Instruction: Generate impression based on medical findings.

Input: Altered mental status.Additional clinical history from electronic medical records: 44-year-old woman with ESRD on dialysis; missed her Wednesday and Friday dialysis. Admitted because of change in the LOC. The behavioral change can be due to encephalitis/meningoencephalitis/ seizures/ metabolic disturbance/ stroke (PRES, or ischemic stroke) MRI: There are multiple oval-shaped focal T2-hyperintense, T1-hypointense lesion in the cerebral white-matter that are somewhat perpendicularly oriented relative to the long axis of the lateral ventricles. There is multifocal punctate susceptibility effect in the cerebrum and cerebellum without associated edema, may reflect hemosiderin staining. These microbleeds are probably related to end-stage renal disease-associated microangiopathy. Otherwise, there is no acute intracranial hemorrhage or acute infarct. There is no mass-effect, midline shift or brain herniation. The ventricles, sulci and basal cisterns are mildly to moderately enlarged, reflecting underlying global brain volume loss. The major intracranial vascular flow voids are preserved.There are retention cysts in the maxillary sinuses. There has been bilateral eye lens placement. There is no gross destructive skull lesion or gross scalp soft tissue abnormality.MRV:The study is markedly limited, in part by patient motion and in part by lack of intravenous contrast. The superior sagittal and straight sinuses as well as the deep cerebral veins are grossly patent with preservation of their flow voids on T2/FLAIR conventional sequences.MRA:Slight irregularity of caliber involving the distal cervical internal carotid arteries likely represent artifact. Otherwise, there is no flow-limiting stenosis, occlusion or aneurysm of the major intracranial arteries.

Output: 1.Multifocal cerebral white-matter lesions are nonspecific with differentials including demyelinating disease, or prior ischemia or inflammation.2.There is no acute infarct. No findings to suggest encephalitis within the limits of noncontrast study. Multiple scattered foci of chronic microhemorrhage are nonspecific but may represent microangiopathy related to chronic renal disease.3.MRA shows no significant steno-occlusive disease.4.MRV is very limited by lack of contrast and by patient motion though there is no definite sign of occlusive thrombosis of the major dural sinuses. However, if there is high suspicion for venous thrombosis, consider contrast-enhanced CT venogram.


Instruction: Generate impression based on medical findings.

Input: Ms. Hollie is a 55 year old female with a personal history of right breast mastectomy in 2007 for IDC and left breast reduction treated with chemotherapy. Family history of breast cancer in two paternal aunts. She has no current breast complaints. Patient is status post mastectomy of the right breast. There is no abnormal enhancement seen in the right reconstructed breast or axillary region.There is minimal background parenchymal enhancement noted in the left breast. There is no abnormal enhancement seen in the left breast or axillary region.

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


Instruction: Generate impression based on medical findings.

Input: 59-year-old male patient with newly diagnosed prostate cancer, Gleason 6 adenocarcinoma left mid medial gland. Staging examination. PELVIS:PROSTATE:Prostate Size: 4.2 x 5.5 x 4.4 cm.Peripheral Zone: Numerous linear areas of low T2 signal with low ADC values are indeterminate. The largest on the right measures 1.0 x 0.7 cm (image 95, series 301) and the largest on the left measures 1.0 x 0.5 cm (image 95, series 301). Central Gland: The central gland is hypertrophied with BPH nodules.Seminal Vesicles: No evidence of involvement.Extracapsular Extension: No specific evidence of extraprostatic extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Areas of signal abnormality within the bilateral peripheral zone which is indeterminate for tumor. No specific evidence of extraprostatic extension.


Instruction: Generate impression based on medical findings.

Input: Altered mental status, unspecified [R41.82], Reason for Study: ^Reason: AMS; eval for leptomeningeal spread; NSCLC w mets to brain s/p recent stereotactic brain XRT History: see above There are a couple of focal enhancing lesion on the left posterior temporal lobe which are new lesions not seen on Apr 5 2016.Right frontal white matter lesion (series 12, image 9), right middle frontal gyrus (series 12, 7) image are seen, unchanged since prior scan.The right occipital intraaxial mass which abuts dura shows interval decrease in size since prior scan.  Patchy FLAIR high signal intensities on periventricular white matter indicating non specific small vessel ischemic lesions are seen, unchanged.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Interval development of new nodular enhancing lesions on the left posterior temporal lobe.2. Interval decrease in size of the right occipital lobe lesion since prior scan.3. Small nodular enhancing lesions at the right frontal lobe do not show any significant interval change.


Instruction: Generate impression based on medical findings.

Input: 72 year-old female with right hemipelvis retroperitoneal mass extending to the right hip There is a large fatty mass extending through the obturator foramen inferiorly and medial to the hip with several septations, but no enhancement. The mass measures 12.2 x 4.5 cm in largest AP and transverse dimensions and displaces the surrounding musculature. The underlying osseous structures appear unremarkable. A fibroid uterus is also noted.

Output: Fatty mass involving the right hip and pelvis most likely representing a lipoma, as described above.


Instruction: Generate impression based on medical findings.

Input: A patient submitted outside study for review. Submitted for review are digital mammographic images (5/24/16), images from ultrasound guided biopsy of right breast with specimen radiograph and postprocedural right mammographic images (5/27/2016), breast MRI (6/3/16), ultrasound images (6/9/16) performed at outside institution. DIGITAL MAMMOGRAPHIC IMAGES (5/24/16):The breast parenchyma is extremely dense (BiRADS Density Category D), which limits the sensitivity of the mammogram . A BB marker is placed at upper outer quadrant of right breast, denoting the area of palpable lump.There is a cluster of pleomorphic calcifications at the site of palpable lump in the right breast at upper outer quadrant. The cluster measures approximately 18 mm in AP dimension.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in left breast. IMAGES FROM ULTRASOUND GUIDED BIOPSY OF RIGHT BREAST WITH SPECIMEN RADIOGRAPH AND POSTPROCEDURAL RIGHT MAMMOGRAPHIC IMAGES (5/27/2016):An irregularly-shaped, ill-defined hypoechoic mass is detected at 11:00 position in the right breast, measuring 21 x 11 mm. This lesion likely corresponds to the area of pleomorphic calcifications on the mammogram., In addition, there is an ill-defined hypoechoic mass measuring 12 x 7 mm at 10:00 position. This mass is annotated as "area of pain/area of palp." There are a few benign-appearing lymph nodes in the right axilla.Ultrasound guided biopsy for the mass at 11:00 position and 10:00 position in the right breast were performed with an appropriate needle placement. Specimen radiograph demonstrates a single calcification within one of the cores.Postprocedural mammographic images demonstrate a coil clip at 11:00 position, near the cluster of calcifications, and a ribbon clip at 10:00 position in the right breast. Distance between these 2 clips is 23 mm on CC view, and 17 mm on ML view.Per outside radiology report, the pathology results for both sites were malignant.BREAST MRI (6/3/16):MR images were submitted with non-DICOM format, and this could not be processed at our workstation. We tried to upload the images from the original DVD, but again images could not be uploaded to our workstation.Pre and post contrast MR images uploaded to PACS are not interpretable, because only axial images are available and no subtraction images are available. On T2 weighted images and non-contrast T1 weighted images, there are two metallic artifacts, at posterior upper outer quadrant, corresponding to the biopsy clips. There are a few small cysts in the right breast.ULTRASOUND IMAGES (6/9/16):This study was performed for MR directed ultrasound after abnormal findings on the MRI performed 6/3/2016. Per outside radiology report, there was a small focal area of masslike enhancement in the retroareolar region in the right breast. On the provided ultrasound images, there is a simple cyst at retroareolar region, and a complicated cyst next to it. There are no suspicious findings in the ultrasound images.

Output: Biopsy proven malignancy in the right breast at upper outer quadrant. MRI provided from outside institution is not interpretable. MR directed ultrasound for the right retroareolar region demonstrated a simple cyst with a complicated cyst.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on medical findings.

Input: MRI brain:The study is motion degraded. The morphology of the brain parenchyma is within normal limits. There are a few scattered foci of white matter T2 hyperintensity, which is nonspecific but compatible with mild chronic small vessel ischemic changes. There is no restricted diffusion abnormality or abnormal signal on susceptibility weighted imaging. The ventricles and sulci are within normal limits. There is no midline shift or mass effect. No extra-axial fluid collection is identified. The orbits appear normal without evidence of mass. The midline structures and craniocervical junction are within normal limits. MRA brain:Image quality is suboptimal. The anterior and posterior intracranial circulation is patent. There is no evidence of aneurysm, vascular malformation, or flow limiting stenosis. There is fetal origin of the left PCA.

Output: 1.Mild chronic small vessel ischemic changes, but otherwise normal MRI brain for patient age. If there is high suspicion for orbital pathology, consider dedicated MR imaging of the orbits. 2.Normal MRA brain without evidence of PCA aneurysm.


Instruction: Generate impression based on medical findings.

