Instruction: Generate impression based on medical findings.

Input: Evaluate for steno-occlusive disease, etiology of TIA: episode of aphasia and amnesia. Brain MRI: There is no evidence of intracranial hemorrhage or acute infarct. There two punctate fat signal intensity lesions in the midline of the posterior suprasellar cistern and interpeduncular cistern. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is a small left maxillary sinus retention cyst. There is fluid within the pneumatized left petrous apex. Brain MRA: The vertebrobasilar system is relatively diminutive diffusely. Otherwise, there is no evidence of significant steno-occlusive lesions or saccular aneurysms.Neck MRA: There is a two vessel arch. There is no evidence of significant steno-occlusive lesions.

Output: 1. No evidence of intracranial hemorrhage or acute infarct. 2. The vertebrobasilar system is relatively diminutive diffusely, but without focal steno-occlusive lesions.3. No evidence of significant steno-occlusive lesions in the major neck arteries.4. Two punctate lipid-containing lesions in the midline of the posterior suprasellar cistern and interpeduncular cistern are compatible with lipomas or dermoids. 5. Left petrous apex effusion.


Instruction: Generate impression based on medical findings.

Input: A patient submitted outside study for review. Submitted for review are MRI guided biopsy images and right breast mammogram dated 5/13/2015 and performed at Rush University Medical Center. For comparison, MRI breast 4/21/2015 are available. MRI breast 4/21/2015: There is extreme amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally. There is a 8 x 5 x 5 mm irregular mass in the right breast at the 11 to 12 o'clock position, for which MRI guided biopsy was subsequently done. Multiple cysts are seen in both breasts, right greater than left, on the T2W sequences.MRI breast guided biopsy and right breast post-procedure mammogram 5/13/2015: The obturator of the biopsy needle is along the posterior aspect and slightly deep to the 8 mm irregular mass at the time of biopsy in the right breast. Post-procedure ML and exaggerated CC lateral view of the right breast showed the biopsy clip to be in the appropriate location in the upper outer to central breast. Multiple scattered calcifications are present.Outside hospital pathology results from this biopsy showed Grade I DCIS, which is felt to be concordant with imaging.

Output: 8 mm irregular enhancing mass in the right breast 11 to 12 o'clock position biopsied to be Grade 1 DCIS with an appropriately positioned biopsy clip.Kindly submit bilateral diagnostic mammogram if performed. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old, with neck pain. The cervical lordosis is mildly reversed. Sagittal alignment is unremarkable. Vertebral body height and morphology are within normal limits. No worrisome marrow replacement is seen. Mild endplate edema at C6-7 is noted.The visualized spinal cord demonstrates normal signal intensity and morphology except as discussed by level as follows. No epidural abnormalities are suspected.C2-3: Facet hypertrophy. No significant spinal canal or foraminal stenosis. C3-4: Minimal facet hypertrophy. Mild posterior disc-osteophyte complex formation which slightly flattens the ventral cord. No significant spinal canal stenosis. Mild left foraminal narrowing.C4-5: Facet hypertrophy. Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Moderate left foraminal narrowing. C5-6: Mild facet hypertrophy. Posterior disc-osteophyte complex formation asymmetric to the left foraminal region. Slight flattening of the ventral cord but no significant spinal canal stenosis. Severe left and mild right foraminal narrowing. C6-7: Minimal facet hypertrophy. Mild posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Severe bilateral foraminal narrowing. C7-T1: Facet hypertrophy. No significant spinal canal stenosis. Mild bilateral foraminal narrowing with perineural root sleeve cysts bilaterally.

Output: Multilevel disc degeneration and posterior element hypertrophy result in scattered variable foraminal narrowing, most severely affecting C5-6 on the left and C6-7 bilaterally. No significant spinal canal stenosis is seen.


Instruction: Generate impression based on medical findings.

Input: Reason: hx of prostate cancer, evaluate extent of disease, scheduled for RALP History: see above. PELVIS:PROSTATE:Prostate Size: 3 x 4.7 x 3.5 cmPeripheral Zone: Multifocal extensive tumor bilaterally, predominantly involving the right. Large dominant tumor involving the right apex with extension into the left apex and right mid measures 2.5 x 2.3 cm. There is right apical extracapsular extension. Smaller tumors involving the right anterior mid and left posterior mid. Central Gland: No significant abnormality. Seminal Vesicles: No significant abnormality. Extracapsular Extension: Mild extracapsular extension of large right apical tumor. BLADDER: No significant abnormality noted.LYMPH NODES: Small right pelvic side wall lymph nod measures 4 mm. Small nonenlarged right external iliac chain lymph node. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multifocal tumor with large dominant right apical tumor with extracapsular extension. 4 mm right pelvic side wall lymph node; metastases cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: Syncope. There is no evidence of acute intracranial hemorrhage or acute infarct. There is a subcentimeter left pons focus of susceptibility effect that corresponds to calcification on CT. There is focal right pons and periventricular frontoparietal white matter T2 hyperintensity. The ventricles and sulci are dilated due to cerebral volume loss. There is a partially empty sella. There is no midline shift or herniation. Partial loss of flow void in the V4 segment of the left vertebral artery correlates with the proximal stenosis described on the recent CTA. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the ethmoid sinuses and left mastoid air cells. The retrodental pannus moderately narrows the upper cervical spinal canal. There is also a posterior disc-osteophyte complex at C3-4 that abuts the spinal cord.

Output: 1.No evidence of acute intracranial hemorrhage or acute infarct.2.A subcentimeter left pontine lesion may represent a chronic calcified hemorrhage or cavernous malformation.3.Moderate cerebral and pontine white matter chronic microvascular ischemia and moderate brain volume loss, with slight frontotemporal predominance.


Instruction: Generate impression based on medical findings.

Input: Female, 11 years old. Bilateral foot pain RIGHT FOOT: The medial hallux sesamoid has low signal on T1 and PD sequences and increased bone marrow signal on STIR sequences suggesting marrow edema. The sesamoid bone maintains its morphology, without surrounding signal abnormality in the soft tissues. Bone marrow signal elsewhere is normal. No joint effusion, soft tissue edema, or discrete fluid collection.LEFT FOOT: The medial hallux sesamoid is bipartite. The hallux sesamoids, medial greater than lateral, have low signal on T1 and PD sequences, with slightly increased bone marrow signal on STIR sequences. No surrounding signal abnormality in the soft tissues. Bone marrow signal elsewhere is normal. No joint effusion, soft tissue edema, or discrete fluid collection.

Output: Bone marrow edema involving the right medial hallux sesamoid and left hallux sesamoids without surrounding soft tissue edema, compatible with chronic sesamoiditis.


Instruction: Generate impression based on medical findings.

Input: 45-year-old female patient with a left breast medullary cancer per outside hospital pathology, status post lumpectomy and complete axillary lymph node dissection 9/2014 with unoriented margins and 2 positive nodes. No adjuvant therapy. Assess for residual disease. There is scattered fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.There is a mass in the 7 o'clock position of the left breast demonstrating heterogenous enhancement and a central focus of fat signal intensity, which may represent a component of fat necrosis. The mass measures 3.2 x 2.9 x 3.6 cm (AP x ML x CC) and is inseparable posteriorly from the pectoralis major muscle. There is associated skin thickening of the medial left breast, measuring up to 9 mm in thickness. An enlarged enhancing interpectoral lymph node measures 2.9 x 1.7 cm. There is soft tissue thickening along the left internal mammary chain that may represent an internal mammary lymph node with associated adjacent sternal enhancement. The soft tissue component measures 1.5 x 2.3 cm. There is an additional small area of peri-sternal enhancement superiorly that measures up to 1.2 x 1.0 cm. Post surgical changes in the left axilla compatible with lymph node dissection.There is no suspicious enhancement in the right breast. Note that evaluation of the right axilla is limited by patient motion artifact. Prominent right axillary lymph nodes are noted with diminished fatty hila, and with cortical thickening measuring up to 6 mm. There is an enhancing lesion along the inferior axillary skin may that represent an inflamed epidermoid inclusion cyst.

