Instruction: Generate impression based on medical findings.

Input: Left hip pain after fall. Inability to ambulate. The marrow signal intensity of the left proximal femur is normal. There are tiny foci of abnormal signal intensity in the acetabular dome which I suspect are degenerative in etiology. There is a small amount of fluid in the left hip joint, within normal limits. I see no focal injury to the musculature of the left hip.There is extensive signal abnormality noted within the upper sacrum on the large field-of-view images. The right sacral wing is largely replaced with low signal intensity on T1-weighted images and high signal intensity on T2-weighted images. There is a bandlike focus of low signal intensity extending vertically through the right sacral wing suggesting an underlying nondisplaced fracture. Similar but slightly less pronounced signal abnormality is noted in the left sacral wing, with findings suggestive of a nondisplaced fracture.Degenerative disc disease affects the lower lumbar spine. Mild osteoarthritis affects the pubic symphysis. There is mild edema-type signal within the subcutaneous fat of the buttocks bilaterally which is nonspecific but could represent a mild contusion.

Output: 1.No evidence of fracture of the left proximal femur or acetabulum.2.Extensive signal abnormality in the upper sacrum is suggestive of nondisplaced fractures involving both sacral wings. I am not certain if these fractures are due to the patient's recent fall or represent insufficiency fractures, but I suspect the former given the degree of edema. Further evaluation with CT may be considered, if clinically warranted. Per the electronic medical record, the patient has been admitted to the hospital. Findings were relayed over the phone to Vanessa Alonso at the time of dictation.


Instruction: Generate impression based on medical findings.

Input: Right calf pain Ankle: TENDONS: No significant abnormality noted.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: No significant abnormality noted. ADDITIONAL

Output: Soleus muscle tear with associated hematoma.


Instruction: Generate impression based on medical findings.

Input: 40 year old male with a history of bicuspid aortic valve, aortic pseudocoarctation and aneurysm with perforated ulcer who is status-post hemasheild graft placement in 10/2013. He is referred for cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 67%, the LV end diastolic volume index is 88 ml/m2 (normal range: 74+/-15), the LVEDV is 194 ml (normal range 142+/-34), the LV end systolic volume index is 29 ml/m2 (normal range 25+/-9), the LVESV is 63 ml (normal range 47+/-19), the LV mass index is 44 g/m2 (normal range 85+/-15), and the LV mass is 98 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 63%, the RV end diastolic volume index is 94 ml/m2 (normal range 82+/-16), the RVEDV is 207 ml (normal range 142+/-31), the RV end systolic volume index is 35 ml/m2 (normal range 31+/-9), and the RVESV is 78 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size. Hemashield graft noted in the descending thoracic aorta with surrounding post-operative changes, not changed in size.  The aortic dimensions are as follows: (Previous two dimensions in parentheses)  Sinus of valsalva 30x30mm (33x32mm, 31 x 31mm)Sinotubular junction 29x27mm (28x27mm, 30 x 27mm)Ascending aorta 29x31mm (32x32mm, 31 x 31mm)Proximal aortic arch 30x31mm (30x30mm, 32 x 32mm)Distal aortic arch 27x23mm (27x23mm, 25 x 24mm)Aortic graft measurements essentially unchanged. 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 present. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function (LVEF 67%). 2. The right ventricle is normal in size with normal systolic function (RVEF 63%). 3. Aortic measurements as above, not substantially changed compared to previous study.


Instruction: Generate impression based on medical findings.

Input: 40 year old male with Crohn's disease, s/p collectomy, atrial flutter after ablation and after cardiac arrest post-cardioversion presenting for follow up MRI for ventricular function and scar evaluation. Left VentricleThe left ventricle is mildly dilated with moderately reduced systolic. The overall LV ejection fraction is 37%, the LV end diastolic volume index is 110 ml/m2 (normal range: 74+/-15), the LVEDV is 277 ml (normal range 142+/-34), the LV end systolic volume index is 69 ml/m2 (normal range 25+/-9), the LVESV is 174 ml (normal range 47+/-19), the LV mass index is 64 g/m2 (normal range 85+/-15), and the LV mass is 160 g (normal range 164+/-36). The LV dysfunction is global with regional variation . There is mild amorphous late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process present in the anterior, septal and inferior walls as seen previously. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is mildly dilated with moderately reduced systolic function. The overall RV ejection fraction is 32%, the RV end diastolic volume index is 128 ml/m2 (normal range 82+/-16), the RVEDV is 323 ml (normal range 142+/-31), the RV end systolic volume index is 87 ml/m2 (normal range 31+/-9), and the RVESV is 220 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is 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. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is mildly dilated with moderately reduced systolic. The overall LV ejection fraction is 37%. The LV dysfunction is global with regional variation. There is mild amorphous late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process present in the anterior, septal and inferior walls as seen previously. 2. The right ventricle is mildly dilated with moderately reduced systolic function. The overall RV ejection fraction is 32%.Compared to 11/18/15 CMR, the LGE pattern and LV/RV function appears similar and compared to CMR of 8/7/2015 the RV/LV function is clearly better.


Instruction: Generate impression based on medical findings.

Input: 12-year-old female with wrist pain. LIGAMENTS: No significant abnormality noted.TRIANGULAR FIBROCARTILAGE COMPLEX: No significant abnormality noted.TENDONS: No significant abnormality noted. BONES: Small focus of increased T2 signal and enhancement in the dorsal aspect of the hamate likely reflects a bone contusion.ADDITIONAL

Output: Small focus increased T2 signal and enhancement in the dorsal aspect of the hamate, likely reflecting a bone contusion. No evidence of synovitis or ligamentous injury, per clinical query.


Instruction: Generate impression based on medical findings.

Input: Neck mass. There is marked diffuse and heterogeneous enlargement of the thyroid gland, measuring up to approximately 8 cm craniocaudally and up to nearly 10 cm in transverse width. There is associated severe narrowing of the trachea, measuring a minimum of 3 mm in width. There is lateral displacement of the bilateral internal jugular and carotid arteries by the thyroid. There is no significant cervical lymphadenopathy. The salivary glands are unremarkable. The osseous structures appear to be grossly intact. The orbits and imaged intracranial structures are unremarkable. There appears to be a carious tooth number 14.

Output: 1. Marked thyromegaly with severe tracheal narrowing.2. Apparently carious tooth number 14.Discussed with Dr. Fatunde at 2:30 PM on 9/16/16.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old, neck pain with radiation into the right arm. Straightening of the cervical lordosis is seen. Vertebral body heights are preserved. Degenerative signal abnormality is noted at multiple levels, particularly C4-5 and C5-6, where findings have progressed. No concerning marrow replacement is seen. The spinal cord shows normal signal and morphology. No epidural lesions are seen. C2-3: Mild facet arthropathy. Minimal disc osteophyte formation. No spinal canal stenosis. No foraminal narrowing. C3-4: Mild facet arthropathy. Mild disc osteophyte formation, progressed. No spinal canal stenosis. Mild bilateral foraminal narrowing.C4-5: Uncovertebral hypertrophy. No spinal canal stenosis. Moderate bilateral foraminal narrowing. No changes. C5-6: Disc osteophyte formation, progressed. Moderate spinal canal stenosis without significant cord deformation, progressed. Severe foraminal narrowing.C6-7: Disc osteophyte formation, progressed. Mild spinal canal stenosis, similar to prior. Moderate foraminal narrowing.C7-T1: Minimal disc degeneration without spinal canal or foraminal compromise. Thoracic levels: Mild disc bulging as assessed on sagittal images, without spinal canal compromise.

Output: Multilevel disc degeneration is seen, progressed at some levels including at C5-6 where there is a moderate spinal canal stenosis. Severe foraminal narrowing is also present at this level.


Instruction: Generate impression based on medical findings.

Input: Evaluate for demyelinating lesions: paresthesias. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Cervical Spine: The spinal cord displays normal signal and morphology. 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: No evidence of acute intracranial or cervical spine demyelinating lesions.


Instruction: Generate impression based on medical findings.

Input: A patient submitted outside study for review. Submitted for review are left breast ultrasound dated 4/4/2011, left diagnostic mammogram dated 4/4/2011, and MRI breast dated 4/13/2011 performed at Northwestern Graylake. LEFT DIAGNOSTIC MAMMOGRAM (4/4/2011): Two standard views of the left breast and 2 spot compression views were obtained. The breast parenchyma is heterogeneously dense. The breast tissue in the left upper inner quadrant appears slightly more conspicuous on recent mammogram dated 2/19/2015LEFT BREAST ULTRASOUND (4/4/2011): A cyst was seen in the 12 o'clock position of the left breast that measures 4 mm.BREAST MRI (4/13/2011): There is no significant interval change compared to mammogram dated 12/22/2014.

Output: Slightly more conspicuous breast parenchyma the left upper inner quadrant compared to examination in 2011 without interval change from breast MRI dated 4/13/2011 and 12/22/2014. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.


Instruction: Generate impression based on medical findings.

