Instruction: Generate impression based on medical findings.

Input: cT1N0 nasopharynx squamous cell carcinoma treated with radiation therapy. There are post-treatment findings in the neck. There has been interval decrease in size of the right posterior nasal cavity mass, which now measures up to approximately 6 mm, previously 26 mm. There is no evidence of significant cervical lymphadenopathy based on size criteria. There is elevated T2 signal in the trapezius muscles bilaterally, which may be due to denervation effects. The thyroid and major salivary glands are unremarkable. The major cervical arterial flow voids appear to be intact. The osseous structures are unremarkable. The imaged intracranial structures are unremarkable.

Output: Post-treatment findings in the neck with interval decrease in size of the nasal cavity mass.


Instruction: Generate impression based on medical findings.

Input: MRI brain: There is about 10 mm inferior descent of the right cerebellar tonsil below the foramen magnum consistent with a Chiari I malformation.The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. MRI cervical spine:There is a cervical syrinx which begins at the level of the C1 vertebra extending down up to mid C3 level. The syrinx occupies nearly the entire diameter of the cervical cord, measuring about 10 x 8mm in maximum axial dimensions when measured at the lower C2 vertebral body level. In the CC dimension, the syrinx extends up to 13 mm. There is no abnormal enhancement in the cervical spinal cord. There is normal biphasic CSF flow through the anterior foramen magnum, and diminished flow posteriorly.The cervical spine is in normal alignment, with a normal cervical lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There is no pathological enhancement.The intervertebral discs are preserved. No significant spinal canal or foraminal stenosis is seen. The paraspinal soft tissue structures are unremarkable.

Output: 1. Findings compatible with Chiari I malformation. Otherwise, MRI of the brain is unremarkable.2. Syringohydromyelia involving the upper cervical cord extending from C1 to mid C3 vertebral body as described.


Instruction: Generate impression based on medical findings.

Input: 53 year old female with sjogren's, diabetes, hypertension and known coronary artery disease with history of chronic total occlusion of right coronary artery (s/p PCI 12/2015) presenting for evaluation post interventionMEDICATIONS: aspirin, atorvastatin, bumetanide, carvedilol, lisinopril, clopidogrel, ranolazine, spironolactone First Pass PerfusionDuring hyperemia, there is a perfusion defect ("ischemia") in the RCA territory, specifically there are perfusion defects in mid to basal inferior and inferolateral walls. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 60%, the LV end diastolic volume index is 91 ml/m2 (normal range: 65+/-11), the LVEDV is 185 ml (normal range 109+/-23), the LV end systolic volume index is 36 ml/m2 (normal range 18+/-5), the LVESV is 74 ml (normal range 31+/-10), the LV mass index is 29 g/m2, and the LV mass is 60 g. There is basal to mid inferior and possibly inferolateral hypokinesis. Native T1 time approximately 1110 ms (LV cavity 1550 ms). There is diffuse late gadolinium enhancement noted in the subendocardial and mid myocardial region isolated to the inferior wall suggesting myocardial infarction, fibrosis, inflammation, or infiltration. This was seen on previous CMR in 2014, however it appears similar to slightly improved. This specific area is likely to be viable along with the remaining myocardium. 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 64%, the RV end diastolic volume index is 73 ml/m2 (normal range 69+/-14), the RVEDV is 148 ml (normal range 110+/-24), the RV end systolic volume index is 26 ml/m2 (normal range 22+/-8), and the RVESV is 53 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is 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 FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. During hyperemia, there is a perfusion defect ("ischemia") in the RCA territory, specifically there are perfusion defects in the mid to basal inferior and inferolateral walls. 2. There is diffuse late gadolinium enhancement noted in the subendocardial and mid myocardial region isolated to the inferior wall suggesting myocardial infarction, fibrosis, inflammation, or infiltration. This was seen on previous CMR in 2014, however it appears similar to slightly improved. This specific area is likely to be viable along with the remaining myocardium. 3. Normal LV size and systolic function (LVEF 60%).4. Normal RV size and systolic function (RVEF 64%).


Instruction: Generate impression based on medical findings.

Input: Female, 4 years old, with history of JPA, follow-up three month evaluation. Evidence of occipital craniotomy is again seen. A resection cavity centered on the cerebellar vermis has decreased in size from the prior exam. No evidence of surrounding edema or any significant T2 signal abnormality is seen. On postcontrast images, previously seen curvilinear enhancement along the cavity margins has diminished. There remains a small focus of curvilinear enhancement at the anterior margin of the cavity. No additional new intracranial lesions are seen. The fourth ventricle has reexpanded and the ventricular system has resumed normal caliber and morphology. Supratentorial parenchymal morphology and signal are within normal limits.

Output: Expected postoperative findings compatible with resection of tumor from the posterior fossa. The resection cavity has decreased in size along with decreasing nonspecific curvilinear enhancement along the cavity margins. No evidence of any new or recurrent lesion is seen.


Instruction: Generate impression based on medical findings.

Input: Susceptibility artifact somewhat limits evaluation of the tissues immediately surrounding the craniotomy site secondary to a metallic plate. There are postoperative findings related to recent resection of left cerebellar lesion, with foci of gas and blood products within the resection cavity. There is persistent T2 hyperintensity in the surrounding cerebellum, but decreased mass effect on the fourth ventricle when compared to the prior MRI. There is persistent herniation of cerebellar tissue through the previous craniotomy defect. There is a stable amount of blood products and a small fluid collection at the craniotomy site. There are persistent areas of peripheral enhancement surrounding the resection cavity, which are suspicious for residual disease. There is an unchanged appearance of the known right parietal lesion with surrounding edema, measuring 13 x 13 mm in axial cross-section. The subcentimeter right cerebellar lesion is again identified, but is less conspicuous than on the previous MRI. Normal flow-voids are demonstrated in the major intracranial vascular structures. There are nonspecific fluid levels in the maxillary and sphenoid sinuses. There is staphylomatous deformity of the bilateral globes.

Output: 1.Postoperative findings related to recent resection of left cerebellar mass with areas of peripheral, but irregular enhancement in the resection bed, particularly anteriorly, which are suspicious for residual tumor.2.Persistent right parietal and cerebellar metastatic lesions.


Instruction: Generate impression based on medical findings.

Input: This 53 old male status post liver transplant with a history of seizures and VZV meningitis as well as a history of intraventricular hemorrhage. Would like to rule out expansion/stroke. Again noted is trace blood in the bilateral lateral ventricles which was seen in the brain MRI dated 7/07/08.There is no evidence of new intracranial hemorrhage.There is asymmetric prominence of the lateral ventricles as well as mild prominence of the third ventricle. This may be due to mild/moderate volume loss. This prominence has increased slightly when compared with the CT scan dated 7/02/08.There are periventricular white matter changes indicative of small vessel disease. There is no evidence of intracranial mass or edema. The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Trace blood is again seen in the lateral ventricles. There is no evidence of new intracranial hemorrhage.2. There is prominence of the lateral and third ventricles which is slightly increased when compared to the prior CT scan dated 7/2/08.3. There is evidence of small vessel disease.


Instruction: Generate impression based on medical findings.

Input: BRAIN: There is no suspicious intracranial enhancement, acute infarct, mass effect, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. CERVICAL: There is normal alignment of the cervical spine with preserved vertebral body heights and intervertebral disk heights. There is normal osseous marrow and disk signal. The cord caliber and signal are within normal limits. There is no disk herniation or spinal stenosis the cervical spine. There is no suspicious enhancement within the cervical spine.THORACIC: There are the usual complement the 12 thoracic vertebral bodies. There is normal alignment of the thoracic spine with preserved vertebral body heights and intervertebral disk heights. There is normal osseous marrow and disk signal. The cord caliber and signal are within normal limits. There is no disk herniation or spinal stenosis the thoracic spine. There is no suspicious enhancement within the thoracic spine.LUMBAR: There are the usual complement the 5 lumbar type vertebral bodies, with the last well formed disk space referred to as L5-S1. There is minimal straightening of lumbar lordosis with preserved vertebral body heights and intervertebral disk heights. There is normal osseous marrow and disk signal. The conus shows normal caliber and signal intensity and terminates at L1-2, within normal limits. There is a nonenhancing high T1 signal intensity thin linear structure extending from T12, lying anterior to the conus, and exiting through the right L5-S1 neural foramen, likely representing a thin vessel. There is no suspicious enhancement within the thoracic spine.There is no significant disk herniation or spinal stenosis in the lumbar spine. There is a minimal disk bulge at L3-4 and L4-5 without spinal stenosis. There are tiny posterior annular fissures at L4-5 and L5-S1 disks centrally.

Output: Unremarkable examinations of the brain and the spine with no mass or suspicious enhancement.


Instruction: Generate impression based on medical findings.

