Instruction: Generate impression based on medical findings.

Input: Please evaluate neck and ear pain. Enhanced CT of the soft tissues of the neck:60 cc of Omnipaque 350 was administered.Limited images of the intracranial demonstrate findings suggestive of small was ischemic disease.Images through the skull base, cavernous sinuses, bilateral Petrus bones and paranasal sinuses are unremarkable. Mastoid air cells and middle ear cavities are pneumatized and unremarkable.Images through the neck demonstrate no evidence of a mass or any pathologic adenopathy.Calcification and cystic changes of left lobe of thyroid there is suspected of goiter. Very limited view of the apices of the lungs are unremarkable.Examination demonstrates extensive degenerative disk disease of the cervical spine and hypertrophic changes of posterior elements. No evidence of lytic or sclerotic changes. There is no evidence of fracture or malalignment. There is however unusual presentation of posterior arch of C1 projecting anterior to the posterior elements of C2. This may be result of extensive degenerative changes at C1 -- C2 level. This can be started around or through the dedicated MRI of the cervical spine.

Output: 1.Negative enhanced CT of soft tissues of neck for tumor or pathologic adenopathy.2.Excessive degenerative changes of cervical spine and with unusual appearance of location of posterior arch of C1 anterior to the posterior elements of C2. There is no evidence of fracture or malalignment. If patient's neck pain persists recommend follow-up with dedicated MRI of cervical spine.


Instruction: Generate impression based on medical findings.

Input: Assess for AVM spinal: LE claudication, multifocal fasciculation. There are postoperative findings related to anterior fusion of C6 and C7. There is degenerative spondylosis at C5-6 with an eccentric right disc-osteophyte complex that results in mild spinal canal and moderate right neural foraminal narrowing. There is a small perineural cyst in the right C7-T1 neural foramen. There are also posterior disc-osteophyte complexes at T2-3, T6-7, and T7-8 without spinal cord impingement. In addition, there are small disc bulges and facet hypertrophy bilaterally at L3 through S1, without significant spinal canal or neural foraminal stenosis. The spinal cord signal and morphology is unremarkable. There is no evidence of abnormal enhancement within the spinal canal. The vertebral column alignment is anatomic. The vertebral body heights are preserved. There is a small hemangioma or area of focal fat in the T8 vertebral body. The paravertebral soft tissues and imaged intracranial structures appear to be unremarkable.

Output: 1. Degenerative spondylosis in the cervical, thoracic, and lumbar spine without spinal cord compression.2. No evidence of spinal arteriovenous malformation, although MRI has limited sensitivity for the detection of such lesions. If clinical suspicion persists, a catheter angiogram may be considered for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Breast cancer There is abnormal marrow signal within the proximal humerus extending from the metadiaphysis through the distal diaphysis. Similar abnormal marrow signal within the distal clavicle and possibly involving the glenoid. There is abnormal associated enhancement of the humerus. There is no evidence of fracture or soft tissue mass.Multiple enlarged axillary lymph nodes are noted. There is partial visualization of a right breast implant.

Output: Abnormal marrow signal within the humerus concerning for metastatic disease. Additional areas of abnormal marrow signal may also be present in the glenoid of these could be degenerative in nature.


Instruction: Generate impression based on medical findings.

Input: Reason: re-evaluate suspected ischemic changes: migraine. There is a non-enhancing T2 hyperintense cortical and subcortical lesion in the right superior parietal lobule that measures up to 7 mm, which is not significantly changed. There is no evidence of intracranial hemorrhage, mass-effect, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: A non-enhancing T2 hyperintense cortical and subcortical lesion in the right superior parietal lobule that measures up to 7 mm, which is not significantly changed, may represent a prior ischemic event, but is otherwise nonspecific. Otherwise, no evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on medical findings.

Input: The risks (including, but not limited to, those of bleeding, infection, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The left hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 12 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 54 seconds

Output: Successful injection of dilute gadolinium into the left hip for subsequent MR arthrography.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old, with altered mental status. Evaluate for worsening brain metastases and new ischemia. Evidence of a prior large resection is again seen involving portions of the left frontal and temporal lobes. Since the prior examination, thickened enhancing tissue surrounding the cavity on all sides has progressed. Pathologic enhancement extends up to and along the ependymal margin of the left lateral ventricle which is partially effaced similar to prior. Enhancement also extends up to the left temporal horn which is progressively effaced. Extensive confluent T2 hyperintensity is again seen involving the white matter of both cerebral hemispheres, more so on the left right. The geographic extent of this abnormal signal has progressed mildly at least within the left hemisphere. There is perhaps slightly increased left cerebral mass effect but only a 2 to 3 mm midline shift to the right. The left suprasellar cistern is partially effaced similar to prior. The quadrigeminal plate cistern remains patent.Progressive T2 hyperintensity is evident within the left cerebral peduncle. Also noted is new ill-defined ependymal enhancement along the right ventricular atrium and along the left posterior fourth ventricle.Signal abnormality compatible with an evolving hematoma is again seen along the floor of the left middle cranial fossa. No new acute intracranial hemorrhage is suspected. The caliber of the right lateral ventricle, third and fourth ventricles is similar to prior.

Output: Findings compatible with progression of tumor are seen within the left cerebral hemisphere surrounding the previous resection site. Only mild increased mass effect is seen, however. Evidence of scattered new ependymal disease is also noted, for example at the right atrium and along the left posterior fourth ventricle, findings which may reflect dissemination via the CSF.


Instruction: Generate impression based on medical findings.

Input: 20-year-old male with wrist pain. LIGAMENTS: Intra-articular contrast is identified within both the midcarpal and radiocarpal joints. Intra-articular contrast traverses the scapholunate ligament indicating a tear. The lunotriquetral ligament appears intact.TRIANGULAR FIBROCARTILAGE COMPLEX: The triangular fibrocartilage complex appears intact. No intra-articular contrast is identified within the distal radioulnar joint.TENDONS: The flexor and extensor tendons appear intact. BONES: There is increased bone marrow signal abnormality on fluid sensitive sequences within the triquetrum which may represent a direct bone contusion. No linear signal abnormality is identified to suggest an acute fracture.ADDITIONAL

Output: 1. Findings consistent with disruption of the scapholunate ligament as described above. The triangular fibrocartilage complex appears intact.2. Bone contusion of the triquetrum.


Instruction: Generate impression based on medical findings.

Input: Female 60 years old Reason: History of diabetes, hypertension, JL w b/l knee pain; recent flare up of right knee s/p twist injury on Jan 5th 2016 r/o tear MENISCI: There is intrasubstance increased signal in both the medial and lateral meniscus, likely representing intrasubstance degeneration. No discrete tear is identified.ARTICULAR CARTILAGE AND BONE: Increased T2 edema type signal in the medial tibial patella. There is focal chondral thinning of the medial patellar facet. There is focal fissuring of the cartilage of the lateral patellar facet with underlying bone edema. There is loss of hyaline cartilage along the lateral tibial plateau.LIGAMENTS: Complete rupture of the ACL. PCL is intact. Collateral ligaments are intact. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: 1.Complete rupture of the ACL. 2.Intra-articular mass highly suspicious for focal nodule of PVNS.3.Large joint effusion and diffuse subcutaneous edema. 4.Contusion of the medial tibial plateau.


Instruction: Generate impression based on medical findings.

Input: 62-year-old female with history of neurofibromatosis type I Chest: Again seen is a large T2 bright, mildly enhancing mass involving the left chest wall, which measures 8.4 x 4.4 cm and previously measured 8.6 x 5.0 cm. Osseous components of the adjacent rib are noted extending anterior to the mass. An additional small dumbbell-shaped lesion involving the right chest wall is again visualized, unchanged from the prior exam. Numerous additional small enhancing lesions involving the skin and left breast are visualized likely representing additional neurofibromas There is nonspecific skin thickening along the right posterior chest wallPelvis: Again seen is a large enhancing mass along the right gluteus medius which measures 2.7 x 5.2 cm and previously measured 2.6 x 5.3 cm. Numerous additional enhancing lesions involving the body wall, likely represent additional neurofibromas. The uterus is atrophic or absent. An enhancing mass is present within the pelvis abutting the sigmoid and rectum which measures 9.8 x 7.0 cm, not significantly change from the prior exam.

Output: Numerous neurofibromas as described above, overall appearing similar to the prior exam.


Instruction: Generate impression based on medical findings.

Input: 56 year-old male. Left hip pain. Assess for abnormality. Please see hip xray (4/2015) density noted on femoral neck. There is a irregular focus of low signal intensity within the the femoral neck along the posterior cortex associated with a tiny central focus of relatively high signal intensity. The etiology of this finding is uncertain but it is not associated with any significant edema and does not have a typical appearance of a metastatic focus. We suspect it is benign in etiology, perhaps a focus of corticotrabecular thickening. This likely corresponds to the focus of sclerosis seen on recent radiographs. Degenerative disk disease affects the lower lumbar spine, most severely at L5-S1. Mild osteoarthritis affects both hips. There is increased signal intensity within the anterosuperior acetabular labrum on the left suggesting degeneration or degenerative tearing. There is slight prominence of the anterior aspect of the left femoral head/neck junction with an alpha angle of 55 degrees suggesting a borderline CAM deformity. Mild heterogeneity of the bone marrow on T1-weighted images likely represents residual red marrow. The musculature is unremarkable. On the large field of view T2 weighted images, there are small elongated foci of high signal intensity within the left sciatic nerve, which may represent prominent fascicles or perhaps tiny benign nerve sheath tumors, but these not necessarily of any clinical significance.

