Instruction: Generate impression based on medical findings.

Input: There are unchanged postoperative findings related to right occipital craniotomy and occipital mass resection. The previously seen focus of enhancement along the superior margin of the postoperative bed is no longer appreciated on today's exam. There is no other evidence of recurrence or residual tumor. Again seen is extensive confluent subcortical and periventricular white matter T2 signal abnormality which likely represents therapy related change. No evidence of acute intracranial hemorrhage, mass, mass effect or midline shift. There is an unchanged right transfrontal ventricular catheter terminating in the third ventricle/level of the foramen of Monro. Mild diffuse volume loss is again noted with stable ventricles. There is mild bilateral maxillary and scattered ethmoid sinus mucosal thickening.

Output: Stable postsurgical findings within the right occipital region without evidence of residual/recurrent tumor.


Instruction: Generate impression based on medical findings.

Input: There is an unchanged expanded-empty sella without evidence of mass lesions. The pituitary gland is markedly flattened along the superior aspect of the sella. The pituitary stalk lies in the midline. The optic apparatus and cavernous sinuses are intact. There are prominent arachnoid granulations in the left middle cranial fossa, into which the inferior temporal lobe slightly protrudes. There is a subcentimeter cystic lesion in the posterior nasopharynx, which may represent a retention cyst or Thornwaldt cyst.

Output: Unchanged enlarged partially-empty sella and prominent left middle cranial fossa arachnoid granulations, into which the left inferior temporal lobe slightly protrudes, may be manifestation of pseudotumor cerebri.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Headache(784.0)Clinical question: pain behind right eyeSigns and Symptoms: pain behind right eye 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.There is a cystic-appearing extra-axial mass present measuring 18 x 13 mm axial dimensions which is underneath and adjacent to the left inferior temporal gyrus and abuts the petrous portion of the temporal bone it is somewhat heterogeneous on T2 imaging but it is low signal on FLAIR imaging and low signal on T1-weighted imaging is suspected to be associated with the lumen of susceptibility effect. It appears to be covered by dura. There also appears to communicate with the left temporomandibular joint. Incidental note is made of some hypertrophic changes at the left temporomandibular jointThere is a 18 x 7 mm coronal dimension sessile extra-axial lesion present which is adjacent to the right parietal lobe. It is associated with diffusion restriction.No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.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. The patient is status post anterior fusion at C5-6.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There are small uncovertebral osteophytes present at this level associated with some disc material and mild narrowing of the neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There are uncovertebral osteophytes present on the right side at this level with some narrowing of the right neural foramen.At C5-6 there is no significant compromise to the spinal canal or neural foramina.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.Small lesions are suspected present in the left upper mediastinum which are bright signal on T2 STIR imaging. The adjacent to each other one measures 10 x 14 mm sagittal dimensions and the other measures 9 x 12 mm sagittal dimensions. This is not completely imaged on this exam. It's possible that may represent lymph nodes at the upper limits of normal in size.

Output: 1.There is a small extra-axial mass present adjacent to the right parietal lobe. It most likely represents a meningioma. It does not compress the underlying brain.2.There is a small complex cystic extra-axial lesion adjacent to the left temporal lobe. If clinically appropriate MRI of the brain with gadolinium may be of further benefit in evaluating this since it does have a somewhat complex appearing component. Its proximity to the left TMJ may suggest a relationship with this such as a ganglion cyst or synovial chondromatosis. Another possibility is that it represents a cystic meningioma. It is atypical for an arachnoid cyst.3.There are multilevel degenerative changes present in the cervical spine but no significant compromise to spinal canal or exiting nerve roots. The patient is status post anterior fusion at C5-6.4.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.5.There are degenerative changes present in the left temporomandibular joint that are not completely imaged on this exam and appear to be adjacent to the cystic lesion identified next to the temporal lobe. If clinically appropriate CT or plain film imaging of the temporomandibular joint may be of benefit.6.Nodules in the left upper mediastinum are incompletely imaged on this exam and may represents lymph nodes but are not adequately imaged for a more conclusive interpretation. This would represent an incidental finding.7.Findings were discussed with Dr. HEKMATPANAH at 11:30 on 7/6/15.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Unspecified convulsionsClinical question: Evaluate for seizure like activity, patient is admitted to LTMSigns and Symptoms: Episode of GTC like activity in her sleep witnessed by husband. No known gaze deviation or focality noted. The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate opacification of a right sphenoid sinus air cell. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. There is a 3mm submucosal cystic nodule present in the nasopharyngeal mucosal space which is probably benign

Output: MRI of the brain is within normal limits. There is no evidence for intracranial mass lesion and no evidence for cerebral infarction to explain the patient's tonic-clonic seizures.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old, with lacrimal gland enlargement. The left lacrimal gland is enlarged relative to the right. However, both lacrimal glands demonstrate similar T2 signal characteristics with only slightly more heterogeneity on the left. No discrete solid or cystic lesion is identified. Enhancement of both lacrimal glands is solid and fairly homogeneous. There are no findings to suggest significant inflammation in the adjacent orbital soft tissues. The extraocular muscles, optic nerve, orbital fat and globe are all within normal limits. Mucosal thickening and evidence for osteogenesis are demonstrated in the right maxillary sinus.

Output: Enlargement of the left lacrimal gland is seen without evidence for a discrete underlying cystic or solid lesion. The differential diagnosis would include inflammation, including idiopathic orbital inflammation (orbital pseudotumor), infectious or postinfectious processes, a manifestation of granulomatous or connective tissue disease. The possibility of a lacrimal gland tumor would remain in the differential as well.


Instruction: Generate impression based on medical findings.

Input: 40 year-old female with family history of breast carcinoma in her mother at age 69 and a paternal aunt. History of bilateral breast implants. Known left breast fibroadenoma. Heterogeneous fibroglandular tissue with marked background parenchymal enhancement is noted bilaterally. Bilateral retropectoral saline implants are identified. The implants demonstrate normal contour with no evidence for rupture. At the approximate 1:00 position of the left breast, posterior depth, there is a 1.0 cm intermediate signal intensity nonenhancing mass best seen on the T2 weighted sequence, corresponding to the benign morphology mass on recent ultrasound, likely the patient's known fibroadenoma. A nonenhancing cyst is present at the 6 o'clock position of the left breast.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: Benign morphology left breast mass, corresponding to the known left breast fibroadenoma. No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on medical findings.

Input: 84-year-old male with possible rotator cuff tear. ROTATOR CUFF: High T2 signal is present within the anterior supraspinatus tendon supraspinatus tendon near its insertion, most likely representing a full-thickness tear, as there is a small amount of fluid within the subacromial/subdeltoid bursa. There is no evidence of tendinous retraction. Foci of low T1 and T2 signal adjacent to the supraspinatus insertion are consistent with calcium hydroxyapatite deposition, corresponding to enthesopathic changes seen on the recent left shoulder radiograph. The remaining rotator cuff musculature and tendons are within normal limits.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenoid labrum is grossly intact, as is the articular surface of the humeral head.BICEPS TENDON: A small amount of fluid is present within the biceps tendon sheath, just distal to the bicipital groove. ADDITIONAL

Output: Findings consistent with calcific tendinopathy of the supraspinatus tendon, with a tear at its insertion which is most likely full-thickness, but without evidence of retraction.


Instruction: Generate impression based on medical findings.

Input: Pain, instability. Evaluate labrum. ROTATOR CUFF: The supraspinatus, infraspinatus, subscapularis, and teres minor tendons are intact. No partial or full thickness rotator cuff tear is present. No significant fluid is seen in the subacromial/subdeltoid bursa.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is contrast seen deep to a displaced labral fragment of the superior labrum, extending from approximately the 10:00 to 1:00 position, suggestive of SLAP lesion (best seen on image 14, series 401).BICEPS TENDON: The biceps tendon is intact. ADDITIONAL

Output: Findings suggestive of SLAP lesion, as above.


Instruction: Generate impression based on medical findings.

Input: 51-year-old female with chronic elbow pain LIGAMENTS: The collateral ligaments appear intact.TENDONS: The flexor and extensor tendons are intact without associated signal abnormality.ARTICULAR SURFACES AND BONE: The bone marrow signal is within normal limits. The articular surface is grossly within normal limits.SURROUNDING STRUCTURES: The biceps and triceps tendons are intact.ADDITIONAL

Output: No specific findings to account for the patient's chronic elbow pain.


Instruction: Generate impression based on medical findings.

Input: Vocal cord paralysis and dysphagia. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain, cerebellum, and brainstem 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. There is a 5 mm diameter right paraophthalmic aneurysm. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a small left maxillary sinus retention cyst.

