Instruction: Generate impression based on medical findings.

Input: Glioblastoma status post surgery and radiation therapy. There has been interval evolution postsurgical changes related to left frontotemporal craniotomy with mild enhancement along the margins of the insular lobe resection cavity and susceptibility effect within the resection cavity. Otherwise, there is no significant change in the extent of the confluent T2 hyperintensity in the remaining portions of the left insula and anterior left temporal lobe. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable.

Output: Interval evolution postsurgical changes with mild nonspecific enhancement along the margins of the insular lobe resection cavity. Otherwise, no significant change in the residual T2 hyperintense portions of the tumor in the left insula and anterior left temporal lobe.


Instruction: Generate impression based on medical findings.

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

Output: Unremarkable brain MRI.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Other malaise and fatigueClinical question: r/o acute processSigns and Symptoms: weakness MRI of the brainMultiple small foci of diffusion restriction are present in the territory of the left precentral artery at the left middle frontal and lateral precentral gyri as well as a small portion of the operculum. These are accompanied by FLAIR and T2 signal hyperintensity.A small focus of diffusion restriction is present in the right thalamusThe CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The vertebral arteries are similar in size. There is extra-cranial origin of the right PICA.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. The RVA is larger than the LVA.

Output: 1.Patchy distribution of left precentral artery territory acute cerebral infarction. 2.Small acute cerebral infarction in the right thalamus.3.No evidence for intra-cranial or extra-cranial cerebrovascular occlusive disease is appreciated.


Instruction: Generate impression based on medical findings.

Input: Other speech disturbances [R47.89], Reason for Study: ^Reason: stroke History: stroke. Brain MRI:Multiple scattered bihemispheric patchy high signal intensity lesions on FLAIR/T2 images indicating nonspecific small vessel ischemic disease.There is no evidence of acute ischemic or hemorrhagic lesion on the scan.Linear susceptibility lesion with associated encephalomalacia on the posterior inferior aspect of the left thalamus indicating prior hemorrhagic infarction with associated ex focal changes of left lateral ventricle. The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be within normal limits with some irregularities of intracranial arterial system indicating minimal atherosclerotic changes.There is no evidence of significant intracranial arterial luminal narrowing or occlusion. No aneurysm.Bilateral Pcom arteries and Acom artery are patent. Retention cyst on the left maxillary sinus.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Moderate to severe non specific small vessel ischemic disease.3. Normal brain MRA.


Instruction: Generate impression based on medical findings.

Input: 16-year-old female with new onset pain and weakness on testing. Assess for repeat rotator cuff tear. Personal history of partial undersurface tear of the supraspinatus tendon and posterior labral tear. ROTATOR CUFF: There is thickening and increased signal abnormality within the supraspinatus tendon consistent with moderate tendinosis. There is a partial-thickness undersurface tear of the infraspinatus tendon measuring approximately 4 mm in the AP dimension. There is a trace amount of fluid within the subacromial bursa.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: Again seen is a prominent middle glenohumeral ligament with absence of the anterior superior glenoid labrum, consistent with a normal variant Buford complex. Although this examination was not protocoled for evaluation of the glenoid labrum, there appears to be deformity with increased signal abnormality within the posterior superior glenoid labrum suggestive of degenerative tearing.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Findings suggestive of internal impingement including a partial-thickness undersurface tear of the infraspinatus and tearing of the glenoid labrum. No full-thickness rotator cuff tear is evident.


Instruction: Generate impression based on medical findings.

Input: MRI Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are bilateral prominent perivascular spaces in the basal ganglia. Minimal scattered periventricular and subcortical white matter T2 hyperintensity is nonspecific. 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.MRA Brain: The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. No evidence of aneurysms or vascular malformations.MRA Neck: There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. The common carotid arteries and cervical internal carotid arteries are normal in course and caliber. There is a retropharyngeal right internal carotid artery. Both vertebral artery origins are patent. There is no evidence of stenosis or occlusion. There appears to be a right thyroid nodule that measures up to 6 mm.

Output: 1.No evidence of an acute infarct.2.Minimal scattered likely chronic small vessel ischemic disease.3.No high-grade stenosis involving the intracranial or neck arteries.4.Apparent right thyroid nodule that measures up to 6 mm. A thyroid ultrasound may be useful for further evaluation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: 25-year-old male with knee pain for weeks MENISCI: The medial and lateral menisci are intact. Minimal increased signal within the posterior horn of the medial meniscus likely represents vascularity.ARTICULAR CARTILAGE AND BONE: The patellofemoral and tibiofemoral articular cartilage is intact. The bone marrow signal is within normal limits.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The quadriceps tendon and patellar tendon are intact.ADDITIONAL

Output: No specific findings to account for the patient's knee pain. Intact menisci, cruciate and collateral ligaments.


Instruction: Generate impression based on medical findings.

Input: Clinical question: History of brain lesion, evaluate for change in size. Signs and symptoms: Surveillance scan. Pre-and post-enhanced brain MRI:Examination redemonstrates a left paraclinoid residual enhancing meningioma measuring at 10 x 15-mm in transaxial dimensions. This lesion is remeasured on prior exam and demonstrates no convincing evidence of interval change in its size or morphology. Stable postoperative changes of left frontal craniotomy and expected minimal uniform dural thickening and enhancement.Negative diffusion weighted series.Extensive left anterior temporal encephalomalacia and to a lesser degree left inferior frontal encephalomalacia with resultant ex vacuo dilatation of the adjacent cortical sulci. Residual gliosis in the left frontal and temporal lobe similar to prior exam.Findings of mild to moderate chronic nonhemorrhagic small vessel ischemic strokes in the subcortical, periventricular and minimally of right basal ganglia and moderately in the pons without convincing evidence of change since prior study.Stable normal size of ventricular system and with maintained midline.

Output: 1.Stable residual left paraclinoid meningioma since prior study as measured /measured above.2.Negative diffusion weighted images and stable findings of mild to moderate chronic nonhemorrhagic small vessel ischemic strokes.3.Stable extensive postoperative changes of the left frontal craniotomy, extensive left anterior temporal and left inferior frontal S. malacia and gliosis.


Instruction: Generate impression based on medical findings.

Input: Assess for intracranial pathology, ischemic causes of dementia: altered mental status. There is extensive, mainly confluent, T2 hyperintensity in the cerebral, brainstem, and cerebellar white matter. 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.

Output: Extensive cerebral, brainstem, and cerebellar white matter disease is nonspecific, but may represent hypertensive encephalopathy or sequelae of a prior toxic-metabolic process, for example. Otherwise, no evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on medical findings.

Input: Male 37 years old Reason: history of testicular cancer and left RPLND 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: Nonenhancing T2 hyperintense lesion along the left lateral margin of infrarenal IVC measures approximately 2.5 x 1.9 x 6.4 cm and likely represents postsurgical seroma.BOWEL, MESENTERY: Multiple shotty mesenteric lymph nodes do not meet CT criteria for enlargement.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.OTHER: The left testis is surgically absent.

Output: 1.Status post orchiectomy. No evidence of metastatic disease in the abdomen or pelvis.


Instruction: Generate impression based on medical findings.

Input: 62 year old man with coronary artery disease s/p CABG in 1998 with known occluded SVG to RCA and OM. He is referred to assess for ischemia and viability.MEDICATIONS: aspirin, clopidogrel, lisinopril, metoprolol First Pass PerfusionDuring hyperemia, there was a perfusion defect involving the basal inferior, inferolateral, and anterolateral wall.Viability/ Myocardial ScarThere are 2 large myocardial infarctions (i.e. late gadolinium enhancement). The first is transmural and involves the basal to mid inferior walls (RCA territory). These segments are very unlikely to be viable. The second is non-transmural and involves the basal to mid inferolateral and anterolateral walls (LCx territory) and has an intermediate probability of viability. The remainder of the myocardium (LAD territory) is free of myocardial infarction and is viable.Left VentricleThe left ventricle is severely dilated with moderately reduced systolic function. There is akinesis of the basal to mid inferior, inferolateral, and anterolateral walls. The overall LV ejection fraction is 34%, the LV end diastolic volume index is 142 ml/m2 (normal range: 74+/-15), the LVEDV is 289 ml (normal range 142+/-34), the LV end systolic volume index is 94 ml/m2 (normal range 25+/-9), the LVESV is 191 ml (normal range 47+/-19), the LV mass index is 62 g/m2, and the LV mass is 126 g. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 81 ml/m2 (normal range 82+/-16), the RVEDV is 165 ml (normal range 142+/-31), the RV end systolic volume index is 39 ml/m2 (normal range 31+/-9), and the RVESV is 78 ml (normal range 54+/-17).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.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere are numerous masses in the liver, consistent with the patient's diagnosis of metastatic renal cell cancer. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. There is a large severe perfusion defect involving the basal inferior, inferolateral and anterolateral walls during hyperemia.2. There are 2 large myocardial infarctions (i.e. late gadolinium enhancement). The first is transmural and involves the basal to mid inferior walls (RCA territory). These segments are very unlikely to be viable. The second is non-transmural and involves the basal to mid inferolateral and anterolateral walls (LCx territory) and has an intermediate probability of viability. The remainder of the myocardium (LAD territory) is free of myocardial infarction and is viable.3. Severe LV dilation with moderately reduced systolic function (LVEF 34%) with akinesis of the basal to mid inferior, inferolateral, and anterolateral walls. 4. Normal RV size and systolic function (RVEF 52%).5. See extra-cardiac findings.


