluid, presumably hemorrhage, since on prior CT on 5/6/2015. Abutting the left posterolateral aspect of the lower uterine segment, there is an ovoid lesion measuring up to 2.4 x 1.6 cm (series 801/48) which demonstrates T1 hyperintensity, T2 shading with low signal rim, and questionable minimal enhancement. This lesion is separate from the left ovary, which is felt to be visualized more superiorly. Overall, this lesion is felt to represent a small residual hematoma.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Right perineal T2 hyperintense cystic lesion measuring 8 mm (series 801/21), most likely a Bartholin's gland cyst. A left sacral neural foraminal Tarlov cyst is noted (series 801/60).OTHER: No significant abnormality noted.

Output: Interval decreased pelvic free fluid, presumably hemorrhage, with left pelvic lesion likely representing a small residual hematoma, as detailed above.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for dynamic instability and spondylolisthesis; flexion and extension views History: low back pain, lumbar degeneration Degenerative disc disease most severe at L4-5 and L5-S1 levels with vacuum phenomena. Alignment is anatomic without evidence of spinal instability. Small anterior osteophyte formation.

Output: Degenerative changes of the lumbar spine as above. No evidence of spinal instability.


Instruction: Generate impression based on medical findings.

Input: 72-year-old female with adnexal mass seen on CT and ultrasound. Evaluate adnexal mass. ABDOMEN:LIVER, BILIARY TRACT: No suspicious hepatic lesions are noted. Mild intra and extra hepatic biliary prominence. The common bile duct tapers smoothly to the level of the ampulla without evidence of lesion or mass.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Asymmetric prominence of left breast tissue.PELVIS:UTERUS, ADNEXA: There is a large left adnexal nonenhancing lesion demonstrating T2 hyperintensity, T1 hypointensity, and measuring 7.1 x 6.5 x 5.4 cm. There is a thin nonenhancing septation within this adnexal lesion.T2 heterogenous, heterogeneously enhancing subserosal uterine lesion, likely a fibroid.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Large left adnexal cystic lesion without suspicious features measuring approximately 7 cm. Thus, this favors a benign ovarian neoplasm. Consider gynecological consultation.2.Uterine fibroid.3.Asymmetric prominence of left breast tissue is noted. Correlation with recent mammography is recommended.


Instruction: Generate impression based on medical findings.

Input: 58-year-old male with simple partial seizures. No restricted diffusion to suggest acute ischemia. In the limited context of this examination, no intracranial hemorrhage is identified. There is left greater than right T2/FLAIR hyperintensity seen within the subcortical and periventricular frontal white matter that is consistent with encephalomalacia. There is ex vacuo dilation of the left lateral ventricle and expanded perivascular spaces secondary to this confluent encephalomalacia in the left frontal lobe. The T2/FLAIR hyperintensity is also visualized within the left internal capsule, left external capsule, and left thalamus. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1.Findings are compatible with encephalomalacia and gliosis in the left greater than right subcortical and periventricular white matter associated with extension into the left external capsule, left internal capsule and left thalamus. Etiology is nonspecific. Although it could be vascular related or could be related to other process resulting in encephalomalacia.


Instruction: Generate impression based on medical findings.

Input: New onset HA, visual disturbance. Brain MRI: A small focus of enhancement is noted just inferior to the right caudate head which also demonstrates susceptibility abnormality. There is no surrounding hypointensity on T2/FLAIR to suggest edema. There is also no evidence of restricted diffusion. Constellation of above findings suggest possibility of cavernous malformation. Differential diagnosis include cavernous malformation with associated capillary telangiectasia. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are grossly unremarkable.Orbits MRI:No abnormal mass or abnormal enhancement is seen. No abnormal signal intensity is evident. The optic nerves are normal in size and signal intensity, and are symmetric bilaterally. No retrobulbar mass, chiasmatic mass, or parasellar abnormality is seen. Extraocular muscles are unremarkable.Brain MRA: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.Neck MRA: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, without evidence of stenosis or occlusion. There is a left dominant vertebral artery. The C6 level of the right vertebral artery shows crossing of venous structure and overlapped deep cervical artery which created an artifactual narrowing of that segment on MIP reformat image. There is no evidence of stenosis or occlusion.