Output: 1. No evidence of gross brainstem lesions or lesions along the proximal portions of the vagus nerves.2. A 5 mm diameter right paraophthalmic aneurysm is better depicted on the prior MRA.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old, with GBM, status post clinical investigation. Postoperative findings are again seen at the left parieto-occipital junction. The heterogeneously rim-enhancing lesion at this location has increased in size with a maximal axial dimension of approximately 50 mm, previously 38 mm. As before, the lesion extends to the ependyma of the left ventricular atrium which is progressively effaced. A small portion of the enhancing component correlates to elevated rCBV, but the majority shows relatively reduced rCBV. T2 hyperintense signal abnormality and edema within the adjacent parenchyma has progressed further into the anterior temporal lobe, temporal stem and capsular white matter, the splenium of the corpus callosum, and the superior parietal lobule. No entirely new enhancing lesions are seen. No definite contralateral involvement is detected.

Output: There has been interval increase in size of the enhancing lesion in the left parieto-occipital junction along with progressive T2 hyperintensity and edema. These findings are concerning for progressive disease. However, given that the lesion demonstrates overall low rCBV, the possibility of a treatment related effect can be entertained. Correlation with timing and nature of treatment may be helpful.


Instruction: Generate impression based on medical findings.

Input: 67-year-old female with right knee pain and recurrent falls. MENISCI: There is intrasubstance degeneration within the body of the lateral meniscus, but we see no definite tear. Additionally, there is perhaps fraying of the undersurface of the posterior horn of the medial meniscus, but we see no discrete tear. ARTICULAR CARTILAGE AND BONE: There is mild to moderate diffuse degeneration of the articular cartilage of the patella. There is a small, focal full thickness defect along the articular cartilage of the medial femoral condyle, best seen on coronal image 14 of series 9. There is a subcentimeter, amorphous, and somewhat lobulated focus of abnormal signal intensity within the anterior aspect of the medial tibial plateau that may represent a small vascular malformation or cartilaginous rest, but this is of questionable significance.LIGAMENTS: The cruciate, lateral, and medial ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact. There is minimal edema anterior to the patella and patellar tendon, which is not necessarily of clinical significance. ADDITIONAL

Output: Mild to moderate diffuse degeneration of the articular cartilage of the patella, and other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Altered mental status, unspecifiedClinical question: eval for PRESSigns and Symptoms: somnolence bone marrow transplantComments: Patient does not need sedation but is on Precedex and Dilaudid so needs appropriate monitoring | There is a mild degree of generalized brain atrophy for the patient's stated age of 22.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 demonstrate mild mucosal thickening.. 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 cerebral infarction or other intracranial lesion. There is no evidence for posterior reversible encephalopathy syndrome.2.For the patient's stated age of 22 there is a mild degree of generalized brain atrophy present which is unchanged since the prior exam. This is nonspecific but is not significantly changed since the prior exam3.Examination is mildly degraded due to patient motion. This may obscure more subtle abnormalities.


Instruction: Generate impression based on medical findings.

Input: Right ptosis and diplopia. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are mild scattered nonspecific cerebral white matter T2 hyperintense foci. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are grossly unremarkable. There is mild right maxillary sinus mucosal thickening.Orbits: There is no evidence of orbital mass lesions. The bilateral globes, optic nerves, extraocular muscles, lacrimal glands, and orbital fat are unremarkable.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. No evidence of orbital mass lesions.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old, history of GBM, assess for growth. Has been on Avastin and AMG386 since 1/2015. Findings are redemonstrated compatible with prior left temporal surgery. A heterogeneous, hemosiderin stained lesion occupying a large part of the left lateral temporal lobe has increased in size, including the thick enhancing component, particularly when compared to examinations from early 2015 and before.Numerous additional areas of tumor have also progressed, including an enhancing lesion within the right frontal lobe, as well as scattered nodular diffusion-restricting deposits along the corpus callosum and bilateral centrum semiovale bilaterally, some of which are new and some of which are larger. Diffuse nonenhancing T2 hyperintense thickening through the right temporal lobe is not substantially increased. Likewise, T2 hyperintense signal within the bilateral thalami is grossly stable. Vague bilateral periventricular T2 hyperintensity, distinct from the nodular disease mentioned above, has not significantly changed and is likely treatment related.No new or significant generalized mass effect is seen. No new abnormal collections are detected. Ventricular system is stable in size.

Output: Progressive multifocal tumor with a combination of growing and new lesions.


Instruction: Generate impression based on medical findings.

Input: 64 years Female (DOB:7/8/1951)Reason: new right precentral gyrus stroke History: left sided paresis and sensory deficitsPROVIDER/ATTENDING NAME: DAVID A HARTER RICHARD KRAIG 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 abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:The MRA exam is mildly degraded due to patient motion.Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are small to medium sized. The vertebral arteries are similar in size.

Output: 1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.No evidence for acute ischemic cerebral infarction4.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 5.Exam is somewhat degraded due to patient motion artifact which may obscure more subtle abnormalities.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Thoracic or lumbosacral neuritis or radiculitis, unspecifiedClinical question: assess stenosisSigns and Symptoms: radiculopathy Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is some loss of disc space height as well as a disc bulge at this level and a disc desiccation.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is mild facet hypertrophy present at this level. There is mild loss of disc space height and a mild disc desiccation at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is an incompletely included cystic lesion present in the left side of the pelvis measuring approximately 50 x 44 mm in sagittal dimensions . It is bright on T2 and dark on T1-weighted imaging.

Output: 1.There are some mild degenerative changes present in the lower lumbar spine without significant compromise to spinal canal or exiting nerve roots.2.There is a left pelvic cystic lesion present which is not completely included on this exam. Please correlate with clinical exam findings. If clinically appropriate an ultrasound of the pelvis may be of benefit to further evaluate this. One possibility is that this is related to the left ovary.3.At the time of this dictation alphanumeric page was sent to Dr. James Mok with the above unusual finding and callback number. In addition an email was sent to Dr Mok as well.


Instruction: Generate impression based on medical findings.

Input: Female, 11 years old, status post head injury, craniectomy. Brain:Right frontal scalp swelling is seen along with evidence of the recent craniectomy. The known right frontal bone fracture is not specifically visualized on MRI. Sequelae of prior left frontal ICP monitor are also seen.The right frontal parenchyma subjacent to the area of skull fracture demonstrates mild T2 and questionable mild restricted diffusion. Clear restricted diffusion is seen within the splenium of corpus callosum. There may also be a few additional punctate foci of restricted diffusion, for example along the right superior cerebellum.No evidence of significant generalized mass effect is seen. No abnormal extra-axial collections are detected. Several punctate foci of susceptibility are evident in the right frontal lobe compatible with microhemorrhage. The ventricular system is normal in size and morphology. The mastoid air cells are opacified.C-spine:Straightening of the cervical lordosis is likely positional. Vertebral body height and morphology are within normal limits. No evidence of marrow replacement or marrow edema is seen. The visualized spinal cord demonstrates normal signal intensity and morphology. No epidural collections are observed. The prevertebral tissues are difficult to assess due to intubation. The posterior paraspinal musculature is edematous. In addition, there is edema along the inferior aspect of the nuchal ligament, as well as mild edema within some of the interspinous spaces. However, the ligaments of the craniocervical junction, the ALL, PLL and ligamenta flava all appear to be intact. The intervertebral discs are preserved. No significant compromise of the spinal canal or neural foramina is demonstrated.

Output: 1.Sequelae of right skull fracture and craniectomy are demonstrated.2.The frontal lobe parenchyma subjacent to the area of fracturing demonstrates edema with perhaps a minor component of cytotoxic edema. There is also evidence of subtle microhemorrhage. 3.Restricted diffusion is also seen in the splenium of corpus callosum which can indicate axonal shear injury. There may be a few additional foci of punctate restricted diffusion also indicating axonal injury.4.No evidence of injury to the spinal cord or the osseous cervical spine is seen. The posterior paraspinal musculature is edematous. In addition, there is edema suggesting strain or partial tearing along the inferior nuchal ligament and to a lesser degree within the interspinous spaces of the mid cervical spine.


Instruction: Generate impression based on medical findings.