Input: 7 years, Male, left-sided paresthesias. BRAIN MRI: Brain parenchyma appears within normal limits. No signal abnormality or intracranial mass is appreciated. No evidence of intracranial mass effect, midline shift, or herniation. No evidence of recent ischemia or hemorrhage. No hydrocephalus. No extra-axial collections. Sella and orbits are grossly within normal limits. There is trace mucosal thickening in the paranasal sinuses, which are otherwise clear. Mastoid air cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits. BRAIN MRA: The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. No evidence of aneurysms or vascular malformations.

Output: MRI of the brain appears within normal limits.MRA of the brain appears within normal limits.


Instruction: Generate impression based on medical findings.

Input: 48-year-old female with bilateral complex ovarian masses with pelvic pain, suspect endometriosis PELVIS:UTERUS, ADNEXA: Predominantly cystic left adnexal mass with enhancing septa has increased in size when compared to the prior exam now measuring 9.8 x 8.8 cm. The mass displaces the uterus to the right. A left ovary is not differentiated from this mass.A conglomerate mass in the right adnexa with predominantly solid enhancing tissue and tubular structures which may represent the fallopian tube. This conglomerate has intermediate T1 and T2 bright signal measuring 7.4 x 4.3 cm.A probable fibroid is noted within the posterior wall of the uterus.BLADDER: No significant abnormality noted.LYMPH NODES: Enlarged bilateral inguinal lymph nodes with the largest measuring 2.1 x 1.9 cm in the left inguinal chain. BOWEL, MESENTERY: There is mild tethered appearance to the anterior portion of the sigmoid colon which may reflect adhesive disease related to the pelvic pathology.BONES, SOFT TISSUES: Probable lipoma in the posterior left iliac wing.OTHER: Susceptibility artifact caused by metallic object in the subcutaneous tissue of the midline abdomen.

Output: 1.Bilateral adnexal masses as described above have increased in size since prior exam. Although findings may represent inflammatory disease with adhesions, malignancy is not excluded. Imaging features are not supportive of endometriosis.


Instruction: Generate impression based on medical findings.

Input: Shoulder instability ROTATOR CUFF: No significant abnormality noted.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is mild fraying of the posterior labrum but no full-thickness detachment is identified. There is mild flattening of the anterior aspect of the humeral head likely the result of remote dislocation.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Mild fraying of the posterior labrum without full-thickness detachment and mild flattening of the anterior humeral head, which is likely posttraumatic. This findings are not significantly changed from the prior exam and no additional abnormality is identified.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate for spondylolysis and/or disc herniation History: lbp with extension for 2 years worse now with some radicular sx in legs Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.No compromise to lumbar spinal canal or neural foramina.2.Although there are no indirect or direct findings to suggest spondylolysis on this exam, please not that plain films and CT are more sensitive in evaluating bony lesions such as pars defect relative to MRI.


Instruction: Generate impression based on medical findings.

Input: 49-year-old female with long-standing right hip pain, evaluate labrum. ACETABULAR LABRUM: Linear high signal is present within the anterior superior labrum (series 1001/14), which was equivocally present on the prior study, but is more distinct on today's examination.ARTICULAR CARTILAGE AND BONE: The bone marrow signal and articular cartilage is normal. SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Linear high signal within the anterior superior labrum concerning for a nondisplaced labral tear.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Bladder cancer with new lung primary. Evaluate for CNS metastases. Signs and symptoms: Lung and bladder cancer. CT of brain with contrast:Examination demonstrates multiple bilateral hemispheric and cerebellar metastatic lesions with enhancement and central necrosis and surrounding vasogenic edema. The metastatic lesion within the left cerebellum measures 16.8-mm x 20.7-mm. There is mass effect on the fourth ventricle without complete collapse of the fourth ventricle. There are multiple supratentorial metastatic lesions. The largest of these lesions is along the medial aspect of right temporal lobe and measures 16 mm times 60-mm on axial image 9. There is no evidence of midline shift or hydrocephalus. There is no evidence of leptomeningeal enhancement. Edema surrounding the metastatic lesions produces subtle focal mass effect only. No detectable hemorrhage.The bony density of calvarium is diffusely abnormal with numerous small areas of low density. This is concerning for diffuse miliary metastases lesions to the calvarium. Further study would nuclear medicine scan or an MRI is recommended.108 cc of Omnipaque 350 was utilized for the above study.

Output: 1.Multiple intracranial metastatic lesions two bilateral cerebral hemispheres and left cerebellum as detailed.2.There is only focal mass effect secondary to surrounding vasogenic edema of these tumors.3.There is no evidence of hemorrhage or midline shift or hydrocephalus.4.Diffusely abnormal density of the calvarium concerning for miliary metastatic lesions.


Instruction: Generate impression based on medical findings.

Input: Basilar invagination status post suboccipital craniectomy and C1 laminectomy for decompression of brainstem. There are recent postoperative findings related to suboccipital craniectomy and C1 laminectomy for decompression of brainstem, with a small amount of fluid and emphysema along the surgical approach. There is a dysmorphic clivus, a prominent dens, and basilar invagination with persistent indentation upon the medulla by the dens, although the degree of spinal canal stenosis at the level of the dens has diminished. There is also considerable interval decrease in the extent of T2 hyperintensity within the spinal cord at the level of the dens, perhaps now with mild volume loss of the spinal cord at this location. There is long-segment fine linear T2 hyperintensity that extends inferiorly from this lesion along the left aspect of the spinal cord. The vertebral bone marrow signal is unremarkable and the aliment of the cervical spine is anatomic, beyond the region of the craniocervical junction. There are right thyroid nodules, which measure at least up to 15 mm. There is mild mucosal thickening in the maxillary sinuses.

Output: 1. Recent postoperative findings related to suboccipital craniectomy and C1 laminectomy for decompression of brainstem in the setting of basilar invagination, with persistent indentation upon the medulla by the prominent dens, but decreased spinal canal stenosis and spinal cord edema at the level of the dens, with what may represent the development of myelomalacia and associated right Wallerian degeneration.2. Right thyroid nodules. A thyroid ultrasound may be useful for further evaluation.


Instruction: Generate impression based on medical findings.

Input: History of breast cancer in mother diagnosed at the age of 58 and sister diagnosed at the age of 48. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. A stable benign 4 mm enhancing focus is present at the 6 o'clock position of the right breast representing a benign intramammary lymph node. A few other scattered foci are also stable and not suspicious in appearance.No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on medical findings.

Input: CERVICAL: There is minimal 1 mm retrolisthesis of C3 on C4, C4 on C5 and C5 on C6. The osseous marrow is diffusely low on T1 and heterogeneous without associated STIR signal abnormality or enhancement. The vertebral body heights are intact. There is loss of T2 intervertebral disk signal especially at all levels from desiccation. The spinal cord signal is within normal limits. There is no suspicious enhancement.C2-3: Tiny central disk osteophyte complex with no spinal stenosis.C3-4: Small disk osteophyte complex and right uncovertebral hypertrophy with mild spinal canal and right neural foraminal stenosis.C4-5: Posterior disk osteophyte complex causing mild spinal canal stenosis no significant neural foraminal stenosis.C5-6: Disk osteophyte complex, ligamenta flava thickening causing mild spinal canal stenosis. Bilateral uncovertebral hypertrophy causing moderate left and mild right neural foraminal stenosis.C6-7: Small disk osteophyte complex with no spinal stenosis.C7-T1: Small posterior disk osteophyte complex with no spinal stenosis.THORACIC: There is mild motion degradation of some sequences limiting evaluation. There is normal alignment of the thoracic spine. The osseous marrow is diffusely low on T1 and heterogeneous without associated STIR signal abnormality or enhancement. There is loss of T2 signal in multiple thoracic disks from desiccation. The cord signal is within normal limits. There is no suspicious enhancement.There is no significant disk herniation, or spinal stenosis in the thoracic spine.LUMBAR: There is bilateral L4-5 facet facet edema extending into the pedicles, and small facet joint effusions with mild regional enhancement felt to be reactive from facet arthropathy. Elsewhere, the osseous marrow is diffusely low on T1 and heterogeneous without associated STIR signal abnormality or enhancement.The S1 vertebral body is lumbarized with the last well formed disk space being at S1-2. There is exaggerated lumbar lordosis. There is minimal grade 1 anterolisthesis of L4 on L5. The conus terminates at L2, within normal limits. The conus shows normal signal. There is heterogeneous the osseous marrow the sacrum in the bilateral iliac bones. T12-L1: No spinal stenosis or disk herniation.L1-2: No disk herniation or spinal stenosis.L2-3: Mild disk bulge and facet arthropathy with no significant spinal stenosis.L3-4: Mild disk bulge, ligamenta flava thickening and and facet arthropathy with mild right neural foraminal stenosis and no significant left neural foraminal stenosis and mild spinal canal stenosis.L4-5: Diffuse disk bulge asymmetric of the right, moderate bilateral facet arthropathy with small joint effusions, edema in the facets extending to the pedicles and regional enhancement. Mild/moderate bilateral neural foraminal stenosis and moderate spinal canal stenosis.L5-S1: Diffuse disk bulge, bilateral facet arthropathy and ligamenta flava thickening causing mild bilateral neural foraminal stenosis. No spinal canal stenosis.

