Instruction: Generate impression based on medical findings.

Input: Reason: Eval Thumb UCL History: instability Multiple sequences are limited by patient motion artifact and splint. Additionally, repeat images were not obtained due to the patient's inability to tolerate further imaging. The ulnar collateral ligament is abnormally thickened. There is increased signal intensity which traverses the proximal fibers of the ulnar collateral ligament that we suspect represents a complete tear, however, due to the thickening of the ligament, it is difficult to determine if this represents a mid substance tear or proximal avulsion with adjacent scar tissue. It is also difficult to determine whether this represents an acute or chronic tear or if there is a Stener lesion due to the thickening of the ligament and possible adjacent scar tissue. There is also intermediate signal intensity within the distal fibers of the ligament at its attachment which may correspond to the calcification seen on recent radiographs, perhaps representing further injury to the ligament. There is edema within the base of the proximal phalanx concentrated within the volar and ulnar aspect of the proximal phalanx, but we see no fracture. We see no edema within the sesamoid bones. There is mild edema along the myotendinous junction of the adductor pollicis suggesting a strain. Fibers of the radial collateral ligament can be traced from the first metacarpal head to the base of the proximal phalanx.

Output: 1. Limited study as described above due to patient motion artifact and inability of the patient to tolerate repeat images. The ulnar collateral ligament is thickened with what appears to be a full-thickness tear, but it is difficult to assess whether this is an acute or chronic lesion or if there is a Stener lesion.2. Strain of the adductor pollicis along the myotendinous junction and other findings as described above.


Instruction: Generate impression based on medical findings.

Input: 4 month old male; rule out bleed. Prominent extra-axial fluid bilaterally with questionable peripheral high attenuation that could represent intracranial hemorrhage; if clinically concerned for bleed, recommend MRI for further evaluation.There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Prominent extra-axial fluid bilaterally with questionable peripheral high attenuation that could represent intracranial hemorrhage; if clinically concerned for bleed, recommend MRI for further evaluation.


Instruction: Generate impression based on medical findings.

Input: 46-year-old female with elevated liver enzymes and bilirubin. Status post heart transplant. Evaluate biliary/pancreatic ducts and setting of cholestasis and transaminitis. T.Bili of 1.4, AST 37, ALT, 63, Alk Phos 500. ABDOMEN:LIVER, BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation. The common bile duct measures 3.6 mm in diameter. Normal distention of the gallbladder without wall thickening or inflammatory changes. No suspicious parenchymal lesions on this noncontrast exam. Decreased T2 signal intensity of the hepatic parenchyma suggestive of iron deposition.SPLEEN: No significant abnormality noted.PANCREAS: No pancreatic ductal dilatation. No peripancreatic inflammation. There are 2 well-circumscribed subcentimeter T1 hyperintense foci anterior to the pancreatic tail (series 801 image 75), which could represent sequelae from prior pancreatitis versus small lymph. A small foci are unchanged compared to the 7/14/2014 PET/CT exam.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral punctate T2 hyperintensities are too small to characterize, favor cystic. No hydronephrosis. Trace inferior right perinephric T1 hypointense signal intensity suggestive of old hemorrhage, likely related to prior renal biopsy.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Nonspecific T2 hyperintense focus of the left hemisacrum is only seen on the coronal T2 sequence (series 401 image 29) and could represent an osseous hemangioma. Susceptibility artifact from lower sternotomy wires are noted.OTHER: No significant abnormality noted.

Output: 1.No intra or extrahepatic biliary ductal dilatation. No evidence for cholecystitis.2. The T2 hypointense signal intensity of the hepatic parenchyma is suggestive of iron deposition, which could be related to prior blood transfusions.3. The subcentimeter T1 hyperintense rounded foci anterior to the pancreatic tail could represent sequelae of prior pancreatitis versus lymph nodes. In retrospect, these small foci identified on the 7/14/2014 PET/CT exam.4. Evidence of old hemorrhage inferior to the right renal pole likely related to prior biopsy.


Instruction: Generate impression based on medical findings.

Input: 75-year-old female patient with medial knee pain. Question of chondromalacia, meniscal tear. MENISCI: The posterior horn of the medial meniscus is abnormally small in size with increased signal intensity consistent with degeneration and fragmentation. Increased signal intensity within the body of the medial meniscus likely represents complex tearing. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is loss of the articular cartilage of the medial femoral condyle overlying the posterior horn of the medial meniscus, which extends over a 1.6 cm distance. This appears to have progressed from the prior examination. Furthermore, there is thinning of the articular cartilage anteriorly as well. There is diffuse thinning of the articular cartilage of the lateral femoral condyle with a 0.5 cm full-thickness defect posteriorly. There is fraying/fissuring of the articular cartilage of the lateral patellar facet and median eminence, without full thickness defect, with underlying subchondral cystic change, appearing similar to the prior study.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. Tearing and degeneration of the medial meniscus as described above.2. Chondromalacia, most predominately affecting the medial compartment, which appears slightly progressed from the prior study.


Instruction: Generate impression based on medical findings.

Input: Trauma. The ventricles and basal cisterns are normal in size and configuration. The gray-white matter differentiation is preserved. There is subtle hypoattenuation seen in the subcortical and deep white matter of the superior frontal gyri subcortical white matter and possible expansion of the gyrus. This is unusual for a patient of this age and further assessment with an MRI is advised.There is no mass-effect or midline shift, intra-extra axial fluid collection, or acute hemorrhage.The calvaria and skull base appear normal, no evidence of a skull fracture or diastases of the calvarial sutures. No pneumocephalus.The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. No acute intracranial abnormality.2. Subtle low attenuation in the in the high convexity bifrontal deep white matter unlikely traumatic and may represent congenital leukomalacia, further assessment with MRI may be helpful.


Instruction: Generate impression based on medical findings.

Input: 42-year-old male with altered mental status and lethargy There is no evidence of intracranial hemorrhage, mass or edema. Encephalomalacia involving bilateral frontal lobes and bilateral temporal lobes are again noted and not significantly changed from comparison MRI accounting for technical differences. Otherwise symmetric prominence of a ventricular system is in proportion to the diffuse sulcal prominence compatible with generalized brain atrophy. Slight hyperdense lesion extending from the left basal ganglia into the left cerebral peduncle that corresponds to high T1 signal lesion on prior MR is of uncertain clinical etiology and significance.Basal ganglia and right insula calcifications have increased in size, but were likely present on prior MRI. There are atherosclerotic calcifications of the basilar artery as well as bilateral internal carotid arteries and middle cerebral arteries.Hyperostosis frontalis is noted. Otherwise, the calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Accounting for technical differences, there is no significant change compared to prior MRI as described above. Due to multiple abnormalities correlation with MRI should be considered for more definitive comparison.


Instruction: Generate impression based on medical findings.

Input: 76-year-old male with autoimmune sclerosing cholangitis. Evaluate for cholangiocarcinoma or dominant stricture. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology with nodular surface contour. No focal hepatic lesions. No biliary ductal dilation. Patent portal and hepatic veins.Stable wall thickening of the common duct just proximal to the biliary enteric anastomosis, which is nonspecific and may be related to postoperative change. MRCP images are limited due to large amount of ascites.SPLEEN: Moderate splenomegaly.PANCREAS: Postoperative changes from modified Whipple's procedure, similar to prior exam. Again, the pancreatic duct is mildly dilated with atrophy of the pancreatic pancreatic parenchyma, compatible with chronic pancreatitis. No focal pancreatic lesions are evident.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Moderately enlarged mesenteric and superior trabecular lymph nodes are not significantly changed.RETROPERITONEUM, LYMPH NODES: Postoperative changes from gastrojejunostomy anastomosis. No evidence of bowel obstruction.BOWEL, MESENTERY: Large amount of abdominal ascites, new since prior exam.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Redemonstration gastrosplenic and paraesophageal varices.

Output: 1.No significant interval change in postoperative findings from modified Whipple's procedure and chronic pancreatitis of the residual pancreas.2.No significant interval change in postoperative changes from biliary enteric anastomosis with stable mild wall thickening of the common duct near the anastomosis, likely related to postoperative change. No biliary ductal dilation.3.Large amount of abdominal ascites, new since prior exam.


Instruction: Generate impression based on medical findings.