Input: Confusion, ataxia There is a globular and elliptical shaped enhancing mass starting from the right basal ganglia extended superiorly toward right caudate head and downward to the level of right midbrain with the extensive surrounding edema. The longitudinal diameter of the mass is measured about 43.7 mm in transverse diameter was measured around 23 mm. There is also midline shift toward left side at the level of the third ventricle measured around 6 mm.Due to significant motion artifact during susceptibility imaging, intralesional hemorrhagic foci cannot be evaluated precisely.There is no evidence of restricted diffusion on the scan.There is no evidence of additional enhancing lesion on the scan.The differential diagnosis of this intra-axial mass includes primary brain tumor such as high-grade glioma or metastatic lesion.Underlying brain shows multiple encephalomalacia seen including right external capsule left cerebellar hemisphere and right posterior edema of internal capsule indicate chronic ischemic infarct related encephalomalacia seen.Moderate degree nonspecific small vessel ischemic disease is also seen.The ventricles, sulci and cisterns are symmetric and unremarkable. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Intra-axial mass centered at the level of right basal ganglia extends from right caudate nucleus to the level of right midbrain with contrast enhancement, surrounding edema and mass effect as described above. Differential diagnosis includes primary malignant brain tumor or metastasis2. Underlying brain shows multifocal chronic ischemic infarcts with encephalomalacia seen as well as moderate degree nonspecific small vessel ischemic disease.3. There is no evidence of acute ischemic lesion on the scan.


Instruction: Generate impression based on medical findings.

Input: Female, 37 years old. Reason: SLE pt with palpable bilateral goiter. History: no symptoms - feeling hot a lot of the time. RIGHT LOBE MEASUREMENTS: 3.4 x 1.8 x 6.5 cmLEFT LOBE MEASUREMENTS: 2.4 x 2 .0 by 4.8 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Heterogeneous echotexture. Multiple predominantly cystic. A dominant cystic lesion in the right thyroid lobe measures 3.7 x 1.9 x 4.7 cm, with small mural nodular solid component, with mildly increased vascularity of the solid component. An additional right thyroid lobe complex cystic nodule measures 1.0 x 0.7 x 1 .0 cm, with peripheral vascularity. An additional mixed cystic and solid nodule in the right thyroid lobe measures 2.3 x 2.2 x 1.2 cm, with increased vascularity of the solid component.LEFT LOBE: Heterogeneous echotexture, with multiple subcentimeter predominantly cystic. A larger nodule with cystic and solid components measures 2.2 x 2.1 x 1.7 cm, with increased vascularity of the solid component, and may be part of a larger nodule with a hypoechoic rim.ISTHMUS: Mildly heterogeneous echotexture.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multiple bilateral predominantly cystic lesions as detailed above, which most likely represent colloid nodules. A mixed cystic and solid nodule in the left thyroid lobe may be part of a larger nodule with a hypoechoic rim.


Instruction: Generate impression based on medical findings.

Input: Blurry vision and intermittent paresthesia. Evaluation for demyelination. No evidence of acute ischemic or hemorrhagic lesion on the scan.No evidence of abnormal signal intensity on FLAIR imaging.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. The paranasal sinuses and mastoid air cells are clear.

Output: Normal brain MRI scan.


Instruction: Generate impression based on medical findings.

Input: 73-year-old female with history of recurrent/progressive GBM status post resection and radiation Again seen are post operative changes of a right posterior temporal-parietal craniotomy. Surgical resection cavity with CSF signal intensity in the right superior temporal gyrus measures 23 x 20 mm, previously 25 x 20 mm, not significantly changed from prior exam. Surrounding FLAIR hyperintensity is not significantly changed. On post enhanced images the previously noted linear inhomogeneous enhancement along the posterior surgical cavity wall is not significantly changed and demonstrates restricted diffusion, intrinsic T1 shortening, and evidence of blood products. Additional focus of enhancement along the anterior inferior aspect of the surgical cavity measuring approximately 5 mm is also unchanged. 4 mm focus of enhancement along the supermedial wall of the resection cavity is also unchanged. There are no new intracranial lesions or abnormal enhancement noted. No new mass effect, herniation, or hydrocephalus.

Output: Compared to 5/12/2015, there is no evidence of interval tumor progression. Specifically, 5 mm focus of nodular enhancement along the anterior margin of the resection cavity and 4 mm focus along the superomedial aspect of the resection cavity are not significantly changed. Additional less suspicious areas of enhancement posteriorly also remains unchanged.


Instruction: Generate impression based on medical findings.

Input: Multiple sclerosis: right sided numbness. Brain: There has been interval increase in the size and number of T2 hyperintense lesions involving the cerebral white matter, including in the unilateral corona radiata, posterior cingulate gyri, and peritrigonal regions. 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.Cervical Spine: There is a faint patchy area of T2 hyperintensity in the left spinal cord at the C4 level. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: 1. Interval progression of the intracranial demyelinating lesions.2. Small residual demyelinating lesion in the left spinal cord at the C4 level.


Instruction: Generate impression based on medical findings.

Input: 15-year-old male with history of knee trauma and mechanical symptoms. Evaluate for cruciate/meniscal injury. MENISCI: There is a large complete longitudinal tear of the periphery of the body and posterior horn of the lateral meniscus, seen on multiple sequential sagittal and coronal images. The anterior horn appears intact. There is a complex tear of the posterior horn of the medial meniscus, consisting of a complete longitudinal tear through the periphery of the horn and a more oblique component, extending from the periphery to the femoral articular surface. The periphery of the body of the medial meniscus is indistinct and we cannot exclude meniscocapsular separation.ARTICULAR CARTILAGE AND BONE: There is a small bony fragment along the lateral aspect of the proximal tibial epiphysis representing a Segond-type fracture and/or an iliotibial band avulsion fracture. There is edema within the underlying marrow of the tibial plateau. There is also an impaction fracture along the lateral femoral condyle along the anterior horn of the meniscus which is associated with underlying bone marrow edema consistent with a "lateral notch sign". There is mild edema within the far medial aspect of the tibial plateau as well. There are no fluid-filled articular cartilage defects.LIGAMENTS: There is a full-thickness rupture of the ACL. The PCL appears intact. There is a partial thickness tear of the anterior fibers of the proximal half of the MCL. The femoral attachment of the medial patellofemoral ligament is not well visualized amidst this edema. The lateral collateral ligament proper and biceps femoris tendon appear intact. The anterior fibers of the iliotibial band can be traced to their insertion onto Gerdy's tubercle. The posterior fibers appear to attach to the aforementioned Segond type avulsion fracture.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Rupture of the ACL with a Segond type fracture and other associated findings as described above.2. Medial and lateral meniscus tears as described above with possible medial meniscocapsular separation.3. Joint effusion and other findings as described above.


Instruction: Generate impression based on medical findings.

Input: This exam is mildly degraded by motion artifact. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are no areas of abnormal parenchymal signal. There is mild prominence of the ventricles and extra-axial spaces. There is no midline shift or herniation. There is asymmetric prominent T2 and FLAIR hyperintensity within the right transverse sinus, without susceptibility or diffusion restriction. The remainder of the major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. The midline structures and craniocervical junction are within normal limits.

Output: 1.Mildly motion degraded exam without evidence of mass, acute infarct, or structural abnormality. 2.Findings compatible with benign external hydrocephalus, a finding that should resolve by 2 years of age. Follow-up imaging may be obtained as clinically indicated.3.Apparent asymmetric signal within the right transverse sinus is likely artifactual relating to differential venous flow, however, an MRV or contrast-enhanced MRI to exclude the possibility of thrombus.


Instruction: Generate impression based on medical findings.

Input: Female 58 years old Reason: patient presents with left plantar foot ulcer; evaluate for osteomyelitis History: left foot ulcer There is ulceration of the soft tissues of the ball of the foot beneath the first metatarsophalangeal joint. Best seen on postcontrast sequences there is what appears to be a nonenhancing tract extending from the ulcer toward both hallux sesamoid bones. There is edema and enhancement of adjacent soft tissues indicating inflammation. There is abnormal signal and enhancement in the medial sesamoid bone consistent with osteomyelitis although we see no frank cortical destruction. There is also low signal intensity within the lateral sesamoid on T1 images which may also represent osteomyelitis although this is less likely as there is no edema seen on the STIR sequence. Signal intensities of the metatarsals is normal. Signal intensity of the first through third toe phalanges is normal. Evaluation of the fourth and fifth toes is limited due to metallic susceptibility artifact, likely from foreign body in the fifth toe.There is enhancement of the sheath of the flexor hallucis longus as it courses beneath the first proximal phalanx and first metatarsal indicating tenosynovitis with a tiny amount of fluid, particularly distally. Atrophy of the plantar muscles of the foot is noted. There is mild increased STIR signal in the muscles which may represent mild edema.

Output: 1.Ulceration of the base of the great toe with underlying inflammatory changes in the soft tissues.2.Signal abnormality of the hallux sesamoid bones, with changes compatible with osteomyelitis in the medial sesamoid bone, and findings equivocal for osteomyelitis in the lateral sesamoid bone.3.Tenosynovitis of the flexor hallucis longus tendon which could represent infection.