Instruction: Generate impression based on medical findings.

Input: Clinical question: History of epidermoid cyst. Evaluate for change. Signs and symptoms: Headache. Pre and post enhanced brain MRI:Examination demonstrates a loculated extra-axial T1 hypointense, T2 hyperintense, FLAIR hyperintense restricted diffusion in the medial right anterior temporal lobe which partially herniates through the tentorium into the right perimesencephalic cistern similar to prior exam. A larger slightly more posteriorly located similar signal changes in the right posterior medial temporal and perimesencephalic cistern similar to prior exam consistent with patient's known epidermoid tumor. The largest transaxial dimensions of the more anteriorly located component of tumor is 22.5 x 25 mm compared to prior study measurement of 22 x 23.5 mm. There is subtle associated mass effect of this component of tumor on the right cerebral peduncle. The larger contiguous more posteriorly located component of epidermoid demonstrate interval increased size and measures at 21 x 28 mm in transaxial dimensions compared to prior study re-measurements of 17.5 x 23 mm. There is also subtle interval increased size and mass effect of the infratentorially herniated component of epidermoid on the superior aspect of right cerebellar. There is no edema of the adjacent brain parenchyma. Similar to prior exam there is expected restricted diffusion of epidermoid and without abnormal enhancement. The anatomical morphology and signal intensity of brain parenchyma is otherwise within normal on all MRI sequences and without change since prior study.Ventricular system remains within normal and with maintained midline. There is no detectable abnormal parenchymal or leptomeningeal enhancement.Calvarium has normal signal intensity and without abnormal enhancement.Unremarkable images through the orbits and including axial fat sat post enhanced series.

Output: 1.No acute intracranial process.2.Examination redemonstrates a loculated right medial temporal and right perimesencephalic cistern epidermoid with interval increased size of its more posteriorly located perimesencephalic and infratentorially herniated components with resultant increased mass effect on the superior aspect of right cerebellum as detailed/measured above. 3.Unremarkable pre and post enhanced brain MRI otherwise.


Instruction: Generate impression based on medical findings.

Input: Arm weakness. Rule out stroke.. Brain MRI: There is a punctate lesion in the periventricular white matter of the right occipital lobe is associated with diffusion restriction. There is encephalomalacia in the pons. There are also multiple T2 hyperintense lesions in the cerebral white matter without restricted diffusion. There is no acute intracranial hemorrhage. There is no intracranial mass lesion or midline shift. The ventricles are normal in size and symmetric. The pituitary gland appears unremarkable. The orbits, skull and scalp soft tissues are grossly unremarkable. A T1 hyperintense retention cyst in the maxillary sinus is present. In the left posterior neck, there is a subcutaneous lesion that measures up to 3 cm in diameter and likely represents an inclusion cyst, but is incompletely characterized. Brain MRA: There is no evidence of significant steno-occlusive lesions or aneurysms.

Output: 1. Recent punctate infarct in the periventricular white matter of the right occipital lobe. 2. Chronic infarction of the pons and a background of probable chronic small vessel ischemic white matter disease. 3. No evidence of significant steno-occlusive lesions.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Mr. Brinkley is a 57-year-old female with biopsy proven malignancy in the right breast. She presents for MR-directed ultrasound for the focal non-mass enhancement in the left breast at 3:00 position found on the MRI dated 9/19/2015. Ultrasoud for left retroareolar region is also requested by Dr. Jaskowiak, as the patient reports a history of brownish nipple discharge on the left. A targeted left ultrasound was performed for the MRI area of concern. In the left breast, 3:00 location, 4 cm from the nipple, there is a 10 x 7 x 8 mm hypoechoic mass, which corresponds to the MR findings. The mass is centered in a dilated duct, which extends to the nipple. There are no abnormal findings other than dilated ducts in the left retroareolar region. At 5:00 location, 3 cm from the nipple, there is a 17 x 8 x 11 mm simple cyst, which correlates with the cyst on the MRI.

Output: 10 mm hypoechoic mass with dilated duct in the left breast, correlating with the nonmass enhancement on the MRI and likely representing a papilloma. Ultrasound guided biopsy of this mass was performed after this study.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old, with memory loss. Assess for any specific pattern of atrophy. Diffusion weighted images are within normal limits. There are numerous scattered foci of T2 hyperintensity in the subcortical and periventricular white matter, with a few also to be found in the pons.No evidence of significant parenchymal atrophy is seen. No edema or mass effect is detected. There is no evidence of acute intracranial hemorrhage. A focus of susceptibility within the right cerebellar hemisphere likely represents chronic microhemorrhage. No abnormal extra-axial fluid collections are seen. The ventricles are normal in size and morphology.On post contrast imaging, no pathologic parenchymal or extra-axial enhancement is seen.

Output: 1. No evidence of significant parenchymal atrophy is seen.2. Numerous scattered foci of white matter signal abnormality are nonspecific but most commonly represent the sequelae of chronic microvascular ischemic disease.3. No acute intracranial abnormality or other specific findings are seen which would account for the patient's memory loss.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old, with history of CNS lymphoma status post autologous stem cell transplant. Restaging exam. Residual T2 signal abnormality and susceptibility are again seen within the right lateral cerebellum and left anterior cingulate gyrus compatible with sites of prior treated disease. No associated enhancement is seen.Patchy foci of T2 hyperintensity are also redemonstrated in the periventricular white matter, right more than left, which are unchanged. No new lesion or pathologic enhancement is detected.No acute intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricular system is stable in size and morphology.

Output: Stable posttreatment findings with no evidence of residual or new active CNS lymphoma.


Instruction: Generate impression based on medical findings.

Input: Unspecified cerebral artery occlusion with cerebral infarction [434.91], Reason for Study: ^Reason: acute ischemic infarct History: left neglect There are multifocal scattered restricted diffusion lesions on the right frontal and parietal lobes without evidence of hemorrhagic conversion.There are also patchy white matter matter high signal intensity lesions on FLAIR images especially on the right frontal and parietal lobes indicating prior ischemic insults indicating prior ischemic events.Above finding suggest possible underlying right side vascular lesion, thus brain MRA or CTA can be considered for further imaging evaluation.Minimal non specific small vessel ischemic disease on the left hemisphere.Right lateral ventricle is slightly enlarged due to ex vacuo dilatation than the left side.The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.

Output: Multifocal acute ischemic infarctions on the right frontal and parietal lobes without evidence of hemorrhagic conversion. Comment: Since there are evidence of prior ischemic insults, underlying vascular lesion such as focal intracranial arterial luminal narrowing or stenosis may need to be investigated with either brain MRA or CTA.


Instruction: Generate impression based on medical findings.

Input: Ulnar nerve pain There is a small focus of increased signal intensity involving the ulnar nerve at the level of the elbow joint best appreciated on series 4 image 15. Otherwise the ulnar nerve appears normal in signal intensity and caliber throughout its visualized course. The course of the ulnar nerve is delineated on PACS and is best seen on series 4, 7, and 10. There is no abnormal enhancement following contrast administration although visualization of the nerve on the postcontrast sequences is somewhat limited. There is skin irregularity and enhancement along the posterior medial aspect of the elbow likely relating to prior surgical intervention. Enhancement of the soft tissues is thought to represent scarring and there are small foci of signal void relating to prior surgical intervention. There is no abnormal signal intensity within the musculature surrounding the elbow. Although not tailored for the evaluation of the ligamentous and tendinous structures of the elbow, the ulnar collateral ligament and origin of the common extensor tendons are poorly visualized which likely relates to chronic tearing.The marrow signal intensity of the distal humerus, proximal radius, and proximal ulna is normal.

Output: Small focus of increased signal intensity involving the ulnar nerve at the level of the elbow joint which is nonspecific but may reflect a minimal neuritis. Otherwise the ulnar nerve demonstrates normal signal intensity and caliber.