Input: There is a 4 x 5 mm T2 hyperintense and T1 hypointense lesion within the location of the right geniculate ganglion corresponding to the abnormality on recent CT. The signal intensity is slightly brighter than CSF and there appears to be possibly dura or bone between the lesion and the intracranial compartment, although on CT the bone is very thinned at this level, and may be partially not visualized. Evaluation is limited without intravenous contrast.The internal auditory canals are symmetrical and normal in size. The left inner ear structures are unremarkable. There is a 1 cm T2 hyperintense cystic structure within the midline nasopharyngeal soft tissues most compatible with a Tornwaldt cyst. There is polypoid mucosal thickening within both maxillary sinuses. There is minimal fluid within the mastoid air cells bilaterally.

Output: 5 mm lesion within the expected location of the right geniculate ganglion corresponds to the abnormality seen on recent CT. While it is not fully evaluated without contrast, it is suspicious for a cystic facial nerve schwannoma as the normal geniculate ganglion and tympanic segment of the nerve are not visualized as they are on the contralateral side, with a meningocele felt less likely. Further characterization with a contrast exam is suggested.No evidence for IAC lesion on this limited non-contrast exam.


Instruction: Generate impression based on medical findings.

Input: Male, 17 years old, with history of locoregional synovial sarcoma of the spine with cardiac extension, surveillance imaging. Brain:A 5-mm non-enhancing focus of T2 hyperintensity in the right middle frontal gyrus has not significantly changed. Two or three punctate foci of susceptibility scattered through the brain are also unchanged. No other significant parenchymal signal abnormality is seen. No enhancing lesions are detected. There is no evidence of acute hemorrhage or any other abnormal fluid collections. The ventricles are normal in size and morphology.C-spine:Sequalae of C2-T2 laminoplasty and tumor debulking are again seen. Confluent enhancing left spinal and paraspinal tumor is redemonstrated spanning these levels with invasion of each neural foramen and minimal extension into the intraspinal epidural space. The overall bulkiness of this extensive lesion, and the degree to which it infiltrates the foramina, are stable compared to the immediate prior exam, and improved relative to older studies. Infiltrative tumor in the deep neck soft tissues adjacent to the spine has also decreased in size mildly. A collection seen previously in the left neck has resolved. Patchy heterogeneous marrow replacement throughout the cervical spine is unchanged. A progressive kyphotic curvature has developed at the cervico-thoracic junction. Vertebral body heights are preserved. The bony spinal canal is narrowed from C3-C7 which may in part be positional and in part due to scarring. There is mild cord flattening though this region without convincing cord signal abnormality. No cord or leptomeningeal enhancement is seen. The posterior paraspinal tissues are extensively scarred. T-spine:Patchy marrow replacement continues into the thoracic spine with involvement of the T1-T3 vertebral bodies. A focus in the T3 vertebral body is slightly larger than on prior exams, but these marrow abnormalities are otherwise unchanged. No other areas of concerning marrow signal are seen. Vertebral body heights are preserved. Spinal alingnment is anatomic. Below the laminoplasty levels, the spinal canal is widely patent. No additional paraspinal, foraminal or intraspinal tumor is seen. The spinal cord is normal in morphology and signal. Two nodules are present in the partially visualized right lung, the largest measuring up to 18 mm.

Output: 1.Redemonstrated are finding related to prior left spinal and paraspinal tumor debulking and C2-T2 laminoplasty. 2.The size and distribution of residual paraspinal and foraminal tumor is unchaged when compared to the immediate prior exam. Tumor is smaller when compared to older exams. 3.Heterogeneous marrow replacement of the cervical and upper thoracic vertebral bodies is seen compatible with treated tumor. A small focus of marrow replacement in the T3 vertebral body is slightly larger, but the remaining marrow lesions are not changed. 4.Right lung nodules are better assessed on chest CT.5.No convincing evidence of intracranial metastases. A focus of T2 hyperintensity in the right middle frontal gyrus, and scattered punctate foci of susceptibility, are non-specific and may be related to therapy.


Instruction: Generate impression based on medical findings.

Input: Male, 17 years old, with history of pineal region tumor, status post chemotherapy and radiation, 4 weeks post radiation scan. Irregular enhancement in the pineal region is again seen measuring approximately 10 x 10 mm (image 14 series 1001), not significantly changed from the prior examination accounting for technical differences between scans.No new areas of pathologic parenchymal enhancement or signal abnormality are seen. Evidence of a prior right frontal approach biopsy tract is redemonstrated similar to prior. Patchy T2 hyperintensity within the bilateral parietal periventricular white matter is stable from prior, perhaps representing white matter thinning or prominent perivascular spaces in association with previous transependymal CSF flow. Ventricular caliber and morphology remain within normal limits and are significantly improved from earlier exams. No acute intracranial hemorrhage or any abnormal extra-axial fluid collection is seen.

Output: Stable irregular enhancing lesion in the pineal region compatible with a treated germinoma. As noted on prior exams, this lesion is much improved when compared to older studies. No new intracranial lesions are seen.


Instruction: Generate impression based on medical findings.

Input: Malignant neoplasm of right lung. The right frontal lobe lesion is no longer discernible and there is no evidence of new enhancing intracranial lesions. There are diffuse areas of white matter T2 hyperintensity bilaterally. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild right maxillary sinus mucosal thickening.

Output: The right frontal lobe metastasis is no longer discernible. Diffuse areas of white matter T2 hyperintensity bilaterally may represent treatment effects and/or chronic small vessel ischemic disease.


Instruction: Generate impression based on medical findings.

Input: Female 49 years old Reason: Evaluate loose fragment/cyst at scaphoid History: Pain after fall 2 days ago BONES: There is a comminuted, essentially nondisplaced, intra-articular fracture of the distal radius consisting predominantly of a transverse fracture plane with longitudinal extension to the articular surface proximal to the lunate. The ulnar styloid appears intact. A subcentimeter triangular focus of low signal intensity is situated dorsal to the distal pole of the scaphoid and proximal to the trapezoid bone corresponding to a small mineralized fragment seen on outside radiographs perhaps reflecting sequela of old trauma. We see no acute fracture of the scaphoid or of the other carpal bones.Mild osteoarthritis affects the basilar joint. A small focus of signal abnormality in the proximal lunate may represent a cyst or bone contusion.LIGAMENTS: Evaluation the scapholunate and lunotriquetral ligaments is limited due to lack of intra-articular contrast but we see no findings to suggest a tear.TRIANGULAR FIBROCARTILAGE COMPLEX: There is mild heterogeneity of signal intensity of the lamina and adjacent articular disc of the triangular fibrocartilage which may reflect degeneration but we see no fluid traversing the articular disc to indicate an acute tear.TENDONS: There is a bifid abductor pollicis longus which may be a normal variant. There is a small amount of fluid surrounding the extensor pollicis longus tendon as it crosses the second dorsal compartment tendons, this has been described in association with distal radius fractures.ADDITIONAL

Output: Nondisplaced, comminuted, intra-articular fracture of the distal radius and other findings as described above.Findings were discussed by phone with Dr. Birnie at 09:31 on 6/1/2016.


Instruction: Generate impression based on medical findings.

Input: Change in size of pituitary macroadenoma: Chronic left eye visual loss. There are postoperative findings related to prior frontal craniotomy with a large area of encephalomalacia of the anterior left frontal lobe and ex vacuo dilatation of left lateral ventricle. There appears to be slight interval increase in size of the heterogeneous sellar mass with extension into the cavernous sinuses, mass effect upon the optic chiasm, and invasion of the sphenoid sinuses. The tumor measures up to 45 mm in width, 34 mm in height, and 38 mm in length. There is encasement and narrowing of the left cavernous carotid and a small left cavernous carotid aneurysm.

Output: 1. Postoperative findings related to prior frontal craniotomy with a large area of encephalomalacia of the anterior left frontal lobe.2. Apparent slight interval increase in size of the heterogeneous sellar mass with extension into the cavernous sinuses, mass effect upon the optic chiasm, and invasion of the sphenoid sinuses. 3. Encasement and narrowing of the left cavernous carotid and a small left cavernous carotid aneurysm.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Rule out bleed. Signs and symptoms: History of mass. Non-enhanced CT of brain:Examination demonstrates a high density extra axial mass along the clivus and dorsum sella. This mass abuts the clivus however no definitive bony changes of the clivus. The mass is well-demarcated and measures 26-mm in cranial cephalad axis and 12.4-mm in AP axis on sagittal reformatted image 26. On axial image 9 the largest transaxial dimension of this tumor are 16.8 x 19.2-mm.superior A. the mass projects into the basal cistern and inferiorly in mid section of clivus. There is no evidence of any edema of brain parenchyma associated with this mass. Subtle mass effect on the pons and posterior displacement is noted. The exact etiology of this finding is not clear. The mass is not correctly state of any particular tumor. Differentials could include a hamartoma, mesenchymal type tumor, neuroepithelial cysts, aneurysm as well as less likely possibility of a meningioma. Follow-up with an enhanced MRI examination is recommended. There is normal density and morphology of brain parenchyma and no evidence of hemorrhage, edema, midline shift or hydrocephalus. The gray -- white matter differentiation is well preserved.

Output: 1.Nonspecific extra axial mass in the prepontine cistern extending along the clivus and superiorly terminates and is inseparable from the floor of the third ventricle. Follow-up with an MRI exam is recommended. There is no associated parenchymal edema.2.Unremarkable CT examination of brain otherwise.