Input: Female, 8 days old, ex-35 weeker, with prenatal ultrasound concerning for Dandy-Walker malformation, presenting with abnormal leg movements. Sibling with Dandy-Walker. The foramen of Magendie is slightly wide as visualized in the sagittal plane. This can represent normal variation or mild inferior vermian hypoplasia. The vermis is not upturned and the cerebellar hemispheres are normally formed. The posterior fossa is not enlarged.As appreciated in the sagittal plane, the tectum appears mildly prominent and the dorsal pons mildly thinned. These findings are not as conspicuous when viewed in the axial plane.The cerebral hemispheres are fully formed and demonstrate normal gyration for gestational age. No areas of signal abnormality or edema are seen. No generalized mass effect is detected. There are no findings to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collections. Diffusion-weighted images are within normal limits.The pituitary region is within normal limits. The corpus callosum is fully formed and unremarkable. The pattern of white matter myelination is appropriate or even somewhat advanced for the corrected gestational age.

Output: 1.No evidence of a classic Dandy-Walker malformation is seen. At most, the inferior vermis may be mildly hypoplastic but this could also reflect normal variation.2.As appreciated in the sagittal plane, the tectum appears mildly prominent and the dorsal pons mildly thinned. These findings are not as conspicuous on axial images which calls into question their validity. If real, such findings could reflect a mild midbrain patterning anomaly.3.Cerebral morphology is otherwise unremarkable. No focal or acute lesions are identified.


Instruction: Generate impression based on medical findings.

Input: 64-year-old female with mesothelioma status post HIPEC (06/2016) ABDOMEN:LIVER, BILIARY TRACT: Slitlike T2 hyperintense focus with hypointense nodularity in the inferior right lobe of the liver is new since the prior exam. Perihepatic disease has been resected since the prior MR with residual disease studding the surface of the liver. Implant at the dome of the liver is increased in size since prior CT.Reference measurement on the lateral right lobe is provided. There is a subhepatic peritoneal mass that is increased in size when compared to the prior exam.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal gland nodule is unchanged.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Focus of peritoneal disease along the right abdominal wall. Nodules noted in the greater curvature of the stomach and gastrosplenic ligament are new/increased in size. Trace perisplenic fluid.BONES, SOFT TISSUES: Rightward curvature of the lumbar spine with degenerative changes centered at L3-L4.Right paralabral cyst anterior to the to the right hip joint, increased in size. Right paralabral cyst in the gluteus minimus is unchanged in size. 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: Reference right lower quadrant soft tissue implant and not significantly changed in size. The posterior pelvic soft tissue implant is slightly increased to stable in size since the prior examination. BONES, SOFT TISSUES: Rightward curvature of the lumbar spine with degenerative changes centered at L3-L4.Right paralabral cyst anterior to the to the right hip joint, increased in size. Right paralabral cyst in the gluteus minimus is unchanged in size. Heterogenous enhancement in the proximal femoral diaphysis is not evaluated well and likely unchanged.OTHER: No significant abnormality noted.INDEX LESION MEASUREMENTS (Current exam date/time: 11/1/2016 09:18:26)VENTRAL BODY WALL COMPLEX CYSTIC LESION: 7.5 x 1.3 cm (Image 45, Series 6); 9.3 x 1.5 cm on prior (8/9/2016) (Image 94, Series 3).POSTERIOR PELVIC SOFT TISSUE IMPLANT: 3.1 x 3.7 cm (Image 60, Series 18); 3.4 x 3.0 cm on prior (8/9/2016) (Image 127, Series 3).RIGHT LOWER QUADRANT SOFT TISSUE IMPLANT: 4.3 x 4.3 cm (Image 63, Series 18); 4.1 x 3.4 cm on prior (8/9/2016) (Image 127, Series 3).RIGHT SUBHEPATIC NODULE: 2.2 x 2.8 cm (Image 234, Series 10).

Output: 1.Interval increase in size and number of peritoneal/mesenteric and subcapsular metastatic foci as above.


Instruction: Generate impression based on medical findings.

Input: Nine-year-old male with new onset of chest pain, shortness of breath, lower extremity clonus, upward gaze. Non-verbal. There is no evidence of intracranial hemorrhage. No mass or midline shift is present. Gray-white differentiation is normal and cortical sulci are preserved.The ventricles and basal cisterns are normal in size and configuration. Slight prominence of the temporal horn of the left lateral ventricle may represent normal anatomic asymmetry -- however, given the patient's symptoms, further evaluation with MRI should be considered.The calvaria and skull base are radiographically normal. Minimal mucosal thickening is present in the sphenoid sinus and ethmoid air cells. The mastoid air cells and middle ear cavities are normal in appearance.

Output: 1. No CT findings of acute intracranial process.2. Slight asymmetry of temporal horns of lateral ventricles -- given reported symptoms, consider further evaluation with MRI.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old, with GBM on Avastin and temozolomide. Findings are redemonstrated compatible with prior right craniotomy and tumor resection from the posterior right frontal lobe. The region of the resection cavity contains T2 heterogeneous thickened tissue which, on comparison with multiple prior examinations, shows a slow interval increase in size. On postcontrast images, most this tissue does not enhance. However, there is patchy, discontiguous thin and/or nodular enhancement particularly along the anterior and inferior margins of this tissue which is stable to minimally increased from the prior exams. On rCBV mapping, most of this tissue demonstrates very low blood volume. Areas of elevated volume around the margins could simply represent sulcal vascularity. Elevated blood volume along the inferior margin, however, is more convincing.T2 hyperintensity extending through the white matter of the surrounding parenchyma has progressed from the prior examination, with local mass effect in the form of sulcal effacement. It also appears that the degree of susceptibility indicating microscopic blood product within and around the lesional tissue has increased from prior exams though this could partly be due to imaging at higher field strength.No discontiguous or contralateral lesions are suspected. Scattered foci of T2 hyperintensity elsewhere in the brain are unchanged and nonspecific. The ventricular system is stable in size and morphology.

Output: Heterogeneous tissue within the right posterior frontal resection bed shows a slow but steady increase in size over multiple prior examinations. The lesional tissue shows a pattern of patchy, discontiguous enhancement which may reflect partial suppression by antiangiogenic therapy. A majority of the lesional tissue shows low rCBV, but some elevated blood volume is noted along the inferior margin of the lesion correlating with an area of enhancement.Overall, the findings are concerning for residual and slowly progressive tumor, some features of which are likely masked by antiangiogenic therapy. A mixed process with both tumor and treatment effect would also be likely.


Instruction: Generate impression based on medical findings.

Input: BRAIN: Again seen are posttreatment findings related to prior embolization and radiosurgery of a left hippocampal/thalamic/lateral ventricle arteriovenous malformation that appears to be fed by the left posterior cerebral artery. There is no significant change in T1 hyperintensity which may related to calcification. There is slight decrease in surrounding T2 hyperintensity/edema within the left hippocampus and posterior thalamus compared to 5/20/2015 and more clear decrease when compared to 3/5/2015. There is no evidence of acute infarct or acute hemorrhage. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and scalp soft tissues are unremarkable. There is minimal paranasal sinus mucosal thickening.MRA HEAD: There is unchanged flow-related signal within the AVM fed from the left posterior cerebral artery. 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 otherwise normal in course and caliber. There is no evidence of flow-limiting stenosis.

Output: No significant change in size of left hippocampal/lateral ventricle/thalamic AVM compared to 5/20/2015, but smaller compared to remote study from 10/30/2014. There is minimal interval decrease in edema compared to most recent prior and more significant decrease in edema compared to 3/5/2015. No hydrocephalus. No new hemorrhage or mass effect.


Instruction: Generate impression based on medical findings.

Input: Right knee pain MENISCI: The medial meniscus is intact. There is abnormal signal and morphology of the body and anterior horn of the lateral meniscus likely reflecting combination of postsurgical change and tearing. This appears similar to the exam dated 8/16/2012.ARTICULAR CARTILAGE AND BONE: There are new full-thickness cartilage defects within the medial compartment affecting both the femoral condyle and tibial plateau. The largest extent measures approximately 2.3 cm in the greatest AP dimension within the mid to posterior femoral condyle. There is associated underlying reactive marrow change which is also new from the prior exam. There is mild thinning of the articular cartilage of the lateral and patellofemoral compartments without discrete full-thickness defects.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The quadriceps and patellar tendons are intact.ADDITIONAL

Output: 1. Abnormal appearance of the body and anterior horn of the lateral meniscus likely reflects a combination of postsurgical change and tearing. Overall this appears similar to the prior exam.2. New large full-thickness defects of the articular cartilage of the medial compartment affecting both the femoral condyle and tibial plateau. The articular cartilage of the lateral patellofemoral compartments is thinned at otherwise intact.


Instruction: Generate impression based on medical findings.