Input: Preoperative planning for a cystic lesion in the left cerebellar pontine angle. There is a cystic lesion in the left cerebellopontine angle cistern that measures up to approximately 25 mm. There is associated posterior deviation of the left cranial nerve 7 and 8 complex and mass effect upon the brainstem, left middle cerebellar peduncle, and left cerebellar hemisphere. There is a small developmental venous anomaly in the right inferior frontal gyrus. There is scattered mild mucosal thickening in the paranasal sinuses. There is a small amount of fluid signal in the right mastoid air cells. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Left cerebellopontine angle cistern arachnoid cyst that measures up to approximately 25 mm with associated posterior deviation of the left cranial nerve 7 and 8 complex and mass effect upon the brainstem, left middle cerebellar peduncle, and left cerebellar hemisphere.


Instruction: Generate impression based on medical findings.

Input: Male, 10 years old, history of choroid plexus cyst at birth, with developmental delay and family history of brain tumor. Evaluate for structural abnormalities. Brain parenchymal morphology is within normal limits. No evidence of focal signal abnormality, edema or mass effect is seen. No pathologic parenchymal or extra-axial enhancement is detected. No evidence of intracranial hemorrhage is seen. No abnormal extra-axial fluid collection or cystic lesion is noted. In particular, there are no findings to suggest choroid plexus cysts. The right lateral ventricle is slightly larger than the left but this is within the limits of anatomic variation. The ventricular system is otherwise unremarkable.

Output: Unremarkable evaluation with no evidence of cord plexus cysts or any other specific structural abnormality.


Instruction: Generate impression based on medical findings.

Input: Male 35 years old Reason: pain History: pain in right knee MENISCI: Medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: Cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: No findings to account for patient's pain.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Unspecified convulsions Apnea, not elsewhere classifiedClinical question: Eval for AVMSigns and Symptoms: New Seizures, xanthochromia in CSF, Macrophage w hemosiderin MRI of the brainNo diffusion weighted abnormalities are appreciated.The posterior limbs of internal capsules demonstrate some myelination. Otherwise there is little myelination.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The right A1 segment is small. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.

Output: 1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial arteriovenous malformation or aneurysm.3.No evidence for acute ischemic cerebral infarction.4.Myelination pattern is neonatal.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Atrophy. Signs and symptoms: Memory loss. Nonenhanced head CT:The cortical sulci, ventricular system and CSF cisterns are within normal range for patient's stated age of 85.Periventricular and subcortical patchy foci of low attenuation are concerning for mild small vessel ischemic strokes of indeterminate age.MRI is more sensitive for assessment of the extent of this finding.Mild calcification of cavernous carotid bilaterally is present.No evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.Calvarium is intact.Image images through the orbits are unremarkable.Mastoid air cells and middle ear cavities as well as all visualized paranasal sinuses are unremarkable.

Output: Mild small vessel ischemic strokes of indeterminate age and unremarkable exam otherwise. In particular no convincing evidence of atrophy for patient's stated age.


Instruction: Generate impression based on medical findings.

Input: Nasopharyngeal cancer, status post treatment. There are post-treatment findings in the posterior nasopharynx, but no evidence of measurable nasopharyngeal mass. The skull base appears to be intact. There is no significant cervical lymphadenopathy. The salivary glands and thyroid appear unchanged. There is a posterior small disc osteophyte complex at C5-6. There is a small amount of fluid in the right mastoid air cells. The orbits are unremarkable. The numerous subcentimeter non-enhancing lesions with associated susceptibility effect in the brain are better depicted on the recent brain MRI. There is a 3 mm diameter posteromedially directed right aneurysm arising from the anterior genu of the internal carotid artery.

Output: 1. Post-treatment findings in the nasopharyngeal region without evidence of measurable locoregional tumor.2. The numerous subcentimeter non-enhancing lesions with associated susceptibility effect in the brain are better depicted on the recent brain MRI. 3. A 3 mm diameter posteromedially directed right aneurysm arising from the anterior genu of the internal carotid artery is better depicted on the recent brain MRA.


Instruction: Generate impression based on medical findings.

Input: Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: acute stroke on ct History: hemiparesis Brain MRIThere are multifocal scattered restricted diffusion lesions involving bilateral cerebellar hemispheres, pons, left thalamus and right occipital lobe indicating acute ischemic infarctions. There is no evidence of hemorrhagic transformation.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage.The midline structures and cranial-cervical junction are normal. 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 occluded right ICA but patent and normal appearing left ICA, bilateral MCAs and bilateral ACAs. Bilateral PCAs are fetal origin.Vertebrobasilar system appears to be normal.

Output: 1. Multifocal acute ischemic infarctions involving bilateral cerebellar hemispheres, pons, left thalamus and right occipital lobe.2. Bilateral fetal PCAs. Otherwise no evidence of intracranial arterial stenosis or occlusion. No aneurysm was seen.


Instruction: Generate impression based on medical findings.

Input: Other hallucinations [R44.2], Reason for Study: ^Reason: phantosmia, history of brain issue in 1980s, eval for smell pathway lesions History: phantosmia There is ovoid shape well circumscribed intra axial lesion on the left pre central gyrus. The lesion has thin low signal intensity rim on T2 with internal multiple compartmentalized high signal intensity. The size of the lesion is about 5mm x 6mm x 4mm on T2 images and it shows significant susceptibility artifacts on Gradient echo image indicating the diagnosis of cavernous malformation. There is no evidence of surrounding edema.There is no other susceptibility lesion seen on this scan.There is no evidence of acute ischemic lesion.Underlying brain shows multiple scattered bihemispheric high signal intensity lesions on T2/FLAIR indicating non specific small vessel ischemic lesions.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Mucosal thickenings on bilateral ethmoid sinuses and retention cysts on the right frontal sinus and bilateral maxillary sinuses.

Output: 1. Left pre central gyrus cavernous malformation as described above.2. No acute ischemic lesion on this scan.3. Non specific small vessel ischemic disease.


Instruction: Generate impression based on medical findings.

Input: Clinical question: please do dr Javed protocol, MS progressionSigns and Symptoms: MS progression There is a T2 hyperintense focus present within the thoracic spinal cord at the T10-T11 level located along the midline and posterior aspect of the thoracic spinal cord. There is a questionable lesion within the thoracic spinal cord at the T8-9 level. There is no associated contrast enhancement with these lesions.The thoracic vertebral bodies are appropriate in the overall alignment and height. There is no compromise of thoracic spinal canal or exiting nerve roots. No abnormal enhancing lesions are identified in the thoracic spine. There is no associated mass effect or cord enlargement.

Output: A couple lesions are present within the distal thoracic spinal cord which are suspicious for demyelination.


Instruction: Generate impression based on medical findings.

Input: 27-year-old female with question of demyelination. Neck pain and left upper extremity weakness. MRI brain: Some sequences are limited by patient motion artifact. Allowing for this limitation, there is no specific evidence of demyelinating lesion, mass, infarct, or pathologic enhancement. The ventricles and sulci appear normal for age. There is a small right maxillary polyp, otherwise the paranasal sinuses and orbits appear unremarkable.MRI cervical spine: There is straightening of the normal cervical lordosis which may be in part positional. Vertebral body heights and disc spaces appear preserved. The cervical cord appears normal in morphology and signal. The cervicomedullary junction appears unremarkable. There is no evidence of neuroforaminal compromise or spinal canal stenosis. There is no pathologic enhancement on postcontrast images.

Output: 1. No evidence of acute or chronic demyelinating disease in the brain or cervical spine. No specific findings to account for the patient's symptoms.2. No abnormal signal in the cervical cord. No significant spinal canal or neural foraminal stenosis in the cervical spine. 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: Right side weakness There is no evidence of acute ischemic or hemorrhagic lesion on this scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate significant (more than 50%) of luminal stenosis and irregularity on the right MCA M1 segment. The left MCA shows subtle luminal irregularity but did not show any significant luminal stenosis. Bilateral PCAs are fetal origin.Vertebrobasilar system shows relatively smaller diameter and shows tortuosity, however, do not show any significant luminal narrowing. There is no evidence of intracranial arterial aneurysm.3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The right vertebral artery origin appear to be normal but the left vertebral artery appears to be small in diameter. The left vertebral artery completes as left PICA. No aneurysm was seen.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Significant (more than 50%) stenosis of the right MCA M1 segment with irregularity as well as left MCA luminal irregularity indicate atherosclerotic changes.3. Bilateral fetal PCAs with relatively small vertebrobasilar system, especially left vertebral artery is hypoplastic.4. Bilateral carotid bifurcations appear to be normal.


Instruction: Generate impression based on medical findings.

Input: 46 years, Male, left-sided weakness. Evaluate for acute stroke. There is motion degradation on multiple sequences. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. 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. Mild gliosis and subtle volume loss in the right anterior temporal lobe is unchanged. There is also global parenchymal volume loss, which appears advanced for age. No hydrocephalus. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. No evidence of acute infarct.2. Mild chronic small vessel ischemic changes.3. Mild global parenchymal volume loss, which is advanced for age, similar to prior. 4. Mild right anterior temporal encephalomalacia is also unchanged, which may be related to remote trauma or other injury.