Instruction: Generate impression based on medical findings.

Input: Comatose status post PEA arrest on 12/14/2015. Evaluate anoxic brain injury. Prominent restricted diffusion involving the gray matter and to lesser extent subcortical white matter of the entire cerebral cortex. There is also restricted diffusion within the caudate heads bilaterally. Pattern is compatible with an acute to subacute anoxic brain injury.There is only mild associated edema and no significant mass effect. The lateral ventricles and basal cisterns remain widely patent. Scattered foci of periventricular white matter T2 hyperintensity compatible with chronic small vessel ischemic changes.The expected intracranial vascular flow voids are present.No intracranial hemorrhage. Prominent opacification of the paranasal sinuses as well as the bilateral mastoid air cells. Postoperative changes from a left cataract removal.

Output: Findings compatible with acute to subacute anoxic brain injury involving the near entirety of the cerebral cortex as well as partial involvement of the basal ganglia. No significant associated mass effect or herniation.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for rotator cuff pathology History: R shoulder pain Images are of slightly suboptimal quality, secondary to noise.ROTATOR CUFF: Mild intermediate signal within the undersurface fibers of the supraspinatus and infraspinatus tendons suggests mild tendinosis, and perhaps mild undersurface fraying. We see no discrete rotator cuff tear, however. The supraspinatus and infraspinatus muscles are within normal limits. The teres minor and subscapularis muscles and tendons are within normal limits.SUPRASPINATUS OUTLET: There is edema within the distal clavicle; while this may be degenerative in etiology, there is a band of low signal intensity traversing the distal end of the clavicle, which raises the possibility of a small stress fracture. We see no abnormal edema within the acromion. There is no fluid in the subacromial/subdeltoid bursa. The acromion morphology is type II.GLENOHUMERAL JOINT AND GLENOID LABRUM: Given the limitations of a non-arthrogram study, the labrum is unremarkable. The glenohumeral joint is within normal limits. There is no joint effusion.BICEPS TENDON: The biceps tendon is within normal limits. ADDITIONAL

Output: 1.Very mild rotator cuff tendinosis. No discrete rotator cuff tear is identified.2.Edema within the distal clavicle, while nonspecific, may represent a stress fracture in the correct clinical context.


Instruction: Generate impression based on medical findings.

Input: Pain after injury There is a tear of the midportion of the tendon of the medial head of the gastrocnemius which extends slightly superiorly however further distally, the tendon appears intact. There is a small associated hematoma and edema within the subcutaneous musculature. The remaining muscles and tendons are intact. The marrow signal of the tibia and fibula are normal.

Output: Tear of the midportion tendon of the medial head of the gastrocnemius although further distally, the tendon is intact. There is a small associated hematoma and subcutaneous edema. Remaining evaluation is otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Check flexor hallucis longus, history of dorsal bunion and first MTP. Unable to flex Exam moderately limited given field of view, specifically imaging the entire foot decreases sensitivity TENDONS: No significant abnormality noted. Specifically tendons appear intact and properly inserted given mild limitations secondary to pronounced pes planus deformity.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: Scattered moderate degenerative changes with findings more pronounced in the mid foot and first MTP is previously described on plain film. This includes a bunion and subluxation of the first digit as well as old healed fracture deformity of the fifth metatarsal. Alignment of the hindfoot and midfoot again remains unchanged and significant for partial mid foot collapse and hind foot valgus deformity. ADDITIONAL

Output: Severe pes planovalgus and hallux valgus deformities without additional ligamentous or tendonous findings.


Instruction: Generate impression based on medical findings.

Input: Lumbar radiculopathy Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: Minimal disc bulge. No spinal canal or neural foraminal stenosis.L2-L3: Minimal disc bulge without significant spinal canal or neural foraminal stenosis.L3-L4: Mild disc bulge with mild to moderate bilateral neural foraminal narrowing. No spinal canal stenosis.L4-L5: There is disc bulge and moderate bilateral facet arthropathy. No spinal canal stenosis. There is moderate bilateral neural foraminal stenosis. L5-S1: Minimal disc bulge. No spinal canal stenosis. No significant neural foraminal stenosis. Moderate bilateral facet arthropathy.Paraspinous soft tissues are within normal limits.

Output: Mild multilevel degenerative changes in the lumbar spine with mild disc bulges. There is up to moderate narrowing of the neural foramina at the L4-L5 level which may be impinging on the L4 nerve roots. Minimal degenerative changes at additional levels as described above. There is no spinal canal stenosis at any level.


Instruction: Generate impression based on medical findings.

Input: Low back pain radiating to right thigh Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. There is edema involving the L5 pedicles likely related to facet arthropathy. The conus medullaris is normal in position. Small Schmorl's node is noted involving the superior endplate of L2.Lumbar spinal canal appears mildly narrowed on a congenital basis with superimposed prominence of the epidural fat and degenerative changes as described below: L1-L2: Mild disc bulge and facet arthropathy. No significant spinal canal or neural foraminal stenosis.L2-L3: Mild disc bulge and bilateral facet arthropathy. There is minimal spinal canal narrowing. No significant neural foraminal narrowing.L3-L4: There is disc bulge, ligamentum flavum thickening, facet arthropathy, and prominence of the epidural fat which results in mild spinal canal stenosis. There is mild to moderate right and mild left neural foraminal stenosis.L4-L5: There is disc bulge eccentric to the right, with ligamentum flavum thickening and advanced bilateral facet arthropathy. There is effacement of the lateral recesses as well as mild to moderate central spinal canal stenosis. There is moderate right neural foraminal stenosis and possible impingement of the exiting right L4 nerve root. Mild left neural foraminal stenosis.L5-S1: There is disc bulge and advanced bilateral facet arthropathy. There is partial effacement of the lateral recesses without significant central spinal canal stenosis. There is mild right and mild to moderate left neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: 1. Degenerative changes throughout the lumbar spine as detailed above, worst at the L4-L5 level. There is mild to moderate spinal canal stenosis at this level and moderate right neural foraminal stenosis, which may be impinging on the exiting right L4 nerve root.2. Advanced bilateral facet arthropathy at L4-L5 and L5-S1 which may be contributing to patient's low back pain.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Slurred speech, RUV/RLE weakness, on therapeutic AC, concerning for possible acute stroke. Signs and symptoms : As above. Nonenhanced brain MRI:Diffusion weighted images demonstrate no evidence of an acute ischemic stroke.Examination demonstrates extensive periventricular and to a lesser degree subcortical foci of flair/T2 hyperintensity in bilateral cerebral hemispheres and suggestive of moderate chronic hemorrhagic small vessel ischemic strokes. Very minimal similar findings are also identified in bilateral basal ganglia and moderate degree and bilateral paramedian pons. Unremarkable cerebral cortex and cortical sulci. Mild dilatation of lateral ventricles likely ex vacuo. The signal void of major intracranial arterial branches are identified.Unremarkable calvarium, soft tissues of the scalp, paranasal sinuses and images through the orbits.

Output: 1.No acute intracranial process.2.Findings of mild to moderate chronic non-hemorrhagic small vessel ischemic strokes as detailed.3.Unremarkable nonenhanced brain MRI otherwise.


Instruction: Generate impression based on medical findings.

Input: 38-year-old female with new acute leukemia, pancreatic head lesion on ultrasound ABDOMEN:LIVER, BILIARY TRACT: Perfusion abnormality of the posterior right hepatic segments. There is a persistent filling defect within the proximal right hepatic veins that may represent thrombus. Additional smaller foci within the proximal left hepatic veins suspicious for thrombus.SPLEEN: Mottled T2 signal and enhancement of the spleen may reflect known diagnosis of leukemia.PANCREAS: There is a small lymph node adjacent to the pancreatic head that likely represents the hypoechoic lesion identified on prior ultrasound. There is a T2 hyperintense cystic lesion in the distal body of the pancreas measuring 9 x 11 mm (series 9, image 22) with probable communication with the main pancreatic duct favored to represent side branch type IPMN. The main pancreatic duct caliber is normal.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Scattered subcentimeter peripancreatic lymph nodes. No pathologically enlarged lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: T2 hyperintense cyst in the left hemipelvis may be adnexal in origin, incompletely evaluated.

Output: 1.Filling defects within the proximal right and left hepatic veins may represent thrombus. 2.Small lymph node adjacent to the pancreatic head that likely represents the hypoechoic lesion identified on prior ultrasound. 3.T2 hyperintense cystic lesion in the distal body of the pancreas with probable communication with the main pancreatic duct favored to represent side branch type IPMN.4.Mottled enhancement of the spleen may reflect known diagnosis of leukemia. No splenic vein thrombosis is present.Findings discussed with clinical service at 1155 on 11/9/2016.


Instruction: Generate impression based on medical findings.