Input: Male, full-term 21 days old infant, with increasing head circumference and bulging fontanelle. Evaluate for aqueduct stenosis/hydrocephalus. The lateral ventricles are markedly dilated, right side greater than left, with moderate dilatation of the third ventricles. The fourth ventricle is normal in caliber.Subacute blood clot is evident dangling within the right lateral ventricle. Subacute subdural blood product is also seen along the left anterior temporal lobe and along the posterior cerebellum. On susceptibility weighted imaging, however, there is a much more extensive pattern of chronic hemosiderin staining along the ependymal surface of the ventricles, the choroid plexi, and the surface of the brainstem and the cerebellum.Marked ventriculomegaly causes deformation of the brain parenchyma and periventricular white matter thinning. The corpus callosum appears to be present but is severely thinned. No areas of acute ischemia or significant parenchymal edema are detected.The pituitary region is unremarkable. The brainstem, cerebellar vermis and cerebellar hemispheres are normally formed. The cerebral aqueduct is patent. The posterior aspect of the right thalamus is smaller than that of the left and there is signal abnormality suggesting gliosis. The pattern of white matter myelination is otherwise appropriate for age.

Output: 1.Marked supratentorial ventriculomegaly.2.Subacute blood clot within the right lateral ventricle and in the subdural spaces along the left anterior temporal lobe and the posterior cerebellum.3.Superficial hemosiderin staining along the ependymal surface of the ventricles as well as the surface of the brainstem and cerebellum indicating a fairly extensive prior hemorrhagic event.4.Volume loss and gliosis of the right posterior thalamus are seen possibly suggesting prior injury or insult.5.The cerebral aqueduct is patent.


Instruction: Generate impression based on medical findings.

Input: 60 year-old male with history of left nasal vestibule is squamous cell carcinoma involving left lateral nasal wall. Now status-post left medial maxillectomy and ethmoidectomy. Has granulation tissue, possible requirements left superior/anterior nasal area. Please evaluate and stage. Enhanced CT of soft tissues of neck:In comparison with prior examination there is interval resolution of previously noted soft tissue densities within the left frontal sinus and left ethmoid sinus region which is leave to have represented mucosal thickening and inflammatory changes. There is no definitive evidence of interval new bony changes.Images through the nasal cavity demonstrate overall decrease in the amount of soft tissue density that was present in the left nasal cavity. On coronal reformatted image 14 in the most anterior aspect of the left nasal cavity the soft tissue within the nasal cavity demonstrate subtle enhancement. This finding measures approximately 12 mm in cranial cephalad access and 7-mm in transverse axis. Although this finding may represent postop scarring considering the provided clinical data it may represent recurrence of tumor. This finding could be better evaluated with a dedicated MRI of maxillofacial region. On axial image 16 this tissue appears to extend beyond the confinement of nasal cavity and into the soft tissues of the nose. There is no detectable new bony changes since prior study.Residual mucosal thickening within the left maxillary sinus.Images through the skull base remain unremarkable.Images through the neck demonstrate multiple small nonenhancing and not pathologic by CT size criteria lymph nodes which were present and read no detectable change since prior study from 2009. There is no evidence of any pathologic lymph nodes in the neck.No evidence of osseous or cartilaginous erosion.Heterogeneously enlarged right lobe of thyroid is consistent with goiter. This finding was also present on prior study.Limited images of the apices of the lungs and mediastinum are negative.Enhanced CT of brain:There is no evidence of intracranial metastatic lesion. Calvarium is intact.Findings consistent with small vessel disease are again identified and made no gross interval change since prior study from 2009.80 CT of Omnipaque 350 was administered for the above studies.

Output: 1.Interval decrease in the amount of soft tissue within the left nasal cavity compared to prior nonenhanced CT of the maxillofacial region. A small enhancing tissue in the anterior aspect of the left nasal cavity may represent recurrence of tumor as detailed above. Further evaluation with a dedicated enhanced MRI is recommended since this finding could also conceivably represent postoperative scarring. This finding is not associated with any new bony changes.2.Stable CT examination through the rest of soft tissues of neck and with no evidence of pathologic adenopathy.3.No evidence of metastatic disease to the brain or calvarium. Findings of small vessel disease remains grossly stable since prior study.


Instruction: Generate impression based on medical findings.

Input: A 68 year old male with history of coronary artery disease, s/p coronary artery bypass surgery (LIMA to LAD, RIMA to RCA, SVG to OM), s/p PCI to LAD. Recently the patient complaint of progressive dyspnea on exertion. After review of last coronary angiogram, the patient is referred to stress cardiac MRI to evaluate ischemia.MEDICATIONS: Aspirin, Atorvastatin, Clopidogrel, Metoprolol, Levothyroxine, Nitro as needed. First Pass PerfusionDuring hyperemia, perfusion abnormalities were noted in the basal anteroseptum, inferoseptum, inferior, inferolateral, and anterolateral walls; the mid anteroseptum, inferoseptum, and inferior walls; and the apical inferior and septal walls. The overall ischemia score is 10 out of a possible 32 and 31% of the myocardium is ischemic. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 71 ml/m2 (normal range: 74+/-15), the LVEDV is 147 ml (normal range 142+/-34), the LV end systolic volume index is 32 ml/m2 (normal range 25+/-9), the LVESV is 66 ml (normal range 47+/-19), the LV mass index is 42 g/m2, and the LV mass is 87 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 84 ml/m2 (normal range 82+/-16), the RVEDV is 174 ml (normal range 142+/-31), the RV end systolic volume index is 37 ml/m2 (normal range 31+/-9), and the RVESV is 80 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. 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 FindingsSternal wires were noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. There is a large burden of "ischemia" as described above.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 55%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.4. Normal RV size and systolic function (RVEF 54%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old, with neck pain and left arm radicular symptoms. Trace retrolisthesis of C3 relative to C4, and C6 relative to C7 are demonstrated. Endplate irregularity and edema is seen at most levels compatible with degeneration. Otherwise, vertebral body morphology is unremarkable.Multiple small chronic strokes are seen within the cerebellum. Details of the cervical spinal cord will be discussed by level as follows:C2-3: Left facet hypertrophy. Mild posterior disk osteophyte formation. No significant spinal canal stenosis. Moderate right and mild left foraminal narrowing. No spinal cord abnormality.C3-4: Right worse than left facet hypertrophy. Significant posterior disk osteophyte formation, asymmetric to the right. Severe spinal canal stenosis with flattening and impingement of the spinal cord. Mild increased T2 signal within the cord at this level and slightly below along with cord thinning. Moderate left and severe right foraminal narrowing.C4-5: Mild facet hypertrophy. Mild posterior disk osteophyte formation. No significant spinal canal stenosis or cord abnormalities. Moderate bilateral foraminal narrowing. C5-6: Mild facet hypertrophy. Moderate posterior disk osteophyte formation with mild generalized spinal canal narrowing but no significant cord impingement. Severe left and moderate right foraminal narrowing. C6-7: Mild facet hypertrophy. Moderate posterior disk osteophyte formation causing mild/moderate generalized spinal canal stenosis and slight cord flattening. Moderate bilateral foraminal narrowing. C7-T1: Facet hypertrophy. Minimal central disk protrusion. No significant spinal canal stenosis. Moderate right and mild left foraminal narrowing.

Output: Multilevel cervical spondylosis, most severely affecting the C3-4 level where a disk osteophyte complex, in combination with posterior element hypertrophy, results in significant spinal canal stenosis with cord impingement. The cord is thinned and T2 hyperintense at this level which favors myelomalacia, though some component of superimposed edema cannot be excluded.Less significant spinal canal stenosis, and variable foraminal narrowing, are also seen as discussed above.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: HeadacheClinical question: ha etiologySigns and Symptoms: HAPatient History: Patient had a concussion x's 2 years ago. C/O Frontal Headaches off & on x's 1 year. Headaches associated with dizziness. No N/V. No blurred vision. The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: MRI of the brain is within normal limits. There is no intracranial lesion identified which can explain the patient's headaches.


Instruction: Generate impression based on medical findings.

Input: Reason: mass or old infarct? History: new headache with left-sided numbness. There is no evidence of intracranial hemorrhage, mass, or acute infarct. Increased DWI signal in the anterior medial frontal lobes likely represents artifact. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. Right maxillary mucous retention cyst/polyp.

Output: No acute infarct or other findings to explain patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: No diffusion restriction to suggest acute infarction. Periventricular and subcortical white matter T2/FLAIR signal abnormality consistent with chronic small vessel ischemic disease. Additionally, there is encephalomalacia with gliosis involving the anterior temporal lobes and bilateral paramedian frontal lobes including rectus gyri consistent with sequelae of remote trauma. Foci of scattered susceptibility consistent with prior remote microhemorrhages. Moderate prominence of the ventricles and sulci consistent with age-related diffuse volume loss. There are no masses, mass effect, or midline shift. There are no extraaxial fluid collections or subdural hematomas. There is no evidence of acute intracranial hemorrhage. The cerebellar tonsils are in normal position. The pituitary gland is normal in size. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear.