Output: 1.Large enhancing left breast mass compatible with recurrent or residual breast cancer with a possible component of fat necrosis. There is associated skin thickening. Enlarged left interpectoral node and left internal mammary enhancing tissue highly suggestive of metastatic breast cancer.2.Indeterminate right axillary lymph nodes. Prominent lymph nodes may be related to inflamed right axillary skin lesion versus metastatic disease. Suggest correlation with physical examination and consideration of right axillary ultrasound to evaluate for lymphadenopathy.BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: Reason: TRANSVERSE MYELITIS History: WEAKNESS. MRI brain:There is no evidence of intracranial hemorrhage or mass. There is a 7 mm nonenhancing focus of diffusion restriction and increased T2 signal immediately adjacent to the occipital horn of the left lateral ventricle. 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 and paranasal sinuses are grossly unremarkable. Multiple scalp lesions likely represent sebaceous cysts.MRI cervical spine:Alignment is anatomic. Vertebral body heights are intact. Multilevel disc desiccation with minimal degenerative disc disease at C6-C7. No abnormal signal within the cord. No abnormal signal within the cord. C2-C3: No significant spinal or neuroforaminal stenosis. C3-C4: No significant spinal or neuroforaminal stenosis. C4-C5: No significant spinal or neuroforaminal stenosis. C5-C6: No significant spinal or neuroforaminal stenosis. C6-C7: Mild posterior disc osteophyte complex without significant central or neural foraminal stenosis. C7-T1: No significant spinal or neuroforaminal stenosis.

Output: 1.Small focus of diffusion restriction in the white matter adjacent to the left occipital horn likely represents a focus of ischemia, although early demyelinating disease may also be considered.2.Minimal degenerative changes of the cervical spine without evidence of demyelinating disease or other cord pathologies.


Instruction: Generate impression based on medical findings.

Input: 23-year-old with history of Li-fraumeni syndrome and anaplastic astrocytoma status post proton therapy. Interval follow-up exam. Stable postoperative changes from left parietal craniotomy and remote ependymoma resection. Resection cavity is CSF filled and appears to communicate with the atrium of the left lateral ventricle. The cystic focus anterior to the resection cavity related to recent biopsy with susceptibility artifact indicating postbiopsy hemorrhage.Compared to the prior MRI, there has been marked interval decrease in the extent of abnormal T2 signal within the white matter of the left parietal, temporal, and frontal lobes. The masslike thickening of the posterior corpus callosum has resolved. The previous abnormal increased T2 signal in the cingulate gyrus has also resolved. There remains mildly increased T2 signal crossing the splenium into the right parietal lobe as well as increased T1 and T2 signal extending into the left thalamus. A more nodular area of increased T2 signal in the subcortical white matter of the left inferior parietal lobule is not significantly changed.A cavernous malformation within the central pons is not significantly changed from prior. There are additional punctate foci of susceptibility artifact adjacent to the temporal resection cavity compatible with micro-hemorrhage.The ventricles and basal cisterns are normal in size and configuration. The expected intracranial vascular flow voids are present. Unchanged right maxillary sinus mucous retention cyst. New near-complete opacification of the right sphenoid sinus. The visualized mastoid air cells are clear. The orbits are unremarkable.

Output: 1. Evidence of treatment response with significant interval decrease in masslike T2/flair hyperintensity involving the corpus callosum and left cingulate gyrus. There remains abnormally increased T2 signal centered in the periatrial region and inferior parietal lobule related to known tumor.2. Expected findings from recent left parietal biopsy. Also seen is a separate left parietal resection cavity related to prior ependymoma resection without findings to suggest ependymoma recurrence.3. No significant change in pontine cavernous malformation.4. Please note examination was performed without gadolinium due to severe renal insufficiency.


Instruction: Generate impression based on medical findings.

Input: Male, 10 years old, with autism and concern for epilepsy. A cystic lesion is evident along the superior aspect of the mid left hippocampal body which follows CSF signal on all sequences. This lesion exerts some degree of mass effect upon the underlying hippocampus which is slightly flattened as a result. The lesion does not appear to arise from the hippocampus, but instead may be intraventricular in origin, possibly related to the choroid plexus.Brain parenchymal morphology is otherwise within normal limits. No evidence of edema or mass effect is seen. No structural abnormalities or evidence of dysplasia or migrational abnormality are noted. There is no significant parenchymal edema. No evidence of intracranial hemorrhage is seen. The ventricles are unremarkable. The mesial temporal lobes are otherwise unremarkable.

Output: A cystic lesion is evident centered along the superior aspect of the mid left hippocampal body. This lesion is too far posterior to represent a choroidal fissure cyst, and the location and orientation are not appropriate for a hippocampal sulcus remnant cyst. Instead, it appears that the lesion may be intraventricular in origin, possibly representing an arachnoid cyst or a choroid plexus cyst.


Instruction: Generate impression based on medical findings.

Input: word finding difficulties No evidence of acute ischemic or hemorrhagic lesion on this scan.There is encephalomalacia with hemosiderin deposition on the left precentral gyrus, left insular as well as left superior temporal gyrus indicating prior hemorrhagic infarction.Patchy high signal intensities on bilateral periventricular white matter on FLAIR images indicating non specific small vessel disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal flow enhancement in bilateral ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.Acom artery is patent but bilateral Pcom arteries are not seen.3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The left vertebral artery origin is normal. The right vertebral artery origin appears to be a bit narrowed but this could well be an artifactual. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

Output: 1. Chronic hemorrhagic infarction involving the left insular, inferior aspect of frontal lobe (precentral gyrus) and superior temporal lobe as described above.2. Non specific small vessel ischemic disease.3. No evidence of acute ischemic or hemorrhagic lesion.4. Normal brain and neck MRAs.


Instruction: Generate impression based on medical findings.

Input: cT1N2bM0 L BOT SCC, s/p CT please evaluate in comparison to previous MRI and need measurements. Multiple sequences are motion degraded. Mild residual enhancement at the left tongue base is not significantly changed since 9/12/2016 and compatible with treatment change. No new or enlarging lesion is appreciated. There is also no significant cervical lymphadenopathy.Airway is patent. There is fluid opacifying the vallecula. The thyroid and salivary glands are unremarkable. There is a disc-osteophyte complex at C5-6, which mildly indents the spinal cord. There is minimal scattered paranasal sinus opacification including a small fluid level in the right maxillary sinus. The orbits and imaged intracranial structures are unremarkable.

Output: 1. No significant change in mild residual enhancement at the left base of tongue without residual measurable mass.2. No significant cervical lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: Re-evaluate abnormal T2/Flair signal in the white matter. There is no evidence of intracranial hemorrhage, mass, or acute infarct. Redemonstrated are multiple scattered foci of non-enhancing T2 hyperintensity in the bilateral cerebral periventricular and subcortical white matter, which are grossly unchanged since 2013, accounting for differences in technique. A previously demonstrated enhancing focus adjacent to the right anterior clinoid process is compatible with mildly prominent venous structures and is unchanged. 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. There is fluid within the right mastoid air cells.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. Multiple scattered T2 hyperintensity in the bilateral cerebral hemispheres are nonspecific and appear to be unchanged since 2013.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: 77-year-old female with cirrhosis and HCV ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted. Cholelithiasis. Stable fluid signal lesion in the dome of the liver, possible subcapsular cyst. Prominent, unchanged gastric ligament and porta hepatis lymph nodes are likely reactive secondary to chronic liver disease.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: 10 mm right superior pole cyst. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Susceptibility artifact from lumbar stabilization hardware is again noted. T2 coronal large field-of-view sequences demonstrate severe degenerative and dysplastic changes of the left hip with a moderate joint effusion, similar to the prior exam.OTHER: No significant abnormality noted.

Output: 1.Cirrhotic liver morphology without focal lesion suspicious for HCC.2.Degenerative and dysplastic changes of the left hip with moderate joint effusion, similar to the prior exam.3.Cholelithiasis without evidence of cholecystitis.


Instruction: Generate impression based on medical findings.

Input: Reason: 3T scanner History: s/p epilepsy surgery. There is a rim of susceptibility along the margins of the previously seen post ablation area, corresponding to the prior prominent peripheral enhancement along the mesial left temporal lobe along the left hippocampus and amygdala, with a more conspicuous rounded focus of susceptibility along the anterolateral margin on the left side. Mild heterogeneous T2 signal is seen in the location of previous ablation. There is minimal residual ill-defined peripheral enhancement consistent with expected evolution of postoperative changes. The area of residual peripheral enhancement measures 9 x 24 mm compared to previous 12 x 22 mm. The previous laser fiber tract is also visualized via a left posterior parietal temporal approach with trace susceptibility along its, as well as focal rounded susceptibility in the left periatrial region. The ventricles and basal cisterns are stable in size and configuration. There is no midline shift or mass effect. Known new area of abnormal signal is seen. There is no extra axial fluid collection. No diffusion abnormalities appreciated. Faint rounded area of subtle enhancement suggested along the ventral pons likely represents a capillary telangiectasia. Lobulated mucosal retention cyst is present in the left maxillary sinus. Additional left sided trephination holes are also noted.

Output: Interval expected evolution of previously seen postoperative changes from repeat laser ablation of the left hippocampus and portion of the amygdala.


Instruction: Generate impression based on medical findings.