Input: 57 years Female (DOB:3/1/1959)Reason: cervical stenosis History: neck and arm painPROVIDER/ATTENDING NAME: BEN-ZION ROITBERG BEN-ZION ROITBERG The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine. The patient is status post anterior fusion at C4-C7 with anterior plate and screws as well as bone plugs at the disc space levels. Overall the cervical spinal canal is small on a congenital basis.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is a mild disc bulge present this level. There is mild narrowing of the left neural foramen at this level.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a mild disc bulge present this level. There are some mild narrowing of the left neural foramen at this level.At C4-5 there is no significant compromise to the spinal canal or neural foramina.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 some ligamentum flavum hypertrophy present at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.The patient is status post anterior fusion from C4 through C7. The prior exam there is some further narrowing of the left neural foramen at C3-4 and C2-32.Exam is mildly degraded patient motion which may obscure more subtle abnormalities.


Instruction: Generate impression based on medical findings.

Input: 37 year old with history of prior myocardial infarction is referred to evaluate LV function and viability. Left VentricleThe left ventricle is severely dilated with moderately reduced systolic function. The overall LV ejection fraction is 33%, the LV end diastolic volume index is 127 ml/m2 (normal range: 65+/-11), the LVEDV is 294 ml (normal range 109+/-23), the LV end systolic volume index is 85 ml/m2 (normal range 18+/-5), the LVESV is 197 ml (normal range 31+/-10), the LV mass index is 64 g/m2 (normal range 67+/-11), and the LV mass is 147 g (normal range 114+/-24). The LV dysfunction is global with regional variation, specifically the mid to basal inferior, inferoseptum, and septal walls appear hypokinetic . There is mid-wall stripe pattern of myocardial late gadolinium enhancement in the septal wall to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. This is more typical of nonischemic cardiomyopathy such as dilated cardiomyopathy or old myocarditis rather than ischemic cardiomyopathy. Left AtriumThe left atrium is severely enlarged.Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 43%, the RV end diastolic volume index is 58 ml/m2 (normal range 69+/-14), the RVEDV is 135 ml (normal range 110+/-24), the RV end systolic volume index is 33 ml/m2 (normal range 22+/-8), and the RVESV is 58 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease. There is a small pericardial effusion. Extracardiac FindingsThe thyroid gland is somewhat enlarged. 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 severely enlarged with moderately reduced systolic function. The overall LV ejection fraction is 33%. There is evidence of a mid-wall stripe of septal late gadolinium enhancement. The pattern is not typical for prior myocardial infarction. It is well described to represent myocardial fibrosis in patients with dilated cardiomyopathy or old myocarditis.2. The right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 43%3. Severe left atrial dilation.4. Small pericardial effusion.5. See extra-cardiac findings. 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: Secondary malignant neoplasm of brain [C79.31], Reason for Study: ^Reason: brain metastasis from lung CA, followup scan History: occasional headaches There is no evidence of acute ischemic lesion on this scan.Multiple susceptibility lesions on bilateral hemispheres are again seen, no change since prior scan in terms of size and location. There is no evidence of new susceptibility lesion indicating acute hemorrhagic lesion on this scan.Underlying brain show patchy bilateral periventricular white matter high signal intensity lesions on FLAIR/T2 indicating non specific small vessel ischemic disease, no change since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. Bilateral mastoid air cells show opacifications, no change since prior scan.The paranasal sinuses are clear.

Output: No evidence of acute ischemic lesion.No evidence of new hemorrhagic lesion.No change of multiple susceptibility lesions since prior scan.No change of non specific small vessel ischemic disease since prior scan.Comment: Non contrast MRI is limited for detecting small metastatic lesion, thus, if clinically indicated, Gad enhanced MRI can be considered.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old, with new left-sided headache. No evidence edema, mass effect, focal signal abnormality or diffusion restriction is seen. The pattern of intracranial enhancement is within normal limits. No findings to suggest intracranial hemorrhage or any abnormal extra-axial fluid collection are observed. Ventricular size and morphology are within normal limits.MRA images of the head demonstrate congenital hypoplasia of the left vertebral artery which primarily supplies the left PICA. No significant intracranial vascular stenosis or occlusion is seen. A small laterally directed outpouching from the proximal right ACA at the origin of the orbitofrontal branch most likely represents an infundibulum. No other definite aneurysm or vascular malformation is observed.MRA images of the neck demonstrate conventional aortic branching. The origins of the great vessels are patent. No significant stenosis is detected in the carotid vessels by NASCET criteria. Likewise, the vertebral vessels are patent throughout. The left vertebral artery is congenitally small.

Output: 1.No brain parenchymal abnormalities.2.No abnormalities of the intracranial or neck vessels.


Instruction: Generate impression based on medical findings.

Input: There are scattered patchy foci of T2 hyperintensity within the supratentorial white matter, including within the corpus callosum and pericallosal regions. 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. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: Multiple white matter lesions compatible with provided history of multiple sclerosis.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Trauma secondary to MVA. Findings and symptoms: Headache. Nonenhanced brain MRI:No diffusion weighted abnormalities.There is normal anatomical morphology of brain. There is normal signal intensity of brain parenchyma on all MRI sequences. Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.The signal void of major intracranial arterial branches are identified. The signal intensity of the intracranial venous sinuses is within normal.Calvarium and soft tissues of the scalp are unremarkable.Orbits, paranasal sinuses and mastoid air cells are unremarkable.Nonenhanced cervical MRI:There is normal anatomical alignment of the vertebral column however with mild straightening of cervical lordosis.There is no detectable posttraumatic soft tissue or bony abnormality of vertebral column.There is mild uniform smaller than expected caliber of the spinal canal and which is highly suspected of a congenital anatomical variation of short pedicle.Foramen magnum is unremarkable.C2 -- C3 is unremarkable. C3 -- C4 demonstrate mild disk desiccation and loss of disk height, mild bilateral ( R >L) uncovertebral hypertrophy and subtle volume disk. There is mild right neural foraminal compromise. Minimal degenerative changes at this level with congenitally smaller size of the spinal canal results in mild central spinal stenosis.C4 -- C5 demonstrate mild disk disease and loss of disk height, bilateral uncovertebral hypertrophic changes and mild bulging disk is noted. Findings results in mild bilateral neural foraminal compromise and central spinal stenosis.C5 -- C6 demonstrate mild disk disease and loss of disk height, bilateral ( R > L ) uncovertebral hypertrophy is also present. Constellation of findings is seen significant right and mild to moderate left neural foraminal compromise and moderate central spinal stenosis.C6 -- C7 demonstrate minimal disk disease, mild uncovertebral hypertrophy on the left. No spinal stenosis and mild left neural foraminal compromise is noted.C7 -- T1 is unremarkable.Uppermost visualized thoracic spine and thoracic cord through T4 is unremarkable.

Output: 1.Unremarkable nonenhanced brain MRI.2.Nonenhanced cervical MRI demonstrate congenital anatomical variation of short pedicles/small canal. Mild degenerative changes at C3 -- C4, C4 -- C5 and C5 -- C6 levels with congenitally small canal results in mild to moderate central spinal stenosis and with neural foraminal compromise as detailed per level above. There is normal signal intensity and caliber of the cervical cord. There is no detectable posttraumatic changes of vertebral column for the perispinal soft tissues.


Instruction: Generate impression based on medical findings.

Input: 80 year-old female with left PCA the and left PICA infarctions and possible occluded left vertebral artery. Evaluate for structural changes. There is no evidence of intracranial hemorrhage, mass, extra-axial fluid collection or midline shift. An area of hyperdensity is noted within the left medial temporal lobe. Additionally areas of hypodensity are noted within the left thalamus, the left superior medial cerebellum and the left occipital lobe. There is no volume loss or effacement of the sulci. These findings are consistent with the patient's history of stroke. Additionally, there are multiple areas of hypodensity within the periventricular and deep white matter which are compatible with the MRI findings of chronic small vessel disease.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses are normally pneumatized. There is minimal opacification of the mastoid air cells. Vascular calcifications of the internal carotid and vertebral arteries bilaterally.

Output: Findings consistent with known stroke involving the left medial temporal lobe, left thalamus, left superior medial cerebellum, and the left occipital lobe. There is no mass effect, midline shift, or evidence of hemorrhagic conversion. These findings appear stable since the previous MRI examination on 10/24/2011.


Instruction: Generate impression based on medical findings.

Input: 53-year-old female with knee mechanical symptoms and pain, evaluate for medial meniscal tear MENISCI: There is small focus of abnormal signal within the posterior horn of the medial meniscus which is seen on only one slice. No definite medial or lateral meniscal tear. ARTICULAR CARTILAGE AND BONE: No abnormal marrow signal. There is diffuse thinning within the medial and lateral compartments with a small foci of partial-thickness cartilage loss along the medial femoral condyle. No full-thickness defects in the articular cartilage. Tiny osteophytes are identified.LIGAMENTS: The MCL and lateral collateral ligament complex is intact ACL and PCL are intact. EXTENSOR MECHANISM: The extensor mechanism is intact. A small amount of pretibial edema is seen.ADDITIONAL

Output: 1.Small focus of abnormal signal within the medial meniscus is seen on only one slice, equivocal for a tear. No definite tears of the medial or lateral meniscus.2.Minimal osteoarthritic changes.


Instruction: Generate impression based on medical findings.

