Instruction: Generate impression based on medical findings.

Input: Reason: Check MPFL, trochlear dysplasia, measure TT-TG distance, check for loose bodies History: R patellar instability Multiple sequences are degraded by patient motion artifact resulting in suboptimal image quality.MENISCI: The medial and lateral meniscus appear intact. There is a subcentimeter lobulated focus of fluid signal intensity along the posterior aspect of the posterior horn of the medial meniscus which likely represents ganglion formation.ARTICULAR CARTILAGE AND BONE: Signal abnormality within the medial aspect of the patella and lateral aspect of the lateral femoral condyle indicating bone contusions from prior lateral transient patellar dislocation. The femoral trochlea appears shallow superiorly and the medial facet appears diminutive, indicating femoral trochlear dysplasia. There is near full-thickness chondromalacia affecting the articular cartilage along the lateral facet of the patella. No full-thickness defects are identified. The articular cartilage of the medial and lateral tibiofemoral compartment appears relatively spared.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The quadriceps and patellar tendons appear intact.ADDITIONAL

Output: 1. Findings indicating prior lateral transient patellar dislocation with bone contusions and complete disruption of the distal fibers of the medial retinaculum.2. Femoral trochlear dysplasia and edema within the superolateral aspect of Hoffa's fat pad can be seen in patients with patellofemoral instability.3. The tibial tubercle to trochlear groove distance and Insall Salvati ratio are within normal limits.4. Moderate size joint effusion. No definite loose bodies are identified.5. Chondromalacia affecting the patellofemoral articulation, however, no full-thickness or near full-thickness articular cartilage defects are seen.


Instruction: Generate impression based on medical findings.

Input: Displacement of lumbar intervertebral disc without myelopathy. History of discectomy. Now with low back pain and difficulty ambulating distance Five lumbar type vertebral bodies are presumed to be present. There is 25% loss of vertebral body height redemonstrated at L2 elated to superior endplate compression and mild anterior subluxation of L4 on L5 redemonstrated. Compared to the February exam there is no significant change in the appearance of either the compression fracture or the subluxation. There is multilevel disk desiccation present.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. There is a minor disk bulge at this level associated with mild ligamentum flavum and facet hypertrophy.At L4-5 there is diffuse disk bulge associated marked bilateral facet hypertrophy with associated effacement of the fat at the lateral recesses. Since the previous exam the patient has undergone left-sided hemilaminectomy at this level. The thecal sac is enlarged on the current exam relative to the prior. The cerebral spinal fluid surrounding the nerve roots is not effaced though the thecal sac is smaller than at other levels. There is associated narrowing of the neural foramina bilaterally and mild effacement of the fat surrounding the exiting nerve roots within the neural foramina. The exiting nerve roots within the neural foramina are surrounded by fat. There is enhancement of the soft tissues at the lateral recesses and surrounding the thecal sac at this level. There is associated mild anterior subluxation of L4 on L5.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is mild ligamentum flavum hypertrophy present at this level and a minor disk bulge.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.There is a small cyst present in the right kidney measuring 6 mm in diameter.

Output: 1.Since the prior exam the patient has undergone surgery at L4-5. The spinal canal has enlarged. There is less ligamentum flavum hypertrophy at this level now and mild narrowing of the spinal canal which is a significant improvement since the prior exam. There is however some suspicion for scar formation at the lateral recesses at this level involving the nerve roots at the lateral recesses.2.There is a benign-appearing chronic compression fracture at L2.


Instruction: Generate impression based on medical findings.

Input: 50-year-old female with history of von Hippel-Lindau and surgery in 2014 for renal cell carcinoma and cysts. Evaluate kidneys and pancreas for lesions. ABDOMEN: Limited examination given motion artifact (per technologist note, patient is claustrophobic).LIVER, BILIARY TRACT: Scattered T2 hyperintense nonenhancing foci consistent with cysts. Hepatic steatosis. No intra or extrahepatic biliary ductal dilatation.SPLEEN: Scattered T2 hyperintense foci consistent with splenic cysts. Additional scattered nonspecific T2 hypointense subcentimeter splenic foci noted. Splenule noted.PANCREAS: Cystic lesions within the pancreas have increased in size; reference pancreatic body/head lesion measures 2.2 x 2.2 cm (series 5, image 18), previously measuring 1.9 x 1.8 cm.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Postoperative changes of right partial nephrectomy. There are 3 T2 heterogeneous cystic and enhancing lesions in the left lower pole. Reference measurements are as follows: 3.0 x 2.5 cm (series 15, image 14), 2.9 x 2.7 cm (series 15, image 16); the third lesion is exophytic, demonstrates peripheral enhancement and measures 2.6 x 1.7 cm (series 15, image 47).There are multiple bilateral T2 hyperintense nonenhancing lesions compatible with cysts; some of these have increased in size and are complex in appearance. For example right upper pole Bosniak 2 lesion measures 5.6 x 4.4 cm (series 5, image 14), previously measuring 5.3 x 4.2 cm.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.Within limitations of motion artifact, there are 3 left lower pole renal lesions demonstrating enhancement. These are highly suspicious for renal cell carcinoma, particularly the larger 2 detailed above.2.Partial right nephrectomy. Multiple bilateral cysts.3.Hepatic, splenic, and pancreatic cyst formation.4.Hepatic steatosis.


Instruction: Generate impression based on medical findings.

Input: 65 years, Male, Reason: research exam History: prostate cancer. Found to have PSA elevation to 6.2. This prompted TRUS biopsy 12/23/2014 revealing Gleason 6 disease involving 6/12 cores: Right base to apex, left base to mid gland. PELVIS:PROSTATE:Prostate Size: 5.2 x 2.4 x 5.2 cmPeripheral Zone: Lesion in the mid gland/apex peripheral zone, immediately left of midline measures 0.6 x 1.0 cm (903/204) and demonstrates low signal on ADC/T2 and early enhancement, suspicious for prostatic adenocarcinoma. An additional small foci more superiorly in the left mid gland peripheral zone measures 0.4 x 0.4 cm (903/304) with low T2/ADC signal and without early enhancement, suspicious for prostatic adenocarcinoma.Central Gland: Multiple well-circumscribed heterogeneous lesions in the central gland suggest benign prostatic hypertrophy.Seminal Vesicles: No involvement.Extracapsular Extension: No extracapsular extensionBLADDER: No significant abnormality noted.LYMPH NODES: Right external iliac node measures 7 mm (2501/77)BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Two small foci within the left mid gland peripheral zone and right mid gland/apex peripheral zone with signal characteristics suspicious for prostatic adenocarcinoma.2.Indeterminate right pelvic lymph node.


Instruction: Generate impression based on medical findings.

Input: Female, 2 months old, with abnormal movements, history of subarachnoid hemorrhage. Evaluate for structural laterality. Bilateral convexity subdural collections are seen, best visualized on series 1001. The left-sided collection is slightly larger than the right and measures up to 6 mm in thickness. There is susceptibility effect associated with the left-sided collection. The fluid is FLAIR hyperintense to CSF but relatively similar to CSF on T1 and T2-weighted images. The collections exert minimal regional mass effect on the underlying brain.A small extra-axial focus of diffusion restriction is seen along the right parietal lobe with associated susceptibility effect. Elsewhere no diffusion restriction is seen. Small foci of susceptibility effect are also present along the right sylvian fissure and right inferior frontal sulcus, as well as within the occipital horns of the lateral ventricles. No evidence of parenchymal edema is detected. Brain parenchymal morphology is within normal limits. No developmental anomalies or structural defects are identified. The pattern of white matter myelination is appropriate for age. The pituitary region is within normal limits. The corpus callosum is fully formed and intact. The brainstem and cerebellum are within normal limits. Ventricular size and morphology are normal.

Output: Bilateral convexity subdural collections are seen measuring up to 6 mm in thickness on the left. The signal characteristics of the collections would favor that these represent chronic subdural hematomas. A small focus of extra-axial diffusion restriction and susceptibility along the right parietal lobe could indicate blood at an earlier stage of evolution. Findings are also seen suggesting a small amount of hemosiderin staining in the subarachnoid spaces and the ventricles likely indicating prior subarachnoid hemorrhage. The brain itself is developmentally normal.


Instruction: Generate impression based on medical findings.

