Instruction: Generate impression based on medical findings.

Input: Reason: ?cervical radiculopathy History: pain in axilla and shoulder. Per technologist note patient has right-sided neck pain radiating down the right shoulder and arm. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Minimal disc bulge. No significant compromise to the spinal canal or neural foramina.C4-5: Mild disc bulge and mild right-sided uncovertebral hypertrophy. No significant compromise to the spinal canal or neural foramina.C5-6: Small disc osteophyte complex with right greater than left uncovertebral hypertrophy. There is no significant spinal canal stenosis. There is mild to moderate right neural foraminal stenosis. No significant left neural foraminal narrowing. C6-7: Small central disc extrusion without significant narrowing of the spinal canal. There is possible small amount of disc material in the right neural foramen, as seen on sagittal oblique sequence series 9 image 5 of 11. There is uncovertebral hypertrophy on the right. There is mild to moderate neural foraminal stenosis at this level. No significant left neural foraminal narrowing.C7-T1: No significant compromise to the spinal canal or right neural foramen. Mild left neural foraminal narrowing.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits. Secretions noted within the trachea. Partial opacification of the right mastoid air cells also noted.

Output: 1. Multilevel degenerative changes in the cervical spine. There is mild to moderate right C5-C6 and right C6-C7 neural foraminal stenosis which may be affecting the C6 and C7 nerve roots. Please see details above. 2. No significant spinal canal stenosis in the cervical spine.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old, with lung adenocarcinoma. Assess for brain metastases. No pathologic intracranial enhancement is seen. No edema or mass effect is detected. There are numerous foci of T2 hyperintensity scattered through the cerebral white matter which are non-specific. No intracranial hemorrhage or abnormal extra-axial fluid is seen. The ventricles are normal in size and morphology.

Output: 1.No evidence of intracranial metastases.2.Scattered non-specific foci of white matter signal abnormality may reflect chronic small vessel ischemic disease.


Instruction: Generate impression based on medical findings.

Input: Ataxia. Subacute cerebellar degeneration. There is redemonstration of substantial disproportionate diffuse cerebellar volume loss and scattered areas of mild T2 hyperintensity. There are also a few unchanged nonspecific foci of T2 hyperintensity in the cerebral white matter. The brainstem and supratentorial structures are otherwise unremarkable. There is no evidence of intracranial hemorrhage, mass, 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 orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No significant interval change in the findings related to cerebellar degeneration.


Instruction: Generate impression based on medical findings.

Input: Male 29 years old Reason: eval for fai; djd; labral tear History: hip pain with sports for months and back pain right > left with a click ACETABULAR LABRUM: The acetabular labrum is intact. No fluid enters the labrum to suggest tear.ARTICULAR CARTILAGE AND BONE: Bone marrow signal is within normal limits for patient's age. Articular cartilage is intact.SOFT TISSUES: Muscles and ligaments are within normal limits. There is no T2 abnormality to suggest trochanteric bursitis or other tendinous injury.ADDITIONAL

Output: MRI of the hip within normal limits. No labral tear as clinically questioned.


Instruction: Generate impression based on medical findings.

Input: 6-month-old male with history intraventricular hemorrhage. Rule out hydrocephalus. Slight decrease in size of extra axial fluid which remains moderate on the left and mild on the right. Slight decrease in size of left porencephalic cyst. Prominent ventricular volumes are stable except in the frontal horn of the left lateral ventricle which has increased in size secondary to ex vacuo dilatation as adjacent left cerebral mass containing internal calcification has decreased in size.No new hemorrhage identified.Within the porencephalic cyst anteriorly (image 29, series 2) there is a rounded density that appears slightly larger than the prior study. This may represent organizing hematoma and can be further evaluated with an MRI. The calvaria and skull base are radiographically normal.

Output: 1. Decrease in size of extra-axial fluid collection, porencephalic cyst, and left cerebral mass representing hematoma2. Rounded density within the anterior aspect of the porencephalic cyst is slightly larger than the prior study and may represent an organizing hematoma. Further evaluation may be performed with a brain MRI.


Instruction: Generate impression based on medical findings.

Input: 63-year-old male with altered mental status, assess for etiology. CVA, hemorrhage, mass.IMAGE ACQUISITION: Nonenhanced CT of the head. No acute intracranial abnormality is evident. Specifically, there is no evidence of intracranial hemorrhage, focal mass, edema, midline shift, or hydrocephalus. There is no CT evidence for acute territorial ischemia.Again demonstrated is extensive hypoattenuation in the supratentorial white matter, unchanged and most consistent with small vessel ischemic disease. Atherosclerotic vertebral and internal carotid arteries arteries are again noted.Persistent opacification of the bilateral mastoid air cells with soft tissue attenuation within the left external auditory canal, unchanged. Please refer to recent MRI of the internal auditory canal for additional details.

Output: 1. No acute intracranial abnormality.2. Unchanged small vessel ischemic disease of indeterminate age.3. Persistent opacification of the left mastoid air cells with soft tissue attenuation within the left external auditory canal. Please refer to recent MRI from 9/28/11 for additional information.


Instruction: Generate impression based on medical findings.

Input: Hypothyroid, adrenal insufficiency, hypo-PTH. The pituitary gland is not enlarged and there is no evidence of sellar or suprasellar mass lesions. A small posterior pituitary bright spot is apparent. The pituitary infundibulum is slightly wide, but otherwise intact and situated in the midline. The optic apparatus, regional internal carotid artery flow voids, and cavernous sinuses are intact. There is diffuse, thin, smooth dural hyperenhancement, along with trace diffuse subdural effusions. The imaged portions of the brain parenchyma are unremarkable.

Output: 1. No evidence of pituitary tumor.2. Diffuse, thin, smooth dural hyperenhancement, along with trace diffuse subdural effusions is nonspecific, but may be related to intracranial hypotension, for example.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Assess for progression of posterior fossa lesion. Signs and symptoms: Spasticity. Pre- and post enhanced brain MRI:Negative diffusion weighted images.Examination demonstrates multiple patchy foci of T2 hyperintensity in bilateral basal ganglia with interval progression since prior exam from 2012. Multiple tiny foci of FLAIR hyperintensity is also noted in the subcortical and periventricular white matter without convincing evidence of change.Tiny foci of T2 hyperintensity in bilateral thalami (left greater than right are better visualized on T2-weighted images) without significant change.Images through posterior fossa demonstrates extensive bilateral peroneal and pontine foci of FLAIR and T2 hyperintensity without convincing evidence of progression since prior exam. There are no detectable signal abnormality of cerebral cortex or cerebellum/vermis which is a similar observation as prior exam.Cortical sulci as well as ventricular system remain within normal size for patient of stated age and with maintained midline.Post enhanced images demonstrate no detectable abnormal parenchymal or leptomeningeal enhancement and none of the above described foci of T2/FLAIR hyperintensity demonstrate enhancement. The signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses are within normal and the normal pattern of enhancement.Unremarkable images through the orbits including axial fat sat post enhanced series. Unremarkable images through the paranasal sinuses and mastoid air cells.

Output: 1.Negative diffusion-weighted images.2.Extensive bilateral basal ganglia and to a lesser degree bilateral thalami and pons and minimally in the subcortical and periventricular white matter foci of FLAIR hyperintensity without evidence of enhancement are again noted. There is progression of disease in bilateral basal ganglia since prior study. There is no convincing evidence of lesions in the corpus callosum or the cerebellar peduncles. Findings are more suggestive of chronic small vessel ischemic strokes.3.Unremarkable pre and post enhanced brain MRI otherwise.


Instruction: Generate impression based on medical findings.

Input: 19 years Female (DOB:6/28/1997)Reason: ocular migraine History: photopsias with or without HAsPROVIDER/ATTENDING NAME: JEFFREY W. NICHOLS JEFFREY W. NICHOLS The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There is no evidence for intracranial mass lesion. MRI of the brain is within normal limits


Instruction: Generate impression based on medical findings.

Input: Male 51 years old with prostate cancer on active surveillance, restaging MRI and biopsy. PELVIS:PROSTATE:Prostate Size: 5.3 x 4.4 cm.Peripheral Zone: There is a 6 x 5 mm focus of restriction diffusion in the left lateral apex (series 43, image 244) and a 1.2 x 7.3 cm focus of T2 signal abnormality in the left base (series 801, image 19) that demonstrates restricted diffusion.There are multiple linear areas of T1 hyperintensity consistent with post biopsy hemorrhage.Note is made of a utricle cyst.Central Gland: The central gland is heterogeneous consistent with benign nodules.Seminal Vesicles: The seminal vessels are unremarkable.Extracapsular Extension: No evidence of extracapsular extension or perineural spread.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 6 x 5 mm area of signal abnormality in the left apex is suspicious for prostate carcinoma. The larger focus of signal abnormality in the left base may represent central zone verses an additional focus of carcinoma.