Input: Ataxia, stroke, diabetes type II. 44-year-old female The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a hyperdense focus along the lower aspect of the right postcentral gyrus representing a focus of infarction identified and a recent MRI of the brain it measures approximately 3.5 cm by 9 mm in axial dimensions. There is also a small hypodense focus along the left cingulate gyrus extending towards the left paracentral lobule and another smaller one along the left inferior parietal lobule. These are also identified on a recent MRI of the brain . Atherosclerotic calcifications are present along the distal internal carotid arteries.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. The visualized portions of the paranasal sinuses demonstrate partial opacification of right and middle ethmoid air cells.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits demonstrate a hyperdense left eyeball probably postoperative. It is unchanged since prior exam.

Output: 1.The patient has a focus of infarction in the right postcentral gyrus. 2.There are small foci of encephalomalacia along the left cingulate gyrus extending towards the left paracentral lobule and along the left inferior parietal lobule. 3.No evidence for acute intracranial hemorrhage.


Instruction: Generate impression based on medical findings.

Input: Status post orthotopic liver transplant. Evaluate for HCC. ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes from orthotopic liver transplant. The gallbladder has been surgically removed.No suspicious liver lesion. There is mild biliary ductal wall thickening and enhancement with mild central ductal dilatation without a focal lesion. The hepaticojejunostomy appears patent.The portal and hepatic veins are patent. Susceptibility artifact at the hepatic hilum limits evaluation of the hepatic artery.SPLEEN: Multiple punctate splenic siderotic nodules. The spleen is normal in size.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple appearing renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Postsurgical changes of the anterior abdominal wall.OTHER: No significant abnormality noted.

Output: No suspicious liver lesion.There is mild biliary ductal wall thickening and enhancement with mild central ductal dilatation without a focal lesion. The hepaticojejunostomy appears patent.


Instruction: Generate impression based on medical findings.

Input: Daily abdominal pain after eating. Terminal ileal inflammation seen intraoperatively during MALS release. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size, signal intensity and enhancement without biliary ductal dilatation, focal lesion or vascular abnormality. Status post cholecystectomy. No extrahepatic biliary ductal dilatation.SPLEEN: The spleen is normal in morphology and size without a discrete lesion. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is wall thickening and hyperenhancement of at least 5 cm of the terminal ileum suggesting compatible with acute inflammation. There is surrounding inflammation involving approximately 5 x 5.6 cm (series 13/59) and fibrofatty proliferation. There is a mild tethering of the surrounding small bowel loops, enteroenteric fistulization cannot be excluded. There is no proximal bowel dilatation. No loculated fluid collection.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Suspected acute inflammatory bowel disease involving at least 5 cm of the terminal ileum with surrounding phlegmonous inflammation and mild tethering of the surrounding small bowel loops without definite fistulous communication but which cannot be entirely excluded. No loculated fluid collection.


Instruction: Generate impression based on medical findings.

Input: HPV-positive, T2N2cM1 squamous cell carcinoma of the left tonsil progressed on pembro, Extreme(carbo/5fu/cetux), BKM 120/cetuximab. An occipital brain lesion was treated with SBRT. There is a newly apparent peripherally enhancing lesion in the right perirolandic region that measures up to 7 mm in width. Otherwise, a right occipital lobe enhancing lesion has markedly decreased in size, now measuring 2 mm in width, previously 7 mm. There is no evidence of intracranial hemorrhage or acute infarct. There is scattered cerebral white matter T2hyperintensity, predominantly in a periventricular distribution. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1, A new subcentimeter right perirolandic lesion likely represents a metastasis.2. A right occipital metastatic lesion has markedly decreased in size in response to treatment.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: HeadacheClinical question: multiple cerebral aneurysms, r/o SAHSigns and Symptoms: sudden onset headache The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.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. There are flow voids present where the patient's known right posterior communicating artery bilobed aneurysm is present. It appears to be at least in part embedded in the medial aspect of the right temporal lobeThe visualized portions of the paranasal sinuses demonstrate mild mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.No abnormal mass lesions are appreciated intracranially. Please refer to CT angiogram of the same date for further comments regarding the patient's aneurysm.2.No stigmata of subarachnoid hemorrhage are appreciated on this exam.


Instruction: Generate impression based on medical findings.

Input: 17 years Female (DOB:2/14/1999)Reason: CCM Protocol, QSM/Permeability, 3T Scanner, CCM3, yearly follow up please evaluate for changes History: CCM3 SurveillancePROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD The CSF spaces are appropriate for the patient's stated age with no midline shift. There are multiple lesions identified on susceptibility imaging present in both hemispheres of the supratentorial brain as well as the brainstem. The largest one is located in the left side of the brainstem at the junction of the pons and the left middle cerebellar peduncle and measures 12 mm on T2 imaging. It appears stableOne in the right periventricular white matter in the right parietal lobe measures 10 mm on the current exam and the 5 mm on the prior exam.One in the right postcentral gyrus which on the prior exam measured 13 x 10 mm on current exam represents hemosiderin and is smaller. A smaller on in the right precuneus is stable . One in the left periventricular white matter is also stable.On susceptibility imaging many small punctate foci of susceptibility effect are identified in the frontal lobes and periventricular white matter which are also identified on the prior exams unchanged.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There are multiple cavernous hemangiomas present. Compared to the previous exam the lesion in the right periventricular white matter in the right parietal lobe has enlarged. Another lesion in the right postcentral gyrus has decreased in size. The rest of the lesions do not appear to have changed substantially. Findings were communicated to Dr. Issam Awad at the time of this interpretation.


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old, with history of multiple sclerosis and ataxia. Brain:Extensive, confluent T2 hyperintensity is evident within the juxtacortical and periventricular white matter of the cerebral hemispheres. Lesions are associated with moderate to marked T1 hypointensity. Lesions in the pons and cerebellum are much more subtle. Marked callosal thinning and generalized cerebral volume loss is noted with corresponding ventricular prominence. No abnormal fluid collections are seen.C-spine:Patchy ill-defined T2 hyperintensity is evident throughout the visualized cervical spinal cord. A more focal appearing T2 hyperintense lesion dorsally at C6-7 could represent a small area of cystic degeneration or simply a more circumscribed lesion. A small focal central disc osteophyte complex at C3-4 mildly impinges on the spinal cord. A small focal central disc osteophyte complex at C6-7 is present without cord impingement. No significant foraminal narrowing is detected.

Output: Evidence of extensive long-standing demyelinating disease is seen in the brain and in the visualized spinal cord.


Instruction: Generate impression based on medical findings.

Input: Swelling, warmth, pain. Abscess, deep space infection of left Syme stump? The patient has undergone a Syme-like amputation through the ankle, with the associated expected postoperative changes. There is irregularity of the skin surface along the lateral aspect of the ankle suggesting ulceration. The underlying subcutaneous fat is replaced with heterogeneous signal intensity compatible with edema and scarring. There is perhaps a small, elongated thin collection of fluid within the soft tissues superficial to the fibula, but this is difficult to determine with certainty in the absence of contrast enhancement. I see no frank drainable abscess. Bone marrow signal intensity of the fibula is within normal limits, without evidence of osteomyelitis. The distal end of the stump representing the plantar "heel pad" appear slightly edematous, but largely maintains normal fat signal intensity. Between the heel pad and the distal ends of the tibia and fibula is a heterogeneous collection of tissue representing a surgically created muscular flap which shows high signal intensity on T2-weighted images that may reflect edema, although such signal can also be a normal finding in muscular flaps. This is admixed with low signal intensity that I suspect represents a combination of scar tissue, heterotopic ossification and residual tendinous structures. Increased signal intensity on T2WI deep to the musculature along the inferomedial aspect of the distal tibia may represent edema or perhaps a phlegmon, but I see no well-defined fluid collection to confirm an abscess. Multiple foci of signal void represent metallic susceptibility artifact from the surgery, as I see no gas density on the radiographs. There is mild periosteal reaction along the distal tibia that I suspect is chronic in etiology, as mild periosteal reaction is seen on ankle radiographs dating back to 2013. There is also mild edema-type signal within the medial aspect of the remaining distal tibia; although I cannot exclude osteomyelitis, the overlying cortical bone appears relatively preserved and hence this may simply represent reactive edema.

Output: Postoperative changes of Syme amputation with soft tissue ulceration and inflammation as described above. There is an equivocal thin elongated fluid collection underlying the lateral ulcer, as well as poorly defined increased signal intensity on T2WI between the muscular flap and the distal tibia medially that could represent a phlegmon, but I see no well-developed abscess given the limitations of a nonenhanced study. Mild edema of the bone marrow of the medial aspect of the distal tibia is nonspecific and while I cannot exclude osteomyelitis this may simply represent reactive edema associated with adjacent soft tissue inflammation.


Instruction: Generate impression based on medical findings.