Input: Reason: please comment on the "lesion" in the midportion of the abd hallucis. Please compare to previous outside MRI in pacs History: pain medial arch There is a fusiform enhancing mass in the abductor hallucis muscle inferior to the medial cuneiform measuring approximately 1.5 x 1 cm in AP and transverse dimension. The longitudinal dimension is less well-defined but measures approximately 3 cm including a thin tail of enhancement that extends along the proximal tendon of the muscle. There is mild edema in the adjacent soft tissue. The lesion is predominantly isointense to skeletal muscle on T1 weighted images and heterogeneous on T2 weighted images with components that are hyperintense, isointense, and perhaps hypointense to skeletal muscle. The enhancement is likewise heterogeneous with a region of relative nonenhancement centrally. This mass has no appreciable effect on adjacent bones. Superficial to this mass are small foci of signal void, likely representing metallic susceptibility artifact from prior surgery. Proximal and distal to this mass there is mild fatty atrophy of the abductor hallucis muscle. The size of the mass is similar to that seen on outside MRI from 4/4/2016 accounting for technical differences. Of note, on this outside study the mass is of low to intermediate signal intensity on non-fat-saturated T2 weighted images. The mass has increased in size from the 9/3/2014 study, at which time the margins were less well defined.Slight irregularity of the medial navicular tuberosity is noted, which could conceivably be postoperative in nature, but this is equivocal. Only the distal posterior tibialis tendon is included on this study, but it appears to attach to the navicular tuberosity. The mass in question is clearly distal to the insertion of the posterior tibialis tendon, as is the most of the metallic susceptibility artifact. We see no additional masses. The remaining bones and soft tissues appear normal.

Output: Enhancing mass within the abductor hallucis muscle as described above, which appears to underlie the site of prior surgery. Although nonspecific, the signal characteristics of this mass as well as tail-like extension along the tendon is a common feature of proliferating fibrous lesions.


Instruction: Generate impression based on medical findings.

Input: 26 years Female (DOB:2/23/1990)Reason: eval structural lesion History: head traumaPROVIDER/ATTENDING NAME: THOMAS J. KELLY THOMAS J. KELLY MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are small. There is an infundibulum at the origin of the right posterior communicating artery. The left vertebral artery is larger than the right vertebral artery. There is an infundibulum at the origin of the right superior cerebellar artery.

Output: There is no evidence for traumatic brain injury or intracranial cerebrovascular traumatic injury.


Instruction: Generate impression based on medical findings.

Input: History of fever, pain, nausea/vomiting, elevated LFTs, and elevated total bilirubin. Evaluate for cholangitis, choledocholithiasis. Past surgical history of cholecystectomy. ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in signal intensity. No focal hepatic lesions are identified. The gallbladder is surgically absent. There is minimal intrahepatic biliary ductal dilatation centrally. The common hepatic duct is mildly prominent measuring up to 9 mm in diameter. No biliary strictures or definite biliary ductal stones are identified. There is a questionable filling defect within the common bile duct (series 51, image 28).SPLEEN: No significant abnormality noted.PANCREAS: The pancreas demonstrates normal ankle signal intensity. No focal pancreatic lesions identified. The pancreatic duct is normal in diameter.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: An intrauterine pregnancy is partially visualized in the lower abdomen.

Output: 1.Status post cholecystectomy with minimal intrahepatic biliary ductal exertion and mild extradural hepatobiliary ductal dilatation.2.Questionable tiny stone within the common bile duct.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: 47-year-old female with a new foci mass. Evaluate mass. A vitamin E capsule overlies the medial soft tissues of the left thigh, presumably representing the patient's palpable area of concern. Note is made of a focus of fat signal intensity within the subcutaneous tissue along the medial aspect of the thigh/femoral diaphysis, underlying the aforementioned skin marker, with increased signal abnormality peripherally on fluid sensitive sequences, measuring approximately 17 x 7 x 13 mm (AP by TR by CC). There is thin peripheral enhancement on postcontrast sequences. No additional masses or pathologic enhancement is identified. The imaged musculature is normal in appearance. No bone marrow signal abnormality is identified.

Output: 17 mm mass with fat signal intensity which appears most consistent with a lipoma, although atypical lipoma remains as a differential consideration. Follow-up evaluation by an orthopedic oncologist is recommended.


Instruction: Generate impression based on medical findings.

Input: Radiculopathy. The vertebral body heights are maintained. Mild loss of vertebral disc signal at L4-5 and L5-S1 along with minimal loss of disc height. Mild straightening of the lumbar lordosis, otherwise the alignment is anatomic. Nonspecific heterogeneous marrow signal without discrete lesion. The visualized spinal cord is normal in signal and morphology. The conus medullaris terminates at the L1-2 level.T12-L1: No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.L1-L2: No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.L2-L3: No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.L3-L4: Mild diffuse disc bulge. Mild thickening of the ligamentum flavum. Minimal left neural foraminal narrowing. No significant right neural foraminal or spinal canal stenosis.L4-L5: Moderate disc bulge slightly asymmetric to the right with a central annular fissure. Mild hypertrophy of the ligamentum flavum. Minimal left and mild to moderate right neural foraminal narrowing. No spinal canal stenosis.L5-S1: Prominent right paracentral annular fissure and disc protrusion. Mild hypertrophy of the ligamentum flavum and facet arthropathy. The disc protrusion effaces the lateral recesses and impinges on the bilateral S1 nerve roots, right greater than left. There is also mild bilateral neural foraminal narrowing. Mild spinal canal stenosis.

Output: Prominent central disc protrusion at L5-S1 which impinges on the S1 nerve roots, right greater than left. There is also mild bilateral neural foraminal narrowing at this level.


Instruction: Generate impression based on medical findings.

Input: 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. There is a mild levocurvature to the lumbar spine.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a mild disc bulge and disc desiccation at this level associated with some endplate reactive changes. The endplate reactive changes are high signal on T1.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is mild ligamentum flavum hypertrophy and facet hypertrophy at this level associated with a diffuse disc bulge. There are some endplate reactive changes present at this level which are high signal on T1-weighted imagingAt 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. There is a disc bulge present at this level.

Output: There are some mild degenerative changes present in the lumbar spine without significant compromise to the spinal canal or exiting nerve roots.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old, with acoustic neuroma status post radiosurgery on 4/17/2015, bibasal changes. A tumor is redemonstrated involving the left CP angle and IAC. The lesion enhances heterogeneously. On comparison with the prior examination, there has been no significant interval change in size.No additional enhancing lesions are seen. Patchy periventricular white matter T2 hyperintensity is unchanged. No evidence of parenchymal edema or mass effect is detected. No acute intracranial hemorrhage or any abnormal extra-axial fluid collections are seen. The ventricles and sulci are slightly prominent compatible with parenchymal volume loss.

Output: 1.A treated schwannoma involving the left CP angle and IAC shows no interval change in size.2.No new enhancing lesions are seen.


Instruction: Generate impression based on medical findings.

Input: 16-year-old female with knee pain. MENISCI: The medial and lateral menisci are normal.ARTICULAR CARTILAGE AND BONE: There is a bipartite patella and a contusion is present within the patellar accessory ossification center. The bones are otherwise intact. The articular cartilage is normal.LIGAMENTS: The medial retinaculum demonstrates a somewhat wavy contour with mild surrounding edema near its insertion on the patella, which suggests a partial tear. The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The quadriceps and patellar tendons are normal. ADDITIONAL

Output: Probable partial tear of the medial retinaculum and contusion of the patellar accessory ossification center likely reflects a prior patellar dislocation. There is evidence of patellar instability given findings suggestive of patella alta and trochlear dysplasia. However, the patella is currently in anatomic alignment.


Instruction: Generate impression based on medical findings.

Input: 65 year old male with a history of coronary artery disease s/p PCI to the left anterior descending artery in 2014 and amyloidosis s/p stem cell transplant in 2015 who is referred for cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 59%, the LV end diastolic volume index is 64 ml/m2 (normal range: 74+/-15), the LVEDV is 138 ml (normal range 142+/-34), the LV end systolic volume index is 26 ml/m2 (normal range 25+/-9), the LVESV is 56 ml (normal range 47+/-19), the LV mass index is 38 g/m2 (normal range 85+/-15), and the LV mass is 84 g (normal range 164+/-36). There is moderate hypertrophy of the left ventricle (IVSd=14mm). The basal myocardial septal T1 relaxation time is 1099ms (upper limits of normal). There is diffuse circumferential late gadolinium enhancement involving the endocardial half of the myocardium. Although not reported on the prior study it was there also. This pattern is strongly suggestive of the diagnosis of cardiac amyloidosis. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 60%, the RV end diastolic volume index is 54 ml/m2 (normal range 82+/-16), the RVEDV is 118 ml (normal range 142+/-31), the RV end systolic volume index is 22 ml/m2 (normal range 31+/-9), and the RVESV is 47 ml (normal range 54+/-17). Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is a 11x11mm nodule in the right upper lobe of the lung. This is unchanged from the prior study. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size and systolic function (LVEF 59%). There is moderate left ventricular hypertrophy with global, circumferential late gadolinium enhancement involving the endocardial half of the myocardium. This pattern is strongly suggestive of cardiac amyloidosis. 2. The right ventricle is normal in size and systolic function (RVEF 60%). 3. Mild biatrial enlargement. 4. Right upper lobe lung nodule, unchanged from prior study. 5. When compared to the prior study from 10/2015, the LV wall thickness has increased a little; however, there are no other obvious changes noted. 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: Bilateral essential tremor preoperative planning for DBS. There is no evidence of intracranial hemorrhage or mass. There a mild scattered nonspecific cerebral white matter T2 hyperintense lesions. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is staphylomatous deformity and enlargement of the right globe.