Instruction: Generate impression based on medical findings.

Input: 63 years, Female, right CSF otorrhea. Evaluate brain. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Minimal scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Partially empty sella is noted which can be seen as a normal variant but can be associated with intracranial hypertension in the appropriate clinical setting. Cerebellar tonsils are low-lying without clear evidence of Chiari I reformation. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.There is diffuse opacification of the right-sided mastoid air cells. There is osseous defect involving the right tegmen mastoideum and compatible with history of CSF leak. Osseous defect and better seen on recent outside CT from 2/2/2016 as well as prior temporal bone CT from 12/8/2010. Minimal if any protrusion of the brain parenchyma is seen through this right temporal defect. There is asymmetrically increased enhancement of the overlying dura which may be reactive. No edema or clear evidence of encephalomalacia in the right temporal lobe is evident.Thinning of the roof of the left middle ear is also suspected as well as undulation of the left lateral temporal bone surface as well as the left greater sphenoid wing, better appreciated on outside CT and suggesting arachnoid pits. There is minimal opacification of the left-sided mastoid air cells.

Output: 1. Diffuse opacification of the right mastoid air cells with osseous defect involving the right tegmen mastoideum, which is better seen on recent CT. There is evidence of a meningocele at this level. There is minimal if any protrusion of the brain parenchyma through this right temporal bone defect. Dedicated temporal bone MRI can be considered for higher resolution visualization of this region if clinically indicated. There is asymmetrically increased enhancement of the overlying dura which may be reactive. No parenchymal edema or clear evidence of encephalomalacia in the right temporal lobe or elsewhere is appreciated.2. There is undulated appearance the floor of the contralateral left middle cranial fossa including the left sphenoid and left temporal bones with suggestion of "arachnoid pits". There are areas of osseous thinning/dehiscence in the left tegmen tympani. These osseous findings are better appreciated on prior temporal bone CT. 3. Partially empty sella which can be normal variant but can also be seen with intracranial hypertension. 4. Minimal nonspecific left mastoid air cell opacification.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old, with lightheadedness multiple falls. Multiple scattered small foci of FLAIR hyperintensity are seen within the cerebral hemispheres. No restricted diffusion is seen.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. Signal intensity of the bone marrow is unremarkable. No significant abnormalities of the paranasal sinuses are detected.

Output: 1.Numerous scattered foci of FLAIR hyperintensity are seen which most likely represent chronic microvascular ischemia.2.No definite acute lesions are seen.3.No specific findings are detected to account for the patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: Syncope and collapse, if the source of nonresponsiveness, evaluate for the cause of syncope. There is no evidence of acute infarct. There is encephalomalacia along the watershed zone between the right anterior and middle cerebral artery territory extending to the centrum semiovale with ex vacuo dilatation of the right lateral ventricle and right-sided cortical sulci. There are patchy and scattered foci of cerebral white matter T2 hyperintensity which are nonspecific, mostly related to chronic small vessel ischemic changes. There is gyriform susceptibility effect involving the right posterior parietal lobe likely related to chronic microhemorrhage. The ventricles and basal cisterns are unchanged, with evidence of diffuse cerebral volume loss. There is no midline shift or herniation. The right internal carotid artery flow void is lacking proximally, with reconstitution of the flow voids at the petrous and cavernous portion, with heterogeneous flow void signal, which may relate to slow flow. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Chronic infarction involving the right frontal and parietal lobes in a watershed distribution, as well as a background of probable chronic small vessel ischemic changes.2. Redemonstration of occlusion of the proximal intracranial right internal carotid artery.


Instruction: Generate impression based on medical findings.

Input: 42 year-old female history of treated triple negative breast cancer in 2013 with abnormal T5 vertebral body enhancement. Redemonstrated is a small well demarcated focus of increased T2 signal and mild enhancement within the right dorsal aspect of the T5 vertebral body and right pedicle. This lesion measures approximately 8 x 5 mm, previously 8 x 5 mm (image 26/6). There has been no significant change in appearance when compared to two prior exams. There is no evidence of bony erosion. The surrounding structures are unremarkable. The remaining bone marrow signal is normal. No abnormal enhancement to suggest metastasis. Tiny central disk protrusions are unchanged at T4-5 and T5-6. There is no underlying spinal cord signal abnormality. There is no significant spinal cord or neuroforaminal stenosis.

Output: 1.Stable demarcated focus of signal abnormality involving the right pedicle and right posterior aspect of the T5 vertebral body. While the appearance of this lesion is nonspecific, the benign morphology and stability over time are reassuring.2.No additional concerning lesions are present to suggest metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Cerebral infarction, unspecified Hb-SS disease with crisis, unspecifiedClinical question: s/p stroke. Hgb SS. Evaluate for strokeSigns and Symptoms: worsening left arm and leg weakness. MRI of the brainNo diffusion weighted abnormalities suggestive of acute infarction are appreciated.There is redemonstration of encephalomalacia involving the watershed zone of the right anterior and middle cerebral artery territories with additional involvement of the right middle frontal gyrus and extension to the centrum semiovale. There is a smaller focus of encephalomalacia involving a small portion of the posterior aspect of the right temporal lobe. There is associated ex vacuo effect along the right lateral ventricle. There is redemonstration of small foci of susceptibility effect within the encephalomalacic brain.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 some mucosal thickening along the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.A small 6mm cyst is present in the pharyngeal mucosal space to the right of midline in the nasopharynx which is likely benign.Cervical spine:There is redemonstration and no change in os odontoideum.The cervical vertebral bodies are appropriate in overall height. The cervical spinal cord has normal signal characteristics and overall morphology. There is diffuse marrow replacement.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.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.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be 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. Attenuation of right MCA vasculature is likely related to encephalomalacia.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The left vertebral artery is a little larger than the right vertebral artery.There is extracranial origin of the left PICA.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.

Output: 1.There is redemonstration of encephalomalacia involving the right hemisphere at or adjacent to watershed territories of the right frontal, parietal and temporal lobe.2.There is redemonstration and no change in os odontoideum. Extension/Flexion plain films may help assess for instability.3.There is no evidence for intracranial cerebrovascular occlusive disease.4.There is no evidence for extracranial cerebrovascular occlusive disease.5.There is diffuse marrow replacement present which is likely related to the patient's sickle cell anemia.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Malignant neoplasm of prostate. Malignant neoplasm of prostateClinical question: eval for progression of lytic metastasisSigns and Symptoms: prostate cancer with L1 metastasis Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment. The conus medullaris on sagittal imaging is grossly intact. Please note that there is a transitional vertebra present with partial lumbarization of the S1 segment.There is a marrow replacing lesion present at L1 associated with the compression fracture and convex posterior bowing of the posterior wall of the L1 vertebra into the spinal canal. Compared to the 6/5/2015 exam there is no significant change. There is approximately 20% loss of vertebral body height at L1.At S1-S2 there is a formed disc present as well as left-sided facet hypertrophyAt L5-S1 there is a diffuse disc bulge present associated with bilateral facet hypertrophy. The facet hypertrophy is worse on the left compared to the right side. There is partial effacement of the fat at the left lateral recess at this level with some encroachment of the nerve roots at the left lateral recess. There is some mild encroachment of the nerve roots within the left neural foramen at this level with some partial effacement of fat surrounding the left-sided exiting nerve root. There is loss of disc space height and disc desiccation at this level.At L4-5 there is loss of disc space height present as well as disc desiccation and a mild disc bulge associated with bilateral facet and ligamentum flavum hypertrophy. There is some effacement of the fat at the lateral recess bilaterally but slightly more on the right side when compared to the left. There is narrowing of the neural foramina bilaterally.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is some disc desiccation present at this levelAt L2-3 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation present at this levelAt L1-2 there is no significant compromise to spinal canal or neural foramina.The left kidney is not readily identified. There is a retroperitoneal nodule which is not imaged on this exam.

Output: 1.Please note the enumeration vertebral bodies. S1 is a transitional vertebra.2.There is redemonstration of a malignant compression fracture at L1 which is stable compared to the prior exam.3.Status post left nephrectomy.4.There are multilevel degenerative changes present in the lumbar spine which are worse at L5-S1 where there is encroachment of the nerve roots of the left neural foramen and the left lateral recess.5.A retroperitoneal nodule suspected represent a benign adrenal gland nodule is not well imaged on this exam. There is a CT of the abdomen from 10/9/2015 which showed assesses this further. Please refer to that report for further comments.


