Instruction: Generate impression based on medical findings.

Input: Redemonstrated is a heterogeneous T2/FLAIR hyperintense lesion within the cerebellar vermis, with areas of intrinsic T1 shortening and several foci of susceptibility artifact corresponding to previously noted calcifications as well as minimal patchy enhancement. Mild mass effect on the posterior wall of the fourth ventricle is again noted, without associated hydrocephalus. The mass is best delineated on the T2-weighted FLAIR images. It again measures 2.4 cm transverse x 3.0 cm AP dimension. These findings are unchanged.Low-lying cerebellar tonsils again extend 7 mm below the foramen magnum with associated crowding, unchanged in appearance. CSF flow analysis is nondiagnostic secondary to technical factors.No evidence of diffusion restriction or midline shift. No new pathological enhancement is identified. There is no extra-axial fluid collection. Normal flow voids are identified in the major intracranial vessels. There is mild mucosal thickening in the maxillary sinuses, unchanged, with an increase in ethmoid and frontal sinus mucosal thickening. There are no air-fluid levels. Mastoid air cells are clear.

Output: 1.No significant interval change in heterogeneous midline cerebellar vermian lesion with foci of calcification and enhancement.2.Stable low lying cerebellar tonsils, possibly relating to the mass effect from the cerebellar vermian lesion.


Instruction: Generate impression based on medical findings.

Input: 54 years Female (DOB:2/24/1962)Reason: pain History: painPROVIDER/ATTENDING NAME: RODERICK H. BIRNIE RODERICK H. BIRNIE The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine. Overall the patient's cervical spinal canal is rather small on a congenital basis.There are large anterior osteophytes present at this level.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is disc desiccation and a disc bulge present at this level associated with uncovertebral osteophytes. There is facet hypertrophy predominantly on the left side at this level. There is mild encroachment of the exiting nerve roots within the neural foramina at this level.At C4-5 there is some loss of disc space height and disc desiccation as well as endplate and uncovertebral osteophytes. There is encroachment of the exiting nerve roots within the neural foramina bilaterally at this level and there is effacement of spinal fluid ventral and posterior the spinal cord at this level. Overall there is a mild to moderate degree of spinal stenosis present. There is bilateral encroachment of exiting nerve roots within the neural foramina this level.At C5-6 there are endplate and uncovertebral osteophytes present at this level associated with narrowing of the neural foramina bilaterally and some encroachment of the exiting nerve roots.At C6-7 there are endplate and uncovertebral osteophytes present at this level associated with narrowing of the neural foramina bilaterally and some encroachment of the exiting nerve roots.At C7-T1 there is no significant compromise to the spinal canal or neural foramina. There is some ligamentum flavum hypertrophy which does narrow the neural foramen bilaterally at this level.The vertebral artery flow voids appear to be intact.

Output: There are multilevel degenerative changes present in the cervical spine with encroachment of exiting nerve roots within the neural foramina at multiple levels from C4-5 down to C6-7 and some mild to moderate spinal stenosis at C4-5.


Instruction: Generate impression based on medical findings.

Input: 21-year-old male with left knee pain after soccer injury on May 31, evaluate for ligamentous/meniscal injury MENISCI: There is a complex tear of the posterior horn and body of the medial meniscus, which includes a large longitudinal component that involves the posterior horn and body of the meniscus, as well as a horizontal component that extends into the peripheral fibers of the posterior horn. Furthermore, the peripheral third of the posterior horn near its root is absent, and we suspect the displaced fragment has flipped adjacent to the medial aspect of the PCL. The anterior horn of the medial meniscus is intact.There is undulation of the inner third of the anterior horn of the lateral meniscus, suggestive of a normal variant meniscal flounce. However, there is also suggestion of a partial thickness radial tear at the junction of the anterior horn and body of the lateral meniscus on axial image 17, series 3. The posterior horn of the lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is edema within the posterior aspect of the lateral tibial plateau, as well as the lateral femoral condyle just above the anterior horn of the lateral meniscus, representing bone contusions. There is also a slight depression of the articular surface of the lateral femoral condyle at the site of contusion, indicating a mild impaction fracture. Note is made of mild edema in the posterior aspect of the medial tibial plateau, likely also representing a contusion. We see no fluid -filled articular cartilage defect.LIGAMENTS: The ACL is poorly defined indicating full thickness rupture, presumably mid-substance. The PCL, medial collateral ligament, and lateral collateral ligament are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: ACL rupture with complex tear of the medial meniscus and possible partial thickness radial tear of the lateral meniscus as described above.


Instruction: Generate impression based on medical findings.

Input: Clinical question to be answered: Response. Clinical question to be answered: Rule-out intracranial process. Extensive decreased density of white matter of both cerebral hemispheres are redemonstrated. There is no evidence of effacement of cortical sulci or mass effect on the lateral ventricles. No evidence of hemorrhage, hydrocephalus or midline shift. In comparison with the prior CT examination from 11 -- 25 -- 2008 and MRI examination from 5 -- 15 -- 2009 no evidence of interval change is detected.

Output: No evidence of new finding since prior study.


Instruction: Generate impression based on medical findings.

Input: Female, 15 years old, history of Chiari decompression, surveillance imaging. Evaluate flow. Again seen are postsurgical changes of Chiari decompression including suboccipital craniectomy and resection of the posterior arch of C1. The CSF space at the level of the foramen magnum remains preserved. The cerebellar tonsils show a normal rounded morphology. As before they descend to the level of the basion.A syrinx is redemonstrated within the spinal cord beginning at approximately T7 and extending to the conus. Syrinx measures up to 2.7 x 3.1 mm in the axial plane at the T8 level similar to prior. There has been no significant change in craniocaudal extent. Mild prominence of the central canal is again also seen from T7 up to T3 similar to prior. No new cord signal abnormality.Cervical and thoracic alignment is anatomic. Vertebral body morphology is normal. No concerning bone marrow signal abnormality is seen. No spinal canal or neural foraminal stenosis.

Output: 1.Status post Chiari decompression with continued patency of the CSF spaces at the level of the foramen magnum and preserved biphasic CSF flow. 2. Stable small thoracic syrinx. No new cord signal abnormality.


Instruction: Generate impression based on medical findings.

Input: Neurofibromatosis type I. Neck pain. CERVICAL SPINE: There is sagittal straightening of the cervical spine and disc desiccation. There is mild disc height loss at C5-C6. The vertebral bodies are preserved in height and there is no suspicious marrow focal lesion. The spinal canal is preserved other than small indentations by degenerative changes at C5-C6 and C6-C7 as described below. The cervical and upper thoracic spinal cord is unremarkable.C2-C3, C3-C4 and C4-C5: There is no spinal canal or significant foraminal stenosis. There is mild right C4-C5 uncovertebral arthropathy.C5-C6: There is small disc-osteophyte complex but no significant spinal canal stenosis. Uncovertebral and, to a lesser extent, facet arthropathy results in mild-to-moderate left worse than right neural foraminal stenosis.C6-C7: There is minimal central disc protrusion and mild ligamenta flava thickening but no significant spinal canal stenosis. Also, there is no neural foraminal stenosis.C7-T1: There is no spinal canal or foraminal stenosis.NECK:In addition to small lymph nodes on both sides of the neck, which are not enlarged by size criteria, there are small T2-hyperintense nodules in the dorsal subcutaneous tissues which may represent small neurofibromas. There is no definite enlargement of the cervical nerve roots. The thyroid gland and the major salivary glands are unremarkable. The airway is preserved. There is trace anterior ethmoid mucosal thickening. The mastoid air cells are clear. The orbits are unremarkable. The included part of brain is unremarkable as well.

Output: 1.Mild degenerative disease of cervical spine but no significant spinal canal and only mild-to-moderate, left more than right, C5-C6 neural foraminal stenoses. 2.Multiple small T2-hyperintense nodules in the dorsal subcutaneous tissues are nonspecific but may represent small neurofibromas. There is no definite plexiform neurofibroma.


Instruction: Generate impression based on medical findings.

Input: 63-year-old man with history of PSA of 10.7 and 2 prior negative prostate biopsies. PELVIS:PROSTATE:Prostate Size: 5.7 x 4.0 x 6.6 cm.Peripheral Zone: Hazy low T2 signal in the left peripheral zone with mildly decreased ADC signal is felt to be due to artifact or possibly mild prostatitis secondary to biopsy. Unfortunately, an underlying lesion cannot be excluded due to diffuse signal changes.Central Gland: Hyperplastic nodules in the transitional zone are compatible with benign prostatic hyperplasia. Seminal Vesicles: The seminal vesicles are unremarkable.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Hazy low T2 signal in the left peripheral zone with mildly decreased ADC signal felt to be artifactual or possibly related to mild prostatitis secondary to biopsy. An underlying neoplastic lesion cannot be excluded due to diffuse signal changes.2.Hyperplastic nodules in the transitional zone consistent with benign prostatic hyperplasia.


Instruction: Generate impression based on medical findings.

Input: Chronic medial elbow pain, evaluate. LIGAMENTS: The radial and ulnar collateral ligaments are intact.TENDONS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: No significant abnormality noted. SURROUNDING STRUCTURES: No significant abnormality noted.ADDITIONAL

Output: Normal MRI of the right elbow.


Instruction: Generate impression based on medical findings.