Output: Grossly unremarkable treatment planning MRI.


Instruction: Generate impression based on medical findings.

Input: The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. No opacification of the paranasal sinuses or mastoid air cells.

Output: Normal exam without specific findings to account for the patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: 19-year-old male with a history of lupus and right distal femur and bilateral distal tibial bone infarction No evidence of acute fracture or malalignment. No joint effusion. Previously seen distal femoral AVN on MRI exam is not well visualized on radiographs.

Output: AVN seen on prior MRI is not well visualized on radiographs.


Instruction: Generate impression based on medical findings.

Input: Daily headache. There is concavity of the superior aspect of the pituitary. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears 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.

Output: 1. Concavity of the superior aspect of the pituitary may indicate pseudotumor cerebri, but is otherwise nonspecific.2. No intracranial hemorrhage, mass, or mass effect.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: 31 year old female with family history of breast and ovarian cancer, presents for screening MRI. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. 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: 68-year-old female with acute on chronic knee pain. MENISCI: Complex tear of the posterior horn of the medial meniscus which includes a complete vertical component just medial to its root attachment, and an additional vertical tear (perhaps a small oblique/flap tear) affecting the inner third of the posterior horn more medially. Additional signal abnormality within the body of the medial meniscus is compatible with intrasubstance degeneration. Mild extrusion of the body of the medial meniscus.Signal abnormality within the body of the lateral meniscus is compatible with intrasubstance degeneration. No meniscal tear is evident.ARTICULAR CARTILAGE AND BONE: There is tricompartmental osteoarthritis with diffuse full-thickness cartilage loss along the lateral facet of the patella and marked thinning of the articular cartilage of the lateral trochlea. Small subchondral cysts and foci of edema type signal are likely degenerative in etiology. Near full-thickness loss of articular cartilage along the medial plateau of the tibia and moderate degeneration of the articular cartilage with clefts noted along the medial femoral condyle. Relatively mild degeneration of the articular cartilage of the lateral tibiofemoral compartment.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Osteoarthritis most severely affecting the patellofemoral and medial tibiofemoral compartments.2.Complex tear of the posterior horn of the medial meniscus.3.Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Left knee pain MENISCI: There is focal partial-thickness radial tearing of the body of the medial meniscus. Additional faint linear increased signal intensity within the body and both horns appears to extend to this tear and may reflect additional tearing or intrasubstance degeneration.The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is edema within the medial femoral condyle anteriorly surrounding subchondral plaque-like foci of low signal intensity which may be degenerative in nature or represent small subchondral insufficiency fractures. The cartilage overlying these areas appears intact. There is a degenerative subchondral lesion within the medial facet of the femoral trochlea inferiorly with heterogeneity of the overlying articular cartilage likely representing focal full-thickness degeneration. There is additional mild superficial fraying of the articular cartilage of the patella. The articular cartilage of the lateral compartment is relatively spared.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Medial meniscal tear as described above.2. Bone marrow edema in the medial femoral condyle surrounding small subchondral foci of low signal intensity which may be degenerative in nature or represent small subchondral insufficiency fractures.3. Focal cartilage degeneration of the patellofemoral joint.


Instruction: Generate impression based on medical findings.

Input: Elevated PSA, evaluate for Prostate cancer. PELVIS:PROSTATE:Prostate Size: 5.2 x 6.2 x 5.3 cmPeripheral Zone: Peripheral zone is fairly homogeneous without definite focal lesion.Central Gland: Hypertrophied central gland with likely hypertrophic nodules. One of the nodules in the right mid gland is fairly round circumscribed that is dark on T2-weighted sequence (image 22, series 601) measuring 1.3 x 1.1 cm with restricted diffusion (image 244, series 704) ; however favor a BPH nodule over malignancy.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No definite evidence of extracapsular extensionBLADDER: No significant abnormality noted.LYMPH NODES: Small nonspecific external iliac lymph nodes are noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No suspicious lesion in the peripheral zone.2.Central gland hypertrophy with a dominant nodule in the right mid gland, favor BPH nodule over malignancy.


Instruction: Generate impression based on medical findings.

Input: Iron deposition and FNH lesions. Follow-up. History of Ewing's sarcoma. ABDOMEN:LIVER, BILIARY TRACT: The liver parenchyma signal intensity is compatible with iron deposition. The liver measures 19 cm in craniocaudal dimension. No biliary ductal dilatation or vascular abnormality.Multiple mildly T2 hyperintense and T1 isointense lesions demonstrating avid arterial enhancement are noted in both lobes of the liver. The largest is a segment 2/3 lesion measuring 2.3 x 2.4 cm compared to 1.8 x 2.0 cm previously. The lesions progressively become isointense to liver on portal venous and delayed/equilibrium phase imaging. The lesions also retain contrast on hepatobiliary phase imaging. They have mildly lobular contours. These are mildly increased in size.SPLEEN: Normal splenic size without a focal lesion.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Mild interval increase in size of the multiple liver lesions which are consistent with focal nodular hyperplasia.2.Iron deposition of the liver.


Instruction: Generate impression based on medical findings.

Input: 75-year-old female with mental status changes status post fall on face. Evaluate for acute bleed. Extensive areas of low-attenuation in the deep, subcortical, and periventricular white matter consistent with small vessel ischemic disease of indeterminate age. They appear grossly stable when comparing to prior MRI of the brain. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.Additionally, there is a mottled appearance to the bones of the skull base and frontal bone that is of uncertain etiology. Given patient's history of malignancy, bone metastasis is a differential consideration.The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Extensive small vessel ischemic disease of indeterminate age.2. Mottled appearance of the bones of the skull base and frontal bone is of uncertain etiology. Given patient's history of malignancy, metastatic disease to bone is a differential consideration. Nuclear medicine bone scan may be helpful for further evaluation as clinically indicated.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Reoperative for OR on 5-20. Signs and symptoms: Right parietal brain tumor. Pre- and postenhanced brain MRI:Examination demonstrates a loculated necrotic or cystic enhancing mass in the right posterior temporal-occipital region with extensive surrounding vasogenic edema. The enhancing tumor measures approximately at 23 x 26 mm in transaxial and 27 mm in craniocaudad axis. Mass effect is regional and without deviation of midline. There is no evidence of any additional parenchymal, leptomeningeal or calvarial enhancement. Ventricular system remains within normal size and maintained midline. There is however prominence of cortical sulci and cerebellar-vermian folia for the stated age of 46 concerning for underlying parenchymal volume loss.

Output: 1.Loculated cystic enhancing tumor in the right posterior temporal-occipital measuring 23 x 26 x 27 mm with surrounding vasogenic edema resulting in regional mass effect without deviation of midline.2.Prominence of cortical sulci and cerebellar-vermian folia for the stated age of 46.3.No additional foci of parenchymal, leptomeningeal or calvarial enhancement.


Instruction: Generate impression based on medical findings.

Input: Reason: Evaluate for rotator cuff tear. History of rotator cuff repair in 2003 with recent fall with concern for partial tear History: pain, decreased ROM ROTATOR CUFF: Evaluation of the rotator cuff is limited due to metallic susceptibility artifact from suture anchors within the humeral head as well as additional foci of susceptibility artifact within the soft tissues adjacent to the rotator cuff. The anterior fibers of the supraspinatus tendon are poorly defined. The distal 1 cm of the anterior fibers of the tendon are replaced with intermediate-high signal intensity that we suspect represents tendinosis, and although we see no frank fluid signal intensity traversing the tendon, we cannot exclude the possibility of a chronic tear filled with granulation tissue. There is also irregularity of the undersurface of the supraspinatus tendon indicating undersurface fraying and furthermore, the supraspinatus tendon is thinned, posteriorly, likely reflecting chronic attritional tearing. There is mild fatty atrophy of the supraspinatus at the level of the myotendinous junction. The infraspinatus tendon appears intact, although there is mild to moderate atrophy of the infraspinatus muscle. The teres minor and subscapularis muscles and tendons appear intact.SUPRASPINATUS OUTLET: Mild to moderate osteoarthritis affects the acromioclavicular joint. There is a trace amount of fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The superior portion of the anterior labrum is not well visualized and the middle glenohumeral ligament is noted to be prominent. This may represent a normal variant Buford complex. Mild osteoarthritis affects the glenohumeral joint. BICEPS TENDON: There is mild tendinosis of the intra-articular portion of the long head of the biceps tendon.