Instruction: Generate impression based on medical findings.

Input: Biliary dilation and chronic pancreatitis. Portal vein thrombus. Hepatitis C and alcoholic liver disease. Per medical record, patient has history of chronic pancreatitis and dilated pancreatic and CBD ducts in 2004, s/p pancreaticojejunostomy, choledochoduodenostomy, cholecystectomy, splenectomy at Rush for obstructive jaundice. Since then, he has been found to have biliary dilatation on his MRI MRCP in July 2014. ABDOMEN:LIVER, BILIARY TRACT: Cavernous transformation of the portal vein, similar to that seen on the CT on 11/3/2014, reflecting chronic thrombosis. The recanalized right portal vein is seen, though narrow. The left portal vein is not well seen. There is diffuse nodular enhancement of the liver on arterial phase, which becomes homogeneous on venous phase, without washout to raise suspicious for focal lesions. No specific stigmata of cirrhosis. There is moderate diffuse biliary dilation. The hepatic duct measures up to 8 mm wide, with smooth narrowing of the common bile duct at the choledochoduodenostomy, which remains patent and similar to the CT on 11/3/14. No associated mass is seen.SPLEEN: Surgically absent.PANCREAS: Post surgical changes at the pancreatic head and pancreaticojejunostomy, without complication evident. The remaining pancreas is atrophic with heterogenous parenchymal T1 signal and beading irregularity of the pancreatic duct, compatible with the known history of chronic pancreatitis. No focal mass is seen.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral renal cysts. Otherwise, no significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Evidence of pancreaticojejunostomy and choledochoduodenostomy, without acute abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1. Stable post-surgical biliary changes and moderate biliary dilation. No specific evidence of complication. 2. Chronic portal vein thrombosis with cavernous transformation, similar to 2014. No specific evidence of cirrhosis.


Instruction: Generate impression based on medical findings.

Input: There is significant interval worsening of intracranial tumor burden in the right temporal lobe, as well as new mass in the genu and rostrum of the corpus callosum crossing the midline. There is extensive increased nonenhancing confluent T2 signal abnormality in the right temporal lobe extending into the right periatrial white matter with a significantly larger enhancing mass in the right temporal lobe measuring 28 x 26 mm with a 7-mm exophytic nodule along the anterolateral contour of the mass. There is increased mass effect on the right temporal horn and the right atrium of the lateral ventricles with partial effacement. On the previous exam, the larger mass measured less than 15 mm in maximal dimension. There is a new mass centered in the genu and rostrum of the corpus callosum crossing the midline measuring 10 x 11 mm with associated mild mass effect on the frontal horns. There is mild periventricular and subcortical white matter T2 hyperintensity with involvement of the central pons which is nonspecific, likely representing a combination of small vessel ischemic changes and post treatment changes.There is no acute infarct or midline shift.

Output: 1.There is significant interval worsening of intracranial tumor burden in the right temporal lobe, as well as new mass in the genu and rostrum of the corpus callosum crossing the midline.2.Worsened vasogenic edema in the right temporal lobe and mass effect on the right lateral ventricle.Findings were communicated to the Hematology/Oncology Dr. Veneris over the telephone by Dr. Pranay Uppuluri at 3:45 PM today.


Instruction: Generate impression based on medical findings.

Input: Male, 88 years old, with left facial droop. No restricted diffusion is seen. Fairly extensive patchy periventricular FLAIR hyperintensity is again seen similar to that noted on prior MRI. No evidence of significant parenchymal edema or mass effect is detected. A small chronic infarct of the right cerebellum is unchanged. Prominence of the ventricles and sulci is unchanged and compatible with underlying volume loss. No evidence of acute intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. Foci of susceptibility in the pons and adjacent to the left restiform body may represent chronic microhemorrhage.

Output: 1.No evidence of acute ischemia.2.Moderately advanced chronic microvascular ischemic disease without significant interval change.


Instruction: Generate impression based on medical findings.

Input: BRAIN: There is a region of T2 signal abnormality centered in the dorsal pons but extending inferiorly into the medulla, and superiorly into the midbrain with mild expansion. This area demonstrates patchy internal enhancement. There is no definite leptomeningeal enhancement within the brain. There is no acute infarct. There is mild persistent crowding at the foramen magnum without evidence of Chiari I malformation.CERVICAL: Although the findings are subtle, there is very likely mild bilateral scattered nerve root enhancement in the cervical spine. There is a small somewhat linear focus of T2 signal hyperintensity in the cervical cord on the right at C3, and an additional somewhat linear focus on the left at C6. No convincing pathologic enhancement is seen in the cord. There is enhancement and high T2 signal in the left superior articulating facet of C4 probably representing a hemangioma. Minimal degenerative findings in the cervical spine are unchanged from the prior recent MRI.

Output: Stable signal abnormality with ill-defined enhancement in the brainstem, and additional lesions in the cervical cord without enhancement. Additionally, there is likely subtle enhancement of some of the cervical nerve roots. These findings are nonspecific, and the differential diagnosis again includes infectious diseases including atypical or viral etiologies, granulomatous, post-infectious and autoimmune etiologies. A neoplastic etiology is felt to be unlikely.


Instruction: Generate impression based on medical findings.

Input: 25 year-old woman with history of pain and catching of the right knee. MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage of the tibiofemoral and patellofemoral compartments is intact. Marrow and cortical signal is normal.LIGAMENTS: The ACL, PCL, MCL, and LCL complex are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: No finding to explain the patient's pain.


Instruction: Generate impression based on medical findings.

Input: There is no no abnormal enhancement, acute infarct, mass effect, or cerebral edema. There are moderate periventricular and subcortical white matter T2 hyperintensities which are nonspecific, likely representing chronic small vessel ischemic changes with involvement of the central pons. There is age related sulcal prominence. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: No intracranial metastases. Moderate chronic small vessel ischemic changes.


Instruction: Generate impression based on medical findings.

Input: Q.D. MENISCI: There is complex tearing of the posterior horn of the medial meniscus which extends to the tibial articular surface. Lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is mild articular cartilage loss of the medial femoral condyle anteriorly with associated degenerative marrow signal. The remaining cartilage of the medial, lateral, and patellofemoral compartments is otherwise intact.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Complex tear of the posterior horn of the medial meniscus.2. Mild articular cartilage loss of the medial femoral condyle.3. Small joint effusion.


Instruction: Generate impression based on medical findings.

Input: 29-year-old female with neutropenic fever, sore throat for 1 week and an enlarged lymph node in the right neck. Evaluate for abscess. Enlarged right cervical lymph node near the carotid bifurcation (image 47, series 10535) does not appear necrotic and measures 15 mm in short dimension, indicating inflammation. No other enlarged lymph nodes or evidence of abscess.Patent and unremarkable vasculature. Asymmetric prominence of the right adenoids. Nonspecific thickening of the tongue base is symmetric and may be correlated clinically for significance. Airway appears patent. Paranasal sinuses and mastoid air cells are well-pneumatized. No significant prevertebral soft tissue swelling. Cervical spine with unremarkable alignment.Visualized upper lungs are unremarkable.

Output: Enlarged right cervical lymph node and nonspecific tongue base thickening associated with right parapharyngeal adenoidal enlargement. Please correlate with clinical exam findings.


Instruction: Generate impression based on medical findings.

Input: 75-year-old female with mental status changes status post fall on face. Evaluate for acute bleed. Extensive areas of low-attenuation in the deep, subcortical, and periventricular white matter consistent with small vessel ischemic disease of indeterminate age. They appear grossly stable when comparing to prior MRI of the brain. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.Additionally, there is a mottled appearance to the bones of the skull base and frontal bone that is of uncertain etiology. Given patient's history of malignancy, bone metastasis is a differential consideration.The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Extensive small vessel ischemic disease of indeterminate age.2. Mottled appearance of the bones of the skull base and frontal bone is of uncertain etiology. Given patient's history of malignancy, metastatic disease to bone is a differential consideration. Nuclear medicine bone scan may be helpful for further evaluation as clinically indicated.


Instruction: Generate impression based on medical findings.

Input: 3 months, Male, bradycardia with apnea. Brain parenchyma appears within normal limits for age. Sulcation and myelination appear age-appropriate. Midline structures including the corpus callosum and posterior fossa structures appear within normal limits. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Major flow-voids are preserved with apparent low signal surrounding the basilar artery on the T2 weighted and susceptibility weighted sequences probably artifactual.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct.2. Apparent low signal surrounding the basilar artery on the T2-weighted and susceptibility weighted sequences favored to be artifactual.