Input: There is no evidence of intracranial hemorrhage, mass, or acute infarction. There are a couple punctate foci of increased T2/FLAIR signal within the right frontal subcortical white matter which are thought to be artifactual. Subtle confluent increased T2/FLAIR signal within the bilateral periatrial white matter is compatible with terminal zones of myelination. 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 unremarkable. The midline structures and craniocervical junction are within normal limits.

Output: No acute intracranial abnormalities or specific findings to account for patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: 61-year-old female with occasional headache, partial adrenal insufficiency, central hypothyroidism, and known pituitary adenoma, evaluate for interval change. The examination redemonstrates enlargement of pituitary gland in a uniform fashion which appears similar in signal intensity, morphology and pattern of enhancement since prior study. It again measures 10 x 9 mm on coronal post enhanced images and 12 x 13 mm on sagittal post enhanced images (when measured at the same locations utilized previously). There is also stable minimal thickening of the pituitary stalk however with normal pattern of enhancement since prior study. As before, the macroadenoma approaches the optic apparatus, however without abutment. There is no detectable involvement of the cavernous sinuses.

Output: Stable pituitary macroadenoma in signal intensity, morphology, extent, and overall measurements.


Instruction: Generate impression based on medical findings.

Input: Painful nodule in the 2nd intermetatarsal space. Evaluate for neuroma. An ovoid lesion is present at the plantar aspect of the foot between the 2nd and 3rd toes at the level of MCP joint, measuring 4 mm wide in transverse dimension. This lesion demonstrates homogenously low T1 signal and heterogeneous mixed T2 signal, compatible with fibrosis of a Morton neuroma. The soft tissues are otherwise unremarkable. The bone marrow signal is normal. No significant abnormality is otherwise identified.

Output: Findings compatible with a Morton neuroma between the 2nd and 3rd digits.


Instruction: Generate impression based on medical findings.

Input: Right knee pain MENISCI: There is abnormal signal intensity within the posterior horn of the lateral meniscus concerning for complex tear. The medial meniscus is intact.ARTICULAR CARTILAGE AND BONE: Mild articular cartilage thinning is seen within the lateral compartment with a partial-thickness defects seen along the posterior weightbearing surface. The articular cartilage of the medial and patellofemoral compartments appears relatively intact.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Findings concerning for complex tear of the posterior horn of the lateral meniscus.2. Increased signal intensity within the gastrocnemius which may represent a mild muscle strain.


Instruction: Generate impression based on medical findings.

Input: Reason: tumor recurrence, ischemia, abscess History: somnolence The patient is status-post right-sided craniotomy for right temporal lobe surgery and right frontal lobe surgery. There is a right-sided subdural collection present measuring 10 mm in thickness.There is a contrast enhancing lesion present along the posterior aspect of the right temporal lobe measuring approximately 24 by 21 mm in axial dimensions and 31 x 19 mm coronal dimensions. It is adjacent to the trigone of the right lateral ventricle. It is associated with a ependymal enhancement. There is associated enhancement along the temporal lobe at the sylvian fissure extending to the posterior aspect of the insula. There is associated susceptibility effect within the focus of enhancement. There is abnormal T2 and flair signal present within the white matter of the right temporal lobe in the gray and white matter of the insular cortex as well as right basal ganglia and internal capsule and external capsule. This temporal lobe enhancing lesion is not clearly associated with elevated cerebral blood volume. Part of the enhancing lesion has elevated CBV, however, this may represent adjacent choroid (The perfusion study is degraded by patient motion).There is a contrast enhancing lesion present along the anterior/inferior aspect of the right frontal lobe associated with adjacent T2 and flair signal hyperintensity. This frontal lobe enhancing lesion is associated with what appears to be elevated cerebral blood volumeThere is a focus of diffusion restriction present along the posterior limb of the right internal capsule extending to the right cerebral peduncle which is associate with contrast enhancement and loss of signal on SWI. CBV evaluation is not clear.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 midline shift with 8mm shift of the septum pellucidum to the left.

Output: 1.Status with right-sided craniotomy for tumor surgery. The right-sided subdural effusion present which is somewhat larger on the current versus the prior exam . It is associated with midline shift2.There is an enhancing lesion present along the right temporal lobe and insular cortex. Differential considerations include radiation necrosis, infection and recurrent tumor.3.Right internal capsule and cerebral peduncle lesion is new. Differential considerations include radiation necrosis, infection and recurrent tumor.4.Right frontal lobe lesion is new. Differential considerations include radiation necrosis, infection and recurrent tumor.5.Exam is somewhat compromised due to patient motion which confounds interpretation.


Instruction: Generate impression based on medical findings.

Input: Leukodystrophy and epilepsy. Assess progression of brain involvement. Bilateral subdural effusions over the cerebral convexities have increased in size mildly. They have a maximum thickness of 13 mm on the right and 11 mm on left, compared to 6 mm and 8 mm previously. As before, the fluid is T2 bright, similar to CSF, and T1 hyperintense to CSF. The underlying prominent subarachnoid spaces as well as the ventricles are slightly smaller than previously though remain abnormally enlarged. There is no susceptibility effect in either the subdural or subarachnoid spaces. The confluent, T1-hypointense, T2/FLAIR-hyperintense signal involving the deep and periventricular cerebral white-matter is slightly less prominent. However, this apparent improvement may reflect evolution of the white-matter injury and white matter volume loss rather than an improvement in the disease process. There continues to be signal abnormality in the subinsular white-matter but relative sparing of the subcortical U fibers otherwise. T2-hyperintensity along the corticospinal tracts extending into the posterior aspect of the posterior limb of the internal capsules is unchanged. There is also abnormal T2-hyperintensity in the corpus callosum. Striated T2-hyperintensity in the pons is unchanged. Confluent T2-hyperintensity involving the deep cerebellar white-matter has slightly increased since the previous examination.Brain parenchymal volume loss continues to be symmetric other than being slightly more pronounced in the frontal and temporal lobes. The degree of volume loss has perhaps slightly increased from the prior examination.There is mild, smooth dural contrast enhancement and thickening, likely reactive to the effusions. There is no abnormal intracranial contrast enhancement otherwise. No acute infarct is seen. There is no mass or mass-effect. The major cerebral flow voids are intact. The posterior pituitary bright spot is absent. The orbits, skull, and scalp soft tissues are grossly unremarkable. Fluid signal is present posterior ethmoid and right maxillary sinuses as well as the mastoid air cells. There are also secretions in the posterior aspect of the pharynx along nasogastric and endotracheal tubes.

Output: 1.Since the previous examination of November 2015, there has been evolution of the brain parenchymal (predominantly white-matter) injury. Though the cerebral T2-hyperintense white-matter lesions appear less prominent and less discrete, associated volume loss is suspected to have mildly progressed since the previous examination. At the same time, the cerebellar white-matter T2-hyperintense abnormality has mildly increased. 2.The bilateral cerebral convexity subdural collections have slightly increased in size, which may reflect passive dilatation due to progressive underlying brain volume loss. The lack of susceptibility effect within the collections suggests that they may represent nonhemorrhagic effusions, though chronic subdural hematoma remains in the differential.


Instruction: Generate impression based on medical findings.

Input: Right upper extremity pain and weakness Several sequences are slightly limited by patient motion artifact.ROTATOR CUFF: No significant abnormality noted.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: Although evaluation of the glenoid labrum is limited on this nonarthrogram study, high signal intensity traverses the superior labrum suggestive of a tear. The inferior glenohumeral joint capsule appears thickened, but the clinical significance of this is uncertain. Glenohumeral joint alignment is normal. I see no effusion.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Tear of the superior labrum. The inferior glenohumeral joint capsule appears thickened, but the clinical significance of this is uncertain. If further imaging evaluation of the capsular/labral structures is clinically warranted, MR arthrography may be considered.


Instruction: Generate impression based on medical findings.

Input: 66-year-old female presents with a new onset headache, evaluate for space-occupying lesion. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild scattered periventricular and subcortical white matter T2 hyperintensity. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. There is minimal mucosal thickening in the bilateral maxillary sinuses. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is left mastoid air cell fluid.

Output: 1. Nonspecific cerebral white matter abnormality may represent chronic small vessel ischemic disease. Otherwise, no evidence of intracranial hemorrhage, mass, or acute infarct. 2. Left mastoid air cell fluid may represent mastoiditis.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: Diagnosis: Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus Headache(784.0)Clinical question: Outside Request: headaches The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: MRI of the brain is within normal limits


Instruction: Generate impression based on medical findings.

Input: 35-year-old male with right-sided weakness, history of potential multiple sclerosis Redemonstrated are numerous T2 hyperintense lesions within the supratentorial and infratentorial brain, many of which demonstrate an ovoid shape, are perpendicular to the callosal-septal interface, and are confluent in several locations. Several lesions with low T1 signal are again noted. Unlike previously, none demonstrate enhancement, and there are no definite new discrete lesions. No evidence of acute ischemia or hemorrhage. No intracranial mass or mass effect. No hydrocephalus. No extra-axial collections. There is volume loss, particularly involving the corpus callosum. Major flow-voids are preserved. Sella and orbits are grossly within normal limits. Mucous retention cysts are again seen within the maxillary sinuses. Paranasal sinuses and mastoid cells are otherwise clear.

Output: Redemonstrated are numerous T2 hyperintense lesions within the supratentorial and infratentorial brain, many of which demonstrate an ovoid shape, are perpendicular to the callosal-septal interface, and are confluent in several locations. Several lesions with low T1 signal are again noted. Unlike previously, none demonstrate enhancement, and there are no definite new discrete lesions. The constellation of these features are suggestive of demyelination (e.g. multiple sclerosis) in the correct clinical context.