Instruction: Generate impression based on medical findings.

Input: 28-year-old female with right knee pain. Evaluate for possible meniscal pathology. MENISCI: No evidence of meniscal tear.ARTICULAR CARTILAGE AND BONE: No significant thinning of the articular cartilage.LIGAMENTS: The ACL, PCL, MCL, and LCL are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Normal examination of the right knee.


Instruction: Generate impression based on medical findings.

Input: Chiari malformation, post decompression, headaches, worsening symptoms. Brain: There are postoperative findings related to Chiari decompression surgery. The cerebellar tonsils extend to the level of C1, which is unchanged. There is no significant crowding of the neo-foramen magnum and there is apparent CSF flow across the anterior and posterior aspects of the neo-foramen magnum, similar to the prior exam. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There are a few scattered secretions in the paranasal sinuses. Cervical Spine: There has C1 laminectomy as part of the Chiari decompression surgery. There is no evidence of residual fluid collections in the surgical bed. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology.

Output: Unremarkable findings related to Chiari decompression surgery without evidence of hydrocephalus, pseudomeningocele, or syrinx.


Instruction: Generate impression based on medical findings.

Input: Right frontal mass: preoperative planning for biopsy. There is a cystic lesion with a centrally hypoattenuating nodule with thin peripheral enhancement that measures up to 12 mm in the anterior right superior frontal gyrus. There is mild surrounding vasogenic edema, but no midline shift. The ventricles are within normal limits in size and configuration. Thre is a right maxillary sinus retention cyst.

Output: A cystic lesion that measures up to 12 mm in the anterior right superior frontal gyrus has features suggestive of neurocysticercosis, although neoplasm is also a consideration.


Instruction: Generate impression based on medical findings.

Input: Female, 5 months old, with E. coli meningitis, cerebritis and ventriculitis. Assess size of subdural abscess and for residual ventricular abscess. Since the prior examination, a small left parietal craniotomy has been performed through which the previously seen left-sided extra-axial abscess has been evacuated. The collection is much smaller than that seen on the prior examination with only trace residual diffusion restricting material.There is air within the ventricular system and the right frontal approach EVD has been replaced. The catheter now takes a more medial course into the third ventricle. The ventricles remain markedly dilated, the severity of which is stable to minimally increased when compared to the immediate prior examination. The quantity of diffusion restricting debris within the ventricular system has slightly decreased.On postcontrast images, ependymal enhancement persists in the periatrial and temporal regions, similar to the prior examination. The previous rim-enhancing left parietal collection has collapsed into a small residual cavity with thick enhancement of the surrounding dura. No new enhancing lesions are seen.Marked parenchymal thinning is again seen. T2 hyperintensity within the anterior temporal lobes is unchanged. Mild periventricular T2 hyperintensity elsewhere, and a focus of abnormal signal within the right pons, are also unchanged.

Output: 1.Postoperative findings are seen compatible with evacuation of a left parietal extra-axial abscess. Only a small amount of residual diffusion restricting material is seen.2.Findings are seen compatible with endoscopic intervention and replacement of the right-sided EVD. Ventricular caliber is stable to very slightly increased relative to the prior exam.3.The quantity of diffusion restricting infectious debris within the ventricular system has decreased. Ependymal enhancement is unchanged.4.Generalized parenchymal thinning with areas of parenchymal signal abnormality are also unchanged.


Instruction: Generate impression based on medical findings.

Input: 75 year-old female with altered mental status and lethargy. Evaluate for ICH or mass. There is no evidence of intracranial hemorrhage, mass or edema. Multifocal areas of patchy hypoattenuation in the subcortical and deep white matter distribution, nonspecific, however most likely related to small vessel ischemic disease, age indeterminate. No evidence of acute cortical stroke is noted. If there is clinical concern for acute ischemia, an MRI may be considered.The ventricles and basal cisterns appear enlarged secondary to volume loss.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Multifocal white matter hypoattenuation most likely representing small vessel ischemic disease, age indeterminate. 2. No evidence of acute cortical stroke. If there is clinical concern for acute ischemia, MRI may be considered.3. No evidence of mass or intracranial hemorrhage as clinically questioned.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Evaluate for low grade disseminated glial tumor. Signs and symptoms: Brain tumor. Pre-and post-enhanced brain MRI:Examination demonstrates extensive bilateral frontal white matter flair hyperintensity and with resultant ex vacuo dilatation of ventricles without evidence of appreciable interval change since prior exam. Extensive susceptibility signal changes primarily in the frontal horn of the left lateral ventricle remains similar to prior exam. Also similar to prior exam there is a thin fairly uniform band of enhancement along the ependymal lining of left frontal horn and body of lateral ventricle.Also stable since prior exam are additional nonenhancing patchy foci of flair hyperintensity in the periventricular white matter of the cerebral hemispheres as well as bilateral basal ganglia. There is no detectable new foci of flair hyperintensity or abnormal enhancement since prior study.Prominence of cortical sulci for patient's stated age of 51 similar to prior exam and suggestive of underlying parenchymal volume loss.Unremarkable calvarium and without abnormal enhancement.Unremarkable images through the orbits including axial fat sat post enhances.All visualized paranasal sinuses demonstrate normal pneumatization signal pattern.

Output: 1.No evidence of an acute or new finding since prior study.2.Diffuse bilateral anterior frontal encephalomalacia, ex vacuo dilatation of the ventricles and a thin uniform enhancement along the ependymal lining of the left frontal horn remains similar to prior exam.


Instruction: Generate impression based on medical findings.

Input: There is a T2/FLAIR hyperintense cortical and subcortical mass involving the right mesial temporal lobe, including at least the head of the hippocampus. The mass has ill-defined margins but appears overall stable allowing for differences in technique, approximately measuring in the transverse axis 2.3 cm (previously 2.4 cm), and in the craniocaudal axis 2.3 cm (previously 2.5 cm). The margins in the AP view could not be well delineated. This mass has no restricted diffusion. There is thin smooth dural enhancement superomedial to the mass, but the mass itself is not enhancing. Tiny T2 hyperintense cystic areas are seen along the anterior aspect of the mass. The right temporal horn is posteriorly displaced due to mass effect.There are no susceptibility abnormalities. The ventricular size is normal. There is no midline shift. Basal cisterns are patent. Vascular flow voids are normal.

Output: There is an overall stable appearance of a nonenhancing slightly ill-defined mass involving the mesial right temporal lobe with thin smooth superomedial dural enhancement. Differential diagnosis includes pleomorphic xanthoastrocytoma, DNET, pilocytic astrocytoma or other low grade astrocytoma, and ganglioglioma.


Instruction: Generate impression based on medical findings.

Input: 64 years, Female, Reason: eval for progression of toxic metabolics lesions and hemorrhage There has been mild evolution of the multiple previously seen acute infarcts involving the bilateral cerebral hemispheres, left pons and left cerebellar hemisphere on recent MRI brain study dated 1/2/2016. There are however new foci of restricted diffusion consistent with new infarcts including the right frontal lobe involving the right superior frontal gyrus as well as the right paracentral lobule and in the right parietal lobe involving the periventricular white matter as well as the right splenium. There is continued evolution of the left thalamic intraparenchymal hematoma. Multiple patchy areas of T2/FLAIR hyperintensity in the periventricular and subcortical white matter as well as in the pons which are likely reflective of chronic small vessel ischemic disease are also again noted. Chronic infarct with encephalomalacia in the right occipital lobe is also again seen as well as additional chronic infarcts including the right corona radiata, right cerebellar hemisphere, left pons, and bilateral thalami which were seen on exam dating back to 3/7/2015. Multiple scattered foci of susceptibility related to chronic microhemorrhages are again seen.No evidence of intracranial mass effect, midline shift, or herniation. No hydrocephalus. Minimal mucosal thickening involving the paranasal sinuses. Partial mastoid air cell opacification bilaterally is similar to prior.

Output: 1. Compared to MRI brain dated 1/2/2016 there has been evolution of multiple previously seen acute supratentorial and infratentorial infarcts and development of multiple new punctate infarcts in the right frontal and right parietal lobes.2. Continued evolution of the left thalamic intraparenchymal hemorrhage with surrounding vasogenic edema.3. Mild diffusion restriction with FLAIR hyperintensity in the bilateral middle cerebellar peduncles appears similar to prior. Finding is favored to represent Wallerian degeneration along the pontocerebellar tracts although toxic metabolic injury remains an alternative possibility.4. Background of chronic small vessel ischemic disease as well as multiple chronic infarcts as described above. Dr. Ali discussed findings of new infarcts with Dr. Buerki at 1020 hours on 1/10/2016


Instruction: Generate impression based on medical findings.