Input: 7-year-old male with right knee pain MENISCI: The menisci are intact and normal in signal intensity with no evidence of tear or degeneration. ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: The anterior cruciate ligament demonstrates intermediate signal intensity and is discontinuous throughout its course. The posterior cruciate ligament, medial and lateral collateral ligaments are intact. The patellar ligament demonstrates a wavy contour throughout its course, however is normal in signal intensity with no evidence of tear or degeneration. EXTENSOR MECHANISM: The extensor mechanism is intact with no significant abnormality noted.ADDITIONAL

Output: Wavy patellar ligament and an abnormal anterior cruciate ligament without a joint effusion suggesting a chronic anterior cruciate ligament tear.


Instruction: Generate impression based on medical findings.

Input: Brain:Note that a FLAIR sequence was not obtained. The patient will be invited back to complete this sequence and an addendum will be issued at that time.The ventricles, sulci and cisterns are symmetric and unremarkable. Note is made of hemosiderin staining in the high right frontal lobe without associated enhancement or evidence of acute hemorrhage. The gray-white matter differentiation is normal. There is no mass, midline shift, intra or extra-axial fluid collection/acute hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Lumbar spine: There is loss of the normal lumbar lordosis. Vertebral body heights and disk spaces are maintained. There is no significant neuroforaminal or spinal canal stenosis. T1 hypertensity is noted within the filum terminale. The conus medullaris is normal in appearance and location at L1. The signal of the visualized lower spinal cord is within normal limits.

Output: 1. Hemosiderin staining in the high right frontal lobe, which may reflect prior contusive injury.2. Fatty filum terminale, which is an occasional incidental finding, although correlation with symptomatology is recommended. The visualized spinal cord and conus are normal in appearance and location.Note that a FLAIR sequence was not obtained and the patient will be invited back to complete this sequence. An addendum to this report will be issued at that time.


Instruction: Generate impression based on medical findings.

Input: MRI brain: Artifact related to the shunt reservoir limits evaluation particularly in the susceptibility weighted and diffusion weighted images. Some of the images are also motion degraded.There are postsurgical findings related to Chiari decompression. The cerebellar tonsils are unchanged in position and morphology, and extend down to level of the upper margin of the odontoid process. Neo foramen magnum is widely patent.CINE phase contrast CSF flow sequence shows biphasic flow at the level of neo-foramen magnum. CSF flow is well visualized along the ventral aspect with diminished flow dorsally, caudal to the cerebellar tonsils, which is unchanged.There is right frontal ventriculostomy shunt catheter and reservoir with tip terminating in the region of left foramen of Monro, unchanged. The ventricular size and configuration is unchanged. There is no midline shift or mass effect. There are no areas of abnormal signal. There is no diffusion abnormality or susceptibility within limitation of artifact related to the shunt reservoir. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. MRI spine: There is redemonstration of syringomyelia in the cervical cord which extends from C4-C5 disc space down to mid T1 level, measuring 3 x 5 mm in axial dimensions at mid C7 level, previously 3 x 5 mm, without significant interval change.The cervical spine is in normal alignment, with a normal cervical lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. Stable very minimal degenerative changes are noted in the cervical spine predominantly at C6-C7.There is no significant neural foraminal or spinal stenosis at any levels. Paraspinal soft tissue structures are unremarkable.

Output: 1. Stable postoperative findings of posterior fossa decompression for Chiari malformation and right frontal ventriculostomy. Ventricular size and configuration is unchanged.2. No evidence of intracranial hemorrhage or mass.3. Cervical syringomyelia extends from C4-C5 disc space down to mid T1 level, without significant change in size and morphology.4. Mild degenerative changes in the cervical spine without significant neuroforaminal or spinal canal stenosis.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old, with lung cancer metastases to the brain status post radiation therapy. Multiple scattered small lesions are again seen in the brain and cerebellum compatible with treated metastases. Most of these lesions show minimal if any enhancement, and are primarily visualized by virtue of their susceptibility effect on T2 and SWI images. One lesion, at the junction of the right parietal and occipital lobes, does show heterogeneous enhancement, unchanged from prior. The size of this lesion, at 9 mm diameter, has also not significantly changed from the immediate prior examination and is smaller when compared to older studies. No new enhancing or susceptibility inducing lesions are seen.Patchy bilateral periventricular white matter T2 hyperintensity is seen. The extent of this finding has progressed when compared to prior examinations, though in the absence of mass effect or new enhancement, this is favored to represent posttreatment change. No new areas of parenchymal edema are detected. No acute intracranial hemorrhage is suspected. The ventricles are stable in size and morphology.Patchy opacification of the right mastoid air cells is unchanged. An area of thickening and enhancement involving the bony floor of the right middle cranial fossa is unchanged over multiple prior examinations, possibly representing an incidental benign fibro-osseous lesion or venous space.

Output: Stable posttreatment appearance of numerous intracranial metastatic lesions. No new or growing lesions are seen.


Instruction: Generate impression based on medical findings.

Input: Breast cancer with diffuse bony metastasis, declining function and ability to walk. Left lower extremity weakness. There is diffuse osseous metastatic disease throughout the cervical, thoracic, and lumbar spine involving the anterior and posterior elements. Vertebral body heights are maintained. There is most likely epidural tumor at the L4 level dorsal to the vertebral body measuring up to 1 cm in thickness and is associated with mild spinal canal stenosis. There is otherwise no high-grade spinal canal stenosis in the cervical, thoracic, or lumbar spine. No evidence of acute cord compression or cauda equina compression. Alignment is maintained. No gross cord signal abnormality is evident. Mild degenerative changes are also evident including multilevel small disc osteophyte complexes and ligamentum flavum thickening in the cervical spine, but again without high-grade spinal canal stenosis.

Output: 1. Numerous osseous metastatic lesions throughout the spine without evidence of acute cord compression or cauda equina compression.2. Epidural tumor at the L4 level without high-grade spinal canal stenosis.3. This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Patient DLB and episodes of confusion. Signs and symptoms: Cognitive decline and parkinsonism there Nonenhanced brain MRI:Negative diffusion weighted images.Subtle periventricular and subcortical flair hyperintensity remains is stable since prior exam. Although the findings are nonspecific possibility of mild chronic small vessel ischemic strokes should be considered. Prominence of cortical sulci similar to prior exam. Mildly prominent ventricular system similar to prior exam. The signal void of major intracranial arterial branches are identified.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells.

Output: 1.No evidence of an acute or new finding since prior exam.2.Mild periventricular and subcortical flair hyperintensities without change since prior exam.3.Mild prominence of cortical sulci and supratentorial ventricular system is stable since prior study.4.Unremarkable calvarium, orbits and paranasal sinuses/mastoid air cells


Instruction: Generate impression based on medical findings.

Input: 51-year-old female status post craniotomy for tumor resection. Presents for surveillance. Redemonstration of a right parietal craniotomy status post resection of a lesion from the right precentral gyrus. A small somewhat ill-defined focus of enhancement along the precentral gyrus appears similar to the preoperative examination. T2 hyperintensity within the gyrus is unchanged.Evidence of additional previous surgery includes a right pterional craniotomy and multiple surgical/aneurysm clips along the right sphenoid wing, multiple bilateral burr holes and placement of a posterior fossa drainage catheter. The loculated appearing subdural collection seen along the right parietal lobe on the prior examination has completely or near completely resolved. Bilateral frontal subdural collections are not significantly changed. Bilateral diffuse dural thickening and enhancement is unchanged.The previously demonstrated shunted lesion within the medial left cerebellum shows no significant interval change. As before, this lesion contains an enhancing focus which measures up to 12 mm in diameter. A nonenhancing area of T2 signal abnormality within the left middle frontal gyrus is unchanged. Scattered nonspecific foci of T2 hyperintensity are seen within the cerebral hemispheres, nonspecific but unchanged. The ventricles are stable in size and morphology.

Output: 1.Postsurgical findings are seen compatible with lesion resection from the right precentral gyrus. A small nodule of enhancement and associated T2 signal abnormality at this site appears similar to the preoperative study.2.Evidence of more remote surgical intervention is again seen including aneurysm clipping along the right sphenoid wing and placement of a drainage catheter through the left cerebellum.3.An enhancing lesion within the left medial cerebellum and a nonenhancing lesion within the left middle frontal gyrus are unchanged. No new intracranial lesions are demonstrated.4.A somewhat loculated subdural collection seen previously along the right parietal lobe has significantly improved. Bilateral frontal subdural collections are unchanged.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: Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: please rule out acute on chronic brain infarct History: presenting with acute on chronic right sided weakness There are scattered restricted diffusion areas on the left precentral gyrus indicating acute ischemic infarct. There is no evidence of hemorrhagic conversion.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Retention cyst on the left maxillary sinus.