Instruction: Generate impression based on medical findings.

Input: 57 years Female (DOB:10/4/1959)Reason: h/o Chiari s/p decompression with nystagmus HA and ataxia History: h/o Chiari s/p decompression with nystagmus HA and ataxiaPROVIDER/ATTENDING NAME: CHRISTOPHER M GOMEZ CHRISTOPHER M GOMEZ The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient status post suboccipital craniotomy. There is reversal of normal cervical curvature present. There is no evidence for ventriculomegaly or syrinx.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.CSF flow study is stable.The visualized portions of the paranasal sinuses demonstrate a small mucous retention cyst in the right maxillary sinus.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Status post suboccipital craniotomy for Chiari I malformation. There is no evidence for ventriculomegaly on this exam and no significant change compared to the prior exam.


Instruction: Generate impression based on medical findings.

Input: T4N0 adenoid cystic carcinoma of minor salivary gland/maxillary sinus with intracranial extension. There has been interval partial left maxillectomy. There is diffuse mild left maxillary sinus mucosal thickening, with persistent patchy enhancement in the underlying left maxillary alveolus and retromaxillary region. There is also persistent perineural tumor extension involving the left infraorbital nerve, pterygopalatine fossa, Vidian canal, foramen rotundum, foramen ovale, and cavernous sinus, as well as along the cisternal segment of the left trigeminal nerve, but no evidence of intraparenchymal extension. There is also persistent enhancing tumor within the medial left extraconal orbit, which measures up to 6 mm in width. There is no discernible residual right pituitary tumor. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is no evidence of significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable.

Output: 1. Interval post-treatment findings in the left sinonasal region with persistent perineural tumor involving the left trigeminal nerve branches with intracranial extension, as well as persistent patchy enhancement in the underlying left maxillary alveolus and retromaxillary region. 2. Persistent left medial orbit extraconal tumor.3. No evidence of brain parenchymal metastases.


Instruction: Generate impression based on medical findings.

Input: 61 year-old female with cognitive changes and memory loss. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. Right cerebellar hemispheric encephalomalacia, compatible with remote infarction with mild associated vacuo dilatation of the fourth ventricle. There is complete loss of the flow void of the distal right V3 segment of the vertebral artery with partial distal reconstitution along the right V4 segment likely representing retrograde flow.Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, pons and medulla which are nonspecific, but compatible with chronic small vessel ischemic changes. Sella and orbits are grossly within normal limits. Trace fluid in the right mastoid air cells. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct.2. Moderate chronic small vessel ischemic changes as described above.3. Stable remote extensive right cerebellar infarction.4. Loss of the right vertebral artery (V3 segment) flow void flow as seen on prior ultrasound with partial distal reconstitution of right V4 segment likely representing retrograde flow. If further evaluation of the vasculature is clinically warranted, CTA or MRA may be considered.


Instruction: Generate impression based on medical findings.

Input: 62-year-old male with weakness, ataxia, multiple falls, perianal anesthesia and decreased rectal tone. Evaluate for stenosis or cord compression. The vertebral bodies are appropriate in the overall alignment and height. There are multiple disc-osteophyte complexes in the cervical spine with evidence of cord signal abnormality at the C3-4 level, indicating cord edema. There are multiple discs protrusions involving the lower lumbar lumbar spine with some narrowing of the spinal canal. There is a sigmoid curvature to the spine with levoscoliosis of the lower spine and dextroscoliosis of the upper spine.

Output: This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. There is abnormal cord signal indicating cord edema at the C3-4 level. There is a disc-osteophyte complex and facet degenerative disease at this level. These findings are compatible with spondylotic myelopathy at this level. Please refer to the dedicated MRI C-spine for further characterization which as since been performed. Additional degenerative changes are seen in the cervical and lumbar spine.


Instruction: Generate impression based on medical findings.

Input: Clinical question: History of head and neck cancer with brain metastases status post SRS, surveillance MRI. Signs and symptoms: None. Pre and post enhanced brain MRI:Negative diffusion weighted series.Examination demonstrates significant interval improvement of postoperative changes of left temporal lobe surgery for removal of tumor. There is significant interval decreased postoperative enhancement at the site with trace residual enhancement. Examination also demonstrates significant interval decreased parenchymal FLAIR hyperintensity at this site.There is no detectable abnormal parenchymal or leptomeningeal enhancement to suggest new metastatic disease since prior exam. Stable few punctate nonspecific FLAIR hyperintensity in the periventricular and subcortical white matter of cerebral hemispheres. There is revisualization of a tiny left anterior frontal developmental venous anomaly without detectable associated cavernoma.Unremarkable cerebral cortex, cortical sulci, ventricular system and CSF spaces otherwise for age.Unremarkable calvarium other than expected postoperative changes of prior left sided craniotomy.Unremarkable images through the orbits and including axial fat sat post enhanced images.All paranasal sinuses and bilateral mastoid air cells demonstrate normal pneumatization signal pattern.

Output: 1.No acute intracranial process and negative diffusion weighted series.2.Significant interval improvement of postoperative changes of left temporal lobe without residual tumor.3.No detectable metastatic lesion of the brain, leptomeninges or the calvarium.4.Stable few punctate nonspecific FLAIR hyperintensity in bilateral cerebral hemispheres.5.Revisualization of a tiny left anterior frontal developmental venous anomaly without associated cavernoma.


Instruction: Generate impression based on medical findings.

Input: 48-year-old male with left elbow wound, assess for communication with elbow joint, history of steel pipe falling on arm There is a skin defect along the medial aspect of the elbow with herniation of the subcutaneous fat. Diffuse edema is present within the subcutaneous fat surrounding the elbow. Heterogeneous signal within the subcutaneous fat along the medial aspect of the elbow presumably represents hematoma. There is extensive edema within the distal aspect of the medial and long heads of the triceps muscle, compatible with the stated history of crush injury; the majority if not all of the triceps tendon appears to insert on the olecranon. There is edema within the common flexor tendon and adjacent musculature, but no fluid filled gap to indicate complete rupture. The anterior bundle of the ulnar collateral ligament is intact. The ulnar nerve is slightly medially subluxed from the cubital tunnel. There is a small amount of surrounding fluid as well as mild increased signal intensity within the nerve itself suggesting edema. There is no visible communication of the wound with the elbow joint space. A small amount of fluid is present in the joint without significant effusion. Edema is present within the proximal brachioradialis and extensor carpi radialis longus muscles. Foci of low signal within the extensor carpi radialis longus may represent blood product. There are additional foci of low signal within the subcutaneous fat and musculature along the posterolateral elbow which may likewise reflect blood products. The common extensor tendon and lateral collateral ligament appear intact. There is mild edema within the brachialis muscle, but the tendon of the brachialis and the tendon and muscle of the biceps appear intact. Mild osteoarthritis affects the joint with associated degenerative subchondral signal abnormality.

Output: Soft tissue findings consistent with the stated history of crush injury as described above. No findings to suggest communication of the wound with the elbow joint.


Instruction: Generate impression based on medical findings.

Input: 54 year old male patient with stiffness and pain about left long finger. Evaluate for long finger flexor tendon injury. TENDONS: The flexor and extensor tendons of the third digit appear intact with normal signal and orientation.BONES: Bone marrow signal is within normal limits.ADDITIONAL

Output: Intact flexor and extensor tendons of the left long finger.


Instruction: Generate impression based on medical findings.

Input: 65 year old with history of coronary artery disease with drug eluting stent to the proximal right coronary artery, hypertension, dyslipidemia, known mitral regurgitation and COPD presenting prior to potential shoulder surgery. MEDICATIONS: amlodipine, aspirin, atorvastatin, metoprolol, symbicort, tamsulosin and spiriva. First Pass PerfusionDuring hyperemia, there is a large perfusion defect which involves the basal anterolateral and inferolateral walls; the mid anterolateral, inferolateral, and inferior walls; and the apical lateral and inferior walls. The overall ischemia score is 8 out of a total of 32 and involves 25% of the myocardium.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 with normal systolic function. There is mild hypokinesis of the mid anterolateral, inferolateral, and inferior walls; and the apical inferior wall. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 72 ml/m2 (normal range: 74+/-15), the LVEDV is 154 ml (normal range 142+/-34), the LV end systolic volume index is 31 ml/m2 (normal range 25+/-9), the LVESV is 68 ml (normal range 47+/-19), the LV mass index is 67 g/m2, and the LV mass is 144 g. Left AtriumThe left atrium is mildly dilated (111ml). Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 56%, the RV end diastolic volume index is 60 ml/m2 (normal range 82+/-16), the RVEDV is 129 ml (normal range 142+/-31), the RV end systolic volume index is 26 ml/m2 (normal range 31+/-9), and the RVESV is 57 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 moderate to severe mitral regurgitation. There is both evidence of mild mitral prolapse and also "ischemic" mitral regurgitation via tethering of the posterior leaflet due to the above mentioned wall motion abnormalities.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is mildly dilated (Sinus of Valsalva 42mm and Ascending Aorta 41mm). There is a left sided aortic arch with a pseudo-bovine 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 FindingsThe lungs are hyper-inflated. 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 amount of ischemia, as described above.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 56%) with mild hypokinesis of the mid anterolateral, inferolateral, and inferior walls and the apical inferior wall.4. Normal RV size and systolic function (RVEF 56%).5. There is moderate to severe mitral regurgitation, likely secondary to both mitral valve prolapse and ischemic mitral regurgitation.