Output: 1.No findings to suggest acute ischemia.2.MRI evidence for sequelae of remote brain trauma.


Instruction: Generate impression based on medical findings.

Input: 41-year-old female with right knee pain and swelling. Evaluate for meniscus tear. Due to the patient's body habitus, an HD coil was not able to be utilized resulting in slightly suboptimal image quality.MENISCI: There is globular signal abnormality within the anterior horn of the lateral meniscus indicating intrasubstance degeneration. The signal also extends to both the tibial and femoral articular surfaces indicating degenerative tearing. There is a heterogeneous collection of signal abnormality along the anterior aspect of the lateral meniscus representing a parameniscal cyst. There is additional branching signal abnormality within the body of the lateral meniscus which extends to the free edge, representing additional tearing. There is horizontally oriented signal abnormality within the posterior horn of the lateral meniscus which extends to the tibial articular surface, representing additional tearing. There is perhaps minimal undersurface fraying of the posterior horn of the medial meniscus, but we see no discrete tear. The anterior horn appears intact.ARTICULAR CARTILAGE AND BONE: There is full-thickness cartilage loss along the inferior aspect of the lateral facet of the patella. There is also a full-thickness defect of the articular cartilage along the medial facet of the patella with what appears to be a dislodged cartilaginous fragment within the patellofemoral joint. There is also a full-thickness defect of the articular cartilage of the femoral trochlea superiorly. Additional full-thickness cartilage loss is identified along the lateral facet of the femoral trochlea with small underlying subchondral cysts. There is full-thickness cartilage loss along the lateral tibial plateau with underlying degenerative subchondral signal abnormality. There is relatively mild degeneration of the articular cartilage of the lateral femoral condyle. There is near full-thickness degeneration of the articular cartilage of the weightbearing portion of the medial femoral condyle above and anterior to the posterior horn of the medial meniscus. There are tricompartmental osteophytes.LIGAMENTS: The cruciate and collateral ligaments appear intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Extensive degenerative tearing of the lateral meniscus as described above.2. Tricompartmental osteoarthritis as described above.3. Large joint effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old, with low back pain. Assess for signal changes. Cervical:Straightening of the cervical lordosis is seen. Sagittal alignment is unremarkable. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement, edema or enhancement is seen.The visualized spinal cord demonstrates normal signal intensity and morphology. No pathologic parenchymal or leptomeningeal enhancement is detected within the limitations of motion artifact. No epidural abnormalities are seen.C2-3: Left facet arthropathy. No significant spinal canal stenosis. Minimal left foraminal narrowing.C3-4: Left facet arthropathy. No spinal canal stenosis. No significant foraminal narrowing. C4-5: Left facet arthropathy. Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis related moderate left foraminal narrowing. C5-6: Loss of disc height with posterior disc-osteophyte complex formation. Effacement of the ventral thecal sac but no significant spinal canal stenosis. Moderate to severe bilateral foraminal narrowing. C6-7: Loss of disc height with posterior disc-osteophyte complex formation. Effacement of the ventral thecal sac but no significant spinal canal stenosis. Moderate bilateral foraminal narrowing. C7-T1: No spinal canal stenosis or neuroforaminal narrowing. Thoracic:A slight exaggeration of the thoracic kyphosis is seen. Sagittal alignment is otherwise unremarkable. Vertebral body heights are preserved. No pathologic marrow replacement, edema or enhancement is seen.The visualized spinal cord demonstrates normal signal intensity and morphology. No areas of pathologic parenchymal or leptomeningeal enhancement are detected. No epidural lesions are suspected.Minimal degenerative findings of the intervertebral disks and posterior elements are seen. No areas of significant spinal canal or foraminal stenosis are observed.

Output: 1.No evidence of marrow edema or pathologic spinal enhancement is seen. The spinal cord is within normal limits.2.Degeneration of the intervertebral discs and left-sided facets is seen in the cervical region. No high-grade spinal canal stenosis is detected. However, significant foraminal narrowing is evident on the left at C4-5 and bilaterally at C5-6 and C6-7.3.No significant abnormalities are detected in the thoracic spine.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p Right knee arthroscopy microfracture patella and MFC evaluate healing History: right knee pain MENISCI: There is intrasubstance signal within the medial meniscus indicating intrasubstance degeneration. The body of the medial meniscus also appears slightly extruded. There is perhaps mild fraying of the undersurface of the body of the medial meniscus but we see no findings suggestive of an unstable tear.ARTICULAR CARTILAGE AND BONE: There has been progression of the degeneration of the articular cartilage in the medial compartment with areas of full-thickness cartilage loss along the medial femoral condyle and medial tibial plateau just posterior to the anterior horn of the medial meniscus. There is edema-type signal in the underlying subchondral bone that is likely degenerative in etiology and is perhaps slightly less pronounced in the tibia on the current study than on the prior study but slightly more extensive in the medial femoral condyle. There is extensive partial thickness degeneration of the articular cartilage of the medial facet of the patella as well as small foci of full-thickness degeneration that appears similar to that seen on the prior study. A 1 cm disc-shaped focus of low signal intensity in the adjacent joint fluid may represent a displaced cartilage fragment. The articular cartilage of the lateral patellar facet appears unusually thickened, which likely reflects degeneration. There are cysts in the underlying subchondral bone. Note is made of a bipartite patella with cyst formation appearing similar to the prior study. The articular cartilage of the lateral compartment appears relatively spared.LIGAMENTS: The cruciate and collateral ligaments appear intact.EXTENSOR MECHANISM: The quadriceps and patellar tendons are intact. Patella alta is again noted, appearing similar to the prior study.ADDITIONAL

Output: 1. Progression of cartilage degeneration within the medial compartment as described above.2. Degeneration of the articular cartilage of the patella appears similar to that seen on the prior study although there may now be a displaced fragment in the adjacent joint fluid.3. Other findings as above.


Instruction: Generate impression based on medical findings.

Input: Stage IV non-small cell lung adenocarcinoma. There are numerous T1 hypointense lesions through the imaged axial skeleton. However, the vertebral body heights are preserved and there is no significant associated narrowing of the spinal canal. There is a background of high T1 signal in the lower thoracic spine bone marrow suggestive of prior radiation therapy effects. The spinal cord signal and morphology is unremarkable. There is degenerative spondylosis in the lumbar spine with small posterior disc bulges and facet hypertrophy with resultant moderate to severe neural foraminal stenosis at L5-S1 bilaterally. There is a left pleural effusion with consolidation in a portion of the left lung.

Output: 1. Numerous metastatic lesions involving the axial skeleton without evidence of associated significant spinal canal stenosis.2. Degenerative spondylosis in the lower lumber spine with moderate to severe neural foraminal stenosis at L5-S1 bilaterally.3. Left pleural effusion with consolidation in a portion of the left lung that likely corresponds to the lung adenocarcinoma. Please refer to the recent chest CT for additional details.


Instruction: Generate impression based on medical findings.

Input: There is redemonstration of a resection cavity involving the right anterior temporal lobe, a portion of the right insula, the frontal operculum, and a portion of the right inferior frontal lobe. The size and morphology of the resection cavity are unchanged. The degree of the T2 signal abnormality surrounding the resection cavity and extending into the right frontal white matter has not significantly changed. There is enhancement along the ependyma of the right frontal horn, which appears significantly more prominent than on the previous studies of 8/28/2015 and 7/10/2015. There is also a new focus of nodular enhancement along the ependyma of the left frontal horn. Enhancement in the midline along the septum pellucidum remains the same. Enhancement along the ependyma of the lateral aspect of the body of the right lateral ventricle is unchanged.There is enhancement along the medial aspect of the resection cavity, which is contiguous with the ependymal enhancement, which is not significantly changed. There is no evidence of restricted diffusion. There is susceptibility effect along the resection cavity, due to old blood products.There is fluid in the right mastoid and in the left maxillary sinus, unchanged.

Output: 1. Redemonstration of findings related to tumor resection and treatment. 2. Progressive ependymal enhancement is seen along the right frontal horn, with a new area of ependymal enhancement along the left frontal horn. 3. Stable appearance of the resection cavity.


Instruction: Generate impression based on medical findings.