Instruction: Generate impression based on medical findings.

Input: Acinic cell carcinoma of the right parotid gland, metastatic to the skull base, status post treatment. There are postoperative findings related to right parotidectomy and mastoidectomy, which are partially imaged. There is no significant interval change in the extent of the ill-defined heterogeneously enhancing mass that involves the right basiocciput, petrous ridge, and condylar and squamous portions of the occipital bone. The areas of non-enhancement within the skull base likely represent necrosis and are not significantly changed. Portions of the tumor still abut the right internal carotid artery and surround the right internal jugular vein. There is also persistent enhancement within the lateral mass of the C1 vertebra. There are a few unchanged nonspecific scattered foci of T2 hyperintensity in the cerebral white matter. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The orbits are unremarkable. The remaining salivary glands are unremarkable.

Output: No significant interval change in the treated acinic cell carcinoma metastasis involving the right lateral skull base and craniocervical junction, perhaps superimposed upon osteonecrosis.


Instruction: Generate impression based on medical findings.

Input: Testicular cancer. Left testicular cancer status post radical orchiectomy showing mixed germ cell tumor. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size, signal intensity and enhancement. No suspicious lesion, biliary ductal dilatation or vascular abnormality. Normally distended gallbladder with cholelithiasis.SPLEEN: The spleen is normal in morphology and size without a focal lesion.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Very small non-specific subcentimeter left paraaortic lymph nodes just inferior to the left renal vein, the largest measuring 9 x 6 mm, unchanged. Non-specific subcentimeter gastrohepatic ligament and mesenteric lymph nodes. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Non-specific subcentimeter left paraaortic lymph nodes located just inferior to the left renal vein are unchanged.


Instruction: Generate impression based on medical findings.

Input: 82-year-old female with a history of a left distal internal carotid artery aneurysm presents with a headache.82-year-old female (DOB: 7/31/1934)Reason: Headache. History: Intracranial aneurysm.PROVIDER/ATTENDING NAME: Robert Mulliken. MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. The CSF spaces are appropriate for the patient's stated age with no midline shift. 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:No significant change in the left posterior communicating region internal carotid artery aneurysm which measures up to 4 mm in size (series 301, image 85). No new intracranial aneurysm is identified.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 left A1 segment is greater in size than the right. Loss of signal in the distal left vertebral artery is likely artifactual. There is no evidence for cerebrovascular occlusion.The anterior communicating artery is intact. The posterior communicating arteries are intact.

Output: 1. No significant change in 4 mm left posterior communicating region internal carotid artery aneurysm.2. There is no evidence for acute ischemic cerebral infarction or hemorrhage.3. There is no evidence for extracranial or intracranial cerebrovascular occlusive disease.4. Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on medical findings.

Input: MRI Brain:There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are two nonspecific T2/flair hyperintensities in the right periatrial white matter which are nonspecific. There is no abnormal brain parenchymal contrast enhancement. There is a punctate area of susceptibility abnormality along the right lateral cerebellum which is nonspecific and possibly related to chronic microhemorrhage or mineralization. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, 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. There is a small left A1 segment and small right P-comm artery which are normal variants. The left P-comm artery is large. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. No evidence of aneurysms or vascular malformations.MRV Brain:There is a dominant right transverse and sigmoid sinus. The superior sagittal sinus, inferior sagittal sinus, transverse sinuses, sigmoid sinuses, straight sinus, vein of Galen, and internal cerebral veins are patent. There is no evidence of venous thrombosis.

Output: No evidence of acute infarct, hemorrhage or venous sinus thrombosis.


Instruction: Generate impression based on medical findings.

Input: Acute onset paresthesias and back pain after twisting injury: left sided radiculopathy. There are far left lateral foraminal disc protrusions superimposed upon disc bulges and mild facet hypertrophy at L4-5 and L5-S1, which compress the exiting nerve roots at these levels. There is also mild to moderate right neural foraminal stenosis at these levels. In general, the pedicles appear rather short, such that the neural foramina throughout the lumbar spine are not very capacious. Otherwise there is no significant spinal canal stenosis. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: Far left lateral foraminal disc protrusions superimposed upon disc bulges and mild facet hypertrophy at L4-5 and L5-S1, which compress the exiting nerve roots at these levels.


Instruction: Generate impression based on medical findings.

Input: Lung cancer with metastases. There has been overall slight interval decrease in size and number of the enhancing lesions in the brain. For example a right superior frontal lobe lesion now measures up to 2 mm, previously 5 mm and a right globus pallidus lesion is now inconspicuous. A few lesions demonstrate punctate foci of susceptibility effect, which may represent hemorrhage or calcifications. However, there is is generally negligible or no appreciable associated vasogenic edema. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are unremarkable. There is mucosal thickening within the bilateral maxillary sinuses.

Output: Overall slight interval decrease in size and number of the intracranial metastases.


Instruction: Generate impression based on medical findings.

Input: Ms. Cleary is a 52-year-old female with known multicentric invasive lobular carcinoma in the right breast and recent MRI demonstrating mass/nonmass enhancement in the left breast, presenting for further diagnostic workup of the left breast. An ML view and two spot compression views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. No specific correlate to the enhancing foci on the MRI is identified. LEFT BREAST ULTRASOUND

Output: Segmentally distributed band of complex and clustered cysts in the left breast, corresponding to the non-mass enhancement identified on recent MRI. Ultrasound-guided biopsy with clip placement of two sites, including an anterior and posterior site, can be performed if clinically warranted. Results and recommendations were discussed with the patient as well as Dr. Bao. BIRADS: 4 - Suspicious Abnormality.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: Clinical question: Stroke, Rule out acute ischemia. Signs and symptoms: Speech difficulty. Nonenhanced brain MRI:There is no detectable acute intracranial process in particular no evidence of acute stroke is seen.Examination however demonstrate patchy and confluent foci of FLAIR/T2 hyperintensity in the periventricular and subcortical white matter of bilateral cerebral hemispheres and minimally in the basal ganglia without associated susceptibility signal changes likely representing chronic small vessel ischemic strokes of mild to moderate degree.Slight prominence of supratentorial ventricular system suggestive of underlying parenchymal volume loss likely secondary to small vessel ischemic strokes.No detectable cortical signal abnormality, unremarkable cerebral cortical sulci and CSF spaces.The signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses are within normal.Calvarium and soft tissues of the scalp are unremarkable.Extensive opacification of right mastoid air cells without signal abnormality of the right middle ear cavity is noted of questionable clinical significance.

Output: 1.No acute intracranial process.2.Mild to moderate chronic nonhemorrhagic small vessel ischemic strokes in the supratentorial brain parenchyma as detailed.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Follow-up lumbar stenosis. Signs and symptoms: Low back and lower extremity pain. Nonenhanced lumbar MRI:At T11-12 through L2-L3 levels mild to moderate degenerative changes without central spinal or neural foraminal compromise is noted. There is no significant change since prior exam.L3-L4 demonstrate progression of degenerative changes with resultant moderate to severe central spinal stenosis. There is worsening diffuse broad based bulging disc (L>R) contributing to spinal stenosis. No significant neural foraminal stenosis. Mild left facet effusion is noted.L4-L5 demonstrate progression of degenerative changes with resultant severe central sinal stenosis and bilateral moderate foraminal since prior exam.L5-S1 demonstrate mild interval progression of degenerative changes without spinal stenosis, however severe bilateral (L>R) neural foraminal stenosis.

Output: 1.Progression of degenerative changes at L3-L4 and L4-L5 levels with resultant sever central stenosis at both levels as detailed. 2.No spinal stenosis at other levels.3.Neural foraminal compromise at detailed per level above.


Instruction: Generate impression based on medical findings.

Input: Enlarged orbital muscles: proptosis. Orbits: There is interval decreased enlargement of the extraocular muscles, with mild residual prominence of the right superior and lateral rectus muscles. There is mild protosis bilaterally, right more than left, which appears to be attributable to diffuse prominence of the orbital fat in addition to the rectus muscle swelling. Otherwise, the bilateral globes, lacrimal glands, and optic nerves bilaterally are intact. There is no evidence of orbital mass lesions.Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are nonspecific punctate foci of T2 hyperintensity in the right parietal lobe white matter. The brain, brainstem, and cerebellum otherwise appear unremarkable. There is no abnormal meningeal 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, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Interval decreased enlargement of the extraocular muscles, with mild residual prominence of the right superior and lateral rectus muscles, which may be related to evolution of an inflammatory process, such as sarcoidosis. Otherwise, mild protosis bilaterally, right more than left, appears to be attributable to diffuse prominence of the orbital fat in addition to the rectus muscle swelling.2. Mild thickening of the pituitary infundibulum may represent an inflammatory process as well, such as sarcoidosis.3. No evidence of intracranial hemorrhage, mass, or acute infarct. Punctate foci of T2 hyperintensity in the right parietal lobe white matter are nonspecific, but may represent chronic small vessel ischemic disease, for example.