Output: 1. Cortically based focus of low signal intensity within the posterior aspect of the left femoral neck likely corresponds to the sclerosis seen on the recent radiographs. While its etiology is uncertain, we suspect that it is benign and of doubtful clinical significance.2. Degenerative arthritic changes and other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Female, 38 years old, with headache, status post Chiari decompression, six-week follow-up exam with CSF study. Postoperative findings are seen compatible with interval Chiari decompression including suboccipital craniectomy and resection of the posterior arch of C1. Edema and a small amount of fluid in the suboccipital extracranial soft tissues are within acceptable limits.With the postoperative changes, the caliber of the CSF space at the level of the posterior foramen magnum has been expanded. The cerebellar tonsils demonstrate a relatively round morphology. CSF flow imaging shows little if any biphasic biphasic signal alteration which may be technical in nature.Spinal alignment is anatomic. Vertebral body morphology and signal characteristics are within normal limits. The visualized spinal cord demonstrates normal signal intensity and morphology. No significant degenerative disc disease is seen. No spinal canal or neuroforaminal stenosis is detected.Incidental note is made of a partially cystic pineal gland which is, however, under 1 cm in diameter.

Output: Expected findings status post Chiari decompressive surgery. The caliber of the CSF space along the posterior foramen magnum is expanded relative to the preoperative study. CSF flow imaging is felt to be technically unreliable.


Instruction: Generate impression based on medical findings.

Input: Reason: 6 year old with juvenile pilocytic astrocytoma receiving vinblastine - any signs of progression? History: JPA. Postsurgical findings in the right posterior fossa appear similar to the prior exams. There is redemonstration of a predominantly extra-axial soft tissue mass at the right cerebellopontine angle measuring approximately 3.4 x 1.9 cm (801/20), previously 3.4 x 1.7 cm. The tumor is stable in extent, encasing the basilar and vertebral vertebral arteries, extending into Meckel's cave and the right internal auditory canal, and tracking along the posterior lateral aspect of the spinal cord beyond the inferior slice of the MRI. Cystic components more inferiorly are unchanged in size. There is decreased FLAIR signal intensity with overall increased heterogeneous appearance on this sequence, likely reflecting treatment-related changes. Postcontrast images show no significant enhancement within the lesion. There is persistent significant mass effect on the leftward displaced lower brainstem and upper cervical cord, with slight increased visualization of the foramen of Magendie compared to remote comparisons.There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are stable in size and configuration. A right parietal ventriculostomy catheter is unchanged in position with its tip in the midline. There is no midline shift or herniation. The major cerebral flow voids are intact. There has been resolution of severe mucosal thickening of the maxillary sinuses.

Output: No significant interval change in size of a predominantly extra-axial posterior fossa juvenile pilocytic astrocytoma, although with interval increased heterogeneity on FLAIR with overall decreased FLAIR hyperintensity, which likely reflect posttreatment changes.


Instruction: Generate impression based on medical findings.

Input: There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Right breast:In the right breast 10:00 position there is a an irregular enhancing mass with microlobulated margins showing homogeneous enhancement that measures 15 x 18 x 20 mm (AP x ML x CC). Clip artifact is identified within the center of the mass. This corresponds to biopsy-proven cancer. Located anterior to the mass is an area of non mass enhancement that measures 12 x 15 mm. Total measurement of the mass with anterior extension measures 3. 4 mm. Mild right breast skin thickening is noted.Multiple enhancing foci identified in the central right breast for which six-month follow-up MRI is recommended.At least 5 enlarged right axillary lymph nodes are identified, largest measuring 25 x 28 x 24 mm with a clip artifact within it.Left breast: A clip artifact from prior benign biopsy is identified in the left breast posterior depth at 7 o'clock position without any abnormal enhancement around it.There is an oval homogeneously enhancing mass in the left breast 3:00 position measuring 9 x 8 x 10 mm (AP x ML x CC) that needs MR directed ultrasound for further evaluation.No abnormal lymph nodes are identified in left axillary region.

Output: 1. Biopsy-proven cancer right breast 10:00 position with anterior non mass enhancement extension measuring 3.4 cm.2. At least 5 enlarged right axillary lymph nodes are identified3. Homogeneously enhancing mass in the left breast 3:00 position measuring 10 mm that needs MR directed ultrasound for further evaluation.4. Multiple small enhancing foci in the central right breast for which six-month follow-up MRI is recommended to confirm stability.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: 28-year-old male with pain. Evaluate for ulnar collateral ligament tear. LIGAMENTS: There is thinning and increased signal abnormality consistent with partial thickness tearing of the distal undersurface fibers of the ulnar collateral ligament at the level of its insertion on the base of the proximal phalanx of the thumb, which appears to remain deep to the adductor pollicis tendon/muscle. There is no evidence of significant retraction or medialization of the proximal tendon fragments to suggest a Stener lesion. TENDONS: The imaged flexor and extensor tendons of the thumb are normal in appearance. BONES: No bone marrow signal abnormality is identified. ADDITIONAL

Output: Partial thickness tearing of the ulnar collateral ligament without evidence to suggest a Stener lesion as described above.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old, with neck pain and radiculopathy; with back pain and right lower extremity radiculopathy. Cervical:Alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or edema is seen. The visualized spinal cord shows normal signal intensity throughout. No epidural abnormalities are suspected.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Left facet arthropathy. Mild uncovertebral hypertrophy. Mild right foraminal narrowing. No spinal canal stenosis. C4-5: Left facet arthropathy. Mild uncovertebral hypertrophy. Moderate left and mild right foraminal narrowing. C5-6: Facet arthropathy. Mild posterior disc-osteophyte complex formation. Mild spinal canal stenosis without significant cord deformation. Moderate to severe bilateral foraminal narrowing. C6-7: Facet arthropathy, left more than right. Posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Moderate left foraminal narrowing. C7-T1: No spinal canal stenosis or neuroforaminal narrowing. Lumbar:Alignment is anatomic. Vertebral body height and morphology are within normal limits. Edema along the anterior inferior endplates of L3 and L4 is likely degenerative in nature. No concerning marrow replacement is demonstrated.The visualized distal spinal cord, conus and nerve roots of the cauda equina are within normal limits. No epidural abnormalities are suspected.L1-2: Small left paracentral disc protrusion. No significant spinal canal or foraminal stenosis. L2-3: Facet arthropathy and ligamentum flavum thickening. Mild disc bulging. No significant spinal canal narrowing. Mild bilateral foraminal narrowing. L3-4: Facet arthropathy and ligamentum flavum thickening. Disc bulging. Mild spinal canal narrowing. Mild bilateral foraminal narrowing. L4-5: Facet arthropathy and ligamentum flavum thickening. Disc bulging with left foraminal annular fissuring. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. L5-S1: Facet arthropathy. Minimal disc bulging. No spinal canal stenosis. Mild right foraminal narrowing.

Output: 1.Multilevel degenerative findings are seen in the cervical spine. No high-grade spinal canal stenosis is demonstrated. However, moderate to severe foraminal narrowing is evident bilaterally at C5-6, with scattered mild to moderate foraminal narrowing at additional levels as above.2.Multilevel degenerative findings are also seen in the lumbar spine. No high-grade spinal canal stenosis is demonstrated. Only mild scattered foraminal narrowing is seen.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old, history of lumbar ependymoma resection, baseline evaluation. A few scattered small foci of T2 hyperintensity are evident within the cerebral white matter which are nonspecific. No edema or mass effect is detected. There is no evidence of pathologic parenchymal or extra-axial enhancement. Diffusion weighted images are normal.No evidence of acute intracranial hemorrhage or any abnormal extra-axial fluid is seen. The ventricles are normal in size and morphology. The basal cisterns are patent.The bone marrow signal characteristics are within normal limits. No abnormalities of the paranasal sinuses are seen.

Output: No evidence of metastatic disease to the brain.


Instruction: Generate impression based on medical findings.

Input: 41 years Female (DOB:12/1/1975)Reason: rule out CVA History: right arm and face numbnessPROVIDER/ATTENDING NAME: JAMES X. TAO JAMES X. TAO The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient is status post right temporal craniotomy. There is encephalomalacia present in the right temporal lobe. This appearance is stable compared to the previous exam.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. This appearance is stable compared to the previous exam.Small foci of T2 and FLAIR hyperintensity are also present along the gray matter in the left watershed zone predominantly involving the left frontal lobe cortex and subcortical white matter. This appearance is stable compared to the previous exam.Several punctate foci of susceptibility are present in the right middle frontal gyrus subcortical white matter. This appearance is stable compared to the previous exam.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.The patient status post right middle cranial fossa surgery. There is encephalomalacia present in the right temporal lobe.2.Findings suggest prior small watershed distribution infarctions in the left frontal lobe. This appearance is unchanged since previous exams. 3.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific.


Instruction: Generate impression based on medical findings.

Input: Brain MRI:There are multiple scattered punctate to small foci of T2 hyperintensity within the supratentorial white matter, primarily subcortical white matter in location, without associated restricted diffusion, susceptibility abnormality, or enhancement. There are no posterior fossa lesions. 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. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. 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. No arterial stenoses, occlusions or arteriovenous malformations are identified and there is no evidence for cerebral vasculitis. A 2 mm base dimension infundibulum is noted of the right posterior communicating artery.