Instruction: Generate impression based on medical findings.

Input: There are foci of T2/FLAIR hyperintensities in the subcortical and the periventricular white matter, which are nonspecific, but most likely consistent with chronic small vessel ischemic changes. There is no evidence of acute hemorrhage, mass effect, or edema. The ventricles and sulci are enlarged, which may be age related versus neurodegeneration. There is no midline shift. Corticomedullary differentiation is maintained. The basal cisterns are patent. There is a partial empty sella. There are no diffusion or susceptibility abnormalities. The T2 flow voids are unremarkable.

Output: 1. No evidence for acute intracranial hemorrhage, mass effect, or edema. No evidence of acute cerebral infarction.2. Brain parenchyma volume loss and ventriculomegaly is present. The cause for this is unknown based on this study alone. Differential considerations could include neurodegenerative disorder and normal pressure hydrocephalus3. There is a mild degree of nonspecific T2/FLAIR hyperintensities in the subcortical and periventricular white matter, at this age is most likely vascular related.


Instruction: Generate impression based on medical findings.

Input: 58-year-old female with a concern for enterovaginal fistula and possible pelvic mass. Also infection outside/tracking to duodenum. ABDOMEN:LIVER, BILIARY TRACT: Again seen is a heterogeneous encapsulated collection, with peripheral enhancement in the posterior inferior perihepatic region with extension into Morrison's pouch, appearing similar to the prior study, measuring 6.0 x 3 .6 cm, previously 5.7 x 3.8 cm (70; series 1701). There is associated restricted diffusion consistent with abscess formation. There is linear increased T2 signal abnormality with associated enhancement originating from the superolateral aspect of the proximal 2nd portion of the duodenum which extends to the aforementioned abscess in the right upper quadrant consistent with fistula formation.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: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small right pleural effusion.PELVIS:UTERUS, ADNEXA: The previously described foci of gas density, interposed between the anterior rectum and vagina appears to represent air within the vaginal cuff. No convincing evidence of fistula formation.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Right upper quadrant abscess with apparent fistula formation with the 2nd portion of the duodenum as detailed above. These findings may represent the sequela of a perforated duodenal ulcer and clinical correlation is indicated.2.No evidence of enterovaginal fistula as clinically questioned. The previously described air interposed between the vagina and rectum is not definitively visualized on today's examination and may represent air within the vaginal cuff which can be related to prior pelvic physical examination or instrumentation.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Postconcussional syndromeClinical question: evaluate for abnormalitySigns and Symptoms: hx of TBI, post concussive symptoms 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 demonstrate mucosal thickening in the maxillary sinuses - right more than left - and some scattered opacities in the ethmoid air cells and frontal sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There is no evidence for intracranial hemorrhage or diffuse axonal injury to suggest traumatic brain injury.


Instruction: Generate impression based on medical findings.

Input: 51-year-old female with left knee swelling and pain. Evaluate for meniscal tear. MENISCI: There is diffuse attenuation of the medial meniscus likely reflecting extensive chronic attritional tearing. There are linear foci of intermediate signal intensity within the anterior and posterior horns which extend to the tibial articular surface, representing additional tears. An ossicle replaces much of the posterior horn of the medial meniscus near its root. The root of the posterior horn of the lateral meniscus is ill-defined and likely reflects chronic tearing. There is intermediate signal intensity within the body of the lateral meniscus, which extends to the free edge, likely representing fraying. There is extensive intermediate signal intensity within the anterior horn of the lateral meniscus consistent with intrasubstance degeneration and degenerative tearing.ARTICULAR CARTILAGE AND BONE: There is near full-thickness to full-thickness degeneration of the articular cartilage of the weightbearing portion of the lateral femoral condyle with associated degenerative subchondral signal abnormality. There is also thinning of the articular cartilage of the lateral tibial plateau posteriorly. There is near full-thickness degeneration of the articular cartilage of the weightbearing portion of the medial femoral condyle and to a lesser degree the medial tibial plateau. There is moderate degeneration of the articular cartilage of the patellofemoral compartment with findings suggestive of focal delamination of the articular cartilage along the medial facet of the patella. There are large tricompartmental osteophytes, which have progressed since the prior examination.LIGAMENTS: The ACL is not visualized suggesting chronic rupture. The PCL appears intact. The collateral ligaments appear intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Moderate to severe tricompartmental osteoarthritis which has progressed slightly when compared to the prior examination as well as degeneration and degenerative tearing of both menisci as described above.2. Nonvisualization of the ACL indicating a chronic tear.


Instruction: Generate impression based on medical findings.

Input: Right facial weakness. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are numerous foci of high T2 signal in the supratentorial and infratentorial white matter. 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 a nonspecific subcentimeter nodule in the right parietal scalp. The skull, orbits, and scalp soft tissues are otherwise unremarkable. There is diffuse paranasal sinus mucosal thickening and secretions, including air-fluid levels in the left maxillary sinus.

Output: 1. Numerous foci of high T2 signal in the supratentorial and infratentorial white matter are nonspecific, but may represent chronic small vessel ischemic disease, for example. Otherwise, no evidence of intracranial hemorrhage, mass, or cerebral edema.2. Evidence of acute sinusitis.


Instruction: Generate impression based on medical findings.

Input: A 41 year old female with history of idiopathic aortitis, status post ascending aortic aneurysm repair and mechanical aortic valve placement in August 2010. The patient is asymptomatic and was referred to cardiac MRI to evaluate the stability of aneurysm and valve repair. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 59%, the LV end diastolic volume index is 87 ml/m2 (normal range: 65+/-11), the LVEDV is 131 ml (normal range 109+/-23), the LV end systolic volume index is 36 ml/m2 (normal range 18+/-5), the LVESV is 53 ml (normal range 31+/-10), the LV mass index is 36 g/m2 (normal range 67+/-11), and the LV mass is 56 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Septal bounce was noted.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 57%, the RV end diastolic volume index is 78 ml/m2 (normal range 69+/-14), the RVEDV is 116 ml (normal range 110+/-24), the RV end systolic volume index is 33 ml/m2 (normal range 22+/-8), and the RVESV is 50 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveArtefacts were noted due to the mechanical aortic valve replacement, there is mild regurgitation (regurgitation fraction 14% by Q-flow analysis).Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. There is an ascending aortic graft with no aneurysm formation noted; however, there is mild dilation of the ascending aorta just distal to the anastomosis site of the graft. This finding was noted in the 2 previous MRI's (2012, 2013).Aortic diameters: Ascending aortic graft maximum diameter: 31mm (31 mm in 2013, 30 mm in 2012).Distal anastomosis: 22mm (23mm in 2013, 23mm in 2012).There is an area of mild dilatation just distal to the anastomosis site that measures 32 x 36mm - this has not changed when compared to the 2013 or 2012 CMR.Ascending aorta just proximal to brachiocephalic vessels: 31mm (30mm in 2013 and 2012).Distal arch: 23mm (23mm in 2013 and 2012).Descending aorta at the level of the main PA: 17mm (17mm in 2013 and 2012).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. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function, the LVEF is 59%, no evidence of an underlying fibrosing, infiltrative, or inflammatory process. Septal bounce was noted.2. The right ventricle is normal in size with normal systolic function, the RVEF is 57%.3. Mechanical aortic valve, there is mild regurgitation (regurgitation fraction 14% by Q-flow analysis).4. Ascending aortic graft, no aneurysm noted; however, there is mild dilation of the ascending aorta just distal to the anastomosis site of the graft.5. When compared to the prior study, no significant change is noted.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: History of leukemia and abnormal LFTs. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology and size, measuring 19 cm in craniocaudal dimension.1.1 cm T2 hyperintense cyst in the posterior segment of the right hepatic lobe.No suspicious lesion is evident.Normally distended gallbladder.No intra or extrahepatic biliary ductal dilatation. Mild irregularity near the the proximal common hepatic duct likely represents a crossing vessel.SPLEEN: The spleen is normal in size measuring 9 cm in length. No focal lesion.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No findings to account for the patient's abnormal LFTs.