Instruction: Generate impression based on medical findings.

Input: 43 years Male (DOB:3/3/1973)Reason: Radicular low back pain. History of spinal stenosis and sciatica. PATIENT IS 406 lbs. History: severe back painPROVIDER/ATTENDING NAME: KRISTINE CHRAPEK CHRISTINE S JUN Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is a large left paramedian disc extrusion present with disc material compressing the thecal sac and effacing it. There is effacement of the fat at the left lateral recess and to some degree at the right lateral recess. Disc material extrudes behind the inferior aspect of the L5 vertebral body and superior aspect of the S1 segment. This extrusion appears to have progressed relative to the prior exam from 7/10/2015. There is loss of disc space height and disc desiccation at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is a left far lateral disc protrusion present at this level which impresses on the left-sided exiting nerve root. There is unchanged prior exam.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There is a large left paramedian disc extrusion present at L5-S1 which creates spinal stenosis and compresses the nerve roots at the left lateral recess. This has progressed since the prior exam from July 2015.2.There is a left far lateral disc protrusion present at L4-5 which impresses on the left-sided exiting nerve root. There is unchanged prior exam.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Stroke. Signs and symptoms: Aphasia. Nonenhanced brain MRI:Examination demonstrates a focus of cortical restricted diffusion in the right postcentral gyrus without evidence of hemorrhage and with subtle effacement of adjacent cortical sulci consistent with an acute nonhemorrhagic ischemic stroke.There is a large chronic left MCA territory ischemic stroke involving the left frontal and left basal ganglia with resultant ex vacuo dilatation of the left lateral ventricle.Minimal chronic small vessel ischemic stroke is also noted. Unremarkable images through posterior fossa.The signal void of major intracranial arterial branches are identified.Unremarkable calvarium, soft tissues of the scalp, orbits, paranasal sinuses and mastoid air cells.

Output: 1.Small acute cortical ischemic stroke in the right post central gyrus without evidence of hemorrhage.2.Large chronic left MCA territory stroke with resultant ex vacuo dilatation of left lateral ventricle.3.Unremarkable exam otherwise.


Instruction: Generate impression based on medical findings.

Input: Multiple sclerosis. Paresthesias. Assess for disease progression. Compared to the previous examination, the extensive burden of multiple sclerosis lesions on both T1 and T2 sequences has not significantly changed, still most extensive in the frontoparietal periventricular white-matter but also with infratentorial involvement in the cerebellum and brainstem. A few of the lesions are now more conspicuous on FLAIR, such as a cortical lesion that involves the right paracentral lobule, but are stable on T1W imaging. This change in lesional conspicuity is most probably artifactual. There is no definite new brain lesion.The associated severe corpus callosal thinning and the moderate global brain volume loss remain unchanged.Retention cysts and mucosal thickening in the maxillary sinuses are unchanged.

Output: The supratentorial and infratentorial involvement by multiple sclerosis has not significantly changed since the previous examination from December 2015, with extensive burden of T1 and T2 lesions, most pronounced in the frontoparietal white-matter as described above. There is no definite new brain lesion.


Instruction: Generate impression based on medical findings.

Input: 41-year-old female with popping, locking sensation, repeat traumatic injury. Bone ligaments? MENISCI: There is an abnormally small posterior horn of the medial meniscus which is expelled medially with a flipped fragment underneath the PCL compatible with a bucket handle tear. The lateral meniscus is normal.ARTICULAR CARTILAGE AND BONE: The hyaline cartilage of the patella is uniformly thinned with perhaps some fraying at the junction of the medial and lateral facets. Bone marrow signal is unremarkable. There is mild lateral osteophyte formation noted. LIGAMENTS: The anterior collateral ligament is torn. The posterior collateral ligament, medial and lateral collateral ligaments are normal in appearance.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Bucket-handle tear of the posterior horn of the medial meniscus and anterior collateral ligament tear as described above.


Instruction: Generate impression based on medical findings.

Input: 37-year-old male with left knee pain. MENISCI: The medial and lateral menisci are morphologically normal with no evidence of meniscal tear.ARTICULAR CARTILAGE AND BONE: Similar to prior study there is degeneration of the articular cartilage along the weightbearing portion of the medial femoral condyle as well as the medial tibial plateau unchanged in extent and distribution. There is mild underlying subchondral marrow edema. In addition there is superficial fraying of the articular cartilage of the medial patellar facet with a full-thickness cleft also unchanged. There is mild increased signal intensity of the articular cartilage of the lateral tibial plateau beneath the posterior horn of the lateral meniscus also unchanged.LIGAMENTS: The anterior and posterior cruciate ligaments are normal. Medial and lateral collateral ligaments are morphologically normal.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: No interval change in the extent of degeneration of the articular cartilage along the medial femoral condyle and patella as described above.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old, with probable Alzheimer's disease and multiple hemangioblastomas. Evaluate for change. Sequelae of prior right frontal craniotomy and prior posterior fossa surgery are again seen. Enhancing dural thickening and tumor nodularity along the anterior interhemispheric falx is demonstrated. Likewise, multiple enhancing nodules within the posterior fossa and the upper cervical spinal cord are again seen. The size of these enhancing lesions has not significantly changed when compared to the immediate prior examination but has increased relative to the older examination of 7/29/2015. Likewise, the associated edema is unchanged from the immediate prior but progressed relative to the older study. rCBV mapping shows elevated blood volume within the enhancing lesions and in the immediate surrounding parenchyma.Within the limitations of a motion degraded examination, no definite evidence of any new enhancing lesion is seen. No restricted diffusion is evident. Scattered small foci of white matter T2 hyperintensity are unchanged and nonspecific, perhaps representing microvascular ischemic disease. No acute intracranial hemorrhage or any abnormal extra axial fluid collection is suspected. The ventricles are stable in size.

Output: Findings compatible with hemangioblastomatosis are again seen including dural tumor studding along the anterior interhemispheric falx and numerous enhancing nodules within the posterior fossa. Relative to the immediate prior examination, there has been no significant interval change. Compared to an older examination, increased tumor size and progressive edema are noted.


Instruction: Generate impression based on medical findings.

Input: 68-year-old male with elevated PSA. PELVIS:PROSTATE:Prostate Size: The prostate measures 7 cm in transverse, 6 cm in AP, and 9 cm in craniocaudal diameter.Peripheral Zone: Small peripheral zone in comparison to the large transitional zone. No suspicious lesions identified.Central Gland: Enlarged heterogenous appearance compatible with BPH.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No suspicious lesions.


Instruction: Generate impression based on medical findings.

Input: 39 years Female (DOB: 5/6/1977)Reason: please look for hallmarks of transverse myelitis, stroke, MS, meningitis History: left sided hypoesthesia below C3-4levelPROVIDER NAME: JACQUELINE T. BERNARD JACQUELINE T. BERNARD MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a vague signal hyperintensity in the right pons and medulla identified on the axial T2 and coronal T2 images which is nonspecific. It is not readily appreciated on the FLAIR. There isNo 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.There is dislocation at the left temporomandibular joint. This was also present on prior exams. There is an old healed fracture at the left mandibular head.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal lesions are identified in the cervical spine. There is some multilevel disc desiccation present.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina. Some endplate uncovertebral osteophytes are present at C4-5 bilaterally with associated narrowing of the right neural foramen.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.Some vague signal abnormality is present in the right pons and medulla. This is of uncertain significance. It is conceivable that it could represent a form of demyelination. Please correlate clinical symptoms. A contrast enhanced exam may help further evaluate this.2.No abnormal lesions are present in the cervical spinal cord to suggest cervical spinal cord demyelination.3.There are some mild encroachment of the right-sided exiting nerve roots at C4-5 related to osteophytes.4.Chronic fracture of the left mandibular head with dislocation at the left temporomandibular joint.


Instruction: Generate impression based on medical findings.