Output: 1.There are multiple scattered punctate to small foci of T2 hyperintensity within the supratentorial white matter, primarily subcortical white matter in location, without associated restricted diffusion, susceptibility abnormality, or enhancement and there are no posterior fossa lesions. These are nonspecific in appearance, and for a patient aged 59 years the most likely etiology is chronic small vessel disease. However, the differential diagnosis would also include migraine sequelae or vasculitide. Given lesional morphology and locations, demyelination is felt to be unlikely. 2.A 2 mm base dimension infundibulum is noted of the right posterior communicating artery. Otherwise negative MRI of the brain.


Instruction: Generate impression based on medical findings.

Input: New onset seizure comprising of 5-10 sec arrest of activity with staring raising both arms, watery eyes, and drooling, with accompanying occipital headaches, loss of vision, and out of body experience per EPIC. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable, without evidence of heterotopia, medial temporal sclerosis, or gross cortical malformation. The pituitary and pineal glands also appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of gross seizure foci.


Instruction: Generate impression based on medical findings.

Input: Facial droop and dysarthria. The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild scattered cerebral white matter T2 hyperintensity. 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 and orbits are unremarkable. There is a 12 mm thick right occipital scalp lipoma. There is a subcentimeter left maxillary sinus retention cyst.

Output: Mild probable chronic small vessel ischemic disease, but no evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on medical findings.

Input: Rule out CVA. Patient with two days of left-sided weakness. Several areas of encephalomalacia, the largest in the right occipital lobe that likely represent areas of prior infarct. Multiple areas of subcortical and periventricular white matter hypodensity indicate small vessel ischemic disease of indeterminate age. An MRI is recommended if there is clinical concern for acute stroke.There is no evidence of intracranial hemorrhage, mass or midline shift. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Areas of encephalomalacia and evidence of small vessel ischemic disease of indeterminate age. An MRI is recommended for further evaluation if there is concern for an acute stroke.


Instruction: Generate impression based on medical findings.

Input: 46 year old female presenting with recent biopsy-proven intraductal papillary proliferation and focal ADH in the right breast inner quadrant presents for preoperative wire localization. On review of the prior studies, there are multiple oval masses in the lower inner right breast in a ductal distribution confirmed on ultrasound. One of the masses subsequently biopsied showed intraductal papillary proliferation and focal ADH. On MRI similar findings are seen within a large area of abnormal segmentally distributed clumped non-mass enhancement, spanning approximately 13 cm. Upon discussion with Dr. Jaskowiak, plan is to perform a bracket localization targeting the biopsy clip and additional asymmetry anteriorly.Target biopsy clip with adjacent masses are in the right breast in the lower inner quadrant region located posteriorly at 3 o’clock (site 1). Target asymmetric density is located in the right breast in the lower inner quadrant region located in mid-breast (site 2), anterior to site 1.The procedure, risks including bleeding, mis targeting and infection, and benefits of needle-wire localization were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time out form was completed to confirm patient identity and site of procedure. Right breast wire localization site 1:The right breast was placed in an alphanumeric grid using medial to lateral approach. When the target was positioned in the aperture of the grid, the skin was cleansed with chlorhexidine. Local anesthesia was obtained using 2% Lidocaine. Using coordinates from the grid, a 5 cm Kopans needle was placed adjacent to the lesion. On orthogonal mammography, adequate positioning of the needle was confirmed after adjusting depth so the needle tip was approximately 2cm deep to the center of the target. A spring wire was then deployed. Repeat two view orthogonal mammograms reveal the spring wire to be in excellent position.Right breast wire localization site 2:The right breast was placed in an alphanumeric grid using medial to lateral approach. When the target was positioned in the aperture of the grid, the skin was cleansed with chlorhexidine. Local anesthesia was obtained using 2% Lidocaine. Using coordinates from the grid, a 5 cm Kopans needle was placed through the lesion. On orthogonal mammography, adequate positioning of the needle was confirmed after adjusting depth so the needle tip was approximately 2cm deep to the center of the target. A spring wire was then deployed. Repeat two view orthogonal mammograms reveal the spring wire to be in excellent position. The mammogram was annotated and reviewed with Dr. Jaskowiak prior to the patient's procedure. Patient tolerated the procedure well and was sent to the holding area in stable condition. Dr. Udoji performed the procedure under direct supervision of Dr. Abe, who was present during the procedure at all times.Orthogonal digital specimen radiographs revealed the clip, multiple small masses, and both wires to be within the specimen.

Output: Successful needle localization of the right breast, two sites.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on medical findings.

Input: 49-year-old female with left knee pain, medial joint line tenderness, no improvement with injections or conservative treatment MENISCI: Globular intermediate signal within the outer third of the anterior horn of the lateral meniscus extending to the femoral articular surface consistent with degenerative fraying. Blunting of the free edge of the posterior horn of the lateral meniscus compatible with a tear.The medial meniscus is within normal limits.ARTICULAR CARTILAGE AND BONE: A focal chondral defect is noted in the lateral tibial articular cartilage measuring up to 4 mm in AP dimension, directly beneath the aforementioned meniscal tear. Grade 1-2 chondromalacia medial tibiofemoral compartment. There is severe thinning of the lateral patellar facet articular cartilage. Subchondral cysts are noted in the lateral tibial plateau/spine. Otherwise, there is no abnormal marrow signal. Mild tricompartmental osteophytosis is noted.LIGAMENTS: Cruciate ligaments are intact. Collateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Blunting of the free edge of the posterior horn of the lateral meniscus compatible with a tear. Underlying focal chondral defect is also noted in the lateral tibial articular cartilage measuring up to 4 mm in AP dimension2.Globular intermediate signal within the outer third of the anterior horn of the lateral meniscus extending to the femoral articular surface consistent with degenerative fraying. 3.Focal 4 mm loose body is also noted in the pocket of fluid posterior to the femoral metaphysis.4.Mild to moderate osteoarthritis affects the left knee.


Instruction: Generate impression based on medical findings.

Input: This exam is mildly degraded by motion artifact. There is unchanged dilatation of the central spinal canal extending from the T6-T10 levels, largest at the T8 level where it measures 3 x 4 mm in the axial plane. The spinal cord otherwise displays normal signal and morphology with the conus terminating at L2. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: Stable midthoracic syringohydromyelia.


Instruction: Generate impression based on medical findings.

Input: Left plantar foot wound. MRI not sure about "osteo". Evaluate for "osteo". There is swelling of the soft tissues adjacent to the first metatarsophalangeal joint. There is ulceration of the soft tissues beneath the proximal phalanx of the great toe. There is dorsal dislocation of the proximal phalanx of the great toe relative to the first metatarsal. Erosive deformity of the head of the first metatarsal and base of the proximal phalanx is better appreciated on the recent MRI examination; based on the MRI examination, I suspect these erosions are chronic. The sesamoid bones are absent either, due to long-standing destruction or resection.

Output: Ulceration of the soft tissues beneath the proximal phalanx of the great toe. Erosive deformity of the head of the first metatarsal and base of the proximal phalanx of the great toe likely represents sequela of infection; based on the MRI examination, I suspect this is chronic.


Instruction: Generate impression based on medical findings.

Input: History of nonfunctioning pituitary macroadenoma, please evaluate for interval change. There is a homogeneously enhancing mass within an expanded sella that measures 16 AP x 15 RL x 14 SI mm, which is not significantly changed. There is no significant encroachment upon the cavernous sinuses and there is no mass effect upon the optic apparatus; however, the tumor or expanded sella extends into the sphenoid sinuses. The pituitary stalk is intact and situated in the midline. However, the posterior pituitary bright spot is not evident. The imaged portions of the brain are unchanged. The imaged portions of the sinonasal cavities are grossly unremarkable.

Output: No significant interval change in the sella mass, which likely represents a macroadenoma.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old, with hypocortisolism. Assess for pituitary adenoma. The overall size pituitary gland is within normal limits. No discrete pituitary lesions are seen. The posterior pituitary bright spot is slightly prominent but this is likely within normal limits. The pituitary stalk sits at midline and enhances normally. No abnormalities of the cavernous sinuses or Meckel's caves are suspected.No suprasellar lesions are seen. The visualized portions of the optic apparatus are unremarkable. Limited views of the brain demonstrate scattered white matter T2 hyperintense lesions which are nonspecific.