Input: 25 year old with history of chest pain and newly diagnosed left ventricular systolic dysfunction. Left VentricleSevere LV dilation when adjusted for body surface area (mildly dilated based on absolute volume) with mildly reduced systolic function. The overall LV ejection fraction is 51%, the LV end diastolic volume index is 109 ml/m2 (normal range: 65+/-11), the LVEDV is 166 ml (normal range 109+/-23), the LV end systolic volume index is 54 ml/m2 (normal range 18+/-5), the LVESV is 82 ml (normal range 31+/-10), the LV mass index is 59 g/m2 (normal range 67+/-11), and the LV mass is 90 g (normal range 114+/-24). The systolic dysfunction is global. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is mildly enlarged. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 60%, the RV end diastolic volume index is 91 ml/m2 (normal range 69+/-14), the RVEDV is 139 ml (normal range 110+/-24), the RV end systolic volume index is 36 ml/m2 (normal range 22+/-8), and the RVESV is 55 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely with evidence of mitral valve prolapse and bileaflet billowing. Trace mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size. Normal origin of the coronary arteries.Shunts No evidence of atrial septal defect or ventricular septal defect.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 a trace pericardial effusion.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Severe LV dilation when adjusted for body surface area (mildly dilated based on absolute volume) with mildly reduced systolic function (LVEF 51%). No evidence of underlying myocardial fibrosis, infiltration, and inflammation.2. Normal RV size and systolic function (RVEF 60%).3. Mild left atrial dilation.4. Mitral valve prolapse with bileaflet billowing.5. No evidence of cardiac shunt. Normal coronary origins.


Instruction: Generate impression based on medical findings.

Input: 19 year-old female with slurred speech, evaluate for stroke and demyelination There are numerous foci of T2/FLAIR hyperintensity within both periventricular and subcortical white matter locations involving the supratentorial brain bilaterally as well as corpus callosum proper, the right cerebral peduncle, and perhaps the right anterior medulla. These foci also demonstrate slight restricted diffusion with ADC which appears mildly hypointense with a few lesions also demonstrating mixture with ADC hyperintense signal. A few of the larger lesions demonstrate T1 hypointensity. Some of these lesions are new, and others have significantly enlarged compared to prior. A previous corpus callosal genu lesion has decreased.The CSF spaces are appropriate for the patient's stated age with no midline shift. No intracranial hemorrhage is identified. Normal vascular flow voids are present. The visualized portions of the paranasal sinuses and mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There are numerous foci of T2/FLAIR hyperintensity within both periventricular and subcortical white matter locations involving the supratentorial brain bilaterally as well as corpus callosum proper, the right cerebral peduncle, and perhaps the right anterior medulla. These foci also demonstrate slight restricted diffusion with ADC which appears mildly hypointense with a few lesions also demonstrating mixture with ADC hyperintense signal. A few of the larger lesions demonstrate T1 hypointensity. Some of these lesions are new, and others have significantly enlarged compared to prior. A previous corpus callosal genu lesion has decreased. These findings are nonspecific, however would be consistent with demyelination in the appropriate clinical context. Other inflammatory etiologies remain within the differential diagnosis. Given the distribution and lack of defined vascular territorial involvement, ischemia is unlikely.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: Slurred speech [R47.81], Reason for Study: ^Reason: stroke workup History: dysarthria Brain MRIThere are scattered multiple diffusion restriction on the left precentral gyrus indicating acute ischemic infarct. There is no evidence of hemorrhagic transformation.There are also increased FLAIR/T2 high signal intensity lesion with tissue loss on the right inferior parietal lobule, in particular supra marginal gyrus as well as left cerebellar hemisphere indicate chronic ischemic infarct with encephalomalacia.Scattered and somewhat patchy T2/flair high signal intensity lesions on bilateral periventricular white matter and centrum semiovale indicating nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage. The midline structures and cranial-cervical junction are normal. 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 normal. Left vertebral artery and is with left PICA.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries. Left vertebral artery appears to be hypoplastic.

Output: 1. Acute ischemic infarct without evidence of hemorrhagic transformation on the left MCA territory, left frontal lobe precentral gyrus.2. Chronic ischemic infarct with encephalomalacia on the right MCA territory, inferior parietal lobule as well as left cerebellar hemisphere. 3. Nonspecific small vessel ischemic disease.4. No evidence of luminal stenosis, major vessel occlusion on post intra and extra cranial arterial system.5. No evidence of intracranial arterial aneurysm.


Instruction: Generate impression based on medical findings.

Input: 39-year-old male with left shoulder pain and weakness. Difficulty reaching. Suboptimal evaluation on multiple sequences due to patient motion artifact.ROTATOR CUFF: There is intermediate signal abnormality within the supraspinatus tendon indicating mild tendinosis. The supraspinatus muscle and tendon appear intact. There is a small partial thickness undersurface tear of the infraspinatus muscle at the level of its insertion on the greater tuberosity measuring approximately 6 mm in the AP dimension without significant retraction, involving less than 50% of the tendon width. There is interstitial tearing of the infraspinatus at the level of the myotendinous junction. The infraspinatus muscle appears intact. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: There is no significant fluid within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. Although this examination was not protocoled for evaluation of the acetabular labrum, there is heterogeneity and increased signal abnormality within the anterior superior glenoid labrum with associated deformity suggesting degenerative tearing.BICEPS TENDON: There is circumferential fluid within the tendon sheath of the long head of the biceps which may represent fluid extension from the joint versus a mild tenosynovitis. The tendon of the long head of the biceps appears intact. ADDITIONAL

Output: 1. Findings consistent with avascular necrosis of the humeral head as described above.2. Small partial-thickness rotator cuff tear without evidence of a full-thickness rotator cuff tear or retraction.


Instruction: Generate impression based on medical findings.

Input: psychosis, neuropsychiatric lupus. There is no evidence of acute ischemic or hemorrhagic lesion on this scan.There is no evidence of abnormal enhancement.Developmental venous anomaly (normal variation of venous drainage) is seen on the right temporal lobe superior temporal gyrus crossing underneath of the right Heschel's gyrus toward right lateral ventricle posterior horn ependymal vein.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate decreased luminal diameter of bilateral distal intracranial ICAs (left worse than right). In addition, bilateral proximal MCA M1 and bilateral ACA A1 segments also show decreased luminal diameter. However, distal MCAs and distal ACAs appear to be normal. Angiographically, these findings constitute Moyamoya syndrome.Vertebrobasilar system appears to be normal.Right Pcom artery appears to be patent and normal size.The left PCA is fetal origin.There is no intracranial arterial aneurysm.3D MRV brain post-gadolinium with maximum intensity projections of the superficial/deep intracranial venous drainage demonstrate normal flow enhancement in the superior sagittal sinus, transverse sinuses, sigmoid sinuses, internal cerebral veins, vein of Galen and straight sinus.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. No evidence of abnormal enhancement.3. DVA on the right superior temporal gyrus.4. Normal brain MRV.4. Bilateral distal intracranial ICA and proximal MCAs and ACAs luminal narrowing on MRA. This may represent Moyamoya syndrome. Clinical correlation is recommended.Discussed with Dr. Di-Ranieri at the time of this dictation.


Instruction: Generate impression based on medical findings.

Input: Mild aphasia and cognitive decline, assess for atrophy/cerebrovascular disease. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are minimal scattered bilateral cerebral white matter T2 hyperintensity, which are unchanged and 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. There is opacification in the right maxillary sinus, which appears to be atelectatic. The orbits, skull, and scalp soft tissues are unchanged. There is multilevel degenerative cervical spondylosis, with mild anterolisthesis of C3 on C4.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Unchanged mild probable chronic small vessel ischemic cerebral white matter disease.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: 33-year-old male with history of treated Ewing's sarcoma. Currently off therapy for 1.5 years, assess for recurrent disease. Again seen is a pelvic mass located between the bladder and rectosigmoid colon, measuring approximately 6.2 x 5.5 cm in transverse dimension (series 601, image 23) and 5.7 cm in craniocaudal dimension (series 401, image 22), not significantly changed since the prior study. This mass demonstrates predominantly increased signal intensity on T1- and T2-weighted images, with a low signal intensity rim and no enhancement on post-contrast images. The MRI appearance is compatible with blood products of a chronic hematoma. Mild mass effect on the adjacent rectosigmoid colon is unchanged. The remaining visualized soft tissues are normal.An irregular enhancing region of signal abnormality in the anterior aspect of the left sacroiliac wing appears similar to the prior study and likely represents a small focus of bone infarction.Also redemonstrated is a small round non-enhancing focus of decreased signal intensity on T1-weighted images in the posterior aspect of the left iliac wing. While nonspecific, this could represent a treated metastasis.Patchy intermediate signal intensity within the vertebrae, pelvis, and proximal femora likely represents residual red marrow and is unchanged. Bone marrow signal intensity is otherwise within normal limits.

Output: Post-treatment changes of pelvic Ewing's sarcoma, which appear similar to the prior study. No evidence of disease progression.


Instruction: Generate impression based on medical findings.