Output: 1.Small enhancing lesion just inferior to the right caudate head with associated susceptibility abnormality but without restricted diffusion. Differential considerations include cavernous malformation or cavernous malformation associated with capillary telangiectasia. Additional less likely considerations are subacute lacunar infarct or hemorrhage as well as metastasis. Mild mucosal thickening is noted of the left sphenoid sinus which is nonspecific. 2.No significant sterile occlusive disease or aneurysm involving the intracranial and extracranial craniofacial vasculature.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: History of lymphoma in the proximal femur with prophylactic intramedullary rod fixation. Patient presents with pain in the left leg for 2 months. Metallic susceptibility artifact from an intramedullary rod and screw device within the left femur limits evaluation. No evidence of hardware complication is evident. No acute fracture is seen. Heterogeneous bone marrow signal abnormality in the right femoral diaphysis is nonspecific but likely represents residual islands of red marrow. There is a small amount of fluid within the right hip which is not necessarily of any current clinical significance. There is a lobulated focus of fluid signal intensity within the subcutaneous tissue along the lateral aspect of the greater trochanter which may represent a postoperative seroma, although this is incompletely imaged/included in the field-of-view. There is linear decreased signal abnormality within the subcutaneous tissues along the lateral aspect of the subtrochanteric region of the left thigh likely postsurgical in etiology. There is increased bone marrow signal abnormality in the subtrochanteric region of the proximal femoral diaphysis which enhances on postcontrast sequences suspicious for osseous disease which appears decreased in size when compared to the prior MRI hip examination. There is also enhancement of the surrounding soft tissues within the vastus lateralis and intermedius musculature consistent with soft tissue extension of disease which also appears decreased in size when compared to the prior MRI examination of the left hip. There is enhancing increased signal abnormality at the level of the left femoral head/neck junction which likely represents residual osseous disease seen on prior MRI examination, although this is poorly evaluated due to the extensive metallic susceptibility artifact. There is serpentine signal abnormality within the superior aspect of the femoral head consistent with avascular necrosis. Evaluation for subchondral collapse is limited due to the aforementioned metallic susceptibility artifact. Although this examination was not protocoled for detailed evaluation of the knee, there appears to be articular cartilage degeneration along the lateral facet of the patella with degenerative underlying subchondral signal abnormality. The remainder of the imaged musculature is normal in appearance

Output: 1. Limited examination demonstrating findings consistent with the patient's known history of osseous lymphoma involving the left femur which appear decreased in size and extent when compared to the prior study, within the confines of this examination.2. Postoperative changes of orthopedic fixation of the left femur without evidence of acute fracture or hardware complication.3. Findings consistent with avascular necrosis of the left femoral head. Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: 36-year-old male with left shoulder squeaking. Rule out loose suture anchors status post shoulder stabilization. ROTATOR CUFF: The supraspinatus muscle and tendon appear intact. There is increased signal abnormality within the supraspinatus indicating mild tendinosis. The infraspinatus muscle and tendon appear intact. The subscapularis and teres minor muscle and tendon appear intact. SUPRASPINATUS OUTLET: There is a trace amount of fluid within the subacromial subdeltoid bursa which is not necessarily of any clinical significance. The acromioclavicular joint is normal in appearance.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. There is deformity, heterogeneity and increased signal abnormality within the anterior inferior glenoid which presumably represents prior tearing and postsurgical change, within the limitations of this non arthrogram study. No fluid-filled defects are identified to confirm a re-tear. BICEPS TENDON: The tendon of the long head of the biceps appears intact. ADDITIONAL

Output: Postoperative changes of prior Remplissage procedure and osseous Bankart repair. There is increased fluid signal abnormality surrounding the inferior suture anchor within the glenoid, which raises the question of loosening.


Instruction: Generate impression based on medical findings.

Input: Examination is limited by motion artifact, and lack of dedicated anosmia protocol. There is mild global volume loss. The cisterns remain patent. There is no midline shift or mass effect. There are no definite areas of abnormal signal or pathological enhancement. There is no diffusion abnormality. The T2 appearance of the olfactory bulbs is grossly unremarkable, however the postcontrast images are nondiagnostic due to motion artifact. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. There is trace fluid in the bilateral mastoid air cells, right greater than left. Moderate to severe developmental cervical spine stenosis is partially visualized.

Output: 1. The T2 appearance of the olfactory bulbs is grossly unremarkable, however the postcontrast images are nondiagnostic due to motion artifact. If there is persistent concern, dedicated anosmia protocol imaging can be performed.2. Moderate to severe overall cervical spine stenosis is partially visualized with underlying developmental narrowing. An MRI of the cervical spine can be obtained for further evaluation.3. There is trace fluid in the bilateral mastoid air cells, right greater than left. Please correlate clinically.


Instruction: Generate impression based on medical findings.

Input: Evaluate for recurrence of meningioma. Patient had two seizures today. There is no evidence of intracranial hemorrhage. A hyperdense region is identified along the superior falx. Adjacent to an area of encephalomalacia in the left frontal lobe is a density along the inner table of the left skull that likely represents cerebral cortex. However, an MRI is needed for further evaluation of these areas.White matter hypodensity in the right frontal lobe is more prominent than on the prior study. Correlate with any history of radiation therapy.The ventricles and basal cisterns are normal in size and configuration.Postsurgical findings of a craniotomy are noted. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Hyperdense region is identified along the superior falx. Further evaluation with MRI is recommended. White matter hypodensity in the right frontal lobe is more prominent than on the prior study.


Instruction: Generate impression based on medical findings.

Input: Right knee pain not responsive to steroid injection. MENISCI: There is a full-thickness vertical tear of the posterior horn of the medial meniscus.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Full-thickness tear of the posterior horn of the medial meniscus.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old, breast cancer with bony lesions in the thoracic spine. Assess for cord compression. Diffuse marrow signal heterogeneity is seen compatible with widespread osseous prostatic disease. There is a partial compression of the L4 vertebral body with only trace retropulsion. No epidural disease spread is seen. No acute cord compression is evident. The lower lumbar spinal canal is narrowed due to a combination of a congenitally slender canal and posterior element hypertrophy.