Input: 11 year old male with diffuse ankle pain following injury 7/2015. TENDONS: The flexor and extensor tendons appear intact. The peroneal tendons appear intact. The achilles tendon is normal in appearance. LIGAMENTS: The lateral collateral ligament complex appears intact. The distal tibiofibular syndesmotic complex appears intact. The visualized portions of the deltoid ligament appear intact. ARTICULAR SURFACES AND BONE: There is a nondisplaced, slightly comminuted, but predominantly sagittally oriented fracture through the sustentaculum tali of the calcaneus, extending to the middle facet of the subtalar joint. Edema extends into the medial aspect of the body of the calcaneus. There are tiny foci of edema seen within the subarticular marrow of the head of the talus which perhaps represent small bone contusions. We see no osteochondral defect.ADDITIONAL

Output: Fracture of the sustentaculum tali of the calcaneus and other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Visual changes and word finding difficulties with headache in the setting of pregnancy. MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The A1 segments are similar in size. The right posterior communicating artery is medium size whereas the left PCOMA is small. The vertebral arteries are similar in size.MRV brain:The dural venous sinuses are patent. Straight sinus, internal cerebral veins and basal veins are identified and appear patent.

Output: 1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.MR venogram of the brain is within normal limits.4.No evidence for intracranial mass lesion or cerebral infarction.


Instruction: Generate impression based on medical findings.

Input: Partially imaged cervical spine demonstrates disc osteophyte complexes at the C4-C5, C5-C6, and C6-C7 levels. There is moderate degree of neural foraminal stenosis at right C5-C6 and moderate to severe right C6-C7 neural foraminal stenosis. There may be associated impingement of the right C6 and right C7 nerve roots. There are no abnormal masses impinging on the right brachial plexus. No T2 signal abnormality or abnormal enhancement involving the right brachial plexus.

Output: No evidence of brachial plexopathy. There is right-sided neural foraminal stenosis at the C6-C7 and to a lesser degree C5-C6 levels which can be more completely assessed with dedicated cervical spine MRI.


Instruction: Generate impression based on medical findings.

Input: Follow-up brain metastases. History of non-small cell lung cancer. There are prominent essentially confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, which are likely posttreatment related. There is no residual contrast enhancement. There is no diffusion abnormality or extra-axial fluid collection. 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, paranasal sinuses, and scalp soft tissues are grossly unremarkable. The clivus, left frontal bone and C3 vertebral body lesions are unchanged, probable related to metastasis.

Output: Posttreatment effects within the brain parenchyma, with no new or enlarging parenchymal metastases. Unchanged osseous metastases.


Instruction: Generate impression based on medical findings.

Input: 36 year old BRCA2 positive with strong family history of breast cancer and ovarian cancer. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on medical findings.

Input: 8-year-old male with history of laceration to mid body/tail of pancreas, blunt abdominal trauma. Elevated amylase and lipase. EXAMINATION: MRCP without and with IV contrast 12/02/16 ABDOMEN:LIVER, BILIARY TRACT: No focal liver lesion is identified. No intrahepatic or extrahepatic biliary ductal dilatation. No evidence of cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: Decreased T1-weighted signal and increased T2 weighted signal of the distal body and tail of the pancreas, distal to the known laceration, and compatible with inflammation. On contrast enhanced images, there is heterogeneous pancreatic parenchymal enhancement with relatively increased enhancement of the distal body and tail. The main pancreatic duct appears dilated distal to the laceration with visualization of a few dilated side branches.Small amount of peripancreatic fluid. No loculated intraparenchymal or peripancreatic fluid collection.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted. No hydronephrosis.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. Stricture of the main pancreatic duct at the site of injury, with dilatation of the duct distally.2. Pancreatitis of the tail, distal to the site of injury. Small amount of peripancreatic fluid.


Instruction: Generate impression based on medical findings.

Input: 30-year-old female patient with wrist pain. Evaluate for radioscaphoid arthrosis. There is enlargement of the membranous portion of the scapholunate ligament with increased signal intensity that likely represents mucinous degeneration and probable partial-thickness tearing. The dorsal and volar components of the scapholunate ligament appear intact. There is also lobular abnormal signal intensity within the adjacent proximal portion of the scaphoid, likely representing mucinous extension into the bone (intraosseous ganglion). This was not present on the prior examination. There is a defect in the distal radial articular surface, measuring 5 x 7 mm an area and approximately 1 mm in depth. This defect is immediately proximal to the abnormal scapholunate ligament and was also not present on the prior MRI exam. We are uncertain if this defect is due to prior trauma or represents a shallow erosion related to the aforementioned abnormal scapholunate ligament. The remaining articular cartilage of the distal radius is intact, including that of the radioscaphoid articulation. The lunotriquetral ligament is not well visualized on this study, but this is often the case on non-arthrogram MRI examinations. The remainder of the bones appear normal. We suspect that there is a partial-thickness tear of the proximal surface fibers of the articular disc of the triangular fibrocartilage that extends into the volar radioulnar ligament. This can be further evaluated with dedicated MRI arthrogram, if clinically warranted. The tendons and visualized muscles appear normal as do the visualized nerves.

Output: 1.Enlargement of the membranous portion of the scapholunate ligament likely represents mucinous degeneration with adjacent ganglion formation in the proximal pole of the scaphoid.2.Articular surface defect in the distal radius just proximal to the abnormal portion of the scapholunate ligament may represent additional erosion or may be due to old trauma. 3.Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: 46 years Female (DOB:10/18/1969)Reason: persistent right temporal headaches; evaluate for mass or vascular changes History: persistent right temporal headachesPROVIDER/ATTENDING NAME: NICOLE M LEONG NICOLE M LEONG 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 small air-fluid levels.. 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 intracranial mass or other intracranial lesion that would explain the patient's headaches2.There were air-fluid levels present in the maxillary sinuses. The possibility of acute sinusitis cannot be excluded. Another possibility is that this represents retained secretions due to other cause. Patient reportedly has a history of allergic retinitis and sinusitis.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old, history of lung cancer with brain metastases. Since the prior examination, patchy ependymal enhancement has developed along the bodies of the lateral ventricles. Minimal ependymal enhancement at the frontal horns is relatively unchanged. No definite intraparenchymal enhancing lesions are seen. No enhancement of the cranial nerves is detected.Extensive confluent white matter T2 hyperintensity is unchanged. No evidence of generalized mass effect is seen. No acute intracranial hemorrhage or any abnormal extra-axial fluid collections are detected. Ventricular size and morphology are unchanged.

Output: Interval development of ependymal enhancement along the bodies of the lateral ventricles raises concern for progressive intracranial metastatic disease. Treatment related changes do not typically present in this way and are therefore considered less likely. However, an inflammatory or infectious process is not entirely excluded.


Instruction: Generate impression based on medical findings.

Input: Trauma to spine and ataxia. Fall at home few days prior to presentation. Brain: There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There is mild nonspecific cerebral and pontine white matter T2 hyperintensity. There is also a small focus of encephalomalacia in the left thalamus. However, the cerebellum appears to be unremarkable. There is a punctate focus of susceptibility effect in the right thalamus, which may represent a chronic microhemorrhage. The ventricles and basal cisterns are normal in size and configuration. However, there are mild bilateral cerebral convexity subdural fluid collections, measuring up to 5 mm in thickness. 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 intermediate to high T1 and low T2 signal material in the anterior epidural space of the cervical spinal canal at the C1-4 levels, measuring up to approximately 5 mm in thickness, with associated narrowing of the thecal sac. However, the spinal cord signal is normal. There is high T2 signal in the interspinous spaces at Oc-C1 and C1-2 levels. There is degenerative vertebral bone marrow signal alteration in the cervical spine, particularly at C6-7. There are small effusions in the bilateral C5-6 facet joints. There is 3 mm of anterolisthesis of C4 on C5. There is also slight retrolisthesis of C3 on C4. There are multilevel degenerative changes of the cervical spine with multilevel neural foraminal stenosis of varying degrees.

Output: 1. Chronic lacunar infarct in the left thalamus, but no evidence of acute infarct.2. Mild bilateral cerebral convexity subdural fluid collection may represent hygromas. 3. Findings suggestive of early subacute hemorrhage within the anterior spinal canal at the C1-4 levels with associated narrowing of the thecal sac. However, the spinal cord signal is normal.4. Findings suggestive of soft tissue strain and perhaps ligamentous injury in the interspinous spaces at Oc-C1 and C1-2 levels.Discussed with Dr. DEL BRUTTO ANDRADE at 11 AM on 3/13/16.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Assess for progression of disease, history of SCC of lung with metastases to brain. Signs and symptoms: Altered mental status. Pre-and post-enhanced brain MRI:Negative diffusion weighted images for acute ischemic stroke.Previously noted two metastatic foci in the vermis demonstrates subtle interval increased size. The larger midline lesion measuring at 13-mm compared to prior study measurement of 11. There is a tiny metastatic lesion in the right lateral aspect of the pons with interval increased size since prior exam and measuring at approximately 2.8 mm in size. No surrounding edema or mass effect.Images through supratentorial space demonstrate multiple parenchymal metastatic lesions which demonstrate interval increase size since prior study. A superficially located left posterior temporal lobe because the lesion measuring at 13.5-mm has increased since prior exam measurement of 9. A right parietal cingulate gyrus metastases lesion measuring at 14.5-mm compared to prior study measurement of 10.5mm.A left posterior parietal metastatic lesion measuring 18.8 x 14.4-mm has increased since prior exam measurement of 11.7 times 12-mm.there is extensive flair hyperintensity of bilateral hemispheric white matter with disproportionately less mass effect is due to represent a combination of peritumoral edema and post treatment/radiation change. Ventricular system remains within normal size and maintained midline.There is no evidence of calvarial or soft tissues of the scalp metastatic lesions. Unremarkable images through the orbits and including axial fat sat post enhanced series.