Output: 1. Limited evaluation of the rotator cuff due to metallic susceptibility artifact showing chronic tendinosis and attritional tearing of the supraspinatus. We suspect that increased signal intensity within the anterior fibers of the supraspinatus represents tendinosis, as we see no fluid signal intensity traversing the tendon, nor do we see a large subdeltoid bursitis; however, we cannot exclude the possibility of a chronic full-thickness tear filled with granulation tissue. If further imaging is clinically warranted, MR arthrography could be considered.2. Mild osteoarthritis and other findings as described above.


Instruction: Generate impression based on medical findings.

Input: 74 years Female (DOB:4/16/1942)Reason: 3 t scanner HHT pt please evaluate for AVMs History: screening for HHTPROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD Examination is somewhat degraded due to motion artifact.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There is a small focus of low signal on T2 and FLAIR measuring 2 mm diameter located in the left temporal lobe adjacent to the temporal horn of the left lateral ventricle associated with blooming effect on the stability weighted imaging. There is an adjacent punctate focus of signal loss and susceptibility weighted imaging.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. The eyeball lenses are thin.

Output: 1.There is a hemorrhagic lesion present in the left temporal lobe. The underlying cause is uncertain.2.Exam is degraded due to artifact related to patient motion. This will obscure more subtle abnormalities which are frequently seen with HHT.3.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on medical findings.

Input: 53 year old woman with right shoulder pain. ROTATOR CUFF: There is a small amount of fluid in the subacromial-subdeltoid bursa, consistent with mild bursitis. There is a less than 50% thickness articular surface fraying of the supraspinatus. The remaining structures of the rotator cuff appear intact. SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is moderate degeneration in the posterior superior labrum, but no evidence of a SLAP tear. Chondral surfaces are intact.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Articular surface fraying of the supraspinatus tendon. Degeneration in the posterior superior labrum.


Instruction: Generate impression based on medical findings.

Input: Multiple sclerosis [G35], Reason for Study: ^Reason: MS compare to prior evaluate for progression JAVED PROTOCOL History: R sided numbness/weakness Again seen multiple high signal intensity lesions on FLAIR images including bilateral corpus callosum body extended toward cingulate gyrus, right frontal deep white matter, right side trigone area, periventricular white matter of bilateral lateral ventricle occipital horn, and left parietal lobe inferior parietal lobule. There is no evidence of enhancement on Gad infusion.Above described lesions do not show any significant interval change since prior scan. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection or abnormal contrast enhancement. The mastoid air cells are clear.There is a retention cyst on the left maxillary sinus, no change since prior scan.

Output: Multifocal high signal intensity lesions involving corpus callosum, cingulate gyrus, deep white matter and periventricular white matter without evidence of contrast enhancement. No change since prior scan.


Instruction: Generate impression based on medical findings.

Input: CNS recurrence of DLBCL status post 2 cycles of MTR chemotherapy, in need of restaging. There has been interval decrease in size of the infiltrative enhancing mass involving the bilateral basal ganglia, hypothalami, columns of the fornices, and perhaps the anterior commissure, now measuring up to approximately 22 mm, previously 32 mm. There are right transfrontal post-biopsy findings with associated areas of susceptibility effect. There is no evidence of acute infarction. There is decreased effacement of the anterior third ventricle. The lateral ventricles are not significantly changed. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unchanged.

Output: Interval decrease in size of the CNS lymphoma, indicating treatment response.


Instruction: Generate impression based on medical findings.

Input: Reason: C6 vertebral body lesion, no abnormality on CT scan, and only site of uptake on bone scan History: above Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the C6 vertebra. Post biopsy images do not demonstrate a hematoma

Output: C6 vertebral bone biopsy under CT guidance. A total of seven samples in three containers were delivered to pathology for analysis.


Instruction: Generate impression based on medical findings.

Input: Clinical question:? Hemorrhage. Signs and symptoms: Facial droop Nonenhanced CT of brain:There is no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus. Heavy vascular calcification of intracranial right vertebral. There is also high density of bilateral middle cerebral arteries in the sylvian fissures and basilar artery. Above findings are believed to represent vascular calcification and atherosclerotic disease.There is prominence of the folia of cerebellum and vermis for patient stated age which are concerning for underlying cerebellar parenchymal volume loss. Note should be made that acute early stroke can be missed on CT. If patient's symptoms persist follow-up CT or an MRI is recommended.

Output: 1.No evidence of acute intracranial findings.2.Suspect the parenchymal volume loss of cerebellum.3.If clinical symptoms persist an MRI or follow-up CT is recommended


Instruction: Generate impression based on medical findings.

Input: Knee pain Note the examination is limited by large size of the patient's knee.MENISCI: There is intrasubstance degeneration of the lateral meniscus without discrete tear. There is maceration of the body and posterior horn of the medial meniscus.ARTICULAR CARTILAGE AND BONE: There is severe full-thickness cartilage loss of the medial compartment with bone-on-bone apposition of the tibial plateau and femoral condyle. Tricompartmental osteophytes are noted. There is severe cartilage loss of the patellofemoral compartment and lateral compartments as well.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Limited exam secondary to body habitus patient motion. Within the limits of the exam, there is no evidence of osteomyelitis or septic arthritis.2. Diffuse increased signal within the muscles of the calf which are nonspecific in nature but could relate to myositis or diabetic myopathy.3. Additional findings of the knee are described above.


Instruction: Generate impression based on medical findings.

Input: 62-year-old female with a history of osteoarthritis presents with right knee pain. Please note the study is somewhat suboptimal due to patient's morbid obesity.MENISCI: The lateral meniscus is laterally extruded and the medial meniscus is medially extruded. There is abnormal intermediate signal in the posterior horn of the medial meniscus representing mucoid degeneration. There is also mucoid degeneration within the anterior horn of the lateral meniscus.ARTICULAR CARTILAGE AND BONE: There is marked loss of hyaline cartilage, particularly of the medial tibiofemoral compartment. No underlying abnormal bone marrow signal is identified.LIGAMENTS: The anterior cruciate ligament, posterior cruciate ligament, medial collateral ligament, and lateral collateral ligament complex are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Severe osteoarthritis of the right knee with marked loss of cartilage.


Instruction: Generate impression based on medical findings.

Input: 43 year old female with abnormal EF of echo, MRI done for further evaluation. Left VentricleThe left ventricle is normal in size and function. The overall LV ejection fraction is 57%. The LVEDV is 134 ml (normal range 109+/-23), LV end diastolic volume index is 73 ml/m2 (normal range: 65+/-11), LVESV is 58 ml (normal range 31+/-10), and LV end systolic volume index is 32 ml/m2 (normal range 18+/-5). There are no regional wall motion abnormalities present. There is a small focus of LV late gadolinium enhancement at the inferoseptal RV insertion point of unclear significance.Left AtriumThe left atrium is normal in size.Right VentricleThe right ventricle is normal in size and function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 81 ml/m2 (normal range 69+/-14), the RVEDV is 148 ml (normal range 110+/-24), the RV end systolic volume index is 39 ml/m2 (normal range 22+/-8), and the RVESV is 72 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Left ventricle is normal in size and function. The overall LV ejection fraction is 57%.2. Right ventricle is normal in size and function. The overall RV ejection fraction is 51%.3. There is a small focus of LV late gadolinium enhancement at the inferoseptal RV insertion point of unclear significance. 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: Secondary malignant neoplasm of brain [C79.31], Reason for Study: ^Reason: history of brain metastases. follow up MRI History: none There is about 6.9mm (RL) x 8.6mm (AP) x 7.5mm (CC) peripheral enhancing intra axial lesion on the right superior frontal gyrus. Comparing to prior scan, the size of the lesion has been decreased, however the extent of surrounding edema appears to be stable.There is no other abnormal enhancing lesion seen on this scan.Evidence of prior bifrontal craniotomy is again seen, unchanged.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Interval decrease in size of the right superior frontal gyrus metastatic lesion since prior scan.2. No evidence of new metastatic lesion.


Instruction: Generate impression based on medical findings.

Input: Clinical question to be answered: Evaluate for intracranial process. Signs and symptoms: 51-year-old female with severe headaches x 4 days, family history of brain aneurysm. MRI CT of brain without and with infusion of contrast.No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Cortical sulci, ventricular system and all CSF cisterns remain within normal. Calvarium, paranasal sinuses and mastoid air cells are unremarkable.Post infusion images demonstrate no abnormal enhancement the brain parenchyma or leptomeninges. This examination cannot exclude possibility of aneurysm. If an aneurysm is highly suspected a CTA of intracranial circulation is the appropriate test for detection of aneurysm.65 cc of Omnipaque was utilized for this study.