Output: 1.Evidence of widespread osseous metastatic disease.2.Partial compression of the L4 vertebral body without significant retropulsion or associated canal impingement.3.No acute cord compression.4.Narrowing of the lower lumbar spinal canal due to a combination of a congenitally slender canal and posterior element hypertrophy. If clinically warranted, this can be assessed with dedicated lumbar spine imaging.


Instruction: Generate impression based on medical findings.

Input: Hodgkin's lymphoma with worsening left shoulder pain ROTATOR CUFF: No significant abnormality noted.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Normal MRI of the left shoulder.


Instruction: Generate impression based on medical findings.

Input: Developmental delay and Sandifer's syndrome. Evaluate for sequela of HIE versus dysplastic brain. There is no significant interval change in the dysplastic appearance of the brain. Again seen is asymmetric dilatation of the right lateral ventricle. The left putamen appears enlarged and abnormally shapred, and the lentiform nuclei on the left collectively seem to wrap around the left frontal horn suggesting dysplasia. There are several foci of T2 hyperintensity in the periventricular white matter of the bilateral cerebral hemispheres are well as subcortical white matter of the bilateral anterior frontal lobes, left greater than right. The gyration pattern of the cerebral hemisphere is otherwise grossly unremarkable. The myelination pattern is appropriate for age. The brainstem is hypoplastic and most pronounced in the pons. In addition, the right half of the brainstem appears to be slightly larger than the left side. There is a left choroidal fissure cyst.The cerebellum also appears to be dysplastic, in which the right hemisphere is larger than the left and associated anomalous foliation pattern. The inferior cerebellar vermis lobules also appear somewhat underdeveloped. The fourth ventricle appears enlarged. The corpus callosum is fully formed, but appears to be slightly smaller than normal. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. The major cerebral flow voids appear to be grossly intact. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: No significant interval change in the appearance of abnormal brain morphology, which is likely at least partly congenital and related to dysplasia or maldevelopment.


Instruction: Generate impression based on medical findings.

Input: Posterior fossa epidermoid resection. There are postoperative findings related to posterior fossa epidermoid cyst resection. There are residual punctate foci of somewhat restricted diffusion and high T2 signal along the left lateral aspect of the resection cavity, along the medial margin of the left cerebellar hemisphere and left inferior cerebellar peduncle. There is also a small area of high T2 signal in the posterior medulla. There are also several scattered foci of high T2 signal in the cerebral white matter bilaterally. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged.

Output: Postoperative findings related to posterior fossa epidermoid cyst resection with residual punctate foci of somewhat restricted diffusion and high T2 signal along the left lateral aspect of the resection cavity, along the medial margin of the left cerebellar hemisphere and left inferior cerebellar peduncle, which may represent post-treatment effects or perhaps a small amount of residual epidermoid components. A small area of high T2 signal in the posterior medulla may represent prior injury related to involvement by epidermoid and/or its resection.


Instruction: Generate impression based on medical findings.

Input: 44-year-old female with constant knee pain and swelling. MENISCI: Note is made of a discoid lateral meniscus. There is linear increased signal abnormality within the posterior horn of the lateral meniscus which is consistent with a horizontal tear of the meniscus. There is blunting and deformity consistent with complex tearing of the posterior horn of the medial meniscus extending into the body of the meniscus. The anterior horn appears intact. ARTICULAR CARTILAGE AND BONE: There is tricompartmental osteophyte formation. There is full thickness articular cartilage degeneration involving nearly the entire weightbearing surface of the medial femoral condyle and medial tibial plateau. There is subchondral signal abnormality in the surrounding area, likely degenerative. There is subjective thinning of the articular cartilage of the lateral compartment. There is near full thickness to full thickness articular cartilage degeneration along the lateral facet of the patella. There is also a partial thickness articular cartilage fissure along the medial facet of the patella. LIGAMENTS: There is thinning and increased signal abnormality within the distal fibers of the ACL suggesting a partial tear. The PCL, MCL, and LCL appear intact.EXTENSOR MECHANISM: Extensor mechanism appears intact.ADDITIONAL

Output: 1. Tearing of a discoid lateral meniscus as well as complex tearing of the medial meniscus.2. Degenerative changes including full-thickness articular cartilage degeneration as described above.3. Thinning and increased signal abnormality within the distal fibers of the ACL suggesting a partial tear. 4. Large knee joint effusion with foci of internal fat signal intensity suggesting lipoma arborescens as well as multiple loose bodies within the joint space.


Instruction: Generate impression based on medical findings.