Instruction: Generate impression based on medical findings.

Input: Again seen are postsurgical changes including suboccipital craniectomy and resection of the posterior arch of C1. The CSF space remains well expanded at this level and the cerebellar tonsils are neither crowded nor peglike. CSF flow is seen through both the anterior and posterior aspects of the foramen magnum, similar to prior. Minimal scarring is again evident involving the posterior inferior aspect of the cerebellar surface. No evidence of tumor recurrence at the site of prior tumor dorsal to the medulla.No evidence of parenchymal edema, mass, or mass effect is seen. No evidence of ischemia or hemorrhage. The ventricular system is normal in caliber and morphology. No abnormal parenchymal or meningeal enhancement is seen.CERVICAL SPINE

Output: 1. Postoperative changes related to resection of exophytic tumor along the posterior aspect of the medulla. No evidence of tumor recurrence.2. Postoperative changes related to lipomyelomeningocele repair and prior cord untetherings. No significant change in appearance of the conus which appears to adhere to the dorsal dural surface and demonstrates no ventral motion with prone imaging. Extensive adhesions within the distal thecal sac are also evident and unchanged. Re-tethering is again not excluded and can be correlated with clinical findings. No new cord signal abnormality or syrinx.


Instruction: Generate impression based on medical findings.

Input: 33-year-old male with history of right shoulder pain. Evaluate for instability ROTATOR CUFF: The muscles and tendons of the supraspinatus, infraspinatus, teres minor, and subscapularis are unremarkable. There is no evidence of rotator cuff tear.SUPRASPINATUS OUTLET: The supraspinatus outlet is unremarkable. There is no fluid within the subacromial or subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a linear fluid-filled tear of the posterior labrum from approximately the 7 to 9 o'clock positions. The remaining labrum appears unremarkable.BICEPS TENDON: The biceps tendon is unremarkable. ADDITIONAL

Output: 1.Posterior labral tear as above.2.Subcoracoid intraarticular loose body.3.Paralabral cysts with no evidence of nerve impingement.4.Intact rotator cuff.


Instruction: Generate impression based on medical findings.

Input: 63-year-old female with cervical cancer and seizures, concern for metastasis. There is no evidence of intracranial hemorrhage, mass, or acute infarct. Scattered punctate foci of increased T2 signal within the periventricular and subcortical white matter, do not appear substantially changed compared from the prior examination, when accounting for differences in acquisition technique. The hippocampi are normal in signal and morphology. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.No evidence of intracranial hemorrhage, mass, or acute infarct.2.Grossly stable scattered foci of high T2 signal in the periventricular and subcortical white matter are nonspecific, but may reflect chronic small vessel ischemic disease.3.Normal appearance of the bilateral hippocampi.


Instruction: Generate impression based on medical findings.

Input: 62-year-old male with a history of multiple myeloma with 3 weeks of cough, hemoptysis. Bronchoscopy showed adenocarcinoma of the lungs. Rule-out brain metastases. There are areas of white matter hypodensity in the right frontal lobe. Given the history of a neoplastic primary, metastatic involvement cannot be ruled out. An MRI with contrast is recommended for further evaluation. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. There is partial opacification of the dependent portions of the left maxillary sinus, improved compared to the prior examination. The remaining visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Patchy areas of hypodensity in the right frontal white matter. Given the history of neoplasm, an MRI is recommended for further evaluation to rule out metastatic foci as clinically indicated.


Instruction: Generate impression based on medical findings.

Input: 53-year-old woman with history of fall from horse, left pubic ramus fracture, and urinary incontinence. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Lumbar spine alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position at L1. Of note there is thin, discontinuous linear T1 hyperintense signal extending from the L2/3 to lower L4 level and again from the L5 level to the distal thecal sac. This appears similar to the prior examination from 2012 and is of normal thickness.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: There is a minimal disc bulge without spinal canal or neural foraminal stenosis.L4-L5: There is a minimal disc bulge without spinal canal or neural foraminal stenosis. There is a small right perineural cyst.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis. There is a small left perineural cyst.There is a curvilinear area of T1 hypointensity and T2 hyperintensity extending from the anterior left sacral ala to the left lateral margin of the S1-S2 foramen (501/3). There is increased T2 signal in the surrounding marrow, however no evidence of significant cortical displacement. There are cysts in the right lobe of the liver and right kidney, otherwise the paraspinous soft tissues are within normal limits.

Output: 1.Incompletely visualized nondisplaced left sacral alar fracture extending to the margins of the dorsal sacral foramina, with prominent associated bone marrow edema. CT can be considered for further characterization if clinically warranted.2.Incidentally noted discontinuous fatty filum terminale which can be a normal variant but could also be seen in tethered cord syndrome, please correlate with clinical history.


Instruction: Generate impression based on medical findings.

Input: altered mental status No evidence of acute ischemic or hemorrhagic lesion on this scan.Patchy scattered high signal intensities on FLAIR images on bilateral periventricular white matter indicate non specific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The sphenoid sinus shows opacification.Bilateral mastoid air cells show fluid collections indicating possible mastoiditis. Clinical correlation is recommended.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal flow enhancement in bilateral ICAs, MCAs, ACAs and vertebrobasilar system.Acom artery and bilateral Pcom arteries are patent.There is no evidence of intracranial arterial aneurysm or stenosis.3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

Output: 1. Non specific small vessel disease as described above.2. No evidence of acute ischemic or hemorrhagic lesion on this scan.3. Normal brain MRA and neck MRA3. Sphenoid air cell opacification and bilateral mastoid fluid collections, clinical correlation is recommended.


Instruction: Generate impression based on medical findings.

Input: Reason: Area of lucency found on radiograph of the left knee History: Left knee pain There is a lesion within the proximal fibula extending from the fibular head into the proximal diaphysis over a total longitudinal distance of approximately 7.5 cm. The lesion occupies the majority of the width of the medullary canal and measures approximately 2.5 cm in its greatest transverse dimension in the fibular head. The lesion has a lobulated morphology. On T1 images it is slightly hypointense to skeletal muscle and near-fluid signal intensity on T2 weighted images. Following gadolinium administration, the lesion shows predominantly peripheral and septal enhancement. The lesion appears to be associated with mild cortical thinning but we see no frank cortical penetration. There are small round foci with similar signal intensity and enhancement characteristics in the soft tissues in the general the vicinity of the fibular head, some of which appear to erode into the proximal tibia.Severe osteoarthritis affects the knee, with tricompartmental osteophytes. The medial tibiofemoral compartment is devoid of articular cartilage with degenerative subchondral signal abnormality. There is moderate degeneration of the articular cartilage of the lateral tibiofemoral compartment with smaller full-thickness defects along the femur and tibia. There is also degeneration of the articular cartilage along the femoral trochlea.There is complex tearing of the medial meniscus. The ACL is not well visualized, presumably due to chronic tear. The PCL, MCL, and LCL are intact. The extensor mechanism is intact. There is a small joint effusion with a small amount of fluid extending into the semimembranosus-gastrocnemius recess. The visualized portions of the tibial and peroneal nerves appear normal.

Output: 1. Proximal fibular lesion as described above. Although the lesion does show heterogeneous enhancement, it is predominantly peripheral and septal in nature and furthermore similar appearing smaller lesions are seen in the soft tissues adjacent to the fibular head; thus we favor that this represents an intraosseous ganglion rather than an aggressive neoplasm, however follow-up with orthopedic oncology is recommended.2. Poor visualization of the ACL suggesting chronic tear.3. Severe osteoarthritis predominantly affecting the medial tibiofemoral compartment with complex tearing of the medial meniscus and other findings as described above.


Instruction: Generate impression based on medical findings.

Input: 58 year old with biopsy proven DCIS in the left breast, at two sites in upper inner quadrant and lower outer quadrant, presents for MRI evaluation. There is scattered fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.Metallic artifacts are identified at anterior 11:00 position and posterior 5:00 position, both from the recent DCIS biopsy.A mild linear enhancement is present in transverse direction at each of the biopsy sites, likely a post biopsy change. No significant enhancing lesion suggesting residual disease is present in the left breast.No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in either axillary region.

Output: 1. Biopsy proven DCIS in the left breast at two sites. No significant enhancement is present at the site of DCIS biopsy.2. No MRI evidence of malignancy in the right breast. BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on medical findings.