Output: Normal CT of brain without and with infusion of contrast.


Instruction: Generate impression based on medical findings.

Input: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Disc osteophyte complex and ligamentum flavum thickening. There is mild narrowing of the spinal canal. No significant neural foraminal stenosis.C4-5: Disc osteophyte complex and ligamentum flavum thickening result in moderate to severe spinal canal stenosis with flattening of the cord. There is suggestion of volume loss. There is adjacent cord signal abnormality at the upper C5 level involving the cord bilaterally. There is moderate bilateral neural foraminal stenosis related to uncovertebral hypertrophy. C5-6: Disc osteophyte complex and ligamentum flavum thickening result in moderate spinal canal stenosis and mild deformity of the cord. There is severe right and moderate left neural foraminal stenosis related to uncovertebral hypertrophy. C6-7: Disc osteophyte complex and ligamentum flavum thickening result in mild to moderate spinal canal stenosis. There is mild to moderate neural foraminal stenosis on the right related to osteophyte. Mild left neural foraminal narrowing. C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.LUMBAR SPINE

Output: 1. Multilevel degenerative changes in the cervical spine with disc osteophyte complexes and ligamentum flavum thickening at C3-C4, C4-C5, C5-C6, and C6-C7 which is associated with significant spinal canal stenosis as described above. Findings are most severe at the C4-C5 level where there is flattening of the cord and T2 hyperintensity which is favored to be related to myelomalacia. 2. Multilevel degenerative changes in the lumbar spine with moderate spinal canal stenosis at L2-L3, L3-L4, and L4-L5 related to combination of degenerative changes and prominence of the epidural fat. Additional details as above.


Instruction: Generate impression based on medical findings.

Input: History of recently diagnosed Gleason 8 prostate cancer. PELVIS:PROSTATE:Prostate Size: 6.7 x 5.8 x 7.3 cm.Peripheral Zone: There is a large, exophytic mass arising from the right base and mid gland which demonstrates decreased T2 and ADC signal which is compatible with neoplasm.Central Gland: Hyperplastic nodules compatible with prostatic hypertrophy.Seminal Vesicles: There is abnormal signal within the right seminal vesicle adjacent to the aforementioned right peripheral zone mass compatible with seminal vesicle invasion.Extracapsular Extension: There is extensive extracapsular extension associated with the large right peripheral zone exophytic mass including involvement of the right neurovascular bundle. The aforementioned lesion also abuts the rectal wall.BLADDER: No significant abnormality noted.LYMPH NODES: There are are a few subcentimeter perirectal and internal iliac lymph nodes which are nonspecific.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.INDEX LESION MEASUREMENTS (Current exam date/time: 12/2/2016 10:15:00)RIGHT PERIPHERAL ZONE LESION: 4.1 x 2.6 cm (Image 61, Series 501); 3.9 cm (Image 72, Series 503).

Output: Large, exophytic mass arising from the right peripheral zone compatible with neoplasm with associated extracapsular extension, invasion of the right seminal vesicle, invasion of the right neurovascular bundle, abutment of the rectal wall, and possible pelvic lymph node involvement.


Instruction: Generate impression based on medical findings.

Input: 90 year-old female with altered mental status, evaluate for bleed. There is no evidence of intracranial hemorrhage or mass. Multiple scattered hypoattenuating foci in the left frontal, right occipital, and right temporal lobe consistent with cortical infarcts of indeterminate age. If there is clinical concern for an acute infarct, MRI may be obtained. Numerous hypoattenuating foci within the subcortical, deep, and periventricular white matter consistent with ischemic small vessel disease of indeterminate age. The ventricles and basal cisterns are prominent compatible with age-appropriate volume loss.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Multiple areas of cortical and subcortical infarcts, age indeterminate. If there is clinical concern for acute infarction, MRI may be obtained.


Instruction: Generate impression based on medical findings.

Input: Reason: Pt is a 70 y/o male with RCC, evaluate for recurrence History: RCC Note that the examination is limited by lack of intravenous contrast.ABDOMEN:LIVER, BILIARY TRACT: Lobular T2 hyperintense lesion in segment 7 of the liver, which has previously been characterized as a hemangioma, not significantly changed.SPLEEN: Lobulated T2 hyperintense lesion in the anteroinferior spleen nonspecific but likely benign, not significantly changed.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post right nephrectomy. There is no soft tissue signal seen in the region of the right renal bed to suggest local tumor recurrence. T2 hyperintense lesions in the left kidney compatible with renal cysts, not significantly changed.RETROPERITONEUM, LYMPH NODES: No significant retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.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: Degenerative changes in the lumbar spine are again noted.OTHER: No significant abnormality noted.

Output: Surgical changes of right nephrectomy without evidence of recurrent or metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate for cord compression - 62 yo with recent C spine laminectomy complicated by fluid collection and MRSA bacteremia now with AMS, new LE weakness and supratherapeutic PTT c/f cord compression per neurosurgery History: AMS, dec LE strength, fever, supratherapeutic PTT Vertebral body heights in the cervical, thoracic, and lumbar spine are normal. Alignment is grossly maintained. There are postsurgical changes of cervical laminoplasty from C3 to C7. Degenerative changes are again seen in the cervical spine including T2 hyperintensity within the C3-C4 disc space with small disc extrusion as seen on recent MRI. There is mild spinal canal stenosis at this level without cord compression. Thoracic and lumbar spinal canal are also patent. There are postsurgical changes of spinal canal decompression and fusion at L4-L5. There is edema involving the T12 vertebral body with minimal irregularity and Schmorl's node involving the superior endplate, questionably worse since 12/6/2010. No significant loss of height. There is focus of T2 hyperintensity involving the dorsal spinal canal at the epidural space at L1-L2 which is not well evaluated on these limited sequences and may represent fluid; finding is nonspecific and may be from a degenerative, traumatic, or infectious basis.

Output: 1. This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No cord compression is identified.2. Postoperative changes of cervical laminoplasty for spinal canal decompression. Cervical spine is better assessed on recent MRI from 12/14/2015.3. Edema involving the T12 vertebral body, possibly related to minimal irregularity of the T12 superior endplate or trauma. No significant loss of height or osseous retropulsion. Small focus of T2 hyperintensity in the dorsal epidural space at the L1-L2 level which may be on a degenerative basis although other etiologies such as infection or blood products may also be considered in the appropriate clinical setting. There is no associated cord compression. Please note this is a limited study to exclude cord compression. Although there is no cord compression, if there is high suspicion for infection including epidural abscess, would recommend a dedicated MRI spine study with gadolinium.


Instruction: Generate impression based on medical findings.

Input: Reason: Post TACE/RFA, evaluate for new or recurrent HCC; Evaluate IPMN History: HCV cirrhosis, SVR; HCC s/p TACE/RFA, IPMN ABDOMEN:LIVER, BILIARY TRACT: Nodular cirrhotic liver morphology.The segment 8 ablation cavity measures approximately 1.8 x 1.3 cm, compared to 1.8 x 1.3 cm previously. There is again a punctate nodular focus of arterial enhancement along the anterior aspect of the ablation cavity without definite washout. Minimal thin enhancement around the ablation cavity is unchanged.There is plaque-like enhancing focus at the gallbladder fundus measuring 0.4 x 0.8 cm, not significantly changed back to 1/6/2015, with associated T2-weighted cystic intensity on prior exams, likely focal adenomyomatosis. Cholelithiasis without cholecystitis. Recanalized umbilical vein. The common hepatic artery originates from the aorta. The vessels are patent.Cholelithiasis without evidence of cholecystitis. No biliary ductal dilatation.SPLEEN: Stable mild splenomegaly, measuring 14 cm in length.PANCREAS: Lobular cystic focus in the pancreatic head measuring approximately 1.3 cm is unchanged, likely communicates with a normal caliber pancreatic duct. No suspicious postcontrast imaging features.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple appearing renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small fat-containing umbilical hernia.OTHER: No significant abnormality noted.

Output: 1.Cirrhotic liver with evidence of portal hypertension.2.Punctate nodular enhancement along the anterior aspect of the segment 8 ablation cavity not significantly changed and which may be a posttreatment change. Attention to this on follow-up imaging is recommended. No new suspicious liver lesions.3.Stable cystic lesion in pancreatic head suggestive of a side branch IPMN without suspicious imaging features.


Instruction: Generate impression based on medical findings.