Output: Acute ischemic infarct on the left precentral gyrus without hemorrhagic transformation as described above.


Instruction: Generate impression based on medical findings.

Input: Cervical spine:There is mild straightening of the normal cervical lordosis. There is diffuse heterogeneity of the bone marrow signal. The cervical cord is normal in signal without abnormal enhancement. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C1/2: No significant canal stenosis.C2/3: No significant canal or neural foraminal stenosis.C3/4: No significant canal or neuroforaminal stenosis.C4/5: No significant canal stenosis. Mild bilateral uncovertebral hypertrophy without neural foraminal stenosis.C5/6: No significant canal stenosis. Mild right uncovertebral hypertrophy without neural foraminal stenosis.C6/7: Degenerative disc disease with a posterior disc osteophyte complex causing mild canal stenosis. There is marked right and moderate left uncovertebral hypertrophy causing moderate to severe right and moderate left neural foraminal stenosis.C7/T1: No significant canal or neuroforaminal stenosis.Thoracic spine:There is a smooth, physiologic thoracic kyphotic curve. There is mild anterior wedging of the T12 vertebral body without significant internal T2 signal abnormality. There is endplate irregularity of multiple lower thoracic vertebra consistent with degenerative changes. A nonenhancing focus abutting the inferior endplate of T7 with high T1 and low T2 signal is suggestive of a degenerative Schmorl's node as well as herniated disc material within the superior endplate of T12 . Marrow signal intensity is slightly heterogeneous throughout the thoracic spine. There are no masses or abnormal enhancement. The spinal cord has a smooth contour and is without focal atrophy, edema, or myelomalacia. T1/2 demonstrates no significant disc bulge or cord encroachment.T2/3 demonstrates no significant disc bulge or cord encroachment. T3/4 demonstrates no significant disc bulge or cord encroachment. T4/5 demonstrates no significant disc bulge or cord encroachment. T5/6 demonstrates no significant disc bulge or cord encroachment.T6/7 demonstrates a small central disc protrusion which causes mild flattening of the cord without internal signal abnormality.T7/8 demonstrates no significant disc bulge or cord encroachment. T8/9 demonstrates no significant disc bulge or cord encroachment. T9/10 demonstrates no significant disc bulge or cord encroachment.T10/11 demonstrates no significant disc bulge or cord encroachment. T11/12 demonstrates no significant disc bulge or cord encroachment. T12/L1 demonstrates no significant disc bulge or cord encroachment. Lumbar spine:Alignment is anatomic. There are no fractures or subluxations. There is diffuse heterogeneity of the bone marrow. Endplate irregularity of the upper lumbar vertebral bodies compatible with degenerative disc disease. The conus is normal in signal and morphology and terminates at an appropriate level. There is a small linear focus of fat within the filum terminale from L2-L3. The visualized intra-abdominal and paraspinal contents are unremarkable. There is no abnormal enhancement.L1/2: Mild posterior disc bulge and ligamentum flavum hypertrophy cause mild canal stenosis. No significant neural foraminal stenosis.L2/3: No significant canal stenosis. Mild right greater than left ligamentum flavum hypertrophy with mild right foraminal stenosis.L3/4: Mild ligamentum flavum hypertrophy without significant canal or neural foraminal stenosis. L4/5: Bilateral ligamentum flavum hypertrophy with mild right neural foraminal stenosis. No significant canal stenosis.L5/S1: No significant canal or neural foraminal stenosis.

Output: 1. Multilevel spondylosis of the cervical, thoracic ,and lumbar spine with a small disc protrusion at T6/T7 causing mild flattening of the cord without intrinsic cord signal abnormality.2. Mild chronic anterior wedging of the T12 vertebral body.3. Small linear fatty lesion within the filum terminale.4. Diffuse bone marrow heterogeneity, however, without suspicious findings on STIR imaging. This is felt to represent a benign process; the differential diagnosis most likely includes anemia of any cause and/or chronic smoking.


Instruction: Generate impression based on medical findings.

Input: The ventricles are mildly prominent, as are the anterior subarachnoid spaces. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is left mastoid air cell and middle ear fluid opacification. Incidental note is made of a small oval-shaped T2 hyperintense structure along the left lateral supraorbital region, along the adjacent frontozygomatic suture, which measures 11 x 6 mm in greatest axial dimensions on 601/17. This demonstrates dropout of signal on axial fat saturated postcontrast images without enhancement. It demonstrates heterogeneous T1 hypointense signal and mild diffusion restriction.Anterior to the expected location of the anterior fontanelle, just the right of midline, there are some asymmetrically prominent cortical veins along the dural surface, as seen on 1403/75 and 1402/32-33. Fontanelle patency is difficult to assess on MRI. Probable benign enlargement as arachnoid spaces of infancy.The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. The right vertebral artery is dominant. There is no evidence of flow-limiting stenosis or aneurysm

Output: 1. Unremarkable contrast enhanced MRI of the brain and noncontrast MRA head.2. Incidental small probable left lateral orbital dermoid/epidermoid.3. Probable benign enlargement of subarachnoid spaces of infancy which should resolve by 2 years of age. Follow-up imaging may be obtained as clinically indicated.4. Anterior to the expected location of the anterior fontanelle, incidental note made of asymmetrically prominent cortical veins to the right of midline. Please correlate with physical exam.


Instruction: Generate impression based on medical findings.

Input: Hemiplegia and hemiparesis following cerebral infarction affecting right dominant side [I69.351], Reason for Study: ^Reason: ? stroke History: AMS No evidence of acute ischemic or hemorrhagic lesion.There are multifocal susceptibility lesions especially involving bilateral thalami and basal ganglia indicating possible petechial chronic hemorrhage. In addition, there are multifocal lacunar infarcts involving bilateral basal ganglia as well as left periventricular white matter, left frontal lobe and the left side pons.Relatively smaller left side cerebral peduncle indicate possible Wallerian degeneration.Scattered T2/FLAIR high signal intensities on bilateral periventricular white matter and centrum semiovale indicate associated nonspecific small vessel ischemic disease. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Multifocal bilateral lacunar infarctions with petechial hemorrhages involving bilateral thalami and basal ganglia.2. Suggestive findings of left side Wallerian degeneration.3. Associated small vessel ischemic disease.4. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on medical findings.

Input: 58 y.o with a h/o of testicular CA w/orchiectomy and chemo, autoimmune hemolytic anemia and CVID on IVIG with fatigue and diarrhea. Please eval for small bowel involvement. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesion. Signal characteristics on T2 and in and out of phase sequences suggest possible iron deposition in the liver. Gallbladder is unremarkable.SPLEEN: Status post splenectomy.PANCREAS: Pancreas is unremarkable.ADRENAL GLANDS: No adrenal nodularity or thickening.KIDNEYS, URETERS: Multiple bilateral simple cysts. Kidneys enhance symmetrically. No suspicious renal mass is identified.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Bowel is normal in caliber without evidence of obstruction or ileus. There is no suspicious bowel wall thickening. No abnormal mural enhancement is identified.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of significant bowel pathology to suggest metastatic involvement.


Instruction: Generate impression based on medical findings.

Input: 52-year-old female presents with right knee pain, evaluate for meniscal tear. MENISCI: Mild intrasubstance degeneration of the medial and lateral menisci, essentially normal for age. No discrete tear is identified.ARTICULAR CARTILAGE AND BONE: There is focal partial-thickness degeneration of the articular cartilage of the lateral surface of the medial femoral condyle just above the free edge of the posterior horn of the medial meniscus. There is a small full-thickness focus of degeneration of the articular cartilage along the medial facet of the femoral trochlea. There is perhaps mild superficial fraying of the articular cartilage of the lateral facet of the patella inferiorly, however this is equivocal. There is no significant bone marrow signal abnormality.LIGAMENTS: There is minimal edema type signal between the iliotibial band and the lateral femoral condyle which could conceivably represent a mild "friction syndrome", but this is equivocal. The cruciate and medial collateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. Mild degeneration of the menisci without evidence of a tear.2. Small foci of cartilage degeneration as described above, not atypical considering the patient's age.3. Tiny Baker's cyst, not necessarily of any clinical significance.4. Minimal edema type signal between the iliotibial band and the lateral femoral condyle which could conceivably represent a mild "friction syndrome" in the appropriate clinical context.


Instruction: Generate impression based on medical findings.

Input: 41 year old male with a hypergammaglobulinemia. SKULL: No discrete lytic lesions seen.CERVICAL SPINE: There is disc space narrowing at C3-C4, C4-5.THORACIC SPINE: Loss of height of several mid thoracic vertebral bodies which could be pathological and would be better evaluated with MRI. LUMBAR SPINE: Loss of height at the body of L3 which may be pathological.RIBS: Questionable lytic lesions noted in the right 7th ribs, denoted by arrows in the frontal radiograph of the ribs.PELVIS: No discrete lytic lesions seen.UPPER EXTREMITY: No discrete lytic lesions seen.LOWER EXTREMITY: No discrete lytic lesions seen.