Output: 1.Interval progression of metastatic disease demonstrating increased size of all supratentorial and infratentorial metastatic lesions as detailed/measured above.2.Fairly extensive flair hyperintensity of bilateral hemispheric white matter is believed to represent a combination of peritumoral edema and post treatment/radiation change. This appearance remains fairly similar to prior exam.3.Stable normal size of ventricular system and without evidence of midline shift.4.No detectable calvarial, soft tissues of the scalp or orbital metastatic lesions.


Instruction: Generate impression based on medical findings.

Input: 32-year-old male with history of knee pain. The right knee appears normal with no specific radiographic findings to account for the patient's pain. The left knee likewise appears normal on the frontal views.

Output: Normal exam with no radiographic findings to account for the patient's pain.


Instruction: Generate impression based on medical findings.

Input: Right knee pain MENISCI: The lateral meniscus is intact. There is a small radial tear of the body of the medial meniscus. Additional signal abnormality within the posterior horn of the meniscus is thought to reflect changes of prior repair as opposed to true meniscal tearing.ARTICULAR CARTILAGE AND BONE: There is mild thinning of the articular cartilage of the medial compartment but no evidence of a full-thickness defect. Mild heterogeneity of the signal intensity of the patellofemoral cartilage also likely reflects degenerative change but is otherwise intact. The articular cartilage of the lateral compartment is preserved.LIGAMENTS: There is evidence of prior ACL reconstruction. The ACL graft is intact. The remaining cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Radial tear of the body of the medial meniscus. Additional signal abnormality within the posterior horn of the medial meniscus is thought to reflect changes of prior repair.2. Prior ACL reconstruction with intact ACL graft.3. Mild cartilage degeneration of the medial patellofemoral compartments without evidence of partial or full-thickness defect.


Instruction: Generate impression based on medical findings.

Input: 65-year-old male with history of GBM status post resection, chemotherapy, radiation therapy. Now still on chemo status post URI two weeks ago, presents with left sided weakness.IMAGE ACQUISITIONS: Brain CT without contrast There is a large cystic mass with surrounding edema in the right frontal lobe. Findings have worsened since the prior MRI study. There is 15 mm of leftward midline shift. Significant mass effect is noted on the right lateral ventricle. Findings are suggestive of tumor recurrence.

Output: Increase in the large cystic mass and surrounding edema in the right frontal lobe suggestive of tumor recurrence. A subsequent brain MRI study has been interpreted.


Instruction: Generate impression based on medical findings.

Input: Clinical question: AMS since shunt placement. Signs and symptoms: AMS since shunt placement. Pre and post enhanced brain MRI:Diffusion weighted images are partially obscured by extensive metallic artifact obscuring the right aspect of posterior fossa, right mid and posterior temporal lobe and portion of right parietal. Beyond the region of artifact no evidence of restricted diffusion detected.Stable extensive bilateral periventricular FLAIR hyperintensity since prior exam.Interval decreased size of chronic hemorrhagic changes in the right frontal along the course of previously removed right ventricular catheter. Mild residual blood still detected. Compared to prior study there is suggestion of mild interval decreased size of supratentorial ventricles. A right posterior temporal approach ventricular catheter is a new finding since prior exam. The catheter traverses the brain parenchyma, enters the right lateral ventricle and the tip in the anterior aspect of body of right lateral ventricle and intermediate and right paramedian location. There is edema of right posterior temporal-parietal parenchymal at the site of new catheter. Images through posterior fossa are unremarkable and stable since prior study.The signal void of major intracranial arterial branches are identified.Unremarkable images through the orbits.

Output: 1.No detectable acute intracranial process and negative diffusion-weighted images.2.New right posterior temporal-parietal ventricular catheter with the tip in the anterior right lateral ventricle. 3.Mild interval decrease size of ventricular system and focus of edema at the site of catheter entry in the right posterior temporal-parietal region.4.Stable examination otherwise and with revisualization of extensive periventricular FLAIR hyperintensity since prior study.5.Interval decreased size of focus of hemorrhage in the right frontal along the course of the previously removed catheter.


Instruction: Generate impression based on medical findings.

Input: Stroke. Cranial MR Angiography:The intracranial internal carotid arteries are of preserved caliber and flow-related signal. Similarly, the anterior and middle cerebral arteries as well as their major branches are normal as well. The basilar artery is codominantly supplied by the vertebral arteries. The posterior cerebral arteries are unremarkable. There is no aneurysm.Neck MR Angiography:While there is no significant abrupt change in vessel caliber, the vessels cannot be accurately assessed given the nature of MR angiography technique (non contrast enhanced MRA of the neck vessels). The vertebral arteries are normal.

Output: There is no significant steno-occlusive disease in the head and neck. However, the assessment of the neck vessels is limited given the technical limitation of used MR angiography.


Instruction: Generate impression based on medical findings.

Input: Headache, nausea, preoperative planning for craniotomy for tumor resection. Examination is limited to sequences for operative planning and intraoperative navigation. Again seen is an enhancing, predominantly solid fourth ventricular mass measuring approximately 3.6 x 4.2 x 4.2 cm in the AP, transverse, and craniocaudal dimensions. Mass demonstrated restricted diffusion on prior study. Again noted is obstructive hydrocephalus with dilated lateral, third, and upper aspect of the fourth ventricles similar to prior. Periventricular T2 hyperintensity is consistent with transependymal CSF flow. Distended optic nerve sheaths also again seen. No additional foci of parenchymal or meningeal enhancement are appreciated. No midline shift or uncal herniation. Mild inferior cerebellar tonsillar herniation again seen. Major flow-voids are preserved. Mucosal thickening in the maxillary sinuses, right worse than left again noted. Calvarium and extracranial soft tissues are otherwise unremarkable.

Output: Examination for operative planning again demonstrates a fourth ventricular mass which is favored to represent a medulloblastoma. Associated obstructive hydrocephalus again seen.


Instruction: Generate impression based on medical findings.

Input: Metastatic esophageal cancer and left lower extremity weakness.. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild diffuse cerebral volume loss. There is trace nonspecific periventricular white matter T2 hyperintensity. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, and scalp soft tissues are grossly unremarkable. There are mild secretions in the anterior left ethmoid sinus. There is a subcentimeter retention cyst in the right lateral nasopharyngeal recess. There are bilateral lens implants.Cervical Spine: There is fusion of the C3 through C6 vertebral body with loss of the usual kyphosis and bony projection into the spinal canal C3-4 and C5-6 with mild indentation of the spinal cord at C3-4. There are also disc-osteophyte complexes and prominent facet joint hypertrophy at C2-3, right greater than left, and at C7-T1. There is mild left C2-3, severe left C3-4, moderate left C4 though C6, severe right C2 though C6, and bilateral moderate C7-T1 neural foraminal stenosis. There are foci of high T2 signal in the grey matter bilaterally and associated mild volume loss in the spinal cord at the C5 level. However, there is no evidence of mass lesions in the cervical spine and the vertebral bone marrow appears unremarkable.

Output: 1. No evidence of intracranial metastases or acute infarction.2. Fusion of the C3 through C6 vertebral body, multilevel neural foraminal stenosis, moderate spinal canal stenosis at C3-4, and myelomalacia at C5, but no evidence of cervical spine metastases.


Instruction: Generate impression based on medical findings.

Input: Reason: Cuff, Labrum Tear History: Shoulder Pain ROTATOR CUFF: Subtle intermediate signal intensity in the distal aspect of the supraspinatus tendon and indicates tendinopathy. There is no full-thickness rotator cuff tear. The remainder of the musculature/tendons of the rotator cuff are unremarkable. There is no communication with the subacromial/subdeltoid bursa.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Tendinopathy of the distal supraspinatus tendon. Otherwise, unremarkable appearance of the right shoulder.


Instruction: Generate impression based on medical findings.

Input: Knee pain after fall MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: Marrow edema is present predominantly within the medial femoral condyle and lateral tibial plateau but also affecting the lateral femoral condyle and medial tibial plateau. The articular cartilage of the medial and femoral compartments appears subjectively thinned otherwise intact. There is mild degenerative heterogeneity of the articular cartilage of the lateral patellar facet but otherwise the patellofemoral articular cartilage is preserved as well. LIGAMENTS: The anterior cruciate ligament is ruptured. The posterior cruciate ligament and collateral ligaments are intact.EXTENSOR MECHANISM: There is mildly increased signal intensity and thickening of the patellar tendon both at its insertion on the patella and on the tibial tubercle.ADDITIONAL

Output: 1. Ruptured ACL.2. Bone contusions predominantly affecting the medial femoral condyle and lateral tibial plateau.3. Mild patellar tendinosis.4. Small joint effusion.