Input: 72 years Female (DOB:1/25/1944)Reason: h/o DM and HTN, now with amnestic syndrome, please assess for CVD and/or focal atrophy History: memory impairmentPROVIDER/ATTENDING NAME: JAMES A. MASTRIANNI JAMES A. MASTRIANNI The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Punctate T2 and FLAIR hyperintense foci are present in the brainstem, basal ganglia and internal capsules.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is no evidence for acute cerebral infarction.2.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 3.Punctate lesions in the brainstem, internal capsules and basal ganglia are likely vascular related


Instruction: Generate impression based on medical findings.

Input: Exam is limited by patient motion.ORBITS: There is mildly increased fluid surrounding the left optic nerve especially distally compared with the right. The optic nerves are otherwise symmetric and normal in size and signal intensity. There is no chiasmatic mass or parasellar abnormality. There is no intraorbital mass or abnormal enhancement. The extraocular muscles are unremarkable. There are bilateral lens implants.BRAIN: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are multiple small patchy foci of T2 hyperintensity within the supratentorial and infratentorial white matter most compatible with chronic small vessel ischemic disease, as well as scattered chronic lacunar infarcts. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is unchanged atelectasis of the left maxillary sinus. The skull, paranasal sinuses, and scalp soft tissues are otherwise unremarkable.

Output: 1.There is mildly increased fluid surrounding the left optic nerve compared with the right, a non-specific finding. The orbits are otherwise unremarkable. 2.Mild to moderate supratentorial and infratentorial chronic small vessel ischemic disease.


Instruction: Generate impression based on medical findings.

Input: 39 year-old female with multiple sclerosis diagnosed in 2005. MRI BRAIN: There is a new left pontine lesion with low T1 signal and a newly apparent patchy T2 hyperintense lesion in the right middle cerebellar hemisphere. Otherwise, there has been no significant interval change of the T2 hyperintense cerebral white matter and small medial left cerebellar hemisphere lesions, which are predominantly distributed in the periventricular regions. Many of the lesions demonstrate T1 hypointensity, but there is no evidence of associated enhancement. The ventricles are unchanged in size and configuration. There is no midline shift. There are unchanged mildly low-lying cerebellar tonsils. There is mild persistent scattered paranasal sinus mucosal thickening. The skull and extracranial soft tissues are unchanged. MRI CERVICAL SPINE: There is redemonstration of scattered abnormal T2 signal in multiple reasons of the cord throughout the cervical and thoracic spine cord. No enhancing lesions are identified. The cervical spine is in normal alignment, with a normal cervical lordosis. The vertebral body heights are well-maintained. There is mild disc desiccation signal throughout the cervical spine and mild disc height loss at C5-6. The vertebral bone marrow is unremarkable. A posterior disc osteophyte complex with central disc protrusion is demonstrated at C5-C6 with mild flattening of the ventral spinal cord. There is no significant neural foraminal stenosis is evident.

Output: 1. Newly apparent infratentorial demyelinating lesions. The supratentorial demyelinating lesions otherwise appear to be similar as on the prior exam, accounting for differences in technique. 2. The demyelinating lesions in the cervical and thoracic spinal cord do not appear significantly changed, given differences in technique.3. Interval central disc protrusion at C5-C6 that mildly indents the spinal cord.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: 44-year-old male with shoulder pain. Evaluate for rotator cuff tendinopathy versus partial tear. ROTATOR CUFF: There is perhaps mild thickening and slight increased signal intensity of the insertional fibers of the supraspinatus tendon suggesting mild tendinosis, but we see no fluid-filled tear. The supraspinatus muscle is within normal limits. The infraspinatus tendon and muscle appear intact. The teres minor and subscapularis muscles and tendons appear intact. There is a subchondral cyst within the humeral head which is not necessarily of current clinical significance.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. There is mild anterior spurring of the acromion process. No fluid is identified within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is within normal limits. There is no joint effusion. Given the limitations of a non arthrogram study, the glenoid labrum appears normal. The articular cartilage of the shoulder appears within normal limits.BICEPS TENDON: Given the limitations of a non arthrogram study, the tendon of the long head of the biceps appears within normal limits.

Output: Possible mild supraspinatus tendinosis at its insertion and minimal osteoarthritis of the acromioclavicular joint. We see no rotator cuff tear.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Is there change in cerebellum or ?olivary lesionSigns and Symptoms: ataxia MRI brain:There is redemonstration of cystic lesions in the medulla bilaterally at the expected location of the all of which is larger on the left compared to the right side. There is no associated diffusion restriction. There is no associated susceptibility effect. There is no associated contrast enhancement on the prior exam. The one on the left measures 4 x 5 mm axial dimensions and 4 x 9 mm coronal dimensions whereas the one on the right measures 3 x 3 mm axial dimensions and 3 x 3 mm coronal dimensions. These cystic lesions are slightly more prominent on the current prior exam though this appearance of a larger on the current versus the prior exam may be due to difference in slice thickness and gap on the prior MR acquisition and therefore may not be valid. This there is no convincing evidence for interval change in size of these lesions.There is associated cerebellar atrophy present. This is also present on the prior exam. The degree of cerebellar atrophy appears similar compared to the prior exam.There are no associated lesions appreciated in the dentate nuclei nor in the right nuclei.The supratentorial CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is multilevel disc desiccation present.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this level.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this level.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this level.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There are cystic lesions centered in olivary nuclei bilaterally (left larger than right) - suspected to represent cystic degeneration - associated with relatively symmetric cerebellar atrophy.2.No intrinsic spinal cord lesions are appreciated3.There are mild degenerative changes present in the cervical spine mainly in the form of disk degeneration without significant compromise to the spinal canal or neural foramina. At age 22 this is more disk dessication than usually expected.


Instruction: Generate impression based on medical findings.

Input: known tibial spine avulsion injury. Evaluate meniscal/cartilage injury. MENISCI: Increased signal seen in the posterior horn of the medial meniscus does not definitively extend to the articular cartilage, however a partial tear cannot be excluded. Increased signal seen in the anterior and posterior horns of the lateral meniscus, anterior greater than posterior, extending to the articular cartilage and are compatible with a tear.ARTICULAR CARTILAGE AND BONE: An avulsion fracture of the tibial spine is located in the intracondylar notch. Increased signal abnormalities in the lateral femoral condyle, medial tibial plateau and posterior lateral tibial plateau are compatible with bone contusions.LIGAMENTS: The anterior cruciate ligament is thickened and demonstrates increased laxity with signal changes, a partial tear cannot be excluded. The posterior cruciate ligament, lateral collateral and medial collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Tibial spine avulsion fracture.2.Thickened and lax anterior cruciate ligament with signal abnormalities may reflect a partial ACL tear.3.Lateral meniscal tear as described above. Increased signal abnormality in the posterior horn of the medial meniscal may represent a partial medial meniscal tear.


Instruction: Generate impression based on medical findings.

Input: 56 year old female with a history of left shoulder pain. Evaluate for rotator cuff tear. Evaluation of the shoulder is limited due to the patient's body habitus and patient motion artifact.ROTATOR CUFF: There is metallic susceptibility artifact indicating suture anchors with tunnels extending into the anterior and superior aspect of the humeral head. There is marked thinning of the supraspinatus tendon, likely reflecting chronic attritional tearing. Furthermore, there appears to be delamination of the tendon with retraction of the undersurface fibers to the level of the top of the humeral head. However, some fibers of the supraspinatus can be traced from the myotendinous junction to their insertion on the greater tuberosity. There is also suggestion of a small focal full-thickness defect of the tendon just above the vertex of the humeral head. Additionally, there is intermediate signal intensity within the posterior fibers of the supraspinatus tendon at their insertion likely representing insertional tendinosis. Cuff material is seen along the greater tuberosity superficial to the surgical tunnels, with what appears to be superficial partial-thickness tearing of the bursal surface fibers. There is mild atrophy of the supraspinatus muscle. There is moderate degenerative tendinosis of the infraspinatus tendon with foci of high signal intensity at its insertion likely representing concealed insertional tears and perhaps mild interstitial tearing along the myotendinous junction. There is moderate atrophy of the infraspinatus muscle. The teres minor muscle and tendon appear intact. There is mild increased signal intensity within the distal subscapularis tendon suggesting tendinosis. We see no discrete tear and the muscle of the subscapularis appears intact.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. Fluid within the acromioclavicular joint may reflect prior surgery. There is a small amount of fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The humeral head is slightly high riding. Evaluation of the glenoid labrum is limited due to the aforementioned technical factors and lack of intra-articular contrast. Portions of the labrum appear blunted likely representing degenerative tearing.BICEPS TENDON: The tendon of the long head of the biceps is situated within the bicipital groove as seen on the axial images. On sagittal oblique sequences the tendon appears enlarged with associated increased signal intensity likely reflecting tendinosis.