Output: 1. Questionable lytic lesions in the ribs.2. Compression fractures of the mid thoracic spine and L3 which could be pathological fractures.


Instruction: Generate impression based on medical findings.

Input: 51 year old man with history of inferior STEMI s/p PCI to RCA and LAD chronic total occlusion, referred for CMR for evaluation of LV function and underlying scar. Left VentricleThe left ventricle is moderately dilated with moderately reduced systolic function. The overall LV ejection fraction is 38%, the LV end diastolic volume index is 141 ml/m2 (normal range: 74+/-15), the LVEDV is 260 ml (normal range 142+/-34), the LV end systolic volume index is 88 ml/m2 (normal range 25+/-9), the LVESV is 162 ml (normal range 47+/-19), the LV mass index is 71 g/m2 (normal range 85+/-15), and the LV mass is 130 g (normal range 164+/-36). There is hypokinesis of the basal inferior/inferolateral walls and akinesis with associated myocardial thinning of the mid through apical inferior/inferolateral walls. There is apical akinesis. There is late gadolinium enhancement that is transmural in the apex and the mid through apical inferior/inferolateral walls. This is consistent with transmural infarction and this area is not likely to be viable. There is another area of subendocardial late gadolinium enhancement of the basal inferior/inferolateral walls and the mid anterior/anteroseptal walls. These areas are consistent with prior myocardial infarction and occupy about 50% of the myocardium thickness, indicating an intermediate probability of viability. The remainder of the myocardium appears viable. There is no LV thrombus.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 57%, the RV end diastolic volume index is 86 ml/m2 (normal range 82+/-16), the RVEDV is 159 ml (normal range 142+/-31), the RV end systolic volume index is 37 ml/m2 (normal range 31+/-9), and the RVESV is 68 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild 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 with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac 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 moderately dilated with moderately reduced systolic function. The overall LV ejection fraction is 38%.2. There is hypo/akinesis of the inferior/inferolateral walls with apical akinesis. 3. There is transmural late gadolinium enhancement in the inferior/inferolateral walls and apex that is consistent with prior myocardial infarction. This area is not likely to be viable. There is another area of subendocardial late gadolinium enhancement of the basal inferior/inferolateral walls and the mid anterior/anteroseptal walls that have an intermediate probability of viability. The remainder of the myocardium appears viable.4. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 57%.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: There is no abnormal enhancement in the cervical spine. The cervical spine is in normal alignment, with a normal cervical lordosis. The vertebral body heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal which was better assessed on recent noncontrast study from 11/23/2015.. Mild degenerative changes are seen with small disc osteophyte complexes at C3-C4, C4-C5, and C5-C6 as well as ligamentum flavum thickening. There is no significant spinal canal stenosis at any level. There is mild to moderate right and mild left C4-C5 neural foraminal stenosis as well as mild right and minimal left C5-6 neural foraminal stenosis. No high-grade neural foraminal stenosis seen at any level. These findings are better assessed on recent noncontrast sequences.THORACIC SPINE

Output: No abnormal enhancement involving the cervical or thoracic spine. Please refer to report from 11/23/2015 with findings on the noncontrast sequences.


Instruction: Generate impression based on medical findings.

Input: Evaluate for possible right sided submandibular gland mass/tumor: right submandibular enlargement. There is diffuse mild enlargement of the right submandibular gland, while the left submandibular gland appears to be atrophic. However, there is no evidence of mass lesions or significant cervical lymphadenopathy. The parotid glands and thyroid gland are unremarkable. The major cervical flow voids are intact. There is lack of the usual cervical kyphosis and mild multilevel degenerative spondylosis. The airways are patent. The imaged intracranial structures are unremarkable.

Output: Diffuse mild enlargement of the right submandibular gland may be compensatory to apparent atrophy of the left submandibular gland, without evidence of underlying mass lesions or significant cervical lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: Female, 22 years old, with weakness and paresthesias. The brain parenchymal morphology and post-contrast T1 signal characteristics are within normal limits. There is no focal enhancing lesion or mass effect detected. The ventricles are normal in size and morphology.

Output: No abnormal intracranial enhancement or other significant abnormality identified on post-contrast images. Please refer to the recent brain MRI without contrast report for additional details.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Evaluate interval enlargement of possible frontal meningioma. Signs and symptoms: CTH with enlarged possible meningioma. Nonenhanced brain MRI:No acute intracranial process and negative diffusion weighted series.Examination demonstrates a dural based extra-axial mass in the anterior left middle cranial fossa along the inner table of the great wording of sphenoid. It measures at 32 x 17 mm in transaxial dimensions (axial T2 series 6 image 19). There is resultant mass effect and posterior displacement of left temporal tip however without detectable FLAIR or T2 signal abnormality to suggest vasogenic edema. The location and signal intensity of the finding is suggestive of a meningioma. No contrast was given.Additionally examination demonstrates scattered periventricular and subcortical as well as bilateral basal ganglia and minimally pontine foci of FLAIR hyperintensity which considering patient's stated age of 77 likely representing chronic nonhemorrhagic small vessel ischemic strokes of moderate degree.The signal intensity of cerebral cortex is within normal.Cortical sulci and ventricular system as well as the CSF spaces are otherwise unremarkable. The signal void of major intracranial arterial branches are identified.Signal intensity of intracranial venous sinuses are unremarkable.Mild mucosal thickening of all visualized paranasal sinuses are noted. Bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal patterns.

Output: 1.Dural based extra-axial mass in the left anterior middle cranial fossa presumed a meningioma is again noted. Subtle mass effect on the left anterior temporal tip without vasogenic edema or midline shift.2.Negative diffusion weighted images and findings suggestive of mild to moderate chronic nonhemorrhagic small vessel ischemic strokes are noted.


Instruction: Generate impression based on medical findings.

Input: T4bN0 left sinonasal squamous cell carcinoma status post treatment. There are postoperative findings related to sinonasal surgery. There is interval decrease in size of the enhancing tumor centered in the left anterior ethmoid cavity with protrusion into the medial left extraconal orbit, measuring 11 x 20 mm, previously 20 x 28 mm. There are persistent obstructed secretions and mucosal thickening in the left frontal sinus and frontoethmoid recess. There is also no evidence of intracranial hemorrhage, mass, or acute infarct. There are unchanged, scattered, nonspecific, foci of non-enhancing T2 hyperintensity in the cerebral white matter. There are small areas of encephalomalacia in the right cerebellar hemisphere. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation.

Output: Post-treatment findings in the sinonasal region with interval decrease in size of the tumor centered in the left anterior ethmoid cavity with protrusion into the medial left extraconal orbit.


Instruction: Generate impression based on medical findings.

Input: Images are significantly limited by patient motion. The cervical spine is in normal alignment, with straightening of the normal cervical lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There is no pathological spinal enhancement.There is a minimal posterior osteophyte disc complex at C6-C7 with slight left-sided prominence and left uncovertebral hypertrophy. Left facet arthropathy is also noted, contributing to overall moderate left and mild right foraminal narrowing. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the remainder of the cervical spine. There are multiple areas of abnormal nodular and perhaps leptomeningeal enhancement involving the visualized brainstem and cerebellum. These are not definitely identified on the outside brain MR images. There is extensive T2/STIR hyperintensity within the brachium pontis bilaterally. There is an oval T2 hyperintense nonenhancing T1 hypointense lesion within the midline posterior deep subcutaneous fat, which may represent an inclusion cyst.THORACIC SPINE

Output: 1.No abnormal contrast enhancement within the cervical or thoracic spinal canal, within motion limitation.2.Very minimal cervical and thoracic spondylotic changes as detailed above.3.Partially visualized abnormalities within the visualized intracranial structures, including multiple enhancing nodular lesions as well as leptomeningeal enhancement suspected along the cerebellum, not seen on outside brain MRI images. Extensive abnormal signal in the brachium pontis bilaterally. These findings are of uncertain etiology, possibly representing an inflammatory process.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Assess for cause of severe bilateral leg pain involving calves, thighs, groin. 65-year-old female with metastatic pancreatic cancer. Signs and symptoms: As above. Pre- and post enhanced lumbar MRI:Examination demonstrates multiple osseous metastatic lesion of the thoracolumbar and sacral spine without intravenous fracture or malalignment and without evidence of epidural or paraspinal soft tissue is present. Metastatic lesions are noted in the partially visualized anterior body of and the left pars articularis of T11, large metastatic lesion involving nearly entire vertebral body of L2 and the base of the base of the spinous process, small metastatic lesion in the dorsal inferior midline body of L4, large metastatic lesion involving vertebral body of L5 and extending into the left pedicle, left articulating facet and left transverse process and a large metastatic lesion involving extensively the vertebral body of S1. The lesions demonstrate T1 hypointensity, T2 hyperintensity and with enhancement.Visualized lower thoracic cord, conus and cauda equina demonstrate no detectable abnormal enhancement to suggest metastases.Moderate degenerative changes at L4-L5 and mild bilateral facet and ligamentum flavum hypertrophy as well as bilateral facet effusion results in moderate central spinal stenosis without neural foraminal compromise.No evidence of spinal stenosis at any other level. Degenerative changes at L5-S1 however results in significant bilateral neural foraminal compromise. Partially visualized iliac wings also demonstrate a metastatic lesion on the left measuring approximately at 10 x 15 mm in transaxial dimensions.Findings on this exam were discussed with the clinical service Kwang Jin Choi # 5662 at the time of review of exam.