Input: 73-year-old male with right knee pain for 3 years. Evaluate for medial meniscus tear. MENISCI: There is linear branching signal abnormality traversing the posterior horn of the medial meniscus extending to the tibial and femoral articular surfaces consistent with a complex tear. There is globular increased signal abnormality within the posterior horn of the medial meniscus consistent with intrasubstance degeneration. There is increased signal abnormality along the undersurface of the body and anterior horn which extends to the tibial articular surface and is associated with deformity of the meniscus, consistent with fraying/degenerative tearing. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is full-thickness articular cartilage degeneration along the weightbearing portion of the medial femoral condyle and medial tibial plateau with underlying subchondral signal abnormality. There is also near full-thickness articular cartilage degeneration along the lateral femoral condyle above the anterior horn of the meniscus. There is thinning of the articular cartilage along the medial facet of the patella. There is a focal full-thickness articular cartilage defect along the median eminence of the patella with underlying subchondral signal abnormality and focal articular cartilage delamination. There are tricompartmental osteophytes.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact. There is nonspecific subcutaneous edema along the anterior aspect of the patella and patellar tendon as well as medially about the knee.ADDITIONAL

Output: 1. Tearing of the medial meniscus as described above. Full-thickness articular cartilage degeneration as described above.2. Large joint effusion.3. Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: 39-year-old female. Follow-up lesion from 11/20/2015. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size and signal intensity. There are multiple small well-defined T1-weighted hypointense lesions demonstrating peripheral nodular discontinuous enhancement, which progresses centrally compatible with multiple cavernous hemangiomas. The hepatic segment 7, there are 2 subcentimeter flash-filling hemangiomas (axial series 10 image 37) only seen in the arterial phase. In the peripheral right hepatic lobe, there is a stable septated cyst (axial series 7 image 8).SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: The left adrenal fossa lesion is similar in size measuring 2.6 x 1.9 cm (axial series 11 image 41). The lesion again appears separate from the adrenal gland, pancreas, kidney and spleen. The lesion demonstrates peripheral thick enhancement (axial series 10 image 38), which appears to progress centrally. This enhancement pattern is unchanged.KIDNEYS, URETERS: Few simple cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. The left retroperitoneal mass is stable in size and again demonstrates peripheral thick enhancement which progresses centrally. The differential is unchanged.2. Multiple typical hepatic hemangiomas. Additionally, there are 2 subcentimeter presumably flash-filling hemangiomas in hepatic segment 7. Attention on follow-up imaging is recommended.


Instruction: Generate impression based on medical findings.

Input: 66-year-old female with CT finding of pancreatic ductal dilatation concerning for ampullary lesion. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in size and morphology. There is no suspicious hepatic lesion. The hepatic vasculature is patent.Common duct measures 7 mm in diameter. There is no intrahepatic biliary ductal dilatation. The gallbladder is normally distended without cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: As on the prior CT the pancreatic duct is diffusely dilated to the level of the ampulla measuring up to 7 mm in diameter. At the level of the ampulla there is a 10 x 7 mm T2 hypointense soft tissue focus (series 5, image 11) that may represent normal ampulla although a small mass is not excluded. There is mild diffuse pancreatic atrophy. No suspicious pancreatic parenchymal lesion.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The smoothly marginated right renal pelvis lesion is T1 isointense, T2 hypointense and demonstrates mild enhancement and washout. It is unchanged in size compared to the prior day's CT.Multiple nonenhancing subcentimeter T2 hyperintense lesions within the left kidney are too small to accurately characterize but are favored to represent cysts given the degree of T2 hyperintensity.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.The pancreatic duct duct is dilated to the level of the ampulla, a soft tissue focus at this level may represent a prominent ampulla however a small mass is not excluded. Further evaluation with EUS is recommended.2.Mildly enhancing, slowly growing right upper renal pelvis lesion is unchanged from the prior day's CT and is suspicious for a small papillary neoplasm.


Instruction: Generate impression based on medical findings.

Input: A 60 year old female with syncope and abnormal electrocardiogram (giant negative T-wave) and suspected apical hypertrophy by echocardiogram. Referred to cardiac MRI for further evaluation Left VentricleThe left ventricle is normal in size with systolic hyperdynamic performance. Mild apical cavity obliteration was noted. The overall LV ejection fraction is 75%, the LV end diastolic volume index is 52 ml/m2 (normal range: 65+/-11), the LVEDV is 83 ml (normal range 109+/-23), the LV end systolic volume index is 13 ml/m2 (normal range 18+/-5), the LVESV is 20 ml (normal range 31+/-10), the LV mass index is 67 g/m2 (normal range 67+/-11), and the LV mass is 107 g (normal range 114+/-24). There are no regional wall motion abnormalities present. The basal septum is thickened at 15mm at end diastole. The apical anterior wall is 12mm. No late gadolinium enhancement. While this is not typical case of hypertrophic cardiomyopathy, some cases may not demonstrate late gadolinium enhancement.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 66%, the RV end diastolic volume index is 54 ml/m2 (normal range 69+/-14), the RVEDV is 86 ml (normal range 110+/-24), the RV end systolic volume index is 18 ml/m2 (normal range 22+/-8), and the RVESV is 29 ml (normal range 35+/-13). The RV free wall has normal thickness.Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation. Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation. Systolic anterior movement (SAM) of the mitral valve causes accelerated flow forward in the subvalvular outflow tract. 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 branching pattern. The aorta 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 pericardial effusion.Extracardiac FindingsThere is a right lateral thoracic meningocele.

Output: 1. The left ventricle is normal in size with systolic hyperdynamic performance, the LVEF is 75%. LV mass is normal. Mild apical cavity obliteration with basal septal hypertrophy causing SAM. No enhancement. While this is not a typical case of hypertrophic cardiomyopathy, the constellation of findings do raise the question of LV HCM. 3. The right ventricle is normal in size with normal systolic function, the RVEF is 66%. The RV free wall demonstrates normal thickness.4. The aortic valve opens widely and there is no significant aortic regurgitation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: 37-year-old male with right knee pain. Evaluate for patellofemoral chondromalacia. MENISCI: The medial and lateral meniscus appear intact.ARTICULAR CARTILAGE AND BONE: There is focal full-thickness articular cartilage defect along the medial aspect of the medial facet of the patella with underlying subchondral signal abnormality. The lateral and medial compartments appear relatively spared. Multiple foci of subcentimeter low signal abnormality within the medial and lateral femoral condyle likely represent bone islands.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Focal full-thickness articular cartilage defect along the medial facet of the patella as described above.


Instruction: Generate impression based on medical findings.

Input: Reason: cuff tear? History: pain Exam is slightly limited by patient motion artifact.ROTATOR CUFF: Complete full-thickness tear of supraspinatus tendon from its insertion at the greater tuberosity with retraction to the level of the glenohumeral joint. This tear extends posteriorly to involve the anterior fibers of the infraspinatus tendon, although posterior fibers of the infraspinatus tendon can be traced to their insertion at the greater tuberosity. Moderate fatty atrophy of the supraspinatus and infraspinatus muscles. There is also an incomplete but full-thickness tear of the subscapularis tendon with retraction of the superior tendon fibers anterior to the glenoid, although inferior fibers can be traced to the insertion on the humerus. Severe fatty atrophy of the subscapularis. Teres minor muscle and tendon are intact.SUPRASPINATUS OUTLET: There is extensive fluid within the subdeltoid bursa that extends into the acromioclavicular joint. There are foci of intermediate and low signal within the subdeltoid bursal fluid collection, which may represent old blood products. Tapering of the distal clavicle may reflect prior surgery or chronic erosion.GLENOHUMERAL JOINT AND GLENOID LABRUM: Severe osteoarthritis of the glenohumeral joint with diffuse full-thickness cartilage loss, osteophyte formation, and subchondral cysts. Intermediate signal intensity within the glenohumeral joint likely represents synovitis. Extensive tearing of the labrum.BICEPS TENDON: Tendon of the long head of the biceps is not well visualized within the intertubercular sulcus or rotator interval, likely representing rupture. ADDITIONAL

Output: Massive rotator cuff tear, rotator cuff arthropathy, subdeltoid bursa effusion and other findings as above.


Instruction: Generate impression based on medical findings.

Input: There is a 16 mm AP x 6 mm transverse x 6 mm craniocaudal cystic appearing focus involving the mesial right temporal lobe, lying just superior to the hippocampal formation. There is adjacent persistent FLAIR T2 hyperintensity.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There is no mass effect or midline shift. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. Myelination is mature. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The mastoid air cells and middle ear cavities are clear. High-resolution images of the sella demonstrate the pituitary gland to be normal in size measuring for age. There is no discrete mass to confirm the presence of a pituitary microadenoma. There is no macroadenoma. The pituitary infundibulum inserts on the midline of the gland. There are no sellar, suprasellar or parasellar masses and the cavernous sinuses are symmetric bilaterally.