Input: Following a discussion of the procedure with the patient, including its risks, benefits, alternatives and steps to prevent infection, informed written consent was obtained and documented in the patient's chart. The time-out form was completed to confirm patient identity and side/type of procedure. All operators present for the case performed standard preprocedural prep including hand washing, sterile gloves, mask and cap. The patient was prepped and draped in the usual aseptic fashion. Local anesthesia over the target area was obtained by 1% lidocaine. Localizing CT examination demonstrated a oval soft tissue mass along the anterior aspect of the subscapularis muscle corresponding to the findings on recent PET/CT and MRI examinations. Using CT guidance, a 16-gauge Achieve core biopsy needle was advanced into the lesion. Four 16-gauge core needle biopsy specimens were obtained and placed in formalin. Touch preparations were performed and handed to cytopathology to evaluate for specimen adequacy.The core biopsy specimens were hand carried to the Surgical Pathology labThe patient tolerated the procedure well without immediate complication. Routine post procedure instructions were communicated to the patient.ESTIMATED BLOOD LOSS: Less than 5cc. An adhesive bandage was placed on the patient’s skin.

Output: CT guided biopsy of left shoulder soft tissue mass.


Instruction: Generate impression based on medical findings.

Input: 50-year-old male with history of prostate cancer. Left apex 3+4. PELVIS:PROSTATE:Prostate Size: 4.5 x 3.0 cmPeripheral Zone: There is a round T2 hypointense lesion with associated restricted diffusion and early enhancement located at the left lateral apex/mid gland measuring 8 x 6 mm (image 14 of series 801). T2 hypointense signal abnormality superficial to this lesion likely represents scarring.There is an additional T2 hypointense focus with associated restricted diffusion in the left anterior apex measuring 9 x 7 mm (image 15 of series 801).Ill-defined T2 hypointense area in the right lateral mid gland measuring 12 x 8 mm with mild restricted diffusion is moderately suspicious.There is linear T2 signal hypointensity located diffusely throughout the peripheral gland likely related to prostatitis or scarring.Central Gland: BPHSeminal Vesicles: No significant abnormality notedExtracapsular Extension: No distinct extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Left lateral apical lesion compatible with patient's known biopsy-proven adenocarcinoma. No evidence of extracapsular extension.2. Additional highly suspicious focus in left anterior apex.3. Right lateral midgland lesion is moderately suspicious. Multiple areas of scarring noted involving bilateral peripheral zones.


Instruction: Generate impression based on medical findings.

Input: 66 year old female with history of AL amyloidosis, s/p pacemaker for tach-brady syndrome. Referred for MRI for follow up. Left VentricleThe left ventricle is normal in size and systolic function. There is moderate left ventricular hypertrophy. The basal anteroseptum is 14mm (similar to reported on previous study dated 4/2016). The overall LV ejection fraction is 56%, the LVEDV is 124 ml (normal range 109+/-23), the LV end diastolic volume index is 67 ml/m2 (normal range: 65+/-11), the LVESV is 55 ml (normal range 31+/-10), the LV end systolic volume index is 30 ml/m2 (normal range 18+/-5), the LV mass is 137 g (normal range 114+/-24), and the LV mass index is 74 g/m2 (normal range 67+/-11). There are no regional wall motion abnormalities present. Based on T1 scouts, the gadolinium kinetics are abnormal (i.e. myocardium and LV cavity null within 80ms of each other). There is diffuse late gadolinium enhancement, which is most pronounced in the basal inferolateral wall and also in the basal septal mid-wall. These findings are strongly suggestive of the diagnosis of cardiac amyloidosis. No intracardiac thrombus. An accurate myocardial T1 measurement is not available, possibly due to artifact from the pacemaker. Left AtriumThe left atrium is moderately dilated. No LAA thrombus.The atrial wall is thickened. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 55%, the RVEDV is 141 ml (normal range 110+/-24), the RV end diastolic volume index is 76 ml/m2 (normal range 69+/-14), the RVESV is 63 ml (normal range 35+/-13), and the RV end systolic volume index is 34 ml/m2 (normal range 22+/-8). Pacemaker lead is noted in the RV apex. Right AtriumThe right atrium is dilated. Right atrial pacer lead noted. The atrial wall is thickened. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation. The main PA is mildly dilated and measures 32 mmTricuspid ValveThe tricuspid valve opens widely. There is a pacer lead through the tricuspid valve.AortaThere is a left sided aortic arch with a common origin of the innominate and left common carotid arteries. The thoracic aorta is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC drains normally into the right atrium. The IVC is dilated.PericardiumSmall pericardial effusion. Extracardiac FindingsWell-circumscribed lesions noted in the liver consistent with hepatic cyst. This study is not designed for the specific evaluation of extra-cardiac findings. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1.The left ventricle is moderately hypertrophied (IVSd=14mm) with normal systolic function. LV ejection fraction is 56%. There is evidence of abnormal gadolinium kinetics and diffuse late gadolinium enhancement most pronounced in the basal inferolateral wall and basal septal midwall. These findings are strongly suggestive of the diagnosis of cardiac amyloidosis. 2.The right ventricle isnormal in size and function. RVEF is 55%3.Biatrial enlargement and thickening.4.At least mild mitral regurgitation. 5.When compared to the prior study from 4/1/2016, the LV wall thickness is stable but difference between myocardial and LV cavity inversion time has decreased, which could represent increasing myocardial amyloid burden. Comparison of myocardial T1 times not possible. 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: There has been no significant interval change in the abnormal fatty bone marrow and endplate irregularity involving the L4 and L5 vertebrae related to previous discitis-osteomyelitis. Likewise, the there is persistent mild loss of vertebral body height at L4 and L5. Enhancement involving the right L3-L4 foramen and posterior to the right L3-L4 facet extending along the spinous process is unchanged, but there is no discrete abnormal signal or pathological enhancement within the facet joint. Degenerative spondylosis at L4-L5 and L5-S1 appears similar as before, with mild to moderate narrowing of the lower lumbar neural foramina, except for moderate severe narrowing of the left L5-S1 foramen, with nerve root impingement. There is no significant central spinal canal stenosis. There is redemonstration irregularity and abnormal marrow signal within the left sacrum and iliac bone, with predominantly fatty marrow characteristics. There is again significant irregularity of the left sacroiliac joint consistent with prior sacroiliitis. The lumbar spine is in normal alignment, with a normal lumbar lordosis. The distal spinal cord appears unremarkable.

Output: 1. Redemonstration of sequela of prior discitis-osteomyelitis at L4-L5 with vertebral body height loss and endplate irregularity, but no evidence of epidural abscess. 2. Degenerative spondylosis in the lower lumbar spine with left neural foraminal narrowing and nerve root impingement at L5-S1. In addition, persistent mild enhancement along the posterior aspect of the right L3-L4 facet may be be degenerative in nature.3. Redemonstration of sequela of previous left sacroiliitis.


Instruction: Generate impression based on medical findings.

Input: 68 years Female (DOB:4/8/1948)Reason: lumbar stenosis, back pain and worsening leg numbness History: back pain and worsening leg numbnessPROVIDER/ATTENDING NAME: BEN-ZION ROITBERG BEN-ZION ROITBERG Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to neural foramina. There is marked bilateral facet hypertrophy present at this level. There is mild anterior subluxation of L5 on S1 which is stable compared to the prior exam.. There is a mild disc bulge present at this level. There is effacement of the fat at the left lateral recess adjacent to the nerve root at the left lateral recess. This is unchanged compared to the prior exam.At L4-5 there is no significant compromise to neural foramina. There is a moderate degree of facet and ligamentum flavum hypertrophy present at this level. There is partial effacement of fat at the left lateral recess at this level and some crowding of nerve roots within the thecal sac overall there is a mild to moderate degree of spinal stenosis at this level. This was also present on the prior exam.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is a small central disc extrusion present at this levelAt 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.There is a large right-sided renal cyst present which was also present on the prior exam and measures 35 x 31 mm axial dimensions. It is unchanged compared to the previous exam.

Output: 1.There are multilevel degenerative changes present in the lumbar spine with some moderate spinal stenosis at L4-5 and encroachment of nerve roots at the left lateral recess at L5-S1 which are stable compared to the prior exam.


Instruction: Generate impression based on medical findings.

Input: Female 63 years old Reason: r/o neoplasm History: cystic structure 4x4x1 in the right adnexa PELVIS:UTERUS, ADNEXA: Uterus measures 4.5 x 3.3 x 6.7 cm. Well-circumscribed T2 hypointense lesions within the uterus represent small leiomyomata.1.2 x 1.0 cm on cystic structure in the right adnexa likely represents a small adnexal cyst.Tubular structure in the pelvis adjacent to the right adnexa fills with contrast and is a pelvic vein.Left adnexa is unremarkable.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Nonspecific rectal thickening suboptimally evaluated due to collapse.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.1.2 cm T2 hyperintense structure in the right adnexa may represent a small adnexal cyst.2.Tubular structure near the right adnexa fills with contrast and likely represents a pelvic vein.3.Submission of the outside ultrasound images is recommended so a one-to-one correlation can be performed.