Input: Altered mental status Patchy areas of low attenuation in the subcortical and periventricular white matter reflect small vessel ischemic disease of indeterminate age. If there is clinical concern for acute ischemia, MRI is recommended. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Small vessel ischemic disease of indeterminant age


Instruction: Generate impression based on medical findings.

Input: History of metastatic lung cancer. The images are degraded by patient motion. There are postoperative findings related to left occipital craniotomy and lesionectomy. There is persistent confluent high T2 signal surrounding the resection cavity, but no evidence of abnormal intracranial enhancement that might otherwise suggest the presence of neoplasm. There is also unchanged confluent cerebral white matter T2 hyperintensity elsewhere, particularly in the corona radiata, which may be treatment-related and/or chronic small vessel ischemic disease. There is no evidence of intracranial hemorrhage, mass, 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. There is a small left maxillary sinus retention cyst. There is a punctate cystic focus in the skin of the left cheek. The orbits are unremarkable.

Output: Stable post-treatment findings without evidence of recurrent or new intracranial metastases.


Instruction: Generate impression based on medical findings.

Input: Positive McMurray. Catching x 2 months. Prior meniscus repair 2011. MENISCI: There has been interval surgical repair including partial meniscectomies of both the medial and lateral menisci, reflected by their abnormal and diminutive morphology. Only a thin rim of the medial meniscus remains. There are multidirectional complex tears of the posterior horns of both the medial and lateral menisci.ARTICULAR CARTILAGE AND BONE: Articular cartilage appears intact in the patellofemoral as well as medial and lateral tibiofemoral compartments. Minimal red marrow changes in the distal femoral metaphysis are noted. Otherwise bone marrow signal is unremarkable.LIGAMENTS: Postsurgical findings related to prior ACL reconstruction without evidence of complication. The PCL and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1.Interval medial and lateral meniscectomies.2.Multidirectional complex tearing of the posterior horns of the medial and lateral menisci.3.ACL reconstruction without evidence of complication.


Instruction: Generate impression based on medical findings.

Input: Right craniotomy for resection of a large pituitary adenoma on 3/30/2015 Limited study due to patient inability to cooperate.Redemonstration of right frontal temporal craniotomy. There is swelling and fluid in the extracranial soft tissue. There is also small amount of extra-axial fluid and blood subjacent to the craniotomy. There is trace midline shift to the left with effacement of the right lateral ventricle. There are areas of parenchymal T2 hyperintensity of the right anterior temporal lobe, right inferior frontal lobe, right insula, right caudate head, and left basal ganglia. As seen on prior MRI, right caudate head and left basal ganglia show diffusion restriction suggestive of ischemia. Other areas may represent edema or ischemia. Mega cisterna magna again noted.Debulking of a large sellar/suprasellar tumor with residual tumor seen predominant at the right superior aspect of the suprasellar cistern. The residual tumor extends towards the third ventricle with continued mass effect on the third ventricle. There is track/stalk-like area of enhancement from this tissue to the deformed sella, which may be residual tumor or pituitary infundibulum. Residual tumor is also seen extending into the prepontine cistern. There is blood product in the operative bed. Bilateral ICA flow-voids are present.

Output: 1.Postoperative findings of partial resection of the sellar and suprasellar tumor.2.Areas of parenchymal abnormality of the right anterior temporal lobe, right inferior frontal lobe, right insula, right caudate head, and left basal ganglia. As seen on prior MRI, right caudate head and left basal ganglia show diffusion restriction suggestive of ischemia. Other areas may represent edema or ischemia.


Instruction: Generate impression based on medical findings.

Input: A 28 year old female with personal history of mild asthma recently with dyspnea and atypical chest pain during exercise. Prior MRI 4/2016 with findings of low normal left and right ventricular function and severe biventricular dilation. Etiology unclear, possible Etoh. Recommendations made for Etoh cessation and repeat MRI. Left VentricleThe left ventricle is severely dilated with low normal systolic function. The overall LV ejection fraction is 50%, the LV end diastolic volume index is 98 ml/m2 (normal range: 65+/-11), the LVEDV is 165 ml (normal range 109+/-23), the LV end systolic volume index is 49 ml/m2 (normal range 18+/-5), the LVESV is 83 ml (normal range 31+/-10), the LV mass index is 52 g/m2 (normal range 67+/-11), and the LV mass is 87 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is normal wall thickness. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The native myocardial T1-time 924 which is within normal limits. These findings suggest the absence of an underlying infiltrative, inflammatory, or fibrosis process in the myocardium.Left AtriumThe left atrium is normal in size.Right VentricleThe right ventricle is severely dilated with low normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 98 ml/m2 (normal range 69+/-14), the RVEDV is 165 ml (normal range 110+/-24), the RV end systolic volume index is 49 ml/m2 (normal range 22+/-8), and the RVESV is 115 ml (normal range 35+/-13). The heart is shifted into the left thorax as a consequence of the decreased sternum to spine dimension. The sternum is extrinsically compressing on the RV free wall, distorting its shape and causing variation in the regional motion. However, there is no evidence that this extrinsic compression is hemodynamically significant. 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 drain normally into the right atrium. IVC is grossly normal. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is significant scoliosis and decreased space between the sternum and spine without evidence of a classical pectus deformity. 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 again dilated with low normal systolic function, the LVEF is 50% without evidence of underlying myocardial fibrosis, inflammation, or infiltration.2. The right ventricle is also again dilated with low normal systolic function, the RVEF is 50%. 3. Significant changes of scoliosis are noted as per prior MRI. Although there is no classical pectus deformity of the sternum, the anterior-to-posterior dimension between the sternum and spine is as small as 4.5cm. The reduced space has caused the heart to be shifted into the left thorax and distorted the shape of the right ventricle. This extrinsic compression of the right ventricle does not appear to be causing any hemodynamically significant changes. 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: Autoimmune thyroiditis and epilepsy. There is persistent, albeit slightly reduced diffuse cortical and subcortical swelling and high T2 signal with associated mild gyriform enhancement involving the left posterior temporal, parietal, and occipital lobes. There may be slightly reduced diffusivity in the cortex in some of the affected areas. Patchy areas of high T2 signal in the right cerebellar hemisphere have subsided. There is persistent patchy high T2 signal in the pons bilaterally. The left thalamus lesion appears to have resolved. There is slightly less mass effect upon the left lateral ventricle and no significant midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Overall slight improvement of the edema involving the left posterior temporal, parietal, and occipital lobes. Furthermore, patchy areas of edema in the right cerebellar hemisphere have subsided and the left thalamus lesion appears to have resolved, which may have been related to seizure activity superimposed upon autoimmune encephalopathy. The nonspecific patchy high T2 signal in the pons bilaterally otherwise persists.


Instruction: Generate impression based on medical findings.

Input: 60 year old male with a history of three vessel coronary artery disease, congestive heart failure, Hypertension, Diabetes, and CVA. DES placed in RCA in October 2014. Referred for cardiovascular MRI to evaluate for function and scar burden. Left VentricleThe left ventricle is normal in size with severely reduced systolic function. There is dyssynergy with a regional wall motion abnormality and myocardial thinning in the basal and mid inferolateral and lateral walls. The overall LV ejection fraction is 30%, the LV end diastolic volume index is 89 ml/m2 (normal range: 74+/-15), the LVEDV is 199 ml (normal range 142+/-34), the LV end systolic volume index is 62 ml/m2 (normal range 25+/-9), the LVESV is 138 ml (normal range 47+/-19), the LV mass index is 71 g/m2 (normal range 85+/-15), and the LV mass is 159 g (normal range 164+/-36). There is late gadolinium enhancement > 50% wall thickness seen in the basal and mid inferolateral and lateral walls. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 41%, the RV end diastolic volume index is 64 ml/m2 (normal range 82+/-16), the RVEDV is 142 ml (normal range 142+/-31), the RV end systolic volume index is 37 ml/m2 (normal range 31+/-9), and the RVESV is 83 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.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe IVC is normal sized.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. Severe LV systolic dysfunction2. Inferolateral and lateral wall motion abnormality with > 50% transmural extent c/w non-viability.


Instruction: Generate impression based on medical findings.

Input: 30 years Female (DOB:8/30/1985)Reason: Please evaluate for cerebral AVMs, HHT History: HHTPROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a T2 and FLAIR hyperintense lesion located in the right temporal lobe white matter behind the right sylvian fissure and just lateral to and adjacent to the right inferior longitudinal fasciculus which measures 8 x 5 mm axial dimensions. It is not associated with any susceptibility effect and it is not associated with contrast enhancement.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 and is medium sized. The right posterior communicating arteries is not readily identified. The left posterior communicating artery is small The vertebral arteries are similar in size. The left A1 segment is larger than the right A1 segment. There is triplication of the anterior cerebral artery.