Output: 1.There is a 16 mm x 6 mm x 6 mm cystic appearing lesion involving the mesial right temporal lobe, lying just superior to the hippocampal formation, with adjacent persistent FLAIR T2 hyperintensity. The brain MRI portion of the exam was ordered without contrast, however the postcontrast pituitary study concurrently ordered demonstrates no enhancement of this anteriorly (although it is only partially imaged). The differential diagnosis most likely includes a postinflammatory cyst or perhaps low-grade cystic neoplasm. Given the persistent FLAIR hyperintensity, simple choroidal fissure cyst is not favored. Recommendations are made to obtain a follow-up exam in 3 months with contrast.2.Negative MRI of the sella including gadolinium enhancement.3.Findings were discussed with Dr. Patel (covering for Dr. Koren) on 9/28/2015 at 10:15 AM.


Instruction: Generate impression based on medical findings.

Input: facial numbness, possible stroke No evidence of acute ischemic or hemorrhagic lesion.The right mastoid shows fluid collection which could imply possible mastoiditis. If clinically indicated, ENT consultation and dedicated temporal bone CT scan can be considered for further evaluation.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. 3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate segmental signal loss on bilateral paraclinoid segments and proximal left MCA M1 segment on MIP images. Source image review shows linear signal void lesions were seen within the lumen which degraded MIP signal. These linear signal loss likely represent flow artifacts but may represent segmental intra luminal filling defects such as luminal irregularity or intra luminal blood clots. Thus, if clinically indicated, CT angiography can be considered for further anatomical evaluation. The proximal left MCA M1 segment lesion could represent early development of sickle cell disease related moyamoya syndrome, thus follow up MRA is recommended.Otherwise, vertebrobasilar system appears to be normal, bilateral PCAs are fetal origin, Acom artery is patent and bilateral ACAs and right MCA appear to be normal.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Likely represent artifacts for bilateral paraclinoid ICAs' segmental signal decrease. Anatomical vascular imaging such as CTA can be considered if clinically indicated.3. Subtle luminal narrowing of the left MCA proximal portion which may indicate early development of the Moyamoya syndrome, thus follow up MRA is recommended.


Instruction: Generate impression based on medical findings.

Input: Lateral knee arthritis MENISCI: The medial meniscus is unremarkable. There is some lateral extrusion of the lateral meniscus but no discrete tears.ARTICULAR CARTILAGE AND BONE: There is some generalized thinning of the articular cartilage of the lateral plateau. No focal abnormalities..LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Bone marrow edema and subchondral cysts in the lateral plateau with generalized thinning of the articular cartilage


Instruction: Generate impression based on medical findings.

Input: 21 year old male with a diagnosis of Von Hippel-Lindau disease; history of 6 small asymptomatic brain hemangioblastomas, evaluate for growth and new lesions. BrainAgain visible are changes of a prior suboccipital craniotomy. There are at least three new suspicious areas of nodularity compared to the prior exam, although there was extensive motion degradation on the prior exam, limiting direct comparison. Just medial to a previously seen lesion in the right paramedian cerebellum is a smaller lesion which is now more conspicuous and not definitively present prior to Jan 2015 (series 4500, image 52). An additional new punctate left mid-superior cerebellar lesion is seen (series 4500, image 54). Finally there is suspicion of a new punctate left medial superior cerebellar peduncle lesion (series 4500, image 53).The enhancing nodule along the midline dorsal medulla at the level of the foramen magnum, measures 6 x 6 mm and is unchanged in size compared to the prior exam but has had a gradual increase in size since the baseline exam from 9/10/2012. The additional previously described small enhancing nodules in the bilateral cerebellar hemispheres are again seen. No lesions within the supratentorial brain are appreciated. No evidence of acute ischemia or hemorrhage. The ventricles and basal cisterns are normal in size and configuration. The expected intracranial vascular flow voids are present.Interval development of diffuse paranasal sinus mucosal thickening and opacification most prominently involving the bilateral maxillary and sphenoid sinuses as well as the ethmoid air cells. There is mild mucosal thickening involving the frontal sinuses and scattered mastoid air cell opacities bilaterally. The calvarium and extracranial soft tissues are grossly unremarkable.Cervical spine: Redemonstration of an intramedullary lesion in the posterior cervical cord at the C4 level which measures 9 mm in maximum dimension and is not significantly changed. There is equivocal slight cranial extent of the surrounding upper cervical spine STIR hyperintense edema, on axial images more along the right aspect of the central cord. Otherwise, the edema pattern is not significantly changed.The vertebral body and intervertebral disc heights are maintained. Straightening of the cervical lordosis is seen, alignment is otherwise maintained. No suspicious bone marrow signal abnormalities. No new cervical cord lesion. No disc bulges, neural foraminal stenosis, or spinal canal stenoses in the cervical spine. Thoracic spine:Redemonstrated are enhancing lesions in the right posterior cord at the T4 level measures 7 mm, unchanged. An additional lesion in the right posterior cord at the T6 level measures 6 mm, and is unchanged on re-measurement compared to the prior exam. These lesions are associated with mild cord edema appearing similar to prior.There is stable mild straightening of the thoracic spine. Mild endplate irregularity which was also previously present from T9 through L1 with mild wedging deformities of the T10 and 11 vertebral bodies are unchanged. No evidence of acute fracture. There is no significant disc bulge, spinal canal stenosis, or neuroforaminal narrowing. Lumbar Spine:The lumbar spine alignment is anatomic, and the vertebral body and intravertebral disc heights are maintained. No bone marrow signal abnormalities. No enhancing masses are noted in the conus or cauda equina. There is no significant disc bulge, spinal canal stenosis, or neuroforaminal narrowing. The paraspinal soft tissues and partially visible intra-abdominal contents are unremarkable.

Output: 1.At least three new suspicious areas of nodularity in the cerebellum compared to the prior exam, although note that the prior exam was limited by motion.2.Dorsal medullary nodule stable from recent comparisons although progressed since baseline exam.3.The additional previously characterized enhancing lesions in the bilateral cerebellar hemispheres, cervical spinal cord, and thoracic spinal cord are unchanged.4.There is equivocal slight cranial extension of the upper cervical spinal cord edema more along the right aspect of the cord, versus artifact, which would warrant close attention on follow up exams. The remainder of the edema pattern in the cerebellum and elsewhere in the spine is stable.5.Findings indicating acute pan-sinusitis, new since the prior exam. Please correlate clinically.


Instruction: Generate impression based on medical findings.

Input: There are post-surgical findings related to anterior cervical discectomy and fusion at C3-4. There is multilevel degenerative spondylosis and thickening of the posterior longitudinal ligament superimposed on a congenitally narrowed spinal canal that results in severe bilateral neural foraminal stenosis at C3-4 through C5-6, as well as slight indentation of the spinal cord at C5-6 by a disc-osteophyte complex. However, there is no definite abnormal signal in the cervical spinal cord. There is straightening of the cervical spine in the sagittal plane. The vertebral body heights are preserved. There is diffuse loss of disc height with corresponding signal dessication. There is a hemangioma within the T2 vertebral body. The paravertebral soft tissues are unremarkable.

Output: Post-surgical findings related to anterior C3-4 fusion with persistent multilevel degenerative spondylosis and thickening of the posterior longitudinal ligament superimposed on a congenitally narrowed spinal canal that results in severe bilateral neural foraminal stenosis at C3-4 through C5-6, as well as slight indentation of the spinal cord at C5-6 by a disc-osteophyte complex.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Brainstem lesion, preop planning, surgery today. Signs and symptoms: Preop planning. Pre- and post enhanced fusion brain MRI:Examination is performed utilizing fusion protocol which is a limited study and not a true diagnostic test.Within this limitation the study demonstrate a focus of T2 hyperintensity in the anterior aspect of the pons and extending superiorly into the right Cipro peduncle without significant change since prior exam or detectable abnormal enhancement. The finding traverses the entire anterior aspect of pons measuring at 28 mm and 10 mm in AP axis. There is no appreciable associated mass effect with this finding.Additional focus of T2 hyperintensity with internal foci of mixed signal intensity and subtle patchy enhancement in the right thalamus without convincing evidence of interval significant change.Additional focus of extensive edema and ring-enhancing focus in the subcortical white matter of left posterior frontal is also noted. Patchy foci of enhancement within a focus of vasogenic edema involving the cortex and subcortical white matter of interhemispheric aspect of the left posterior frontal is also again noted noted without change.

Output: Multiple foci of signal abnormality with surrounding vasogenic edema and patchy enhancement in bilateral cerebral hemispheres without significant change since prior exam as detailed/measured above.


Instruction: Generate impression based on medical findings.