Output: 1.No definite cord lesion or suspicious enhancement.2.Multilevel lumbar spondylosis with advanced L4-5 degenerative facetitis with small bilateral L4-5 facet effusions, reactive facet marrow edema and enhancement, all felt to be secondary to the patient's facet arthropathy at this level.3.Multilevel cervical spondylosis.4.Heterogeneous and low T1 osseous marrow signal, but without associated STIR signal abnormality or enhancement. This is felt to be a benign process, most likely related to anemia of any etiology or chronic smoking.


Instruction: Generate impression based on medical findings.

Input: Reason: assess for labral tear History: had traumatic dislocation and now 6mo instability ROTATOR CUFF: The supraspinatus and infraspinatus muscles and tendons appear intact. The subscapularis and teres minor muscles and tendons appear intact. There is subtle increased signal abnormality on fluid sensitive sequences within the superior muscle belly of the subscapularis.SUPRASPINATUS OUTLET: No fluid or intra-articular gadolinium is identified within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. There is separation of the anterior and superior labrum from the underlying glenoid at the level of the 12 o'clock position to the 3 o'clock position, which may reflect a normal variant sublabral foramen.BICEPS TENDON: The tendon of the long head of the biceps appears intact. ADDITIONAL

Output: Increased signal abnormality within the superior aspect of the muscle belly of the subscapularis which is nonspecific, but can be seen in subacute denervation or perhaps in Parsonage Turner syndrome.


Instruction: Generate impression based on medical findings.

Input: Paralysis agitans, DBS stage 1 today The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses demonstrate minor opacities. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Examination is limited for the purposes of stereotactic guidance for deep brain stimulator placement. There is no intracranial mass lesion or brain hemorrhage identified.MRI of the brain is within normal limits


Instruction: Generate impression based on medical findings.

Input: 49-year-old history of CHF 3 presenting with headache and dizziness x 2 days. Increased right-sided weakness and paresthesia. There is no evidence of intracranial hemorrhage, mass or edema. No definite acute cortical stroke is seen however MRI is recommended if concern for ischemia is present. Focal hypoattenuation in the left centrum semiovale consistent with old subcortical infarct. 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: No evidence of acute cortical stroke. Old left subcortical stroke.


Instruction: Generate impression based on medical findings.

Input: 22 years old Male. History of repeated shoulder dislocation (4 dislocations in the last 4 months). Evaluate for glenoid bony loss. IMAGE ACQUISITIONS: CT of the right shoulder without contrast The osseous structures of the glenoid are intact with no evidence of osseous Bankart's fracture.Depression at the superior lateral aspect of the humeral heads is consistent with Hill-Sachs deformity which was noted on prior MRI dated 7/15/2010

Output: 1.No abnormalities in the osseous components of the glenoid.2.Hill-Sachs deformity of the humeral head is noted.


Instruction: Generate impression based on medical findings.

Input: 62 years Male (DOB:1/2/1954)Reason: s/p SRS please compare HPROVIDER/ATTENDING NAME: STEVEN J. CHMURA STEVEN J. CHMURA The patient is status post left parietal lobe surgery and left-sided craniotomy for a mass previously present left precuneus. There is now some susceptibility effect along the left precuneus associated with some volume loss. There is no evidence for new enhancing lesion.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.On susceptibility weighted imaging there is a focus of susceptibility effect present in the left putamen of the basal ganglia which has been previously present. A punctate focus of susceptibility effect is present in the left dentate nucleus of the cerebellum. These foci of susceptibility have not changed since the prior exam.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening in the ethmoid air cells and right sphenoid sinus and to a lesser degree left maxillary sinus.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Status post left parietal lobe surgery without evidence for local recurrence.2.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.3.A couple microhemorrhages are present left basal ganglia and left cerebellar hemisphere which are too few to establish a pattern.


Instruction: Generate impression based on medical findings.

Input: 60-year-old female with knee pain. Assess for lateral meniscus tear. MENISCI: There is linear increased signal abnormality within the posterior horn of the lateral meniscus which extends to the tibial and femoral articular surfaces consistent with a complex tear with both a vertical and horizontal component. The anterior horn of the lateral meniscus appears intact. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is full-thickness articular cartilage degeneration along the weightbearing surface of the lateral femoral condyle above the posterior horn of the meniscus. There is relative sparing of the articular cartilage of the medial compartment. There is fraying of the articular cartilage of the patella, centrally.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Complex tear of the lateral meniscus as described above.2. Articular cartilage degeneration as described above.


Instruction: Generate impression based on medical findings.

Input: There is an elongated non-enhancing T2 hyperintense lesion that measures up to 14 mm in length and 5 mm in width within the anterolateral left larynx, centered in the region of the laryngeal vestibule. There is associated surrounding mild edema and enhancement with mild narrowing of the airway. Otherwise, there is no evidence of soft tissue mass or significant cervical lymphadenopathy in the neck. There is nonspecific fluid in the bilateral mastoid air cells. The osseous structures are otherwise unremarkable. The airways are patent. There is mil d prominence of the subarachnoid spaces anterior to the bilateral temporal lobes. The orbits are unremarkable.

Output: A cystic lesion in the left anterolateral larynx measures up to 14 mm and is associated with mild airway narrowing. The imaging characteristics are nonspecific and the evaluation is somewhat limited without an available preoperative comparison study. Nevertheless, differential considerations include residual congenital saccular laryngeal cyst and perhaps less likely a branchial apparatus anomaly or lymphatic malformation. Apparent mild surrounding inflammatory changes may be reactive or postoperative in nature, although superimposed infection cannot entirely excluded.


Instruction: Generate impression based on medical findings.

Input: A patient submitted outside study for review. Submitted for review are ultrasound images of left breast (10/26/2016), images from ultrasound guided biopsy of the left breast (11/3/2016), breast MRI (11/9/2016) performed at outside institution. Those studies are compared to the mammogram and ultrasound performed at University of Chicago on 11/10/2016. ULTRASOUND IMAGES OF LEFT BREAST (10/26/2016):An irregularly shaped hypoechoic mass measuring 13 x 11 mm is present at 5:00 position in the left breast. This is the same lesion located at 5:30 position in the left breast at the ultrasound study performed on 11/10/2016 at University of Chicago.IMAGES FROM ULTRASOUND GUIDED BIOPSY OF THE LEFT BREAST (11/3/2016):A needle biopsy of the left breast mass was performed with an appropriate needle placement. A marker clip is placed within the mass. The pathology result was malignant.BREAST MRI (11/9/2016):The study was performed with a protocol outlined in the outside radiology report.There is heterogeneous amount of fibroglandular tissue in both breasts.Marked parenchymal enhancement is noted bilaterally.A known cancer with a marker clip is demonstrated at posterior 5:00 position measuring 18 x 15 x 17 mm (AP x LR x CC). There is possible satellite lesion measuring 6 mm, located anterior to the main lesion. Total measurement including the main mass with possible satellite is 26 mm in AP dimension. This possible satellite is not the same one as seen at the ultrasound study on 11/10/2016 at University of Chicago. The satellite lesion seen on that ultrasound study is seen as a small focus attached to the lateral portion of the main mass on MRI.No other abnormal findings are seen elsewhere in the left breast or in the right breast.No abnormal lymph nodes are identified in either axillary region.

Output: Known left breast cancer with possible anterior satellite. MR-directed ultrasound for the possible satellite lesion is recommended. If no lesion is found on ultrasound study, MR guided biopsy should be considered.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required.


Instruction: Generate impression based on medical findings.

Input: Female, 85 years old, with hyperreflexia and falls. Evaluate for cervical stenosis, myelopathy. Alignment is anatomic. Vertebral body height and morphology are within normal limits. No evidence of pathologic marrow replacement or edema is seen. The visualized spinal cord is free of focal signal abnormality. No epidural lesions are suspected.C2-3: Posterior disc-osteophyte complex formation. No spinal canal or foraminal stenosis. C3-4: Posterior disc-osteophyte complex formation. No spinal canal or foraminal stenosis. C4-5: Posterior disc-osteophyte complex formation. Ligamentum flavum thickening. Mild spinal canal stenosis. Moderate right and mild left foraminal narrowing. C5-6: Posterior disc-osteophyte complex formation. No spinal canal stenosis. Severe left and moderate right foraminal narrowing. C6-7: Posterior disc-osteophyte complex formation. The spinal canal stenosis. Mild left foraminal narrowing. C7-T1: Posterior disc-osteophyte complex formation. No spinal canal stenosis. Mild left foraminal narrowing due largely to facet arthropathy.