Input: 12 years, Female, evaluate for intracranial mass or intraorbital mass. Severe headaches and history of neuroblastoma. MRI brain: A single focus of T2/FLAIR hyperintensity (series 701, image 10) is unchanged within the right temporal lobe subcortical white matter with no associated restricted diffusion, enhancement, susceptibility or mass effect. No new suspicious lesions are identified.No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. The ventricles are within normal limits in size and configuration. No abnormal leptomeningeal enhancement. Major flow-voids are preserved. Empty sella is not identified. There is also mild mucosal thickening in scattered paranasal sinuses.MRI Orbits: There is subtle flattening of the posterior aspects of the globes at the optic nerve head insertion. Although there is no frank optic nerve head elevation, there is questioned punctate enhancement at the optic nerve heads. Artifact on diffusion-weighted images limits evaluation for associated optic nerve head restriction. There is also mild fluid distention of the distal optic nerve sheath which is nonspecific. Grossly, mild flattening of the posterior globes was noted on the prior exam.No abnormal orbital mass or other abnormal enhancement is seen. No abnormal signal intensity is evident. The optic nerves are normal in size and signal intensity, and are symmetric bilaterally. No retrobulbar mass, chiasmatic mass, or parasellar abnormality is seen. Extraocular muscles are unremarkable.

Output: 1. Stable to slightly decreased conspicuity of nonspecific nonenhancing T2 hyperintense right temporal lobe white matter lesion. No abnormal parenchymal enhancement or new abnormal signal.2. Slight flattening of the posterior aspects of the globes at the optic nerve head insertion without frank elevation of the optic nerve head, although there is punctate enhancement suggested and slight fluid distention of the optic nerve sheath distally. The flattening of the posterior globes is grossly similar to prior exam, although correlation with ophthalmological exam is recommended to assess for papilledema, and consideration may be made for lumbar puncture. If further assessment is needed of cranial nerves to evaluate exotropia, MRI of the cranial nerves may be obtained. No evidence of associated empty sella to suggest pseudotumor cerebri.Dr. Yang discussed these findings over the telephone with Dr. JAMES W. MITCHELL on 10/4/2016 9:00 AM.


Instruction: Generate impression based on medical findings.

Input: 81-year-old female status post fall; evaluate for fracture/dislocation BRAIN:There is no evidence of acute intracranial hemorrhage, mass or edema. Several bilateral lacunar infarctions in the basal ganglia. Multiple nonspecific foci of attenuation are seen in the periventricular and subcortical white matter which may represent small vessel ischemic disease, appearing similar to the previous MRI.Ventriculomegaly out of portion with age-related volume loss and may represent normal pressure hydrocephalus, unchanged. Prominence of the cortical sulci consistent with age-related volume loss. Atherosclerotic calcifications are seen in the internal carotid arteries, most prominently at the carotid bifurcations.The calvaria and skull base are radiographically normal without evidence of depressed skull fracture. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.CERVICAL SPINE:There is reversal of the normal cervical lordosis with grade 1-2 anterolisthesis of C3 on C4. There is also grade 1 retrolisthesis of C4 on C5 and of C5 on C6. The vertebral body heights are grossly maintained. Prevertebral soft tissues are grossly unremarkable.Multilevel extensive degenerative changes are seen throughout the cervical spine with uncal vertebral joint hypertrophy, osteophyte formation, disk space narrowing, and neuroforamina narrowing. If high clinical concern for cord or ligamentous injury, MRI may be obtained for further evaluation.

Output: 1. No acute intracranial hemorrhage. No evidence of acute fracture.2. Stable ventriculomegaly. 3. Bilateral lacunar infarcts and likely small vessel ischemic disease of indeterminate age, appearing similar to the previous exam.4. Reversal of normal cervical lordosis extensive multilevel degenerative changes. If high clinical concern for spinal cord or ligamentous injury, MRI may be obtained for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Female, 13 years old, with syrinx of the cervical and thoracic spinal cord, yearly follow-up. Redemonstrated is evidence of prior suboccipital craniectomy and resection of the posterior arch of C1. The foramen magnum remains somewhat crowded with a relatively pointed configuration of the cerebellar tonsils, but this is similar to the prior examination.Since the prior examination, the patient's cervicothoracic syrinx has significantly increased in caliber, now measuring 14 x 10 mm at the C6-7 level, previously 7 x 4 mm at this level. The syrinx cavity and associated T2 signal abnormality have also expanded in the craniocaudal dimension extending from the C1 level down to the T11 level. The syrinx itself contains multiple septations.Slight reversal of the cervical lordosis is seen. Spinal alignment is otherwise unremarkable. Vertebral body heights are preserved. No areas of marrow replacement or edema are seen. The thyroid gland is diffusely bulky and heterogeneous with a superimposed 15 mm T2 hyperintense lesion in the left thyroid lobe.