Instruction: Generate impression based on medical findings.

Input: 70 year old female with history of right-sided weakness and hyperacusis in right ear. History of TIA, DM and HTN. Evaluate. Low attenuation within the right posterior parietal lobe with loss of gray-white differentiation. Likely subacute infarct; recommend MRI for further evaluation.Periventricular low attenuation compatible with small vessel disease of indeterminate age.Atrophy of the right caudate head with ex-vacuo dilatation of the frontal horn of the right lateral ventricle.There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.Ectasia of the basilar artery is noted.

Output: Low attenuation within the right posterior parietal lobe with loss of gray-white differentiation. Likely subacute infarct; recommend MRI for further evaluation.


Instruction: Generate impression based on medical findings.

Input: 68-year-old female with pain, evaluate for rotator cuff tear ROTATOR CUFF: There is diffuse thickening and increased signal intensity of the supraspinatus tendon, indicating moderate to severe tendinosis. We see no fluid signal intensity within the tendon to indicate a tear, although there may be mild associated undersurface fraying. The supraspinatus muscle is within normal limits. Cysts are noted within the underlying humeral head. Similar tendinosis also affects the distal infraspinatus tendon without discrete tear. The infraspinatus muscle is within normal limits. The teres minor tendon and muscle appear normal. There is mild thickening of the distal subscapularis tendon consistent with mild tendinosis. The subscapularis muscle appears normal. SUPRASPINATUS OUTLET: Mild osteoarthritis affects the AC joint. Trace fluid is present within the subacromial-subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral alignment is within normal limits. There is a small collection of fluid signal intensity along the anteroinferior margin of the glenoid with mild signal abnormality within the adjacent bone. There is also mild increased signal intensity within the adjacent anteroinferior labrum, which may represent a focal tear, although this is equivocal. The superior labrum and superior half of the posterior labrum are attenuated, perhaps from longstanding degenerative tearing. No joint effusion.BICEPS TENDON: There is thickening and increased signal intensity in the tendon of long head of the biceps at its transition from the rotator interval to the intertubercular sulcus indicating moderate tendinosis.

Output: 1. Moderate to severe tendinosis of the rotator cuff and biceps tendon without discrete tear.2. Additional degenerative arthritic changes as described above.


Instruction: Generate impression based on medical findings.

Input: Reason: Evaluate plexiform neurofibroma History: Patient with NF-1 and large plexiform tumor causing pain Due to technologist error, the superior extent of the plexiform neurofibroma was not included in its entirety on the field of view. We will attempt to have the patient return for repeat sequences that cover the entire cranial extent of the tumor in addition to the sagittal sequences that were not obtained as part of the routine University of Chicago protocol. Note is made of an extensive plexiform neurofibroma involving the soft tissues of the distal thigh, knee, and leg. The largest mass is again noted within the lateral aspect of the popliteal fossa, measuring approximately 8.6 x 4.9 cm, appearing similar to the previous study, following remeasurement. Medial to this large mass, is a second mass measuring approximately 5 x 3.6 cm in the transverse dimension, previously 3.9 x 3.3 cm. A third mass, resulting in scalloping of the posterolateral aspect of the proximal tibia, measures approximately 2.6 x 2.0 cm, appearing similar to the prior study when accounting for positional differences. A fourth lesion along the lateral aspect of the mid fibular diaphysis measures approximately 3.8 x 2.1 cm, appearing similar in size when accounting for positional differences. Additional smaller neurofibromas are noted surrounding the distal femoral diaphysis and along the lateral and posterior margins of the distal femoral metaphysis, as well as within the biceps femoris muscle and along the sciatic nerve. Multiple additional neurofibromas are noted within all of the compartments of the leg, appearing similar to the prior study. There is fatty infiltration of the deep posterior compartment musculature of the leg, appearing similar to the prior study.

Output: Incomplete study showing plexiform neurofibromas as described above. We will attempt to have the patient return for further images so that the proximal extent of the tumor can be scanned along with the remainder of the lesion.


Instruction: Generate impression based on medical findings.

Input: backpain For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is focal minimal to mild bulging of L34 intervertebral disc toward left side proximal neural canal just after the isthmus. There is no definitive imaging evidence of direct nerve root compression from this focal disc bulging.Diffuse bulging of disc with minimal ligamentum flavum thickening were seen at the level of L45. No definitive evidence of spinal stenosis at this level. There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing. The conus medullaris terminates at the L1-2 level. The intervertebral discs demonstrate normal T2 intensity and height with no evidence of disc herniation. The paraspinal soft tissues are unremarkable.There is no evidence of abnormal enhancement, cord compression or mass. Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: Focal disc bulging toward left side neural foramen without evidence of direct nerve root compression. no neuroforaminal narrowing or spinal stenosis. L4-L5: diffuse bulging of disc without evidence of spinal canal stenosis. no neuroforaminal narrowing or spinal stenosis. L5-S1: no neuroforaminal narrowing or spinal stenosis.

Output: 1. Focal bulging of disc toward left side neural foramen without direct compression of the nerve root at the level of L34.2. Diffuse bulging of disc at the level of L45.3. Otherwise no remarkable finding.


Instruction: Generate impression based on medical findings.

Input: Apocrine adenocarcinoma. New onset memory deficit, incoordination and left hemiparesis. This is a motion degraded exam. There is a lobulated heterogeneously enhancing mass measuring approximately 5.2 x 4.0 cm in maximum transaxial dimension and 5.9 cm in craniocaudal dimension involving the anterior right temporal lobe. There is enhancement extending along the adjacent dura. There is extensive perilesional vasogenic edema. There is mass effect with effacement of the right lateral ventricle and midline shift about 10 mm towards left. The temporal horn of the right lateral ventricle is displaced superiorly and medially. There is effacement of the right sylvian fissure and right sided cortical sulcal sulci. There may be erosion of the overlying right temporal bone.There is approximately 4.2 x 2.6 cm enhancing mass in the left paravertebral region extending anteriorly and invading posterior to the carotid space and adjacent paraspinal musculature. The major deep cervical vessels are intact.The major cerebral flow voids are intact.

Output: 1. Findings consistent with a 5.2 cm right temporal lobe metastasis with extensive vasogenic edema, mass effect and midline shift as described. There are findings suggesting adjacent dural invasion and perhaps erosion of the right temporal bone.2. Interval increase in size of left paravertebral mass with involvement of the paraspinal muscles also consistent with metastasis.Findings were discussed with Dr Maitland by Dr Kumar at 11:20 hours on 1/8/2016.


Instruction: Generate impression based on medical findings.

Input: History of transaminitis, cholestasis, and liver failure. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in signal and morphology. No focal parenchymal lesion. The portal vein, hepatic vein, and hepatic artery are patent.Prominent gallbladder wall thickening and edema. The gallbladder however is not distended and there is no enhancement on the postcontrast images. No cholelithiasis or choledocholithiasis. No intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Pancreas has normal signal and morphology. The main pancreatic duct is not dilated. The pancreatic duct joins the common bile duct at the major papilla.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: There is nonspecific fluid/edema within the retroperitoneum.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Diffuse soft tissue anasarca.OTHER: No significant abnormality noted.

Output: 1.Nondistended gallbladder with prominent gallbladder wall thickening suggestive of edema. There is no associated enhancement to indicate active inflammation. Appearance most likely reflects an edematous state given the patient's anasarca.2.No cholelithiasis, choledocholithiasis, or biliary ductal dilatation.


Instruction: Generate impression based on medical findings.

Input: 3 month follow up for a residual pituitary tumor. There are postoperative findings related to right frontal craniotomy and transsphenoidal surgery, with right frontal lobe encephalomalacia. There is an unchanged enhancing mass in the left aspect of the sella with suprasellar extension that measures up to 13 mm in the craniocaudal dimension. There is mild protrusion of the lesion into the left cavernous sinus and perhaps slight mass effect upon the adjacent left optic nerve. There is also unchanged mild optic apparatus atrophy. There is persistent scattered paranasal sinus mucosal thickening.

Output: Postoperative findings with unchanged residual pituitary tumor.


Instruction: Generate impression based on medical findings.

Input: 51 years Female (DOB:1/13/1965)Reason: lateral recess syndrome at L5/S1 1012 ct recommended: HNP History: left and right sciaticaPROVIDER/ATTENDING NAME: JAMES J. CURRAN JAMES J. CURRAN Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation present at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: No compromise to lumbar spinal canal or neural foramina. There are only minor degenerative changes present lumbar spine.


Instruction: Generate impression based on medical findings.

Input: confusion, left lower extremity weakness No evidence of acute ischemic or hemorrhagic lesion.Minimal to mild non specific small vessel ischemic disease, no change since prior exam.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion.No change of minimal non specific small vessel ischemic disease since prior exam.


Instruction: Generate impression based on medical findings.

Input: Brain MRI:A punctate focus of susceptibility weighted artifact is again seen in the posterior right putamen without blooming artifact. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. Brain MRA:There is antegrade flow within the distal bilateral vertebral arteries, within the basilar artery, distal bilateral internal carotid arteries and carotid siphons and bilateral anterior, middle and posterior cerebral arteries. The circle of Willis is intact without arterial stenoses, occlusions or aneurysms. The right vertebral artery is hypoplastic with a dominant left vertebral artery, a normal variation. No arteriovenous malformations are identified and there is no evidence for cerebral vasculitis.