Instruction: Generate impression based on medical findings.

Input: Developmental delay and epilepsy. Complicated birth history, born via C-section due to breech where mother's heart rate and blood pressure dropped and baby heart rate was non reassuring. The baby was born breech and with cyanosis. There is volume loss and high T2 signal involving the hippocampi and the deep gray nuclei bilaterally. There are scattered areas of high T2 signal in the cerebral white matter bilaterally. There is a diffuse background of mild cerebral volume loss, with tinning of the corpus callosum. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild nonspecific mucosal thickening in the paranasal sinuses.

Output: Findings suggestive of perinatal hypoxic-ischemic injury in a central and peripheral pattern with associated diffuse cerebral volume loss.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: Male 73 years old Reason: Adrenal and kidney lesion - please evaluate History: Adrenal and kidney lesion - please evaluate ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No suspicious hepatic lesions. Hepatic and portal veins are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal gland nodule is mildly T2 hyperintense shows enhancement does not have significant intra-Voxel fat. There are small foci of signal dropout on out of phase imaging but the majority of the lesion does not lose signal.KIDNEYS, URETERS: Small bilateral renal cysts. Some of the cysts in the kidney have internal complexity and several septations. No hydronephrosis.The previously measured left upper pole renal lesion currently measures 3.3 cm likely due to differences in technique. The lesion is hyperintense on T2-weighted imaging and shows some hairline internal enhancement and is compatible with a minimally complex cyst.RETROPERITONEUM, LYMPH NODES: Small retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Left adrenal gland nodule may represent a lipid poor lipoma given its signal characteristics. It remains indeterminate but probably benign given its size stability for a year.2.Bilateral small renal cysts some of which have increased complexity with internal septations.3.The 3.3 cm left upper pole renal cyst has minimal internal complexity.


Instruction: Generate impression based on medical findings.

Input: Status post L5-S1 left microdiscectomy one year ago Examination is mildly motion degraded. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is grade 1 to 2 anterolisthesis of L4 on L5 similar to prior. There is also trace retrolisthesis of L3 on L4 and L4 on L5. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: Minimal disc bulge. No spinal canal or neural foraminal stenosis.L2-L3: Minimal disc bulge. No spinal canal or neural foraminal stenosis. Mild facet arthropathy.L3-L4: Dorsal annular fissure with minimal central disc extrusion. There is ligamentum flavum thickening and facet arthropathy, relatively worse on the left. There is minimal central canal narrowing. There is mild left neural foraminal stenosis. No significant right neural foraminal narrowing.L4-L5: Grade 1/2 anterolisthesis similar to prior with disc uncovering. There is partial effacement of the lateral recesses with minimal central canal stenosis. Mild bilateral neural foraminal narrowing. Advanced bilateral facet arthropathy.L5-S1: Interval microdiscectomy with previously seen left-sided disc extrusion no longer evident. No evidence of recurrent disc herniation. There is minimal low T1 signal likely related to scar tissue in the left lateral and dorsal epidural space. Advanced facet arthropathy, left worse in right, with minimal left neural foraminal stenosis. No significant central canal narrowing or right neural foraminal stenosis.Small right renal cyst.

Output: 1. Compared to 9/9/2014, interval postsurgical changes related to left-sided microdiscectomy at L5-S1. No evidence of recurrent disc herniation.2. Degenerative changes at additional levels including degenerative spondylolisthesis at L4-L5 similar to prior. Advanced facet arthropathy is present at L4-L5 and L5-S1.3. Minimal central canal narrowing at L3-L4 and L4-L5. There is also mild neural foraminal narrowing at multiple levels as above. No high-grade spinal canal or foraminal stenosis at any level.


Instruction: Generate impression based on medical findings.

Input: Female 54 years old Reason: Hx of Rectal Cancer, restaging History: Hx of Rectal Cancer, restaging PELVIS:UTERUS, ADNEXA: The uterus is enlarged with multiple T2 hypointense well-defined enhancing nodules compatible with leiomyomata. The endometrium/endometrial cavity is distorted.BLADDER: Urinary bladder is normally distended without focal abnormality. There is abnormal marked symmetric circumferential thickening of the urethra extending from the bladder base for approximately a 2.6 cm segment.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: In comparison with the study of 3/25/2015 the lesion involving the distal rectum has resolved. There is new circumferential wall thickening involving the anorectal junction/anus with the wall measuring up to 8 mm in thickness. The segment of in rectum/anus measures 4 cm. The rectum proximal to this is mildly distended. There is slight hyperenhancement in this region.BONES, SOFT TISSUES: Post radiation changes with replacement of the normal red marrow.OTHER: No significant abnormality noted.

Output: 1.Resolution of the distal rectal mass.2.Circumferential thickening of the anal rectal region which is nonspecific and may be due to underdistention of the segment.


Instruction: Generate impression based on medical findings.

Input: Left shoulder pain ROTATOR CUFF: No significant abnormality noted.SUPRASPINATUS OUTLET: There is a tiny focus of signal abnormality within the distal clavicle which may represent early cyst formation, but this is equivocal and not necessarily of clinical significance. Otherwise no abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Essentially normal MR arthrogram of the shoulder. Specifically, there is no evidence of labral tear or Bankart lesion.


Instruction: Generate impression based on medical findings.

Input: Cervical spondylosis without myelopathy Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal. There is a disc bulge present at this level associated with bilateral uncovertebral osteophytes and narrowing of the neural foramina bilaterally. Overall there is no significant compromise of the spinal cord. These findings were present on the prior exam and have not changed substantially.At C4-5 there is no significant compromise to the spinal canal. There are small uncovertebral osteophytes present at this level associated with disc material bilateral narrowing of the neural foramina and encroachment of the left exiting nerve roots. These findings were present on the prior exam and have not changed substantially.At C5-6 there is loss of disc space height, disc bulge, endplate and uncovertebral osteophytes as well as encroachment of the neural foramina bilaterally with encroachment of exiting nerve roots and effacement of spinal fluid ventricle and posterior to spinal cord. Overall there is moderate spinal stenosis at this level. These findings were present on the prior exam and have not changed substantially.At C6-7 there is loss of disc space height, and disc bulge and bilateral uncovertebral osteophytes as well as small endplate osteophytes and narrowing of the neural foramina bilaterally and encroachment of the exiting nerve roots bilaterally. There is a mild to moderate degree of spinal stenosis present at this level. This was present on the prior exam and has not changedAt C7-T1 there is no significant compromise to the spinal canal. There is a right lateral recess disc protrusion present at this level associated with encroachment of the right-sided exiting nerve roots. This was also present on the prior exam and has not substantially progressed.The vertebral artery flow voids appear to be intact.MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The patient is status post laminectomy at T11-T12. There is redemonstration of multilevel degenerative changes in the thoracic spine with a Schmorl's nodes at multiple levels. At T5-6 there is a right paramedian disc protrusion redemonstrated and unchanged.At the T11-T12 level there is a disc bulge present. Additionally there is some signal change redemonstrated within the spinal cord posteriorly and eccentric towards the right side this level associated with focal volume loss. There is no compromise of thoracic spinal canal or exiting nerve roots.

Output: 1.There is redemonstration of multilevel degenerative changes present in the cervical spine with moderate spinal stenosis at C5-6 and mild to moderate spinal stenosis at C6-7 which have not substantially progressed since the previous exam from March 2013. There is multilevel encroachment of exiting nerve roots within the neural foramina present as detailed above which for the most part has not changed since the prior exam.2.The patient is status post laminectomy at T11-T12. There is some myelomalacia present at the spinal cord at this level. This is stable when compared to the previous exam.


Instruction: Generate impression based on medical findings.