Output: 1.Multiple intraosseous metastatic lesions involving lower most visualized thoracic spine, lumbar spine and sacral spine as well as left iliac wing detailed above. No evidence of extraosseous spread of tumor.2.No detectable leptomeningeal enhancement.3.Extensive degenerative changes at L4-L5 results in moderate central spinal stenosis without neural foraminal compromise.4.Degenerative changes at L5-S1 results in significant bilateral neural foraminal compromise and without central spinal stenosis.5.No spinal stenosis or neural foraminal compromise at any other level.


Instruction: Generate impression based on medical findings.

Input: Male, 33 years old, with seizures after encephalitis for presurgical evaluation. Sensorimotor cortical activation observed during the hand, foot and face/tongue motor tasks maps to its expected locations along the pre- and post-central gyri.All tested language paradigms produced reliable language related cortical activation. Language is left dominant.There are 2-3 foci of activation within the pars opercularis and pars triangularis of the left inferior frontal lobe, any or all of which could represent Broca's area cortical activity. There are 1-2 foci of activation along the left posterior superior temporal gyrus, which likely represent Wernicke's area cortical activity. Strong secondary language activation is seen in the left middle frontal gyrus and at the level of the SMA.

Output: Sensorimotor cortical activity maps as expected along the pre- and post-central gyri.Language is left dominant. Broca's area is identified as expected in the left inferior frontal lobe. Wernicke's area is identified as expected along the posterior aspect of the left superior temporal sulcus.


Instruction: Generate impression based on medical findings.

Input: Speech disturbance, altered consciousness. There is restricted diffusion on the left side of pons indicating acute ischemic stroke.On the right side pons, there are a couple of focal tissue loss indicating prior ischemic stroke.There is no evidence of acute hemorrhage lesion on the scan.Patch bilateral high signal intensities on FLAIR imaging on periventricular white matter indicate nonspecific small vessel ischemic disease.There are multiple scattered bihemispheric round low signal intensities on gradient echo scans indicate either brain calcifications or chronic hemorrhagic foci.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Acute ischemic infarct, left side of pons without evidence of hemorrhagic transformation.Nonspecific small vessel ischemic disease.


Instruction: Generate impression based on medical findings.

Input: Altered mental status. Gait abnormalities. Question CVA. Patchy areas of subcortical and periventricular white matter hypodensity likely represent small vessel ischemic disease, age indeterminate by CT. If there is strong clinical concern for an acute stroke, an MRI may be considered for further evaluation. There is no evidence of intracranial hemorrhage, mass or midline shift. Vascular calcification is noted of the intracranial carotid arteries.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: Small vessel ischemic disease, age indeterminate. If there is strong clinical concern for acute stroke, an MRI may be considered for further evaluation.


Instruction: Generate impression based on medical findings.

Input: 68 year old male with history of hyperlipidemia and anginal symptoms who presents for cardiac MRI to evaluate for ischemiaMEDICATIONS: aspirin, Lipitor, metoprolol First Pass PerfusionDuring hyperemia, there is a severe, large sized defect in the basal to mid inferior and inferoseptum and the apical inferior and septal walls. Additionally, there is a mild perfusion defect involving all of the other segments in the mid ventricle and and the apical anterior wall. Viability/ Myocardial ScarThere is a small subendocardial basal inferior late gadolinium enhancement involving approximately 25-50% of the wall thickness, suggesting prior non-transmural myocardial infarction. This segment has an intermediate probability of viability. The remainder of the myocardium is viable. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 71%, the LV end diastolic volume index is 69 ml/m2 (normal range: 74+/-15), the LVEDV is 139 ml (normal range 142+/-34), the LV end systolic volume index is 20 ml/m2 (normal range 25+/-9), the LVESV is 39 ml (normal range 47+/-19), the LV mass index is 57 g/m2, and the LV mass is 114 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 67%, the RV end diastolic volume index is 76 ml/m2 (normal range 82+/-16), the RVEDV is 152 ml (normal range 142+/-31), the RV end systolic volume index is 25 ml/m2 (normal range 31+/-9), and the RVESV is 50 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is trivial mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThe ascending aorta is mildly dilated (39x41mm). There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. There is a large, severe perfusion defect in the territory of the right coronary artery. There are additionally mild perfusion defects noted in the usual territory of the mid LAD and mid LCx arteries.2. There is a small non-transmural myocardial infarction involving the basal inferior wall. This segment has an intermediate probability of viability. The remainder of the myocardium is viable. 3. Normal LV size and systolic function (LVEF 71%).4. Normal RV size and systolic function (RVEF 67%).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: Studies are somewhat degraded secondary to patient motion. Given this caveat:Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The spinal cord is normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The conus is normal in signal and morphology and terminates at L1/2. There are no MRI findings of fatty filum terminale. There are no osseous dysplasias. The visualized paraspinal contents are unremarkable.

Output: Negative noncontrast MRI of the complete spine. Specifically, there are no MRI evident abnormalities associated with the patient's coccygeal dimple.


Instruction: Generate impression based on medical findings.

Input: Pilocytic astrocytoma treated with laser ablation. There has been interval evolution of postoperative findings related to left transfrontal laser ablation of a hypothalamic region tumor, which has decreased in size, now measuring up to 10 mm, previously 12 mm. The ventricles are essentially unchanged is size and configuration. The optic apparatus appears grossly intact. There is no evidence of territorial infarction or acute intracranial hemorrhage. There is no midline shift or herniation. The skull and extracranial soft tissues are unchanged.

Output: Postoperative findings related to laser ablation of a hypothalamic region pilocytic astrocytoma, which has further decreased in size.


Instruction: Generate impression based on medical findings.

Input: Right tonsillar squamous cell carcinoma metastatic to the left parietal lobe now status post stereotactic radiosurgery. Evaluate for interval change. Post surgical changes from left parieto-occipital craniotomy and resection of left posterior parietal tumor. Compared to prior, there is significant interval reduction in vasogenic edema adjacent to the resection cavity. There is expected evolution of the resection cavity now with a small residual heterogeneous signal compatible with residual blood products. There is expected mild thickening and enhancement of the adjacent dura and craniotomy site. No residual enhancing mass is identified.No new abnormal enhancing foci. There is no evidence of acute intracranial hemorrhage. The ventricles and basal cisterns are normal in size and configuration. The expected intracranial vascular flow voids are present.Mucosal thickening and mucous retention cysts in the maxillary sinuses. There is complete opacification of the right frontal sinus as well as scattered opacification of the anterior ethmoid air cells. Minimal opacification of the left mastoid air cells. The orbits are unremarkable.

Output: 1. No residual or recurrent enhancing tumor is appreciated at the surgical site. No new lesions.2. Evolution of posttreatment changes with near resolution of the previous seen left parietal perilesional vasogenic edema.


Instruction: Generate impression based on medical findings.

Input: 68-year-old man with history of prostate cancer. PELVIS:PROSTATE:Prostate Size: 36 x 50 mm.Peripheral Zone: The peripheral zone is heterogeneous and striated in appearance with increased T1 signal, likely related to prior biopsy and slightly limiting evaluation.In the left posterior base of the prostate (series 401, image 95) there is an approximately 11 x 8 mm area of T2 hypointensity and decreased ADC which appears to cross the midline into the right lobe. Additionally, this area of signal abnormality abuts the left seminal vesicle with questionable involvement.A linear focus of decreased ADC and T2 hypointensity is seen in the right paramidline apex (series 41, image 65).An area of decreased ADC signal seen in the left apex, however there is no T2 correlate for this region (series 503, image 224).Central Gland: The central gland is heterogeneous in appearance and enlarged with impression on the midline posterior bladder wall.Seminal Vesicles: The seminal vesicles appear normal.Extracapsular Extension: There is no definite evidence of extracapsular extension.BLADDER: The bladder appears normal.LYMPH NODES: No significant lymphadenopathy noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Area of signal abnormality in the left base of the prostate suspicious for carcinoma abutting and possibly invading the left seminal vesicle.2.Questionable, smaller areas of signal abnormality in the left and right apex as above.