Output: 1.Stable focus of susceptibility artifact in the right putamen of questionable clinical significance. This is likely a focus of microhemmorhage, calcification, or very small cavernoma.2.No significant abnormality of the intracranial arteries.


Instruction: Generate impression based on medical findings.

Input: 54 year old with history of left breast cancer status post mastectomy and reconstruction. Screening exam is performed. Minimal parenchymal enhancement is noted in the right breast. There is heterogeneous amount of fibroglandular tissue in the right breast.The patient is status post left mastectomy. There is no suspicious enhancement in the left breast reconstruction. Stable oval mass measuring up to 8 mm in the left lateral chest wall. No abnormal enhancement is seen in the right breast. No abnormal axillary lymph nodes are identified in either axillary region. Post-surgical change in the left axilla is noted.

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


Instruction: Generate impression based on medical findings.

Input: Low back pain, sciatica Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: Minimal disc bulge slightly eccentric to the left with minimal contact of the left descending L5 nerve root and minimal left neural foraminal narrowing. Otherwise no spinal canal or neural foraminal stenosis. Mild facet arthropathy.L5-S1: There is central disc protrusion with contact of the descending S1 nerve roots. Mild central spinal canal stenosis. Neural foramina are patent. Mild facet arthropathy.Paraspinous soft tissues are within normal limits.

Output: Mild lumbar spine degenerative changes including central disc protrusion at the L5-S1 level with contact of the S1 nerve roots as well as minimal L4-L5 disc bulge. No high-grade spinal canal or neural foraminal stenosis at any level.


Instruction: Generate impression based on medical findings.

Input: Previous scoliosis x-ray demonstrated levoscoliosis of the lower thoracic spine with a Cobb angle measuring 50 degrees as well as a compensatory dextroscoliosis at the thoracolumbar junction with a Cobb angle measuring 61 degrees.The patient's scoliosis is redemonstrated, as better demonstrated on the previous x-ray.There appear to be 13 rib bearing segmental units. Thus, C7 is presumed to be the upper-most level containing cervical ribs, and utilizing this nomenclature there are 6 lumbar type vertebral bodies. However, the presence of hemivertebrae as described below magnum are difficult. If a spinal procedure is contemplated, CT may be of benefit for better osseous interpretation.Multiple osseous dysplasias are present including:Narrowed vertebral bodies with partial fusion across C4, C5, C6, and C7.A large anterior bridging osteophyte at C7/T1.A very small left-sided hemivertebra at T2/3.Right lateral wedge deformity of T10.A small right-sided hemivertebra of L2.Foraminal stenoses are as follows:Moderate left neural foraminal stenosis at C4/5.Mild right neural foraminal stenosis at T2/3.The spinal cord is normal in signal throughout. The conus terminates at L2/3.There is a tiny focus of T1 hyperintensity in the region of the presumed filum (although the axial T1 is motion degraded)(best seen series 2801, image 25). This same region on axial T2 demonstrates a small hypointense focus with an inferiorly located linear hyperintense periphery, suggestive of chemical shift artifact, which can be seen from fat (best seen series 2401, image 25). Lastly, the same focus appears to be present on the sagittal T1 (series 2901, image 8, although this sequences also motion degraded). The constellation of these features are suggestive of a tiny portion of fatty filum.There are no fractures. The marrow signal is benign. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.

Output: 1.Scoliosis with osseous dysplasias including vertebral body fusion and hemivertebrae as described in detail above.2.Moderate left neural foraminal stenosis at C4/5, and mild right neural foraminal stenosis at T2/3.3.The spinal cord is normal in signal throughout.4.There is a tiny focus of T1 hyperintensity in the region of the presumed filum (although the axial T1 is motion degraded). This same region on axial T2 demonstrates a small hypointense focus with an inferiorly located linear hyperintense periphery, suggestive of chemical shift artifact, which can be seen from fat. Lastly, the same focus appears to be present on the sagittal T1 (although this sequences also motion degraded). The constellation of these features are suggestive of a tiny portion of fatty filum.


Instruction: Generate impression based on medical findings.

Input: New onset headache. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles are unchanged l in size and configuration, including septum cavum pellucidum and vergae and choroid plexus cysts, which are anatomic variants. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is extensive paranasal sinus mucosal thickening.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or Chiari malformation.2. Findings suggestive of sinusitis.


Instruction: Generate impression based on medical findings.

Input: Hypogonadotropic hypogonadism. The pituitary gland demonstrates homogenous enhancement, without evidence of focal lesions. The pituitary stalk is intact and positioned in the midline. The pituitary gland is not enlarged nor atrophic. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is unchanged scattered mild nonspecific cerebral white matter T2 hyperintensity. There is no abnormal intracranial enhancement. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of pituitary mass.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old, with squamous cell carcinoma of the left eyebrow. The left supraorbital skin is thickened, irregular and enhancing. This abnormal tissue spans approximately 45 mm across the left forehead.This lesion invades the adjacent frontal bone involving the orbital roof and a small portion of the left frontal sinus. This component of the lesion measures 19 x 12 mm. This lesion completely traverses the left frontal bone and abuts the underlying dura. The dura adjacent to this region of contact is enhancing. No definite intraparenchymal lesions are seen.The lesion mildly encroaches upon the extraconal orbit. The lesion approaches the superior margin of the globe rather closely but there is no evidence of intraocular invasion. No intraconal disease is demonstrated at this time.Elsewhere in the brain, a few scattered foci of nonspecific T2 hyperintensity are demonstrated. No significant mass effect or parenchymal edema is demonstrated. No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is seen.

Output: A lesion is seen involving the left supraorbital skin compatible with a history of squamous cell carcinoma. This lesion invades the adjacent frontal bone with erosion of the orbital roof and the left frontal sinus.The lesion completely traverses the frontal bone and contacts the underlying dura. The dura adjacent to this region of contact is enhancing, which could represent an inflammatory reaction but the possibility of malignant dural invasion cannot be excluded. No definite brain parenchymal invasion is seen at this time.The lesion does invades the extraconal orbit to a mild degree. Tumor closely approaches and may even contact the superior surface of the globe, but no intraocular invasion is suspected.


Instruction: Generate impression based on medical findings.

Input: 49 years Male Reason: asymmetric hearing loss, eval for acoustic neuroma History: asymmetric hearing loss, eval for acoustic neuroma Provider Name: JAYANT M PINTO JESSICA YESENSKY IACNo abnormal foci of enhancement are appreciated within the internal auditory canals. The cochlea and semicircular canals appear intact. The cochlear nerve can be followed bilaterally tracking into the cochlea. The modiolus is well formed bilaterally.No abnormal enhancing lesions are appreciated at the cerebellopontine angle cisterns nor the internal auditory canals.Images of both right and left internal auditory canals images normal neural bundles with at least 4 neural bundle seen on the sagittal oblique views. There is normal appearance of the membranous labyrinth with no evidence of enlargement of the endolymphatic ducts at the level of the vestibular aqueduct bilaterally.There is a mucous retention cyst in the left maxillary sinus.

Output: MRI of the IACs are within normal limits. There is no evidence for acoustic neuroma.


Instruction: Generate impression based on medical findings.

Input: 56 year old female with left shoulder pain, concern for SLAP tear. ROTATOR CUFF: There is a very small curvilinear focus of intermediate signal intensity along the articular surface of the distal supraspinatus tendon (series 4, image 10) compatible with a very small articular sided partial tear. No contrast extends to the subacromial subdeltoid bursa. The supraspinatus muscle appears normal. The remaining rotator cuff tendons and muscles appear normal.SUPRASPINATUS OUTLET: Mild acromioclavicular joint osteoarthritis is present.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint is in anatomic alignment. The glenoid labrum appears normal.BICEPS TENDON: Long head of the biceps tendon appears normal with small amount of fluid communicating with the glenohumeral joint. ADDITIONAL

Output: Very small small articular sided partial tear of the supraspinatus tendon.


Instruction: Generate impression based on medical findings.

Input: History of small cell lung carcinoma with metastasis to the brain. There has been interval increase in size and number of numerous supratentorial and infratentorial metastatic lesions and associated vasogenic edema. For example, previously demonstrated lesion in the anterior left temporal lobe now measures 14 mm, previously 6 mm and a lesion in the superior vermis measures 13 mm, previously 4 mm. In addition, there are several new lesions in the cerebral and cerebellar hemispheres. For example, a new lesion in the left inferior temporal lobule measures 11 mm and a lesion in the right mid cerebellum measures 9 mm. Several of these lesions demonstrates leptomeningeal involvement. There is diffuse subcortical and periventricular white matter T2 hyperintensity. There is no evidence of acute intracranial hemorrhage. The ventricles and basal cisterns are unchanged 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. Interval increase in size and number of supratentorial and infratentorial metastatic lesions with associated vasogenic edema.2. Diffuse cerebral white matter T2 hyperintensity is nonspecific, but may in part be related to treatment effects and/or small vessel chronic ischemic disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Pain. Positive O'brien's. Question of right shoulder labral tear. ROTATOR CUFF: The rotator cuff tendons and muscles are intact. No muscle atrophy is identified.SUPRASPINATUS OUTLET: The acromioclavicular joint is within normal limits. No fluid is is seen within the subacromial/subdeltoid bursa. GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. The articular cartilage is intact. The labrum is intact.BICEPS TENDON: The biceps tendon is intact. ADDITIONAL

Output: 1. Intact labrum.2. No specific findings to account for the patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: 71 year-old female with history of CVA in 2006. Breast cancer oblique radiation and now with (unreadable ward), MR presurgical evaluation No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. A very small area of increased soft tissue density overlapping the ependymal lining of the right trigone is noted this finding measures approximately 6 mm times 7-mm on axial image 15. This finding is not associated with any edema and no definitive enhancement. Further follow-up with an MRI scan is recommended to exclude metastatic lesion.Calvarium, partially visualized paranasal sinuses and mastoid air cells remain within normal limits.