Output: No specific lesions of the pituitary gland are identified to account for the patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: 18-year-old female soccer player status post noncontact knee injury with positive Lockman's. Assess for ACL or meniscal injury. MENISCI: There is linear branching increased signal abnormality within the posterior horn of the medial meniscus which extends to the femoral articular surface consistent with a complex tear with a horizontal component. There is linear increased signal abnormality within the posterior horn of the lateral meniscus which extends to the femoral articular surface consistent with a horizontal tear.ARTICULAR CARTILAGE AND BONE: There is increased signal abnormality within the lateral femoral condyle and the posterior aspect of the lateral tibial plateau consistent with bone contusions. There is depression of the cortex of the lateral femoral condyle overlying this edema which may represent an impaction fracture of the lateral femoral condyle/ lateral "notch" sign. Focus of low signal intensity within the proximal tibial metadiaphysis likely represents a bone island. There is subchondral cyst formation within the lateral facet of the patella. Evaluation of the articular cartilage of the patellofemoral joint is suboptimal secondary to patient motion artifact.LIGAMENTS: There is complete disruption of the proximal and midsubstance fibers of the anterior cruciate ligament. The PCL appears intact. There is increased signal abnormality within the meniscofemoral coronary ligament which may represent a sprain. The superficial band of the MCL appears intact. There is increased signal abnormality within the lateral collateral ligament proper suggesting a sprain.EXTENSOR MECHANISM: The extensor mechanism appears intact. The proximal fibers of the medial retinaculum at the level of their insertion on the femur are indistinct and associated with increased signal abnormality on fluid sensitive sequences indicating partial thickness tearing. There is a slight lateral tilt of the patella.ADDITIONAL

Output: 1. Complete rupture of the ACL. 2. Medial and lateral meniscus tears. Bone contusions. Moderate size joint effusion.3. Elevated tibial tubercle to trochlear groove distance and partial thickness tearing of the medial retinacular structures as described above, which can be seen in patient's with patellofemoral instability. Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Pancreatic tail mass on CT. Evaluate for changes/abnormality. ABDOMEN:LIVER, BILIARY TRACT: There are numerous bilobar T2 hyperintense lesions the majority of which are subcentimeter, von Meyenburg complex (few show thin rim enhancement) versus hepatic cysts.SPLEEN: No significant abnormality noted.PANCREAS: There is a 1.1 x 0.7 cm T2 hyperintense cystic lesion within the superior aspect of the pancreatic body, may represent sidebranch IPMN. Within the pancreatic tail there is a 3.1 x 2.5 cm enhancing lesion, isointense to the spleen on T1 and T2 sequences, and follows splenic contrast enhancement, compatible with a splenule.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Hiatal hernia.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Moderate hiatal hernia.

Output: 1.Pancreatic tail mass previously identified on CT compatible with a splenule.2.Pacreatic body cystic lesion, may represent sidebranch IPMN.3.Moderate sized hiatal hernia.


Instruction: Generate impression based on medical findings.

Input: Reason: Evaluate for rotator cuff repair, underwent previous single-row rotator cuff repair and AC resection History: Pain with overhead activities Suboptimal evaluation secondary to patient motion artifact.ROTATOR CUFF: Multiple foci of signal void are identified within the superior soft tissues of the shoulder indicating prior surgery. There is a tubular focus of signal void within the greater tuberosity presumably representing a suture anchor. There is increased signal intensity within the distal fibers of the supraspinatus tendon at its insertion on the greater tuberosity at the 12 o'clock position that is nonspecific and could represent insertional tendinosis or granulation tissue from prior tearing/surgery. This measures approximately 1 cm in the AP dimension. The distal fibers of the supraspinatus also appear thinned. There is a more focal fluid signal intensity defect within the bursal surface fibers of the supraspinatus tendon which may represent a small 2 to 3 mm tear, but we see no full-thickness fluid-filled tear. There is perhaps mild tendinosis of the infraspinatus, but otherwise the tendon and muscle appear intact. There is mild insertional tendinosis of the subscapularis. The tendon and muscle appear intact. The teres minor muscle and tendon appear intact.SUPRASPINATUS OUTLET: A small anterior spur seen previously arising from the acromion process is no longer evident which may represent prior surgery. There is a small amount of fluid within the subacromial/subdeltoid bursa which is not necessarily of any clinical significance.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is within normal limits. No effusion is evident. The superior labrum appears attenuated which may represent a combination of degeneration and prior surgery.BICEPS TENDON: The tendon of the long head of the biceps is noted within the bicipital groove. The intra-articular portion of the tendon of the long head of the biceps appears thinned which may reflect attritional tearing or prior surgery.

Output: Signal intensity within the distal fibers of the supraspinatus likely reflects a combination of tendinosis and undersurface fraying, but we see no full-thickness rotator cuff tear. Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: 55 year old female with sarcoidosis and palpitations, referred for cardiovascular MRI to evaluate for cardiac sarcoid 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 68 ml/m2 (normal range: 65+/-11), the LVEDV is 126 ml (normal range 109+/-23), the LV end systolic volume index is 30 ml/m2 (normal range 18+/-5), the LVESV is 56 ml (normal range 31+/-10), the LV mass index is 43 g/m2 (normal range 67+/-11), and the LV mass is 81 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 53%, the RV end diastolic volume index is 75 ml/m2 (normal range 69+/-14), the RVEDV is 139 ml (normal range 110+/-24), the RV end systolic volume index is 35 ml/m2 (normal range 22+/-8), and the RVESV is 66 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is trace pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch. There is anomalous right subclavian artery originating from the descending aorta (i.e. Lusoria Artery). The artery travels posterior to the esophagus which does not appear to be dilated proximally. 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 FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size and systolic function (LVEF 56%). There is no evidence of cardiac sarcoid involvement.2. The right ventricle is normal in size and systolic function (RVEF 53%)3. Anomalous origin of the right subclavian artery from the descending aorta (i.e. Lusoria Artery), normal variant. The artery travels posterior to the esophagus which does not appear to be dilated proximally. 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: Persistent knee pain MENISCI: There is obliquely oriented tearing of the posterior horn of the lateral meniscus which extends to the tibial articular surface. This tearing extends into the body and there is abnormal morphology and signal intensity of the anterior horn indicating additional tearing.There is abnormal signal intensity within the posterior horn of the medial meniscus indicating the presence of an undersurface tear. The anterior horn and body of the medial meniscus are intact.ARTICULAR CARTILAGE AND BONE: There is severe loss of the articular cartilage of the lateral compartment with areas of full-thickness loss particularly along the lateral femoral condyle anteriorly as well as the nonweightbearing portion posteriorly. Similar articular cartilage loss is seen along the tibial plateau and there is degenerative subchondral edema evident within the lateral compartment.There is moderate articular cartilage thinning of the medial compartment but no discrete full-thickness tear is appreciated.There is severe articular cartilage loss of the patellofemoral compartment with areas of full-thickness loss involving both the medial and lateral facets. The articular cartilage of the femoral trochlea also appears thinned. There is degenerative marrow changes in the undersurface of the patella particularly inferiorly.There are large tricompartmental osteophytes.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Complex tear of the lateral meniscus with mild undersurface tearing of the medial meniscus.2. Severe articular cartilage loss of the lateral and patellofemoral compartments with more moderate changes noted medially.


Instruction: Generate impression based on medical findings.

Input: 39-year-old male with left knee pain MENISCI: Small cysts are noted anterior to the anterior horn of the lateral meniscus, but we see no underlying meniscal tear. The medial meniscus appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is superficial degeneration of the articular cartilage of the lateral facet of the patella. There is also a linear focus of low signal intensity traversing the articular cartilage of the femoral trochlea centrally that may represent a cartilaginous fissure. The articular cartilage of the tibiofemoral compartment appears intact.LIGAMENTS: The ACL appears intact, but there are small linear foci of increased signal intensity between its bundles that may reflect mild mucoid degeneration. There is thickening of the proximal fibers of the MCL with ossification within its proximal fibers at its femoral attachment indicating prior injury, but we see no findings to indicate an acute tear. The PCL appears intact. The LCL appears intact.EXTENSOR MECHANISM: Subjectively, the quadriceps tendon appears slightly thickened with enthesophyte formation at its insertion on the patella, but we see no tear. The patellar tendon appears intact.ADDITIONAL

Output: 1. Patellofemoral cartilage degeneration with a borderline tibial tubercle trochlear groove distance.2. Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: 57-year-old woman with history of vaginal adenocarcinoma and bleeding. Additional history as per chart: Patient status post hysterectomy and bilateral salpingo-oophorectomy in 2011 for benign disease. 2 x 1 cm midline lower one third vaginal mass biopsy and path consistent with poorly differentiated adenocarcinoma. PELVIS:UTERUS, ADNEXA: Patient status post hysterectomy and bilateral salpingo-oophorectomy. There is thickening with irregular intermediate T2 signal seen in the anterolateral left vaginal wall (6/37). Additional masslike intermediate T2 signal seen in the posterior urethra and described below.BLADDER: There is a large saddle urethral diverticulum (5/39). Within this diverticulum, there is a 25 x 17 mm intermediate T2 mass (5/39) extending from the posterior lateral left urethral wall into the anterolateral vaginal wall. This mass is seen extending over a length of approximately 2.4 cm superiorly into the bladder base. Additionally, there is local infiltration into the pelvic floor and surrounding fat along with significant enhancement.LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: The rectosigmoid colon appears normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Soft tissue mass extending from the posterior lateral left urethra to the anterolateral left vaginal wall. The differential for this mass includes an adenocarcinoma within a urethral diverticulum, Mullerian duct remnant adenocarcinoma, or vaginal adenocarcinoma of the anterior wall (considered less likely given location).2.This mass is locally infiltrative involving the base of the bladder and the pelvic floor. No lymphadenopathy noted.3.Large saddle urethral diverticulum.


Instruction: Generate impression based on medical findings.