Instruction: Generate impression based on medical findings.

Input: 55 year old male with history of DVT /PE, HTN, DM, hemachromatosis (heterozygous), and family history of premature CAD who presents for evaluation of possible cardiac involvement of sarcoidosis given history of palpitations/PVCs. Left VentricleThe left ventricle is normal in size with low normal systolic function (LVEF 54%). The overall LV ejection fraction is 54%, the LV end diastolic volume index is 52 ml/m2 (normal range: 74+/-15), the LVEDV is 132 ml (normal range 142+/-34), the LV end systolic volume index is 23 ml/m2 (normal range 25+/-9), the LVESV is 60 ml (normal range 47+/-19), the LV mass index is 45 g/m2 (normal range 85+/-15), and the LV mass is 116 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is late gadolinium enhancement in the basal inferolateral wall and possibly a small patch in the apical inferolateral wall, both of which were previously present. Native myocardial T1 and T2 times are within normal limits, suggesting no active myocardial inflammation. No intracardiac thrombus.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 55%, the RV end diastolic volume index is 62 ml/m2 (normal range 82+/-16), the RVEDV is 159 ml (normal range 142+/-31), the RV end systolic volume index is 34 ml/m2 (normal range 31+/-9), and the RVESV is 88 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least mild tricuspid regurgitation. AortaThere is a left sided aortic arch with a common origin of the innominate and left common carotid artery. The aortic root is mildly dilated (SoV 45 mm).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 drain normally into the right atrium.PericardiumThere is no pericardial effusion.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with low normal systolic function (LVEF 54%). There is a small patch of late gadolinium enhancement in the basal inferolateral wall and apical inferolateral wall suggesting of an underlying fibrotic process consistent with prior episode of cardiac sarcoid. Based on normal myocardial T1 and T2 times, there is no evidence of active myocardial inflammation. 2. The right ventricle is normal in size and systolic function (RVEF 58%)3. Mild dilatation of the Sinus of Valsalva. 4. When compared to cardiac MRI from 9/14/2015, no significant change. 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, 54 years old, with lancinating left facial pain that occurs 100 times per day waking the patient from sleep. Evaluate for structural lesions. Several scattered small discrete foci of T2 hyperintensity are seen within the periventricular and subcortical white matter, a nonspecific finding. More ill-defined T2 hyperintensity just above the right frontal horn is also seen.There is no restricted diffusion or significant parenchymal edema. No mass or mass effect is observed. No pathologic parenchymal or extra-axial enhancement is identified. There are no findings to suggest acute intracranial hemorrhage or any abnormal extra axial fluid collection. The ventricles are normal in size and morphology.Although not a dedicated cranial nerve examination, the trigeminal nerves as visualized show no gross abnormality. No abnormal enhancement is detected along the cisternal portions of the cranial nerves.Dedicated vascular imaging illustrates normal flow related signal within the anterior and posterior circulations. No significant vascular stenosis or occlusion is seen. No aneurysm or vascular malformation is identified. The left superior cerebellar artery and the left petrosal vein course in proximity to the cisternal left fifth cranial nerve, but this is not an atypical finding.

Output: 1.Scattered nonspecific white matter signal abnormality is seen. No acute intracranial abnormality is detected.2.Although not a dedicated cranial nerve examination, no specific abnormalities of the visualized portions of the left trigeminal nerve are seen.3.No significant vascular abnormalities are detected intracranially.


Instruction: Generate impression based on medical findings.

Input: Male, 33 years old, with paresthesias and white matter changes on MRI of the brain. Evaluate for demyelinating disease. Cervical:No focal spinal cord signal abnormality is seen. No pathologic enhancement of the cord or osseous structures is detected. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No evidence of marrow replacement or edema is seen. A small disc protrusion is present at C5-6 without significant spinal canal stenosis. The remaining intervertebral discs are preserved. No significant compromise of the spinal canal or neural foramina is seen.Thoracic:No focal spinal cord signal abnormality is seen. No pathologic enhancement the cord is detected. A focus of signal abnormality and enhancement within the left T9 pars interarticularis, and a larger area within the right posterior T11 vertebral body, are favored to represent benign hemangiomas. Otherwise, vertebral body morphology and signal characteristics are within normal limits. Spinal alignment is anatomic. A left paracentral disc protrusion at T5-6 may very slightly impinge upon the spinal cord. No significant spinal canal or foraminal stenosis is observed.Lumbar:Assuming rudimentary ribs at the T12 vertebral body, there are four fully lumbar type vertebral bodies and a transitional S1.No evidence of pathologic intrathecal enhancement is seen. The distal spinal cord, conus and nerve roots of the cauda equina are within normal limits. No epidural abnormalities are suspected.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. Mild degenerative endplate signal change and enhancement are seen at L3-4. Otherwise, no pathologic marrow space signal abnormality is detected.At L3-4, there is facet arthropathy, disc bulging and a mild central disc protrusion. No significant spinal canal stenosis is seen. The neural foramina are mildly narrowed.At L4-5, there is facet arthropathy, disc bulging and a small superimposed central protrusion. No significant spinal canal stenosis is seen. The neural foramina are mildly narrowed.

Output: 1.No evidence of demyelinating disease is seen within the spinal cord.2.Scattered mild degenerative findings are noted as above.


Instruction: Generate impression based on medical findings.

Input: 54-year-old female with chronic diarrhea, abdominal pain. History of vaginal fistula. Exclude small bowel Crohn's disease. Oral contrast using Volumen was also administered. Motion artifact mildly limits exam quality.ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesion.SPLEEN: Spleen is unremarkable.PANCREAS: No focal pancreatic lesion identified.ADRENAL GLANDS: No adrenal nodularity or thickening.KIDNEYS, URETERS: No focal renal lesion or hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant retroperitoneal lymphadenopathy.BOWEL, MESENTERY: There is questionable focal thickening and enhancement at the very distal terminal ileum adjacent to the ileocecal valve. There is no associated mesenteric lymphadenopathy. No fibrofatty proliferation is seen. While this enhancement may be artifactual from decompressed terminal ileal mucosal folds, superimposed acute inflammatory change in this location cannot be excluded. No other areas of abnormal enhancement, wall thickening, or other findings of acute or chronic inflammatory changes are present.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Exam mildly limited by motion artifact. 2.Questionable focal enhancement of the terminal ileum adjacent to the ileocecal valve. No other findings of acute or chronic inflammation in this location or elsewhere. While this enhancement may be artifactual from decompressed terminal ileal mucosal folds, superimposed acute inflammatory change in this location cannot be excluded. Correlation with clinical, endoscopic, and pathologic findings is recommended to exclude Crohn's disease.


Instruction: Generate impression based on medical findings.

Input: Acute disseminated encephalitis and encephalomyelitis, with worsening headache. There are postsurgical findings related to right frontal approach stereotactic biopsy of the pontine enhancing lesions. There is significant interval improvement in the foci of enhancement within the pons. There are no new enhancing lesions. There are unchanged mild scattered nonspecific punctate foci of T2 hyperintensity in the cerebral white matter. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable.

Output: Interval improvement of the pontine lesions, status post biopsy.


Instruction: Generate impression based on medical findings.

Input: History of right kidney mass status post RFA 10/22/2014. ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis without evidence of acute cholecystitis. No choledocholithiasis or biliary ductal dilatation. Stable nonenhancing T2 weighted hyperintense hepatic lesions likely represent small cysts.SPLEEN: No significant abnormality noted.PANCREAS: 8 x 6 mm non-enhancing cystic lesion adjacent to the distal pancreatic body/tail pancreatic duct, likely a side branch IPMN (series 4/17). 9 x 7 mm pancreatic head side branch IPMN (series 4/26) without mural nodular enhancement. Punctate IPMNs in the pancreatic tail. These are not significantly changed. The pancreatic parenchyma is otherwise normal in morphology.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Post-treatment changes from the prior ablation of the right renal midpole lesion. In the region of the ablation there is an expected defect and "peri-ablational halo". Along the medial margin there is a focal region of intrinsic T1-weighted hyperintensity without evidence of post-contrast enhancement, compatible with clot/proteinaceous material. Additional bilateral simple renal cysts and a left mid/lower kidney likely proteinaceous cyst are stable.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stable appearance of the right kidney status post ablation without evidence of recurrence.2.Stable bilateral renal cysts.3.No significant change in the pancreatic suspected side branch IPMNs.4.Cholelithiasis.


Instruction: Generate impression based on medical findings.