Output: 1. Localized increased soft tissue density on the ependymal lining of the trigon of right lateral ventricle is concerning for metastatic lesion and should be further evaluated with an MRI. Please see above comments. 2.Unremarkable CT examination of brain and calvarium otherwise.


Instruction: Generate impression based on medical findings.

Input: Rule-out AVN versus fracture in the lunate. Prior traumaIMAGE ACQUISITIONS: Ultrahigh routine CT of the right wrist was performed with 0.3-mm reconstruction. No enhancement The osseous structures remain in proper alignment with particular attention placed on the lunate relative to the radius, triquetrum and scaphoid. The shape of the lunate is normal without abnormality. Specifically no evidence of fracture or dislocation. No additional CT findings to suggest AVN, however please note MRI would be more sensitive in this early stage.A small benign-appearing cyst noted in the proximal pole of the scaphoid. Small bone island seen in the distal radius. The remainder of the wrist is otherwise unremarkable. Soft tissues normal.

Output: No additional abnormality, specifically no CT findings to suggest AVN or fracture.


Instruction: Generate impression based on medical findings.

Input: Evaluate right hepatic dome lesion. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology.Previously described intrinsically T1 weighted hyperintense focus in the right hepatic dome is not clearly seen on today's study. No suspicious arterial enhancing or washout lesion.TIPS catheter noted with associated susceptibility artifact.SPLEEN: The spleen measures 11 cm in craniocaudal dimension without a focal lesion. Stable 1.5 cm splenic artery aneurysm.PANCREAS: Punctate cystic focus in the pancreatic tail measuring 3 mm and is too small to characterize. Likely present on 2014 and is unchanged.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: Previously noted right hepatic dome punctate focus is not seen on today's study. Cirrhosis without a suspicious liver lesion.Stable splenic artery 1.5 cm aneurysm.


Instruction: Generate impression based on medical findings.

Input: 59 year old female with biopsy-proven sarcoidosis (bronchoscopic LN biopsy with non-necrotizing granulomas) and palpitations referred to rule out cardiac involvement. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 63 ml/m2 (normal range: 65+/-11), the LVEDV is 140 ml (normal range 109+/-23), the LV end systolic volume index is 28 ml/m2 (normal range 18+/-5), the LVESV is 62 ml (normal range 31+/-10). There are no regional wall motion abnormalities present. There is a subtle region of subepicardial late gadolinium enhancement involving the basal inferior and inferolateral walls which spares the endocardium and is atypical for prior myocardial infarction. This has not changed from previous CMR done1/2014. The finding could suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 58 ml/m2 (normal range 69+/-14), the RVEDV is 140 ml (normal range 110+/-24), the RV end systolic volume index is 28 ml/m2 (normal range 22+/-8), and the RVESV is 78 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild-moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild 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 FindingsMediastinal and hilar lymphadenopathy noted. 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. Normal LV size and systolic function (LVEF 56%).2. There is a subtle region of late gadolinium enhancement involving the basal inferior and inferolateral walls which spares the endocardium and is atypical for prior myocardial infarction. This could suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process; however, this finding has not changed from previous CMR dated 1/2014.3. Normal RV size and systolic function (RVEF 50%).4. Moderate LA dilation.


Instruction: Generate impression based on medical findings.

Input: Right lower quadrant abdominal pain after punch to gut. Rectus muscle hematoma versus tear? Markers were placed along the anterolateral aspect of the right abdominal wall and right hip, presumably denoting the area of the patient's pain. I see no hematoma or muscle tear. A small lobulated focus of fluid is noted immediately anterior to the anterior column of the left acetabulum which may represent a paralabral cyst or fluid in the iliopsoas bursa. This may further evaluated with dedicated left hip MRI if clinically warranted. There is also prominence of the femoral head neck junction bilaterally suggesting a CAM deformity that can be associated with femoroacetabular impingement in the correct clinical context. The hip joints are otherwise unremarkable. The sacroiliac joints are unremarkable. The visualized musculature appears normal. The abdominal viscera, although not visualized in its entirety on this study, likewise appears normal.

Output: No muscle hematoma, muscle tear, or other specific findings to account for patient's right lower quadrant pain. Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: 54-year-old with history of a right lumpectomy for ADH in 2014. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. Mild postsurgical distortion in the right breast underlies the scar marker. A stable benign morphology mass in the right inner breast is compatible with a cyst as is seen on prior MRI.Benign appearing lymph nodes are projected over the left axilla.

Output: No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.


Instruction: Generate impression based on medical findings.

Input: Female 54 years old Reason: Left knee effusion/warmth History: swelling at the end of the day MENISCI: The menisci are intact.ARTICULAR CARTILAGE AND BONE: No significant articular cartilage thinning or focal defect. No abnormal bone marrow signal.LIGAMENTS: The ACL, PCL, MCL, and lateral collateral complex are intact. EXTENSOR MECHANISM: Extensor mechanism is intact. ADDITIONAL

Output: Normal MRI of the knee.


Instruction: Generate impression based on medical findings.

Input: Female, 20 years old, with elevated prolactin and nipple discharge. A 2 mm focus of relative hypoenhancement is seen within the left aspect of the pituitary gland, best visualized on coronal image 10 series 7. Elsewhere, the pattern of pituitary glandular enhancement is homogeneous and within normal limits. The size of the gland is normal. The pituitary stalk enhances normally and sits at the midline. The posterior pituitary T1 hyperintense spot is well visualized and normal. No suprasellar abnormalities are detected. Limited views of the remainder of the brain are within normal limits.

Output: A 2 mm focus of relative hypoenhancement is seen within the left aspect of the pituitary gland. This could potentially represent a microadenoma, though a small cyst or an area of prior parenchymal injury could appear similarly.


Instruction: Generate impression based on medical findings.

Input: 73Yrs gentleman on active surveillance for prostate cancer. He underwent TRUS guided prostate biopsy in 4/2014 for a PSA of 4.8 ng/ml which showed Gleason 6 in 2 cores - right lateral mid and lateral apex (maximal length of 3 mm). His PSA gradually increased- 5.6 in 5/2015, 5.8 in 12/15 and 6.9 in 8/16. He did not undergo a second biopsy. PELVIS:PROSTATE:Prostate Size: 5.1 x 5.2 x 5.0 cm.Peripheral Zone: There is an area of decreased T2 and ADC signal within the right lateral midgland and apex measuring 10 x 12 mm with suspected extracapsular extension. There are additional scattered small foci of decreased T2 and ADC signal within the left peripheral zone.Central Gland: No significant abnormality identified.Seminal Vesicles: No significant abnormality identified.Extracapsular Extension: See above.BLADDER: No significant abnormality noted.LYMPH NODES: No abnormally enlarged lymph nodes are identified within the pelvis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: A penile prosthesis is noted.

Output: Dominant lesion within the right lateral midgland/apex suspicious for neoplasm with suspected extraprostatic extension. Additional possible smaller lesions within the left peripheral zone.


Instruction: Generate impression based on medical findings.

Input: Ensure lesion stability prior to labor and delivery (2nd trimester pregnancy and known familial cavernomas). There are postoperative findings related to right temporal craniotomy. There is an unchanged small defect in the right pons with adjacent punctate susceptibility effect, which may be postoperative in nature. There is no appreciable change in the subcentimeter cavernous malformation in the anterior left external capsule and several other scattered punctate foci of susceptibility in the cerebral hemispheres, including within the right superior frontal gyrus, right cerebellar hemisphere, left thalamus, and bilateral temporal lobes. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable.

Output: No interval change in the multiple cerebral cavernous malformations and superimposed apparent postoperative findings in the right pons.


Instruction: Generate impression based on medical findings.

Input: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is some loss of cervical lordosis, alignment is otherwise maintained. Bone marrow signal is benign. The cervical spinal cord has normal signal characteristics and overall morphology.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: No significant compromise to the spinal canal or neural foramina.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: There is a disc osteophyte complex including a right central disc extrusion. There is also ligamentum flavum thickening. There is resulting moderate spinal canal stenosis including mild cord deformity. No cord signal abnormality. There is moderate to severe right and mild left neural foraminal stenosis related to uncovertebral hypertrophy. Mild facet arthropathy.C6-7: There is a disc bulge with small extrusion component as well as ligamentum flavum thickening. There is mild to moderate spinal canal stenosis. There is mild right and minimal left neural foraminal stenosis. Mild facet arthropathy.C7-T1: No significant compromise to the spinal canal or neural foramina. Mild facet arthropathyThe vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.THORACIC SPINE

Output: 1. Degenerative changes in the cervical spine at the C5-C6 and C6-C7 levels. There is moderate spinal canal stenosis at C5-C6 and to a lesser degree at the C6-C7 level. There is moderate to severe right C5-C6 neural foraminal stenosis this level. No cord signal abnormality. Additional levels as above.2. Minimal degenerative changes in the thoracic spine with no significant spinal canal or neural foraminal stenosis at any level in the thoracic spine. No cord signal abnormality.3. Mild degenerative changes in the lumbar spine including mild left L3-L4 and L4-L5 neural foraminal narrowing. No high-grade neural foraminal stenosis at any level in the lumbar spine.