Input: History of rectal cancer presents for restaging status post chemotherapy. PELVIS:PROSTATE/SEMINAL VESICLES: Heterogeneously enlarged prostate gland.BLADDER: No significant abnormality noted.LYMPH NODES: The perirectal space lymph nodes are markedly decreased in size and restricted diffusion. The reference lymph node at the level of the rectosigmoid junction on the left measures 8 x 5 mm (series 4/13), compared to 1.4 x 0.9 cm previously.BOWEL, MESENTERY: The previously seen intermediate T2-weighted signal intensity solid rectal lesion has significantly decreased in size and is now predominantly markedly low signal intensity on T2-weighted imaging affecting the left posterolateral aspect of the rectum (series 4/40) likely reflecting post radiation scar tissue, measuring approximately 1.6 x 0.9 cm (series 4/40). Interval decrease in restricted diffusion associated with the rectal mass.BONES, SOFT TISSUES: Presacral soft tissue stranding and minimal fluid is likely treatment related.OTHER: No significant abnormality noted.

Output: Interval marked decrease in rectal mass size and decrease in perirectal lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: 29-year-old woman with history of Rasmussen's encephalitis status post right hemispherectomy at age 7, complicated by hydrocephalus status post drainage and multiple revisions ultimately removed 11/1/2016. These procedures have also been complicated by wound dehiscences. There are extensive postoperative changes of right craniectomy and hemispherectomy, similar to the prior examination. A dominant extra-axial fluid and air collection appears minimally smaller compared to the prior examination (701/22). A second, smaller extra-axial fluid collection along the anterior craniectomy margin (701/23) is stable in size. Multiple left cerebral CSF signal cysts are not appreciably changed in the interval. There is extensive T2 hyperintense signal within the posterior left cerebral white matter, similar in distribution and extent to the prior examination and likely reflect gliosis. Additional foci of T2 hyperintense signal in the left cerebral peduncle and left thalamus appears similar to prior examinations. Volume loss with increased T2 signal in the right posterolateral partially imaged cervical cord also appears unchanged.There is no restricted diffusion to suggest acute ischemia. There is no acute intracranial hemorrhage. No new mass or mass effect.The orbits and paranasal sinuses are unremarkable. The bone marrow signal is unremarkable. The soft tissues overlying the right craniectomy appear intact.

Output: Extensive remote postoperative changes of right craniectomy and hemispherectomy with minimally decreased size of right-sided extra axial air and fluid collection. Otherwise, underlying parenchymal findings are not significant changed from 11/4/2016 including intraparenchymal cysts and extensive surrounding T2/FLAIR hyperintensity in the left cerebral white matter which at least predominantly reflect gliosis, although a small component of vasogenic edema not entirely excluded.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: Anterior knee pain. Assess for ACL and meniscal injury. MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Normal appearing knee, without meniscal or ligamentous injury.


Instruction: Generate impression based on medical findings.

Input: Female; 26 years old. Reason: Ileal Crohn's disease, history of abscess, elevated CRP repeat to evaluate distal ileal disease, length, and for abscess History: abdominal pain ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Moderate circumferential wall thickening of the terminal ileum causing stenosis over a length of approximately 9 cm. Mild dilation of the ileal loop just proximal to the stenotic segment, but no evidence of bowel obstruction. Mild increased striated wall enhancement of this segment, most compatible with active inflammatory bowel disease. No pericolonic abscess or fistula.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Trace endometrial fluid, likely physiologic.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: As above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace pelvic free fluid, likely physiologic.

Output: Findings most compatible with active terminal ileitis superimposed over chronic disease as detailed above.


Instruction: Generate impression based on medical findings.

Input: Reason: Left trigeminal neuralgia Please note that MRI of the complete brain was not obtained as this was done per an IAC protocol as requested.There is a mass occupying the sella, right cavernous sinus and large portion of the clivus consistent with patient's known macroadenoma. There is no significant change in size and extent of the lesion, with the bulk of the lesion measuring 2.0 x 1.5 cm (1101/1), previously 2.0 x 1.6 cm on remeasurement. Additional reference measurements cannot be made as the coronal postcontrast sequences do not include the entire extent of the tumor. No mass effect of the tumor on either the left Meckel's cave or cavernous sinus. No abnormal enhancement along the left trigeminal nerve.Enhancement of the pituitary stalk and deviation to the left aspect of the sella is unchanged. Unchanged downward tenting of the chiasm consistent with postsurgical change. Flow voids are intact. No evidence of diffusion restriction to suggest acute infarct. Orbits and skull are grossly unremarkable. Mild mucosal thickening of the ethmoid sinuses.

Output: Pituitary macroadenoma which involves the right cavernous sinus is unchanged. MRI IAC demonstrates no abnormal enhancement or mass effect along the course of the left trigeminal nerve to explain patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: Confusion and amnesia. Follow-up nonspecific small vessel ischemic disease. The examination is mildly limited by patient motion.There is no acute infarct. Compared to the previous examination, there are 3 new superficial foci of T1/T2-hypointense signal and susceptibility effect involving the medial left frontal lobe, left occipital lobe and superior medial right occipital lobe. These are not associated with surrounding edema. Otherwise, there is unchanged confluent periventricular and scattered subcortical/deep white-matter T2/FLAIR-hyperintense lesions that are nonspecific but probably reflect chronic microvascular ischemia.Mild dilatation of the ventricles and the other CSF-containing spaces, reflecting underlying global parenchymal loss is unchanged. In addition, there is expansion of the subarachnoid space around the left cerebellar hemisphere, which is mildly asymmetrically smaller in size but with decreased interfolial spaces which may reflect a retrocerebellar cyst or an enlarged cisterna magna with mass-effect on the left cerebellar hemisphere. This has not changed since the previous examination. Otherwise, there is no mass-effect, midline shift or brain herniation. There is mild ethmoid mucosal thickening. The right lens has been replaced. The orbits are otherwise grossly unremarkable. There is no destructive skull lesion.

Output: 1.Examination is limited by patient motion. There is no acute infarct, mass-effect or midline shift.2.Three microhemorrhages in a cortical/subcortical distribution without associated edema are probably chronic, though new since the January 2016 examination.3.Stable mild chronic microvascular ischemia.4.Stable left retrocerebellar cyst versus mega cisterna magna, with mild mass-effect on the left cerebellar hemisphere.


Instruction: Generate impression based on medical findings.

Input: Reason: liver lesion noted on CT scan please characterize History: liver lesion on CT scan ABDOMEN:LIVER, BILIARY TRACT: In the right lobe of the liver, there is a 8.6 x 5.9 x 9.1 cm lobulated mass (series 1202 image 477, series 701 image 20). This mass remonstrates relatively homogeneous T1 isointense, T2 mildly hyperintense signal and diffusely decreased signal on out of phase sequences. There is avid homogeneous arterial phase enhancement, some contrast retention seen on subsequent delayed imaging. There is mass effect on the vessels with adjacent perfusion abnormality in the right lobe of the liver. The remainder of the liver demonstrates questionably mild signal loss on out of phase imaging, otherwise, normal morphology and size. No intrahepatic or intrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Small nonenlarged left paraaortic lymph nodes. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Fluid within the subcutaneous fat of the right and posterior abdominal walls likely related to recent surgery.OTHER: No significant abnormality noted.

Output: 1.Large 9 cm mass within the right lobe of the liver with signal characteristics that are most consistent with a hepatic adenoma given the patient's age, gender and absence of cirrhotic liver background, specifically the HNF-1 alpha subtype.2.Questionable mild diffuse hepatic steatosis.


Instruction: Generate impression based on medical findings.

Input: The exam is markedly limited due to motion artifact and susceptibility artifact due to braces.BRAIN: The ventricles and sulci are more prominent than expected for the patient's age indicating volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or abnormal intracranial enhancement within the visualized structures. No extra-axial fluid collection is identified. The midline structures and craniocervical junction are within normal limits. The DWI sequence is nondiagnostic due to artifact the SWI are near nondiagnostic.MRA/MRV:Within the limitations described above, the following observations are made. There is no gross stenosis or occlusion within the vertebral arteries, basilar artery and proximal PCAs. The more distal anterior cerebral arteries and visualized A1 branches appear normal. Portions of the M1 segments of the MCAs appear normal but there are areas not visualized secondary to artifact. There is no gross evidence of high-grade stenosis or large aneurysm within these visualized arteries.The superior sagittal sinus, inferior sagittal sinus, transverse sinuses, sigmoid sinuses, straight sinus, vein of Galen, internal cerebral veins, and several visualized cortical veins are patent. There is no evidence of venous thrombosis.

Output: 1.Limited MRA due to susceptibility motion artifacts. Within this limitation there is no gross stenosis or occlusion within the visualized arteries. Recommend repeat MRA once braces are removed.2.Normal MRV.3.Limited evaluation of the brain parenchyma is normal without gross evidence of ischemia however, within limitations of nondiagnostic DWI.


Instruction: Generate impression based on medical findings.