Input: Reason: RCT History: Pain, Weakness Suboptimal evaluation on multiple sequences secondary to patient motion artifact as well as inability to optimally position the patient for the ABER view.ROTATOR CUFF: There is a complete tear of the supraspinatus with approximately 1 cm of retraction of the proximal tendon fragment. Some of this tearing appears to extend posteriorly to involve the anterior fibers of the infraspinatus. There is thickening and intermediate signal intensity within the supraspinatus indicating tendinosis. There is fatty atrophy of the supraspinatus. There is thickening and intermediate signal intensity within the subscapularis indicating moderate tendinosis. The teres minor muscle and tendon appear intact.SUPRASPINATUS OUTLET: Intra-articular gadolinium extends into the subacromial subdeltoid bursa confirming a full-thickness tear. Note is made of postsurgical changes of prior acromioplasty affecting the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. There is a full-thickness articular cartilage cleft along the anterior superior glenoid. There is partial-thickness articular cartilage degeneration along the glenoid. There is heterogeneity and intermediate signal intensity within the posterior and superior labrum indicating degeneration/degenerative tearing.BICEPS TENDON: The tendon of the long head of the biceps appears intact. ADDITIONAL

Output: 1. Postsurgical changes of prior rotator cuff tear with findings indicating a complete retear of the supraspinatus with retraction as described above. Other findings as described above. 2. Degeneration/degenerative tearing of the glenoid labrum as well as articular cartilage degeneration along the glenoid.3. Low signal intensity debris within the glenohumeral joint may reflect a synovitis.


Instruction: Generate impression based on medical findings.

Input: Reason: eval rot cuff, extent of OA History: shoulder pain Study is limited by patient motion artifact.ROTATOR CUFF: Thickening and increased signal of the distal supraspinatus tendon consistent with moderate to marked tendinopathy. No discrete signal change to indicate tear. Fraying of the undersurface of the supraspinatus and infraspinatus tendons at the greater tubercle insertion site. No muscle atrophy.SUPRASPINATUS OUTLET: Moderate degenerative changes of the AC joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: Moderate degenerative changes of the glenohumeral joint with multiple subchondral cysts in the humeral head. Labrum is grossly normal.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1.Findings consistent with moderate to marked supraspinatus distal tendinopathy. No discrete tear is evident.2.Moderate degenerative changes of the AC joint and glenohumeral joint.


Instruction: Generate impression based on medical findings.

Input: Lack of contrast limits evaluation for small lesions including small foci of epidural tumor. Again seen is osseous metastatic disease throughout the thoracic spine. Relatively larger lesions are present at the T7 and T8 levels which were present previously. No new large lesions are evident although there is suggestion of increased tumor infiltration involving the T10 and T11 vertebral bodies with worsening diffuse T1 hypointensity. Thoracic vertebral body heights are maintained. Alignment is maintained. Previously seen epidural tumor at the T7-T8 level on MRI 3/10/2015 study has regressed and no longer appreciable. Thoracic spinal canal demonstrates no significant stenosis at any level.Axial T2 images of the lower thoracic spine were not obtained. Based on the sagittal sequences there is a large right paraspinous mass extending from the right T9-T10 to the T12 levels with extension into the lower thoracic neural foramina. No obvious extension into the spinal canal or mass effect on the cord based on the sagittal sequences.LUMBAR SPINE

Output: Please note patient could not tolerate the full study and limited sequences of the thoracic and lumbar were obtained. There is no evidence of a new pathologic compression fracture, significant spinal canal stenosis at any level, or epidural tumor. If complete MRI study cannot be obtained, follow-up bone scan or PET may be helpful to assess the burden of active osseous metastatic disease.There is a right lower thoracic paraspinous mass which appears to extend into the neural foramina. No significant intraspinal extension is appreciated based on the sagittal sequences. Dorsal epidural tumor at the T7-T8 level seen on prior study from 3/10/2015 has regressed and no longer appreciated.


Instruction: Generate impression based on medical findings.

Input: Headaches, evaluate for progression of periventricular signal abnormality. Again seen is aconfluent hyperintense T2/flair signal in the bilateral centrum semiovale, corona radiata and basal ganglia, including a focus of CSF-like signal in the right centrum semiovale, which have been unchanged in extent since prior exam. There is however a T2 hyperintense focus/cystic encephalomalacia involving the left frontal corona radiata, axial T2 image 19 of series 7 which appears new since prior. There is also a prominent focus of susceptibility effect along the upper aspect of the left caudate head which is not seen on the prior study. There is a tiny focus of susceptibility within this region on the prior study. Punctate focus of susceptibility in the left posterior frontal corona radiata is not definitively seen on prior and may be new although differences in susceptibility-weighting technique limit direct comparison. No evidence of acute infarct, acute hemorrhage, intracranial mass or mass effect. No hydrocephalus. No extra-axial collections. Extracranial soft tissues structures are unremarkable. Mucous retention cysts again seen in the left greater than right maxillary sinuses.

Output: Extensive white matter signal abnormality is largely stable compared to 2/26/2010; however, there is small focus of cystic encephalomalacia involving the left frontal corona radiata and an adjacent chronic hemorrhage which appear new, suggesting mild progression of disease. Differential is broad but favor advanced chronic small vessel ischemic disease. Given a patient's age, entities such as Binswanger and CADASIL could be considered, for example; although characteristic anterior temporal lesions associated with CADASIL are not seen. Other white matter diseases such as chronic demyelinating disease are also in the differential although felt to be less likely.


Instruction: Generate impression based on medical findings.

Input: Paresthesia. There is a subcentimeter area of restricted diffusion and high T2 signal in the left thalamus with punctate foci of susceptibility effect. There are a few other foci of supratentorial and infratentorial susceptibility effect that scattered about, predominantly involving the deep grey matter. There is extensive cerebral white matter T2 hyperintensity without associated restricted diffusion. There are also more focal defects in the right corona radiata, right caudate, and right thalamus. There is a cavum septum pellucidum. The ventricles are otherwise unremarkable. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: Acute infarct in the left thalamus, superimposed upon probable hypertensive chronic microhemorrhages, chronic lacunar infarcts and extensive small vessel ischemic white matter disease.Discussed with Dr. Javed at 1:30 PM on 1/21/15.


Instruction: Generate impression based on medical findings.

Input: 5 week old male ex 40 weeker with recurrent global and focal seizures. There are subcentimeter foci of low T1 and high T2 signal in the bilateral thalami, as well as peripheral T1 hyperintensity in the right side. The degree of myelination otherwise appears to be within normal limits. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Subcentimeter lesions in the bilateral thalami may represent chronic infarcts, but no evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on medical findings.

Input: Nontraumatic subarachnoid hemorrhage, unspecifiedClinical question: Please evaluate for new infarct or other abnormality to explain SAHSigns and Symptoms: Post-R carotid stent for aneurysm (11/2 then 11/11, with acute/subacute infarcts at the time), new SAH There is susceptibility effect, sulcal FLAIR signal hyperintensity and T1 signal hyperintensity suggestive of subarachnoid blood present along the the right sylvian fissure, the right superior temporal sulcus, the right middle temporal sulcus, the right inferior temporal sulcus, and the lateral aspect of the right posterior central sulcus. A small amount of intraventricular blood is also present.There is redemonstration but decrease in size of diffusion restriction along the right precentral gyrus with. Other foci of diffusion restriction identified on the prior exam at the anterior aspect of the insular cortex and in the parietal lobe are less conspicuous on DWI but evident on FLAIR.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.There is a covered stent with flow void coursing through a now thrombosed right upper neck pseudoaneurysm.

Output: 1.Subarachnoid blood is centered along the right Sylvian fissure, the right superior temporal sulcus, the right middle temporal sulcus, the right inferior temporal sulcus, and the lateral aspect of the right posterior central sulcus. 2.Continued evolution of small foci of infarction along the right precentral gyrus, right parietal lobe and right insular cortex.


Instruction: Generate impression based on medical findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.he patient was placed supine on the fluoroscopy table. The left hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 14 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 31 seconds.

Output: Successful left hip injection without immediate complication. MR arthrogram to follow.


Instruction: Generate impression based on medical findings.

Input: Postoperative changes are seen again seen from previous high right frontal parietal convexity craniotomy with underlying areas of encephalomalacia. There is a similar abnormal irregular contour to the clival margins especially inferiorly consistent with erosive changes, progressed since the prior MRI. There is mild overlying soft tissue thickening of the nasopharyngeal region without enhancement. There is a similar pattern of heterogeneous enhancement along the left sphenoid sinus.The ventricles and sulci are prominent, consistent with mild-moderate age-related volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. There are multiple scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with moderate chronic small vessel ischemic changes. Similar pattern of patchy FLAIR hyperintensities also seen within the pons bilaterally. There is no pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. T1 hyperintense mucus retention cysts are identified in the posterior left ethmoid region. There is mild mucosal thickening in the maxillary sinuses with evidence of prior endoscopic sinus surgery. There is residual opacification along the right ethmoid cavity, with history of prior ethmoidectomy.

Output: 1. No acute abnormality. Stable pattern of abnormal FLAIR hyperintense foci within the white matter and brainstem , which are nonspecific but may relate to chronic small vessel ischemic changes.2. Grossly stable regular appearance of the heterogeneous clivus with mild overlying soft tissue prominence along the nasopharynx and enhancement along the left sphenoid sinus region, which again may be related to Rosai Dorfman disease.