Output: Degenerative disease of the disks and posterior elements is seen throughout the cervical spine. While there are no areas of severe spinal canal stenosis or obvious spinal cord impingement, significant neuroforaminal narrowing is evident on the right at C4-5 and bilaterally at C5-6.


Instruction: Generate impression based on medical findings.

Input: Male 70 years old Reason: hx of prostate cancer, interested in focal ablation Signal degradation from bilateral total hip arthroplasties, limits evaluation.PELVIS:PROSTATE:Prostate Size: The prostate gland measures 5.2 x 3.8 x 4.9 cmPeripheral Zone: There is a dominant focus of signal abnormality in the right peripheral zone at the base extending inferiorly to the apex. This measures approximately 1.1 x 1.7 cm.Central Gland: Heterogeneous.Seminal Vesicles: T1 hyperintense signal within the bilateral seminal vesicles suggestive of hemorrhage.Extracapsular Extension: There is extracapsular extension of the aforementioned signal abnormality.BLADDER: No significant abnormality noted.LYMPH NODES: No significant lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Dominant focus of signal abnormality in the right peripheral zone which extends from the base through the apex and is suspicious for a focus of prostatic carcinoma. There is extracapsular extension.


Instruction: Generate impression based on medical findings.

Input: Metastatic NSCLC and pancytopenia. No focal neurological deficits. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few scattered punctate foci of high T2 signal in the cerebral white matter, without associated enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. However, there is partly imaged bilateral cervical lymphadenopathy.

Output: 1. A few scattered punctate foci of high T2 signal in the cerebral white matter are nonspecific, but could represent chronic small vessel ischemic disease. Otherwise, no evidence of intracranial metastases. 2. Partly imaged bilateral cervical lymphadenopathy. Dedicated neck imaging may be useful for further evaluation.


Instruction: Generate impression based on medical findings.

Input: 57 year old with right bloody nipple discharge There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.T1 high signal fluid is seen within a single duct from the nipple to retroareolar region in the right breast, consistent with blood containing fluid. On contrast images, there is a thickened ductal wall with enhancement along the high signal fluid for 13 mm. There is no intraductal enhancing lesion or suspicious breast lesions in the right breast.No abnormal enhancement is seen in left breast. No abnormal lymph nodes are identified in either axillary region.

Output: Findings consistent with ductulitis at the right nipple - retroareolar region. No MR evidence of malignancy.BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed.


Instruction: Generate impression based on medical findings.

Input: History of Crohn's disease. Evaluate for active inflammation and stricture. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology signal intensity and enhancement. No biliary ductal dilatation. No focal suspicious lesion. No vascular abnormality. Normally distended gallbladder.SPLEEN: The spleen is normal in size.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The small and large bowel is normal in caliber. The terminal ileum is normal in wall thickness without adjacent inflammatory changes. No abnormal postcontrast enhancement or restricted diffusion. No fluid collections. No significant fibrofatty infiltration. Small nonspecific right mesenteric lymph nodes. Normal appendix.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of active bowel inflammation. No significant stricture or bowel dilatation.


Instruction: Generate impression based on medical findings.

Input: 63-year-old male with history of thymic carcinoma. Status post chemo/RT, please evaluate, CHEST:LUNGS AND PLEURA: Multiple small calcified micronodules are identified consistent with a previous granulomatous infection. Centrilobular emphysema is again noted. No pleural effusion can be identified.MEDIASTINUM AND HILA: There is redemonstration of an anterior mediastinal mass measuring 28 mm x 14.3 mm (image 47, series 4), previously, measuring 15 mm x 28.8 mm. Port-A-Cath with its tip in the SVC. A coronary artery and aortic calcifications. Cardiac size is normal. There is no evidence of pericardial effusion.No mediastinal or hilar lymphadenopathyCHEST WALL: Right-sided port. Degenerative changes in the thoracic spine.ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. Hypodense subcentimeter lesions, most likely representing cystsSPLEEN: No significant abnormality notedADRENAL GLANDS: Right adrenal nodule is stable, measuring 14.1 mm x 18.5 mm (image 92, series 4).KIDNEYS, URETERS: Redemonstration of a small exophytic mass arising from the superior pole. The left kidney. (Image 96, series 4). Dedicated CT or MRI is recommended to evaluate this lesion. Several subcentimeter hypodense lesions in the right kidney, most represent cysts. Again noted is an accessory right renal artery.PANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Atherosclerotic diseaseBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1. Anterior mediastinal soft tissue mass is stable and presumably represents the residual of this patient's thymic carcinoma.2. Stable right adrenal nodule and small exophytic left renal mass that is indeterminate. Dedicated CT or MRI is recommended to evaluate these lesions.3. Centrilobular emphysema with evidence of a previous granulomatous infection.4. No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: 61-year-old male patient with cirrhotic liver morphology and lymph node seen on ultrasound. ABDOMEN:LIVER, BILIARY TRACT: There is mild intrahepatic biliary ductal dilatation. There is extrahepatic biliary ductal dilatation to the level of the ampulla, measuring up to 1.6 cm in maximal diameter in the common hepatic biliary duct and 1.1 cm in the common bile duct. No stone or enhancing lesion is seen at the level of the ampulla. Mild iron deposition is noted.Gallbladder containing gallstones.Hepatic vasculature is patent. No suspicious enhancing lesions in the liver parenchyma.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic duct in the head and neck is mildly dilated and measures up to 5 mm in maximal dimension. No mass is seen in the pancreas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter T2 hyperintense lesions in the bilateral kidneys most likely represent cysts.RETROPERITONEUM, LYMPH NODES: Lymph node at the porta hepatis measures 2.2 x 1.1 cm (series 601 image 18).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Mild intrahepatic biliary ductal dilatation and extrahepatic biliary ductal dilatation to the level of the ampulla without evidence of obstructive stone or enhancing mass. These findings are suggestive of a benign stricture at the level of the ampulla.2.Stable lymph node at the porta hepatis.


Instruction: Generate impression based on medical findings.

Input: Reason: ro partial biceps tendon tear History: biceps pain LIGAMENTS: The proximal fibers of the radial collateral ligament proper appear thickened and are of increased signal intensity which may reflect a chronic tear. The ulnar collateral ligament appears normal.TENDONS: The tendon of the long head of the biceps appears normal as does the brachialis. The common flexor tendon appears intact. There is increased signal intensity within the anterior undersurface fibers of the common extensor tendon compatible with a partial-thickness undersurface tear.ARTICULAR SURFACES AND BONE: Mild osteoarthritis affects the elbow with small defects of the articular cartilage and subchondral cysts within the distal humerus and proximal ulna.SURROUNDING STRUCTURES: There is mild increased signal intensity within the brachioradialis, supinator, and to a lesser degree the pronator teres muscles. We see no masses. There is no fatty atrophy.ADDITIONAL

Output: 1. Normal-appearing biceps tendon without tear.2. Increased signal intensity within the anterior fibers of the common extensor tendon suggesting a partial thickness undersurface tear / mucoid degeneration with thickening and increased signal intensity of the underlying proximal fibers of the radial collateral ligament proper which may also reflect an underlying chronic tear. The current clinical significance of this finding is uncertain.3. Mild edema type signal within the brachioradialis, supinator, and pronator teres muscles without clear etiology.


Instruction: Generate impression based on medical findings.

Input: Reason: Right knee continued anterior and medial knee pain, s/p patellar microfracture 5/15, evaluate for healing History: Right knee pain MENISCI: Again seen is branching increased signal intensity within the posterior horn of the medial meniscus indicating a complex tear involving the red and red/white zones. There is intermediate signal intensity which extends to the tibial and femoral articular surfaces, however, there is a new fluid-filled defect along the undersurface of the medial meniscus at the junction of the body and posterior horn that indicates a new tear. The anterior horn appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is thinning of the articular cartilage of the medial facet of the patella with heterogeneity of the signal intensity of the remainder of the cartilage which likely represents a combination of chondroplasty, degeneration and perhaps immature cartilage secondary to the stated history of prior microfracture. There is a more focal defect along the median eminence that likely represents prior chondroplasty at the site of a prior articular cartilage cleft seen on the prior MRI examination. There is a small focus of poorly defined low signal intensity within the femoral trochlea, centrally, that may represent a small focus of degeneration. There appears to be increased signal intensity of the articular cartilage within the medial tibial plateau underlying the aforementioned medial meniscal tear suggesting focal degeneration. There is a small adjacent osteophyte. The lateral compartment articular cartilage appears intact.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact. There is a small amount of fluid within the deep infrapatellar bursa.ADDITIONAL

Output: 1. Complex tear of the medial meniscus with new fluid-filled defect along its undersurface.2. Thinning and heterogeneity of the articular cartilage of the medial facet of the patella likely represents a combination of chondroplasty, degeneration and perhaps immature cartilage related to the stated history of prior microfracture.3. Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: History of cirrhosis. Cystic pancreatic lesion. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology with T2 hyperintense particular changes compatible with fibrosis. Segment VIII subcentimeter intrinsically T1 hyperintense lesion without restricted diffusion, unchanged, likely a dysplastic nodule. Findings of iron deposition. No suspicious focal lesion. No biliary ductal dilatation. Multiple subcentimeter T2 hyperintense foci are too small to characterize but likely represent simple cysts.Normally distended gallbladder.SPLEEN: Perisplenic varices.PANCREAS: The T2 hyperintense nonenhancing lesion in the uncinate process measures 4.6 x 3.0 cm (series 8/13), compared to 3.8 x 2.4 cm previously. It contains 2 thin septations without mural nodularity. No definite communication with the pancreatic duct is apparent. The main pancreatic duct is normal in caliber.Decrease in intrinsic T1 weighted signal intensity of the pancreatic parenchyma.Pancreas divisum.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Minimal basilar atelectasis.