Output: 1. Limited study as described above. Postoperative changes of prior rotator cuff repair. There is marked thinning of the supraspinatus tendon likely reflecting chronic attritional tearing and retraction of delaminated undersurface fibers. There is also suggestion of a small focal full-thickness defect at the vertex of the humeral head. Other rotator cuff abnormalities as described above.2. Osteoarthritis and other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Tingling in 4 limbs, evaluation for NMO. Confluent T2 signal in distal medulla to C7 and T3-T12 in NW MRI from November 2015. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is minimal residual T2 hyperintensity in the inferior medulla. The brain parenchyma and cerebellum otherwise appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Spine: There is decrease in the degree of T2 hyperintensity and swelling involving the majority of the cervical and thoracic spinal cord. The cauda equina nerve root sare unremarkable. The vertebral column alignment is unchanged. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: Interval decrease in the degree of edema involving the medulla and large portions of the spinal cord.


Instruction: Generate impression based on medical findings.

Input: Pituitary adenoma, history of resection. Evaluate change to residual tumor. There are postoperative findings related to transphenoidal surgery. There is no significant interval change in size of the lobulated enhancing left sellar and suprasellar mass, which measures approximately 15 AP x 10 RL x 13 SI mm. There is persistent mild mass effect upon the left lateral aspect of the optic apparatus, which otherwise demonstrates normal signal characteristics. There is no evidence of intracranial hemorrhage or acute infarct. The brain parenchyma appears unremarkable. The ventricles are stable in size and configuration. There is no midline shift or herniation.

Output: Persistent lobulated left sellar and suprasellar residual macroadenoma with persistent mild mass effect upon the left lateral aspect of the optic apparatus.


Instruction: Generate impression based on medical findings.

Input: 12 year old female with congenital dysplastic tricuspid valve and tricuspid regurgitation referred for cardiovascular MRI as part of a research study Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 77 ml/m2, the LVEDV is 118 ml, the LV end systolic volume index is 34 ml/m2, the LVESV is 52 ml, the LV mass index is 63 g/m2, and the LV mass is 56 g. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is moderately dilated with mildly reduced systolic function. The overall RV ejection fraction is 46%, the RV end diastolic volume index is 111 ml/m2, the RVEDV is 170 ml, the RV end systolic volume index is 60 ml/m2, and the RVESV is 91 ml. Right AtriumThe right atrium is severely dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve is thickened with elongated leaflets, and mild prolapse of the anterior and posterior leaflets. The coaptation point and the septal leaflet a mildly apically displaced. There is severe tricuspid regurgitation. AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal left ventricular size and systolic function (LVEF 56%)2. Moderately dilated right ventricle with mildly reduced systolic function (RVEF 46%, RVEDVi 111 mL/m2)3. The tricuspid valve is thickened with elongated leaflets, mild prolapse of the anterior and posterior leaflets, The coaptation point and the septal leaflet a mildly apically displaced. There severe tricuspid regurgitation4. Severe right atrial enlargement.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: Reason: evaluate for disease activity History: dizziness and worsening visual acuity; h/o multiple sclerosis MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. One of the lesions is in the right calloso-cingulate junction. Another lesion is present along splenium of the corpus callosum on the left side and is new compared to the prior exam. Previously enhancing lesion in the corpus callosum posteriorly within the body no longer enhances.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI orbits:The eyeballs are intact. No intraconal or extraconal space mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. There is no optic nerve enhancement appreciated. The suprasellar cistern is intact .

Output: 1.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific. There is a new lesion present along the splenium of the corpus callosum which was not clearly present on the prior exams.ptic neu2.There's evidence for optic nerve enhancement to suggest optic neuritis.


Instruction: Generate impression based on medical findings.

Input: Reason: Evaluate for cord compression, disc disease, nerve root compression. New onset left leg pain Alignment is within normal limits. There is multilevel lumbar spondylosis most severely affecting L4-5, with level specific findings as described below. The imaged portions of the distal cord are normal in signal and caliber. There is some redundancy of the cauda equina which is unchanged. Multiple renal cysts are partially imaged. Additional level specific findings are as follows: T12-L1: No significant degenerative disk disease, central canal, or neuroforaminal stenosis. L1-L2: No significant degenerative disk disease, central canal, or neuroforaminal stenosis. L2-L3: No significant degenerative disk disease, central canal, or neuroforaminal stenosis. Mild hypertrophic facet degenerative changes. L3-L4: Mild disk bulge without significant central canal, or neuroforaminal stenosis. Moderate hypertrophic facet degenerative changes. L4-L5: The right paracentral disk protrusion seen on 5/2012 is decreased, with improved central canal stenosis which is now moderate. However, the degree of disk space narrowing has increased, with new extruded foraminal components. These along with moderate facet degenerative changes result in moderate-severe right and severe left neuroforaminal stenosis, increased since 2012. L5-S1: Minimal degenerative changes with minimal narrowing of both neural foramina and no significant central stenosis.

Output: 1. Severe degenerative disk disease at L4-L5. The degree of disk space narrowing has increased, with new extruded foraminal components resulting in moderate-severe right and severe left neuroforaminal stenosis which has progressed since 2012. The right paracental disk protrusion seen on the prior study has somewhat improved, now with moderate central stenosis. 2. Mild degenerative spondylosis affecting L3-L4 and multilevel facet degenerative changes otherwise appear similar to the 2012 study.


Instruction: Generate impression based on medical findings.

Input: 40 year old male with nonischemic cardiomyopathy referred for cardiovascular MRI to evaluate for etiology of LV dysfunction. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. There is global hypokinesis with septal akinesis. The overall LV ejection fraction is 19%, the LV end diastolic volume index is 172 ml/m2 (normal range: 74+/-15), the LVEDV is 310 ml (normal range 142+/-34), the LV end systolic volume index is 169 ml/m2 (normal range 25+/-9), the LVESV is 251 ml (normal range 47+/-19), the LV mass index is 89 g/m2 (normal range 85+/-15), and the LV mass is 161 g (normal range 164+/-36). Mid septal enhancement. No evidence of infarct. There is no evidence of thrombus in the LV.Left AtriumThe left atrium is mildly enlarged. No evidence of atrial or atrial appendage thrombus.Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 41%, the RV end diastolic volume index is 92 ml/m2 (normal range 82+/-16), the RVEDV is 165 ml (normal range 142+/-31), the RV end systolic volume index is 54 ml/m2 (normal range 31+/-9), and the RVESV is 97 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch. The thoracic aorta is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere are no significant extracardiac findings.

Output: 1. Severely dilated left ventricle with severely reduced systolic function (LVEF 19%)2. There is a region of mid-myocardial late gadolinium enhancement in the basal inferior septum. In the setting of a severely dilated left ventricle this is consistent with a diagnosis of dilated cardiomyopathy.3. Normal right ventricular size with mildly reduced systolic function (RVEF 41%).


Instruction: Generate impression based on medical findings.

Input: Altered mental status, unspecified [R41.82], Reason for Study: ^Reason: eval for vascular abnormality History: syncope, gait instability Brain MRIMotion artifacts degraded exam quality.Especially gradient echo images (venbold) are non diagnostic/There is no evidence of acute ischemic lesion.Patchy FLAIR high signal intensity lesions on bilateral periventricular white matter indicate non specific 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, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRAMotion artifacts significantly degraded image quality.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate patent ICAs, MCAs and ACAs. Vertebrobasilar system appears to be patent.Due to significant motion artifacts, precise evaluation of intracranial arterial system for atherosclerotic changes, mild to moderate luminal stenosis or arterial aneurysm cannot be evaluated.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate about 80% or higher degree of luminal stenosis on the left carotid bulb and distal left CCA.Bilateral distal vertebral arteries at the level of C1 show about 50% luminal stenosis.Left vertebral artery ostium appears to have more than 70% luminal stenosis. The right CCA and extracranial ICA do not show any significant luminal stenosis.

Output: 1. Motion artifacts degraded exam quality.2. No evidence of acute ischemic lesion. 3. Non specific small vessel ischemic disease.4. More than 80% stenosis of the distal left CCA and left CCA bulb as described above.5. Various degree luminal stenosis of bilateral distal vertebral arteries and left vertebral artery ostium as described above.


Instruction: Generate impression based on medical findings.