Output: 1.Demonstration of findings related to prior Chiari decompression. The foramen magnum remains somewhat crowded but similar to the prior study.2.Interval worsening of the cervicothoracic syrinx is demonstrated.3.The thyroid gland is incidentally noted to be prominent and diffusely heterogeneous with a focal lesion in the left lobe. This can be further assessed with sonography if clinically warranted.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Assess for sinus disease/infection. Signs and symptoms: 55-year-old female with MDS and severe facial pain. Concern for invasive sinusitis. Non-enhanced CT of paranasal sinuses:Frontal sinuses, worsening of frontal sinus disease since prior study.Sphenoid sinus, worsening of sinusitis since prior exam.Ethmoid sinuses, significant worsening of the left ethmoid sinus disease since prior exam. Minimal new right posterior ethmoid sinus disease.Maxillary sinuses demonstrate significant interval worsening of left maxillary sinus disease with near complete opacification on the current exam. Complete occlusion of left ostiomeatal unit. Unremarkable right maxillary sinus and with patent right ostiomeatal unit which has remained stable since prior exam.There is thinning of the posterolateral wall of left maxillary sinus with a suspect a small area of bony defect. There is also effacement of fracture plane in the left infratemporal fossa and including the left retromaxillary fat pad. There is also effacement of fascial planes between the masticator muscles at this site. There is edematous changes of the musculature. Comment a follow-up with an enhanced MRI exam for further evaluation.There is no detectable retro-orbital space abnormality on the left however the edematous changes of the left infratemporal fossa extends into the left inferior orbital fissure.Images through nasal cavity demonstrate increased soft tissue density in the posterior aspect of left nasal cavity.Visualized mastoid air cells and middle ear cavities are unremarkable.Above findings were discussed at the time of interpretation with Dr. Scott Siglin pager number 2953.

Output: Interval worsening of sinusitis in particular on the left with extension of edema/inflammatory changes into the left infratemporal fossa with effacement of fascial plane which also extends into the left inferior orbital fissure. Follow up with an MRI is recommended.


Instruction: Generate impression based on medical findings.

Input: Neoplasm of unspecified behavior of endocrine glands and other parts of nervous system [D49.7] / Encounter for other preprocedural examination [Z01.818], Reason for Study: ^Reason: Pineal tumor, presurgical MRI STEALTH image guidance for tumor resection. This imaging study was performed under stealth protocol, thus multiple fiducial markers attached on the scalp during the examination.Right occipital craniotomy was seen.Redemonstration of irregular shaped and enhancing pineal tumor which shows evidence of infiltration into bilateral thalami and periaqueductal gray matter, superior colliculi and cranial aspect of tectum unchanged since prior scan.Right frontal approach ventriculostomy tube was inserted and the tip is located at the right lateral ventricle frontal horn, unchanged since prior scan.Unchanged right occipital lobe encephalomalacia since prior scan.The ventricles, sulci and cisterns are unremarkable and stable in size. 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. Preoperative STEALTH protocol brain MRI imaging with multiple fiducial markers.2. Pineal tumor with local extension into bilateral thalami, periaqueductal gray, cranial aspect of tectum and superior colliculus, unchanged since prior scan.3. Stable ventricle size since prior scan with right frontal approach ventriculostomy catheter.4. Unchanged right occipital craniotomy with right occipital encephalomalacia.


Instruction: Generate impression based on medical findings.

Input: Bilateral lower extremity weakness and decreased sensation. Brain: There is ill-defined T2 hyperintensity in the anterior pons, left greater than right, without significant mass effect. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Spine: The cervicothoracic spinal cord signal abnormality is less conspicuous. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: 1. Ill-defined T2 hyperintensity in the anterior pons may represent an inflammatory or demyelinating process, for example, but is incompletely characterized since intravenous contrast could not be administered.2. The cervicothoracic spinal cord signal abnormality is less conspicuous and may also represent an inflammatory or demyelinating process, but is incompletely characterized since intravenous contrast could not be administered.


Instruction: Generate impression based on medical findings.

Input: 76 years, Male, newly diagnosed lung cancer. Evaluate for metastases. There is a 6 mm focus of enhancement along the surface of the inferior cerebellar vermis without associated parenchymal edema or mass effect. There is susceptibility effect involving this lesion with corresponding calcification demonstrated on recent CT. There is no significant abnormal parenchymal or meningeal enhancement in the remainder of the brain. There is minimal smooth enhancement along the right frontal dura which may be related to remote subdural hemorrhage, for example. No significant extra-axial collections are present on the current study. There is global parenchymal volume loss commensurate with patient's age. No intracranial mass effect, midline shift, or herniation. No hydrocephalus.There are multiple punctate foci of susceptibility involving the left paracentral lobule, left parietal and left occipital deep white matter, as well as in the left medial temporal lobe. These are consistent with chronic microhemorrhages. There are minimal foci of T2/FLAIR hyperintensity in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild senescent white matter changes.There is a small lipoma involving the left anterior frontal scalp. No destructive lesions in the calvarium. Degenerative changes in the cervical spine with partial ankylosis of the C4 and C5 vertebrae partially imaged.

Output: 1. No definite evidence of intracranial metastatic disease. There is a 6 mm enhancing nodule along the inferior cerebellar vermis which appears to demonstrate calcifications. Imaging appearance would be compatible with a subependymoma although a solitary metastasis is not excluded. 2. Scattered chronic microhemorrhages in the left cerebral hemisphere as described above which are in a nonspecific distribution. Please see additional comments above.


Instruction: Generate impression based on medical findings.

Input: Diarrhea in the setting of very mild ileitis seen on colonoscopy. 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: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted. Normal-appearing bowel loops without dilation, bowel wall thickening, or abnormal enhancement. The ileocecal valve is within normal limits. No mesenteric fibrofatty changes. No intra-abdominal fluid collections.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Simple appearing adnexal cysts. Intrauterine device noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted. Normal-appearing bowel loops without dilation, bowel wall thickening, or abnormal enhancement. The ileocecal valve is within normal limits. No mesenteric fibrofatty changes. No intra-abdominal fluid collections.BONES, SOFT TISSUES: Bilateral breast implants, partially imaged. No significant abnormality noted.