Instruction: Generate impression based on medical findings.

Input: 65-year-old male with HCV cirrhosis complicated by HCC status post treatment. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology is redemonstrated with small amount perisplenic fluid.Redemonstrated is a segment six ablation cavity with intrinsic T1 hyperintensity reflecting expected postablation changes. There is no evidence of arterial enhancement within the ablation cavity or elsewhere in the liver.Cholelithiasis is again noted.SPLEEN: Splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Scattered gastrohepatic, periportal, and retroperitoneal lymph nodes mildly prominent and unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Limited examination as described in the technique section above.2.Segment 6 lesion treatment cavity without evidence of recurrent or residual disease. No new suspicious liver lesion evident.


Instruction: Generate impression based on medical findings.

Input: Effusion and pain. Evaluate meniscus. MENISCI: There is globular increased internal signal throughout the medial meniscus, with attenuation of the posterior horn compatible with tearing and/or degeneration. The body of the medial meniscus is slightly medially extruded. The lateral meniscus is intact. ARTICULAR CARTILAGE AND BONE: There is an approximately 10 mm full thickness focal defect in the articular cartilage of the weight bearing portion of the medial femoral condyle. There are mild reactive bone marrow changes in the medial femoral condyle and medial tibial plateau associated with this defect as well as the aforementioned medial meniscus degeneration/tearing. There is mild degenerative-type signal in the articular cartilage of the patellofemoral and lateral tibiofemoral compartments, without fluid-filled defects. LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Globular increased internal signal and attenuation of the posterior horn of the medial meniscus compatible with tearing and/or degeneration.2. 10 mm full-thickness focal defect in the articular cartilage of the medial femoral condyle. 3. Mild reactive bone marrow changes in the medial femoral condyle and medial tibial plateau reflecting the aforementioned abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old, with history of lung cancer, with abnormal findings on a prior head CT concerning for intracranial metastases. Post contrast images are degraded by motion artifact. Within this limitation, an irregularly marginated rim-enhancing mass is demonstrated at the junction of the right occipital and temporal lobes which measures up to 32 x 24 x 20 mm. Internally, this lesion is diffusion restricting with a few punctate foci of susceptibility suggesting microhemorrhage. This lesion induces moderate vasogenic edema which tracks through the temporal, occipital and parietal lobes. A 9 mm satellite nodule is also suspected more posteriorly within the right occipital lobe.Postcontrast images are unreliable for assessment of the posterior fossa. However, there are scattered areas of T2 FLAIR hyperintensity throughout both cerebellar hemispheres which are nonspecific.On diffusion weighted images, multiple scattered small hyperintense lesions are seen along the watershed zones of both cerebral hemispheres. At least one and probably several small diffusion restricting lesions are also evident in the cerebellar hemispheres. No detectable mass effect or enhancement is seen in association with these diffusion restricting lesions.Findings related to extensive prior microvascular ischemia are seen including patchy periventricular T2 hyperintensity. Chronic lacunar infarcts are also evident within the right thalamus and possibly the right basal ganglia. Numerous chronic small infarcts are seen within the cerebellar hemispheres. Susceptibility effect compatible with chronic microhemorrhage is seen in the cerebellar vermis.No abnormal extra-axial fluid collections are detected. The ventricular system is unremarkable with the exception of effacement of the right ventricular atrium due to mass effect.A mass is evident within the left parieto-occipital scalp measuring 50 x 50 x 20 mm. This lesion is composed of a substantial extracranial component in addition to a component which invades the underlying bone marrow extending all the way to the inner table. Contact with the underlying dura cannot be excluded, though there is no evidence of invasion into the adjacent brain parenchyma. Additional smaller osseous masses are seen including one within the posterior right frontal bone and one within the right occipital bone.

Output: 1.An irregularly marginated rim-enhancing masslike lesion is seen at the junction of the right occipital and temporal lobes which, given the history, is highly suspicious for an intracranial metastatic lesion. A subcentimeter satellite lesion is also noted somewhat more posteriorly.2.Multiple osseous metastatic lesions are also seen with a dominant lesion noted at the left parietal region. This tumor invades the underlying bone extending at least to the inner table if not the dura, but there is no evidence of invasion of the underlying brain.3.Due to the fact that postcontrast images were severely degraded by motion artifact, the possibility of additional smaller parenchymal metastatic lesions cannot be excluded. Areas of T2 signal abnormality within the cerebellum are nonspecific and could potentially just represent vascular lesions.4.Multiple scattered foci of restricted diffusion are seen in a fairly symmetric distribution along the watershed zones of the cerebral hemispheres. These are favored to represent small perfusional infarcts. One or perhaps several small acute infarcts are also suspected within the cerebellum in the context of fairly extensive chronic ischemic disease.


Instruction: Generate impression based on medical findings.

Input: Following a discussion of the procedure with the patient and/or family, including its risks, benefits, alternatives and steps to prevent infection, informed written consent was obtained and documented in the patient's chart. The time-out form was completed to confirm patient identity and side/type of procedure. All operators present for the case performed standard preprocedural prep including hand washing, sterile gloves, mask and cap. The patient was prepped and draped in the usual aseptic fashion. Local anesthesia over the target area was obtained by 1% lidocaine. Localizing ultrasound examination demonstrates a heterogeneously hypoechoic oval encapsulated mass along the inferolateral aspect of the right knee, corresponding to the findings seen on recent MRI examination. There is internal and peripheral vascularity on Doppler interrogation. A 16-gauge Achieve core biopsy needle was advanced into the lesion using ultrasound guidance. Four 16-gauge core biopsy specimens were obtained and placed in formalin.The core biopsy specimens were hand carried to the Surgical Pathology labThe patient tolerated the procedure well without immediate complication. Routine post procedure instructions were communicated to the patient.ESTIMATED BLOOD LOSS: Less than 5cc. An adhesive bandage was placed on the patient’s skin.

Output: Ultrasound-guided biopsy of right knee soft tissue mass.


Instruction: Generate impression based on medical findings.

Input: Reason: spinal cord astrocytoma s/p RT and TMZ. History: spinal cord astrocytoma. CERVICAL SPINE:T2 hyperintense expansile mass within the right aspect of the cord extending from the C3-C4 level to C7-T1 is not appreciably changed in size measuring approximately 1.5 x 1.2 cm in the transverse and AP dimensions in the axial plane at the mid C6 level. T2 hyperintensity involving the left lateral aspect of the cord at these levels is also again seen and not significantly changed. There are faint small foci of ill-defined enhancement involving the left lateral aspect of the cervical cord at the C5 and C7 levels and also present previously.There is mild reversal of the normal cervical lordosis. Vertebral body heights are maintained. Mild multilevel disc desiccation with mild degenerative disc disease at C5-C6 and C6-C7 is unchanged. Diffuse T1 hyperintensity throughout the vertebral bodies likely related to radiation. Postsurgical changes along the posterior cervical spine with laminectomies at C5 and C6 are unchanged.THORACIC SPINE:T2 hyperintense expansile mass centered on the left aspect of the cord extending from the T2-T3 level to the T8 level is unchanged in size and overall distribution, measuring 11 x 10 mm in the axial plane at the mid T4 level similar to prior. Cord signal abnormality involving the right lateral aspect of the cord is also not significant changed. There is faint diffuse enhancement of the lesion which less conspicuous than on 6/8/2016 with artifacts and differences in contrast timing somewhat limiting comparison. There is however no new suspicious enhancement to suggest progression.No significant spinal or neural foraminal narrowing throughout the thoracic spine. Central disc protrusion at T7-T8 as well as additional mild multilevel degenerative changes are not significantly changed. Vertebral body heights and alignment are normal. T1 hyperintensity in the marrow likely reflects post radiation change.

Output: Compared to 9/7/2016 and 6/8/2016, there is no evidence of interval progression cervical and thoracic astrocytomas.


Instruction: Generate impression based on medical findings.

Input: Persistently altered mental status. MRI: There is a 3 cm wide area of gyriform restricted diffusion and high T2 signal in the right precentral gyrus. There are also several punctate foci of restricted diffusion and high T2 signal in the subcortical white matter of the right occipital lobe and left frontal lobes. There is no evidence of intracranial hemorrhage or mass. There is diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is bilateral tympanomastoid fluid.MRA: There is no evidence of significant steno-occlusive lesions or saccular aneurysms. There is a fetal right posterior cerebral artery.

Output: 1. Moderate-sized recent infarction involving the right precentral gyrus and punctate recent infarcts in the right occipital lobe and left frontal lobes, which may be embolic in nature.2. No evidence of significant steno-occlusive lesions of the proximal intracranial arteries. Vascular imaging of the neck may be useful for further evaluation.3. Diffuse cerebral volume loss.4. Nonspecific bilateral tympanomastoid effusions.


Instruction: Generate impression based on medical findings.

Input: Assess for cause of altered mental status Motion artifact limits the study. Periventricular and subcortical white matter T2/FLAIR hyperintensity is likely secondary to mild small vessel ischemic disease. No focal mass lesion is seen. No extra-axial collection is noted. Moderate volume loss is noted.Mucosal polyps/retention cysts are seen in the maxillary sinuses. The orbits are intact.