Instruction: Generate impression based on medical findings.

Input: This exam is mildly degraded by susceptibility artifact, including the thin section post-contrast images through the IACs. The internal auditory canals are symmetrical and normal in size. The inner ears are normal. There is no evidence for mass, abnormal enhancement, or vascular anomaly. There is a right maxillary sinus retention cyst and mucosal thickening within the right sphenoid sinus.

Output: Normal internal auditory canal MRI.


Instruction: Generate impression based on medical findings.

Input: Obesity too soon after eating disorder, unexplained swelling. There is no evidence of pituitary mass lesions. The pituitary gland is normal in size. The pituitary infundibulum is intact and situated in the midline. The posterior pituitary bright spot is intact. The cavernous sinuses and optic apparatus are unremarkable.

Output: No evidence of pituitary lesions.


Instruction: Generate impression based on medical findings.

Input: 73-year-old female with intractable knee pain, evaluate for degree of osteoarthritis, meniscus tear, and Baker's cyst MENISCI: Globular intermediate signal within the lateral meniscus suggestive of intrasubstance degeneration without focal tear. There is medial extrusion of the medial meniscus with fragmentation and heterogeneous signal within the posterior horn compatible with degeneration.ARTICULAR CARTILAGE AND BONE: Severe osteoarthritis affects the knee with joint space narrowing worst at the patellofemoral compartment followed by the medial tibiofemoral compartment. There is complete to near complete loss of articular cartilage along the medial facet of the patella and medial femoral trochlear cartilage. There is near complete to complete loss of articular cartilage along the lateral facet of the patella and lateral femoral trochlear cartilage. There is greater than 50% articular cartilage loss of the medial tibiofemoral compartment. Abnormal edema type signal is seen within the medial femoral condyle and medial tibial plateau. To a lesser degree, there is greater than 50% articular cartilage loss along the lateral tibiofemoral compartment.LIGAMENTS: The cruciate and collateral ligaments are intact. There is ossification of the MCL near its insertion on the medial femoral condyle suggestive of a prior tear.EXTENSOR MECHANISM: The extensor mechanism is intact. ADDITIONAL

Output: 1.Severe osteoarthritis as described above. 2.Degeneration and fragmentation of the posterior horn of the medial meniscus. 3.Intrasubstance degeneration of the lateral meniscus.


Instruction: Generate impression based on medical findings.

Input: History of known pancreatic cyst. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal morphology, size and signal intensity. Two subcentimeter punctate cysts. Status post cholecystectomy. No intra or extra hepatic biliary ductal dilatation. No common bile duct filling defect.Several small nonspecific periportal lymph nodes.SPLEEN: No significant abnormality noted.PANCREAS: There are several punctate cystic foci in the pancreatic tail best seen on the thin MRCP images. The largest measures approximately 4 mm (series 4/16), communicates with the main pancreatic duct which is normal in caliber. No suspicious imaging features of this lesion. Additional punctate focus in the pancreatic head measures 4 mm.The pancreatic parenchyma is normal in intrinsic T1-weighted signal intensity and demonstrates normal contrast enhancement. No peripancreatic inflammatory changes.Normal excretory response to secretin administration. ADRENAL GLANDS: Right adrenal lipid rich adenoma measuring 2.2 x 1.3 cm (series 1102/45). KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Susceptibility artifact from lumbar spinal fusion hardware.OTHER: No significant abnormality noted.

Output: Punctate cystic pancreatic foci, the largest of which measures approximately 4 mm and communicates with a normal caliber main pancreatic duct, compatible with a side-branch IPMN without suspicious imaging features.


Instruction: Generate impression based on medical findings.

Input: 74-year-old male reported as "LEFT dorsal wrist soft tissue sarcoma now with recurrent mass" although the electronic medical record/pathology states the patient had a right soft tissue mass status post resection, now with recurrent mass. An avidly enhancing, predominantly high T2, intermediate T1 signal mass is noted along the dorsal aspect of the RIGHT wrist, within the subcutaneous tissue.Mass measures 16 x 11 x 20 mm (series 1201, image 13; series 1401, image 12) and extends along although does not appear to invade through the extensor tendon sheath. Small feeding and draining vessels are seen. The extensor and flexor tendons are normal in signal without evidence of invasion.Degenerative changes affect the radiocarpal joint, midcarpal joints, and particularly the basilar joint with multiple subchondral cysts. Abnormal edema type marrow signal within the ulnar aspect of the triquetrum. Degenerative tearing of the triangular fibrocartilage complex with a 6 x 6 mm ganglion cyst at the tip of the ulnar styloid. Small amount of enhancing synovium and fluid within the distal radioulnar joint and midcarpal joints. Scapholunate widening is present suggesting tearing of the scapholunate ligament.

Output: 1.Avidly enhancing subcutaneous mass along the dorsal aspect of the right wrist as described above. Provided the patient's history, may represent an additional soft tissue sarcoma.2.Degenerative disease affects the wrist with ganglion cyst formation along the ulnar styloid as described above.3.Mild synovitis and joint fluid of the distal radioulnar joint and midcarpal joints.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old, with brain metastasis status post resection. MRI from postoperative serous treatment planning. Redemonstrated is evidence of right anterior temporal tumor resection. The surgical cavity is similar in size to that seen on the prior examination. Thin enhancement is evident around a majority of the resection cavity. Enhancement measuring up to 10 mm in thickness is, however, seen along the posterior margin of the cavity, along with a subcentimeter focus of enhancement medially along the cavernous sinus margin. No enhancement was evident in these areas on the immediate postoperative examination, but rather, there was restricted diffusion correlating to both sites.Generalized right cerebral mass effect has significantly improved from the prior examination. No additional enhancing intracranial lesions are seen. Ventricular caliber is within normal limits.

Output: 1.Demonstration of findings related to resection of tumor from the right anterior temporal lobe.2.Enhancement along the posterior margin of the resection cavity measuring up to 10 mm in thickness is new from the prior examination. However, given that it correlates with cytotoxic edema on the prior examination, it is favored to represent postsurgical change.


Instruction: Generate impression based on medical findings.

Input: Paresthesias. Probable CNS vasculitis. Evaluate for progression. There is no evidence of intracranial hemorrhage, mass, or acute infarction. The pituitary gland appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids appear to be intact. There is moderate T2 hyperintensity within the subcortical and periventricular white matter, more extensive on the left, particularly within the left occipital lobe, which is unchanged. Another T2 hyperintense focus within the left medulla appears unchanged. There are postoperative findings related to left posterior parietal craniotomy. The orbits are grossly unremarkable. There are bilateral maxillary sinus retention cysts.

Output: 1.No evidence of acute intracranial hemorrhage, mass, or acute infarction.2.Unchanged white matter lesions and postoperative findings in the left hemisphere.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Evaluate for etiology of right radicular symptoms. Signs and symptoms: Right radicular pain episodes. Nonenhanced lumbar MRI:There is normal anatomical alignment of vertebral column.There is mild signal changes of vertebral column secondary to minimal degenerative disease and unremarkable otherwise.T10-T11 through L3-L4 levels are unremarkable.L4-L5 demonstrate mild disc disease and loss of disc height and mild degenerative changes of posterior elements however without spinal stenosis or neural foraminal compromise.L5-S1 demonstrate mild to moderate disc disease and loss of disc height and decreased T2 signal intensity and mild bilateral facet and ligamentum flavum degenerative changes. There is a tiny shallow right median disc protrusion at this level which is best appreciated on axial T2 series 701 image 10 and sagittal T2 STIR series 601 images 7 and 8. The finding results in very subtle indentation of the thecal sac however without spinal canal, neural foraminal or lateral recess compromise.Limited view of the SI joints are unremarkable.Perispinal soft tissues are unremarkable.

Output: 1.Mild degenerative changes at L5-S1 and a tiny shallow right paramedian disc protrusion without spinal canal, neural foraminal or lateral recess compromise.2.Minimal degenerative disc disease at L4-L5 and unremarkable nonenhanced lumbar MRI otherwise.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old, with von Hippel-Lindau and pre-existing hemangioblastoma of the cerebellum. Evaluate for growth and new lesions. Brain:A punctate focus of enhancement within the left cerebellar tonsil may be slightly more conspicuous than on the prior examination, though it still measures no more than 2 mm in size and does not produce any edema in the surrounding parenchyma. No additional enhancing lesions are seen. No areas of focal signal abnormality or restricted diffusion are detected. There is no edema or mass effect. No evidence of intracranial hemorrhage or any abnormal extra axial fluid collection is seen. Ventricular size and morphology are within normal limits.Spine:The spinal cord, conus and nerve roots of the cauda equina demonstrate normal morphology and signal characteristics. Small foci of enhancement along the cauda equina are nonspecific and may simply represent normal vessels. No definite masslike lesions are seen.Mild reversal of the cervical lordosis is seen. Otherwise, spinal alignment is anatomic. Vertebral body heights are preserved. Spinal numbering reflects the presence of 13 thoracic and 5 lumbar type vertebrae. Evidence of prior posterior element surgery, perhaps reflecting partial laminectomy, is seen at L3-4 and L4-5. No pathologic marrow replacement is noted. Mild degenerative endplate signal changes are seen in the cervical spine at multiple levels and in the lumbar spine at L4-5.Mild posterior disc-osteophyte complex formation is seen at C4-5 through C7-T1 without high-grade spinal stenosis, similar to the prior examination. Mild foraminal narrowing is seen on the left at C5-6 and bilaterally at C6-7. Scattered small disc protrusions are evident in the thoracic spine without significant spinal canal or foraminal compromise. The lumbar intervertebral discs are fairly well preserved with the exception of L4-5 where there is loss of disc height and disc bulging with osteophyte formation. No significant spinal canal stenosis is seen. However, the L4-5 neural foramina are mildly narrowed, similar to prior.