Output: 1.Interval mild increase in size of the uncinate process cystic lesion now measuring 4.6 cm with at least 2 peripheral thin septations without mural nodularity or suspicious enhancing components. 2.Cirrhotic liver morphology without suspicious focal lesion. Stable probable dysplastic nodule.


Instruction: Generate impression based on medical findings.

Input: Male 58 years old Reason: cervical stenosis and progressive extrapyramidal symptoms of uncertain origin History: brisk reflexes. MRI brain:There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRI C-spine:The craniovertebral junction appears within normal limits. The cervical spine alignment is maintained and the cervical vertebral bodies are appropriate in height. There is variable multilevel disc height loss most prominent at the C5-6 level. There is no focal worrisome marrow signal abnormality. Likely benign hemangiomas involving the T1 and T3 vertebral bodies. The cervical spinal cord has normal signal characteristics and overall morphology. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.Interspace observations:C2-3: Small left greater than right disc osteophyte complex and mild right greater than left facet arthropathy. No significant spinal canal or neural foraminal compromise. No interval changes.C3-4: Small disc osteophyte complex which is slightly progressed compared to the prior exam and now has a small left foraminal disc protrusion, uncovertebral and facet hypertrophy. Minimal right and moderate left neural foraminal narrowing. No spinal canal stenosis. C4-5: Small disc osteophyte complex, uncovertebral and right greater than left facet hypertrophy which has progressed slightly compared to the prior exam. Moderate bilateral foraminal narrowing. No spinal canal stenosis.C5-6: Disc osteophyte complex, left greater than right uncovertebral spurring and mild facet hypertrophy which has mildly progressed. Mild right and moderate to severe left neural foraminal narrowing. No spinal canal stenosis.C6-7: Small disc osteophyte complex, slightly progressed. Bilateral uncovertebral spurring and mild facet arthropathy. Mild bilateral neuroforaminal narrowing. No spinal canal or right neuroforaminal stenosis.C7-T1: Small disc osteophyte complex with a small left paracentral disc which lesion which contributes to mild left foraminal narrowing. No spinal canal stenosis.

Output: No acute abnormalities involving the brain.Multilevel degenerative changes involving the cervical spine which have mildly progressed compared to the previous exam from 3/9/2013 without spinal canal stenosis. Scattered foraminal narrowing is seen, most severely affecting C5-6 on the left.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: 54 year old female. Right hip labral debridement, microfracture of acetabulum and iliopsoas release. Continued pain despite PT, NSAIDS. Evaluate for healing of microfracture and a new labral tear. ACETABULAR LABRUM: Again seen is intermediate signal abnormality in most of the anterior labrum, likely representing degenerative tearing and postsurgical change.ARTICULAR CARTILAGE AND BONE: Near full thickness to full-thickness cartilage loss in the right anterior superior femoral and acetabular cartilage, stable to mildly increased in extent. New subchondral marrow edema and small cysts in the acetabulum, probably degenerative in etiology. Small acetabular and femoral osteophytes. Postsurgical scalloping along the femoral head/neck junction, unchanged.Large field-of-view images show mild osteoarthritis of the left hip.SOFT TISSUES: Small lipoma in the iliopsoas near the musculotendinous junction, unchanged. ADDITIONAL

Output: 1. Intermediate signal abnormality in most of the anterior labrum likely representing a combination of extensive degenerative tearing and postoperative changes, not significantly changed.2. Near full thickness to full thickness cartilage loss of the superior femoral and acetabular surface, stable to mildly increased in extent.


Instruction: Generate impression based on medical findings.

Input: Brain: There is no restricted diffusion to suggest acute ischemia. Scattered predominantly subcortical white matter T2 hyperintense foci are nonspecific, unchanged in number and distribution compared to 1/29/2015. Otherwise, the signal intensity within the brain parenchyma is unremarkable. There is no abnormal focus of enhancement. The ventricles and sulci are normal in size. No regional mass effect, midline shift, or herniation. The visualized orbits are normal. The paranasal sinuses are grossly aerated. There is a small amount of fluid in the right mastoid air cells, unchanged. Flow voids are visualized in the major vessels of the intracranial circulation indicating patency.Neck:Nasopharynx, oropharynx, and hypopharynx are unremarkable without mass lesion or abnormal enhancement. Parotid and submandibular glands are normal in appearance without mass lesion. There is a 2 cm cyst in the right thyroid lobe. There are multiple predominantly subcentimeter lymph nodes in the neck measuring up to 1 cm at level II on the right (series 14, image 20). The airway is patent. Expected vascular flow voids are present demonstrating patency.

Output: 1.Scattered predominately subcentimeter cervical lymph nodes measuring up to 1 cm at level II on the right.2.MRI brain without significant interval change. Scattered T2 hyperintense foci in the subcortical and periventricular white matter are nonspecific.


Instruction: Generate impression based on medical findings.

Input: Possible cerebellar infarct. There is a moderate degree of cerebral white matter T2 hyperintensity, primarily in a periventricular distribution. Aside from a mega cisterna magna, the cerebellum appears to be unremarkable. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There are secretions and mucosal thickening in the right maxillary, right frontal, and left sphenoid sinuses. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: 1. Probable chronic small vessel ischemic disease, but no evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Findings suggestive of sinusitis.


Instruction: Generate impression based on medical findings.

Input: 35 years, Female, Reason: 35 yo female with hx of desmoid tumor; please evaluate for recurrence and/or abnormalities History: desmoid tumor. ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Visualized liver without significant change.Lobulated lesion in the left hepatic lobe with high T2 signal and progressive peripheral nodular enhancement is unchanged in size measuring 2.3 x 2.0 cm (8/14) and likely represents a hemangioma.Three adjacent lesions in the right hepatic lobe (8/7, 8/9, 8/10 also have signal characteristics suggestive of a hemangiomas. A few punctate cysts are unchanged as well.SPLEEN: Small splenules.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Postsurgical changes in the right rectus muscle. No evidence of local recurrence.OTHER: No significant abnormality noted.

Output: 1.No evidence of local desmoid recurrence.2.Hemangiomas within the liver are unchanged.


Instruction: Generate impression based on medical findings.

Input: BRCA2 positive There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. A few scattered enhancing foci are present, none suspicious in appearance. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. Annual MRI screening is recommended based on her history. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on medical findings.

Input: Left hip pain There is no evidence of fracture or avascular necrosis of the left hip. The marrow signal of the remaining pelvis is normal. A small amount of fluid is noted within the left hip joint.There is nonspecific increased signal within the vastus intermedius and medialis muscles, the extent of which is not fully included on the exam.

Output: 1. No osseous abnormality, specifically no evidence of fracture or avascular necrosis of the left hip.2. Nonspecific increased signal within the left vastus musculature, the extent of which is not fully included on this exam.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old, with unspecified abnormalities of gait and mobility, paresthesias skin, cervicalgia, abnormal reflexes. Motion artifact is still present on this examination, though improved relative to the prior study.A reversal of the cervical lordosis is again seen centered at C5-6. Trace retrolisthesis of C5 relative to C6 is unchanged. Elsewhere, sagittal alignment is unremarkable.Vertebral body height and morphology are within normal limits. Degenerative endplate edema is seen at C5-6 and C6-7. Elsewhere, no marrow edema or pathologic marrow replacement is observed.No epidural abnormalities are suspected. The spinal cord shows normal signal intensity and morphology within the limitations of motion artifact.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: No spinal canal stenosis or neuroforaminal narrowing. C4-5: Minimal posterior disc-osteophyte complex formation. No spinal canal or foraminal stenosis. C5-6: Posterior disc-osteophyte complex formation contributing to mild spinal canal stenosis and moderate bilateral foraminal narrowing. C6-7: Posterior disc-osteophyte complex formation causing no significant spinal canal stenosis. Moderate bilateral foraminal narrowing.C7-T1: No spinal canal stenosis or neuroforaminal narrowing.

Output: Disc degeneration is seen most notably affecting the C5-6 and C6-7 levels. Both levels show evidence of foraminal narrowing, and there is a mild generalized spinal canal stenosis at C5-6.


Instruction: Generate impression based on medical findings.