Instruction: Generate impression based on medical findings.

Input: 39-year-old male with right hip pain. Evaluate for right hip ACETABULAR LABRUM: The acetabular labrum appears small secondary to the underlying osteoarthritic changes described below.ARTICULAR CARTILAGE AND BONE: Moderate degenerative changes affect the right hip joint with near bone-on-bone apposition, osteophyte formation and subchondral cyst formation. There is mild redundancy and inflammation within the joint which may be related to the intra-articular injection procedure. There is hyperintense signal intensity on the T2-weighted images within the bone marrow of the femoral head raising the possibility of mild avascular necrosis. There is mild bony prominence along the anterolateral femoral head neck junction with the possibility of a small CAM deformity not excluded. Alpha angle measures 65 degrees.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: 1. Possible small CAM deformity along the anterolateral femoral head as described above. 2. Moderate degenerative changes affect the right hip with hyperintense T2 signal within the bone marrow of the femoral head raising the possibility of mild avascular necrosis.3. Mild redundancy and inflammation within the joint which may be related to the intra-articular injection procedure.


Instruction: Generate impression based on medical findings.

Input: Redemonstrated are several foci of T2 hyperintensity within the white matter, both subcortical and periventricular, some of which are oriented perpendicular to the corpus callosum. There has been some subtle change of a few lesional sizes, however there are no new lesions dating back to the 2007 comparison. None demonstrate contrast enhancement.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 are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: Stable nonenhancing multiple sclerosis plaques as described in detail above.


Instruction: Generate impression based on medical findings.

Input: There is a punctate focus of restricted diffusion and high T2 signal in the left corona radiata. There are also scattered punctate foci and confluent areas of T2 hyperintensity within the periventricular and subcortical white matter, right cerebellar hemisphere, as well as in the pons without restricted diffusion. In addition, there also appear to be scattered prominent perivascular spaces. There is linear and branching susceptibility effect in the right parietal lobe, which likely represent developmental venous anomaly. The ventricles and sulci are within normal limits. The basal cisterns are patent. There is no midline shift or mass effect. The major cerebral flow voids are intact. The midline structures and craniocervical junction are within normal limits. There are nasopharyngeal Thornwaldt and/or mucous retention cysts.

Output: A punctate focus of acute microvascular infarct in the left corona radiata. Other areas of white matter abnormality likely represent chronic small vessel ischemic disease and lacunar infarcts.


Instruction: Generate impression based on medical findings.

Input: 65 years, Male, Reason: evaluate for SB lesions, also please note if any pancreatic lesions History: patient has secretory diarrhea and slightly elevated somatostatin level.. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Small left upper pole cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: MalePROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Severely limited exam. Only a few sequences were obtained, as patient refused to continue exam. No gross abnormalities are identified on this essentially nondiagnostic exam.


Instruction: Generate impression based on medical findings.

Input: The brain parenchyma appears within normal limits. No findings to suggest seizure focus are appreciated. Specifically, there is no evidence of gray matter heterotopia or cortical dysplasia. Bilateral hippocampi are symmetric in size, signal characteristics, and with preserved internal architecture. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures.

Output: No findings to suggest seizure focus are appreciated.


Instruction: Generate impression based on medical findings.

Input: 51-year-old male with suspected small bowel Crohn's, bloating and abdominal pain. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted. T2 hyperintense cyst in the left lobe of the liver. 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: Mild subcentimeter lymph nodes surrounding the affect jejunum described below.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Two segments of jejunum approximately 20 cm distal to the ligament of Treitz with narrowing and concentric wall thickening. The proximal segment measures approximately 10 cm in length with an intervening non-thickened segment of bowel measuring 6 cm followed by a second segment of thickened jejunum measuring 9 cm in length. Submucosal fat deposition is noted within these affected loops of bowel. No evidence of small bowel obstruction. No abscess or fluid collection.OTHER: No significant abnormality noted.

Output: 1.Two segments of jejunal narrowing and submucosal fat deposition as described above consistent with chronic disease.


Instruction: Generate impression based on medical findings.

Input: Papilledema associated with increased intracranial pressure. There is marked constriction of the lateral aspects of the bilateral transverse sinuses. However, there is no evidence of venous sinus thrombosis. Prominence of the optic nerve sheaths bilaterally and the enlarged sella are more conspicuous on the dedicated prior brain MRI.

Output: Constriction of the bilateral transverse sinuses is a feature compatible with pseudotumor cerebri, along with other previously demonstrated associated neuroimaging findings. Otherwise, no evidence of venous sinus thrombosis.


Instruction: Generate impression based on medical findings.

Input: Female, 24 years old. History of AML s/p matched sibling stem cell transplant with knee pain. History of steroid treatment. Evaluate for AVN. MENISCI: Medial and lateral menisci appear intactARTICULAR CARTILAGE AND BONE: The cartilaginous surface is intact. No evidence of avascular necrosis or focal marrow occupying lesion. No bone marrow edema.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. No evidence of avascular necrosis or focal marrow occupying lesion.2. No meniscal, cartilaginous, or ligamental injury.


Instruction: Generate impression based on medical findings.

Input: Cavernous malformation. There is no significant interval change in the T2 and T1 hyperintense lesion with extensive surrounding hemosiderin in the right anterior orbital gyrus that measures up to 15 mm. Likewise, there is an unchanged associated small developmental venous anomaly. There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are grossly intact. There is an unchanged non-enhancing T1 and T2 hypointense lesion within the right occipital bone, which likely represents an intraosseous hemangioma. The extracranial soft tissues are unremarkable.

Output: Unchanged right frontal lobe cavernous hemangioma and associated small developmental venous anomaly.


Instruction: Generate impression based on medical findings.

Input: 64-year-old male with acute on chronic left hemiparesis. Evaluate for new acute ischemic infarct. Note that this is an incomplete exam as the patient refused to continue. In particular, there are no susceptibility/gradient echo images.Within the right basal ganglia is an area of diffusion restriction compatible with an acute ischemic infarct. There is also restricted diffusion to a lesser degree within the right corona radiata and the left genu of the corpus callosum which likely represent somewhat older acute to subacute infarcts. There are additional patchy areas of periventricular and subcortical T2/FLAIR hyperintensities with additional FLAIR signal abnormalities within the left basal ganglia and diffusely in the brainstem which do not restrict on diffusion-weighted images and are compatible with chronic small vessel ischemic disease. There is no significant mass effect, midline shift or herniation. The ventricles and basal cisterns are normal in size and configuration. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.Findings compatible with an acute ischemic infarct involving the right basal ganglia. There is no significant mass effect, midline shift or herniation.2.Somewhat lesser degree of restricted diffusion involving the right corona radiata and the left corpus callosum probably represent older late acute to subacute infarcts.3.Additional patchy areas of chronic small vessel ischemic disease elsewhere in a periventricular and subcortical distribution.Findings relayed to the Neurology service physician, Dr. Del Brutto (pager 1706) at the time of this final entry by Dr. Veronesi of the Radiology service.


Instruction: Generate impression based on medical findings.

Input: 53 year old woman with known left breast cancer and metastatic left axillary lymph node, status post neoadjuvant chemotherapy. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.The index cancer in the left breast at 1:00 position now measures 7 x 9 x 7 mm (AP x LR x CC). It is significantly reduced in size when compared to the prior measurement (20 x 20 x 19 mm). A Hydromark clip is present approximately 5 mm lateral to the index cancer. The satellite lesion seen on the prior exam at central left breast is no longer visualized. Only a metallic artifact from marker clip is seen.An enlarged left axillary lymph node becomes smaller, measuring 17 x 8 mm (previous measurement: 34 x 19 mm). A Hydromark clip is identified at the anterior aspect within the lymph node.In the right breast, a benign mass at 9:00 position is unchanged.No new abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in right axillary region.

Output: 1. Interval decrease in size of index cancer in the left breast and left metastatic axillary lymph node, and complete resolution of satellite lesion in the left breast.2. No interval change in the right benign mass.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on medical findings.

Input: Lung cancer. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild nonspecific periventricular white matter T2 hyperintensity. There is no abnormal intracranial enhancement. There is diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of intracranial metastases.


Instruction: Generate impression based on medical findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The right 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, 10 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. 40 mL of Kenalog was injected into the joint. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 31 seconds

Output: Successful intra-articular injection of gadolinium for MR arthrography and Kenalog into the right hip joint.