Output: Limited suboptimal examination with probable mild small vessel ischemic disease. No focal mass lesion or extra-axial collection. Unable to exclude acute infarction as no diffusion-weighted images were obtained.


Instruction: Generate impression based on medical findings.

Input: Follow-up hypoechoic lesion seen on ultrasound. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology and size. It measures 15.8 cm in the craniocaudal dimension. No focal suspicious lesion. No biliary ductal dilatation. The gallbladder is normal in appearance. There is mild signal loss on out of phase imaging compatible with steatosis.SPLEEN: The spleen is normal in size, morphology and signal intensity without a focal lesion.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal subcentimeter simple cyst. Mild right renal cortical scarring. No hydronephrosis.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: Steatosis without a focal suspicious liver lesion.


Instruction: Generate impression based on medical findings.

Input: Secondary malignant neoplasm of brain [C79.31] / Secondary malignant neoplasm of other parts of nervous system [C79.49], Reason for Study: ^Reason: NSCLC brain mets hx. History: hx brain mets. Previously seen left anterior mesial temporal lobe nodular enhancing lesions with the susceptibility artifacts are seen and appear to be stable. However, due to different imaging of adjacent technique (currently 4 mm thickness on fat saturation T1 axial scan and 2 mm thickness on 3-D T1 postcontrast acquisition; the 3-D acquisition was acquired in 1 mm thickness on prior scan), precise interval evaluation is impossible.There is no other abnormal enhancement on this scan.Encephalomalacia with ex vacuo changes of left lateral ventricle of the left parietal lobe especially inferior parietal lobule are again seen, unchanged since prior scan.Left caudate nucleus and bilateral cerebellar hemispheric tissue losses indicate prior ischemic infarct are again seen, unchanged.There is no evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are unremarkable. There is no edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Stable looking left mesial temporal lobe punctate enhancing foci since prior scan. However, the examination can be repeated without additional charge for precise evaluation.2. No new abnormal enhancing lesion on this scan.3. Unchanged postoperative changes of the left parietal lobe lesion and chronic ischemic infarctions on the left caudate and bilateral cerebellar hemispheres.4. No acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on medical findings.

Input: History of ataxia and vertigo, for the last 4 days. Assess for stroke. BRAIN MRI:There is no acute infarct. There is a tiny focus of susceptibility effect in the left frontal centrum semiovale which may represent hemosiderin staining or calcification. There is no associated edema or perceptible abnormality on the STIR sequences. There is no intracranial hemorrhage otherwise.Confluent periventricular and punctate deep and subcortical white-matter T2 FLAIR hyperintensities are present in both cerebral hemispheres. These are nonspecific but most likely reflect mild chronic microvascular ischemia. Focal CSF intensities in the left putamen and the medial aspect of the temporal lobes probably represent perivascular spaces and/or small cysts, which may be a normal variant. There is no space-occupying brain lesion. There is no midline shift or brain herniation. The ventricles and the other CSF-containing spaces are mildly expanded, reflecting mild global brain volume loss. The flow voids of the major intracranial vessels are preserved, reflecting gross patency.Minimal nonspecific opacification of the mastoid air cells. There is a small retention cyst in the right maxillary sinus. In addition, there is mild mucosal thickening in the right maxillary sinus and bilaterally in the frontal and the anterior ethmoid sinuses. These findings are also nonspecific. Orbits are notable for changes of previous bilateral cataract surgery. There is no destructive skull lesion.CRANIAL MRA:There is no flow-limiting stenosis of the major intracranial arteries. Minimal contour irregularity within the intracranial vasculature may represent mild atherosclerotic disease and/or related to technique. There is no definite aneurysm. NECK MRA:Aortic branching pattern is conventional. There is no significant stenosis of the common and cervical internal carotid arteries. There is mild irregularity of the vessel outline at the carotid bulbs, left more than right, which probably reflects atherosclerosis without significant stenosis. The vertebral arteries are also conventional in anatomy and preserved in caliber.

Output: 1.There is no acute infarct, intracranial mass, or mass effect. 2.Mild chronic small vessel ischemic changes in the brain. There is a tiny focus of susceptibility in the left frontal lobe compatible with a chronic microhemorrhage and nonspecific. 3.There is no significant stenosis in the intracranial circulation or the extracranial circulation in the neck.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: 41-year-old female with multicentric left breast cancer, assess response. There is heterogeneous amount of fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.There is an irregularly shaped enhancing mass, measuring 31 x 14 x 12 mm (previously 32 x 24 x 22 mm) (AP x LR x CC)with clip artifact at posterior aspect and anterior-lateral aspect, in the left breast atposterior 12 - 1 o'clock position. Immediately anterior to the proven cancer, there is another irregularly shaped highly suspicious mass, measuring 25 x 15 x 11 (previously 27 x 23 x 19 mm) (AP x LR x CC). Additionally, there is a suspicious enhancing mass at anterior 12 o'clock position, measuring 6 x 7 x 7 mm (previously 11 x 16 x 15 mm) (AP x LR x CC). And there are multiple small enhancing foci in the retroareolar region, anterior upper inner and upper outer region and middle 6 o'clock position. Those foci are all suspicious for malignancy. Overall extent of these lesions is 83 x 55 x 69 mm (previously 83 x 59 x 74 mm) (AP x LR x CC).There are at least two normal morphology left axillary lymph nodes.No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identifiedin right axillary region.

Output: Interval response to treatment with measurements provided above.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on medical findings.

Input: 65 year old woman with sarcoidosis referred to evaluate for possible cardiac sarcoidosis. Left VentricleThe left ventricle is moderately dilated with moderately reduced systolic function. The overall LV ejection fraction is 36%, the LV end diastolic volume index is 99 ml/m2 (normal range: 65+/-11), the LVEDV is 225 ml (normal range 109+/-23), the LV end systolic volume index is 64 ml/m2 (normal range 18+/-5), the LVESV is 145 ml (normal range 31+/-10), the LV mass index is 68 g/m2 (normal range 67+/-11), and the LV mass is 155 g (normal range 114+/-24). There is global hypokinesis with regional wall motion abnormalities. The basal to mid inferior and inferolateral walls are thinned and most hypokinetic. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 43%, the RV end diastolic volume index is 70 ml/m2 (normal range 69+/-14), the RVEDV is 160 ml (normal range 110+/-24), the RV end systolic volume index is 40 ml/m2 (normal range 22+/-8), and the RVESV is 91 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is a large burden of mediastinal lymphadenopathy. 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. Moderate left ventricular dilation with moderately reduced systolic function (LVEF 36%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration. 2. There is pronounced thinning and hypokinesis of the basal inferior and inferolateral walls. These segments are free of myocardial infarction. This abnormality could represent hibernating myocardium due to the presence of a severe coronary artery stenosis supplying viable myocardium. 3. Normal right ventricular size with mildly reduced systolic function (RVEF 43%).4. Severe left atrial dilation.5. At least moderate mitral regurgitation. 6. See extra-cardiac findings.


Instruction: Generate impression based on medical findings.

Input: Lower extremity weakness and decreased sensation, urinary retention, back pain: eval for cord compression and epidural abscess. There is congenital fusion of the C5 and C6 vertebrae. There is cervical kyphosis rather than lordosis, but no spondylolisthesis. Otherwise the rest of the vertebral column alignment is normal and the vertebral body heights are otherwise intact. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. The uterus is retroflexed and there is a small amount of fluid in the cul de sac. The urinary bladder is distended.

Output: 1. No evidence of spinal cord compression or intraspinal mass lesions.2. Congenital fusion of C5 and C6 vertebrae.


Instruction: Generate impression based on medical findings.

Input: 57 year old female with history of right breast invasive ductal carcinoma status post mastectomy in 2007 presents for screening examination. Patient is currently on aromatase inhibitor. No current breast related complaints. Positive family history of breast carcinoma in her sister at age 48. There is heterogeneous amount of fibroglandular tissue in left breast. Postsurgical changes are present consistent with right mastectomy. No abnormal enhancement is seen in the left breast and right chest wall.No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on medical findings.

Input: altered mental status, left temporoparietal ICH Redemonstration of the left temporoparietal ICH with surrounding edema.In addition, there are variable sized multiple susceptibility artifacts on bilateral hemispheres as well as bilateral thalami, brain stem and cerebellar hemispheres. These lesions indicate possible multifocal various aged hemorrhagic foci or possibility of cerebral amyloidosis.The left lateral ventricle occipital horn appears to be obliterated due to mass effect. However, there is no evidence of midline shift or herniation.There is focal restricted diffusion, on the right mesial thalamus indicating acute ischemic infarction. There is no evidence of ventriculomegaly. There is no evidence of abnormal enhancement.The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Bilateral PCAs are fetal origin. Vertebrobasilar system appears to be normal.

Output: 1. Re demonstration of the left temporo-parietal ICH with minimal surrounding edema and mass effect.2. Multifocal variable sized susceptibility artifact lesions indicate possible cerebral amyloidosis or multiple various aged hemorrhagic foci.3. Focal ischemic stroke on the right thalamus.4. No abnormal enhancement.