Input: Ms.Gloria Jackson, 71 years old, submitted outside study for review. She initially presented to outside hospital for evaluation of a palpable lump in the right upper outer breast on 5/20/2016. Diagnostic ultrasound of the right breast demonstrated a 1.6 x 1.4 cm mass corresponding to the palpable abnormality. Additional 1.1 x 0.8 cm hypoechoic lesion was also identified slightly medial and superior to the palpable lump. Ultrasound-guided biopsy of the 10:00 position, posterior palpable mass revealed invasive ductal carcinoma on 5/25/2016. MRI breast on 6/2/2016 demonstrated 2 enhancing masses and 1 additional nonmass enhancement in the right upper outer breast as well as a 1.5 cm right axillary lymph node with irregular cortical thickening.Images performed at Ingalls Memorial Hospital (Harvey, IL) submitted for review: Mammogram 2/11/2016Ultrasound 5/20/2016Ultrasound-guided biopsy 5/25/2016Postprocedure mammogram 5/25/2016MRI breast the 6/2/2016Images submitted for comparison:Mammogram 1/5/2015 and 12/23/2013 MAMMOGRAM 2/11/2016: 2 standard views of both breasts with repeat MLO view were obtained. The breast parenchyma is asymmetric, heterogeneously on the right and scattered on the left, grossly unchanged from the prior. A biopsy clip is identified in the upper outer right breast. Stable benign calcifications are present in both breasts. Linear metastatic marker overlies the scar over the left anterior breast. No new dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in either breast. RIGHT BREAST ULTRASOUND 5/20/2016 : Static ultrasound images are submitted for interpretation.In the right breast, 10:00 position, 4 cm from the nipple, labeled as the palpable lump, there is an irregular, hypoechoic mass measuring 1.6 x 1.4 cm.In addition, along the same radian in the right breast, approximately 2 cm apart from the above palpable mass, there is a another smaller hypoechoic lesion measuring 1.1 x 0.8 cm. Both are suspicious for malignancy.ULTRASOUND-GUIDED BIOPSY 5/25/2016 : The right breast mass at 10:00 was targeted accurately and a clip was placed. POST PROCEDURE MAMMOGRAM 5/25/2016: A lock shaped clip is placed in the right breast 9:00 position, close to the previous biopsy clip.MRI BREAST 6/2/2016:Multisequence MRI breast imaging with and without intravenous contrast was performed as per outside MRI breast protocol. The breasts are composed of asymmetric fibroglandular tissue, heterogeneous on the right and scattered on the left. There is mild background parenchymal enhancement bilaterally. Kinetic analysis of these images was not possible. RIGHT BREAST:There is susceptibility artifact from the biopsy clip in the the right breast, 10:00 position, 3.5 cm from the nipple. There is an enhancing mass surrounding the biopsy clip measuring 1.9 x 2.2 x 2 cm (LR X AP x SI), which is consistent with the biopsy proven malignancy.In addition, in the right breast, 10:00 position, approximately 1.5 cm anterior to the index mass, is another enhancing mass with irregular margins, which measures 1.2 x 0.9 x 1.1 cm (LR X AP x SI) and correlates with the satellite lesion found on the ultrasound.There is a linear enhancement extending from the index mass anteriorly to the skin and close to the satellite mass, which could represent the biopsy track or possibly additional malignant enhancement.LEFT BREAST: There is an enhancing area with high T2 signal intensity in the slightly inferior aspect of the left central breast, posterior depth, which measures 0.7 x 1.1 x 1.2 cm (LR X AP x SI). There is no suspicious kinetic behavior associated with this non mass enhancement.AXILLAE:A nonspecific lymph node is identified in the right axilla. No suspicious lymph nodes in the left axilla.PER OUTSIDE PATHOLOGY:A. right upper outer breast breast, 10:00, posterior lesion; ultrasound guided core needle biopsy:- Invasive ductal carcinoma, grade 2- This result is concordant with the imaging findings.

Output: RIGHT BREAST: 1. 2.2 cm biopsy-proven malignancy in the right posterior breast 10:00 position.2. 1.2 cm suspicious satellite mass in the right breast 1.5 cm anterior to the index cancer. Ultrasound-guided biopsy is recommended.3. Linear enhancement extending from the index mass to the skin may represent post biopsy enhancement, though if the skin entry site from biopsy is not located towards the nipple compared to the target, malignancy would be more likely. Suggest correlation with physical exam. 4. Nonspecific right axillary lymph node for which ultrasound can be considered if clinically indicated.LEFT BREAST:1. 1.2 cm enhancing area in the posterior left breast, likely a benign process, for which 6 month MRI follow-up is recommended.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: 17 year old female status post head trauma. Evaluate for change. There is no evidence of intracranial mass or edema. A small focus of high density presumably represents an extra-axial fluid collection adjacent to the frontoparietal cortex, (images 12 and 13), unchanged. Focus of soft tissue density overlying the left parietal occiput likely represents a hematoma without underlying fracture.These focal findings suspicious for a small subdural hematoma would be better evaluated with an MRI.Low-density focal widening of the right lateral sylvian fissure may represent an arachnoid cyst (image 7).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. Unchanged, small focus of hyperdensity, as described above, may represent a subdural hematoma which would be better evaluated with MRI.2. Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old, with sensory deficit below the nipples. A single nonspecific focus of T2 hyperintensity is seen within the white matter of the left inferior frontal lobe. Otherwise the cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen. No pathologic parenchymal or extra-axial enhancement is detected.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology.

Output: No specific findings are seen to account for the patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: 81 years Male (DOB:3/5/1935)Reason: assess for stenosis History: history of lumbar decompression in April, still having leg and back painPROVIDER/ATTENDING NAME: BEN-ZION ROITBERG BEN-ZION ROITBERG Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact.There is T2 signal hyperintensity present along the superior anterior aspect of the L4 vertebral body adjacent to the endplates and eccentric to the right side. This may represent subacute inflammatory change.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is mild facet hypertrophy present at this level.At L4-5 there is a diffuse disc bulge present associated with loss of disc space height, disc desiccation and bilateral facet and ligamentum flavum hypertrophy. There is mild anterior subluxation of L4 and L5. The patient is status post right-sided hemilaminotomy at this level. There is effacement of the fat at the lateral recess bilaterally at this level but worse in the right compared to the left side. Compared to the prior exam there is no nerve root crowding on the current exam when compared to the prior. There is narrowing of the neural foramina bilaterally at this level. The nerve root exiting the left neural foramen are surrounded by fat whereas the right-sided exiting nerve root is encroached upon by a combination of facet hypertrophy and disc material.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There are large cysts present along the kidneys bilaterally which were also present on the prior exam and do not appear to have changed severe not entirely included on this exam in the assessment of their size cannot be adequately done on this exam.

Output: 1.Since the prior examination the patient is undergone lumbar spine surgery at L4-5 there is no significant spinal stenosis at this level. Currently however, there is encroachment of the nerve roots within the right neural foramen and at the right lateral recess at this level as a result of disc disease and facet disease. A contrast enhanced exam may help differentiate scar from disc protrusion.2.Some subacute inflammatory changes are present along the anterior superior aspect of the L4 vertebral body eccentric towards the right side.3.Multiple large renal cystic lesions are not completely evaluated on this exam. There are present on prior exams and to the extent of visualization have not changed significantly


Instruction: Generate impression based on medical findings.

Input: Clinical question: Assess for MS. Signs and symptoms: Assess for MS. Nonenhanced brain MRI:Negative diffusion weighted images.Sagittal images demonstrate herniation of cerebellar tonsils through the foramen magnum for approximately 7.5 mm and result in mild flattening deformity of the dorsal aspect of tarsal. No change since prior exam from an outside institution exam (Northwest community Hospital) dated 7-23-14.Examination demonstrates a single ill-defined small focus of subtle FLAIR hyperintensity in the left paramedian pons and without interval change since prior exam.Anatomical morphology and the signal intensity of brain parenchyma remains otherwise within normal on all MRI sequences. In particular there are no detectable lesions in the corpus callosum, subcortical or periventricular white matter or in the cerebellar peduncles.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination otherwise.The signal void of major intracranial arterial branches are identified.Signal intensity of intracranial venous sinuses are normal.Unremarkable calvarium and soft tissues of the scalp.Unremarkable images through the orbits.Partial opacification of right chamber of the sphenoid sinus and unremarkable paranasal sinuses otherwise.

Output: 1.Negative diffusion weighted images.2.Herniation of cerebellar tonsils through the foramen magnum of approximately 7.5 mm with mild flattening deformity.3.Single ill-defined nonspecific focus of FLAIR hyperintensity in the left paramedian pons and unremarkable nonenhanced brain MRI otherwise and without evidence of demyelinating disease.4.No evidence of interval change since prior exam from 7-23-14.