Input: 67 years Female (DOB:2/10/1949)Reason: lue radiculopathy History: samePROVIDER/ATTENDING NAME: RICHARD W KANG RICHARD W KANG The cervical vertebral bodies are appropriate in overall height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine. There is mild anterior subluxation of C4 on C5.At C2-3 there is no significant compromise to the spinal canal. There is left-sided facet hypertrophy at this level. There is narrowing of the left neural foramen at this level.At C3-4 there is no significant compromise to the spinal canal. There is left-sided facet hypertrophy at this level. There is narrowing of the left neural foramen at this level.At C4-5 there is mild facet hypertrophy at this level. There is mild anterior subluxation of C4 on C5. At C5-6 there is a right paramedian disc extrusion present at this level which is broad-based. It extends behind the adjacent endplates and impresses on the ventral aspect of thecal sac partially patient's spinal fluid ventral and posterior the spinal cord. Mild-to-moderate degree of spinal stenosis.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this level associated partial effacement of spinal fluid ventral and posterior the spinal cord.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There are multilevel degenerative changes present cervical spine with a mild to moderate degree of spinal stenosis C5-6 related to a disc extrusion. There is also multilevel encroachment of neural foramina involving the left neural foramen at C2-3, left neural foramen at C3-4, bilateral neural foramina at C5-6 and bilateral neural foramina at C6-7. There is mild subluxation at C4-5.


Instruction: Generate impression based on medical findings.

Input: Parkinsonism and cognitive issues. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is blurring of the susceptibility effect in the substantia nigrosomes bilaterally, with loss of the "swallow tail sign". There are a few scattered punctate foci of T2 hyperintensity int eh cerebral white matter. The ventricles and sulci are mildly prominent diffusely due to cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is fluid signal in the mastoid air cells, which may represent an effusion.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Blurring of the susceptibility effect in the substantia nigrosomes bilaterally can be a manifestation of Parkinson's disease.


Instruction: Generate impression based on medical findings.

Input: Clinical question of corner assess post op. Signs and symptoms: Status post right craniotomy. Nonenhanced head CT:Examination demonstrate expected postoperative changes of a large right-sided suboccipital craniectomy/repair. There is interval removal of previously noted large tumor in the right cerebellopontine angle. Subtle increased density within the right internal auditory canal is present on axial image 8 which may represent minimal residual tumor. Follow-up with an MRI is recommended. Widening of right cerebellopontine angle cistern is as result of prior tumor and postop change. Subtle deformity of the right cerebellum and right aspect of the pons is believed to be result of prior long-standing mass effect from tumor.There is also subtle deviation of the fourth ventricle across the midline to the left as was noted on preoperative study.There is no evidence of parenchymal hemorrhage or edema.Images through supratentorial space demonstrate no definitive evidence of abnormality.

Output: Expected postoperative changes of a large right suboccipital craniectomy and repair repair for removal of tumor.


Instruction: Generate impression based on medical findings.

Input: Female 54 years old Reason: stage IV uveal melanoma s/p hepatic embo/RFA History: assess for disease status ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. Segment 6 lesion with peripheral discontinuous enhancement and progressive fill in is unchanged in size measuring 1.9 x 1.1 cmThere is hyperenhancement of the medial aspect of the caudate lesion possibly reflecting post therapy changes.There are 2 subtle subcentimeter lesions in segment 4A and B suspicious a small new metastatic deposits.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.2 new subcentimeter lesions in segment 4 of the liver suspicious for small new metastatic foci.2.Post therapy changes in the caudate.


Instruction: Generate impression based on medical findings.

Input: Right hip pain, hit by a bus at age 4, fractured pelvis, groin pain, evaluate for labral tear ACETABULAR LABRUM: A very small tear is seen at the base of the right anterosuperior labrum.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted. Normal bone marrow signal.SOFT TISSUES: No significant abnormality noted. The pelvic muscles are unremarkable.ADDITIONAL

Output: Very small tear of the base of the right anterosuperior acetabular labrum.


Instruction: Generate impression based on medical findings.

Input: The cerebellar tonsils descend below the level of the foramen magnum by at least 5 mm depending on the level of measurement. There is, however, only mild crowding in the posterior fossa and the CSF spaces appear patent. There are no masses, mass effect or midline shift. There is no abnormal enhancement within the brain. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. The ventricles and sulci are normal in size. 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: 1.Cerebellar tonsils descending below the level of the foramen magnum compatible with a Chiari I malformation. Clinical correlation is recommended to determine whether this may be related to the patient's symptoms.2.No additional abnormalities noted to explain the patient's headache.


Instruction: Generate impression based on medical findings.

Input: Metastatic germ cell tumor: headache. There is an enhancing lesion in the occipital bone, which measures up to 10 mm. There is also an enhancing lesion in the right parietal bone There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are unremarkable. There are small bilateral maxillary and left frontal sinus retention cysts.

Output: Small skull lesions likely represent metastases. Otherwise, no evidence of intracranial metastases.


Instruction: Generate impression based on medical findings.

Input: Hearing loss. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is an expected degree of myelination. There is persistent mild prominence of the lateral ventricles. The cerebral aqueduct is patent. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is mild plagiocephaly.Internal auditory canals: The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. There is small amount of fluid signal in the bilateral mastoid air cells and middle ears.

Output: 1. A small amount of fluid signal in the bilateral mastoid air cells and middle ears is nonspecific.2. No gross inner ear abnormalities.3. Persistent mild ventriculomegaly.4. No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on medical findings.

Input: Wrist pain and swelling LIGAMENTS: No significant abnormality noted.TRIANGULAR FIBROCARTILAGE COMPLEX: The distal portion of the TFCC is not well seen as there is some intermediate signal intensity. The more proximal portion is intact.TENDONS: This proximal to the ulna, extensor carpi ulnaris tendon demonstrates abnormal signal and morphology (series 6 image 15/33) although no fluid-filled signal is identified internally. Further distally, the tendon is of normal appearance. Additionally, there is an small amount of fluid within the radiocarpal and midcarpal spaces as well as within the DRUJ. Increased soft tissue signal is also evident at the radiocarpal articulation.BONES: No significant abnormality noted.ADDITIONAL

Output: 1. Tendinosis of the extensor carpi ulnaris. There is increased signal intensity anterior to the ulna may reflect a component of inflammation.2. Intermediate signal intensity of the distal TFCC which is not well seen. This may be technical in nature but if further evaluation is warranted, MR arthrogram can be obtained.


Instruction: Generate impression based on medical findings.

Input: Memory loss and pituitary adenoma. Brain: There is no evidence of intracranial hemorrhage or acute infarct. There are minimal scattered punctate foci of nonspecific T2 hyperintensity. The brain parenchyma otherwise appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is extensive bilateral maxillary and ethmoid sinusitis with sections.Pituitary: There is a T2 hyperintense lesion with delayed enhancement in the right anterior pituitary that measures up to 2 mm. The pituitary gland is otherwise not enlarged or atrophic. The pituitary stalk is intact. There is no mass effect upon the cavernous sinuses or optic apparatus.

Output: 1. A lesion in the ight anterior pituitary that measures up to 2 mm may represent a microadenoma. 2. Minimal scattered punctate foci of nonspecific T2 hyperintensity. 3. Findings suggestive of acute sinuitis.


Instruction: Generate impression based on medical findings.

Input: 38-year-old woman personal history of triple negative left breast cancer status post lumpectomy and sentinel biopsy in April 2012 and adjuvant radiation therapy presents for screening MRI. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Left breast: Postsurgical changes of lumpectomy with distortion of the breast parenchyma in the upper-outer quadrant. No abnormal enhancement in the left breast or axilla.Right breast: There are three new areas of non mass enhancement in the right breast. All of these demonstrate mixed kinetics on dynamic evaluation and are indeterminate.-The first focus is seen in the central right breast, anterior depth, near 6:00 immediately inferior to the nipple measuring 14 x 7 x 7 mm (AP x TV x CC).-A second focus is seen posterior and lateral to the first focus near 7:00 measuring 8 x 4 x 7 mm (AP x TV x CC).-The third focus is seen in the lateral breast, posterior depth, near 9:00 at the level of the nipple measuring 11 x 6 x 6 mm (AP x TV x CC).The distance between the areas are 4.5 cm (AP), 3.8 cm (CC) and 4.1 cm (TV). Further evaluation of these areas is recommended with right unilateral diagnostic mammogram and MR guided second look ultrasound. If there is no MR correlate identified, MRI guided biopsy should be performed.