Output: No MR evidence of Crohn's disease or findings otherwise to account for the patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: 49-year-old female with history of right knee medial joint line pain. MENISCI: There is increased signal within the posterior horn of a truncated medial meniscus (from prior partial meniscectomy) appearing similar to the prior exam and likely representing degeneration. There is no evidence of new tearing. The anterior horn of the medial meniscus is unremarkable.The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is progressive articular cartilage loss about the medial femoral condyle and medial tibial plateau with near bone on bone apposition. There is increased bone marrow edema within the underlying bone. There is marked articular cartilage loss about the medial patellar facet as well as thinning of the cartilage along the medial femoral trochlea. There are tricompartmental osteophytes.LIGAMENTS: The ACL, PCL, MCL, and LCL are intact. EXTENSOR MECHANISM: The extensor mechanism is unremarkable.ADDITIONAL

Output: 1.Increased signal about the remaining posterior horn of the medial meniscus compatible with continued degeneration, but we see no discrete new tear.2.Progressive articular cartilage loss especially at the medial tibiofemoral compartment with near bone-on-bone apposition and adjacent bone marrow edema.3.Small joint effusion.


Instruction: Generate impression based on medical findings.

Input: History of metastatic breast cancer. Increasing size of liver masses. ABDOMEN:LIVER, BILIARY TRACT: Numerous right greater than left lobe well defined T2 hyperintense lesions without associated enhancement are compatible with multiple cysts. No suspicious ring or solid enhancement.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Postsurgical changes from a right mastectomy. Osseous metastases.OTHER: No significant abnormality noted.

Output: Numerous variable size hepatic lesions without suspicious rim or mural enhancement likely represents numerous hepatic cysts.


Instruction: Generate impression based on medical findings.

Input: History of laparoscopic cholecystectomy November 2015 now with constant right upper quadrant pain unrelated to eating. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size and signal intensity. No suspicious liver lesion. Moderate intrahepatic and extrahepatic biliary ductal dilatation to the level of the ampulla without an obstructing stone or focal mass. The common bile duct is tortuous just superior to the pancreatic head.The remnant cystic duct is noted.Status post cholecystectomy without a fluid collection in the cholecystectomy bed. Following hepatobiliary contrast intravenous administration the hepatic parenchyma takes up the agent but there is no significant biliary excretion on the delayed hepatobiliary phase imaging.SPLEEN: No significant abnormality noted.PANCREAS: The main pancreatic duct is mildly prominent to the level of the ampulla without a discrete mass lesion. The pancreas is otherwise normal in morphology signal intensity and enhancement.ADRENAL GLANDS: Right adrenal 2.9 x 1.6 cm nodule demonstrate loss of signal on out of phase imaging compatible with a lipid rich adrenal adenoma.KIDNEYS, URETERS: Bilateral simple appearing cysts.RETROPERITONEUM, LYMPH NODES: Tortuous and mildly ectatic abdominal aorta. Note is made of narrowing of the visceral artery origins.BOWEL, MESENTERY: No free fluid or loculated fluid collection.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.There is moderate intra and extrahepatic biliary ductal dilatation as well as mild prominence of the main pancreatic duct to the level of the ampulla raising the possibility of ampullary stenosis. No discrete mass or stone. No fluid collection to suggest a bile leak.2.No excretion of hepatobiliary agent in the biliary system raises the possibility of parenchymal/hepatocyte dysfunction.3.Tortuous mildly ectatic and atherosclerotic abdominal aorta. Narrowing of the visceral artery origins may be correlated with mesenteric Doppler ultrasound to evaluate for mesenteric angina.


Instruction: Generate impression based on medical findings.

Input: Right lower extremity weakness, Multifocal scattered various sized high signal intensity lesions on FLAIR imaging are seen on bilateral frontal lobes, parietal lobes and corpus callosum. Especially on sagittal FLAIR scan, those high signal intensity lesions appear to be arranged as per periventricular to ventricle. On gadolinium enhancement, there is a focal enhancing nodule on the right precuneus which may indicate active lesion.Above findings suggest possibility of demyelinating disease such as multiple sclerosis.There is no evidence of acute ischemic or hemorrhagic lesion on the scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.C spine MRI:Again, there are multifocal patch high signal intensity lesions on the spinal cord, especially at the level of C2-C3 and T1-T2 junction level with minimal cord expansion indicating possible edema. On gadolinium enhancement, C3-C4 level as well as T1-2 junction region show patch or periportal enhancement indicating active lesion. Considering multifocal white matter lesions on brain MRI, the spine MRI findings are consistent with spinal cord involvement of demyelinating disease such as multiple myeloma.The cranial-cervical junction is normal. There is straightening of spica spine losing normal lordotic angle. The cervical spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing or myelopathy. The intervertebral discs demonstrate normal T2 intensity and height with no evidence of disc herniation. The paraspinal soft tissues are unremarkable.From C2-C3 to T1-2 level, there is no evidence of neural foraminal or spinal canal stenosis.