Input: Reason: R/O nerve root impingement on the L (?C7). Please compare to last MRI from 2013. History: Neck pain radiating to LUE Examination is motion degraded, particularly the axial T2 sequences. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is straightening of the cervical spinal curvature with minimal anterolisthesis of C4 on C5, which appears new, and minimal retrolisthesis of C6 on C7, which was present previously. Bone marrow signal is benign with small foci of T1 hyperintensity involving the inferior C5 and C6 endplates on a degenerative basis and similar to prior.The cervical spinal cord has grossly 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: Small disc osteophyte complex and uncovertebral hypertrophy contributes to up to moderate right-sided neural foraminal stenosis which appears worse. No spinal canal or left neural foraminal stenosis.C5-6: Disc osteophyte complex including bilateral uncovertebral hypertrophy with contact of the ventral cord. There is mild spinal canal stenosis at this level. There is severe left and moderate right neural foraminal stenosis.C6-C7: Disc osteophyte complex with bilateral uncovertebral hypertrophy. There is severe left and moderate to severe right neural foraminal stenosis. There is at most mild spinal canal stenosis.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Examination is motion degraded, particularly the axial T2-weighted sequence. There appears to be very mild overall progression of degenerative changes in the cervical spine compared to 2/15/2013. Again seen is severe left C5-C6 and left C6-C7 neural foraminal stenoses where there may be impingement of the left C6 and C7 nerve roots.2. Mild spinal canal narrowing at the C5-C6 and C6-C7 levels similar to prior. No high-grade spinal canal stenosis or cord signal abnormality. Additional details as above.


Instruction: Generate impression based on medical findings.

Input: Multiple myeloma with a large lesion on PET impinging on T6/T7: No pain or neurologic deficits. There is an infiltrative, enhancing left posterior chest wall mass with left neural foraminal and epidural extension at theT6-7 level with mild narrowing of the thecal sac, but no spinal cord compression. The vertebral column alignment is within normal limits. There are multilevel small intravertebral disc herniations. The vertebral body heights are otherwise preserved. There is a small focus of left ligamentum flavum calcification that projects into the spinal canal at T10-11, without spinal cord impingement. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. There is a small right renal cyst.

Output: Left posterior chest wall multiple myeloma extends into left neural foramen and epidural space at theT6-7 level with mild narrowing of the thecal sac, but no spinal cord compression.


Instruction: Generate impression based on medical findings.

Input: 30 year-old female status post MPC. MPC, as provided by the clinical history, is most likely an error as other reports indicate history of MVC which is understood to mean motor vehicle collision. BRAIN: 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. Minimal opacification is present in few sided ethmoid air cells.CERVICAL SPINE: There is minimal straightening of the visualized cervical spine secondary to positioning for the examination. Cervical spine alignment is within normal limits without evidence of spondylolysis or spondylolisthesis. Vertebral body heights and intervertebral disk spaces are within normal limits. The pre-and paravertebral soft tissues are within normal limits. The airway is patent.Within the limits of CT scanning, the thecal sac and spinal cord are preserved with no evidence of spinal canal stenosis. If there is clinical concern for spinal cord or ligamentous injury, an MRI may be considered.The lung apices are clear bilaterally.

Output: 1. Normal brain CT.2. Normal cervical spine without evidence of fracture or malalignment.


Instruction: Generate impression based on medical findings.

Input: 60-year-old male with pain over the left knee. MENISCI: There is a horizontal tear of the anterior horn of the lateral meniscus extending to the femoral articular surface. The tear is noted on multiple images extending from the attachment of the transverse meniscal ligament into the body of the meniscus. The posterior horn appears intact. There is intermediate signal abnormality consistent with intrasubstance degeneration of the medial meniscus, which otherwise appears intact.ARTICULAR CARTILAGE AND BONE: There is mild to moderate degeneration of the articular cartilage of the lateral facet of the patella with underlying degenerative subchondral foci of signal abnormality. There is focal signal abnormality within the inferior aspect of the femoral trochlea likely reflecting full-thickness degeneration. The trochlear groove is flattened suggesting dysplasia. There is focal near full-thickness degeneration of the articular cartilage of the medial femoral condyle above the posterior horn of the medial meniscus. There is a lobulated lesion of increased signal intensity in the distal femoral metaphysis compatible with a benign enchondroma. LIGAMENTS: There is thickening of and increased signal intensity of the proximal fibers of the lateral collateral ligament proper suggesting degeneration or sequela of an old injury. The ACL, PCL, and MCL appear intact.EXTENSOR MECHANISM: There is mild increased signal intensity within the undersurface fibers of the proximal patellar tendon suggesting tendinosis. The extensor mechanism appears intact.ADDITIONAL

Output: 1. Horizontal tear of the lateral meniscus.2. Osteoarthritis with cartilage degeneration as described above.3. Thickening and increased signal intensity of the lateral collateral ligament proper may reflect degeneration or the sequela of prior injury.4. Mild proximal patellar tendinosis.5. Baker's cyst.6. Femoral trochlear dysplasia.


Instruction: Generate impression based on medical findings.

Input: There is mild anterolisthesis of L4 on L5 and mild retrolisthesis of L5 on S1. There is disc desiccation throughout the lumbar spine with moderate to severe loss of disc height at L3-L4, L4-L5 and L5-S1, which is progressed from prior study. The vertebral body heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The distal spinal cord and conus are within normal limits with the conus terminating at the L1-L2 level. The cauda equina nerve roots are thickened and redundant.T12-L1: Bilateral facet degeneration, but no significant spinal canal or neural foraminal stenosis.L1-L2: Bilateral facet degeneration, but no significant spinal canal or neural foraminal stenosis.L2-L3: Unchanged disc bulge, bilateral facet degeneration and thickening of the ligamentum flavum, contributing to mild spinal canal stenosis and mild to moderate bilateral foraminal stenosis.L3-L4: Unchanged disc bulge, bilateral facet degeneration and thickening of the ligamentum flavum, contributing to moderate to severe spinal canal stenosis and moderate bilateral foraminal stenosis. There is effacement of the lateral recesses.L4-L5: Unchanged mild anterolisthesis of L4 on L5 with pseudo disc bulge, bilateral facet degeneration and thickening of the ligamentum flavum, contributing to severe spinal canal stenosis and moderate bilateral foraminal stenosis. There is effacement of the lateral recesses.L5-S1: Mild retrolisthesis of L5 on S1 with pseudo disc bulge, bilateral facet degeneration and thickening of the ligamentum flavum, contributing to mild spinal canal narrowing and moderate bilateral foraminal stenosis. There is effacement of the lateral recesses.

Output: 1. Interval progression of multilevel loss of disc height of the lower lumbar spine. Otherwise, no significant interval change in the advanced degenerative changes of the lumber spine, most prominent at L3-L4 and L4-L5 levels, resulting in moderate to severe spinal canal stenosis, moderate bilateral foraminal and bilateral lateral recess compromise. 2. Unchanged mild spinal canal narrowing at L2-L3 and L5-S1 with up to moderate bilateral foraminal stenosis.


Instruction: Generate impression based on medical findings.

Input: Reason: R shoulder soft tissue sarcoma, x/p chemo/xrt, evaluate for treatment effect prior to surgery History: above Note is made of a large heterogeneous mass abutting the posterior margin of the trapezius and superior margin of the supraspinatus, posterior to the scapular spine, measuring 8.0 x 6.1 x 5.4 cm, previously 6.3 x 4.8 x 4.8 cm, consistent with stated history of a soft tissue sarcoma. There are foci of internal increased signal abnormality on T1-weighted images likely representing blood products/internal hemorrhage. There are also fluid fluid levels identified internally. There is mass effect on the supraspinatus and trapezius musculature. There is also increased signal abnormality and fluid sensitive sequences within the medial aspect of the trapezius which demonstrates patchy enhancement on postcontrast sequences which is nonspecific but may reflect intramuscular extension of tumor, appearing similar to the prior study. No bone marrow signal abnormality is identified in the surrounding area. Note is made of heterogeneous bone marrow signal within the proximal humerus which may represent residual islands of red marrow. Although this examination was not protocoled for detailed evaluation of the rotator cuff musculature, there appears to be a partial-thickness bursal surface tear of the supraspinatus approximately 2.5 cm from the level of its insertion on the greater tuberosity. There is thickening and intermediate signal intensity within the supraspinatus indicating tendinosis. No evidence of lymphadenopathy.

Output: Interval increase in size of the enhancing soft tissue lesion consistent with the stated history of soft tissue sarcoma with reference measurements and other findings as provided above.


Instruction: Generate impression based on medical findings.

Input: 43-year-old female with AUB, found to have complex atypical hyperplasia with grade 1 endometrioid endometrial cancer PELVIS:UTERUS, ADNEXA: Heterogeneous T2 hyperintense endometrial thickening and cystic changes extending to involve the outer half of the myometrium. There are foci of T1 hypointensity with associated hypoenhancement (series 1502, image 121). The junctional zone is thickened. A submucosal fibroid is noted. Nabothian cysts. The right ovary is normal. The left ovary is not visualized.BLADDER: No significant abnormality noted.LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Marked cystic changes and thickening of the endometrium extending to involve the outer half of the myometrium with areas of hypoenhancement consistent with patient's history of endometrial cancer. The disease is confined to the uterus without extension to the cervix.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for rotator cuff tear History: shoulder pain on and off afor 10 years + impingement ROTATOR CUFF: No significant abnormality noted.SUPRASPINATUS OUTLET: No significant abnormality noted. Specifically, there is no evidence of impingement.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a thin linear focus of low signal in the glenohumeral joint on the T2-weighted images, which is favored to represent chondrocalcinosis. The glenohumeral joint and glenoid labrum are otherwise within normal limits.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Chondrocalcinosis within the glenohumeral joint. Otherwise, normal appearing shoulder without evidence of impingement as clinically questioned.