Output: 1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm or arteriovenous malformation.3.There is a small lesion present in the right temporal lobe white matter. In isolation this is nonspecific.


Instruction: Generate impression based on medical findings.

Input: 3 years, Female, seizure, follow-up previous study. Again seen is asymmetric enlargement of the right lateral ventricle. There is also suggestion of subtle asymmetrically increased parenchymal volume in the right cerebral hemisphere, as compared to the left. The right caudate head and putamen also appears slightly larger. There is evidence of mild diffuse loss of white matter volume, particularly in the right cerebral hemisphere. There is also diffuse thinning of the corpus callosum as seen before. Myelination has progressed since prior study. Subtle areas of subcortical FLAIR hyperintensity however persist including the left frontal and right greater than left temporal subcortical white matter presumably related to incomplete myelination. Hippocampi are symmetric and grossly unremarkable. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. Major flow-voids are preserved. Moderate opacification of the paranasal sinuses is noted and nonspecific.

Output: 1. Again seen is diffuse thinning of the corpus callosum as well as mild diffuse white matter volume loss, particularly in the right cerebral hemisphere. The right cerebral hemisphere appears overall asymmetrically larger in volume. The right lateral ventricle is also larger, which is in part related to ex vacuo dilatation from white matter volume loss. However combination of these findings is suggestive of hemimegalencephaly.2. There has been progression of myelination since last study. Minimal areas of FLAIR hyperintensity persist in the subcortical white matter, including the left frontal and bilateral temporal lobes, which may be related to mildly delayed myelination given patient's age of 3.


Instruction: Generate impression based on medical findings.

Input: 53 year old patient with a lytic lesion in the T10 vertebral body. History of transitional cell urothelial carcinoma . Now with T10 lytic lesion. Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the right pedicle and transverse process vertebral lytic lesion.

Output: T10 vertebral bone biopsy under CT guidance. A total of seven samples were delivered to pathology for analysis.


Instruction: Generate impression based on medical findings.

Input: 47 years Female (DOB: 5/3/1969)Reason: please do Dr. Javed MS protocol and compare to prior History: progression MS, paresthesias and fatiguePROVIDER NAME: JACQUELINE T. BERNARD JACQUELINE T. BERNARD MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. These were also present on the prior exam. There is a new lesion present in the right parietal lobe subcortical white matter adjacent to an older lesion. It is associated with some ring-like contrast enhancement.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. Within the spinal cord there is a signal hyperintense lesion redemonstrated at the C1 vertebral level centrally and posteriorly. This was also present on the prior exam. There is redemonstration of a right posterior lateral T2 signal hyperintense lesion at the C3 vertebral body level No abnormal enhancing lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this level.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this level.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a small left posterior lateral disc protrusion present this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There is redemonstration of multiple lesions present in the periventricular subcortical white matter with the addition of a new lesion in the right parietal lobe subcortical white matter which appears to be in the subacute or acute stage.2.There is redemonstration of multiple white matter lesions in the cervical spinal cord which are stable compared to the prior exam.3.There are degenerative changes present cervical spine without significant compromise to spinal canal or neural foramina.


Instruction: Generate impression based on medical findings.

Input: Reason: 53 yo F paraplegic, h/o L hip osteomyelitis now with recurrent drainage from L hip sinus; rule out tract; rule out active osteo History: see above. Again seen is skin ulceration and sinus tract overlying the left greater trochanter with surrounding soft tissue edema. Previously seen fluid and gas collection overlying the greater trochanter has decreased in size compared to prior, measuring approximately 2.7 x 1.6 cm, previously 4.9 x 2.4 cm. The previously seen discrete overlying gas collection is no longer visualized. No definite evidence of acute osteomyelitis.Previously seen fluid collection overlying the right greater trochanter measures 2.8 x 1.4 cm, previously 2.5 x 1.6 cm.Diffuse muscle atrophy. Edema within the left gluteal musculature has slightly decreased compared to prior. Edema within the left upper thigh musculature has resolved.Foley catheter in place. Gas within the bladder likely related to recent instrumentation. Small bilateral pelvic lymph nodes again noted, likely reactive.

Output: 1.Interval decrease in fluid collection likely representing abscess overlying the left greater trochanter with surrounding inflammatory changes and overlying skin ulceration. No definite evidence of underlying osteomyelitis. 2.Fluid collection overlying the right greater trochanter is not significantly changed. Enhancement cannot be assessed on the current examination without intravenous contrast. This collection was previously described as suggestive of trochanteric bursitis due to lack of rim enhancement.


Instruction: Generate impression based on medical findings.

Input: Intraventricular meningioma status post radiation therapy: surveillance. There is no significant interval change of the T2 hypointense enhancing mass within the atrium of the left lateral ventricle, which measures up to 1.7 x 1.4 cm in axial cross-section. There is also unchanged surrounding ependymal enhancement and confluent T2 hyperintensity in the left peritrigonal white matter and posterior left thalamus with scattered punctate foci of susceptibility effect. There are unchanged nonspecific scattered punctate foci of cerebral white matter T2 hyperintensity. There is no evidence of acute intracranial hemorrhage, hydrocephalus, or acute infarct. There is no midline shift or herniation. The skull and scalp soft tissues are unremarkable.

Output: No significant interval change of the left lateral ventricular mass with persistent ependymal enhancement and vasogenic edema in the adjacent brain parenchyma.


Instruction: Generate impression based on medical findings.

Input: Primary CNS lymphoma status post treatment. There are post-treatment findings in the left frontal lobe with unchanged areas of patchy T2 hyperintensity with scattered susceptibility effect and mild ex vacuo dilatation of left frontal horn. There are also unchanged foci of high T2 signal in the right anterior frontal lobe. However, there is a new area of enhancement measuring up to 12 mm with surrounding vasogenic edema involving the right inferior frontal gyrus. There is no evidence of acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged.

Output: A new area of enhancement with surrounding vasogenic edema involving the right inferior frontal gyrus likely represents recurrent lymphoma. Otherwise, unchanged post-treatment findings in the left frontal lobe.


Instruction: Generate impression based on medical findings.

Input: Reason: 26yo male with Crohn's ileitis. Assess disease activity History: constipation ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Small non-specific T2 hyperintense splenic structure unchanged and likely benign.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is an approximately 7 cm long segment of abnormal asymmetric bowel wall thickening involving the terminal ileum (series 4, image 20) with saccular dilation on the antimesenteric border, increased mucosal enhancement, and mild upstream bowel dilation appearing similar to the prior examination and compatible with chronic inflammatory changes of Crohn's disease. No associated high-grade bowel obstruction. No definite additional areas of involved bowel. No associated ascites or evidence of fistulous connection.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Chronic inflammatory changes involving the terminal ileum appearing similar to prior without definite evidence of additional bowel involvement or complication.


Instruction: Generate impression based on medical findings.

Input: Male, 2 days old, with unilateral hydrocephalus. Assess for evidence of pressure on brain or vascular issues. A large, multilocular cystic lesion is evident situated between the cerebral hemispheres, the larger part of which resides to the left of midline. The loculations are formed by thin septations which enhance minimally if at all. No solid nodular enhancement is seen. Most of the locules are variably T1 hyperintense relative to CSF, though one or two are fairly close in signal to CSF. No evidence of susceptibility effect is seen within or adjacent to the cysts to suggest hemorrhage.The presence of the cystic lesion causes significant deformity of the brain parenchyma. The thalami are formed but inferiorly and laterally displaced, particularly on the left. The interhemispheric fissure is present and seems to be fully formed. Both cerebral hemispheres are somewhat compressed and there may be a component of edema versus transependymal CSF flow in the temporal lobes, left more than right.No definite corpus callosum or cavum septum pellucidum is visualized. In addition, the morphology of the frontal horns and apparent colpocephaly of the right lateral ventricle are suggestive of agenesis of the corpus callosum. Both temporal horns are dilated, left side more than right, suggesting entrapment.The pituitary region is within normal limits. The brainstem appears to be normally formed and intact. The cerebellum is likewise normally formed but it does experience mass effect from deformity of the supratentorial structures.