Input: Right knee pain MENISCI: There is blunting of the free edge of the medial meniscus suggesting radial tear. The root of the medial meniscus is also not well seen. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is thinning of the articular cartilage of both the medial and lateral compartments although no discrete full-thickness defect is appreciated. There is moderate fibrillation of the patellofemoral cartilage, particularly medially.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Radial tearing of the medial meniscus with the root is not well seen. The lateral meniscus is intact.2. Mild tricompartmental articular cartilage loss.


Instruction: Generate impression based on medical findings.

Input: 57 VF arrest, CAD, MI Left VentricleThe left ventricle is severely reduced. The overall LV ejection fraction is 31%, the LV end diastolic volume index is 112 ml/m2 (normal range: 65+/-11), the LVEDV is 211 ml (normal range 109+/-23), the LV end systolic volume index is 77 ml/m2 (normal range 18+/-5), the LVESV is 146 ml (normal range 31+/-10). There are regional wall motion abnormalities present with apical hypokinesis, inferolateral hypokinesis and apical lateral akinesis. . There is late gadolinium enhancement in the endocardial pattern in the basal-mid inferolateral wall and extension in the basal inferior wall to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pattern of the enhancement is a distribution which suggests myocardial infarct. In most of the segments the enhancement is approximately 50% which suggests partial viability.Left AtriumThe left atrium is enlarged. Right VentricleThe right ventricle is mild-moderately reduced. The overall RV ejection fraction is 38%, the RV end diastolic volume index is 89 ml/m2 (normal range 69+/-14), the RVEDV is 169 ml (normal range 110+/-24), the RV end systolic volume index is 38 ml/m2 (normal range 22+/-8), and the RVESV is 55 ml (normal range 35+/-13). Right AtriumThe right atrium is enlarged. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation, but the severity of aortic regurgitation can be underestimated by the MRI pulse sequence used in this study.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation, but the severity of mitral regurgitation can be underestimated by the MRI pulse sequence used in this study.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation, but the severity of pulmonic regurgitation can be underestimated by the MRI pulse sequence used in this study.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation, but the severity of tricuspid regurgitation can be underestimated by the MRI pulse sequence used in this study.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsBilateral pleural effusions R > L.. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is severely reduced. The overall LV ejection fraction is 31%, There are regional wall motion abnormalities present with apical hypokinesis, inferolateral hypokinesis and apical lateral akinesis.2. There is late gadolinium enhancement in the endocardial pattern in the basal-mid inferolateral wall and extension in the basal inferior wall to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pattern of the enhancement is a distribution which suggests myocardial infarct. In most of the segments the enhancement is approximately 50% which suggests partial viability.3. Mild-moderate RV dysfunction.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old. Reason: Right nodule biopsied and shows cell suspicious for PTC, please assess lateral and central lymph nodes. RIGHT LOBE MEASUREMENTS: At 0.5 x 2.2 x 1.7 cmLEFT LOBE MEASUREMENTS: 7.0 x 2.4 x 1.5 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Heterogeneous echotexture. A heavily calcified nodule in the mid right lobe measures 1.7 x 1.1 x 2.4 cm, unchanged from prior.LEFT LOBE: A nodule in the mid left lobe measures 1.5 x 1.4 x 1 .0 cm, heterogeneous and isoechoic, with a hypoechoic rim, predominantly solid, nonvascular.ISTHMUS: Heterogeneous echotexture.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No cervical lymphadenopathy noted.OTHER: No significant abnormality noted.

Output: Bilateral thyroid nodules, unchanged. No cervical lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: History of multiple sclerosis. There are multiple T2 hyperintense lesions in supratentorial and infratentorial white matter lesions. Many of the lesions demonstrate T1 hypointensity, but none of them appear to enhance. There is no evidence of intracranial hemorrhage or mass. 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 grossly unremarkable.

Output: No appreciable change in the supratentorial and infratentorial demyelinating lesions.


Instruction: Generate impression based on medical findings.

Input: 57 years, Female, 2 month postoperative evaluation of meningioma resection. Since prior MRI from 11/10/2015 there has been resection of previously seen meningioma involving the right high frontal convexity. There are postsurgical changes related to tumor resection including right frontoparietal craniotomy and enhancement of the dura deep to the craniotomy flap. There are minimal areas of dural based thickening which may represent postsurgical change. No definite evidence of residual or recurrent tumor. There is T2/FLAIR hyperintensity involving the posterior aspect of the right superior frontal gyrus and medial aspect of the right precentral gyrus compatible with gliosis. There are minimal foci of T2/FLAIR hyperintensity including the left pons which may be related to chronic small vessel ischemia but unchanged. Remainder of the brain is otherwise unremarkable. No evidence of recent infarct or hemorrhage. No new mass or mass effect. No extra-axial collections. Trace mucosal thickening is seen in the paranasal sinuses, which are otherwise clear. Mastoid air cells are clear. Major flow-voids are preserved. Aside from postsurgical changes, calvarium and extracranial soft tissues are unremarkable.

Output: Postoperative changes of right frontal meningioma resection without evidence of residual or recurrent tumor.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Evaluate for intracranial bleed and or obstructive hydrocephalus. No schizencephaly. Signs and symptoms: Emesis, irritability, I and head deviation to the left. CT of brain without infusion:There is significant interval increase in the size of fourth ventricle since prior examination. Prior MRI demonstrated normal size of the fourth ventricle. On the current exam expanded fourth ventricle upright mass effect on the pons and causes significant deformity of the quadrigeminal plate and appears to extend across the tentorium into the supra-tentorial space. Significant congenital deformity of bilateral schizencephaly with extensive extra axial CSF collection is again identified. There is bilateral larger extension of CSF into the extra-axial space with associated mass effect on the brain parenchyma since prior study.No evidence of hemorrhage is detected. Linear very high density material along the ependymal lining of the left temporal horn and occipital horn of the lateral ventricle are present calcification. These findings were noted on prior exam.

Output: 1.Significant interval enlargement of fourth ventricle since prior study.2.Larger amount of CSF in the extra-axial space with further increased mass effect on the brain parenchyma.3.Microcalcifications along the ependymal lining of the left lateral ventricle stable since prior study.4.No evidence of intracranial hemorrhage as clinically questioned.


Instruction: Generate impression based on medical findings.

Input: 22-year-old male with right leg weakness and lower lumbar midline tenderness to palpation. Concern for disk herniation.IMAGE ACQUISITIONS: CT lumbar spine without contrast. The exam is limited secondary to excessive amount of noise within the images, due to patient's large body habitus.Alignment is anatomic. Vertebral body heights are preserved. Partially visualized is a nonspecific lucency in the right aspect of the T11 vertebral body. MRI can be considered for further evaluation if clinically warranted.At L5/S1 there is a left paramedian disk protrusion that causes stenosis of the left lateral recess and likely impingement of the left S1 nerve root. Please correlate with clinical history and exam.

Output: 1. Left paramedian disk protrusion at L5/S1 causing spinal stenosis likely impinging the left S1 nerve root. Please correlate with clinical history and exam. MRI will be helpful for further evaluation of this level and the rest of the lumbar spine.2. Nonspecific lucency in the right aspect of the T11 vertebral body. MRI can be considered for further evaluation as clinically warranted.


Instruction: Generate impression based on medical findings.

Input: Elevated PSA. 3+3 disease identified on outside hospital biopsy. PELVIS:PROSTATE:Prostate Size: 3.2 x 4.5 x 4.0 cm.Peripheral Zone: In the left mid gland there is an ill-defined region of T2 hypointensity measuring up to 1.0 x 0.6 cm (series 801/15), associated with restricted diffusion (series 704/2 24). There is also associated early arterial enhancement on dynamic contrast-enhanced imaging (series 1 401/201 0). On the ADC imaging the signal abnormality appears to extend across the midline and to the base of the seminal vesicles, however there is no abnormal contrast enhancement of the seminal vesicles appreciated. This signal may be artifactual.In the left apex there is a 8 x 9 mm T2 weighted hypointense rounded focus (series 601/52) with possible associated restricted diffusion (series 704/124) but no arterial enhancement.No additional suspicious lesion is identified.Central Gland: Changes of benign prostatic hyperplasia.Seminal Vesicles: Abnormal ADC signal extends to the base of the seminal vesicles without abnormal postcontrast enhancement appreciated. These findings are equivocal for seminal vesicle invasion.Extracapsular Extension: The left mid gland lesion has a broad base of abutment with spicular enhancement outside of the prostatic margin with a discrete enhancing nodule between the adjacent rectum and prostate suspicious for extraprostatic tumor and involvement of the neurovascular bundle.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.0 cm lesion in the left mid gland peripheral zone with suspected extraprostatic tumor extension involving the left neurovascular bundle.Moderately suspicious 9 mm left apex peripheral zone lesion.