Instruction: Generate impression based on medical findings.

Input: Reason: L knee meniscus tear History: L knee pain MENISCI: The medial and lateral meniscus appear intact. There is globular signal within the posterior horn of the medial meniscus indicating intrasubstance degeneration.ARTICULAR CARTILAGE AND BONE: There is a full-thickness articular cartilage cleft along the median eminence of the patella. There is also a focal near full-thickness to full-thickness articular cartilage cleft along the lateral facet of the patella. There is blistering of the articular cartilage along the medial facet of the patella. There is partial-thickness articular cartilage degeneration along the weightbearing surface of the medial femoral condyle above the posterior horn of the meniscus. There is focal full-thickness articular cartilage degeneration along the anterior aspect of the medial tibial plateau with underlying subchondral signal abnormality and cyst formation. There is a focus of low signal intensity within the medial femoral condyle which likely represents a benign bone lesion.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Focal full-thickness articular cartilage clefts and degeneration most pronounced along the patellofemoral articulation.2. 4 mm focus of susceptibility artifact within the subcutaneous tissue along the anterior and medial aspect of the knee which may reflect postsurgical change although this could represent a foreign body in the correct clinical context.3. The menisci appear intact.


Instruction: Generate impression based on medical findings.

Input: 56 years, Male, behavior changes, possible limbic encephalitis.. Examination is motion degraded. There is moderate degree of global parenchymal volume loss, which is advanced for age and has progressed since prior MRI from 1/28/2012. There is volume loss involving the hippocampi but is not disproportionate. No diffusion abnormality. No abnormal signal involving the medial temporal lobes or elsewhere to suggest evidence of encephalitis. No abnormal parenchymal or meningeal enhancement. No evidence of hemorrhage, intracranial mass, or mass effect. No extra-axial collections. Bone marrow signal and extracranial soft tissues are unremarkable.

Output: Global parenchymal volume loss, which is advanced for patient's age and has progressed since 1/28/2012. No specific MRI findings to suggest limbic encephalitis. CSF evaluation can be considered as clinically indicated.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Secondary malignant neoplasm of brainClinical question: history of metastatic RCC to brain s/p resection. MRI for radiation treatment planningSigns and Symptoms: headacheComments: MRI must be down with contrast even with low GFR. | MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate opacification of the sphenoid sinuses and scattered opacities in the posterior ethmoid air cells. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI pituitary:There is a 16 x 12 mm sagittal dimension sellar and suprasellar mass which bulges into the medial aspects of the cavernous sinuses. It is associated with superior displacement of the optic chiasm. This has not changed substantially in size compared to the prior exam.The patient status post transsphenoidal surgery.The cavernous sinuses are intact bilaterally.

Output: 1.Compared to the prior exam from December 16, 2015 there is no significant change in the size of the patient's sellar and suprasellar mass which is known to represent metastatic clear cell renal cell carcinoma.2. The patient is status post transsphenoidal surgery.3.There is no evidence for brain metastases.


Instruction: Generate impression based on medical findings.

Input: Ms. Brown is a 66 year old female with newly diagnosed right breast cancer in two locations. She has a family history of breast cancer. Preoperative MRI is requested at this time. There is heterogeneous amount of fibroglandular tissue in both breasts.There are scattered foci of enhancement seen in both breasts, compatible with mild background parenchymal enhancement. However, no one focus is more suspicious than the rest. In the right upper outer breast, there are two areas of mass-like enhancement identified, that correspond to the two biopsy-proven malignancies. - The first area of mass-like enhancement is in the 11:00 location, measuring approximately 1.6 x 0.9 x 1.5 cm. A biopsy marker clip is seen at the peripheral aspect of this enhancement. - The second area of mass-like enhancement is in the 10:00 location, measuring approximately 1.4 x 1.3 x 1.7 cm. This measures slightly larger on the MRI, likely due to related post-biopsy changes. Of note, a 1.2 cm hematoma with increased T1 signal is identified just abutting the inferior aspect of this area of enhancement. A biopsy marker clip is also seen at the peripheral aspect of this area of enhancement. - Total span of enhancement measures 3.2 x 3.1 x 2.9 cm (AP x ML x CC). The two biopsy clips are separated by approximately 2.0 cm.There is no additional site of abnormal enhancement seen in the right breast. There is no abnormal enhancement seen in the left breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: Biopsy proven multifocal breast cancer in the right breast. No additional MR evidence of malignancy identified. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: 40 year-old female with headache. There is no evidence of intracranial hemorrhage, mass or edema. Minimal nonspecific white matter hypoattenuation is noted and reported on previous MRI of the patient.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The right ethmoid air cells are partially opacified. Otherwise, the visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No acute intracranial abnormality.


Instruction: Generate impression based on medical findings.

Input: Multiple sclerosis, history of sensory and worsening leg weakness. Brain: There are multiple supratentorial and infratentorial T2 hyperintense lesions. Some of the lesions demonstrate corresponding T1 hypointensity. However, there is no abnormal enhancement or associated restricted diffusion in any of these lesions. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is an unchanged subcentimeter cystic pineal gland. The major cerebral flow voids are intact. There is hypoplasia of the right maxillary sinus with mild mucosal thickening and mucosal thickening involving the right ethmoid sinus. There is also fluid within the right sphenoid sinus. The orbits, skull, and scalp soft tissues are grossly unremarkable.Thoracic Spine: The thoracic spinal cord signal appears unremarkable. There is no evidence of mass lesions or abnormal enhancement. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. There are prominent posterior disc osteophyte complex at T6-T7 and T7-T8, which indent the spinal cord. There is also a right neural foraminal disc-osteophyte complex at T9-10. The paravertebral soft tissue structures are otherwise unremarkable.

Output: 1. No significant interval change of the demyelinating lesions in the brain.2. No evidence of demyelinating lesions in the thoracic cord.3. Prominent posterior disc osteophyte complex at T6-T7, T7-T8, and T9-T10 indent the spinal cord.4. Findings suggestive of acute sinusitis.


Instruction: Generate impression based on medical findings.

Input: 6-year-old male with history of osteomyelitis status post antibiotics for 7 weeks. Again demonstrated are surgical changes relating to previous debridement of the first phalanx involving the distal metatarsal. Foci of susceptibility artifact indicate postsurgical calcification/blood product. There remains decreased T1 signal in the distal most aspect of the lateral portion of the remaining portions of the first metatarsal with associated T2 signal abnormality and overlying soft tissue ulceration/sinus tract. These findings are compatible with osteomyelitis. Further, there is additional minimally increased signal in the heads of the second and third metatarsals, likely reactive edema and unchanged from prior examination. There is no osteolysis of the second or third metatarsals.The diffuse soft tissue edema, particularly about the plantar musculature and retinaculum is not significantly changed in comparison to prior examination.

Output: Not significantly changed findings related to osteomyelitis of the distal aspect of the first metatarsal.


Instruction: Generate impression based on medical findings.

Input: Epilepsy, unspecified, not intractable, without status epilepticus [G40.909], Reason for Study: ^Reason: Seizures-evaluate for structural cause History: seizures 22 years Female (DOB:8/28/1994)Reason: Seizures-evaluate for structural cause History: seizuresPROVIDER/ATTENDING NAME: SANDRA L ROSE SANDRA L ROSE There is a focal susceptibility lesion at the mid Pons which is connected with a linear signal void. Subtle T2/FLAIR high signal intensity are seen around the susceptibility lesion. There is no associated diffusion restriction. There is no evidence of T1 high signal intensity.Constellation of above findings indicate possible focal cavernous malformation associated with developmental venous anomaly. Differential diagnosis include petechial chronic pontine hemorrhage, mineralization or capillary telangiectasia. Possibility of brain AVM is remote.Gadolinium enhanced brain MRI can be considered for further imaging evaluation if clinically indicated.No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in major intracranial arterial system.Complete opacification of the right maxillary sinus and a couple of retention cysts on the left maxillary sinus are seen.The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1. Focal susceptibility lesion associated linear signal void at mid pons without evidence of surrounding edema or mass effects. Differential diagnosis include cavernous malformation with DVA, capillary telangiectasia, chronic petechial hemorrhage or mineralization.2. No acute ischemic lesion.MRI of the brain is within normal limits


Instruction: Generate impression based on medical findings.

Input: 36 years Female (DOB:5/3/1980)Reason: follow up on periventricular lesions, any cause of severe headaches History: severe headachesPROVIDER/ATTENDING NAME: THOMAS J KELLY THOMAS J KELLY The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There is no intracranial mass lesion to account for the patient's headaches. An MRI of the brain is within normal limits.