Input: Muscle weakness. Evaluate for cauda equina syndrome Redemonstrated is a severe compression fracture involving the L3 vertebral body with near complete height loss involving the anterior mid aspect of the vertebral body similar to prior, without residual marrow edema. As before, there is evidence of cement augmentation of the L3 vertebral body. Remainder of the vertebral body heights are normal. Alignment is grossly maintained in the lumbar spine. There are diminished posterior osseous elements from L3-L4 to the sacrum reflecting combination of prior laminectomies and dysplasia, stable in appearance.Abnormal T2 signal likely reflecting myelomalacia in the spinal cord at the L2-L3 level again seen, which is unchanged. The spinal cord remains low-lying with the distal neural tissue/conus extending to the L5 level. Septations/adhesions are again again noted in the thecal sac from the L5 to S1 levels similar to prior. Lipoma within the thecal sac at the right lateral S1 level is again seen as well as along the distal aspect of the filum in the midline at the S2 level. These findings are stable in appearance.Degenerative changes are specified by the intervertebral level as follows and unchanged since 9/26/2016 and 3/31/2016. T12-L1: No spinal canal or neural foraminal stenosis, unchanged.L1-L2: There is bilateral facet hypertrophy and ligamentum flavum thickening. There is minimal disc bulge. There is unchanged mild spinal canal stenosis and bilateral mild to moderate neural foraminal stenosis. L2-L3: There is bilateral facet hypertrophy and ligamentum flavum thickening. There is diffuse disc bulge with central protrusion component resulting in moderate to severe spinal canal stenosis and moderate bilateral foraminal stenosis. These findings are unchanged.L3-L4: There is bilateral facet hypertrophy and ligamentum flavum thickening. There is also mild disc bulge with unchanged mild to moderate spinal canal stenosis and mild to moderate bilateral foraminal stenosis. These findings are unchanged.L4-L5: There is bilateral facet hypertrophy. There is central disc protrusion. No significant spinal canal stenosis. There is unchanged mild bilateral foraminal narrowing, relatively worse on the left. These findings are unchanged.L5-S1: There is bilateral facet hypertrophy without neuroforaminal narrowing or spinal stenosis, unchanged.Fatty atrophy involving the paraspinous musculature again seen, which is predominantly on the right. Left renal cysts again seen.

Output: 1.No significant change in moderate to severe spinal canal stenosis at the L2-L3 level. Unchanged T2 hyperintensity within the cord and volume loss at the this level consistent with myelomalacia.2.Severe chronic compression fracture of the L3 vertebral body with evidence of cement augmentation is unchanged in appearance. 3.Unchanged appearance of the low-lying conus which extends to the L5 level with adhesions within the distal thecal sac as well as residual lipoma involving the right lateral aspect of the thecal sac at the S1 level and to a minimal degree along the distal filum terminale at the S2 level. Re-tethering can be considered in the appropriate clinical setting. 4.Degenerative changes at additional levels as detailed above which are unchanged.


Instruction: Generate impression based on medical findings.

Input: Left tongue cancer: left otalgia and left tongue pain. There is an infiltrative left lateral oral tongue and floor of mouth tumor that measures up to approximately 40 mm, with mass effect or possible invasion of the left sublingual gland. There is no gross mandibular or geniohyoid muscle involvement and the tumor does not cross the midline. There is a heterogeneous left level 2A lymph node that measures 10 x 12 mm in axial section and a left level 3 lymph node that measures 10 x 15 mm in axial section. There is no significant right cervical lymphadenopathy. The thyroid, parotid, and submandibular glands are unremarkable. The orbits and imaged intracranial structures also appear unremarkable.

Output: 1. An infiltrative left lateral oral tongue and floor of mouth tumor that measures up to approximately 40 mm is compatible with squamous cell carcinoma.2. Left level 2 and 3 lymphadenopathy likely represent metastatic disease.


Instruction: Generate impression based on medical findings.

Input: 16-year-old female patient with chronic abdominal pain. Evaluate for small bowel disease.EXAMINATION: MR enterography without and with IV contrast 11/06/2015 ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is no bowel wall thickening, abnormal enhancement, stricture, fistula, or obstruction. Moderate stool burden the colon with mild distention of the descending colon.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: As above.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of free fluid in the pelvis may be physiologic.

Output: 1.No specific evidence of inflammatory changes in the bowel.2.Moderate stool burden in the colon.


Instruction: Generate impression based on medical findings.

Input: 59-year-old female with 3 day history of headache and now has altered mental status. Evaluate for bleed. Patchy nonspecific areas of low attenuation are seen in periventricular white matter with a more discrete focus seen in the right thalamus as well as vague hypoattenuation in the left pons. While these may represent sequela from small vessel ischemic disease, they are of indeterminate age and acute infarct cannot be excluded. If acute infarct is suspected, an MRI should be considered.There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.High density material in the left globe may represent a dislodged lens.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Patchy, nonspecific areas of low-attenuation in the periventricular white matter with a more discrete focus seen in the right thalamus and vague hypoattenuation in the left pons. Without prior comparison studies, it is difficult to distinguish between sequela from small vessel ischemic disease from acute infarct. If acute stroke is clinically suspected, an MRI should be considered.Findings were discussed with the MICU service (pager 3577) via telephone at the time of dictation.


Instruction: Generate impression based on medical findings.

Input: 69 year old male with history of lung cancer with metastases to the brain and thoracic spine. Patient had multiple new strokes recently. Rule out acute bleed or stroke. Curvilinear high density within the right subinsular cortex surrounded by low attenuation white matter corresponds to region of ischemia on MRI dated 11/5/2008 and likely represents dystrophic calcification within an area of chronic ischemia.There is no evidence of intracranial hemorrhage or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No acute abnormality. Chronic ischemia within the right subinsular cortex with encephalomalacia and dystrophic calcification.


Instruction: Generate impression based on medical findings.

Input: 67 year old female with history of left lumpectomy in 2000 for IDC followed by radiation, and right lumpectomy in 2011 for DCIS followed by radiation. Patient received Tamoxifen. No current breast complaints. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Intact bilateral retropectoral silicone implants.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on medical findings.

Input: Clinical question: Optic neuritis, please perform multiple sclerosis protocol. Compared to prior exam. Signs and symptoms: Optic neuritis. Pre and post enhanced brain MRI:Examination demonstrates a punctate new foci of T2 hyperintensity in the corpus callosum (sagittal 3-D FLAIR series 801 image 179) which demonstrate enhancement (axial post enhanced series 901 image 43 and 44) concerning for new enhancing demyelinating plaque.Compared to prior exam there is interval resolution of previously noted enhancing demyelinating plaque.Additionally there is subtle interval decreased size of few of the previously known demyelinating plaques. This observation is particularly noticeable in plaques in the bilateral posterior temporal periventricular white matter and the left parietal subcortical enhancing lesion.There is no convincing evidence of signal abnormality or enhancement of the suprasellar visual complex or the intracranial optic nerves.Subtle increased T2 signal intensity of right optic nerve in the retro-orbital space (axial FLAIR series 601 image 25) could represent a demyelinating plaque or possibly artifactual signal. Post contrast images are not fat saturated and assessment of enhancement in the retro-orbital space is not possible.

Output: 1.New tiny focus of T2 hyperintensity and enhancement in the anterior body of corpus callosum since prior exam.2.Artifact or a true demyelinating plaque of the right retro-orbital optic nerve as detailed. Postcontrast images are not fat saturated and assessment of enhancement in the retrorectal space is not possible.3.Interval resolution of enhancement of a left parietal demyelinating plaques since prior exam.4.Intervertebral decreased size of a few of the previously present lesions as detailed.


Instruction: Generate impression based on medical findings.

Input: Weakness, [728.87], right facial droop, slurred speech There is a focal restricted diffusion on the left basal ganglia (posterior aspect of. Putamen) indicate acute ischemic infarct. There is no evidence of hemorrhage transformation.Underlying brain shows multifocal encephalomalacia especially on the right external capsule anteriorly will internal capsule indicating chronic ischemic infarct.FLAIR imaging shows patch bihemispheric periventricular white matter high signal intensity indicate nonspecific small vessel disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, midline shift, intra or extra-axial fluid collection/hemorrhage. 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.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate a moderate (about 50-70%) stenosis on the mid basal artery. In addition, subtle irregularities of bilateral MCA M2 segments indicate intracranial arthrosclerotic changes. However, there is no evidence of intracranial arterial hemorrhage or occlusion.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. Bilateral vertebral artery origins appear to be narrowed about 50%. Although tortuous, there is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries. No evidence of luminal stenosis.