Input: Previous right tonsil cancer. Biopsy in July 2016 yielded fibrosis and chronic inflammation, negative for carcinoma. There are postoperative findings in the right tongue base region. There appears to be a somewhat ill-defined persistent area of enhancement in the right tonsillar sulcus and posterior tongue region, which measures up to 20 mm. There is a small retropharyngeal effusion. There is no significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable. There is mild multilevel degenerative spondylosis. The imaged intracranial structures and orbits are unremarkable. There is a small amount of fluid in the right mastoid air cells.

Output: Postoperative findings with a persistent area of enhancement in the right tonsillar sulcus and posterior tongue region, which may represent recurrent tumor and/or treatment effects. Otherwise, no evidence of significant cervical lymphadenopathy based on size criteria.


Instruction: Generate impression based on medical findings.

Input: 72 years Female (DOB:2/19/1944)Reason: dysesthesias of lower extremities in pt with possible TIA in 2013 History: as abovePROVIDER/ATTENDING NAME: ANDREW M DAVIS ANDREW M DAVIS The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 2.No abnormal mass lesions are appreciated intracranially.


Instruction: Generate impression based on medical findings.

Input: Ms. Watson-Pitts is a 57 year old female presenting with recently diagnosed right breast cancer. She presents today for MRI staging of disease. Mild parenchymal enhancement is noted bilaterally.Right breast: In the right lower inner breast, 4:00 location, there is a spiculated, enhancing mass measuring 3.6 x 2.5 x 1.7 cm. Susceptibility artifact from biopsy marker clip is present within the central aspect of this lesion, compatible with biopsy proven malignancy. Extending medially from this index lesion are multiple enhancing foci/masses, which are highly suspicious for additional satellite lesions. The largest of the satellite lesions is identified at the right lower inner breast, 7 o'clock location, measuring approximately 1.1 x 1.0 x 0.8 cm. The total span of abnormal enhancement in the right inferior breast measures approximately 6.2 x 5.3 cm.In addition, there are several enhancing foci in the right superior breast, which are also suspicious for additional satellite lesions. One of these enhancing foci in the right upper outer breast was biopsied, measuring approximately 1.0 x 0.9 cm.Diffuse skin thickening is identified around the right breast with a focal area of enhancement within the dermis at the 1 o'clock location, which may be related to recent postbiopsy changes. Multiple enlarged axillary lymph nodes including subpectoral lymph nodes are identified, the largest of which measures approximately 1.1 cm. One of these lymph nodes has a Hydromark clip present, compatible with recently biopsied axillary lymph node measuring approximately 0.8 cm.Left breast: In the left superior breast, 12 o'clock location (mid depth), there is a peripherally enhancing, circumscribed mass which corresponds exactly to the mammographically stable benign morphology mass with biopsy marker clip. There is no abnormal enhancement identified within the left breast.

Output: (1) Multiple enhancing masses and foci compatible with multicentric right breast cancer with multiple enlarged right axillary/subpectoral lymph nodes.(2) No MRI evidence of malignancy within the left breast.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: 43-year-old female with ankle pain and fracture of the lateral malleolus. Assess deltoid competency and for medial talar lesion. TENDONS: The extensor and flexor tendons appear intact. The peroneal tendons appear intact. LIGAMENTS: There is complete rupture of the anterior tibiofibular ligament. There is associated cortical irregularity along the lateral aspect of the tibial plafond which is suspicious for an avulsion fracture of the distal tibia. There is also rupture of the posterior tibiofibular ligament. There is increased signal abnormality within the distal tibiofibular syndesmosis. The deltoid ligament appears intact. The lateral collateral ligament complex appears intact. ARTICULAR SURFACES AND BONE: There is a fracture of the distal fibula at the level of the tibiotalar joint with slight medial displacement of the distal fracture fragment. There is cortical irregularity of the lateral aspect of the tibial plafond suspicious for an avulsion fracture of the distal tibia. There is also a linear focus of signal abnormality traversing the posterior malleolus suspicious for a nondisplaced fracture.Note is made of an osteochondral defect along the medial aspect of the talar dome which measures 1.2 cm in the AP dimension and 0.8 cm in the transverse dimension. There is associated 1 to 2 mm of cortical depression of the talar dome. There is fluid signal intensity surrounding this defect which is consistent with an unstable lesion. The osseous fragment demonstrates low signal intensity on T1 and T2-weighted images suggestive of sclerosis/osteonecrosis. There are cysts within the bone underlying this lesion which suggests that this finding may be chronic in etiology. Focus of increased signal abnormality within the anterior calcaneus appears most consistent with a benign vascular remnant. ADDITIONAL

Output: 1. Distal tibia and fibula fractures with associated injury/disruption of the distal tibiofibular syndesmotic complex as described above. The deltoid ligament appears intact, as clinically questioned.2. Findings suggestive of a chronic appearing unstable osteochondral defect along the medial aspect of the talar dome, with reference measurements provided above.


Instruction: Generate impression based on medical findings.

Input: Left shoulder pain and instability for several months. ROTATOR CUFF: The muscles and tendons of the rotator cuff are intact.SUPRASPINATUS OUTLET: No significant degenerative changes of the acromioclavicular joint. No fluid is present within the subacromial bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is irregularity of the anterior inferior labrum consistent with a cartilaginous Bankart lesion. The remainder of the labrum appears intact. There are no associated osseous fractures or deformities.BICEPS TENDON: Long head of the biceps tendon appears intact. ADDITIONAL

Output: Cartilaginous Bankart lesion. Rotator cuff is intact.


Instruction: Generate impression based on medical findings.

Input: There is a lobulated T2 hyperintense, nonenhancing lesion involving the deep lobe of the right parotid gland. Lesion measures up to 24 x 10 mm in the long and short axis, respectively, coronal series 301 image 36. There is no significant change in size since earliest available MRI dated 11/13/2015. There appears to be a small septation and possibly low signal posteriorly which may represent dependent debris.There are no abnormal masses or evidence of pathologic enhancement elsewhere in the neck. There are scattered subcentimeter lymph nodes which are nonspecific. No pathologically enlarged or necrotic lymph nodes are seen. Remainder of the salivary glands are unremarkable.

Output: 1. Nonenhancing cystic lesion involving the deep lobe of the right parotid gland most likely represents a benign cystic lesion such as lymphatic malformation. This lesion is unchanged since 11/13/2015. Additional follow-up or perhaps aspiration can be considered to exclude other etiologies such as necrotic node as clinically indicated.2. No suspicious neck masses or cervical lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: Right shoulder pain and weakness ROTATOR CUFF: There is thickening and intermediate signal intensity within the supraspinatus tendon indicating moderate tendinosis. There is perhaps focal undersurface fraying posteriorly but no evidence of a fluid-filled tear. The tendinosis extends posteriorly to affect the anterior fibers of the infraspinatus tendon which is otherwise intact. The supraspinatus and infraspinatus muscles are normal without evidence of strain or tearing. The teres minor and subscapularis tendons and muscles are normal.SUPRASPINATUS OUTLET: The acromioclavicular joint is normal and there is no frank fluid within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: No significant abnormality noted.

Output: Rotator cuff tendinosis and possible mild focal undersurface fraying but without a discrete fluid-filled tear.


Instruction: Generate impression based on medical findings.

Input: Right medial joint line pain. Evaluate for meniscus tear. MENISCI: There is a partial thickness radial tear of the posterior horn of the medial meniscus. There is also deformity of the posterior horn of the medial meniscus just medial to its root attachment which may reflect additional tearing and/or an adherent flap fragment of meniscal tissue from the aforementioned radial tear. There is also poorly defined increased signal intensity within the body of the medial meniscus suggesting intrasubstance degeneration that it appears to contact the tibial articular surface, perhaps reflecting undersurface fraying. The anterior horn of the medial meniscus appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is superficial degeneration and fissuring of the articular cartilage of the patella particularly along the median eminence and medial facet. There is a small subchondral cyst within the femoral trochlea centrally with mild heterogeneity of the overlying articular cartilage likely reflecting focal degeneration. There is superficial degeneration of the articular cartilage of the weightbearing portion of the medial femoral condyle. Mild heterogeneity of signal intensity of the articular cartilage of the lateral compartment may reflect mild degeneration, but this is equivocal. The remaining bone marrow signal intensity is normal.LIGAMENTS: Cruciate and collateral ligaments are intact. There is a small bony excrescence arising from the medial epicondyle of distal femur at the proximal attachment of the medial collateral ligament perhaps representing old trauma. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1.Medial meniscal tear as described above.2.Cartilage degeneration as described above.3.Joint effusion.


Instruction: Generate impression based on medical findings.