Instruction: Generate impression based on medical findings.

Input: 82 years, Male, stage III non-small cell lung cancer. No intracranial mass or mass-effect. No abnormal parenchymal or meningeal enhancement. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. There is global parenchymal volume loss commensurate with patient's advanced age. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. The ventricles are within normal limits in size and configuration. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. There are bilateral lens implant. Paranasal sinuses and mastoid cells are grossly clear. No suspicious lesions in the calvarium.

Output: 1. No evidence of intracranial metastatic disease.2. Mild chronic small vessel ischemic changes and global parenchymal volume loss which is appropriate for patient's age.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Stroke. Signs and symptoms: Right arm weakness and aphasia. Nonenhanced brain MRI:Diffusion weighted images demonstrate multiple small foci of restricted diffusion involving the cortex, subcortical and periventricular white matter of the left frontal lobe consistent with acute ischemic stroke without evidence of hemorrhage or mass effect or mass effect. This finding is also poorly appreciated on FLAIR and T2-weighted images. Note should be made that there is extensive motion artifact on FLAIR and T2 series.Additionally study demonstrate moderate to advanced chronic nonhemorrhagic small vessel ischemic strokes of bilateral subcortical and periventricular white matter and pons.There is a large focus of FLAIR/T2 hyperintensity in the left middle cerebellar peduncle with suggestion of mild increased volume. The finding measures approximately at 20 x 21 mm in transaxial dimensions (FLAIR series 601 image 8). The morphology and location of this finding is not highly suggestive of an ischemic change. This finding however demonstrate no significant change when compared to 2 prior head CTs including the exam from 11-26-12. Although relatively stable since 2012 follow-up with an enhanced imaging is recommended to exclude a mass.There is slight prominence of cortical sulci and supratentorial ventricular system with maintained midline.The signal voids of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses are within normal.Extensive chronic sinus disease similar to prior CT examination.Findings and concerns on this exam were discussed by radiology resident on-call Dr. Alexander Anup with neurology resident on call Issa Naoum # 9203 at the time of review of the exam.

Output: 1.Incomplete and suboptimal exam due to motion artifact.2.Small patchy foci of restricted diffusion in the left frontal cortex and subcortical-periventricular white matter consistent with acute nonhemorrhagic ischemic strokes.3.Moderate chronic nonhemorrhagic small vessel ischemic strokes is noted.4.A focus of FLAIR/T2 hyperintensity (20 x 21 mm) in the left middle cerebellar peduncle which has remained stable since 2012 head CT exam however follow-up with enhanced imaging is recommended to entirely exclude possibility of a mass.


Instruction: Generate impression based on medical findings.

Input: 58-year-old male with history of prostate cancer. PSA 3.4 with Gleason grade of 7. PELVIS:PROSTATE:Prostate Size: 2.1 x 3.9 cm. Signal intensity: Note is made of multiple foci of low T2 signal abnormality in the peripheral zone of the prostate gland. There is a 6 x 5 mm, focus of low T2 signal abnormality in the left base of the prostate gland with associated restricted diffusion and contrast enhancement, consistent with the patient's known history of prostate carcinoma. Additionally, note is made of multiple additional foci of low T2 signal abnormality in the right base are as well as the left apex. There is associated enhancement consistent with multiple additional foci of prostate carcinoma.Seminal Vesicles: Normal appearance.Extracapsular Extension: No evidence of extracapsular extension. There is no bulging of the capsule identified.BLADDER: There is diffuse wall thickening of the bladder, which is nonspecific, but may be related to chronic outlet obstruction.LYMPH NODES: No evidence of lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multiple foci of signal abnormality involving the left base, the left apex, and right base of the prostate gland, which are consistent with the patient's known history of multifocal prostate carcinoma. There is no evidence to suggest extracapsular extension or invasion of the neurovascular bundle.


Instruction: Generate impression based on medical findings.

Input: History of elevated PSA.Additional history per electronic medical record:TRUS 3/14/2014, performed for PSA 3.5.3 cores of Gleason 6 prostate cancer totalling 7 mm. This included four mm at the right mid, two mm at the rightapex and one mm at the left space. PELVIS:PROSTATE:Prostate Size: 2.3 x 4.4 x 3.5 cm.Peripheral Zone: There is a focus of decreased T2 and ADC signal within the left apex (series 501, image 52) measuring 7 x 7 mm which is suspicious for neoplasm. There is an additional focus of decreased T2 and ADC signal within the right apex (series 501, image 52) measuring 7 x 15 mm which is also suspicious for neoplasm.Central Gland: No significant abnormality noted.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No definite evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Signal abnormality within the bilateral peripheral zone apices suspicious for neoplasm, please see discussion above.


Instruction: Generate impression based on medical findings.

Input: 49 year old female. Abdominal pain. Is there a persistent GE junction leak? CHEST:LUNGS AND PLEURA: Bilateral lower lobe consolidation and volume loss. Small bilateral pleural effusions. There is possible abscess or small hematoma in the cysts splenic bed, left sub-diaphragmatic region seen best on coronal image 79.MEDIASTINUM AND HILA: Endotracheal tube is present in the expected position. Low lung volumes.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Marked hepatomegaly. The liver measures 27 cm craniocaudally.SPLEEN: Status post splenectomy.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral atrophic and scarred kidneys without evidence of hydronephrosis. There is a questionable 3-cm mass adjacent to the right lung hilum on coronal image 69 and axial image 106. This may be further evaluated with dedicated renal MRI examination and/or noncontrast CT scan.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The patient is status post a vertical sleeve gastrectomy with innumerable surgical clips under the left hemidiaphragm. A stent is present in the gastric remnant. There are multiple surgical drains in the upper abdomen, one in the gastrohepatic region and another at the left lateral aspect of the gastrectomy site.A percutaneous jejunostomy tube is present in the expected position.No free air. No definite leak at the GE junction, but this may be difficult to detect on an examination without esophageal enteric contrast.BONES, SOFT TISSUES: Open midline abdominal wound in the supraumbilical region. OTHER: IVC filter is in expected position.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: A Foley catheter is present in the decompressed urinary bladder.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: A rectal tube is in expected position.BONES, SOFT TISSUES: There is scoliosis of the thoracolumbar spine. Degenerative changes in the lumbosacral spine and pelvis.OTHER: Anasarca.

Output: Bibasilar lower lobe consolidation. Hepatomegaly. Anasarca. Questionable right renal mass at the hilum. Status post splenectomy with questionable hematoma or subdiaphragmatic fluid collection on the left. Multiple additional findings, as described above. Postop changes after partial gastrectomy.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old, with altered mental status. Assess for stroke. A 4 mm focus of mildly restricted diffusion is seen within the white matter adjacent to the left ventricular atrium. A similar lesion was seen on the prior examination at 6/18/2015 but is now reduced in signal intensity. No other definite diffusion restricting lesions are seen.Motion artifact substantially degrades image quality on most of the other sequences. Mild patchy foci of T2 hyperintensity are evident within the cerebral white matter and the pons. Scattered foci of susceptibility are also evident, the largest of which are within the inferior aspect of the right postcentral gyrus, stable, and along the right basal ganglia, possibly new.Postcontrast images are degraded, but no definite pathologic intracranial enhancement is seen.Thin bilateral subdural collections are evident along the cerebral hemispheres demonstrating T2 hyperintense and T1 isointense signal. These collections are symmetric bilaterally and measure no more than 3 mm in thickness. They exert no significant mass effect upon the brain.The ventricles and sulci are stable in caliber relative to the prior exam.

Output: 1.Small evolving late subacute small vessel stroke within the left periatrial white matter.2.Evidence of chronic small vessel ischemic disease and scattered microhemorrhage.3.Interval development of small symmetric bilateral subdural collections which could represent very small subdural hemorrhages or nonhemorrhagic effusions. These exert no significant mass effect upon the brain. Imaging follow-up is suggested to document resolution.


Instruction: Generate impression based on medical findings.

Input: Follow up exam for patient with Sturge Weber syndrome. There is redemonstration of mild focal right frontal lobe volume loss and diffusely prominent leptomeningeal enhancement, but deficiency of overlying cortical veins. There are associated enlarged medullary and deep veins in the right frontal lobe and a dilated striate vein. There are a few scattered foci of nonspecific T2 hyperintensity in the white matter of the bilateral cerebral hemispheres. The ventricles are unchanged in size and configuration. There is a partially empty sella. There is no evidence of acute cerebral infarction of hemorrhage. There is no midline shift. The skull and orbits appear unremarkable.

Output: Unchanged stigmata of Sturge Weber syndrome, predominantly involving the right frontal lobe.