Output: 1. Acute ischemic infarction, left posterior aspect of putamen without hemorrhagic transformation.2. Multifocal chronic ischemic infarctions as well as minimal non specific small vessel ischemic disease.3. Mild atherosclerotic changes of intracranial arterial system including moderate (50-70%) luminal narrowing of mid basilar artery.4. No significant (more than 70%) luminal stenosis on both extracranial and intracranial arterial system. No intracranial aneurysm. No occlusion of arterial system.


Instruction: Generate impression based on medical findings.

Input: facial numbness, possible stroke No evidence of acute ischemic or hemorrhagic lesion.The right mastoid shows fluid collection which could imply possible mastoiditis. If clinically indicated, ENT consultation and dedicated temporal bone CT scan can be considered for further evaluation.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, 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. 3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate segmental signal loss on bilateral paraclinoid segments and proximal left MCA M1 segment on MIP images. Source image review shows linear signal void lesions were seen within the lumen which degraded MIP signal. These linear signal loss likely represent flow artifacts but may represent segmental intra luminal filling defects such as luminal irregularity or intra luminal blood clots. Thus, if clinically indicated, CT angiography can be considered for further anatomical evaluation. The proximal left MCA M1 segment lesion could represent early development of sickle cell disease related moyamoya syndrome, thus follow up MRA is recommended.Otherwise, vertebrobasilar system appears to be normal, bilateral PCAs are fetal origin, Acom artery is patent and bilateral ACAs and right MCA appear to be normal.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Likely represent artifacts for bilateral paraclinoid ICAs' segmental signal decrease. Anatomical vascular imaging such as CTA can be considered if clinically indicated.3. Subtle luminal narrowing of the left MCA proximal portion which may indicate early development of the Moyamoya syndrome, thus follow up MRA is recommended.


Instruction: Generate impression based on medical findings.

Input: 64 old female with witnessed partial seizure (new onset). Evaluate for bleed. Hypodense region in the left posterior parietal and left occipital lobes with no significant mass effect or volume loss concerning for a subacute infarct. MRI is recommended for further evaluation. Subcortical and periventricular white matter diffuse hypodensities consistent with small vessel ischemic disease of indeterminate age.There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1- Left posterior parietal and occipital lobes hyperdense the concerning for subacute infarct. MRI is recommended for further evaluation.2- Small vessel ischemic disease of indeterminate age.These findings were communicated to Dr. Christopher Chapman via phone at 10:50am.


Instruction: Generate impression based on medical findings.

Input: 61-year-old male with a history of multiple myeloma. Evaluate for bone lesions. BONE MARROW: Note is made of multiple foci of increased bone marrow signal abnormality within the bones of the pelvis suspicious for myelomatous deposits, particularly affecting the left sacral wing, left iliac bone, right iliac bone about the right sacroiliac joint, left iliac crest, right superior acetabulum, left lesser trochanter, and left pubic symphysis.SOFT TISSUES: The imaged musculature is normal in appearance. JOINTS: No significant abnormality noted.ADDITIONAL

Output: Numerous foci of bone marrow signal abnormality within the bones of the pelvis and proximal appendicular skeleton, suspicious for myelomatous deposits as described above.


Instruction: Generate impression based on medical findings.

Input: Elevated PSA. PELVIS:PROSTATE:Prostate Size: The prostate measures 5.7 x 3.8 cm.Peripheral Zone: Within the mid peripheral zone, there is a 4.4 x 3.5 mm T2 hypointense lesion which restricts diffusion, which is equivocal. No additional lesion is identified.Central Gland: The transition zone is nodular in appearance, compatible with benign prostatic hypertrophy.Seminal Vesicles: No significant abnormality identified. No evidence of seminal vesicle invasion.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: Subcentimeter perirectal lymph nodes. No lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Equivocal mid peripheral zone T2 hypointense lesion which restricts diffusion, with no seminal vesicle invasion or extracapsular extension.


Instruction: Generate impression based on medical findings.

Input: Code 65-year-old female with history of NHL. Status post transplant. Follow-up on a small subdural hematoma identified on MRI of brain. No evidence of hemorrhage, edema, mass effect, midline shift or hydrocephalus is detected. No evidence of subdural is identified as was noted on prior MRI exam. The cortical sulci, ventricular system and all CSF cisterns remain within normal limits.

Output: Normal CT of brain.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Intracranial hemorrhage. Signs and symptoms: Headaches, nausea and vomiting Subtle periventricular and subcortical foci of increased signal intensity in bilateral cerebral hemispheres are noted. These findings are no noticeable than prior CT from 6 -- 30 -- 2007. This discrepancy may be due to technique. Similar findings were noted on prior MRI examinations and were believed to represent press. Cortical sulci, ventricular system and all CSF cisterns are otherwise within normal limits and stable since prior study. No evidence of hemorrhage, mass effect, midline shift or hydrocephalus.

Output: Subtle subcortical areas of low-attenuation as detailed above which may represent sequela of prior press.


Instruction: Generate impression based on medical findings.

Input: 85 year-old female with facial asymmetry and left hand weakness. There is redemonstration of a left temporal craniotomy with underlying extensive encephalomalacia in the left frontotemporal and ex vacuo dilatation of the left lateral ventricle, unchanged when compared to the previous study. There is no new parenchymal lesion or CT evidence of acute territorial ischemia. MRI would be more sensitive for small or acute infarctions.There is no acute intracranial hemorrhage or extraaxial collection. The ventricles and sulci are stable with ex vacuo dilation of the left lateral ventricle as noted earlier. No midline shift or basal cistern effacement.The visualized mastoid air cells and paranasal sinuses are within normal limits. Orbits unremarkable. Redemonstration of debris within the extra auditory canals bilaterally.

Output: 1. No evidence of acute intracranial hemorrhage or CT evidence of acute territorial ischemia. MRI is offered as a more sensitive test should there be a high degree of suspicion for acute infarction.2. Stable left temporal lobe encephalomalacia underlying prior craniotomy site consistent with prior left MCA infarct.


Instruction: Generate impression based on medical findings.

Input: 72 years Female (DOB:4/5/1944)Reason: 2 temporary episodes of loss of vision in R eye, brief episode of temporal pain History: 2 temporary episodes of loss of vision in R eye, brief episode of temporal painPROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a small air-fluid level in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is small size. There is fetal origin of the posterior cerebral arteries bilaterally with moderate-sized right P1 segment and a hypoplastic left P1 segment. The right vertebral artery is hypoplastic distally and predominantly supplies the right posterior inferior cerebellar artery.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is approximately 40% narrowing at the origin of the right internal carotid artery. There is no significant stenosis along the course of the left vertebral artery. There is a stenosis at the origin of the right vertebral artery.The left common carotid artery originates from the innominate artery.

Output: 1.There is a stenosis at the origin of the right vertebral artery which is hypoplastic intracranially.2.There is no evidence for acute ischemic cerebral infarction.3.There is 40% narrowing at the origin of the right internal carotid artery.4.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 5.Air-fluid level in the left maxillary sinus is nonspecific. The possibility of acute sinusitis, however, cannot be excluded. Please correlate with patient's clinical symptoms.


Instruction: Generate impression based on medical findings.

Input: 53 years Male (DOB:7/15/1962)Reason: seizure protocol History: seizure since 2012PROVIDER/ATTENDING NAME: SHASHA WU SHASHA WU The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical white matter lesions present which are high signal on T2 and FLAIR MRI. There are punctate foci of T2 and FLAIR signal hyperintensity in the basal ganglia and thalami as well as the brainstem.There is a focus of encephalomalacia in the inferior aspect of the right cerebellar hemisphere and another one along the right superior frontal gyrus. These are associated with some punctate foci of susceptibility effect. A small focus of encephalomalacia is present in the right occipital lobeThere are multiple foci of signal loss and susceptibility imaging involving the thalami bilaterally as well as some of the subcortical white matter of the temporal lobes and the brainstem.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 demonstrated minor opacities. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is a focus of encephalomalacia involving the right superior frontal gyrus which is suspected to be the result of prior ischemic events.2.A focus of encephalomalacia along the inferior aspect of the right cerebellar hemisphere is suspected to be a result of a a prior ischemic event. It is associated with a small lesion in the right medulla suspected to represent an old lacunar infarct.3.A small focus of encephalomalacia is present in the right occipital lobe also likely related to prior ischemic event.4.There are multiple punctate lesions in the basal ganglia and brainstem suspected represent old lacunar infarcts5.Multiple microhemorrhages present, involving the thalami and brainstem as well as a bit of the temporal lobes. These are suspected to have resulted from hypertension based on the pattern.6.Periventricular and subcortical white matter lesions of a moderate degree are nonspecific. At this age they are most likely vascular related.