Input: MRI BRAIN: Redemonstrated is subarachnoid hemorrhage along the right frontal lobe convexity, right paramedian interhemispheric fissure and a trace amount in the right Sylvian fissure. It is difficult to compare to prior study, but appears to be similar in distribution. There are either two adjacent foci or one linear focus of diffusion restriction within the right frontal centrum semiovale. There is a new focus of diffusion restriction in the left parietal lobe, which is new compared to 4/16/2015. The previously seen foci of diffusion restriction in the left cerebellar hemisphere have resolved.The ventricles and sulci are unchanged. The basal cisterns remain patent. There is no midline shift or mass effect. There are tiny bilateral cerebellar ischemic strokes, which are chronic. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with mild to moderate chronic small vessel ischemic changes. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is partial opacification of the right maxillary sinus and complete opacification of the left maxillary sinus. There are bilateral lens implants.MRA HEAD: Redemonstrated is a 1-2 mm atherosclerotic aneurysm at the anterior genu of the right internal carotid artery, without change. The anterior communicating artery again demonstrates a tiny bulge on the right, likely representing an infundibulum and likely at the origin off a perforating branch. The intracranial internal carotid arteries are otherwise normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis.MRV HEAD: The left transverse sinus is hypoplastic, which a normal anatomic variant. The superior sagittal sinus, right transverse sinus, sigmoid sinuses, straight sinus, vein of Galen, internal cerebral veins, and several visualized cortical veins are patent. The inferior sagittal sinus is not visualized. There is flow related artifact at the junction of the bilateral transverse and sigmoid sinuses. There is no evidence of venous thrombosis.

Output: 1. Small infarct in the right frontal centrum semiovale as well as a new small infarct in the left parietal lobe.2. Redemonstration of subarachnoid hemorrhage along the right frontal convexity, right paramedian interhemispheric fissure and right Sylvian fissure. 3. Stable 1-2 mm atherosclerotic aneurysm at the anterior genu of the right internal carotid artery. 4. Tiny infundibulum arising from the right side of a small caliber anterior communicating artery, likely at the origin of a perforating vessel.5. No evidence of venous sinus thrombosis.


Instruction: Generate impression based on medical findings.

Input: Multiple sclerosis [G35], Reason for Study: ^Reason: please do dr javed MS protocol, compare to prior. History: progression MS Brain MRIThere are multiple FLAIR high signal intensities on bilateral periventricular white matter, including bilateral trigone area. These findings are nonspecific, however, considering the patient clinical history, these findings also are compatible with demyelinating disease such as multiple sclerosis.Comparing to prior scan performed outside institution, although the signal intensity of those lesions are slightly different, the number and distribution of FLAIR high signal intensity lesions appear to be unchanged.There is an no evidence of abnormal enhancement.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Lumbar MRIFor the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing. The conus medullaris terminates at the T12 level. There is no evidence of abnormal enhancement, cord compression or mass. Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: no neuroforaminal narrowing or spinal stenosis. L4-L5: Disc desiccation. Focal annular tear with minimal bulging of disc which abuts thecal sac. No neuroforaminal narrowing or spinal stenosis. L5-S1: no neuroforaminal narrowing or spinal stenosis.

Output: 1. Multifocal white matter FLAIR high signal intensity lesions which are consistent with demyelinating disease such as multiple sclerosis, unchanged since prior scan.2. Focal annular tear with disc desiccation at the level of L4-5 otherwise unremarkable lumbar spine MRI.


Instruction: Generate impression based on medical findings.

Input: 15 year-old male with history of infiltrating cerebellar astrocytoma status-post subtotal resection, here with headache. Evaluate for ICH. A right frontal shunt catheter has its tip in the left lateral ventricle. There is no significant ventricular dilation. The ventricular size is unchanged since the recent MRI.There is deformity of the cerebellar vermis with foci of calcification. This is compatible with residual tumor. However, evaluation of this is limited due to the lack of intravenous contrast.There is no evidence of intracranial hemorrhage.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. No evidence of intracranial hemorrhage. 2. Partially calcified mass is again seen in the posterior fossa. This is incompletely evaluated due to lack of intravenous contrast.3. Unchanged right frontal shunt catheter with no evidence of hydrocephalus.


Instruction: Generate impression based on medical findings.

Input: 43-year-old woman with right hip pain. Evaluate for labral tear. ACETABULAR LABRUM: The labrum is intact and normal in appearance. ARTICULAR CARTILAGE AND BONE: Bone marrow signal intensity is within normal limits.SOFT TISSUES: The soft tissues are unremarkable. ADDITIONAL

Output: Normal evaluation of the right hip.


Instruction: Generate impression based on medical findings.

Input: Altered mental status, visual hallucination. Evaluate for stroke. Nonenhanced head CT:CT is insensitive for detection of early acute strokes.There is no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus.The cortical sulci and ventricular system as well as CSF cisterns are within normal limits.Very subtle periventricular and subcortical low attenuation of cerebral white matter is suspected of small vessel ischemic disease. These findings are significantly less noticeable on this study compared to prior MRI exam.Calvarium is intact. Visualized paranasal sinuses, mastoid air cells and orbits are unremarkable.

Output: Very subtle findings of small vessel ischemic strokes of indeterminate age. Unremarkable exam otherwise.


Instruction: Generate impression based on medical findings.

Input: Multiple foci of T2 hyperintense signal in the periventricular, deep and subcortical white matter, as well as in the corpus callosum appear similar to the prior exam. No new lesions are identified. There is no associated enhancement. The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. Normal flow-voids are demonstrated in the major intracranial vascular structures. There is a subcentimeter probable Thornwaldt cyst. There is asymmetric fluid in the pneumatized left anterior clinoid process.

Output: No appreciable change in the intracranial demyelinating lesions, without associated enhancement.


Instruction: Generate impression based on medical findings.

Input: Ms. Williams is a 34-year-old female with a personal history of left breast lumpectomy in February 2013 for triple negative IDC. Patient did not receive any chemotherapy or radiation therapy. She has no current breast related complaints. There are innumerable scattered foci of enhancement seen in both breasts, compatible with marked background parenchymal enhancement. Left breast: Postsurgical changes are identified in the upper outer left breast, at site of prior lumpectomy. In the left lateral breast, anterior to the lumpectomy site, there is a 3.5 cm span of linear non-mass-enhancement identified with persistent type kinetics. This was not definitively seen on prior MRI. Right breast: Few scattered cysts are seen in the right breast. No abnormal enhancement is identified in the right breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: (1) 3.5 cm span of linear non-mass-enhancement in the lateral left breast located anterior to the lumpectomy changes. MR-guided biopsy is recommended for further evaluation. (2) Bilateral marked background parenchymal enhancement, which lowers the sensitivity and specificity of MRI. Of note, MRI is optimally performed during the second week of the patient's menstrual cycle.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.All results and recommendations were relayed to Nanna Sulai on 2/18/2015.


Instruction: Generate impression based on medical findings.

Input: Other specified disorders of muscle [M62.89], Reason for Study: ^Reason: assess hypodense lesion History: AMS Bilateral confluent FLAIR high signal intensity lesions bilateral hemispheres especially involving bilateral occipital lobes, bilateral thalami, bilateral frontal, posterior parietal and temporal lobes as well as cerebellar hemispheres. The left basal ganglia and left mesial temporal lobe also show FLAIR high signal intensity lesion. Comparing to prior scan, these lesions are likely to be new interval development or progression of prior scattered FLAIR high signal lesions.Constellation of above findings suggest MR evidence of PRES (posterior reversible encephalopathy syndrome) and differential diagnosis include HIV encephalitis.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.The left maxillary and ethmoid sinus show opacification which are related to prior traumatic fractures, grossly unchanged since prior scan.

Output: 1. Confluent bilateral supra and infra tentorial involvement of FLAIR high signal intensity lesions as described above, indicating possible diagnosis of PRES. Differential diagnosis include HIV encephalopathy, other white matter disease or low grade glioma but could be less likely.2. No evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement.3. No change of left basal ganglia and mesial temporal lobe abnormal FLAIR signal intensity lesions.


Instruction: Generate impression based on medical findings.

Input: Female 75 years old with elevated liver enzymes s/p ERCP 7/21/16 with findings suggestive of PSC vs secondary PSC vs PBCs s/p bilateral stents in place . Now recently with worsening LFTs and leukocytosis, evaluate. ABDOMEN:LIVER, BILIARY TRACT: The wall of the common bile duct is thickened and the lumen is irregular with a stricture of the proximal common duct at the level of Klatskin's point. Filling defects within the common bile duct representing either stones or air due to recent sphincterotomy. Multiple intrahepatic biliary strictures are also noted and unchanged. There is mild thickening of the gallbladder wall however the gallbladder is contracted and not well evaluated.Subcentimeter T2 hyperintense lesions near the dome of the liver are unchanged.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic duct is mildly irregular and dilated up to the level of the ampulla with a maximum diameter of 7 mm. Several subcentimeter side branch IPMNs in the pancreatic body are unchanged (series 3, image 15).ADRENAL GLANDS: Small left adrenal adenoma is redemonstrated.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Again seen within the infrarenal abdominal aorta is an intraluminal linear focus raising the question of focal dissection (series 11, image 28).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Thickening, irregularity and narrowing of the common duct appears similar to the previous exam. The differential diagnosis includes PSC, autoimmune cholangitis and infectious etiologies.