Output: A large multiloculated cystic lesion is evident situated between the cerebral hemispheres with the majority of the lesion residing to the left of midline. No solid enhancing components are seen to suggest that this lesion is neoplastic in nature. Rather, the location and features of the lesion, along with additional findings suggesting agenesis of the corpus callosum, suggest an underlying diagnosis of type II callosal agenesis with interhemispheric cyst. Based on their variable signal characteristics, it is unlikely that the individual cystic locules communicate with each other or with the ventricular system. Findings suggestive of ventricular entrapment are seen, particularly affecting the temporal horns.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Unspecified epilepsy without mention of intractable epilepsyClinical question: h/o epilepsy s/p hippocampal laser ablation The patient is status post bilateral parietal bone and right temporal bone burr hole placement. There are T2 and FLAIR hyperintense tracts extending from the burr holes into the brain parenchyma.There is redemonstration of abutting irregularly shaped ring-enhancing lesions located in the right hippocampal head together measuring 15 x 20 cm in axial dimensions. This was also present on prior exam from 6/2/2015. On T1-weighted imaging and is bright and intermediate signal. On T2-weighted imaging it is predominantly low signal. On FLAIR MRI imaging it is low signal centrally and high signal peripherally. There is no evidence for diffusion restriction associated with it.The CSF spaces are appropriate for the patient's stated age with no midline shift. Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is a ring-enhancing lesion present in the right hippocampus. Most likely this is related to blood products at the prior treatment site. Please correlate with surgical findings.


Instruction: Generate impression based on medical findings.

Input: 53-year-old male with meningioma, evaluate for progression surveillance A small left parietal convexity dural-based contrast enhancing mass has not changed. It has a maximum thickness of less than 5 mm. As before, there is no significant significant mass effect.Diffuse T2/FLAIR signal abnormality involving the deep gray nuclei, bilateral pons (with downward extension into the ventral medulla), left greater than right thalami as well as scattered foci of cerebral white matter remain unchanged. There is no diffusion restriction or susceptibility artifact. This most likely represents chronic microvascular ischemia. There is no space-occupying or contrast-enhancing brain lesion otherwise. The CSF-containing spaces are mildly expanded, reflecting mild volume loss. Major intracranial vessels are patent.Mild mucosal thickening in the right major sinus without fluid is unchanged. The other paranasal sinuses are clear. Remote small right orbital medial wall blowout fracture is unchanged with herniation of the extraconal fat into the ethmoid sinuses but no extraocular muscle entrapment.

Output: 1.A tiny left parietal convexity meningioma has not significantly changed.2.The relatively extensive and symmetric T2 signal abnormality primarily involving the deep gray nuclei and pons is not significantly changed since the previous examination. As discussed previously, this may be sequela of prior osmotic demyelination or other toxic-metabolic injury.


Instruction: Generate impression based on medical findings.

Input: 71-year-old female with shoulder pain. Evaluate for cuff tear. ROTATOR CUFF: There is a partial thickness undersurface tear of the anterior fibers of the supraspinatus tendon at the level of its insertion on the greater tuberosity measuring approximately 6 mm in the AP dimension without significant retraction. Additionally, more posteriorly there is a partial-thickness undersurface tear of the supraspinatus measuring approximately 12 mm in the AP dimension, involving approximately 50% of the tendon width, which extends posteriorly to involve the anterior fibers of the infraspinatus tendon without significant retraction. Supraspinatus tendon appears thickened with associated intermediate signal abnormality consistent with moderate tendinosis. The supraspinatus and infraspinatus muscles appear intact. The teres minor muscle and tendon appear intact. There is a small interstitial tear of the subscapularis tendon at the level of the myotendinous junction. The subscapularis muscle appears intact.SUPRASPINATUS OUTLET: There is a trace amount of fluid within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is heterogeneity and increased signal abnormality within the anterior and posterior superior glenoid labrum suggesting degenerative tearing. There is near full-thickness to full-thickness articular cartilage degeneration along the glenoid with associated subchondral cyst formation. There are subchondral cysts within the humeral head. There is osteophyte formation about the glenohumeral and acromioclavicular joints.BICEPS TENDON: There is a small amount of fluid within the tendon sheath of the long head of the biceps which may represent fluid extension to the glenohumeral joint. ADDITIONAL

Output: 1. Partial-thickness tearing of the rotator cuff without evidence of a full-thickness tear.2. Moderate degenerative changes affecting the glenohumeral joint.3. Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old. Status post cervical fusion There are anterior fixation devices at C4-5 and C5-6 with intervertebral bone graft at these levels. We see no hardware complications. There is minimal anterolisthesis at C4. There is swelling in the prevertebral soft tissues with foci of gas indicating recent surgery.

Output: Postoperative changes of cervical spine fixation as described above.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for osteo History: possible osteo of left ileus on prior MRI, fevers Soft tissue irregularity along the posterior aspect of the left iliac bone consistent with ulceration which extends to the level of the posterior cortex of the left iliac bone. There is associated skin thickening in the surrounding area. There is also associated increased signal abnormality and fluid sensitive sequences as well as decreased signal abnormality on T1-weighted images and cortical indistinctness affecting the left iliac bone about the posterior aspect of the left sacroiliac joint, indicating osteomyelitis. There is marked fatty atrophy of the imaged musculature of the pelvis. There is a large cyst projecting along the inferior pole of the right kidney, which appears atrophic, although this is incompletely imaged on this examination. There is a Foley catheter in place. There is nonspecific increased signal abnormality within the adductor musculature of the pelvis bilaterally. No drainable fluid collection is identified. Note is made of multiple dilated loops of small bowel which are nonspecific but may reflect small bowel obstruction or ileus in the correct clinical setting. Note is made of compression fractures of the L3 and L5 vertebral bodies.

Output: 1. Findings consistent with osteomyelitis of the left iliac bone. There is soft tissue ulceration and inflammatory change in the surrounding area.2. Multiple dilated loops of small bowel are incompletely imaged. Obstruction or ileus could be considered in the correct clinical setting. Other findings as described.


Instruction: Generate impression based on medical findings.

Input: 69 years Male (DOB:9/11/1947)Reason: Evaluate for etiology of L trigeminal neuralgia History: L sided trigeminal neuralgiaPROVIDER/ATTENDING NAME: THOMAS J KELLY THOMAS J KELLY MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There are a couple subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.A punctate focus of signal loss and susceptibility imaging is present in the left thalamus and another one is present in the left frontal lobe subcortical white matter.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucous retention cysts along the floor of the left maxillary sinus. 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 basilar artery is not adjacent to the trigeminal nerves. No sizable arterial structures are identified abutting the trigeminal nerves.The anterior communicating artery is identified. The posterior communicating arteries are identified. The left posterior communicating artery is medium-sized whereas the right posterior communicating artery is very small and the anterior communicating artery is medium-sized. The left vertebral artery is larger than the right vertebral artery.

Output: 1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.No evidence for trigeminal nerve compression4.No evidence for intracranial mass lesion.5.A couple microhemorrhages are identified which do not have a specific pattern and are of unknown clinical significance.6.A couple subcortical white matter lesions are nonspecific and likely of little clinical significance


Instruction: Generate impression based on medical findings.

Input: GBM. There is redemonstration of postoperative changes from previous resection of the right anterior temporal lobe, a portion of the right insula, and right inferior frontal lobe. Overall, there is no significant interval change in appearance of the scattered areas of nodular enhancement along the lateral ventricular margins.Extent of surrounding T2/FLAIR hyperintensity along the cavity margins extending posteriorly remains unchanged, with ex vacuo dilatation of the right lateral ventricle. Ill-defined T2/FLAIR hyperintensity along the left lateral ventricular margins is also stable. There is no diffusion abnormality to suggest recent ischemia. No extra-axial fluid collection is identified. There is no midline shift or mass effect.There is mild mucosal thickening in the right maxillary sinus with a mucosal retention cyst in the left. Mild fluid is noted in right mastoids.

Output: 1.Continued stable appearance of the resection cavity.2.No significant change in scattered areas of nodular ependymal enhancement along the lateral ventricular margins.


Instruction: Generate impression based on medical findings.

Input: H/o renal cell carcinoma with known cerebellar metastasis. Examination demonstrates postoperative change of a left suboccipital craniotomy, including edema and trace amount of blood product at the surgical site. The mass in the left medial cerebellum identified on prior MRI has been resected. The one in the left lateral cerebellum is still present and appears hemorrhagic. It measures 1 x 1 cm. The cerebral hemispheres appear normal in attenuation and morphology. Supratentorially, there is no intracranial hemorrhage, or midline shift. The ventricles appear enlarged. A left frontal arachnoid cyst with remodeling of the adjacent frontal bone is noted. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Postoperative change of a left suboccipital craniotomy. 2. Left cerebellar hemorrhagic metastatic lesion. 3. Hydrocephalus. 4. Left frontal arachnoid cyst.