Output: Multifocal patchy high signal intensity lesions on bilateral hemispheres as well as spinal cord (cervical spine) as described above. There are some enhancing lesions on gadolinium enhancement mostly on cervical spinal cord. These findings suggest possibility of multiple sclerosis with active plaques. Clinical and laboratory [CSF study] correlation are recommended.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old. Right shoulder pain and weakness ROTATOR CUFF: There is moderate to severe thinning of the supraspinous tendon compatible with chronic attritional tearing that has progressed compared to the prior study. Increased signal intensity replacing the distal fibers of the supraspinatus tendon likely represents a combination of tendinosis and tearing. There may be a focal full-thickness tear affecting the anterior fibers of the supraspinatus tendon at their insertion, but this is equivocal. There is mild fatty atrophy of the supraspinatus muscle. Mild edema type signal within the muscle on fat suppressed T2 sequences may reflect denervation injury or a strain. There is thickening and increased signal intensity of the infraspinatus tendon representing tendinosis that has progressed from the prior study. There are also cystic structures along the myotendinous junction more proximally. Mild to moderate fatty atrophy of the infraspinatus muscle appears to have progressed from the prior study. There is also edema type signal within the infraspinatus muscle on fat suppressed T2 sequences which may reflect denervation injury or strain. The teres minor tendon and muscle are intact. There is increased signal intensity within the subscapularis tendon involving the majority of the thickness of the tendon with sparing of the bursal surface fibers indicating a high-grade partial-thickness tear. There also appears to be incomplete insertional tearing of the subscapularis tendon. Subscapularis tendon tearing has progressed when compared to the prior study. There is mild atrophy of the subscapularis muscle.SUPRASPINATUS OUTLET: Moderate osteoarthritis affects the acromioclavicular joint. There is a small amount of fluid in the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Mild osteoarthritis affects the glenohumeral joint. There is a small amount of fluid in the joint but no large effusion. Given the limitations of a nonarthrogram study, the glenoid labrum appears normal for age.BICEPS TENDON: There is medial dislocation of the biceps tendon from the bicipital groove which is new when compared to the prior study.

Output: 1.Progression of partial thickness tearing of the supraspinatus, infraspinatus, and subscapularis tendons with equivocal focal full-thickness tear of the anterior fibers of the supraspinatus tendon at their insertion.2.Osteoarthritis and other findings as above, including medial dislocation of the biceps tendon.


Instruction: Generate impression based on medical findings.

Input: Status post fall from however board on May 24 with arm extended. Elbow pain. Assess for supracondylar fracture. I see no fracture. There is, however, elevation of the distal humeral fat pads indicating a joint effusion or hemarthrosis, and I cannot exclude an occult fracture. If further imaging evaluation is clinically warranted, MRI may be considered.

Output: Although no fracture is evident, elevation of the distal humeral fat pads indicates a joint effusion or hemarthrosis. If further imaging evaluation is clinically warranted, MRI may be considered to assess for an occult fracture.


Instruction: Generate impression based on medical findings.

Input: 56-year-old female with medial joint line pain. Evaluate meniscus. MENISCI: There is branching signal abnormality within the body of the medial meniscus, indicating a complex tear with a displaced flap of meniscus within the medial gutter beneath the body of the meniscus. There is globular increased signal which extends from the body into the posterior horn of the medial meniscus representing intrasubstance degeneration. The signal also extends to the femoral articular surface, indicating additional degenerative tearing. There is also intrasubstance degeneration within the anterior horn of the medial meniscus. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is near full-thickness to full-thickness degeneration of the articular cartilage along the medial facet of the patella with relative sparing of the articular cartilage along the lateral facet. There are small patellofemoral osteophytes. There is full-thickness cartilage loss along the weightbearing portion of the medial femoral condyle and near full-thickness cartilage degeneration along the weightbearing portion of the medial tibial plateau. There is mild subchondral edema type signal within the medial aspect of the medial tibial plateau and medial femoral condyle, which is likely degenerative in etiology. The articular cartilage in the lateral compartment is relatively preserved. There are small medial compartment osteophytes.LIGAMENTS: The cruciate and collateral ligaments appear intact.EXTENSOR MECHANISM: The extensor mechanism appears intact. ADDITIONAL

Output: 1. Complex tear of the medial meniscus with displacement of meniscal tissue into the medial gutter as described above.2. Osteoarthritis of the knee.3. Baker's cyst.


Instruction: Generate impression based on medical findings.

Input: 72 year old female with known left breast cancer with metastatic left axillary lymph node on neoadjuvant chemotherapy presents to evaluate response. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.The known index cancer with an associated Hydromark biopsy clip is decreasing in size and intensity of enhancement now measuring 16 x 16 x 14 mm (AP X ML X CC). Previously the mass measured 14 x 11 x 17 mm (on 4/29/15) and 29 x 33 x 27 mm (on 1/29/15). Previously described anterior extension of non mass enhancement is not appreciated on today's imaging.The two reference left axillary lymph nodes are also smaller and demonstrate normal morphology. The biopsied node now measures 12 x 12 mm (including the clip), previously measured 14 x 6 mm on 4/29/2015 and 33 x 24 mm on 1/29/2015. The level 2 node now measures 13 x 6 mm, mostly unchanged from most recent study.No additional suspicious or new enhancement is seen in either breast. No abnormal lymph nodes are identified in the right axillary region.A port-a-cath is noted in the right upper chest wall.