Instruction: Generate impression based on medical findings.

Input: 60-year-old male with history of muscle weakness and the proximal right arm. Evaluate for muscle inflammation. Although this examination is not protocoled for detailed evaluation of the shoulder, there is a massive tear of the rotator cuff involving the supraspinatus and infraspinatus tendons with retraction of tendon fibers. There is also fatty atrophy of the supraspinatus and infraspinatus musculature. The humeral head is high riding. There is a glenohumeral joint effusion as well as enhancement of the synovium indicating a mild synovitis. Fluid also extends into the subacromial/subdeltoid bursa as well as the biceps tendon sheath. There also appears to be a small amount of fluid in the subcoracoid bursa suggesting a mild bursitis. Evaluation of the glenoid labrum and biceps tendon are limited on this study. There is moderate acromioclavicular joint osteoarthritis. Mild fluid signal intensity and enhancement along the proximal fibers of one of the anterolateral tendons of the deltoid muscle is nonspecific but may represent prior myotendinous strain, and there is mild edema-type signal in the adjacent muscle. The remainder of the deltoid appears normal, as does the remaining musculature of the arm. Marrow signal is within normal limits. Evaluation of the elbow is limited but there appears to be mild osteoarthritis.

Output: 1.Massive rotator cuff tear and arthropathy as described above.2.Abnormal myotendinous signal of the deltoid as described above may reflect prior strain.


Instruction: Generate impression based on medical findings.

Input: Reason: liver mass, pathology unclear as to HCC vs cholangio (mixed), old MRI poor quality from outside 4/2016 that is uploaded, evaluate for satellite lesions and portal lymphadenopathy (ie resectability) History: none ABDOMEN:LIVER, BILIARY TRACT: There is hypertrophy of the caudate and left hepatic lobe with deepening of the fissures, suggestive of chronic liver disease.There is a lesion in segment 5 which appears increased since the prior exam and measures 4.6 x 4.8 cm (801/54). This lesion is slightly hyperenhancing on arterial phase images and demonstrates washout on delayed phases, a pattern suggestive of hepatocellular carcinoma. This lesion was present on the prior MRI, however no corresponding dominant lesion is identified on the CT of 11/24/2015.A previously biopsied hypoenhancing segment 4A lesion measures 4.7 x 3.3 cm (801/73), unchanged. This lesion is hypoenhancing on all phases with increased capsular retraction.There is an additional adjacent hypoenhancing segment 4A lesion in the hepatic dome (11/16) with diffusion restriction, similar in size to the prior MRI.There are numerous additional hypoenhancing T2 hyperintense lesions throughout both hepatic lobes which are suspected to represent metastases. These lesions are slightly less apparent than the prior MRI. These lesions correspond to hypodense lesions on the CT from 11/24/2015SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral perinephric stranding is unchanged.RETROPERITONEUM, LYMPH NODES: Enlarged portacaval node measuring 3.0 x 1.6 cm (14/23).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Median sternotomy wires.

Output: 1.A biopsied segment 4A lesion is unchanged in size with capsular retraction. An additional dominant segment 5 lesion is slightly increased in size. There are findings suggesting chronic liver disease and in this setting, this lesion demonstrates enhancement on arterial phase and washout, suggestive of hepatocellular carcinoma or a hepatocellular carcinoma variant such as a cholangiohepatoma. Although there is capsular retraction of the segment 4A lesion, the enhancement pattern is not consistent with cholangiocarcinoma.2.Numerous hypoenhancing lesions in both hepatic lobes are suspected to represent metastasis. These are slightly less apparent than the prior MRI, which could be due to differences in technique. These lesions correspond to hypodensities on the CT of 11/24/2015.3.Enlarged portacaval lymph nodes.


Instruction: Generate impression based on medical findings.

Input: T4aN2b base of tongue squamous cell carcinoma status post treatment. There is no measurable tumor in the right tongue region. Likewise, there is no evidence of residual significant lymphadenopathy in the neck. For example, a necrotic right level 2B lymph node measures 4 mm in short axis and an ill-defined right level 2A lymph node measures 6 mm in short axis. The thyroid salivary glands are unremarkable. The larynx appears to be intact. There is multilevel degenerative cervical spondylosis with mild spinal canal narrowing at C3-4 and C4-5. The orbits and imaged intracranial structures are unremarkable.

Output: No evidence of measurable tumor in the right tongue base and no evidence of significant lymphadenopathy in the neck.


Instruction: Generate impression based on medical findings.

Input: A patient submitted outside study for review. Submitted for review are left digital mammographic images (3/9/15), ultrasound images of left breast (3/9/15), right digital mammographic images (3/11/15, 4/28/15), ultrasound images of right breast (3/11/15), images from ultrasound-guided biopsy of left breast and postprocedural left digital mammographic images (3/11/15), breast MRI (3/20/15) performed at Advocate Lutheran General Hospital. For comparison, digital mammographic images (10/24/15, 11/5/14), ultrasound images of right breast (11/5/14) are available. LEFT DIGITAL MAMMOGRAPHIC IMAGES (3/9/15):The breast parenchyma is heterogeneously dense. A spiculated mass is present in the retroareolar region, measuring 2 cm. A nipple retraction is associated. No suspicious calcifications are seen in the left breast.ULTRASOUND IMAGES OF LEFT BREAST (3/9/15):An irregularly shaped hypoechoic mass is present at retroareolar region measuring 12 x 10 x 15 mm. The mass is attached to the nipple. A few normal appearing lymph nodes are seen in the left axilla.RIGHT DIGITAL MAMMOGRAPHIC IMAGES (3/11/15, 4/28/15):The breast parenchyma is heterogeneously dense. Three circumscribed round masses are present at upper outer quadrant, likely cysts. They are confirmed benign cysts on the Utrasound study (3/11/15) and MRI (3/20/15). The asymmetry, measuring 2 cm, at posterior superior aspect on ML and MLO view. In addition, there is a cluster of amorphic calcifications at posterior lower outer quadrant in the right breast, seen on the magnification views on 4/28/15. Those two lesions need additional work-up.ULTRASOUND IMAGES OF RIGHT BREAST (3/11/15):Two simple cysts at 9:00 position-10:00 position are present in the right breast, corresponding to the mammographic findings.IMAGES FROM ULTRASOUND-GUIDED BIOPSY OF LEFT BREAST AND POSTPROCEDURAL LEFT DIGITAL MAMMOGRAPHIC IMAGES (3/11/15):Ultrasound guided needle biopsy was performed for the left retroareolar mass, with appropriate needle placement. Postprocedural left on graphic images show a marker clip within the left retroareolar mass.Per outside report, the result was malignant.BREAST MRI (3/20/15):Breast MRI was performed with a protocol outlined in the outside radiology report.Known carcinoma is visualized at left retroareolar region as a spiculated mass measuring 26 x 18 x 31 mm (AP x LR x CC). The mass abuts the nipple, which is enhancing with this mass, suspicious for invasion.A linear non-mass enhancement, measuring 21 x 6 x 11 mm, is seen in the right breast at far posterior upper outer quadrant. This enhancing lesion likely corresponds to the asymmetry on the mammogram.Three simple cysts are seen in the right breast.No abnormal axillary lymph nodes are identified in either axillary region.

Output: 1. Biopsy proven left breast malignancy, suspicious for invading to the nipple.2. Linear enhancing lesion in the right far posterior upper outer quadrant. This lesion could correspond to the asymmetry on mammogram. Additional work-up for right breast, including the asymmetry at posterior upper outer quadrant and cluster of calcifications at lower outer quadrant is recommended.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on medical findings.

Input: Clinical question to be answered: Status post fall from 3 stories with low GCS upon arrival. Now with posturing. Examination redemonstrates extensive previously noted post traumatic findings of the skull fracture, small left frontal subdural and pneumocephalus. There is no evidence of parenchymal hemorrhage or definitive edema on the current exam. The ventricular size and basal cisterns remain similar and within normal limits to prior study and with no evidence of any compromise. No evidence of midline shift or hydrocephalus. No evidence of transtentorial herniation.Extensive scalp hematoma on the left is again identified. New since prior examination this placement of a intracranial pressure monitor with minimal adjacent pneumocephalus.Further evaluation for the extent of brain parenchymal injury with an MRI is again recommended.

Output: 1.No evidence of new hemorrhage or edema. Stable ventricular system and basal cisterns.2.Right frontal ICP monitor.


Instruction: Generate impression based on medical findings.

Input: Clinical question: evaluate tumor. Signs and symptoms: Ataxia Enhanced CT of brain:Examination demonstrate a low attenuation mass in the left cerebellum with significant mass-effect on the fourth ventricle however made no complete collapse of the ventricle. The mass appears to be partially within the fourth ventricle and left lateral recess of the fourth ventricle. There is only questionable subtle enhancement of this mass along its anterior aspect which projects into the left cerebellopontine angle.There is evidence of remodeling of the Petrus bone on the left at the level of its contact with the mass. This is best appreciated on axial image 6 on bony density. This appearance is suggestive of long-standing presence of mass at this location. For better characterization of this mass an MRI exam is recommended.Images through supratentorial space are essentially within normal limits. The ventricular system remain within normal size. There is no abnormal enhancement.