Instruction: Generate impression based on medical findings.

Input: There is a right transfrontal ventricular catheter that terminates in the region of the right foramen of Monro. There is unchanged mild high T2 signal surrounding the catheter. There is also unchanged mild nonspecific T2 hyperintensity in the left corona radiata. The third and lateral ventricles appear to be slightly smaller. Patency of the third ventriculostomy cannot be ascertained based on the available sequences. There is no midline shift or herniation. There is no evidence of acute infarction, hemorrhage, or mass. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is a left maxillary sinus retention cyst.

Output: Slight interval decease in size of the shunted ventricular system.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Female 37 years old Reason: Right shoulder rotator cuff injury History: Right shoulder pain. ROTATOR CUFF: There is focal poorly defined increased signal intensity seen on the fluid sensitive sequences along the myotendinous junction of the supraspinatus tendon that may represent a strain or perhaps focal degeneration, but we see no discrete tear. There is an insertional undersurface tear of the posterior fibers of the infraspinatus tendon involving just over 50% of the tendon thickness, but sparing the bursal surface fibers. The tear measures approximately 8 mm in the craniocaudal dimension. There is a cyst in the underlying humeral head. There is mild atrophy of the infraspinatus muscle.The teres minor muscle and tendon appear intact.There is thickening and increased signal intensity of the subscapularis tendon that extends into the subscapularis muscle which we suspect is iatrogenic due to infiltration of gadolinium during the procedure.We see no findings to suggest a full thickness rotator cuff tear.SUPRASPINATUS OUTLET: The acromioclavicular joint appears normal. We see no gadolinium within the subacromial/subdeltoid bursa. There is mildly increased signal intensity within the subacromial/subdeltoid bursa seen on the fluid sensitive sequences that may represent a mild bursitis.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is increased signal intensity and deformity of the anterior superior labrum that may represent a tear, but is of uncertain clinical significance. The inferior labrum appears normal. There is minimal posterior translation of the humeral head relative to the center of the glenoid.BICEPS TENDON: The tendon of the long head of the biceps is intact. ADDITIONAL

Output: 1.Partial-thickness undersurface tear of the infraspinatus tendon at its insertion.2.Poorly defined focal increased signal intensity along the myotendinous junction of the supraspinatus may represent a strain, but we see no full-thickness rotator cuff tear.3.Findings suggestive of a mild subdeltoid bursitis.4.Increased signal intensity within the anterior superior labrum may represent a tear, but is of uncertain clinical significance.


Instruction: Generate impression based on medical findings.

Input: 43 years, Female, brain metastases. Treatment planning MRI for SRS.. Again seen are multiple enhancing lesions consistent with metastatic disease with evidence of progression since 4/16/2016. Note slight differences in imaging plane slightly limit comparison of measurements with 7/19/2016 study. Lesions with measurements on the post gadolinium axial 3-D T1 series 4 are as described below:Right frontal lobe lesion measures 6 x 5 mm, previously 6 x 4 mm. Image 85. There is small amount of hemorrhage associated with this lesion has before. There is mild interval increase in surrounding edema.Left cerebellar lesion measures 7 x 11 mm, previously 6 x 9 mm. Image 54. There is mild associated edema which appears slightly increased in the interval.Two adjacent right occipital lesions, one measuring 8 x 9 mm previously 7 x 7 mm, and the other measuring 8 x 5 mm, previously 6 x 5 mm. Images 85 through 94. Lesions appear to be along the cortical surface and possibly along the leptomeninges as noted before. There is susceptibility effect compatible with small amount of hemorrhage associated with these lesions, which is new versus subtly present previously and increased in the interval. There is also increase in edema associated with these lesions.Dural based enhancing lesion along the right frontal convexity appears slightly larger as well measuring approximately 12 mm in thickness, previously 9 mm. Image 23. No significant intracranial mass effect associated with the above-mentioned lesions. No midline shift or herniation.

Output: 1. Examination for treatment planning. There appears to be slight enlargement of multiple metastatic lesions compared to 7/19/2016 and more notable progression when compared to 4/12/2016.2. As noted before right occipital lesions are along the cortical surface and may involve the leptomeninges. There is also a right frontal dural based lesion.


Instruction: Generate impression based on medical findings.

Input: 66-year-old male with known prostate cancer. Planning for MRI fusion biopsy. PELVIS:PROSTATE:Prostate Size: The prostate measures 6 cm in transverse, 4.2 cm in AP, and 5.3 cm in cranial caudal diameter.Peripheral Zone: There is a small (2 to 3 mm) focus of early contrast enhancement in the right apex (axial series 1401 image 971) without a discrete targetable lesion on the T2 or ADC sequences.Central Gland: Heterogenous appearance.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Small (2 to 3 mm) focus of early contrast enhancement in the right apex without a discrete targetable lesion on the T2 or ADC sequences.


Instruction: Generate impression based on medical findings.

Input: History of cT2N0 squamous cell carcinoma of the posterior hypopharynx, HPV negative s/p chemoradiation completed 10/20/14 and now presenting with recurrent disease at the posterior pharyngeal wall. There are post-treatment findings in the neck, with swelling and diffuse enhancement in the hypopharyngeal region, stranding of the subcutaneous tissues and other fat planes, as well as hyperenhancement of the submandibular glands. There appears to be a more focal subcentimeter plaque-like area of mucosal enhancement and thickening along the left posterior pharyngeal wall. However, the prevertebral space appears to be intact. There is no evidence of significant cervical lymphadenopathy based on size criteria. The thyroid appears to be unremarkable. The cervical spine appears to be unremarkable. The major cervical arterial flow voids appear to be intact. The imaged intracranial structures are unremarkable.

Output: Post-treatment findings in the neck with swelling and diffuse enhancement in the hypopharyngeal region. A more focal subcentimeter plaque-like area of mucosal enhancement and thickening along the left posterior pharyngeal wall may represent recurrent tumor, but is otherwise nonspecific. However, the prevertebral space appears to be intact.


Instruction: Generate impression based on medical findings.

Input: Reason: R/O progressive white matter abnormality History: Turner syndrome, intellectual disability, ADHD and behavior disorder Please note that gradient echo sequences are limited due to significant susceptibility artifact.There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are several scattered punctate T2 hyperintensities in the subcortical white matter of the frontal lobes bilaterally. 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 pineal gland is prominent measuring 9 mm. The orbits, skull and scalp soft tissues are grossly unremarkable. The paranasal sinuses are unremarkable.

Output: 1.Several scattered punctate subcortical T2 hyperintensities are nonspecific. 2.Incidentally noted prominent pineal gland which is probably benign and of no clinical significance.


Instruction: Generate impression based on medical findings.

Input: Metastatic breast cancer: headaches. There are multiple, approximately 10, supratentorial enhancing lesions. For example, a right occipital lobe peripherally enhancing lesion with mild susceptibility effect measures 10 mm in diameter, previously 5 mm, a new right inferior frontal lobe enhancing lesion measures 5 mm in diameter, a left lateral temporal lobe enhancing lesion measures 5 mm in diameter, previously 2 mm, and a new left periventricular white matter enhancing lesion measures 3 mm in diameter. The lesions are generally associated with mild vasogenic edema. There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles are normal in size and configuration, including cavum septum pellucidum and vergae. There is no midline shift or herniation. There is a 1 mm outpouching along the right aspect of the anterior communicating artery complex. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Interval increase in size and number of intracranial metastases.2. A 1 mm outpouching along the right aspect of the anterior communicating artery complex may represent an aneurysm or infundibulum.


Instruction: Generate impression based on medical findings.

Input: 19-year-old male with knee pain and slight effusion after falling on left knee. MENISCI: There is intrasubstance signal within the posterior horn of the medial meniscus that may reflect prominent vascularity or degeneration, but we see no tear. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage and bone marrow signal appears normal.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. No evidence of patellar chondral injury or PCL injury. No frank joint effusion.2. Elongated collection of fluid signal intensity within the popliteus muscle likely representing a ganglion of questionable clinical significance.


Instruction: Generate impression based on medical findings.

Input: 79 year old history of left mastectomy in 1999 now with positive contralateral (right) axillary node and supraclavicular nodes seen on CT. Recent MRI showed linear non-mass enhancement in the right upper outer breast measuring up to 3.9 cm. Patient presents for second look MRI directed ultrasound. On physical exam, there is no palpable mass.A targeted right ultrasound was performed for the area of concern seen on MRI. Targeted ultrasound of the right breast upper outer quadrant from the 9:00 through 12:00 locations was performed. There is no mass or suspicious areas seen to correspond to the findings on MRI.Incidental note is made of a dilated debris-filled duct in the periareolar region measuring 1.2 x 0.5 x 1.1 cm.