Output: Three new indeterminate areas of non mass enhancement in the right breast as described, with the largest area measuring 14 x 7 x 7 mm. Further evaluation of these areas is recommended with right unilateral diagnostic mammogram and MR guided second look ultrasound. If there is no correlate identified, MRI guided biopsies can be performed.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: 8-year-old male with history of neuroblastoma, 2 years post therapy. ABDOMEN:LIVER, BILIARY TRACT: Similar-appearing faintly T2 hyperintense lesions that demonstrate enhancement on the 20 minute delayed series (axial series 2001 images 68, 78, 86) and consistent with focal nodular hyperplasia. Hypointense T2 signal of the background hepatic parenchyma compatible with deposition.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: In the right retroperitoneum just proximal to the aortic bifurcation, a small 1.2 x 0.6 cm oval structure demonstrating hyperintense signal on the diffusion weighted series (axial series 408 image 32) has decreased in size since the 3/5/2014 CT exam (prior 1.5 x 0.7 cm).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: See below.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Lobulated T2 hyperintense eccentric lesion of the left femoral intertrochanteric region (axial series 701 image 21, coronal series 801 image 17) likely represents a small enchondroma, unchanged.Interval development of an exostosis from the left posterior-superior iliac bone with internal signal intensity following osseous matrix, and there is a curvilinear overlying T2 hyperintense signal. In retrospect, a minimal contour deformity in this region was present on the 9/30/2015 MRI exam (prior exam series 8 image 45), and no contour deformity was seen on the 3/5/2014 CT exam. Imaging appearance of this lesion is suggestive of an osteochondroma.Stable nonspecific T2 hyperintense signal of the T9, T10, and T11 vertebral bodies (coronal series 1501 image 21) with loss of signal on T2 fat saturated sequences. The small hyperintense lesion of the T11 vertebral body on the T2 fat saturated sequence (axial series 1801 image 31) demonstrating contrast enhancement is also unchanged.OTHER: No significant abnormality noted.

Output: 1.The known 3 liver lesions are stable in size and again demonstrate contrast enhancement on the 20 minute delayed/hepatobiliary phase consistent with focal nodular hyperplasia.2.Interval development of an exostosis from the left iliac crest with imaging features suggestive of an osteochondroma. Stable appearance of a small suspected left femoral enchondroma. Follow-up plain film radiographs are recommended.3.Interval decreased size of a small 1.2 x 0.6 cm oval right retroperitoneal structure demonstrating hyperintense signal on the diffusion weighted series compared to the 3/5/2014 CT exam (prior 1.5 x 0.7 cm). This structure is of unclear etiology.4.Stable T2 hyperintense signal of the lower thoracic vertebral bodies as described above.


Instruction: Generate impression based on medical findings.

Input: MRI BRAIN:There is restricted diffusion in the right posterior medulla with associated increased T2 signal compatible with an acute infarct (601/23). Additional scattered T2 hyperintensities without restricted diffusion in the periventricular and subcortical white matter are nonspecific but likely related to mild chronic small vessel ischemic disease.The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified. The midline structures and craniocervical junction are within normal limits. MRA BRAIN:There is moderate narrowing of the cavernous internal carotid arteries bilaterally. There is moderate stenosis of the right M1 segment. The left MCA appears normal. The ACAs are normal without stenosis or aneurysm. There is a right PCOM artery, although no left PCOM artery is identified.There is poor flow-induced signal in the V4 segment of the right vertebral artery, especially at the vertebrobasilar junction. The basilar artery itself is narrow, which may be congenital. The PICA's are identified bilaterally and appear normal.

Output: 1.Focus of diffusion restriction in the right medulla is compatible with an acute infarct.2.Poor flow related signal within the distal right vertebral artery is suspicious for significant stenosis or occlusion. 3.Moderate stenoses affecting the cavernous ICAs and the right M1 MCA.Findings discussed with Dr. Ali at 11:45 a.m. on 1/20/2015


Instruction: Generate impression based on medical findings.

Input: Reason: eval for ATFL tear History: ankle sprain x 10 with recurrent instability and pain TENDONS: The flexor and extensor tendons appear intact. The peroneal tendons appear intact. The Achilles tendon is normal in appearance.LIGAMENTS: The ATFL is poorly visualized with associated increased signal abnormality on fluid sensitive sequences indicating a tear. The PTFL appears intact. The calcaneofibular ligament appears intact. The imaged components of the deltoid ligament appear intact.ARTICULAR SURFACES AND BONE: No bone marrow signal abnormalities are identified. No osteochondral defect is seen. Mild osteoarthritic changes affect the third tarsometatarsal articulation. ADDITIONAL

Output: Disruption of the ATFL.


Instruction: Generate impression based on medical findings.

Input: Male 73 years old Reason: prostate cancer History: prostate cancer PELVIS:PROSTATE:Prostate Size: Prostate measures 5.9 x 4.2 x 4.1 cmPeripheral Zone: There is a broad-based lesion involving mostly the left mid gland near midline extending to the apex. The lesion surrounds urethra near the apex. The lesion extends across midline to the right mid gland and right apex. Small foci of signal abnormality are present in the left mid to apex gland capsule with areas of suspected extracapsular extension.Central Gland: Enlarged central gland with multiple nodules.Seminal Vesicles: No significant abnormality notedExtracapsular Extension: Suspected small foci of extracapsular extension in the left mid gland.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Suspected prostate cancer involving the left mid to apex with suspected small foci of ECE in the left mid gland.


Instruction: Generate impression based on medical findings.

Input: Clinical question: 25 years old male with fevers, vomiting, headaches, mental status change. Rule out intracranial increase pressure, mass, bleed. Signs and symptoms: Altered mental status, vomiting, fever and headaches. Non-enhanced head CT:There is no evidence of intracranial hemorrhage, edema, mass, mass effect, midline shift or hydrocephalus.There is evidence of a prior in the right posterior temporal -- occipital junction with the extensor and inferior to the suboccipital region. There is underlying parenchymal encephalomalacia of right cerebellum and right occipital lobe. Please correlate with history regarding the reason for surgery. Follow-up with an MRI is recommended if there was a recurrence of tumor at this site. No acute finding on the current exam.Images through posterior fossa also demonstrate bilateral patchy and linear calcification that may be result of prior treatment. There is also ex vacuo dilatation of the fourth ventricle. Patchy calcification within the pons is also noted. This finding may be also result of prior treatment or a cavernoma. This finding and may also further evaluated with an MRI examination.Other than above described craniotomy calvarium is intact.Visualized mastoid air cells and middle ear cavities are unremarkable.There is limited view of paranasal sinuses are unremarkable.

Output: 1.No evidence of acute intracranial findings.2.Focal encephalomalacia right occipital and right cerebellum under a right-sided posterior temporal, occipital, suboccipital craniotomy site. Please correlate with past medical history.3.Patchy calcification of bilateral cerebellum may be result of prior treatment.4.Patchy calcification of the pons could result of prior treatment and or a cavernoma.5.If clinical concern persist recommend follow-up with an MRI exam.


Instruction: Generate impression based on medical findings.

Input: Breast cancer and brain metastases treated with surgery and CyberKnife treatments. There are postoperative findings related to right frontal lesionectomy. There is confluent high T2 signal and susceptibility effect surrounding the resection cavity, but no evidence of associated abnormal enhancement. However, there is an irregularly enhancing lesion in the left cerebellar hemisphere that measures up to 20 mm with extensive surrounding vasogenic edema. There is also an irregularly enhancing lesion in the left cerebellar hemisphere that measures up to 10 mm with mild surrounding vasogenic edema and a punctate focus of enhancement in the superior right cerebellar hemisphere. In addition, there is an enhancing lesion in the right occipital lobe that measures up to 5 mm. There are a few punctate foci of nonspecific cerebral white matter T2 hyperintensity without associated enhancement. There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact.

Output: 1. Postoperative findings related to right frontal lesionectomy, without evidence of recurrent tumor in this area. 2. Multiple enhancing intracranial lesions are compatible with metastases, the largest of which is located in the left cerebellar hemisphere with associated extensive vasogenic edema, but no herniation.


Instruction: Generate impression based on medical findings.

Input: 66-year-old female with headaches and a known meningioma. Evaluate meningioma size.Further history from electronic medical record: History of breast cancer. There is no evidence of intracranial hemorrhage or acute infarct. There is no signal abnormality within the brain parenchyma. Along the superior sagittal sinus overlying the right parietal lobe there is a 16 x 16 mm extra-axial lesion which is heterogeneous on T1 and T2 weighted images, dark on susceptibility weighted images, and heterogeneously enhancing. There is no surrounding edema. The adjacent sagittal sinus is thinned but enhances suggesting maintenance of flow. There is no abnormal enhancement elsewhere. 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. Status post right lens replacement. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 16 x 16 mm extra-axial lesion along the right parietal lobe adjacent to the superior sagittal sinus compatible with meningioma.


Instruction: Generate impression based on medical findings.

Input: Motion artifact degrades image quality. The ventricles and sulci are prominent, consistent with mild age-related volume loss. There is no midline shift or mass effect. There are scattered punctate foci and confluent areas of abnormal T2 hyperintensity within the periventricular and subcortical white matter, consistent with moderate chronic small vessel ischemic changes. There are also subcentimeter defects in the bilateral basal ganglia, which likely represent chronic lacunar infarctions. There is no evidence of acute infarction. There are multiple foci of susceptibility artifact, within the bilateral thalami, and to a lesser extent the bilateral cerebral and cerebellar hemispheres and basal ganglia, consistent with chronic microhemorrhages. There is a partially empty sella. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: Chronic basal ganglia lacunar infarcts and small vessel ischemic disease, but no acute infarct, midline shift, or mass effect.