Output: Interval decrease in size of left breast mass and normal sized left axillary lymph nodes.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: Tuberous sclerosis [Q85.1], Reason for Study: ^Reason: patient with TSC follow up study History: TSC, SEGAS Multifocal bihemispheric subcortical T2/FALIR high signal intensity lesions are again demonstrated, unchanged since prior scan.Multiple subependymal nodules some with susceptibility artifacts are unchanged since prior scan.There are enhancing lesions located at the level of foramen of Monroe bilaterally. Specifically, the right side lesion is measured about 18mm (AP) and 10.6mm (RL) which is unchanged since prior scan (17mm x 10mm). The other lesion on the left side was measured about 17.3mm (AP) x 7.6mm (RL), again unchanged since prior scan 17.5mm x 7.4mm. However, comparing to 2011 scan, both lesions show slightly increased in size (right:16mm x 10mm, left:12mm x 7mm).There is no evidence of ventriculomegaly.There is no evidence of acute ischemic or hemorrhagic lesion.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 significant interval change of subcortical tubers, calcified subependymal nodules and enhancing nodules at bilateral foramen of Monroe level since prior scan performed on Jul 1 2015.2. However, both enhancing lesions appear to be slightly increased in size since 2011 as described above.3. No evidence of hydrocephalus.4. No acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on medical findings.

Input: There is a heterogeneously T2 hyperintense, nonenhancing, ovoid lesion in the right frontal white matter measuring 2.1 cm x 1.4 cm in axial dimension and 1.2 cm in coronal craniocaudal height. This is associated with slight heterogeneous T1 hypointensity, however it does not contain foci of susceptibility abnormality, and there is no associated mass effect or edema.There are also small foci of T2 hyperintensity within the right frontal lobe located immediately posteroinferior to the lesion, along the anterior aspect of the internal capsule anterior limb, as well as along the medial aspect of the globus pallidus. These are also nonenhancing and do not contain foci of susceptibility abnormality with no associated mass effect or edema.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There is no 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. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Mucosal thickening is present within the right maxillary sinus which also demonstrates thickened walls suggesting a history of a chronic inflammatory state. Otherwise the remaining paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: 1.There is a heterogeneously T2 hyperintense, nonenhancing, ovoid lesion in the right frontal white matter associated with slight heterogeneous T1 hypointensity, however it does not contain foci of susceptibility abnormality, and there is no associated mass effect or edema.2.There are also small foci of T2 hyperintensity within the right frontal lobe located immediately posteroinferior to the lesion, along the anterior aspect of the internal capsule anterior limb, as well as along the medial aspect of the globus pallidus. These are also nonenhancing and do not contain foci of susceptibility abnormality with no associated mass effect or edema.3.The right frontal lobe lesion may represent a low-grade neoplasm. However, given patient age, in the setting of the other described foci of T2 hyperintensity, the differential diagnosis would also include an inflammatory etiology for all lesions.


Instruction: Generate impression based on medical findings.

Input: 47 year old woman with history of NSVT and concern for ARVD, referred for cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with normal systolic function. There is a subtle wall motion abnormality involving the basal to mid anterolateral wall. The overall LV ejection fraction is 61%, the LV end diastolic volume index is 91 ml/m2 (normal range: 65+/-11), the LVEDV is 184 ml (normal range 109+/-23), the LV end systolic volume index is 36 ml/m2 (normal range 18+/-5), the LVESV is 72 ml (normal range 31+/-10), the LV mass index is 19 g/m2 (normal range 67+/-11), and the LV mass is 38 g (normal range 114+/-24). There is an atypical pattern of late gadolinium enhancement involving the midwall of the basal anterolateral segment and also the epicardium of the basal to mid inferior and inferoseptal walls suggesting the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pattern is not consistent with prior myocardial infarction. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 60%, the RV end diastolic volume index is 73 ml/m2 (normal range 69+/-14), the RVEDV is 148 ml (normal range 110+/-24), the RV end systolic volume index is 30 ml/m2 (normal range 22+/-8), and the RVESV is 60 ml (normal range 35+/-13). There are no regional or focal RV wall motion abnormalities present.Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 61%. There is a subtle wall motion abnormality involving the basal to mid anterolateral walls. There is an atypical pattern of late gadolinium enhancement involving the midwall of the basal anterolateral segment and also the epicardium of the basal to mid inferior and inferoseptal walls suggesting the presence of an underlying fibrosing, infiltrative, or inflammatory process such as old myocarditis, sarcoidosis, etc. The pattern is not consistent with prior myocardial infarction. 2. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 60%. There are no regional wall motion abnormalities present. There is no cardiac MRI evidence to support the diagnosis of arrhythmogenic right ventricular cardiomyopathy. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.