Instruction: Generate impression based on medical findings.

Input: Evaluate ventricular size. Normal pressure hydrocephalus. VP shunt now with increasing headaches. Nonenhanced head CT:Images through posterior fossa are unremarkable and unchanged since prior MRI exam from 2004.Images two supratentorial space demonstrate enlargement of all supratentorial ventricular system. This exam is compared with prior MRI study from 2004. A the transverse axis of the third ventricle on the current head CT measures 16.3-mm compared to prior measurement of 20.7-mm.The transverse measurements of bilateral frontal horns measures 35mm compare to prior measurements of 43.3 mm.There is a BSO a right-sided ventricular catheter with the tip of the catheter in the right frontal horn at the level of foramina of Monroe.Examination also demonstrate small low-density bilateral subdural collections in the frontal and parietal regions. The size of right frontal subdural measures 3.4-mm in thickness and the left frontal subdural measures 4.4-mm in thickness. These subdurals were not present on prior MRI exam from 2004.There is no detectable intraparenchymal hemorrhage or edema. The gray -- white matter differentiation remains within normal.

Output: 1.Smaller size of supratentorial ventricular system since prior MRI examination from 2004. There is however persistent enlargement of all supratentorial ventricular system. Right-sided ventricular catheter with the tip in the right frontal horn.2.No detectable parenchymal abnormality.3.Since 2004 are small bilateral frontal and parietal low-density subdural collections which measure 3.4mm in thickness in the right frontal region and 4.4 mm in the left frontal region.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for TFCC tear History: above LIGAMENTS: No contrast is seen within the midcarpal space, indicating that the lunotriquetral and scapholunate ligaments are intact.TRIANGULAR FIBROCARTILAGE COMPLEX: Contrast injected into the radiocarpal joint is seen within the distal radioulnar joint, consistent with a full thickness tear of the triangular fibrocartilage complex. TENDONS: No significant abnormality noted. BONES: Ossicles adjacent to the ulnar styloid are consistent with prior trauma. No acute fractures are identified.ADDITIONAL

Output: Full-thickness tear of the triangle fibrocartilage complex and old fracture of the ulnar styloid.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Radiculopathy, lumbar regionClinical question: assess for polyradiculopathySigns and Symptoms: H/O inflammatory polyradiculopathy, recent onset of incontinence Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is redemonstration of mild thickening of the nerve roots of the cauda equina associated with some subtle contrast enhancement.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There is redemonstration of some mild thickening of the nerve roots of the cauda equina. This is nonspecific, however, it could be seen with hereditary motor sensory neuropathy, Guillain-Barre syndrome, other infections and a moderate knee and processes as well as other entities such as sarcoidosis and arachnoiditis. It was also present on the prior exam and does not appear to have changed significantly.


Instruction: Generate impression based on medical findings.

Input: Reason: any evidence of gall bladder disease or abdominal masses? History: woman with NF1 land 2 severe episodes of flank pain ABDOMEN:LIVER, BILIARY TRACT: Gallbladder appears normal. No focal hepatic lesions.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Numerable cutaneous neurofibromas.OTHER: Lesions involving multiple sacral and bilateral L4 nerve roots as well as left sciatic nerve likely represent plexiform neurofibromas.

Output: 1.No intra-abdominal masses or evidence of biliary disease.2.Cutaneous and plexiform neurofibromas.


Instruction: Generate impression based on medical findings.

Input: 37-year-old man with history of peritoneal mesothelioma status post 4 cycles of chemotherapy CHEST: LUNGS AND PLEURA: There are small right and trace left pleural effusion with subsegmental right basilar and lingular atelectasis. There is residual right pneumothorax (7/18), grossly stable in size. No pleural masses or nodules noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: The liver appears normal in signal and morphology. There is no intra or extrahepatic biliary ductal dilatation. The gallbladder is distended and normal.SPLEEN: The spleen appears normal.PANCREAS: The pancreas is normal. There is no pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The visualized small bowel and colon appear normal without evidence of obstruction.There is extensive enhancing soft tissue within the omentum, predominantly within the anterior left hemiabdomen (25/348). The thickness of this omental soft tissue measures approximately 23 mm in thickness, previously 21 mm in thickness.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Moderate amount of ascites noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Moderate amount of free pelvic fluid noted.

Output: 1.Peritoneal soft tissue thickening/carcinomatosis predominantly in the left hemiabdomen stable in size compared to the prior CT accounting for differences in technique.2.Persistent right pneumothorax.3.Ascites and small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Prostate cancer. Staging exam.Additional history per EMR: PSA 2010 2.46 ng/mL, biopsy, Gleason 3+3=6 in four cores with maximum involvement 60%. Active surveillance. March 2011, PSA 3.27, prostate biopsy Gleason 3+3=6 in one core 10%. March 2013, PSA 5.52, prostate biopsy Gleason 3+3=6 in three cores, maximum involvement 20%. October 2014, PSA 8.57 prostate biopsy Gleason 3+4=7 in two cores with maximum involvement 35%. PSA 6/19/2015 was 8.27. PELVIS:PROSTATE:Exam is limited by artifact from right hip prosthesis, markedly degrading diffusion-weighted images.Prostate Size: 5.6 x 4.6 cm.Peripheral Zone: Area of T2 hypointense signal in the left medial mid gland with suggestion of enhancement. This is incompletely evaluated without interpretable diffusion weighted images, though suspicious for patient's known prostatic adenocarcinoma.Central Gland: Marked nodularity and hypertrophy of the central zone without suspicious focal lesion.Seminal Vesicles: Seminal vesicles are unremarkable.Extracapsular Extension: There is no evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: Left inguinal, left pelvic sidewall, and left external iliac prominent lymph nodes are noted. Left external iliac node measures 1.9 x 1.3 cm.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Limited exam due to degradation of diffusion weighted images by artifact related to right hip prosthesis.2.Abnormality in the medial left mid gland is suspicious for patient's known prostatic adenocarcinoma. No evidence of extracapsular extension or seminal vesicle invasion.3.Prominent left inguinal, pelvic sidewall, and external iliac lymph nodes.


Instruction: Generate impression based on medical findings.

Input: Reason: 55 y/o F with positive Neer's test, tenderness of L shoulder, fall 3 months ago, eval for rotator cuff tear History: as above Some sequences are suboptimal secondary to patient motion artifact.ROTATOR CUFF: There is thickening and intermediate signal intensity within the supraspinatus indicating moderate tendinosis. The supraspinatus muscle and tendon appear intact. There is thickening and intermediate signal intensity within the infraspinatus indicating moderate to severe tendinosis. There is interstitial tearing of the infraspinatus at the level of the myotendinous junction. No full-thickness tear or retraction is identified. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: There is no significant fluid within the subacromial subdeltoid bursa. Mild osteoarthritis affects the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. The glenoid labrum appears intact within the limitations of a non arthrogram study.BICEPS TENDON: The tendon of the long head of the biceps appears intact. There is thickening and intermediate signal intensity within the intra-articular portion of the tendon of the long head of the biceps indicating a mild tendinosis. ADDITIONAL

Output: 1. Rotator cuff tendinosis and interstitial tearing without evidence of a full-thickness rotator cuff tear or retraction.2. Infiltration of the subcoracoid fat is nonspecific but can be seen in patient's with adhesive capsulitis.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Evaluate for growth of GBM. Patient on TMZ. Compared to prior exam. Signs and symptoms: GBM. Pre-and post enhanced brain MRI:Examination demonstrates further interval decreased size of a focus of enhancing tumor in the left frontal lobe measuring at 5.2 x 9.2-mm compared to prior study measurement of 13.1 x 7.4 mm. surrounding flair hyperintensity consistent with edema is again identified and without appreciably change.There is also interval decrease size of a smaller focus of enhancement in right anterior frontal measuring approximately 4 mm in transaxial dimensions compared to prior study measurement of 7.2 mm. There is no associated surrounding vasogenic edema with this finding. This is a similar observation is prior study.Diffuse patchy confluent foci of flair hyperintensity in the white matter of bilateral cerebral hemispheres (left greater than right) likely secondary to treatment/radiation change however overlapping small vessel ischemic strokes cannot be excluded. This finding remains nearly identical to prior study.No evidence of any additional foci of new edema or abnormal parenchymal/ leptomeningeal enhancement since prior exam. Ventricular system remain within normal size and stable since prior study.

Output: 1.Further interval decreased size of enhancing lesions in the left and right frontal lobes as detailed/measured above.2.Diffuse patchy/confluent foci of flair hyperintensity in bilateral hemispheres white matter (left greater than right) without significant change.