Output: 1.A punctate focus of enhancement within the left cerebellar tonsil is slightly more conspicuous though still only measures 2 mm in size. This perceived difference could potentially be technical in nature. The finding is nonspecific, but given the patient's history, a small hemangioblastoma remains in the differential.2.No definite additional hemangioblastomas are seen in the brain or spine. Scattered tiny foci of enhancement within the cauda equina are nonspecific and could simply represent vascular structures.3.Mild degenerative findings in the spine show no significant interval change.


Instruction: Generate impression based on medical findings.

Input: Male 72 years old Reason: PET shows FDG uptake in left adrenal gland. MRI adrenal advised. Please assess for malignancy. History: HL on active therapy ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis. The liver dome is incompletely imaged on this study.SPLEEN: Multiple subcentimeter lesions within the spleen which are isointense to fat on T2 weighted images and demonstrate arterial enhancement. These are nonspecific but may represent hemangiomas. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: 2.3-cm lesion within the left adrenal gland, isointense to the spleen on T2 weighted images. This is stable in size compared to remote CT 11/06/14. This demonstrates diffusion restriction and on out of phase images the majority of the lesion does not demonstrate signal drop out and it therefore is not compatible with a fat rich adenoma. The right adrenal gland is unremarkable. KIDNEYS, URETERS: Multiple T2 hyperintense lesions both kidneys are most consistent with renal cysts.RETROPERITONEUM, LYMPH NODES: Subcentimeter retrocrural lymph nodes are nonspecific.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.2.3-cm left adrenal lesion is stable in size compared to prior study. This does not meet criteria for a fat rich adenoma and is indeterminate. Continued follow-up is recommended.


Instruction: Generate impression based on medical findings.

Input: A counting sequence was not provided. Correlating with previous MRI cervical spine, the last fully visualized vertebra on the sagittal images is designated as T12, with significant disc degeneration at C6-C7 as noted previously. Axial T2-weighted images through the thoracic cord are somewhat inhomogeneous secondary to technical factors.The thoracic spine is in normal alignment, with a normal thoracic kyphosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. A rounded area of T1/T2 hyperintensity is seen in the T5 vertebral body inferiorly which appears to represent a hemangioma.The spinal cord is of normal caliber. There are questioned areas of patchy abnormal T2/STIR hyperintensity scattered along the thoracic cord, most conspicuous at the T2-T3 level. Additional questioned findings are seen on the right dorsal lateral aspect of the cord at T6-T7 and along the dorsal midline cord at the lower T10 level, perhaps affecting the conus at the mid T12 level.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine. There are incidental rounded T2 hyperintense lesions associated with the kidneys, which are nonspecific but most likely represent small cysts.

Output: 1. Questioned scattered areas of patchy abnormal signal along the thoracic cord, which given the previous cervical cord findings, may represent additional demyelinating plaques. Relation is somewhat limited due to inhomogeneity of the thoracic cord signal secondary to technical factors.2. No significant thoracic spondylotic changes. Redemonstration of focal degenerative changes at C6-C7.


Instruction: Generate impression based on medical findings.

Input: 72-year-old woman with history of portal vein thrombosis and cystic pancreatic lesions on ultrasound. ABDOMEN:LIVER, BILIARY TRACT: The liver is cirrhotic in morphology with nodular contour and relative atrophy of the right lobe compared to the hypertrophic left lobe. No suspicious focal enhancing hepatic lesions identified.The main, right, and proximal left portal veins are patent. The lateral left portal vein is small but patent (1204/223). The medial left portal vein is patent and feeds a large paraumbilical collateral vein.The gallbladder appears normal. There is no intra or extrahepatic biliary ductal dilatation.SPLEEN: There is splenomegaly. The spleen is otherwise normal.PANCREAS: Multiple cystic lesions are noted in the pancreas without enhancement and without clear communication to the pancreatic duct (MRCP images are significantly degraded due to motion). The main pancreatic duct is nondilated. The remainder of the pancreatic parenchyma appears normal.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Paraumbilical and retroperitoneal/perisplenic collaterals seen. The left renal vein and left gonadal vein are dilated, definitive renal vein to splenic vein communication not able to be visualized.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Circumferential gastric wall thickening is nonspecific in the setting of ascites.BONES, SOFT TISSUES: There is soft tissue anasarca.OTHER: Ascites noted. There is cardiomegaly.

Output: 1.Cirrhotic morphology of liver without suspicious focal hepatic lesion.2.Patent portal veins. Evidence of portal hypertension with splenomegaly and paraumbilical and retroperitoneal/perisplenic collaterals. 3.Multiple cystic pancreatic lesions, likely side branch IPMNs.


Instruction: Generate impression based on medical findings.

Input: 27-year-old with history of fibrocystic disease and left bloody nipple discharge from a single duct. Mother with history of breast cancer. There is heterogeneous amount of fibroglandular tissue in both breasts. Numerous high T2 cysts are present bilaterally. Marked parenchymal enhancement is noted bilaterally. This is a limitation to this exam. There is also motion artifact which limits the subtraction images. There is high T1 signal fluid in bilateral retroareolar ducts, most notable in multiple ducts near the left 12:00 position. Subtraction images are limited for evaluating ductal enhancement, but when comparing pre and post T1 images at the level of the duct fluid, the degree of high T1 signal appears largely stable. Numerous benign morphology masses are present bilaterally. The largest is the biopsy proven benign mass in the right upper outer breast which measures 1.2 x 0.9 x 1.4 cm. This mass has internal artifact from a biopsy clip. No morphologically suspicious mass is seen in either breast. This imaging and follow up were discussed for consensus opinion among three breast radiologists. No abnormal lymph nodes are identified in either axillary region.

Output: Limited MRI showing multiple bilateral benign morphology masses and extensive background enhancement. High signal fluid is seen within ducts bilaterally, left greater than right. Motion artifact limits the exam, but there is no definite suspicious ductal enhancement seen. A 6 month MRI follow up is recommended to evaluate the stability of the masses, and should be performed during the second week of her menstrual cycle to maximize the utility of the follow up study. Clinical correlation for her nipple discharge is also recommended.These results and recommendations were discussed with Dr. Jaskowiak. BIRADS: 3 - Probably benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: Recent posterior fossa tumor resection. There are postsurgical changes of a left retrosigmoid suboccipital craniectomy for posterior fossa tumor resection, with a small amount of extra-axial fluid deep to the craniotomy flap. There is an enhancing nodular lesion with measuring approximately 15 mm in diameter in the posterior left cerebellomedullary angle cistern region, along the lateral aspect of the fourth ventricle. There is also a 12 mm diameter nodular enhancing lesion more anteriorly in the left cerebellomedullary angle cistern region. There is extensive encephalomalacia in the left cerebellar hemisphere and middle cerebellar peduncle and what may represent a small amount of acute ischemia in the left cerebellar hemisphere. There is no midline shift or herniation. The third and lateral ventricles are not enlarged. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There are skin fiducial markers.

Output: Recent postoperative findings with residual tumor in the left cerebellomedullary angle cistern region.


Instruction: Generate impression based on medical findings.

Input: 66 years, Female, stage IV melanoma with brain metastases on treatment. Again seen is a hemorrhagic lesion in the right paramedian occipital lobe measuring approximately 11 x 6 mm, which is not significantly change in size on the T1 weighted sequences since prior MRI from 9/16/2015 (measured11x7 mm), but clearly smaller than 6/1/2015 (measured 16x13 mm). There is intrinsic T1 shortening without clear enhancement. There is mild increase in surrounding FLAIR hyperintensity without mass effect. No midline shift or herniation. No abnormal parenchymal or meningeal enhancement is seen elsewhere in the brain to suggest a new lesion. There are multiple nonspecific foci of scattered T2/FLAIR hyperintensity similar to prior. No hydrocephalus. No extra-axial collections. Diffuse low T1 marrow signal is again noted, which is nonspecific. No destructive calvarial lesions.

Output: 1. No new or enlarging lesions to suggest progression of metastatic disease. 2. Treated hemorrhagic right occipital lesion is not significantly changed in size compared to 9/16/2015. There is increase in surrounding FLAIR hyperintensity which may represent mild edema or gliosis from prior treatment.


Instruction: Generate impression based on medical findings.

Input: Knee pain MENISCI: No significant abnormality noted. There is increased signal intensity within the peripheral fibers of the posterior horn of the medial meniscus which is thought to represent vascularity.ARTICULAR CARTILAGE AND BONE: There is heterogeneity of the articular cartilage of the medial and lateral compartments but otherwise there is no evidence of full-thickness cartilage defect.There is heterogeneity and areas of near full-thickness to full-thickness loss of articular cartilage of the patellofemoral compartment particularly within the lateral patellar facet. LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: The Insall Salvati ratio is borderline elevated at 1.4. The femoral trochlea appears subjectively shallow. The TT to TG distance is normal at 1.5 cm and there is a mild amount of nonspecific increased signal within the superolateral portion of Hoffa's fat pad.ADDITIONAL

Output: Moderate articular cartilage loss and heterogeneity of the patellofemoral compartment with areas of near full-thickness to full-thickness loss of the lateral patellar facet.