Output: No sonographic abnormality corresponding to the MRI findings in the right upper outer breast. Recommend MRI guided biopsy of the non-mass enhancement. Findings were discussed with the patient at the time of the exam. The BI-RADS on this report reflects findings on this exam only. This does not reflect MRI findings or known malignant right axilla lymph node.BIRADS: 1 - Negative.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: 3-year-old female with history of intermediate-risk neuroblastoma, off therapy evaluation. Please visualize area of consolidation noted on MRI performed 10/20/10. LUNGS AND PLEURA: Nodular pleural thickening posteromedially in the left apex measures 8 x 6 mm (image 14/59, series #4). This is in the previous location of the large left paraspinal mass. Previously seen consolidation in the right lung base on prior MRI is no longer evident. There are no pulmonary consolidations, nodules, or pleural effusions.MEDIASTINUM AND HILA: Soft tissue density mass in the anterior mediastinum with concave margins and conforming to the contour of the aorta is not significantly changed and consistent with normal thymus. No lymphadenopathy. Normal heart size. No pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: 1. Consolidation in the right lung base on prior MRI has resolved.2. Residual nodular left pleural thickening in the region of the previously described paraspinal mass.


Instruction: Generate impression based on medical findings.

Input: Metastatic head and neck cancer. Head CT:There is no evidence of intracranial hemorrhage or infarction. There is extensive soft tissue abnormality extending from masticator space through the foramen ovale into the right middle cranial fossa and into the right cavernous sinus, better seen on the prior MR study. This appears slightly less prominent. However the subtle interval difference may be secondary to imaging techniques. No new intracranial mass is seen.There is slight prominence of the right superior ophthalmic vein which is unchanged, probably secondary to involvement of mass at the right orbital apex and cavernous sinus, causing impairment of drainage of the vein.Neck CT:Extensive post-treatment changes are again present at the right maxillofacial region. There is extensive enhancing soft tissue abnormality extending from the masticator space, superiorly into the right orbit with involving the right orbital apex, and inferior and medial aspect of the right orbit, along the lamina papyracea. The lesion extends through the skull base, including the foraminal ovale, into the intracranial compartment. Soft tissue abnormalities are also seen in the right ethmoid air cells. There is opacification in the right frontal sinus and frontal sinus ostium, which likely represent trapped secretions. There is involvement of right pterygo-maxillary fissure, pterygopalatine fossa, sphenopalatine foramen, inferior orbital fissure, and foramen rotundum, which is better seen on prior MRI study. Accounting for sampling differences, there is no significant change of the extensive soft tissue abnormality. There is possibly minimal decrease at the right orbit. Opacification of right mastoid air cells is likely secondary to eustachian tube dysfunction.No evidence of adenopathy is seen in the neck.There is degenerative disease of the cervical spine, but no ossenous metastasis is identified.

Output: 1. Status post surgical changes in right maxillofacial region.2. Extensive soft tissue abnormality extending from the right masticator space through the skull base into the right middle cranial fossa, with involvement of the right orbit, cavernous sinus, and right ethmoid air cells. Perineural spread is better seen on prior MRI study. Accounting for sampling differences, there is no significant interval change. There is possibly minimal decrease of the lesion at the medial aspect of the orbit.


Instruction: Generate impression based on medical findings.

Input: 60-year-old male with ventricular ependymoma. Yearly follow-up. There is no restricted diffusion on DWI sequences.Again seen is a nonenhancing T2/FLAIR hyperintense oval lesion along the lateral wall of the left lateral ventricular body which measures 8 mm x 11 mm x 4 mm (series 8, image 26 and series 6, image 15) unchanged when remeasured in a similar manner. An additional 4 mm nonenhancing lesion with similar T2/FLAIR hyperintensity located more posteriorly is unchanged (series 8, image 21). The third previously noted lesion located more anteriorly within the left lateral ventricle is not well visualized on current images (series 1001, image 72). Previously referenced 6 mm x 11 mm T2 and FLAIR signal hyperintense lesion in the right centrum semiovale is stable compared to prior exam. No new intraparenchymal lesions are identified. Scattered periventricular and subcortical punctate hyperintense white matter lesions on the FLAIR and T2 images are also unchanged.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 show a small mucus retention cyst in the left maxillary sinus.

Output: 1. No significant interval change in nonenhancing left lateral ventricle subependymal lesions, with one of the previously noted lesions not well visualized on the current study. 2. Unchanged small right centrum semiovale lesion. 3. Scattered periventricular and subcortical white matter changes are again seen, nonspecific.


Instruction: Generate impression based on medical findings.

Input: 61-year-old female with history of aneurysm presents with left-sided tingling. There is no evidence of intracranial hemorrhage, mass or edema. Small punctate focus of hyperdensity in posterior parietal cortex with a convexity consistent with cavernoma seen on previous MRI.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Normal brain CT.


Instruction: Generate impression based on medical findings.

Input: The brain parenchyma appears normal in signal intensity. There are no masses, mass effect or midline shift. The midline structures appear normal in morphology. The cerebellar tonsils are in normal position. The pituitary gland is normal in size. The ventricles and sulci are symmetric and normal in size. Bilateral hippocampi appear within normal limits. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear.

Output: Negative MRI of the brain.


Instruction: Generate impression based on medical findings.

Input: Left foot pain. Wine cooler fell on dorsum of foot 6 weeks ago. No bone marrow signal abnormality is identified. No discrete fracture line is seen. There is a vitamin E capsule overlying the medial aspect of the base of the first metatarsal presumably representing the patient's site of pain. The visualized flexor and extensor tendons appear intact. Mild degenerative changes affect the talonavicular articulation. There is a small amount of fluid within the talonavicular joint without evidence of a large effusion. The imaged musculature of the foot is normal in appearance.

Output: Osteoarthritis of the foot without evidence of acute fracture. Otherwise no findings to account for the patient's pain.


Instruction: Generate impression based on medical findings.

Input: A patient submitted outside study for review. Submitted for review are digital mammographic images (10/1/14), ultrasound images of left breast (10/1/14) performed at Regenstein Breast Imaging Center. DIGITAL MAMMOGRAPHIC IMAGES (10/1/14):The breast parenchyma is extremely dense, which limits the sensitivity of the mammogram . A scar marker overlays anterior upper outer right breast. Two marker clips are present in the left breast, from prior benign biopsy.There are two large circumscribed masses are seen in the left breast, which correspond to the benign cysts on MRI (4/21/15). Scattered benign calcifications are noted in left breast.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in either breast. On MRI (4/21/15), a suspicious lesion was present in the right breast and subsequent MRI guided biopsy revealed the lesion to be malignant. On retrospect, no abnormal findings are seen in the right breast on the mammogram dated 10/1/14.ULTRASOUND IMAGES OF LEFT BREAST (10/1/14):Three simple cysts are visualized in the left breast, at 3:00, 6:00 and 9:00 position.

Output: No mammographic and sonographic evidence for malignancy.BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on medical findings.

Input: History of prostate cancer in right apex (Gleason 7). PELVIS:PROSTATE:Prostate Size: Prostate measures 3.9 x 5.1 x 3.5 cm (cc by transverse by AP)Peripheral Zone: There is heterogeneous low T2 signal that is asymmetrically more prominent on the right which slightly limits evaluation. Within the right apex there is a small focus is slightly more prominent low T2 signal (series 401 image 62) with corresponding low ADC signal suspicious for tumor.Central Gland: There are mild changes of benign prostatic hypertrophy.Seminal Vesicles: Seminal vesicles are unremarkable. No evidence of tumor invasion.Extracapsular Extension: No definite extracapsular extension is identified.BLADDER: There is a partially visualized dilated right distal ureter.LYMPH NODES: Contour abnormality adjacent to the right internal iliac vessels is felt to represent a small focal varix as opposed to a prominent lymph node based on series 1001 image 72 and 612. No definite pelvic or inguinal lymphadenopathy.BONES, SOFT TISSUES: Patchy bone marrow signal throughout the pelvis likely reflects residual red marrow. There are postsurgical changes in the right inguinal region.OTHER: There is a simple midline cyst at the base of the prostate gland in line with the urethra which may reflect either a mullerian duct or utricle cyst which measures 13 mm in maximum dimension.

Output: 1. Findings suspicious for tumor in the right peripheral zone apex. No evidence of extracapsular extension or metastatic disease.2. Contour abnormality adjacent to the right internal iliac vessels is felt to represent a small focal varix as opposed to a prominent lymph node based on series 1001 image 72 and 612. No definite pelvic or inguinal lymphadenopathyy otherwise.3. Partially imaged dilated right distal ureter.


Instruction: Generate impression based on medical findings.

Input: Clinical question: 87 year-old female with altered mental status, posturing. Signs and symptoms: Altered mental status. Non-enhanced CT of brain:There is no evidence of acute intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus. Cortical sulci, ventricular system, CSF cisterns remain within normal. Very subtle small vessel disease is suspected.Follow-up with an MRI is recommended.Calvarium, visualized orbits, mastoid air cells and middle air cavities are unremarkable.Paranasal sinuses are unremarkable with the exception of minimal sphenoid sinusitis.

Output: No evidence of acute intracranial findings.