Output: Left inferior cerebellar partially enhancing tumor measuring approximately 36 x 40 mm in transaxial dimensions. Severe mass effect on the fourth ventricle without resultant hydrocephalus. There is mass causes bony remodeling of the petrous bone on the left. Findings were discussed with the referring clinical physician Dr. Sophia Shakur at the time of review of study.


Instruction: Generate impression based on medical findings.

Input: 71-year-old female ROTATOR CUFF: Increased signal within the distal supraspinatus and infraspinatus tendons, consistent with mild tendinosis. No full-thickness rotator cuff tear is evident. No significant muscle atrophy.SUPRASPINATUS OUTLET: Mild acromioclavicular joint osteoarthritis.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral alignment is within normal limits. There is moderate osteophyte formation and joint space narrowing with near full-thickness articular cartilage degeneration along the glenoid and mild thinning along the humeral head. There is degeneration and likely degenerative tearing of the labrum.BICEPS TENDON: The long head of the biceps tendon is normally situated in the bicipital groove, but thickened with surrounding fluid, which can be seen with tendinosis and tenosynovitis.ADDITIONAL

Output: 1. Mild rotator cuff tendinosis without evidence of tear2. Glenohumeral articular cartilage and labrum degeneration as described above.3. Thickening and fluid along the biceps tendon, which may reflect tendinosis.4. Small joint effusion with debris.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Cerebral infarction, unspecifiedClinical question: subacute cvaSigns and Symptoms: cva, ams MRI of the brainThere is a focus of diffusion restriction present along the inferomedial aspect of the left cerebellar hemisphere measuring approximately 37 x 30 mm in axial dimensions. It is bright on T2 and FLAIR.. There is an additional punctate focus of diffusion restriction present in the left occipital lobe along the left cuneus. There is volume loss associated T2 and FLAIR signal change along the anteromedial and inferior aspects of the frontal lobes bilaterally involving the anterior aspects of the gyrus rectus and adjacent orbital gyri. There is more involvement on the right side than the left. There is some associated susceptibility effect present. These represent foci of encephalomalacia.A small focus of susceptibility effect is present adjacent to the aqueduct.The visualized portions of the paranasal sinuses demonstrate mild mucosal thickening. The visualized portions of the mastoid air cells are partially opacified. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal right vertebral artery, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. The left vertebral artery is not readily identified on this exam.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The left A1 segment is smaller than the right A1 segment. The posterior communicating arteries are not readily identified.

Output: 1.Subacute infarct involving the posterior, inferior and medial aspect of the left cerebellar hemisphere.2.Microinfarct involving the left occipital lobe in the cuneus.3.A small focus of encephalomalacia is present along the right cerebellar hemisphere. One possibility is that this is related to an old focus of infarction4.Small foci of encephalomalacia are present involving the medial right orbital gyrus and gyrus rectus and to a lesser degree left gyrus rectus and a small portion of the adjacent left orbital gyrus. Its location could suggest prior trauma. Please correlate with clinical history.5.The left vertebral artery is not identified on small occlusion of the left vertebral artery.


Instruction: Generate impression based on medical findings.

Input: 65-year-old man with right shoulder pain and fever. Evaluate for abscess. ROTATOR CUFF: The rotator cuff is intact. There is moderate fatty atrophy of the supraspinatus, infraspinatus and teres minor muscles. There is a small amount of fluid within the subdeltoid bursa.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is severe joint space narrowing, osteophyte formation and cartilage loss with reactive marrow change in the humeral head and glenoid. The glenoid labrum is irregular consistent with degeneration.BICEPS TENDON: The biceps tendon is not seen within the biceps groove and may be torn. The extra-articular portion of the tendon is unremarkable in appearance. ADDITIONAL

Output: 1.Moderate joint effusion with synovitis. These findings are nonspecific but can be seen in a septic joint. This is incompletely evaluated due to the lack of IV contrast.2.The biceps tendon is not seen within the biceps groove and may be torn.3.There are severe degenerative changes of the glenohumeral joint and moderate osteoarthritis at the acromioclavicular joint.4.No evidence of osteomyelitis.5.No discrete extra-articular fluid collection to suggest abscess.


Instruction: Generate impression based on medical findings.

Input: Reason: shoulder pain, stiffness History: shoulder pain, stiffness ROTATOR CUFF: There is intermediate signal intensity within the distal supraspinatus indicating mild tendinosis. There is superficial fraying of the bursal surface fibers of the supraspinatus. No fluid-filled tear is identified. The infraspinatus muscle and tendon appear intact. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: No intra-articular gadolinium or fluid is identified within the subacromial subdeltoid bursa. Mild osteoarthritis affects the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is slight posterior translation of the humeral head relative to the glenoid. There is heterogeneity and intermediate signal intensity within the superior and anterior glenoid labrum likely representing a combination of postsurgical change and degeneration/degenerative tearing. Multiple foci of signal void are identified in the surrounding area which are presumably postsurgical in etiology. Intra-articular gadolinium enters the anterior superior labrum at the 2 o'clock position in a branching configuration indicating a re-tear. There is also intra-articular gadolinium identified entering the superior labrum indicating a re-tear. There is a full-thickness articular cartilage fissure affecting the cartilage of the glenoid, centrally. There is cyst formation in the superolateral humeral head.BICEPS TENDON: The tendon of the long head of the biceps appears intact. ADDITIONAL

Output: 1. Postsurgical changes of prior glenoid labrum repair with findings indicating a re-tear of the anterior and superior glenoid labrum as described above. 2. Mild tendinosis of the rotator cuff without evidence of a full-thickness rotator cuff tear or retraction.


Instruction: Generate impression based on medical findings.

Input: 45-year-old female with history of symptomatic uterine fibroids detected on ultrasound. Evaluate fibroids. PELVIS:UTERUS, ADNEXA: The uterus measures 14.7 x 12.1 x 10.6 cm. There are numerous intramural lesions demonstrating T1 isointensity and T2 iso to hypointensity with enhancement. The fundal fibroid demonstrates no significant enhancement. The largest of these measures 7.8 x 5.6 centimeters (series 601, image 22). Findings consistent with fibroleiomyomatous. BLADDER: There is mass effect upon the bladder from the uterine myomas.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is mass effect upon the rectosigmoid from the uterine myomas.BONES, SOFT TISSUES: Trace pelvic ascites.OTHER: No significant abnormality noted.

Output: Findings consistent with uterine myomas with mass effect on the rectosigmoid and the bladder.


Instruction: Generate impression based on medical findings.

Input: 30 year old with Marfan's syndrome with history of ASD repair and known dilated aorta presenting for evaluation of aorta and left ventricular function. Left VentricleThe left ventricle is severely dilated with low normal systolic function. The overall LV ejection fraction is 53%, the LV end diastolic volume index is 128 ml/m2 (normal range: 65+/-11), the LVEDV is 241 ml (normal range 109+/-23), the LV end systolic volume index is 61 ml/m2 (normal range 18+/-5), the LVESV is 114 ml (normal range 31+/-10), the LV mass index is 43 g/m2 (normal range 67+/-11), and the LV mass is 80 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in sizeRight VentricleThe right ventricle is mild to moderately dilated with normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 111 ml/m2 (normal range 69+/-14), the RVEDV is 210 ml (normal range 110+/-24), the RV end systolic volume index is 55 ml/m2 (normal range 22+/-8), and the RVESV is 105 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is trace mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is dilated with effacement of the sinotubular junction and dilated sinus of Valsalva. The most dilated portion of the aortic root is 50 mm x 43 mm approximately 2 cm above the aortic valve plane. Annulus measures approximately 3.1 x 2.1 cm.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 FindingsSternotomy wires present. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The aortic root is dilated with effacement of the sinotubular junction and dilated sinus of Valsalva. The most dilated portion of the aortic root is 50 mm x 43 mm approximately 2 cm above the aortic valve plane. There is mild aortic regurgitation. 2. The left ventricle is severely dilated with low normal systolic function. The overall LV ejection fraction is 53%. There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.3. The right ventricle is mild to moderately dilated with normal systolic function. The overall RV ejection fraction is 50%.


Instruction: Generate impression based on medical findings.

Input: Benign neoplasm of pituitary gland [D35.2] / Benign neoplasm of craniopharyngeal duct [D35.3], Reason for Study: ^Reason: hx of pituitary adenoma s/p RT, surveillance MRI History: HA Postsurgical changes with a defect along the right sella related to prior pituitary tumor resections are again demonstrated. The pituitary stalk remains mildly deviated to the right. No abnormal enhancing lesion is identified within the pituitary. Non pneumatization of the sphenoid sinus is again noted. Mild cerebellar tonsillar ectopia appears similar to prior examination. Scattered foci of T2/FLAIR hyperintensity involving the subcortical and periventricular white matter are again seen. The visualized brain parenchyma is otherwise grossly unremarkable.

Output: Stable postoperative changes in the sella without new or enlarging lesions.


Instruction: Generate impression based on medical findings.

Input: 29 years Female (DOB:10/1/1987)Reason: assess for meningioma causing 5th cranial nerve palsy History: 5th cranial nerve palsyPROVIDER/ATTENDING NAME: AMBER TALYN PINCAVAGE AMBER TALYN PINCAVAGE No abnormal mass lesions are appreciated. There appears to be platybasia present

Output: This is an incomplete exam. The patient decided to reschedule. There appears to be platybasia present. No obvious abnormal mass lesions are appreciated on the limited available images.