Instruction: Generate impression based on medical findings.

Input: 24-year-old with locally diagnosed endometrial cancer. Assess extent of disease. EPIC Note: Dilation and curettage of the endometrial cavity: endometrial endometrioid FIGO grade 2 adenocarcinoma with background of polypoid endometrium with atypical hyperplasia PELVIS:UTERUS, ADNEXA: There is abnormal heterogeneous thickening of the endometrial cavity measuring up to 2.0 cm in thickness which demonstrates abnormal restricted diffusion. There is abnormal heterogeneous polypoid enhancement of the endometrial contents following contrast administration. Near the internal cervical os the abnormal enhancement appears to involve at least 50% of the myometrial thickness (series 1201/218). Additionally, there is hypoenhancement at the bilateral uterine cornu, also suspicious for tumoral invasion. The cervical stroma is normal in signal intensity. There is no evidence of parametrial tumor extension.On the T2-weighted sagittal images the posterior junctional zone is well-defined and normal in thickness. Anteriorly the junction shown is a well-defined thickened which may represent tumoral invasion versus adenomyosis.Status post resection of the left ovarian dermoid cyst. The right adnexa is unremarkable.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy measuring greater than 1 cm in short axis.BOWEL, MESENTERY: Small amount of free pelvic fluid.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Abnormal heterogeneous thickening of the endometrial cavity with regions of polypoid heterogeneous enhancement with findings suspicious for at least 50% myometrial invasion at the anterior lower uterine segment. No evidence of cervical stromal invasion or extra-uterine tumor extension.


Instruction: Generate impression based on medical findings.

Input: Reason: 64yoF R rotator cuff injury for 1.5years, please assess for tear, capsulitis, etc ROTATOR CUFF: Full-thickness tear of the supraspinatus tendon (series 10 image 15) with moderate muscle atrophy. There is high-grade articular surface partial tear of the infraspinatus tendon with mild muscle atrophy. There is small fluid signal lesion noted within the infraspinatus tendon measuring approximately 1 cm in transverse dimension and approximately 3 cm from the insertion, likely representing intramuscular ganglion cyst secondary to partial tear. There is mild thickening of the subscapularis tendon suggestive of tendinosis with mild muscle atrophy. Teres minor tendon and muscle are intact.SUPRASPINATUS OUTLET: Moderate degenerative change in the AC joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral alignment is within normal limits. Small degenerative subchondral cysts noted in the humeral head. Glenohumeral cartilage without focal defect. Sublabral foramen is noted in the anterior superior labrum. No discrete labral tear is identified on this non-arthrogram study. BICEPS TENDON: Biceps tendon is intact and located within the bicipital groove.ADDITIONAL

Output: 1. Full-thickness tear of the supraspinatus tendon with moderate muscle atrophy. 2. High-grade articular surface partial tear of the infraspinatus tendon with mild muscle atrophy and intramuscular ganglion cyst.


Instruction: Generate impression based on medical findings.

Input: Possible right parotid mass. Per epic: right cheek swelling. This began 1-1/2 years ago. She has episodes that come and go that are associated with pressure and a subsequent salivary 'gush." There is focal dilatation of the right parotid duct overlying the masseter muscle, measuring up to 4 mm in diameter. There is diffuse enhancement of the parotid duct walls, but no associated discrete mass lesions. The right parotid gland is atrophic and does not display ductal dilatation. The left parotid gland and bilateral submandibular glands are unremarkable. There is an enhancing 4 mm diameter nodular lesion in the right buccal space inferior to the level of the parotid duct. There is otherwise no significant lymphadenopathy in the imaged portions of the neck. The osseous structures, paranasal sinuses, orbits, and imaged intracranial structures are unremarkable.

Output: 1. Focal dilatation of the right parotid duct overlying the masseter muscle, measuring up to 4 mm in diameter, along with diffuse enhancement of the parotid duct walls, but no associated discrete mass lesions. These findings may represent chronic ductal inflammation, perhaps secondary to a partially obstructive stricture, with resultant right parotid gland atrophy.2. A 4 mm diameter nodular lesion in the right buccal space inferior to the level of the parotid duct may represent a mildly reactive lymph node or perhaps a neoplasm.


Instruction: Generate impression based on medical findings.

Input: Please note lack of contrast significantly limits evaluation for leptomeningeal disease. Within this limitation, no cord signal abnormality or mass within the cervical, thoracic, or lumbar spinal canal is appreciated to suggest drop metastases. Postsurgical changes in the posterior fossa are partially imaged with T2 hyperintensity along the resection cavity not appreciably changed since MRI dated 1/27/2016.Vertebral body heights in the cervical spine are grossly normal aside from minimal endplate deformities affecting the C3-C7 vertebral bodies. No suspicious osseous lesions are demonstrated. Mild degenerative changes are seen with small multilevel disc osteophyte complexes and ligamentum flavum thickening, but without significant spinal canal stenosis or neural foraminal stenosis at any level.In the thoracic spine, there is extensive T2 hyperintensity and mild T1 hyperintensity involving the T7 and T8 vertebral bodies extending into the posterior elements, particularly on the right. Smaller and more T1 hyperintense lesions are seen at the T5 and T6 vertebral bodies and the T12 vertebral bodies most compatible with hemangiomas. No abnormal flow-voids in the spinal canal. Subtle T2 hyperintensity and deformity of the posterior aspect of the cord is noted at the T7-T8 level which may be sequela of prior treatment with possible adhesions in the thecal sac. There is mild narrowing of the right T7-T8 and T8-T9 right-sided neural foraminal narrowing related to bony expansion of the right-sided pedicles. There is otherwise no significant spinal canal or neural foraminal stenosis in the thoracic spine. There is a small Schmorl's node involving the superior endplate of T6 level. Minimal generalized deformity of the thoracic endplates is noted, as in the cervical spine, but without significant overall loss of height at any level. There is evidence of prior laminectomies from T6 to T8.In the lumbar spine and partially imaged pelvis, there also multiple T1 hyperintense lesions most compatible with hemangiomas. Minimal degenerative changes are present without significant spinal canal or neural foraminal stenosis. Vertebral body heights are grossly maintained. Alignment is maintained. There is no significant spinal canal or neural foraminal stenosis at any level.

Output: 1. Please note lack of contrast significantly limits assessment of leptomeningeal disease and postcontrast sequences should be considered as clinically indicated. No obvious nodularity along the surface of the cord or cauda equina to suggest drop metastases. There are also no intramedullary or epidural masses.2. Evidence of multiple hemangiomas in the spine and visualized pelvis. There are particularly large T2 hyperintense lesions involving the T7 and T8 vertebral bodies with mild osseous expansion and extension into the posterior elements. These would be compatible with more vascular/aggressive hemangiomas/venous malformations but suggest comparison with prior imaging and pathology if available. There is evidence of prior T6-T8 laminectomies. Subtle cord signal abnormality and dorsal cord deformity at the T7-T8 level may be related to myelomalacia and adhesions in the thecal sac.


Instruction: Generate impression based on medical findings.

Input: A patient submitted outside study for review. Submitted for review are screening mammogram dated 4/2/2014, and left diagnostic mammogram dated 10/15/2014, performed at High Tech Medical Park in Palos Heights, IL as well as screening MRI dated 12/2/2014 and images from MRI guided left breast biopsy dated 12/19/2014 performed at Silver Cross Hospital. For comparison, bilateral screening mammogram dated 2/28/2013 and left diagnostic mammogram dated 3/23/2013 are available. MAMMOGRAMS (4/2/2014 and 10/15/2014): Two standard views of both breasts, and spot magnification views of the left breast were obtained on 4/2/2014. Additional left MLO, CC and magnification was performed in October. The breast parenchyma is extremely dense, limiting mammographic sensitivity, unchanged in pattern and distribution.Scattered benign calcifications are present bilaterally. A loosely grouped cluster of calcifications is present within the upper central, slightly inner left breast. Some of these calcifications demonstrate a layered appearance on magnification views, suggesting milk of calcium. The calcifications in the left upper central breast are stable in the short term. No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in either breast. BILATERAL SCREENING MRI (12/2/2014): MRI was performed without and with gadolinium as per outside hospital protocol. There is extremely dense fibroglandular tissue bilaterally, with moderate background parenchymal enhancement, which may decrease the sensitivity of the examination. Multiple cysts are present bilaterally. At the approximate 12:00 position of the left breast, there is a circumscribed, enhancing mass measuring 0.7 x 0.7 x 0.9 cm which demonstrates hyperintense signal on T2 imaging. Dark internal septations are noted. The mass may represent a fibroadenoma. No additional enhancing masses are present in either breast. IMAGES FROM MRI GUIDED LEFT BREAST BIOPSY (12/19/2014): Images from an attempted left breast MRI-guided biopsy were submitted. There is redemonstration of a circumscribed, enhancing mass at the approximate 12:00 position of the left breast. Per report, biopsy was not performed at the time of imaging due to difficulties in accessing the target site.

Output: Enhancing, circumscribed mass at the 12:00 position of the left breast. While this may represent a fibroadenoma, follow up MRI, and possible MRI-guided left ultrasound, should be performed. Additionally, the patient is due for bilateral annual mammogram at this time. It is suggested that the MRI be performed before mammography/ultrasound so that any work-up needed due to the MRI can be performed at the time of the diagnostic mammogram. BIRADS: 3 - Probably benign finding.RECOMMENDATION: X - No Letter.