Instruction: Generate impression based on medical findings.

Input: Motion degrades anatomic detail on some sequences. The medial temporal lobes are symmetric and without abnormal signal. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are mild scattered foci of cerebral white matter T2 hyperintensity. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits paranasal sinuses, and scalp soft tissues are grossly unremarkable. The bone marrow is diffusely hypointense.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarction. 2. Mild scattered foci of cerebral white matter T2 hyperintensity are nonspecific, but may be related to small vessel ischemic disease. 3. Bone marrow signal alterations are likely related to sickle cell 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: 18 year-old female with history of astrocytoma of the posterior fossa, off therapy evaluation. Redemonstrated are postoperative findings within the posterior fossa. Surgical deformation of the fourth ventricle is unchanged as is the degree and extent of T2 hyperintensity along the roof of the fourth ventricle, extending into the vermis, is also unchanged. This tissue also redemonstrates mild intrinsic T1 hyperintensity. As before, there is no abnormal enhancement.Elsewhere, parenchymal signal intensity and morphology are within normal limits. No edema or mass effect is seen. No pathologic enhancement is detected. No evidence of intracranial hemorrhage or any new fluid collections are seen. Ventricles are stable in size and morphology. A small left sphenoid sinus mucous retention cyst is unchanged. The remaining paranasal sinuses and mastoid air cells are clear. Expected vascular flow voids are demonstrated.

Output: Redemonstration of postoperative findings in the cerebellum with no evidence to suggest progressive or recurrent disease.


Instruction: Generate impression based on medical findings.

Input: Pain after injury MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There is moderate thinning of the articular cartilage of the medial femoral condyle anteriorly with associated degenerative marrow signal. Otherwise articular cartilage of the knee is preserved.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Moderate cartilage loss of the medial femoral condyle.2. Mild prepatellar bursitis.


Instruction: Generate impression based on medical findings.

Input: Male, 27 years old. Reason: shoulder pain History: pain, labral tear? ROTATOR CUFF: There is a full-thickness tear of the supraspinatus tendon within 2 cm of its attachment, with minimal retraction. The supraspinatus muscle appears within normal limits. The other tendons and muscles of the rotator cuff appear normal.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint and glenoid labrum appear normal.BICEPS TENDON: The biceps tendon is displaced anteromedially, not present within the bicipital groove. The tendon itself is otherwise intact, without evidence of tear. There is a small amount of fluid surrounding the biceps tendon. ADDITIONAL

Output: 1.Full-thickness, minimally retracted tear of the supraspinatus tendon within 2 cm of its attachment.2.Dislocation of the tendon of the long head of the biceps as described above.


Instruction: Generate impression based on medical findings.

Input: Reason: Evaluate for source of seizure activity, pt is nonverbal at this time which is significantly different from her baseline History: Nonfocal exam except nonverbal The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a ringlike signal hypointensity present along the medial aspect of the left cerebellar hemisphere measuring 5 mm in diameter. Centrally it is high he is signal and intermediate and T1There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additionally, there is T2 and flair signal hyperintensity along the brain stem distributed in a patchy manner.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. The left eyeball lens is thin.Incidental note is made of partial empty sella

Output: 1.There is a small lesion present in the left cerebellar hemisphere measuring 5 mm in size which is suspected to represent a cerebral cavernous malformation . Susceptibility imaging and contrast enhancement may be helpful in evaluating for associated developmental venous anomaly .2.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 3.There are brainstem lesions present which are suspect to be vascular related but are nonspecific.4.Examination was somewhat compromised due to patient inability to cooperate. As a result not all pulse sequences were performed. The susceptibility weighted imaging was not performed. This may result in overlooking more subtle abnormalities.


Instruction: Generate impression based on medical findings.

Input: Painful eye movements and afferent pupillary defect of left eye. Evaluate for optic nerve abnormalities. Orbits: There is new diffuse high T2 signal and enhancement with mild swelling of the orbital segment of the left optic nerve. The left globe and ocular adnexa are otherwise unremarkable. There is no evidence of mass lesions. The right orbit is unremarkable. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a small area of subcortical high T2 signal in the right perirolandic region. There are also a few scattered foci of high T2 signal elsewhere in the cerebral white matter. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There are postoperative findings in the paranasal sinuses with interval decrease of the mucosal thickening in the sphenoid and posterior ethmoid sinuses.Cervical Spine: There is diminished cervical lordosis. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is a small posterior disc-osteophyte complex at C5-6, without significant spinal canal or neural foramen stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1. Newly apparent left optic neuritis. Differential considerations include an inflammatory process, such as IgG4-related disease or sarcoidosis, vasculitis, demyelinating process, neuromyelitis optica, or perhaps an infectious process, such as Lyme disease or a viral disease, but no evidence of compressive neuropathy.2. A few scattered cerebral white matter lesions are nonspecific, but may represent a demyelinating process, neuromyelitis optica, vasculitis, or infectious/inflammatory process, perhaps related to the optic neuritis, but no evidence of acute infarct. 3. No evidence of cervical spinal cord lesions.4. Postoperative findings related to sinus surgery with interval improvement in the previously demonstrated paranasal sinus inflammatory process.


Instruction: Generate impression based on medical findings.

Input: Reason: 6 year old with history of juvenile pilocytic astrocytoma s/p chemotherapy - change in mass? History: JPA. There is redemonstration of postoperative changes within the right posterior fossa. There is redemonstration of a predominantly extra-axial soft tissue mass at the right cerebellopontine angle measuring approximately 3.7 x 2.3 cm in greatest axial dimensions on 701/19, not significantly changed compared to multiple remeasurements dating back to 9/22/2015 as not all prior reference measurements are available. For example, on the 3/23/2016 exam, the mass remeasures 3.9 x 2.2 cm. There is redemonstration of encasement of the vertebro basilar arteries at this level, as well as extension into right Meckel's cave and internal auditory canal. Additional lobule of the tumor extends caudally along the dorsal lateral aspect of the cord, extending out of the axial field-of-view. Cystic components more inferiorly remain unchanged in size. There is no significant corresponding enhancement. There is persistent significant mass effect upon the caudal brainstem and upper cord.There is a right posterior parietal approach ventriculostomy catheter stable position, with the tip of the catheter near the right foramen of Monro. The lateral and third ventricles are stable and decompressed. There is no evidence of acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. There is prominent mucosal thickening in the sphenoid sinuses bilaterally. Both palatine tonsils are somewhat prominent, likely within normal limits for a patient this age.

Output: 1. Continued stable appearance of predominantly extra-axial right posterior fossa mass, with continued mass effect upon the caudal brainstem and upper cord.2. Interval significant bilateral sphenoid mucosal thickening which is nonspecific. Please correlate clinically.


Instruction: Generate impression based on medical findings.

Input: Medial knee pain following injury The examination is limited by motion artifact and the patient's body habitus which prevented the use of a standard knee coil.MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Normal MRI of the knee.


Instruction: Generate impression based on medical findings.

Input: 34 years Female (DOB:1/26/1982)Reason: h/o cervical cancer s/p chemoradiation, assess for metastatic disease and spinal fractures History: back painReferring Attending: SEIKO DIANE YAMADA Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. No abnormal enhancing lesions are appreciated in the lumbar spine.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.No compromise to lumbar spinal canal or neural foramina.2.No evidence for spinal metastases.


Instruction: Generate impression based on medical findings.

Input: Type 1 diabetes mellitus without complications [E10.9], Reason for Study: ^Reason: 27 y/o wm with T1Dm x 21 years, recent acute onset numness and tingling in hands and feet with 7 lb weight loss - eval for MS History: numbness pani and tingling in hands 27 years Male (DOB:1/19/1989)Reason: 27 y/o wm with T1Dm x 21 years, recent acute onset numness and tingling in hands and feet with 7 lb weight loss - eval for MS History: numbness pani and tingling in hands and feet, decreased appeite and weight lossPROVIDER/ATTENDING NAME: LOUIS H. PHILIPSON LOUIS H. PHILIPSON The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: MRI of the brain is within normal limits


Instruction: Generate impression based on medical findings.

Input: Multiple sclerosis, follow up for progression. Motion artifacts degraded exam quality.There are multiple bihemispheric high signal intensity lesions on FLAIR images.The lesions involve right frontal lobe, right parietal lobe, right occipital lobe, left frontal lobe, left parietal lobe, left occipital lobe and periventricular white matter and bilateral trigone areas. 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, or 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.

Output: Multifocal bihemispheric abnormal FLAIR high signal lesions which are consistent with MS lesions as described above.No comparison was made since there is no prior exam available.